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POPULATION SPECIFIC COMPETENCY

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Title: POPULATION SPECIFIC COMPETENCY


1
POPULATION SPECIFIC COMPETENCY
  • East Tennessee Childrens Hospital

2
This module contains
Page 2 of 80
  • Instructions for completion of module
  • Definition of Population Specific Competencies
  • Review of pediatric age-group specific
    interventions
  • ETCH population specific information
  • Important resources you need to know

3
Why?
Page 3 of 80
  • Population-specific staff competence is CRITICAL
    to providing a safe environment for our patients.

4
What is it?
Page 4 of 80
  • Population-specific staff competence relates to
    possessing the knowledge, skills, ability and
    behaviors essential to providing care to a
    specific population.
  • At Childrens Hospital the pediatric age groups
    served is a primary focus of our staff
    competency. However, it does not address the
    full spectrum of the population served.

5
What is it?
Page 5 of 80
  • Beyond a patients age, their health care is also
    affected by their socio-cultural and geographical
    factors. Health care is also influenced by our
    living situation, family dynamics, diagnosis and
    acuity.

6
ETCH Commitment
Page 6 of 80
  • As a pediatric healthcare facility, we are
    committed to providing age-specific care. Every
    element of our approach to healing from the
    specially trained staff to the sophisticated
    equipment- is child and family centered.

7
Children are NOT small adults
Page 7 of 80
  • Age-specific interventions are the skills you use
    to give care that meets each patients unique
    needs.

8
Every patient is an individual with his or her
own...
Page 8 of 80
  • Likes and dislikes
  • Feelings
  • Limitations and abilities
  • Experiences

Everyone grows and develops in a similar way or
stages that are related to their age, BUT at
their own pace.
9
Page 9 of 80
  • Illness and hospitalization places stress on
    our patients and families.

Some patients regress emotionally or mentally
when they are ill/hospitalized
  • By following guidelines based on
    age/developmental characteristics, we can help
    reduce the stress of our patients and families.

10
Strategies to enhance coping Developmental
Considerations
Page 10 of 80
  • Newborns
  • pacifier, blanket, soothing sounds, touch, music,
    parental involvement when appropriate, stay in
    infants line of vision, place parents in
    infants line of vision, place familiar object
    with baby (stuffed animal, etc.), provide
    safe/secure environment, cuddle, hug after
    procedure, adequately hold during procedures.

11
Strategies to enhance coping Developmental
Considerations
Page 11 of 80
  • Toddlers
  • pacifier, blanket, favorite toy, holding a hand,
    party blowers, blowing bubbles, pop-up books,
    toys, mobiles, pre-post procedural play, play
    dough, emphasize being still, let them know Its
    okay to cry, utilize Child Life for distraction
    (bubbles, musical toys, etc.), give toddlers one
    direction at a time, explain procedure in
    relation to what child sees, hears, etc. Use play
    by demonstrating on a doll or stuffed animal,
    provide consistency with daily routines. Use a
    firm and direct approach, involve child in
    procedure by allowing him/her to play with
    equipment when appropriate, allow toddlers a
    choice when possible.

12
Page 12 of 80
Strategies to enhance coping Developmental
Considerations
  • Preschoolers
  • Party blowers, blowing bubbles, counting, pop-up
    books, holding a hand, manipulative toys,
    computer games, listening to music, singing
    songs, pre-post procedural play, play dough,
    explain in simple terms, demonstrate procedure,
    allow to play with equipment/dolls, encourage
    child to talk let them ask questions to clarify,
    tell them this is not punishment- you havent
    done anything wrong, enjoy games/rewards/praise.

13
Strategies to enhance coping Developmental
Considerations
Page 13 of 80
  • School Age
  • deep breathing exercises, music, hand-held games,
    computer games, imagery/fantasy, pretending to be
    in a favorite place or doing a favorite thing,
    pre-post procedural play, squeezing nerf balls,
    explain using correct terms, explain reasons
    use simple diagrams, allow to ask questions,
    prepare in advance, tell what is expected,
    suggest breathing, counting, etc., include in
    decision (where to get injection etc.), encourage
    participation, provide privacy.

