The Importance of Cultural Awareness and Tolerance in EMS - Term Paper Example

The Importance of Cultural Awareness and Tolerance in EMS Cultural awareness has been taunted as the foundation of communication because it involves stepping away from ones self ad becoming aware of cultural values, perceptions and beliefs. Cultural awareness becomes valuable when people interact. Human beings see, react and interpret things differently. Things that are considered appropriate in one culture may be inappropriate in another. The lack of cultural awareness can lead to misinterpretations. People values, experiences and cultural backgrounds lead them to do things in a certain way. A case in point is the perception of Americans by Italians. Italians perceive Americans as people who are always on the go; always talking about work and business over lunch or drinks. Italians view meal times as a time to keep off business and time to engage in social connotations. Since culture is not conscious, people cannot become fully aware of their cultural dynamics (Fuller; 200). Sometimes, EMS personnel have to step outside their cultural boundaries in order to take care of their patients effectively. Cultural competence enables EMS personnel to provide care to diverse populations. However, there are challenges that EMS personnel face in their quest to deliver competent patient care through cultural awareness. It sometimes becomes difficult for EMS personnel to deliver patient centred services when the beliefs of the patient are not in tandem with medical guidelines. This is one of the challenges that EMS personnel face in their line of duty. Cultural competence gives medical personnel the ability to interact with patients of varied cultures. When EMS personnel respond to a call, they are introduced to the patients’ life and are also forced to consider the patient’s culture. Culture plays a significant part in communication and medical care given to the patient. Regardless of their qualifications, the first people to arrive at a pre hospital disaster scene are all known as EMS personnel. Therefore, EMS personnel include a whole lot of emergency workers like fire fighters, paramedics and emergency medical technicians. The extended family of EMS personnel includes dispatchers, support services and administrative staff. As much as the entire EMS fraternity is involved in the effective functioning of the emergency system, it is the EMS personnel on the frontline that really need to be culturally competent because they are often in direct contact with the patients. Cultural competency involves the ability to recognize and obtain cultural facts concerning a patients’ problem. To be culturally competent, EMS personnel have to learn how to conduct a cultural assessment because it is vital in patient care delivery. Galanti (102) states that cultural competency may be used by EMS personnel to understand patients better. There are tools, mnemonic and frameworks that can assist EMS personnel in conducting a cultural assessment. Cultural assessment begins with getting the patients’ explanation of their problem. People ascribing to a certain culture might not assimilate that culture equally. EMS personnel should, therefore, not assume that members of a family or friends have the same viewpoint. An example is the belief that all white people dance without rhythm. This is a perfect example of pigeonholing which results in stereotyping. There are many variables that can be used to define and shape culture. Culture can be defined by religion, education, politics, and socioeconomic status. A patients’ culture affects their belief on health practices. It also molds the patients’ belief and perception of modern health practices. Culture dictates a patients’ willingness to take medication, exercise or follow a diet. The diversity in culture is exhibited by cultural beliefs on health, healing and illness. Some cultures to do not believe in hospital healing. Others believe that illness is brought by evil spirits, immorality, curse or envy. EMS personnel are always the first people to arrive in disaster and catastrophe scenes. Therefore, their ability to appropriately, fast and efficiently serve emergency medical needs is crucial. This comes with challenges and opportunities as well. When EMS responded to a call in the U. S, they found a two year old boy who had collapsed in the bed of the family truck. The parents of the boy were too shaken to speak English. The emergency team relied on the help of a neighbor who translated the Spanish to English. The child succumbed to a ruptured congenital brain aneurysm. The father could not take that explanation and claimed that the EMS team took a lot of time asking questions and failed to attend to the boy because they had suspicions of child abuse. He claimed that they were treated like animals because they were Hispanic. He said that he wished the responders had treated him like a brother. The family took the fire department to court, but an out of court settlement was reached with the city. American fire department learnt from this incident and introduced a mandatory cultural sensitivity training for all fire department personnel (Dees, 34). When appropriately trained, EMS personnel can give their patients a culturally competent medical care and improve overall patient health and wellbeing. Since it is the first point of contact in time of medical distress, the importance of EMS cannot be over emphasized. The lack of cultural competence in health care can leave patients and people with special needs more vulnerable as compred to other groups. It also leaves the society without the necessary information and resources needed to protect them. EMS personnel need to be equipped with training and other materials that will make emergency responses services effective and life saving. Emergency managers are tasked with the responsibility of providing core management and administrative support to all levels of disaster response. However cultural competency and knowledge of issues affecting special groups within the community are said to be vital skills that the emergency manager should have. EMS personnel are expected to continue considering culture, race, ethnic and gender diversity when attending to victims of disaster. It is the responsibility of the state and hospitals to train EMS personnel on hazard prevention, disaster preparedness and planning. Apart from training in cultural competency, skills are also required in handling of emergency medical incidents. Before the introduction of mandatory cultural training for fire department officials, people had to deal with EMS personnel with serious language barriers and varied cultural beliefs. EMS personnel have been encouraged to carry out a ‘culturalogical’ assessment