UNC Communication Problems

The increasing population of immigrants in the United States has contributed to health disparities in the health care system. Cultural competence can remove health disparities by eliminating personal biases, and treating every person with respect. Simply recognizing and accepting different cultures is not enough, one must be able to consistently recognize and understand the differences in order to be culturally competent. Knowledge and culturally competent practices are a must for nurses to deliver quality care in our rapidly changing multicultural world (Edelman, 2014 p. 25).

I am a Brazilian black male with military experience and diplomatic knowledge who grew up in a low-income household in a developing country. In addition, I have traveled to about 35 countries and am acquainted with people from different socioeconomic backgrounds, religions, ethnic groups and nationalities. These characteristics and experiences allow me to see the world from perspectives that are unusual for most people. Besides being open-minded and non- judgemental toward all my future patients, I personally understand the difficulties faced by people of color, immigrants and individuals from low-income families. In sum, my background and my cultural literacy will allow me to be a sensitive and culturally aware patient-centered care.

According to the 2011 U.S. Census, twenty-one percent of the population speaks other language at home besides English. Hence, one of the biggest challenges in Healthcare is the language barrier between the providers, Health care administrators and patients that speak foreign languages. This poses a challenge for medical entities,

Can you imagine the how the healthcare industry would be without language, what seems to be impossible to imagine is the everyday reality of some patients because of their native language. Language is a major contribution to the health disparities that some populations face, because it makes it difficult for some patients to communicate their problems as well as understand the care they provided. Language contributes to the health disparities that some populations face because it creates a barrier between the patient and the care provider, making it difficult for a patient to receive proper care. Language barriers create a communication gap between a patient and a provider, forcing the patient to feel misunderstood and unable to trust his/her provider to properly care for them. I come from a family that speaks more than one language, so I have seen the impact language barriers can have on someone who doesn’t speak fluent English.

I have learned that it is important that educators  and health providers be trained on cultural competency to understand the population they are serving. Marks, Sims, and Osher (King, Sims, & Osher, n.d.) define cultural competency  as a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enables that system, agency, or those professionals to work effectively in cross–cultural situations" ( as cited in Cross et al., 1989; Isaacs & Benjamin, 1991). Health providers and educators should investigate demographic patterns or trends in the place where they live and work. This brings awareness of the types of cultures that they might come across when they are working with people. Organizations should integrate and implement policies that promote the value of  diversity, self-assessment, manage the dynamics of difference, acquire and institutionalize cultural knowledge, and adapt to diversity and the cultural contexts of communities they serve (Georgetown  University, 2004). Georgetown University (2004) also stresses that culture competency grows gradually and is always open for improvement.

Lor et al. (2016) examined the growing problem of language barriers for patients in the United States and around the world. The use of interpreters is often the solution to bridge the gap between languages. The purpose of this study was to examine patient perception of interpreter services.The population for this study included 10 English proficient Hmong patients and 10 Spanish speaking patients. The participants ranged from age 33 to 75 years old. The intervention was that poor quality interpretation could lead to poor relationships among patients, interpreters and providers. In addition poor interpretation could end up in the patient being unable to follow through with treatment plans. Lastly, poor quality interpretation can lead to emotional distress for patients. Comparison was that patients have expectations on how the

Jacobs, E. A., Shepard, D. S., Suaya, J. A., Stone, E. (2004). Overcoming language barriers in health care: costs and benefits of interpreter services. American Journal of Public Health, 94 (5), 866-869.

As the United States becomes more and more culturally diverse one cannot help but be exposed to various cultures and worldviews. America has long been called the melting pot, and that term has never been truer than it is today. According to Green and Reinckens (2013) the U.S. Census Bureau estimates that by the year 2041 the U.S. population will be a majority minority. In other words, less than half of the population will be non-Hispanic, single race Caucasian. This growing diversity makes cultural competence in healthcare a necessary