14
Page 14 of 80
Strategies to enhance coping Developmental
Considerations
  • Adolescents
  • deep breathing exercises, music (head sets are
    popular), computer games, imagery/fantasy,
    imagine a favorite activity, squeezing a nerf
    ball, hand-held games, explain and give reasons,
    encourage questions, provide privacy, discuss
    after effects- scars, etc., involve in decision
    making and planning, accept regression and
    resentment of authority, allow peer involvement

15
Age-Specific Approaches to Physical Examination
Page 15 of 80
16
Age-Specific Approaches to Physical Examination
Page 16 of 80
17
Additional resources
Page 17 of 80
  • The following videos are available through the
    Education department-541-8618 or
    learning_at_etch.com for more review on Age-specific
    Competencies.
  • Pediatric Physical Assessment 3 tape series
  • Infants and Toddlers
  • Preschool and School Age
  • The Adolescent
  • Growth and Development Whaley and Wong

18
Appreciating Cultural Differences
Page 18 of 80
Are you culturally competent?
19
This section will help you to
Page 19 of 80
  • Consider the uniqueness of all your patients and
    recognize cultural differences.
  • Understand what skills are necessary to respect a
    patient while giving care.
  • Ensure appropriate communication and
    confidentiality for all of your patients.
  • Identify resources you can use for developing
    these skills.

20
Imagine yourself
Page 20 of 80
  • Waking in a hospital bed, in a strange room with
    other patients near by
  • Seeing unfamiliar faces and realizing they all
    speak a different language than you
  • Having people talk to you and about you with no
    idea what is being said
  • Seeing looks, smiles, frowns, gestures that you
    think might be related to you, but you are
    uncertain
  • Having people approach and touch you without a
    means to explain
  • Being injected, or washed, or any other private
    or invasive procedure without being able to ask
    questions or state your preferences or
    limitations
  • Hearing discharge instructions and teaching in a
    foreign language while someone points to a paper
    for you to sign
  • Hearing medical advice contrary to your deep
    religious beliefs
  • Not having enough money for medical care or food

21
If the shoe were on the other foot
Page 21 of 80
  • Would you feel respected? Would you consider
    that being treated in a dignified manner?
  • Would you trust your caretakers?
  • How would you know what was wrong and how to get
    better?
  • Would you feel as though you had rights?

22
Culture defined
Page 22 of 80
  • The values, beliefs, norms and practices of a
    particular group that are learned and shared and
    that guide thinking, decisions and actions in a
    patterned way

Source Dynamics of Diversity, Pollar Gonzalez
23
Diversity defined
Page 23 of 80
  • The Diversity Coalition defines diversity as
    encompassing the following categories ability
    disability, age, color, ethnicity, religion,
    gender, job category, class status, national
    origin, race and sexual orientation

Source http//www.diversitycoalition.org/general
_diversity_resources
24
Important Terms to know to be culturally
diverse
Page 24 of 80
  • Environmental Control refers to perceptions that
    a person has about the ability to direct factors
    in the environment and the systems and processes
    that are part of it. Health behaviors and
    disease patterns differ with cultural groups.

25
How do I become Culturally Competent?
Page 25 of 80
It is impossible to memorize all the specific
information about every culture.
  • However, many resources exist at Childrens
    Hospital to help you. Know what they are and how
    to use them
  • Cultural Care Guides and books they provide
    information about various groups and give
    practical and immediately useful advice
  • Interpretive Services know how to access and
    use both live and telephone services (see CBL
    Interpretive Services)
  • Language Services printed materials, visual
    aids
  • The Pediatric Medical Library
  • Social Work and Pastoral Care Departments
  • HIPAA Guidelines each institution has specific
    guidelines that ensure confidentiality for
    patients health information. All employees,
    students, and volunteers are responsible for
    following these guidelines, which state that
    confidentiality can be maintained by only sharing
    MINIMUM information necessary.
  • Outside Resources accessed through Social Work