in cultural values, economic factors, social ties, religious beliefs and practices. In cultural competency, EMS personnel must learn to listen, explain, acknowledge, recommend and negotiate (LEARN). In listening the patient, the EMS personnel has to probe the patient and listen to their view pertaining to the illness. Kleinman (125) gives five ways of getting a patients view of their illness. There are other mnemonic cultural assessment tools that also aid in cultural assessment of patients. Berlin and Fowkes (936) put forward the ETHNIC framework of assessing patients. It entails explanation, treatment, healers, negotiation, intervention and collaboration. In the explanation phase, the EMS personnel should find out the patients’ perception of their problem and if they have used any other kinds of treatments to try and solve the problem. Alternative treatments can be home remedies and herbal medication. In some cultures, people believe that prayer is enough for them to receive healing. This option can also be explored. If the patient cannot speak then the MS personnel should find someone who can give them information on the patient. The EMS personnel should also find out if the patient has sought the services of traditional healers or other healthcare professionals. In instances where the patients’ cultural beliefs contradict those of health practice, the EMS personnel are expected to use their negotiation skills and come up with a mutually acceptable option and determine the appropriate intervention. The EMS personnel and the patient should both take part in the negotiation. Cultural competence does not make EMS personnel cultural experts, but it enable them to use care in their patient valuations and not assumptions. It affords them the opportunity to get information that will help them attend to their patients’ in the best way. Cultural competence is not only about culture. It embodies the sharing of respect for everyone and coming to terms that everyone has different perspectives and opinions. Lack of cultural competence can have grave consequences for patients and may lead to social trauma, financial, physical emotional loss or even death. This further emphasizes the importance of cultural competence in EMS personnel. Apart from cultural competence, EMS personnel should have the ability to perform basic EMS functions. Cultural competency is not included in the job description of EMS personnel nevertheless it plays an important role in patient care on emergency situations. Cultural competence begins with the acquisition of cultural skill. In cultural skill, the EMS personnel are equipped with the relevant knowledge to collect data in relation to the patient’s problem. In this process, the EMS personnel are also taught how to carry out cultural assessments on patients. The acquisition of cultural skill helps in the delivery of patient centred care. Cultural assessment entails the a systematic examination of people, communities and groups according to their cultural beliefs, practices and values. In this way the EMS personnel can get information that will enable them come up with acceptable and culturally appropriate treatment for each and every patient. EMS personnel are also given cultural assessment tools that aid in carrying out of cultural assessment. Patient centred care can also be improved by coming up with a set of cultural questions that guide EMS personnel in the assessment process. Patient explanatory models can also be used to avoid cultural conflict in the provision of EMS services. Patient explanatory models give patients the opportunity to explain their notions of their problems and how they think it can be solved. Kleinman (1980) states that etiology, mode and time of onset of symptoms, cause of condition, pathophysiology and treatment as some of the questions that EMS personnel should ask during patient explanatory model sessions. EMS personnel can also ask open ended questions to ascertain patient’s perception of their condition. The open ended questions can be like; the name that the patient has for their condition, what they think caused the problem, why they think it began, what the condition dos to them, how it works, what the patient fears about their condition, the major problems that the condition has caused the patient, the kind of treatment the patients thinks he should b given and the results hoped for. This set of questions might help the EMS personnel get a patient’s cultural inclination, their practices and if they believe in western, conventional or both methods of treatment. EMS personnel are also encouraged not to limit their assessment to culture. The assessment should be holistic and include other areas like philosophy, economic factors, technological views, educational beliefs, social ties, legal views and political factors. Cultural assessment should also involve negotiations where the EMS personnel and the patient accommodate each other. This assists in the creation of patient care solutions that do not conflict with their culture but instead promote effective patient care that is culturally congruent, effective and safe for the patients. The participation of the medical personnel and the patient is vital for the success of this process (Dees, 2006). The acquisition of cultural skill is important for the EMS personnel since they interact with patients of different cultural backgrounds. Cultural competency therefore equips them with the necessary skills needed in the provision of patient centred health care. EMS personnel are encouraged to be culturally mindful when communicating with patients and avoid exaggerated perceptions of people that might lead to conflict during patient care. Culture as always been a source of conflict in the provision of medical care and should be treated with caution. The level of legal and ethical backlash against first responders has been on the rise in America; a factor that has made it necessary to equip first responders with the guidelines and awareness on sustainable cultural competency procedures. Hurricane Katrina showed the failure of emergency response services in catering for needy and vulnerable people. It proved that needy and vulnerable populations are normally overlooked in cases of disaster yet they are the ones who should be given special attention and care. When the northern California area of San Fransisco was devastated by the Loma Prieta earthquake in 1989, it revealed their unpreparedness. The areas’ emergency service was not prepared to take care of the emergency needs of its people. Immigrant communities faced discrimination in the aftermath of the earthquake. In such instances, minority and migrant residents suffer most (Lasker and Weiss, 42). First responders should be able to respond to calls of distress