Managing a Challenging Communication Interaction - Essay Example

Running head: REFLECTION Managing a Challenging Communication Interaction Association with Cultural Issues (school) Managing a Challenging Communication Interaction Association with Cultural Issues Introduction In the health care practice, reflective practices are important tools for learning and for improving nursing skills and health practice. Even more so, critical reflection helps facilitate the establishment of clinically efficient registered nurses. Reflection is otherwise known as the process of critically evaluating the health practice through the adequate and careful review of the formal standards of the practice in order to establish other influences and motivations (Johns and Freshwater, 2005). It is a process carried out in order to establish differences between theory and practice and it is one which seeks to discover data with which to improve the future practice. Moreover, the nurse’s functions include the various challenges in the provision of care, including the ethical considerations, the various issues in the expansion of roles and the need to secure adequate communication tools with the clients (Johns and Freshwater, 2005). Communication barriers are some of the issues which can make the health care delivery process particularly challenging for nurses and other health professionals. This paper aims to evaluate the management of challenging communication interactions in association with cultural issues. It shall focus on my encounter with a Chinese client who spoke little English. This assessment shall use Johns structured reflective framework model by considering critical reflection based on the main issues of the incident and the possible improvements which could have been implemented to ensure better patient outcomes (Johns, 2009). I Critical Incident During my placement in the mental health unit, I was assigned various patients and was subsequently informed that one of my patients spoke little English and was suffering from major depressive disorder. She was under antidepressants and was also under suicide watch because she recently attempted suicide. She is 65 years old and recently lost her home and her business in China to a fire. She was brought to Australia by one of her children and was now living with them, but was having a hard time adjusting to life in Australia. In one of the encounters with her, I went in to her room to keep her company as she was on suicide watch and she turned aggressive, she wanted to push me out of the door because she wanted to be alone. I managed to convince her that I would just be sitting with her, but even with my attempts to speak to her, she refused to communicate with me. Our language barrier failed to reassure her or provide her any comfort. She had a different understanding of depression as she believed it to be a disease which would permanently place her in an asylum; moreover, she also believed depression as synonymous with being ‘crazy.’ The interpreter available at the hospital had some differences in language understanding because he was raised in Australia and was not acquainted with local ‘slang’ applications of the Mandarin language. This made the communication process even more difficult. II Structured reflection This structured reflection shall be carried out in order to critically reflect on the challenging interaction which was demonstrated above, one which involved a patient who spoke little English and who had a different cultural perception of her disease. Johns’ model includes questions which allow the student nurses and health professionals to structure his or her experience and to review its processes and its overall outcome (Johns, 2009). What was/were the significant issue(s) and what was I trying to achieve in the encounter? The significant issue in this situation involved the difficulty in communicating with the patient due to cultural differences and language barriers. In this encounter, I was trying to achieve rapport and a trusting relationship with the patient. I was trying to get past the language and the cultural barriers and to understand what she was feeling and what she was going through and for her to understand me and what I was explaining to her about her disease and her medications. How was I feeling during the encounter and what factors were affecting my thoughts and behaviour? During the encounter, I felt helpless because I could not get through to the patient on a basic level of communication. I also felt anxious about being understood by the patient because this was an important requisite in helping her to calm down, in settling her fears, in building rapport, and in establishing a trusting relationship with her. I also felt an enormous amount of pressure in making myself understood because she needed her medication to calm down and to get past some of her depressed symptoms. Moreover, I felt that in understanding each other that she would cooperate better and comply better with the medication requirements. The pressure and the anxiety I felt in relation to the patient made me feel nervous and made me feel preoccupied with her as a patient to the exclusion of other patients. Did I respond effectively in the encounter? In reflecting on the encounter, I can say that my response was relatively effective. First and foremost, we called in an interpreter to communicate with the patient. While the interpreter was communicating with the patient, I established eye contact with the patient to a degree which did not appear threatening. I spoke calmly and clearly to her, and used simple words which her limited English knowledge could comprehend (Saia, 2008). I did not use technical terms which she did not understand and I asked the interpreter to use terms which would be applicable and appropriate in the patient’s language. I spoke to her at times when she portrayed a calm attitude and avoided sudden and unnecessary movements which looked threatening to her. When she was calm, I smiled at her and presented a calm and collected demeanour. Even if I did not understand her and she was speaking through an interpreter, I put my attention on her, nodding