Ethnicity matters in the assessment and treatment of children’s pain. }, For many Filipinos, physicians are held in high esteem and are given extensive authority, so questioning the physician’s treatment decision or being asked to make a decision about one’s own health care is not expected. } { bidder: 'ix', params: { siteId: '195464', size: [160, 600] }}, { bidder: 'openx', params: { unit: '539971067', delDomain: 'idm-d.openx.net' }}, Taboo. The Giger and Davidhizar transcultural assessment model. Kline, M., & Huff, R. (2007). Racial/ethnic group differences in treatment decision-making and treatment received among older breast carcinoma patients. Narayan, M. (2010). { bidder: 'triplelift', params: { inventoryCode: 'Cambridge_Billboard' }}, var dfpSlots = {}; It is important to know about Mr. S’s expectations from traditional remedies. Fostering a trusting relationship between the health care provider and the patient and family is a critical component in the planning process which requires discussing the patient’s values, preferences, and options with the health care provider (Braun, et al., 2010). In addition, some families will hold evening prayers with family and friends gathering together for support as they all go through the journey with the patient. Some Filipinos may seek medicinal healing through the use of halaman (herbs) and an herbolaryo (witch doctor), if they believe that evil spirits entering the body caused the illness. Would I handle this differently in a similar situation? The far left side of the ruler is color coded blue, indicating “no pain,” and the far right side is color coded red, indicating “pain as bad as it could possibly be.”  The back of the ruler has a 100 millimeter scale that quantifies the pain intensity (Ramer, et al., 1999). Appreciating one another’s culture and embracing their differences. (2005). S. Hood (1998, 2001) argues that research- ers of … The designee can be a family member and more than one person can be designated, including a back-up person if the designee is not able to fulfill the role. }, tcData.listenerId); }); What are some key elements that should be included in Mr. S’ treatment plan in anticipation of potential problems or concerns? What are the main problems your pain has caused you? Remember there is great diversity within a community. Shin, H., Kim, K., Kim, Y., Chee, W., & IM, E. (2008). The family continues to encourage Mr. W. to eat. S, how bad is your pain? type: "cookie", Click on the arrows to change the translation direction. These lower rates are due to a lack of knowledge and understanding by the patient and family about the advance directive; a distrust in the American health care system and concern that the person’s wishes won’t be carried out; fear of death; and cultural differences regarding the need for an advance directive, which relate back to “death is a taboo subject” (Campinha-Bacote, 2009; Giger, et al., 2006; Searight & Gafford, 2005a). How could an understanding of the cultural beliefs assist the hospital staff in providing effective end-of-life care? Culutral competency and divertiy among hospice palliative care volunteers. Gathering of information is conducted through asking the patient and family specific questions and also through observations of the patient, including family behavior patterns. The discussion should be done in private. Medical Care Research and Review, 58, 234-248. For some cultures, hospice and palliative care’s focus on comfort, harmony, family and support fits nicely with the culture’s values and beliefs. dfpSlots['topslot_b'] = googletag.defineSlot('/23202586/cdo_topslot', [[728, 90]], 'ad_topslot_b').defineSizeMapping(mapping_topslot_b).setTargeting('sri', '0').setTargeting('vp', 'top').setTargeting('hp', 'center').addService(googletag.pubads()); (2012). var pbTabletSlots = [ } Journal of Palliative Medicine, 8(5), 1016-1024. Encouraging the patient to review and value his or her life experiences and complete unfinished business may enable the patient to work on advance directive planning. Upon further discussions with the family it was revealed that the patient’s “heart pain” was referring to his health and how painful it was to him and his family to see him so ill, as well as worrying about his family and the burden his illness placed on them. He does not complain of pain, but his wife says that his back hurts. cmpApi: 'iab', 'cap': true The advance directive becomes a legal document once