Question

Using the perspectives on culture, medicine, and cultural competency you have learned in this class--What strategies would you use in handling the numerous cultural, social and other challenges that his case presents? Please reflect on how you would use the LEARN model (see Culhane Ch. 5) in this case. What is a nurses role in ensuring effective and culturally appropriate health care in cases such as these?

Case study "Culhane 8: Man with Hypertension and Diabetes."

Answer 1

# Learn Model :

Communication framework called the LEARN model can be used to help health care providers overcome communication and cultural barriers to successful patient education. There are 5 steps to the model from Berlin EA. & Fowkes WC. (1983). A teaching framework for cross cultural health care: Application in family practice. West J. Med. 12(139), 93-98.)

1. Listen - Listen with empathy and understanding to your patient’s perception of the problem. Encourage your patient to discuss his understanding of the causes and effects of his illness and to describe the treatment and resources he feels will contribute to recovery. “What do you feel may be causing your problem? What do you feel might help or hinder your recovery?” are examples of questions that elicit patient feedback.

2. Explain - Explain your patient’s illness, the recommended plan of care and subsequent management of self-care. Even without a diagnosis, it is essential that you explain what you have in mind in terms the patient can understand. Take into account literacy level, cultural beliefs, and past experiences which may affect understanding and acceptance of any suggestions you give. Try to link your explanation to something the patient already knows. Do not ask for feedback by asking “Do you understand or have any questions?” but rather, discuss a particular point or pose a problem to which the new information can be applied.

3. Acknowledge - Acknowledge your patient’s feedback and understanding of his illness and plan of care. Discussing the differences and similarities with your observations will help promote patient involvement. Areas you agree upon should be recognized and differences resolved. Whenever possible, integrate your patient’s suggestions into any care approach. This will give him a sense of control and commitment. If his suggestions would have a negative effect, explain the consequences and try to make the appropriate plan of care more desirable.

4. Recommend - Recommend a plan of care that fits within the patient’s parameters. This can be accomplished after completing the 3 previous steps. The more involved your patient is in the development of his plan of care, the more interested he will be in its outcome. It is important to listen to concerns your patient may have and agree on solutions that will enhance commitment.

5. Negotiate - Negotiate agreement with your patient on a course of action. This requires a keen understanding of your patient’s perspective and the ability to integrate the information you gained in the previous 4 steps. Successful completion of this final and key step can lead to a variety of patient-specific approaches that will increase the change of a successful recovery and healthier life.

We can use this model in this case too and by using the main 5 points will help to communicate therapeutically and cross the cultural and challenges if any .

# The role of nurse in ensuring effective and culturally appropriate healthcare in cases such as these are :-

Assess the cultural beliefs, practices and needs of the patient .

- Encourage the patient to express their concerns about any cultural barriers they have in respect to the healthcare services .

- Educating the patient about the importance of the healthcare services that are necessary to be done to save life and how to make decision on cultural aspects .

- KNOWLEDGE: Acquire a knowledge base of cultures in your service area, especially in relation to healthcare practices and beliefs.

- ATTITUDE: Avoid making stereotypical assumptions about your patients' culture; become aware of your own biases and prejudices.

- SKILLS: Learn new communication skills to simplify language for any patient, regardless of primary language.