Final Reflection

I have learned a lot this semester about a variety of cultures, some I had not even thought about as being different from myself. I have learned about Native Americans and how they perceived the "white man." I really enjoyed the book club part of this class. The book I read was The Dancing Healers by Carl A. Hammerschlag M.D. Reading this book gave me a much greater understanding of the Native Americans even though this book was about a Jewish doctor's experiences with Native American culture. I can't say I have ever really experienced Native American culture myself so having the opportunity to read this book gave me an understanding of their culture that I would probably never have if I hadn't chosen this book. The Native American culture is a very spiritual culture with a lot of natural remedies, spiritual healing traditions, and a mistrust of Western medicine. I can understand their mistrust of Western medicine because most of them did not understand the science of modern medicine and it is hard to trust something new that you don't understand. 

This class also gave me a better understanding of a number of other major cultures in America today. African Americans and Asian Americans are the cultures I have had the most experience with already. I can say that I did know a lot of the content from module 3 already. I had already learned that African Americans were at the highest risk for diabetes and that Asian Americans are very family orientated. One thing I did not know was that Asian Americans do not accept diagnostic testing.  The Asian Americans use of alternative medicine I can agree may work in some cases but I hope they do not reject modern medicine practices when it really matters. I did enjoy learning about way finding in that module as well. I never really knew that there was a term for what all of those signs are used for but now that I do I can encourage my workplace to improve their signs and directions. That is one thing that even I can get confused with is the directive signs, in hospitals especially. I cannot imagine being someone who doesn't speak or read English trying to find my way through a hospital in America. 

Another fact I learned was that the U.S. Government created the term Hispanic in the 1970's. This was something very new for me because I thought it had come from their culture that they were called Hispanics. Diabetes was also covered in this module which is covered in every health care class I have taken in some way. Diabetes is such a prevalent problem in America, it is understandable that every health care class covers it in their own way so that everyone has a basic understanding of the disease and why prevention and proper care are so important.

The most eye opening thing I learned was that Caucasian or "white" included a much wider spectrum of people than I ever knew. To be perfectly honest I was very naive in a sense in thinking that "white" meant the white American population and the European population. Now I know that we include Middle Eastern and North African people in this classification. Within this module I also learned a little more about the Amish culture and Roma Americans. Both of these cultures do not like to use modern medicine unless it is absolutely necessary. I have seen a couple of those television shows that portrays Amish teenagers on Rumspringa or Gypsy weddings. I knew those shows were exaggerated for audience appeal, but I did not realize how they actually had some truth in the main concepts of the shows. The Gypsy wedding show definitely portrayed the women as being subordinate after the wedding. That is just part of their culture and their history, a tradition that is still followed today. 

Module 6 covered 2 groups of people that I had not even thought of as being cultures before this class. I have always been very accepting and respectful of people with disabilities or anyone in the LGBT community. I did discover some things that I will definitely be more aware of when I encounter either of these cultures in my work. For instance, pressure ulcer prevention is a big focus point at my work now, and now I know to watch out for people with mobility issues in general. They may be a perfectly functional quadriplegic, but they have a high risk of pressure ulcers and obesity. These secondary conditions can lead to a lot of other complications, not to mention unnecessary pain and discomfort. When it comes to the LGBT community I will try to remember to be aware of the words and terms I use when referring to the person. I will continue to be sensitive to their needs and keep an open door policy if they have any questions or concerns. 

In summary I can say that I have definitely learned a lot from this course. I feel more confident in my ability to provide excellent culturally competent care to my patients both now and in my future career as a diagnostic sonographer. I have actually talked to my nurse educator at Froedtert and she is going to be getting me signed up for the culture awareness continued education modules at work. Froedtert really does have an excellent education program with continued education given every month if not more often and they are giving me the opportunity to branch out from my required learning into other areas such as this that will give me the knowledge to become a better health care provider. I look forward to continuing my education and becoming a culturally competent health care provider for my patients. 