26
Some Basic Tips for Overcoming Initial Cultural
or Communication Barriers
Page 26 of 80
  • Greet patients with their names avoid being too
    casual or familiar
  • Introduce yourself by pointing to yourself and
    saying your name
  • Note and observe any hesitations or special
    requests (ie, no male caregivers for a female
    patient)
  • Determine understanding by hearing person repeat
    or demonstrate instructions
  • Do not talk to other staff in patients area
    using a language he/she will not understand
  • Do not make assumptions about eye contact, space,
    gender issues or any other cultural factor based
    on your opinions. Seek understanding and
    resources!

27
Tips for Overcoming Initial Cultural or
Communication Barriers
Page 27 of 80
  • Pay special attention to any efforts made by the
    patient or family to communicate
  • Use an available resource to get a quick
    glimpse into the patients culture or language
  • Use available visual aids
  • If language barrier exists that prevents this
    communication, seek interpretive services
    continual attempts will only fail and add to
    frustration
  • Maintain confidentiality by using minimum
    necessary information even with interpreter
  • Continue to provide non-judgmental care!

28
Are there other Barriers?
Page 28 of 80
  • Religious preferences/differences can be a
    barrier.
  • Socio economic status as well as educational
    level can be a barrier.
  • Differences in family structure, function, and
    composition are common barriers.

29
Know about Family-Centered Care
Page 29 of 80
  • This is part of the special care we provide to
    children.
  • Our interventions are structured around the
    entire family unit with the patient as the
    center
  • We must respect the various styles, abilities,
    resources, communication patterns and values that
    all families exhibit differently.
  • Our goal is to Individualize patient care to best
    support the family structure without prejudice
    or judgment on our part.

30
R-E-S-P-E-C-T
Page 30 of 80
  • Find out what it means to YOU!
  • Know yourself your own attitudes, beliefs, and
    even prejudices
  • Keep an open mind
  • Acknowledge and celebrate differences all
    cultures and groups have strengths and
    weaknesses
  • IT STARTS WITH YOU

31
No Two People are Created Alike
Page 31 of 80
  • What are some key cultural differences to think
    about?
  • Communication language, patterns, gestures and
    facial expressions, decision-making
  • Personal Space how close is too close?
  • Social Organization how a group mourns,
    celebrates, learns, lives, etc.
  • Time past, present, or future orientation
  • Environmental Control nature versus nurture

32
Important Terms to know to be culturally
diverse
Page 32 of 80
  • Communication and culture are intertwined.
    Written and oral language, gestures, facial
    expressions, and body language are the means by
    which culture is transmitted and preserved.
    Patterns are developed early and affect an
    individuals entire life. Healthcare providers
    should recognize common cultural patterns, but
    not assume that all members of a cultural group
    use the same means of expression.

33
Important Terms to know to be culturally
diverse
Page 33 of 80
  • Personal Space is the area surrounding a
    persons body. It includes the space and objects
    within that designated area. This differs with
    culture and is important to know and respect when
    providing physical care.

34
Important Terms to know to be culturally
diverse
Page 34 of 80
  • Social Organization
  • takes into account patterns of behavior that
    people of various cultures may exhibit during
    such life events as birth, puberty, childbearing,
    illness, disease, and death. Healthcare workers
    need to understand the profound impact this can
    have. Beliefs, values, and attitudes related to
    these events result in traditions and rituals
    that follow an individual through life.

35
Important Terms to know to be culturally
diverse
Page 35 of 80
  • Time Time can be perceived as concrete or
    abstract. Cultural groups may be differentiated
    according to whether their time orientation or
    behavior is related primarily to the past, the
    present, or the future.

