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Back Next POPULATION SPECIFIC COMPETENCY East Tennessee Children’s Hospital Page 1 of 74 Back Page 2 of 80 Next This module contains: Instructions for completion of module Definition of Population Specific Competencies Review of pediatric age-group specific interventions ETCH population specific information Important resources you need to know Page 2 of 74 Back Page 3 of 80 Next Why? Population-specific staff competence is CRITICAL to providing a safe environment for our patients. Page 3 of 74 Back Page 4 of 80 Next What is it? Population-specific staff competence relates to possessing the knowledge, skills, ability and behaviors essential to providing care to a specific population. At Children’s Hospital the pediatric age groups served is a primary focus of our staff competency. However, it does not address the full spectrum of the population served. Page 4 of 74 Back Page 5 of 80 Next What is it? Beyond a patient’s age, their health care is also affected by their socio-cultural and geographical factors. Health care is also influenced by our living situation, family dynamics, diagnosis and acuity. Page 5 of 74 Back Page 6 of 80 Next ETCH Commitment As a pediatric healthcare facility, we are committed to providing age-specific care. Every element of our approach to healing – from the specially trained staff to the sophisticated equipment- is child and family centered. Page 6 of 74 Back Page 7 of 80 Next Children are NOT small adults Age-specific interventions are the skills you use to give care that meets each patient’s unique needs. Page 7 of 74 Back Page 8 of 80 Next Every patient is an individual with his or her own... Likes and dislikes Feelings Limitations and abilities Experiences Everyone grows and develops in a similar way or stages that are related to their age, BUT at their own pace. Page 8 of 74 Back Page 9 of 80 Next • Illness and hospitalization places stress on our patients and families. Some patients regress emotionally or mentally when they are ill/hospitalized • By following guidelines based on age/developmental characteristics, we can help reduce the stress of our patients and families. Page 9 of 74 Back Page 10 of 80 Next Strategies to enhance coping & Developmental Considerations: Newborns – pacifier, blanket, soothing sounds, touch, music, parental involvement when appropriate, stay in infant’s line of vision, place parents in infant’s line of vision, place familiar object with baby (stuffed animal, etc.), provide safe/secure environment, cuddle, hug after procedure, adequately hold during procedures. Page 10 of 74 Back Page 11 of 80 Next Strategies to enhance coping & Developmental Considerations: Toddlers – pacifier, blanket, favorite toy, holding a hand, party blowers, blowing bubbles, pop-up books, toys, mobiles, pre-post procedural play, play dough, emphasize being still, let them know “It’s okay to cry”, utilize Child Life for distraction (bubbles, musical toys, etc.), give toddlers one direction at a time, explain procedure in relation to what child sees, hears, etc. Use play by demonstrating on a doll or stuffed animal, provide consistency with daily routines. Use a firm and direct approach, involve child in procedure by allowing him/her to play with equipment when appropriate, allow toddlers a choice when possible. Page 11 of 74 Back Page 12 of 80 Next Strategies to enhance coping & Developmental Considerations Preschoolers – Party blowers, blowing bubbles, counting, pop-up books, holding a hand, manipulative toys, computer games, listening to music, singing songs, pre-post procedural play, play dough, explain in simple terms, demonstrate procedure, allow to play with equipment/dolls, encourage child to talk; let them ask questions to clarify, tell them “this is not punishment”“you haven’t done anything wrong”, enjoy games/rewards/praise. Page 12 of 74 Back Page 13 of 80 Next Strategies to enhance coping & Developmental Considerations School Age – deep breathing exercises, music, hand-held games, computer games, imagery/fantasy, pretending to be in a favorite place or doing a favorite thing, pre-post procedural play, squeezing nerf balls, explain using correct terms, explain reasons – use simple diagrams, allow to ask questions, prepare in advance, tell what is expected, suggest breathing, counting, etc., include in decision (where to get injection etc.), encourage participation, provide privacy. Page 13 of 74 Back Page 14 of 80 Next Strategies to enhance coping & Developmental Considerations Adolescents - deep breathing exercises, music (head sets are popular), computer games, imagery/fantasy, imagine a favorite activity, squeezing a nerf ball, hand-held games, explain and give reasons, encourage questions, provide