~Samantha Holzberger

LGBT Reflection

I feel that the sexual orientation and gender identity of patients should be included in Electronic Health Records. I view it as the same concept of health care provider knowing your allergies, if your sexually active, or what medications you are on. It is all relevant. Especially for the LGBT community. There are so many health risks associated with the LGBT community that could be prevented or properly treated in a timely manner to prevent further complications if their sexual orientation and gender identity were to be a general charting practice. The LGBT community would be able to get the right help with contraception, medication, or their mental health. I understand that many LGBT may be apprehensive about sharing this information with their health care providers for fear of judgement or ridicule but if we promote understanding and acceptance from our health providers I think it will be a great benefit to the LGBT community. 

Knowing the gender identity of your patients will ensure that you do not offend them by using the wrong gender pronouns when talking to them or about them to other health care staff. This will hopefully improve the trust and comfort level between the patient and their health care provider. Knowing the patient's sexual orientation would be beneficial for the prevention or detection of sexually transmitted infections or mental health concerns. With proper screenings the instances of sexually transmitted diseases could drastically decrease for future LGBT. The spread of HIV could also be prevented with proper screenings and patient education. This knowledge could also help with other everyday patient concerns such as contraception, family planning, aging, and other patient concerns.

Overall I think collecting this data will have so many benefits for every patient and health care provider.

 

~ Samantha Holzberger

Additional Resources

Additional Resource 1:
Apply cultural awareness to all workplace relationships

This educational website about cultural awareness in the workplace provides interactive learning tools that keep the user engaged in the learning material. There are 6 activities within the information given that give the reader an opportunity to practice their knowledge and discover how much they really know. It covers all aspects of other cultures like clothing, religion, and language. Although this website does not really go into depth about specific cultures, it is still very thorough. This website is also more of a generalized information site for any workplace. Despite this generalization, I think it would be very beneficial for anyone going into health care to utilize. The information given about how other cultures may be different from your own would be very helpful in nursing or any medical profession.
This website is a very reliable resource because it was made by the Department of Education and Training  of the State of New South Wales. It is an educational site that also provides an extensive list of other websites and textbooks to explore for further resources. It was also published fairly recently in 2008 so the information is still relevant in the workplace today.

Additional Resource 2:
Dynamics of Diversity

This website would be ideal for someone like myself going into health care. It is focused on cultural competency in nursing. This article gives great examples of how being culturally illiterate could end disastrously for either the patient or the health care personnel. The author also uses a great acronym for COMPETENCE ( Caring, Ongoing, Multidimensional, Proactive, Ethics, Trust, Education, Networking, Confidence, and Evaluation) to help remind us of the key elements for a culturally aware workplace. This article also does not go into great depths about every different culture but it does use quite a few in the scenarios given to demonstrate cultural differences in health care. I think the scenarios are a good way for the readers that work in health care to relate to the actual concept of cultural awareness. As someone who already started working in health care as a CNA I can relate to the situations the author gives.
This is a scholarly article which makes it a very reliable resource. The article was published by The National Student Nursing Association. The author is Marianne R. Jeffreys, EdD, RN. She is a professor at both the CUNY College of Staten Island and the City University of New York. Jeffreys has a list of 12 references included with her article as well.

~ Samantha

Interprofessional awareness and CLAS standards

There are many differences I found in the standards for my future profession and the CLAS standards. The ASRT standards for Sonography Practice Standards gives a complete list of the clinical and quality performance standards for sonographers. They are similar in the fact that they both have standards for making sure patients understand what is happening. For instance, the ASRT has a standards for patient education which state that sonographers must make sure that patients have consented and understand what they have consented to for a procedure. This standard also covers providing them with patient education and proper explanation of precautions when administering medications. 

In the same way the CLAS standards also cover patients understanding. This is also where they differ though. The CLAS standards includes many standards that relate to providing language assistance and providing understandable materials and signage to patients. The CLAS is much more detailed when it comes to cultural competency standards compared to the ASRT standards. I believe that sonographers must follow other health care standards like the CLAS standards in addition to the ASRT standards. The ASRT standards is more job title specific whereas the CLAS standards are for the general health care employee population. It could also be possible that more cultural competency standards are not present in the ASRT standards because this profession is primarily a diagnostic imaging role. There is less communication between a sonographer and the patient depending on the type of sonography being performed. This is less likely the case though. I believe there should be cultural competency throughout the entire health care system in order for patient care to improve for patients of all cultures. I have put a link to the Sonography standards below. 

