Effective Communication, teaching and Learning in Nursing
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Visit the website http://ethnomed.org/ethnomed/ (Links to an external site.) and select a particular ethnic group (select the Cultures tab). Describe how they would tailor their teaching to the particular cultural group. What will be included in the assessment of the learner?
I want to write about the Iraqi refugee, when they are talking about teaching its mean when they go to a doctor’s office how the health care providers would teach them or treat them according to their cultural believes and need. All the information you need to write this paper is on that website, but I wanted to includes these following points:
Recommendations for Health Care Personnel
Familiarize yourself with general knowledge of Iraq. Iraqis are proud of their heritage. Do not confuse Iraq and Iran.
When doing initial intake at health care facility, ask the patient about his or her employment in Iraq, educational background, and religion. For example, knowing that the patient was a professional in Iraq and from a higher socioeconomic standing will help the provider understand that the patient was likely not expecting to work a low wage job or even be unemployed, both of which are significant sources of stress.
When a patient or family is new to the clinic, if possible, have staff explain how the primary care system works, including: annual checkups, well-child care, preventive care, obtaining medications, and the typical length of the office call. Explain that a limited number of health concerns and acute needs are usually addressed in a single appointment, and that additional concerns can be dealt with in follow-up appointments. Explain that referrals to specialists generally take some time to schedule.
Iraqi women generally prefer to receive care from a female provider. When the provider is male, have female staff present when performing physical exams.
Address the patient formally, using Mr., Mrs., or Miss. Do not use first names.
If the husband is in the room with his wife who is the patient, be sure to acknowledge his presence when you are speaking.
Upon starting the medical encounter, a smile, brief pleasantries, and a little small talk before launching into medical issues will help build rapport. Spending a little time on small-talk or pleasantries is part of the culture in Iraq. Ask some questions, such as: Which part of Iraq do you come from? I know there is a rich history there.
Because Iraqi patients may wish to list all physical complaints at the beginning of the office visit, explain that it is best to prioritize their complaints, starting with the most urgent concerns. Clarify that a follow-up appointment can be made to address problems not addressed in this visit. Make sure that the patient doesn’t feel shortchanged due to being a refugee.
Have clinic staff perform follow-up phone calls to help keep patients engaged in health care services. This will help increase the likelihood of patient follow-up.
It is important that patients feel like their providers are listening attentively. This will help build trust and confidence.
Iraqi patients may appreciate a more decisive approach and may expect the physician’s opinion about treatment options. Tell the patient what you think is the best option. Not doing this may give the impression that you don’t know what you are doing.
Provide health education about antibiotics, especially when they are not indicated. Understand the culture around antibiotic use in Iraq.
Provide dietary counseling to help combat high levels of chronic illness, especially to help prevent or treat diabetes.
As part of well-child care, explain to parents that behavior management and discipline may be different in the U.S. than in Iraq. Educate about behavior management and discipline alternatives to physical punishment.
In Iraq it is common for a neighbor or family member to take a child to the doctor if parents are unavailable. If a minor patient’s health care facility in the U.S. requires authorization to treat forms signed by parents, it would be helpful to inform parents of this in advance.
Compliment women who choose to breastfeed as a means of encouragement and to reinforce that cultural norm. If a woman is breastfeeding for a prolonged period of time, inquire about her birth control needs and whether she is supplementing with formula.
Some Iraqis experience a high number of somatic complaints that are characteristic of mental health problems such as PTSD, anxiety or depression. When working with Iraqis, it is important to avoid using the term “mental health.” One alternative is to use symptoms rather than jargon. For example, “You are having trouble sleeping at night and you cry every day.” Rather than, “You seem depressed.” Or, “You have bad nightmares and think about what happened to you all the time.” Instead of, “You have PTSD.” Then talk about the treatment plan in terms of how it might alleviate symptoms. If it is not possible to avoid saying “mental health,” the following explanation may help: “’Mental health’ in the United States means something different than in many parts of the world. I know in many places ‘mental health’ means the same as ‘crazy.’ Here, mental health refers to a range of symptoms from not sleeping well, to having nightmares, to feeling like there are too many thoughts racing in your head, to crying a lot. Because refugees have been through so many bad things, and because adjusting to life in the U.S. is hard, sometimes they need extra support. That is what we do here. This is why we would like to refer you to____. We try to find out what is happening in your life and how we can help.”
If a physician refers the patient for counseling, it is recommended that the physician’s office make the referral instead of simply giving the contact information to the patient. This will increase the likelihood that the patient will go.
Understand that survivors of torture or extreme trauma will have more needs and require more help than other refugees to rebuild their lives. They will likely require more time and encouragement to access the needed medical, legal, mental health, employment, educational, and social services.
Incentives such as public transportation passes and opportunities to socialize with others (thereby improving social support and bonding within the community) can be helpful to encourage participation in health related programs (Giese, 2010). Keep in mind that there is great diversity among Iraqis and understand there may be resistance to mixing with others outside socioeconomic, religious or political lines.
Some people may be more forceful regarding their needs, possibly seeming pushy or demanding. Be patient and explain the system as it works here. Understand that in Iraq’s resource-poor health care system, being loud or insistent could help get what was needed. In the U.S. we might say “it’s the squeaky wheel that gets the grease.” In Iraq, people may have had to resort to bribery or personal connections in order to get what they needed.
Exercise is not emphasized in Iraqi daily life. Instead it is considered a social activity and not generally regarded as important in maintaining good health. Sports, tennis and swimming are typically done at sports clubs. Running outdoors is considered inappropriate. Walking, however, may be a more acceptable exercise option.