the individual signs it and it is signed in front of the two required witnesses. bids: [{ bidder: 'rubicon', params: { accountId: '17282', siteId: '162036', zoneId: '776140', position: 'atf' }}, bids: [{ bidder: 'rubicon', params: { accountId: '17282', siteId: '162036', zoneId: '776140', position: 'atf' }}, pbjsCfg.consentManagement = { Vol. (1992). The nurse or physician can perform the pain assessment, which should then be documented in the patient’s treatment plan. How does it work?”, Mr. S:  “It make me very sick. Without trust there cannot be an effective relationship, which increases health disparities (Campinha-Bacote, 2011; Huff & Kline, 2007b; Kachingwe & Huff, 2007; Leininger, 1999; Schim & Doorenbos, 2010; Tervalon & Murray-Garcia, 1998). I cannot walk. She was having increased difficulty in breathing, which is scary to her; She did not want to be a burden and did not feel it was her place to express  her concerns to her son; Custom dictates that the house belongs to the son and his wife; therefore, Mrs. V felt she could not request changes to be made even for her health and safety; Her faith is important in helping her cope with her terminal illness; She felt like a guest in her son’s home, which made her feel uncomfortable. { bidder: 'ix', params: { siteId: '195453', size: [300, 250] }}, Influence of faith and spirituality. A national outline forum on ethnic differences in cancer pain experience. expires: 365 The questions may be varied and individualized depending on the patient’s problem or if the questions are being asked of the family members. 24-32). filterSettings: { { bidder: 'triplelift', params: { inventoryCode: 'Cambridge_HDX' }}, Journal of American Medical Association, 286(3001), 2993-. Shavers, V., Bakos, A., & Sheppard, V. (2010). In these two examples the patient and family were frustrated by not being able to effectively communicate their concerns, and the health care providers were frustrated by not being able to effectively manage the patient’s pain. Journal of General  Internal  Medicine, 17(1), 48-57. Death and Dying in Buddhism True Freedom. Social Science & Medicine, 70, 1756-1764. Leininger, M. (2002). Title 42: Public Health. Patients and families may be more open to the discussion about and acceptance of advance directive planning. Additionally, an assessment should be made of how acculturated a person and their family are, their language skills, and whether an interpreter is needed. name: "idl_env", HCP: “What does your pain do to you? } else if(window.isCCPAMode()) { Consistent and breakthrough pain in diverse advanced cancer patients: a longitudinal examination. "error": true, Western Journal of Nursing Research, 30(2), 181-196. Cancer 106(4), 957-965. Who, if anyone, in your family do you talk to about your pain? End-of-life care: improving quality of life at the end of life. What assessment and strategies are needed to improve communication between the health care providers and Mr. and Mrs. S? Humility is the key factor in this process. Ask the family if Mr. W has any religious or spiritual beliefs that he might rely on in helping him deal with a serious situation, such as his illness. Questions must be asked directly and specially about each symptom the patient may be experiencing. Patient resources, from http://www.wsma.org/patient_resources/advance-directives.cfm. A limited cultural awareness and sensitivity on the part of some of the health care providers added to the inadequate management of Mr. S’s pain and symptoms. Doorenbos, A., Lindhorst, T., Schim, S., Van Schaik, E., Demiris, G., Wechkin, H., & Curtis, J. Maori healers’ view on wellbeing: the importance of mind, body, spirit, family, and land. Politzer, R., Yoon, J., Hughes, R., Regan, J., & Gaston, M. (2001). The challenges can be influenced by a number of variables, such as the provider’s training and experience is this area, the provider’s comfort level in discussing the subject, and the availability of adequate time for having the discussion (Kamaka, 2010; Tait & Hodges, 2009). Who in your family is most concerned about your illness? googletag.pubads().setTargeting("cdo_pc", "dictionary"); if(window.isCCPAMode()) The influence of large corporate chains has changed the face of modern Chinese cities, as they try to emulate U.S. cities { bidder: 'criteo', params: { networkId: 7100, publisherSubId: 'cdo_mpuslot' }}, A family may expect information to be given to them first, so they can make