36
Examples of Health Care Related Diversity
Page 36 of 80
  • Southern African Americans health is considered
    a gift from God and illness retribution for sin.
  • Chinese believe that health is based on the
    balance of female energy (yin) and male energy
    (yang.) Disharmony between the two is thought to
    disturb the bodys functioning.
  • Mexican patients may believe in hot and cold
    forces that may be thrown out of balance in
    illness.
  • In many Western cultures, calling an elderly
    person by his first name is considered rude.
    (Ask a patient how he wishes to be addressed.)

37
Examples of Health Care Related Diversity
Page 37 of 80
  • Some families especially in rural Appalachian
    areas, may be challenged for basic necessities
    such as heat, water, and food.
  • Native Americans or Southeast Asians may view
    expressions of caring, such as hugging, as
    intrusions of personal space. They may view it
    as discourteous to make direct eye contact or to
    stand too close.
  • Thais or Filipinos may nod their head in a yes
    manner, but it does not necessarily mean they
    understand. People in these cultural groups
    VALUE preserving harmonious relationships and
    avoiding confrontation. They may nod to avoid
    offending or embarrassing anyone.

38
Examples of Health Care Related Diversity
Page 38 of 80
  • Jehovahs Witnesses do not accept blood
    transfusions and refuse to eat foods that contain
    blood.
  • Muslim and Hindu patients may also follow
    religious dietary restrictions.
  • Muslims pray five times a day and must face east
    when doing so
  • Strictly observant Jews may obey dietary laws,
    that prevent the mixing of milk and meat, and
    forbid pork or shellfish.

39
Your Responsibility
Page 39 of 80
  • Offer culturally competent care
  • Respect differences
  • Maintain confidentiality
  • Know and use your resources
  • Ensure patient appropriate communication

40
More about our ETCH Child Family Population
Page 40 of 80
41
Demographic Changes in Tennessee
Page 41 of 80
42
Child Population Projection
Page 42 of 80
2000 Population
2010 Projection
43
Patient Population at ETCH
Page 43 of 80
228 Increase in Spanish speaking population
since 2003
44
IMPORTANT INFORMATION ABOUT OUR ETCH LATINO
FAMILIES
Page 44 of 80
  • It is important to understand the family roles,
    family dynamics, and the role faith plays within
    our Latino families.

45
FAMILY DYNAMICS
Page 45 of 80
  • Understanding La familia
  • We must understand roles and relationships within
    the Latino family to help foster positive
    communication, patient/family cooperation and
    interaction with ETCH staff. This understanding
    will also assist compliance with treatment or
    treatment outcomes.
  • The importance of extended family
  • Latino families believe it is valuable to have
    extended family support and presence during times
    of crisis.

46
GENDER ROLES
Page 46 of 80
  • Mothers Role
  • Determines when a family member is ill and needs
    care
  • The Nurturer
  • Fathers Role
  • Holds the greatest power in the majority of
    Hispanic families and gives the permission to
    seek treatment.
  • The Decision Maker

47
FAITH, RELIGION AND TRADITION
Page 47 of 80
  • Faith and the Church are powerful sources of hope
    and strength for many Hispanic families.
  • This may also impact how they interpret and
    accept our help
  • Roles of faith, religion, and tradition in
    healthcare
  • Religious beliefs of a family may require
    practices that are unfamiliar to ETCH staff. We
    must respect the families need to uphold their
    belief while continuing to provide the best
    possible care for our patients.
  • There are many traditional religious home
    treatments that can impact patient outcomes

48
COMMUNICATION AND RESPECT
Page 48 of 80
  • Verbal and Nonverbal Communication
  • REFRAIN from hand gestures. Different hand
    gestures can have different meanings across
    cultures.
  • Please make eye-contact.
  • Head nodding could mean respect for authority not
    necessarily understanding.
  • Touch, Hugging
  • Should be done only after establishing a
    relationship with a family.
  • Authority
  • Encourage questions. Healthcare workers are
    considered authority and asking questions could
    be viewed as disrespectful.
  • Doctor/Patient Relationship
  • Needs to be based upon mutual respect.
  • Once established will lead to better treatment
    outcomes.

