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  • Subject Name : Nursing

Principles of Family Centred Care 

In the given scenario of the patient named Amir, since his parents are Syrian and English is their second language, they are having difficulties in understanding the instructions and medical terminologies used by the health professional. Amir underwent a procedure where he had to have grommets inserted in his ear under general anaesthetic. He is able to converse with his parents and talks to them in Arabic.

Through this case, we can highlight the importance of proper communication and human interaction in the medical field. When a medical staff, for instance, a nurse, communicates with the patient and their family - in this case, Amir and his parents - she should be mindful of the fact that they are not extremely fluent in English and hence she should refrain from using complicated words. Instead, she should use simple words, be honest and transparent so that unnecessary misunderstandings can be avoided in the future. This will help the patient and caregivers feel safe and secure in an otherwise worrisome environment. It will also help foster trust between the patient party and the medical staff. The patient and their family will not feel burdened, apprehensive due to lack of information and will instead be in a calmer state of mind. Also, the medical professionals should try to be emphatic and understand the emotional state of the patient and their caregivers and instead of being rude, should be helpful, help them understand the problem clearly, help track the progress of the patient and try to be an ally to them instead of a hindrance. Providing the patient and his family with adequate information regarding the post-procedure care is of extreme importance as it all affect the recovery process of the patient. However, barriers in language comprehension may make it troublesome for the caregivers of the patient to understand everything that is being said to them. Missing out on crucial information due to language troubles does not seem appropriate or fair given that there is so much that can be done to rectify this. One way to address language barriers between the caregivers and healthcare workers is for the healthcare professional to stop using speech that is heavily laden with medical terminologies. There are times when caregivers with English as their first language find it difficult to follow such conversations, so one can guess how confused immigrants might feel if technical terms are always thrown at them and they are expected to understand. Healthcare providers need to understand how overwhelming and confusing the use of medical jargon can be for such families and thus should be a bit more sensitive to their needs.

Another approach that comes to mind is using interpreters in the healthcare set-up. Language barriers should not be the excuse or the obstacle due to which someone's quality of healthcare is compromised. Hence, by having interpreters who are given basic medical training and who are on-call would be immensely helpful as it would not only help with the easy flow of communication but also help the patient and his family foster a sense of trust towards the healthcare workers. The caregivers get a better understanding of what is happening, in terms of medical care, the procedures being followed and this helps with their understanding of the situation and trusting in the medical professional, being sure that the professional has their best intentions in mind. This helps foster a sense of safety and security. Health care professionals should support patient participation by recognizing them and their families or caregivers as resourceful individuals. The benefits of patient-centred care could be that patients are more motivated to follow advice and take the treatment serious (Irwin and Richardson, 2006) and are more satisfied with health care (Fossum and Aborelius, 2004).

Immigrant individuals form a major part of the disadvantaged community. It is not easy trying to start a new life in a foreign land with limited resources - not just in terms of monetary and financial resources but also in terms of social and emotional support. Most immigrants do not have jobs that provide them with a good health insurance plan due to which they are already living in a state of constant fear. To add to this, they are not aware of the ever-changing rights and policies pertaining to them and are even subjected to unnecessary discrimination. Inability to properly understand the language therefore adds to their misery and puts their safety and security needs in jeopardy. A growing body of research shows that social discrimination has a negative effect on the health of its perceiver (Pascoe & Richman, 2009). According to a study conducted by Kuzel, negative outcomes in the clinician-patient relationship due to insensitivity, were reported as more common than technical errors in diagnosis and treatment. Ensuring the safety and security of immigrant patients and their caregivers is therefore extremely essential. Educating them about their rights and other policies is a small but much needed step that should be taken. Care should also be taken that unfamiliar words and concepts need to be broken down for their better understanding, as such information is crucial to their existence in a new country.