the health care decisions (Countries and Their Cultures, 2012; Giger, et al., 2006; Klessig, 1992; Koenig & Gates-Williams, 1995). (2011). },{ Pain that is out of control may be more difficult to effectively manage. In M. V. Kline & R. M. Huff (Eds. { bidder: 'triplelift', params: { inventoryCode: 'Cambridge_MidArticle' }}, Collectivism’s core values can cause a treatment dilemma for the health care provider whose focus is on getting the patient involved in the treatment plan. International journal of Circumpolar Health, 70(3), 274-285. googletag.cmd.push(function() { iasLog("setting page_url: - https://dictionary.cambridge.org/example/english/cultural-relevance"); { bidder: 'appnexus', params: { placementId: '11654157' }}, Their work experience in the healthcare field varied between 2 … { bidder: 'sovrn', params: { tagid: '346698' }}, pbjsCfg = { Cross-cultural similarities and differences in attitudes about advance care planning. Patients and families from these cultures may consequently be more open to discussion about advance directives and hospice services. Searight, H., & Gafford, J. 'min': 8.50, These American core values may often be in conflict with the values of many ethnic and culturally diverse groups in the United States. Who helps you? Development of educational tools in collaboration with a targeted culture community can increase awareness of the value and usefulness of advance directive planning and end-of-life choices. name: "pubCommonId", { bidder: 'ix', params: { siteId: '195464', size: [300, 600] }}, A provider may be challenged further when the patient’s cultural norms differ from the health care provider’s, particularly around end-of-life care, which can impact the provision of quality end-of-life care. { bidder: 'ix', params: { siteId: '195465', size: [300, 250] }}, { bidder: 'onemobile', params: { dcn: '8a969411017171829a5c82bb4deb000b', pos: '8a9699e70178783c43f941643ca4022f' }}, National Guideline Clearinghouse. Non-verbal communication includes active listening with pauses between sentences, silence, and holding the patient’s hands. { bidder: 'appnexus', params: { placementId: '11654150' }}, I suffer much.”, HCP:  “Do you take anything for your pain that helps?”. It is also important to determine the patient’s preference for being present at the discussion. In order to provide culturally sensitive pain management, a patient’s pain must be considered within the context of the individual’s beliefs and values, as culture may influence the individual’s perception and response to pain, whether or not the patient will ask for pain medication, or whether the use of traditional healing practices take precedence over Western medical treatment (Dhingra, 2008; Im, et al., 2010; Mossey, 2011; Narayan, 2010; Shavers, et al., 2010). Collectivism. In M. Kline & R. Huff (Eds. WSMA, W. S. M. A. The completed advance directive form does not need to be notarized, but it is advisable. Cola nuts are regarded as important symbols of welcome and }, practice social work “in a manner that recognizes, affirms, and values the worth of individuals, families, communities, and protects and preserves the dignity of each” bids: [{ bidder: 'rubicon', params: { accountId: '17282', siteId: '162036', zoneId: '776156', position: 'atf' }}, bids: [{ bidder: 'rubicon', params: { accountId: '17282', siteId: '162050', zoneId: '776358', position: 'atf' }}, There are numerous cultural issues germane to end-of-life care. So, in order to heal the person’s spirit, the person must relearn the culture as part of a ritual health passage (Mark & Lyons, 2010). (2011). Xiao, H., Kwong, E., Pang, S., & Mok, E. (2011). Explain that as the body begins to shut down, it is difficult for the body to absorb and use the antibiotics or the extra fluids. Clarifying and acknowledging the differences and similarities in the practitioner’s perception of Mr. S’s pain and other symptoms can provide an understanding of Mr. S’ behavior and response to his pain and vomiting. General questions or fleeting questions are meaningless. Minimize the use of medical jargon to explain what is happening with Mr. W’s condition. For example, an assessment would ascertain how well Mr. and Mrs. S understood English and if interpreter services were needed to prevent misunderstandings with his treatment. { bidder: 'ix', params: { siteId: '195453', size: [320, 50] }}, Cultural knowledge is the process of developing an understanding of the differences and