Factors Contributing To Scenario In Refugee Health Care

As evident from the video the factors that contributed to the scenario are as follow:

Culture greatly influences the health-related experiences both collectively and individually (Cummins et al. 2014, p.274). Interpreting a health care message depends on the cultural preferences and beliefs hold by a person.

In the chosen case scenario the influence of the culture was evident in the Ahmed and Tasneem understanding of physical illness, fertility and conception. Different cultures have different consuetude and different meanings to gestures and conventions particularly the non-verbal cues (Watkins et al. 2012, p.126). As depicted in the video it was difficult for Tasneem to communicate with the male physician regarding conception. It was mostly Ahmed who’s discretion was helping Tasneem to interact with the physicians. This prevented them from eliciting an accurate medical history. People from the Islamic or African background mostly enjoy masculine-oriented social status (Milner and Khawaja 2010, p.28). It led to cultural shock of Tasneem due to change in the traditional gender roles. It was offensive according to her to discuss such sensitive issue with a male member. However, she was very comfortable with the female physician and the attending nurse. Gender attitude and health belief thus led to interpretation problem and the waste of appointment, and time.  

It can be interpreted that the health care professionals can meet the requirements of culturally diverse patients only by overcoming the disparities in the cultural practices and having adequate training and cultural awareness (Garg et al. 2017, p.228).

Health literacy is vital for the patients to obtain and understand the basic information on health and applies the same to make effective health decision and improve a quality of life (Grice et al. 2014, pp.  240-253). Health literacy can be achieved if an individual has skills in reading, writing, and speaking in English. Also, an individual must have critical thinking and quick decision making skills. One must be comfortable enough to move from own cultural beliefs and values to those of dominant health care system (Bess et al. 2015, pp. 608-615).  

It was depicted in the video that Ahmed and Tasneem failed to answer questions such as “Since when are trying to conceive?” However, when the word “conceive” was replaced with “baby”, it was easy for them to understand. Bing, a recent refugee, added to their trouble of low health literacy. They failed to rely on the English proficiency and consequently understanding the medical jargon. They failed to solicit additional information while communicating with the receptionist, physician or nurse and navigate the Australian health care system. The low health literacy may have lead to poor self-management of the health concern and may have added to fertility and conception related issue (Hadgkiss and Renzaho 2014, p.158). 

It can be interpreted that low health literacy may compromise patient outcomes by adversely affecting medical decision-making, clinical effectiveness, access to service and increase the risk of hospitalisation (Henderson and Kendall 2011, p.195).

In any hospital, to achieve patient safety and accurate diagnosis and to ensure compliance and health promotion, effective communication is an essential factor (Singleton and Krause 2009, p.1). It is highly essential when dealing with people from ethnic minorities and effective communication means shared decision-making, shared vision and leadership (Yelland et al. 2015, p. 62). Australia is diverse country due to its increasing international migration and change in the ethnic makeup of its population (Parker 2015, p.1).

Since Tasneem and Ahmed were from African origin and new to Australia they had poor English speaking skills. It is due to this language barrier that prevented them from accessing the right doctor in the first attempt. On the other hand, the receptionist in the health clinic did not make any effort to identify their prime concern. Without seeking in-depth details, she arranged the appointment with the male physician. This not only caused inconvenience to the assigned physician but also led to embarrassment as they couple failed to answer basic health questions asked in English. Since the communication was ineffective, the physician could not proceed with a physical assessment.

Hence, it can be interpreted that the misconception due to linguistic barrier adversely affects the clinical effectiveness and patient outcomes. These act as barrier to collaborative care (Hadgkiss et al. 2014, p.146) It leads to the unwillingness among the care users to admit to the health problem, understands and access to the service (Garg et al. 2017, p.228). This also holds negative implications. Thus, implementing facilities to overcome language barrier is the prerequisite to ensure safe medical decision-making and to improve patient’s experience (Betancourt et al. 2016, p.144). Use of interpretrs will eliminate language concordance (Asgary& Segar 2011, p.514) among care providers.

Potential problems/issues faced by the participants of the scenario must be identified and the impact of the problems identified on health care provided.