49
CAUSES AND HOW ILLNESS IS PERCEIVED
Page 49 of 80
  • Opposite Concepts Collide
  • (Hot and Cold) For example, a culture could treat
    fever with blankets to sweat it out, whereas our
    treatment is to remove layers to cool the body.
  • Mal de Ojo- Strictly interpreted as the evil
    eye
  • Be very careful how we look at patients. Can be
    interpreted as looking down upon. Make other
    contact as well by talking or interacting.
  • Safety
  • Patients and families may use bracelets or beads
    as protection against the Mal de Ojo (Evil
    Eye).

50
APPROACHES TO TREATMENT
Page 50 of 80
  • Can vary from culture to culture

51
DIET AND ALTERNATIVE REMEDIES
Page 51 of 80
What have they been using at home or here as
their treatment of choice?
  • Herbs
  • Vitamins
  • Fruits
  • Spices
  • Teas
  • Plants
  • Prayer

These are services often depended upon and may be
consulted after leaving ETCH
  • Healers
  • Herbalists
  • Midwives
  • Massage Therapists
  • Priests

52
EXPLAINING TREATMENT AND AVOIDING MISUNDERSTANDING
Page 52 of 80
  • Filtering Information to families
  • When explaining treatments/medications, be extra
    careful to help families understand what is
    happening and what to expect.
  • Some families inability to read and write
    requires special labeling and instructions for
    at-home treatment.
  • Reactions of families with misunderstood
    expectations
  • Compliance to discharge instructions is not
    certain. Sometimes families will go back to
    home remedies initially or misunderstand
    treatment side effects as ineffective treatment.
  • Impact on the Family System when a
    misunderstanding occurs
  • Can breakdown established trust with healthcare
    staff when treatment is unclear to the family and
    their expectations are not being met.

53
BRIDGING THE GAP
Page 53 of 80
  • Interpreters, Translators, Advocates, and
    Resources
  • For complete information regarding access to
    Interpretive Services, all staff must complete
    the Interpretive Services NetL CBL.

54
IMPERFECT SCIENCE
Page 54 of 80
  • Interpretations and translations are not always
    simple or clear cut.
  • Religion, diet, family structure all play a part
    in our interactions.
  • We have to bridge the gap between us as a
    hospital and healthcare providers and the Latino
    community we serve.

55
OTHER POPULATION-SPECIFIC CONSIDERATIONS
Page 55 of 80
  • APPALACHIAN HERITAGE
  • IMPORTANT BELIEFS AFFECTING HEALTHCARE
  • Self-reliance activities and nature predominate
    over people, many believe that it is best to let
    nature heal
  • Bureaucratic forms foster fear and suspicion of
    health-care providers

June 2008
55
June 2008
55
56
Page 56 of 80
OTHER POPULATION-SPECIFIC APPALACHIAN HERITAGE
  • For many, pain is something that is to be endured
    and accepted stoically
  • it is important for health-care providers to
    approach individuals in an unhurried manner
  • Slow pace is better received

June 2008
57
OTHER POPULATION SPECIFIC CONSIDERATIONS..
Page 57 of 80
  • Patients and families with Low Health Literacy

58
HEALTH LITERACY
Page 58 of 80
  • The ability to obtain, process, and understand
  • basic health information and services needed
  • to make appropriate health decisions.
  • Healthy People 2010
  • Prevalence across 85 medical studies
  • 26 low health literacy
  • 20 marginal health literacy

Paasche-Orlow et al. (2005). J Gen Intern Med.
59
Page 59 of 80
19 000 US adults ?16 years residing in
households or prisons
  • Proficient can perform complex and
  • challenging literacy tasks
  • Intermediate can perform moderately
  • challenging literacy tasks
  • Basic can perform simple everyday
  • literacy tasks
  • Below Basic cannot perform basic tasks