~ Samantha Holzberger

ASRT Sonography Practice Standards

Personal Learning Goals

There are a number of things I know I can improve on when it comes to cultural competency.  The one that I feel is the most important for myself is becoming more aware that every person I interact with in health care and also just in general may come from a different culture or have different opinions or beliefs than my own. I think it's really going to take a lot of work and practice to be perceptive of each person I encounter. This is more of an internal personal goal I have for myself but one that I think will impact how I interact with people on a day to day basis.

Another goal I have for myself is more focused on this class. I am always looking for ways to improve my skills and learning specifically about other prominent cultures in our country will help me do this. I hope to learn more about the various cultures in our nation so that I can better tailor my health care to each individual. The challenge will be learning the information and then knowing when to apply it. I am a firm believer in being open with patients to find out exactly what kind of care they expect from you. I will happily go out of my way to make sure that each of my patients are happier with their experience than they expected. Most patients don't want to be in the hospital in the first place so I try to make it as comfortable an experience as possible. The content of this class I expect to help me better understand how different cultures approach health care. I have already seen the benefits of knowing about the Asian American cultures in my own work. We recently had an Asian American patient who was in the ICU who had a very large family. They were there for weeks, not just the immediate family, but aunts, uncles, cousins, and grandparents. There were always at least 20 people in the waiting room at the end of the hall for this one patient. He eventually came onto the floor but the family still stayed. They would sometimes alternate who was there to try to keep the room less crowded but the rest just waited patiently at the end of the hall. It was a really good insight into the way Asian American families are very family oriented and involved in each others lives.

The other goal of mine is to spread the knowledge I learn about other cultures. The best way to help patients is to keep the entire health care staff informed. I would like to become a part of that mission. I enjoy teaching people things to help them succeed and perform better in their career. In every job that I've held I always ended up in the training aspect of it. I actually ran the entire training program at my very first job by the time it was time for me to move on from that position. I enjoy working with people to make them better customer service providers. I look forward to getting involved in spreading culture competency awareness in the health care field. 

~ Samantha Holzberger

Provider's Guide to Quality and Culture Quiz

 To be honest I really didn't know the correct answer for a lot of the questions from the Provider's Guide to Quality and Culture quiz, so it doesn't really surprise me that I only got 11 questions right. I have to admit I felt some of the questions in this quiz were hard to understand what they were asking for. I generally dislike questions that ask which of these are NOT. But I tried my best and came out with a pretty bad score if I am to judge myself here. 

Now let me be clear. This score does not define me as prejudice or biased in my eyes. I know that I do have tendencies to judge people before I know them, but I like to think I do well at pushing those feelings aside so that I can see what kind of person they are with a clean slate. 

I will admit that this quiz did open up my eyes about how little I know of other cultures or heritages than my own. I have a lot to learn if I am going to be a fair and effective healthcare provider. For example I need to learn more about the Muslim religion. Admittedly I know very little about it, for instance I assumed that Muslim women would not make eye contact because they are taught to be submissive. Turns out the reason is that modesty is an important quality in Islamic tradition.

I also got the question "Which of the following is NOT true of an organization that values cultural competence" wrong. Now this one kind of bugs me that I did get it wrong. I picked the answer that healthcare organizations try to hire people with similar cultural backgrounds or heritage as the patients they provide care to. I know that it is true but I can't help but feel that this is a form of prejudice during hiring then. If they are only treating Hispanic people in a certain clinic, they will only hire Hispanics? It just doesn't seem fair to deny other people who are just as qualified for the job because they are not Hispanic. I understand the need for Spanish speaking employees in this situation but I do not think it necessary that every employee fit an exact mold. 

I am ready and willing to learn more about the many different cultures and religions within our US population so that I may be a better healthcare provider. I would like be a part of the improvement of our healthcare industry and being culturally competent myself will hopefully bring us one step closer to this goal.

~Samantha

Citations: 
http://erc.msh.org/mainpage.cfm?file=3.0.htm&module=provider&language=English , The Provider's Guide to Quality & Culture. Management Sciences for Health