appropriately at what she said and what the interpreter said. I reached out to touch her hand and pat her back at times when she was weepy and emotional and when I detected that her defences were down. There are universal gestures which mean the same thing regardless of language barriers (Patterson, et.al., 2007). For example, a nod, a smile, or a pat on the back shows approval and a relaxing demeanour which can inspire confidence, empathy, and a welcoming attitude. These are nonverbal gestures which show sincerity on the part of the nurse and eventually, it can inspire confidence and trust on the part of the patient (Givens, 2002). What was ineffective about my actions was that I was distracted and driven to anxiety by the patient’s responses. This made me distracted and preoccupied and it compromised my actions as a nurse caring for other patients. What were the consequences of my actions on the patient, others, and me? My actions helped to calm the patient down and to put across the message that I was not intending her any harm, and that she could trust me and my actions as being beneficial to her. However, it also focused all my attention on her and made it difficult for me to exert significant effort for my other patients. I feel that I also stressed other people because I was sometimes anxious and agitated. This made me feel inadequate in terms of compartmentalizing my feelings and actions for each patient. III Critical Reflection Based on the above reflection, the main issue in this incident was the language and cultural barrier I had with the patient. I was very much concerned about our inability to communicate effectively with her and of correcting her perception about her disease. These are significant concerns because her recovery relied heavily on her ability to accept her disease and to trust us as health professionals. Culture and language barriers can sometimes be seen in the hospital and health care setting because of the process of globalization (Okasha, 2005). These barriers can sometimes compromise the communication process with the client because it can make the patient feel unsafe and therefore the process of rapport and trust building can be difficult. The initial process of any encounter is on rapport building with the patient. Building rapport helps the patient relax and to open up about his feelings (Karliner, et.al., 2004). Without such rapport, the patient can become uncooperative and fearful of the nurse’s actions. Accordingly, it was natural to feel some aggression and to face the lack of cooperation from the patient. Therefore, in considering this problem, it is important to evaluate and establish ways to get past the language and cultural barriers with the patient (Hogan, 2007). The language and cultural barrier is a significant barrier to face when dealing with non-English speaking patients. It can sometimes cause misinterpretation and errors in the assessment, diagnosis and subsequent treatment of the patient (Schyve, 2007). Nurses usually spend the most time with patients and they are often burdened with assessing and monitoring the patient 24 hours a day, 7 days a week. Failure to overcome the cultural and language barriers with patients can lead to a difficult and burdensome situation for both patient and the nurse (Hogan, 2007). It can cause stress and anxiety on the part of the patient, thereby causing him to even be more cooperative, and it can cause stress on the part of the nurse who is unable to effectively carry out her functions as a nurse (Schyve, 2007). Based on the above considerations in the language and cultural barriers between patients and nurses, I may be able to resolve such barriers by understanding how different cultures work and how to communicate effectively with patient through non-verbal gestures (Schyve, 2007). In establishing rapport and trust with a foreign non-English speaking patient, it is important to understand the general traditions and norms which certain races and cultures have (Wilson-Stronks and Galvez, 2007). The Chinese culture has a different understanding of depression as they believe it to be a disease which is likened to being crazy, and as a result, they usually deny its existence (Parker, et.al., 2001). In fact, China has been known to have low rates of depression diagnosis, and yet, it has one of the highest rates of suicide (Parker, et.al., 2001). This disparity clearly reflects that the low rates of depression may be attributed to the denial of the disease. My language barrier with the patient also made the communication process difficult. In this situation, my knowledge of transcultural nursing informed me that the best way for me to effectively communicate with the patient is through an interpreter, and a correct interpreter. Since the patient was from Beijing, it was important for me to get an interpreter who spoke the same language as those in Beijing, and who shared the same colloquial expressions with the patient. Speaking Chinese may be different even for those who are from China because the expressions and interpretations for some parts of China may be different for some other regions. And without considering this situation, misinterpretation may be seen (Karliner, et.al., 2004). Since the patient still did not calm down and still did not understand clearly what was being explained to her by the interpreter, poor communication between the interpreter and perhaps including myself is still a major consideration in this case. Based on these elements, the language and cultural barrier is a significant barrier which is preventing the patient and the nurse from communicating effectively with each other. Insisting on carrying out the procedures without attempting to make the patient understand about her medical needs is one of the factors which may have caused her uncooperative attitude. IV Strategies for Improvement In order to overcome the cultural and language barriers in this case, it is important to be learned in the different cultural practices of major cultures (Ngo-Metzger, et.al., 2003). It is important to gain as much information as possible about the cultural practices and beliefs of different cultures