The refugees have complex health care structure. Refugees are associated with multiple agencies thus, poor coordination occur at both individual and systematic level (Asgary& Segar 2011, p. 512-514). In the  video, there key issues faced by the participants of the scenario are discussed in this section.

Firstly, they had difficulty locating health clinic. Secondly, they had miscommunication with the staff member and failed to arrange appointment with appropriate physician in first attempt. It is the evidence of the gap in cross-cultural communication, which is profound in culturally diverse patients (Milner and Khawaja 2010, p. 19-29). It led to unfair treatment by the staff. Thirdly, the couple had difficulty in understanding physician’s perspective due to language barrier. Unwillingness to admit to the clinical problem due to cultural barrier was also highlighted in the video. The interaction between the physician and the patients were not aligning with the TeamSTEPPS® principles (Sheppard et al. 2013, p.5-10) discussed in the subsequent sections in details.

The impact of the problems faced by the couple on the health care includes failure to extract health history by the male physician. It delayed the physical assessment. It also delayed immediate diagnosis of the illness and making clinical decision. In addition the couple also had to undergo unnecessary anxiety and confusion. Due to communication gap the physician was  unable to make therapeutic relationship with the patient which is an important aspect of the evidence based practice. It includes referring Ahmed and Tasneem to appropriate doctor, adequate handover of health information, allocation of case manager and recruiting medical interpreter (Henderson & Kendall 2011, p. 195). The negative implications of this case include medical mistrust in patients, loss of hospital reputation and patient dissatisfaction. The loss of the physician includes waste of appointment and time. The male doctor failed to meet the care services of refugee patient.

The key stakeholders and their role in the scenario must be identified.

The Key stakeholders in the scenario are Ahmed and Tasneem, Physicians, nurses and the entire health care team.

The role of the patient is to engage actively in the clinical decision and treatment by effective communicating with the care providers (Edge et al. 2014, p. 37). Simultaneously it is the role of the health care team to ensure patient engagement in understanding the physician’s perspective, providing medical history, making decision related to care providers and benefits of treatment (Truong et al. 2014, p. 99). The role of the attending nurse is to provide patient centered care to improve clinical experience (Ferguson et al. 2013, p.283).

TeamSTEPPS® is an evidenced based protocol  designed to eliminate communication barrier. The full form of TeamSTEPPS is “Team Strategies and Tools to Enhance Performance and Patient Safety” (Agency for Healthcare Research and Quality 2016). It has been found effective in improving patient safety. The key competencies of this program are communication, team structure, situation monitoring, leadership, and mutual support (Sheppard et al. 2013, p.5-10). However, in this scenario the staff failed to implement the team structure competency that is the initial point of reference not correctly provided to the client (Asgary and Segar 2011, p. 513). The health care team is accountable for adequate transfer of information to its members, which was not found in this scenario. They failed to identify the cultural needs of the client in the initial stage. Identifying the needs include arranging for skilled medical interpreter and case manager and satisfying the gender attitude of patients from patriarchal culture (Purnell 2014, p.1). The nurses must play a vital role in fostering mutual support by monitoring the situation prudently. The nurses must exhibit leadership skills in exploring the cultural background and discussing sensitive issues with relevant questions and provide best clinical advice (Betancourt et al. 2014, p.145). The same was depicted in the second part of the assignment after the client was assigned to female physician.

What barriers are identified in this scenario to collaborative and effective care

In this scenario the key barriers to collaborative and effective care were low health literacy of the client, and language barrier that is poor English proficiency of Ahmed and Tasneem. In addition, cultural barrier includes gender attitude of Tasneem. Other key barrier was communication gap as discussed above. The negative attitude of staff that is not working or implementing the evidence base principles further added to this barrier. These are commonly known barriers when dealing with refugee asylum seekers (Hadgkiss et al. 2014, p.142-159).

What are the key outcomes in the scenario that would be considered as evidence of effective care?

