Unit 6Communication in the Health Care

Setting

Chapter 15The Patient as an Individual

Patients as Individuals

• Patient well-being affected by attitude, expressed concern, and technical skills

• Individuals are complex– Cultural influences, personal experiences, and

basic human needs all play role

Philosophy of Individual Worth

• Every human being has worth• Give same level of care regardless of

patients’ circumstances– Some patients present unique challenges

• More difficult than others• Experiencing pain and anxiety

Dealing with Prejudice

• Prejudice– Negative feelings about people due to race,

cultural background, appearance, etc.– Prevents seeing people as unique individuals– Must identify own prejudices to deal with them– However, encourage positive health changes

when necessary

Question

• True or False:– Almost everyone has prejudices of some type.

Answer

• True• Although possibly unaware of them, almost

all people have prejudices

Meaning of Culture

• Culture includes the following:– Values and beliefs– Social organization– Family structure– Language– Religion– Everyday activities

Purpose of Culture

• Provides guidelines for behavior• Gives life predictability• Provides means for people to live together

in relative harmony

Cultural Differences

• Customs vary among cultures– Differences can cause misunderstandings

• Approaches:– Appreciate different approaches to life– Learn about other cultures

• Especially those of likely future patients

Cultural Differences

• Approaches:– Avoid assuming patients will always

understand you– Remember that members of cultural groups

may or may not practice certain customs

Cultural Differences

• Approaches:– Be sensitive to possible cultural differences

and patient needs– Ask appropriate questions to learn about

patients– Recognize there are many cultural sub-groups

Dominant Culture

• Generally accepted foundational beliefs of society or country

• Examples of U.S. culture:– Importance of efficiency and punctuality– Shaking hands when meeting new people

Subcultures

• Many subcultures exist in U.S.– Individuals may have customs different from

dominant culture• But never make assumptions about people based

on appearance– Personal space

• Comfortable distance for conversation• Varies among cultural groups

Question

• Comfortable personal space in the dominant culture of the U.S. is about ____ .A. 6 inchesB. 12 inchesC. 18 inches

Answer

• C. 18 inches• Comfortable personal space considered

appropriate by dominant culture of U.S.:– Approximately 18 inches

Question

• True or False:– A new female patient arrives at Dr. Hendrick’s

office wearing a long dress and a head covering. It is safe for the medical assistant to assume the patient is Muslim.

Answer

• False• Never safe to assume anything about

patient’s culture based on appearance

Major U.S. Cultural Groups

• African Americans• Asian Americans• European Americans• Hispanic Americans• Native Americans

Question

• Which of the following immigrant groups tends to retain their native language and customs?A. Young people looking for better economic

opportunitiesB. Older adults escaping persecutionC. Professionals who have skills in the U.S.

Answer

• B. Older adults escaping persecution• Older adults who feel forced to leave native

countries tend to retain customs more than younger people

Question

• True or False:– Direct eye contact is a sign of sincerity for most

cultural groups.

Answer

• False• Eye contact

– Sign of sincerity in dominant U.S. culture• However, many groups view as rude or aggressive

Health Care Beliefs

• Vary widely among cultural groups• Differences include the following:

– Definitions of good health– Causes of disease– Methods of treatment

Health Care Beliefs

• Traditional Western medicine– Practiced by most U.S. physicians– Focused on physical aspects of body– Employs scientific methods

Religion and Health Care

• Religious and spiritual beliefs influence many health care practices– Shamans– Faith healing– Illness as will of God or punishment for sins– Prayer– Evil eye

Harmony and Health

• Balance of body, mind, and spirit• Growing interest in U.S.• Basic belief of many cultures

– Chinese concept of yin and yang

Harmony and Health

• Body humor theory– Traditional Hispanic belief– Four fluids control body– Hot and cold disorders and treatments

Question

• True or False:– T’ai chi is a form of acupuncture that originated

in China and is becoming accepted in the U.S.

Answer

• False• T’ai chi

– Form of Chinese martial arts– Involves focusing mind and performing slow

body movements

Herbs and Plant Medicines

• Used for thousands of years• Many used today• Growing interest in U.S. in “natural”

remedies– Not controlled by Food and Drug

Administration (FDA)– Can be harmful

Maslow’s Hierarchy of Human Needs

• Developed by American psychologist Abraham Maslow

• Human behavior motivated by efforts to meet needs

• Five categories of needs ranked in order of importance for human fulfillment

Maslow’s Hierarchy of Human Needs

• Level 1: physiological– Food, shelter, and water

• Level 2: safety and security– Free from physical and psychological harm

• Level 3: love and affection– Friendships and intimacy

Maslow’s Hierarchy of Human Needs

• Level 4: self-esteem– Opinion individual has of self

• Level 5: self-actualization– Achievement of full personal potential

Question

• True or False:– It is necessary to fully meet each need on

Maslow’s hierarchy before moving up to the next level.

Answer

• False• Life is dynamic process

– Not necessary to fully meet need category before moving to next level

Maslow’s Hierarchy of Human Needs

• Illness and injury alter human needs• Full recovery may involve moving up

hierarchy• Role of health care professionals:

– Recognize patients’ needs– Help patients meet needs at each level

Defense Mechanisms

• Responses to perceived threats to self-esteem– Provide relief from mental discomfort and

anxiety– Commonly used at times of stress

• E.g., illness, injury

Defense Mechanisms

• Compensation– Meet need through substitution

• Control– Use inappropriate control to make up for loss of

control elsewhere• Denial

– Pretend something is not true

Defense Mechanisms

• Displacement– Transfer feelings about one person to another

• Acting out– Express difficult feelings by performing extreme

behavior• Malingering

– Pretend to be ill

Defense Mechanisms

• Projection– See own weaknesses in others

• Rationalization– Explain behavior with socially acceptable

reason• Regression

– Use inappropriate behavior for age

Defense Mechanisms

• Repression– Keep unpleasant memories out of awareness

• Withdrawal– Refuse to communicate with others or

participate in social activities

Question

• If the health care professional suspects a patient is displaying a defense mechanism to deal with fear, it is best to _____ .A. Show interest in patient’s well-beingB. Tell the patient not to worryC. Ignore the patient’s behavior

Answer

• A. Show interest in the patient’s well-being– Demonstrate acceptance of patient’s feelings,

listen, provide information as needed

Dealing with Loss

• Losses include:– Death of loved one– Independence– Physical ability– Good health

• Loss can significantly influence patient behavior

Dealing with Loss

• Health care professionals can help patients deal with loss– Recognize significance to individuals– Give patients opportunity to share feelings– Help patients explore ways to deal with loss

Ways Individuals Deal with Loss

• Seek support from family and friends• Find comfort in religion• Draw on self-esteem• Employ problem-solving techniques• Use defense mechanisms• Become angry or depressed

Individual Needs

• Effectiveness of health care worker dependent on– Understanding and respecting individual

differences• Patients have different perceptions of health

care setting

Determining Individual Needs

• Observe patient’s behavior and ways of interacting with others

• Determine whether language barriers present

• Ask questions to learn individual preferences

Determining Individual Needs

• Listen carefully to patient’s responses• Some patients need more information than

others– Explain what is being done and why

Question

• True or False:– It is appropriate to ask patients directly about

their health care beliefs.

Answer

• True• Appropriate to ask patients questions about

health care beliefs– Should be done in inquiring manner

• Rather than judgmental