and ethnicities, especially those which pertain to patient and health care. Patients often want their providers to understand and to respect their culture, especially those which pertain to health practices (Ngo-Metzger, et.al., 2003). It is therefore important for health professionals to be aware also of the accepted alternative and complementary medical practices which may be based on cultures and traditions of patients. The nurse must gather as much information as possible, not just on traditional medicine practices, but also on culturally-based health practices which may be preferred by the patients. Some of these cultural practices often serve to provide comfort and helps ease anxiety of patients because these are practices they are used to and have practiced before (Betancourt, et.al., 2003). The nurse should know which practices can be safely carried out in the hospital setting, and which practices cannot. The best source of information regarding these traditional practices is the patient herself. Her family can also be interviewed about their traditions. By understanding and respecting these practices, it is possible to gain the patient’s cooperation, and to relax and calm him (Betancourt, et.al., 2003). In instances when language barriers are present, the best remedy would be to call for an interpreter who is well-versed in the language and the colloquialisms of the patient. Hospitals and health institutions must have these interpreters on call at all times. Bilingual health care advocates must also be recruited by the hospital in order to assist in the efficient delivery of patient care (Betancourt, et.al., 2003). These health advocates assist not just the patient, but also the health institutions in educating the health staff about the language, the culture, and the beliefs of certain cultures, nationalities, and ethnicities. The nurse must try to gain training in various languages as well, especially those languages which they may come in contact with. Even a rudimentary knowledge of another person’s language can help provide a common ground for building rapport (Divi, et.al., 2007). The effort in knowing and learning the language can help gain the patient’s cooperation. The patient would feel more respected when he sees that the nurse is making an effort to speak to him in his language. The quality of interpreter services must also be continually assessed by establishing a feedback from patients and providers (Betancourt, et.al., 2003). Trainings in languages must also be made a part of each hospital and school system. Research has established that in many instances the encounters between health professionals and patients have been reduced due to the increase in encounters with patients requiring interpreters (Betancourt, et.al., 2003). Since Asia is the closest neighbour that Australia has, a good majority of its immigrant population comes from China. Knowledge of common languages in Asia (Mandarin) is essential in the current practice. The time to develop cross-cultural practice is ripe due to the trends in globalization (Okasha, 2005). The health care profession would greatly benefit from these improvements and strategies. Cultural competence is also important in the management of cultural barriers with patients. This would mostly involve education and training interventions which would arm health providers with the knowledge and skills to understand and manage the socio-cultural problems encountered during the clinical encounters (Schouten, 2006). The means for cross-cultural education have changed over the years and they have included the multicultural approach where specific data about the cultures are provided to the learners. Trainings in Asian culture can include the presentation of specific data about them as to their health practices and beliefs and the way they communicate with each other (Betancourt, 2003). Language services employed by health institutions can include interpretation services and translations of written materials (Lee, 2003). Even with various studies on language barriers reducing the access of care, there are few studies which actually assess the efficacy of language services in improving health care delivery. Trained interpreters have also been known to increase patient-health provider communication by reducing medical errors and by increasing the communication with the patient (Lee, 2003). These interpreters have been known to reduce disparities in compliance among non-English speaking patients. In other studies, it was also revealed that non-English speaking patients seen by bilingual health professionals had an improved understanding of their condition and their health needs (Lee, 2003). They also participated more in the communication process. In a study comparing the functions of bilingual nurses versus non-bilingual nurses, it was established that those who were cared for by bilingual nurses manifested an improved compliance with medication orders. Given the same situation again, I would better manage the situation by getting an interpreter and also by trying to learn more about the Chinese language – even if it is only the greetings that I would remember. This may trigger some response from the patient. I would also try to enlist the assistance of the family members to try to gain more knowledge about the patient and her belief system. This would help me understand the patient and assist in the establishment of patient care. Conclusion Based on the above reflection, this essay has provided an initial starting point for my critical reflection on how I can later apply therapeutic use of self when I would encounter patients with whom I would have cultural and language barriers with. This reflection has allowed me to establish that these barriers are crucial to the establishment of effective communication patterns with the patient. It is crucial to assess these patterns of communication and not to ignore the resolution of these barriers because failure to resolve can lead to medical errors and negative patient outcomes. Works Cited Betancourt, J., Green, A., Carrillo, E., Ananeh-Firempong, O. (2003). 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