The client was appointed to female physician that overcame the cultural barriers and fastened the diagnosis of Tasneem. Together with nurse she was successful in implementing the TeamSTEPPS® such as situation monitoring, open communication, and provision of mutual support. The use of medical interpreters assisted in understanding the cultural perspectives of the patients and prevented cultural shock and potential communication barriers as highlighted in Watkins et al. (2012, p.126). It allowed Tasneem to feel comfortable to discuss private health issues and have correct diagnosis. It is an evidence of effective and collaborative care provided as discussed above. It was due to early identification of this cultural barrier that problems faced by the Ahmed and Tasneem were quickly resolved. Nurses and physicians played a significant role by realising the patient-communication barriers and its impact on the patient from a culturally different background. They also fulfilled their role as health advocates. It helped Tasneem to have successful pregnancy.

How will you use this knowledge to inform your future clinical practice?

Based on the case study the theme that appeared to deserve the highest priority was cross-cultural communication. The implications in future practice would involve planning to work towards developing cross-cultural skills. It will help in providing holistic care. As a nursing professional, future practice will include evidence based principles such as providing education and patient centred care to the diverse patient population. In support of TeamSTEPPS® providing health advocacy, care and case management will eliminate the challenges due to the triad of communication, health literacy and cultural barriers. It will improve their health outcomes and make a difference in the patient’s experiences. Thus, it will be integrated in the future practice positively.

 In addition, future practice would ensure compliance with the code of ethics (Truong et al. 2014, p.99). It will assist in maintaining patient’s rights, dignity, autonomy and respect. I would develop education materials for the patient from diverse backgrounds in Australia that are appropriate from linguistic, cultural, and communication standpoints as suggested by Yelland et al. (2015, p.62). Cultural brokers and medical interpreters who are cross-trained in cultural competence would be compulsory in future practice (Hadgkiss and Renzaho, 2014, p.158).

Conclusions

Conclusively, communication, health literacy cultural and linguistic barriers are prime factors that prevent adequate health access by the patients particularly those belonging to a culturally different background. However, with the present of appropriate protocol and resources (material and workforce such as medical interpreters), it is possible to eliminate these barriers. The same was evident from the video where the female doctor, attending nurse and the interpreter worked in collaboration to satisfy the care demand of the patient. It can be concluded that the nurses positively influence the health care seeking behaviour and interactions between the individuals from a priority population and the care providers. Exploring this case study as a nursing student has enlightened my knowledge on culturally competent care and its significance in this profession.

Author/s (Year)

Country

Aims

Sample/ setting

Design/ methods

Main findings

Strengths and limitations of the study

Garg et al. 2017

Sydney

Australia

To describe patients experiences while accessing child health surveillance program

6 focus groups-33 parents

7-in depth interviews of CALD parents Purposive sampling

Qualitative design

Thematic analysis

Awareness of available services in Australia for CALD patients influences the clinical experiences

Strength- The paper emphasised on awareness, choices and beliefs, which influence access to services.

It emphasise that language concordance can be eliminated by cross cultural training to the health care professionals and with use of medical interpreters.

Limitation-The reliability of the research may have ensured with use of quantitative data.

Hadgkiss et al. 2014

Australia

To document the experiences of asylum seekers in Australia while accessing the health services

PsycINFO, CINAHL, MEDLINE, Embase databases were searched. Articles from 2002 to October 2012 were used.

Systematic review of qualitative and quantitative studies

Asylum seekers utilise health services at higher rate and also face significant barriers to care

Identification of health literacy, linguistic and cultural factors, and attitude of health professional as barrier is the strength of paper.

The limitation include review of papers that recruit convenience sample that may result in overrepresentation of health problems

Yelland et al. 2015

Australia

To improve access to health care for patients belonging to refugee background.

Partnership with 11 organisations participating in bridging the gap in health access to refugee patients

Multi-phase quasi experimental study and used interrupted time series design.

Identified the core competencies such as shared decision-making, shared vision, building relationship and leadership to improve maternity support

The strength includes rich information on Australian care services for refugee families and established framework that defines how cross cultural health services to be delivered to minimise child health inequalities

The drawback of paper is its particular focus on maternity support and child health services