60
Page 60 of 80
HOW DO TENNESSEE ADULTS COMPARE?
54 of adults function at Below Basic or
Basic
61
LOW HEALTH LITERACYPROBLEMS WITH
Page 61 of 80
  • Pill bottles
  • Appointment slips
  • Informed consents
  • Discharge instructions
  • Patient/health education
  • materials
  • Insurance applications

Medication Take as directed
Dr. Literate
62
PROPER USE OF ASTHMA INHALER
Page 62 of 80
Williams et al. (1998). Chest.
63
MOTHERS WITH LOW LITERACY
Page 63 of 80
  • Less knowledge about adverse effects of smoking
  • Less breast-feeding
  • Less able to read a thermometer

Arnold et al. (2001). Prev Med.
Kaufman et al. (2001). South Med J.
Fredrickson et al. (1995). Kan Med.
64
Page 64 of 80
COMMON MEDICAL WORDS
Common medical words that patients with limited
literacy may not understand
  • Blood in the stool
  • Bowel
  • Colon
  • Growth
  • Lesion
  • Polyp
  • Rectum
  • Screening
  • Tumor

Davis et al. (2002). Cancer Invest.
65
EDUCATIONAL ATTAINMENT AND READING LEVEL
Page 65 of 80
  • Years of formal schooling tells us what people
    have been exposed to, NOT what skills they have
    acquired. (Doak, Doak, Root, 1996)
  • Most American adults read 3-5 grade levels lower
    than the highest grade level of schooling
    completed.
  • Average reading level in US6-8th grade

Davis et al. (1996). Pediatrics. Meade et al.
(1994). Am J Pub Health.
66
AT RISK GROUPS
Page 66 of 80
  • Elderly
  • Minority
  • Recent immigrants
  • Non-English speakers
  • Low-income
  • School drop-outs

67
POSSIBLE INDICATORS OF LOW HEALTH LITERACY
Page 67 of 80
  • Seek help only when illness is advanced.
  • Have difficulty explaining medical concerns.
  • Excuses I forgot my glasses.
  • Lack of follow-through with tests/appointments.
  • Seldom or never have any questions.
  • Identifies drugs by pill color and shape rather
    than by name.
  • Does not know purpose of each medication.

68
Page 68 of 80
HEALTH LITERACY SCREENING ITEMS FOR PARENTS
  • 3 items combined associated with 6th grade
    parental reading level
  • lt12th grade completion
  • nnot living with childs other parent
  • Nnot reading for pleasure

2 items independently associated with adequate
parent health literacy gt10 adults books in the
home gt10 childrens books in the home
Bennett et al. (2004). Fam Med.
Sanders et al. (2004). Ambul Pedriatr.
69
STRATEGIES TO IMPROVE COMMUNICATION
Page 69 of 80
  • Limit information (3-5 key points)
  • Use living room language
  • Be specific and concrete, not general
  • Demonstrate, draw pictures, use models
  • Use a Teach Back or Show Me approach
    (confirm understanding)
  • Be positive, respectful, caring, sensitive,
    empowering

70
IN SUMMARY
Page 70 of 80
  • We are all advocates and professional allies and
    our goal is to treat the patient and help him or
    her achieve better health.

71
IN SUMMARY
Page 71 of 80
  • Patient needs to trust you and believe what you
    are telling them is true.
  • Patient needs to understand you.
  • There MUST be mutual respect among the healthcare
    provider, the interpreter, and the patient.
  • Towards all patients, we ALWAYS remain neutral
    and NEVER judgmental.

72
IN SUMMARY
Page 72 of 80
  • Generalization is a beginning point and a
    stereotype is an ending point.
  • Focus on similarities rather than pointing out
    differences.
  • Do not allow cultural assumptions or prejudices
    to interfere with treatment.

73
Page 73 of 80
  • "Because Children are Special...they deserve the
    best possible health care given in a positive,
    child/family centered atmosphere of friendliness,
    cooperation, and support - regardless of race,
    religion, or ability to pay."
  • At ETCH, providing Population Specific Competent
    Care is essential to our vision of
  • Leading The Way To Healthy Children.
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