indiscriminately. The need for cultural competency for EMS personnel evolved as a result of the demand that first responders should serve people with special need in a better way. The question then arises of how much training the EMS personnel should undergo in order to make them culturally competent, considering budgetary constraints. EMS personnel apply the one-size-fits all kind of approach in emergency situations; an approach that has failed to take care of individual patient needs. A dilemma arises because the EMS personnel are also given blanket training in cultural competency. Cultural competence has become complicated and needs to be expanded to include community leaders, educators and patients. Since culture shapes the patient’s confidence and view of healthcare and professionals, it should be considered as a significant part of the training of first responders. Another factor that should be looked at in emergency response is the contribution of family members and onlookers when emergency teams arrive at disaster scenes. In some communities like the Africans, the oldest female normally speaks for the patient while, in other communities like the Arabs and Middle Eastern cultures, the EMS personnel is expected to speak to the male figurehead first. But when the emergency relates to women issues, then the EMS personnel will speak to a female in the family or group. Hispanics, on the other hand, expect the EMS personnel to try and establish trust and acknowledge the interest and opinions of the patient. In some communities children are brought up to believe that medical personnel will give them an injection when they make mistakes. This makes it difficult for EMS personnel when they encounter such a child. Much time is needed to convince the child that the medical personnel is there to help and not punish them. With all the cultural competency challenges that EMS personnel face, they are moving forward in an attempt to respond better to the next emergency call than the previous one. Cultural awareness has enabled EMS personnel to get into the patients’ life and become part of it through understanding which has in turn increased patient recovery and confidence in emergency personnel. Apart from the initiatives made to make EMS personnel culturally competent, the government came up with national standards referred to as Culturally and Linguistically Appropriate Service (CLAS) in 2001. These are standards that stipulate the goals, activities and benchmarks for healthcare systems and organizations. The aim of this is to improve the quality of health given to ethnic, minority, special and vulnerable communities. CLAS gives communities, organization and emergency service personnel the opportunity to work towards a common good. EMS personnel encounter people of varied cultural orientation in their line of duty, but it is their responsibility to make sure that the patient is comfortable, well taken care and not violated culturally. The hardest part of attending to EMS is when EMS personnel respond to a distress call and discover that the beliefs of the patient contradict with the practices of conventional healthcare. Such instances put the negotiation and cultural competency of the EMS personnel into test. In such instances, the EMS personnel is expected to put cultural skills and previous experiences into practice in order to avert a cultural conflict. There varied cultural preferences for the treatment of illnesses. Immigrant communities hold dear the traditional healing practices of their communities and practice them wherever they go. However, this does not eliminate the use of Western medical practices is ruled out. Both practices can be used harmoniously. But EMS personnel still face the challenge of helping some patients’ overcome the fear of western medicine and have confidence in its practices. That is why it is vital for EMS personnel to be culturally competent; it will enable them gain the trust of the patients thereby reaching an agreement on patient care. By the time a distress call is made to the emergency services, the symptoms of illness have become unbearable to the patient. It is, therefore, imperative that EMS personnel have cultural competence as this will help avert further disaster in disaster scenes. It is also important for EMS personnel to understand the full effect of culture on health and health care. EMS personnel have always been held responsible for emergency services gone wrong or for failure to attend to the needs of the community when in their most vulnerable situations. The critics forget that the EMS personnel have the most stressful time in disaster response. They have to uphold and respect patients’ decisions on healthcare and at the same time save human life in the limited time. Their decision to respect patient decision might lead to loss of life while, at the same time, it might save the patients’ life. It is a delicate balance that they have to learn to work with. For effective and beneficial EMS response and patient care it is necessary to take care of the challenges and barriers to the provision of culturally and linguistically efficient patient care. This involves understanding the issues of different cultural, racial and ethnic groups. The knowledge of the effect of acculturation to patient perception and care also need to be incorporated into the healthcare decisions. Communication patterns also play a role in cultural awareness and should be considered as well especially in taking care of underserved communities. Even with the introduction of CLAS, one size still does not fit all. EMS personnel should keep in mind that a particular approach will not work for the entire group of people with like cultural orientation. For the effective provision of culturally and linguistically competent services, EMS personnel should be able to define culture broadly and know that it is not static; it changes, and they should change with it to make patient care effective. Works cited Berlin, E., and Fowkes, W. A teaching framework for cross-cultural health care. The Western Journal of Medicine, 139. 6 (1982): 934-938. Dees, L. Brady Spanish reference for EMS providers. Upper Saddle River, NJ: (2006). Pearson, Prentice Hall. Print. Fuller, K. Eradicating essentialism from cultural competency education. Academic Medicine, 77.3 (2002): 198-201. Galanti, G-A. Caring for patients of different cultures (3rd ed.). Philadelphia: University of Pennsylvania Press. (2004). Print. Kleinman, A. Patients and healers in the context of culture. CA: University of California Press. (1980). Online. Lasker, R. D. and Weiss, E. S. Broadening participation in community problem solving: A multidisciplinary model to support collaborative practice and research. Journal of Urban Health, 80, (2003): 14-47. Read More