If we are to consider the case of Amir, he has received grommet insertions and has an intravenous cannula insitu in his left hand. Based on the given information, he will require post procedure care and his parents need to be given all the essential information on how to take care of him at home, before discharging him. The nurse should check for bleeding, pain, discharge coming from the ears and infections. The appropriate medication or ear drops should be administered to the patient in case any of the above symptoms occur. Since Amir is a three year old child, he may not be able to clearly express himself, if he is experiencing any discomfort. Instead, he may cry or fuss when distressed. The nurse should be monitoring him and be on the lookout for such signals of distress and upon noticing them, give the child a thorough check-up in order to determine what the cause of distress is.

Since the child is young, he may not be mindful about taking the necessary precautions needed after grommet insertions in his ears. In this case, the nurse must monitor the child as long as he is in her care as well as educate the parents so that they can provide care for the child at home independently. The nurse can even demonstrate to the parents what can be done while they are still at the hospital. Educating the parents in taking the correct precautionary measures with respect to not letting water get into the ear canal of the child, as it may risk the development of an Infection. Hence, activities involving water, such as bathing, will need to be exercised with precaution and the child should abstain from participating in non-essential activities such as swimming. Parents should also be taught to look out for discharge from the ear, bleeding and other possible conditions that could develop. The parents have to be informed about follow-ups, check-ups and subsequent tests such as hearing tests or an otoscopy, that may be done as part of the follow-up.

As Amir has an intravenous cannula inserted in his left hand, the nurse will have to remove it before discharging him. Care should be taken to follow all the hygiene protocols and carefully removing the cannula so as to not hurt the patient or cause subcutaneous bleeding. Once the cannula is removed the nurse should sterilize the hand and dispose of the waste safely and under hygienic conditions. Before discharging the patient, it is important to make sure that the necessary information is conveyed to the parents, important documents and reports are handed over to them (which they are able to read and understand) and required contact information is provided to them for when they need to call in case of a medical query.

In the above scenario the importance of proper communication in the healthcare sector was highlighted. It explained how something as simple as communication is so crucial in-patient care, especially if the patient and their family are not too familiar with English. The assessment helped in the understanding of the importance of being emphatic, using simple speech, using interpreters as and when required, trying to create a safe space for the patient and their caregivers instead of a chaotic one and overall, being an ally to them and helping them in every step instead of being a hindrance. The medical and healthcare field is a highly respected one and we as medical professionals should continue to uphold its high standards. 

References for Perceived Discrimination and Health

Fossum, B., & Arborelius, E. (2004). Patient-centred communication: videotaped consultations. Patient Education and Counseling, 54(2), 163–169. https://doi.org/10.1016/s0738-3991(03)00208-8

Irwin, R. S., & Richardson, N. D. (2006). Patient-Focused Care. Chest, 130(1), 73S-82S. https://doi.org/10.1378/chest.130.1_suppl.73s

Jaeger, F. N., Pellaud, N., Laville, B., & Klauser, P. (2019). The migration-related language barrier and professional interpreter use in primary health care in Switzerland. BMC Health Services Research, 19(1), 429. https://doi.org/10.1186/s12913-019-4164-4

Kuzel, A. J. (2004). Patient Reports of Preventable Problems and Harms in Primary Health Care. The Annals of Family Medicine, 2(4), 333–340. https://doi.org/10.1370/afm.220

Pascoe, E. A., & Smart Richman, L. (2009). Perceived discrimination and health: A meta-analytic review. Psychological Bulletin, 135(4), 531–554. https://doi.org/10.1037/a0016059

Snyder, H., & Engström, J. (2016). The antecedents, forms and consequences of patient involvement: A narrative review of the literature. International Journal of Nursing Studies, 53, 351–378. https://doi.org/10.1016/j.ijnurstu.2015.09.008

White, J., Plompen, T., Osadnik, C., Tao, L., Micallef, E., & Haines, T. (2018). The experience of interpreter access and language discordant clinical encounters in Australian health care: a mixed methods exploration. International Journal for Equity in Health, 17(1), 151. https://doi.org/10.1186/s12939-018-0865-2

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