similarities between and within cultural groups. What do you call your pain? iasLog("__tcfapi removeEventListener", success); Additionally, underreporting of pain intensity by minority patients was a significant barrier to effective pain management (Dhingra, 2008; Mossey, 2011; Shavers, et al., 2010). On the other hand, the role of religion and spirituality can be considered a positive pain coping strategy, as seen in some studies of African-Americans, with the result of lowering pain scores, more positive pain and symptom attitudes, and greater acceptance of pain medication (Shavers, et al., 2010). In a telephone conversation with the sons, the sons agree to hospice services. (For more information on coining and other traditional Cambodian healing practices, see the Traditional Medical Practices section of the Cambodian Cultural Profile. { bidder: 'ix', params: { siteId: '195464', size: [160, 600] }}, { bidder: 'criteo', params: { networkId: 7100, publisherSubId: 'cdo_topslot' }}, Rockvile, MD. 'min': 3.05, Spanish speakers, for example, are relevant to all Hispanic students. Curtin and Goldstein (Curtin & Goldstein, 2010), who work with the Native Alaskan Yup’ik culture, effectively utilized the modified Wong-Baker FACES™ scale, known as the Northern Pain Scale, which depict Native Alaskan faces to improve  communication about pain with patients (Curtin & Goldstein, 2010; Ellis et al., 2011). addPrebidAdUnits(pbAdUnits); Hunter, M., & Cassey, J. name: "criteo" Journal of Transcultural Nursing, 10, 94-101. { bidder: 'triplelift', params: { inventoryCode: 'Cambridge_SR' }}, { bidder: 'openx', params: { unit: '539971066', delDomain: 'idm-d.openx.net' }}, She is very short of breath with minimal activity and uses oxygen. gdpr: { (2011). Custom dictates that the house belongs to the son and the elder parent has no say in making household changes. When discussing medical issues with the family, it is important to confirm their understanding of the situation. // FIXME: (temporary) - send ad requests only if PlusPopup is not shown Cultural attitudes of Vietnamese migrants on health issues. The daughter, who was her caregiver, was very frustrated with her mother for not sharing that she was in pain and that it took a long time before her mother’s pain was brought under control. Health care providers may assume that if the patient is not expressing pain, that pain does not exist, resulting in under treatment. The provider needs to determine if there are contraindications to their use with Western medicines. When the patient or family wants “everything possible done,” an exploration of what that means can provide a greater understanding of what’s behind the request. }, Le, Q., & Le, T. (2005). where is it now? { bidder: 'ix', params: { siteId: '195452', size: [336, 280] }}, Results. params: { 'max': 36, { bidder: 'sovrn', params: { tagid: '346698' }}, It is critical that the assessment by each discipline and the documentation of the assessment be coordinated and incorporated into the patient’s treatment plan to ensure continuity of care. Therefore for some individuals, asking for pain medication may be considered a sign of weakness. They have three young children. { bidder: 'ix', params: { siteId: '195452', size: [300, 250] }}, J Soc Work End Life Palliat Care, 6(3-4), 236-255. Although the hospice and palliative care movements have been instrumental in increasing awareness in end-of-life issues, many people are still not familiar with these services. if(refreshConfig.enabled == true) Examining the validity, reliability, and preference of three pediatric pain measurement tools in African-American children. dfpSlots['houseslot_b'] = googletag.defineSlot('/2863368/houseslot', [], 'ad_houseslot_b').defineSizeMapping(mapping_houseslot_b).setTargeting('sri', '0').setTargeting('vp', 'btm').setTargeting('hp', 'center').setCategoryExclusion('house').addService(googletag.pubads()); ga('set', 'dimension3', "combinationPage"); For cultures where dying at home is a valued norm, those values are congruent with hospice care. googletag.pubads().setTargeting("cdo_pt", "ex"); It is hard to get around and I don’t have the strength to do a lot of cooking. { bidder: 'ix', params: { siteId: '195465', size: [300, 250] }}, How severe is it? { bidder: 'criteo', params: { networkId: 7100, publisherSubId: 'cdo_topslot' }}, Clear explanations of natural written and spoken English. 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