Healthcare managers are responsible for ensuring that their organization has a plan or strategy that is geared toward eradicating health inequality through cultural competency. Best practices are of utmost importance in assuring cultural proficiency. Buchbinder and Shanks (2012) outlined these practices in their textbook Introduction to Healthcare Management: a diverse workforce, leadership and organizational culture that fosters cultural competence as well as human resource policies which do the same, appropriate training/education for all employees, linguistic services and materials, systems capable of tracking data with regards to health outcomes, and responding to and engaging the community (p. 321). Additionally, a Commonwealth Fund study provided a list of actions that diversity leadership should adhere to in accordance with the National Standards on Culturally and Linguistically Appropriate Services (CLAS) standards. Aside from employing a culturally diverse staff and patient services and regular re-evaluations of goals, healthcare leaders engage and report their progress to diversity goals the community (Dreachslin, 2008). Inasmuch as cultures change and evolve, it is suggested that cultural competence training be an ongoing process and that organizational policy and strategic plans be reassessed periodically for effectiveness (Buchbinder & Shanks, 2012). Time, revenue, and energy spent in interventions that do not bring the desired results is not

Effective communication is a two-way process of not only relaying the correct information but receiving and understanding the correct information (Tay, Ang, & Hegney, 2012). The number of persons with limited English proficiency (LEP) in the United States has increased by 80% in the past 16 years accounting for 25.2 million people or 9% of the total population (Gil, Hooke, & Niess, 2016). This presents a communication challenge for the healthcare provider when the LEP patient presents for medical care. Communication barriers can interfere

It has been predicted that the nation will increase its racial and ethnic diversity throughout the mid-century. Disparty in health care quality and access among minority populations, especially among African Americans, Hispanic Americans, and American Indians. By the middle of the century, racial and ethnic minority groups will comprise almost half of the US population. The barriers were recognized by Leininger and along with culturally and linguistically appropriate services, Leininger’s Culture and Diverse offers a structured approach to promoting culturally congruent care.

From the self-assessment survey for quality and culture I took, I would like to improve and understand how cultural competence can have a real impact on clinical outcomes. There are a few questions I was surprised that I answered them incorrectly. Now I do understand that what I learned in this culturally competence class will help me become more efficient in cultural competence, to provide quality care to all my patients regardless of gender, socioeconomic status, and ethnic, but it will take consistent individual practice, patience, and training on my part to develop and maintain that. I have learned that being culturally competent and implementing sound cultural competency techniques, will help to increase health access and reduce health disparities among different racial and ethnic groups. Cultural competence can lead to, health literacy, health equity, and fewer diagnostic errors, which might help the patient expand their choices and access high quality medical providers because the patient is no longer restricted to a small pool of clinicians who share their culture.

One key skill which is essential to nurses is being able resolve a way to communicate though barriers. Language barriers is something which be very challenging to overcome. For this barrier to be overcome it is common that a translator or an interpreter is brought into the setting. This requires specific training and allows the conversation to happen much more smoothly. Interpreters however can be a negative factor in communication, this is due to the nursing becoming reliant on the interpreter and not the patient themselves. For this not to occur it is essential that the nurse talking is speaking to both the interpreter and the patient. This could be making sure that eye contact is given to both. Unfortunately, interpreters aren’t always available meaning that the communication faces a barrier. This can make the patient feel angry and upset leaving them to feel unsatisfied with the care they are receiving. During a short placement in the North West there was a situation where a man could only speak Mandarin and no interpreter was available. The man was due to be discharged yet a discharge chat was needed to be made. The man himself began to get annoyed and aggressive as he wanted to

My experience with language accessibility is limited, but I have noticed at the free clinics where I have volunteered, the language interpretation services are sometimes unsatisfactory. I have heard interpreters respond to a patient’s question before even relaying the question to the physician or provider in charge of the case. As a medical student, I can obtain proper interpretation services even if I feel like I have some knowledge of the language that the patient speaks. Patients deserve to receive healthcare services in their native

Information cannot be relayed between the patient and the healthcare provider without successful and appropriate communication. Communication problems can arise between speakers of two different languages, but also between two speakers of the same language who may be used to two different regional dialects. Words may have different meanings, certain idioms might not be used, and polite communication techniques for one culture might even be seen as offensive to another. If an intrepreter is to be used, it is best if the interpreter does not have any relation to the patient, as this could make the patient embarrassed (Galanti,