privacy, discuss “after effects”scars, etc., involve in decision making and planning, accept regression and resentment of authority, allow peer involvement Page 14 of 74 Back Page 15 of 80 Next Age-Specific Approaches to Physical Examination Developmental Indicators Positioning Sequence Prep Infant (0-1) Stranger anxiety begins at 7 mo. Peaks at 9 mo. Resists being restrained. Responds to simple commands by age 9mo. Separation anxiety peaks at 13 mo. Supine or prone, before 4 to 6 months, can be placed on exam table. After 6 mos. Sits alone, uses this position whenever possible in parent’s lap, if on table place with parent in full view. If quiet, ascultate heart, lungs, abdomen. Palpate and perscuss same areas. Proceed in usual head-toe direction. Perform traumatic procedure last (eyes, ears, mouth [while crying], rectal temperature [if taken]). Elicit reflexes as body part examined, elicit generalized primitive reflexes last. Completely undress if room temperature permits. Leave diaper in place. Gain cooperation with distraction, bright objects, rattles, talking. Smile at infant; use soft high pitched voice. Pacify with pacifier or sugar water or feeding. Enlist patent’s aid for restraining to examine ears, mouth. Avoid abrupt, jerky movements. Toddler Autonomy important. Egocentric stranger anxiety decreases at 18 mo. Speech begins. Negativism present. Knows several external body parts. Separation anxiety decreases at 2y. Sitting on or standing by parent. Prone or supine in parent’s lap. Inspect body areas through play: “count fingers”, “tickle toes”. Minimize physical contact initially. Introduce equipment slowly. Auscultate, percuss, palpate whenever quiet. Perform traumatic procedures last (same as for infant). Have parent remove outer clothing. Remove underwear as body part examined. Allow to inspect equipment., demonstrate use of equipment usually effective. If uncooperative, perform procedures quickly. Use restraint when appropriate; request parent’s assistance. Talk about exam if cooperative; use short phrases. Praise cooperative behavior Age (1-3) Page 15 of 74 Back Page 16 of 80 Next Age-Specific Approaches to Physical Examination Developmental Indicators Positioning Preschool Child (3-5) Likes to “help”. More cooperative, follows simple instructions. Knows most external body parts, 3-5 internal parts. Fears bodily harm School Aged Chld (5-12) Adolescent (12-18) Age Sequence Prep Prefer standing or sitting. Usually cooperative. Prefer parent’s closeness. If cooperative proceed in head to toe direction. If uncooperative, proceed as toddler. Request self-undressing. Allow to wear underpants if shy. Offer equipment for inspection, briefly demonstrate use. Make up story about procedures. Use paper doll technique. Give choices when possible. Expect cooperation; use positive statements. Industrious. Cause and effect develops. Increasing self control. Understands simple scientific explanations. Knows 5-10 internal body parts. Prefers sitting. Cooperative in most positions. Younger age prefers parent’s presence. Older age may prefer privacy. Proceed in head to toe direction. Examine genitalia last. Request self-undressing. Allow to wear underpants. Give gown to wear. Explain purpose of equipment and significance of procedure. Teach about body functioning and care. Increasing independence. Separates readily from parents. Future oriented. Knows basic anatomy and physiology. Generally prefer privacy. Offer option of parent’s presence. Proceed in head to toe direction. Examine genitalia last. Allow to undress in private. Give gown. Expose only area to be examined. Explain findings during exam. Matter of factly comment about sexual development. Emphasize normalcy of development Page 16 of 74 Back Page 17 of 80 Next Additional resources The following videos are available through the Education department-541-8618 or [email protected] for more review on Agespecific Competencies. 1. Pediatric Physical Assessment – 3 tape series Infants and Toddlers Preschool and School Age The Adolescent 2. Growth and Development – Whaley and Wong Page 17 of 74 Back Page 18 of 80 Next Appreciating Cultural Differences Are you culturally competent? Page 18 of 74 Back Page 19 of 80 Next This section will help you to: Consider the uniqueness of all your patients and recognize cultural differences. Understand what skills are necessary to respect a patient while giving care. Ensure appropriate communication and confidentiality for all of your patients. Identify resources you can use for developing these skills. Page 19 of 74 Back Page 20 of 80 Next Imagine yourself Waking in a hospital bed, in a strange room with other patients near by… Seeing unfamiliar faces and realizing they all speak a different language than you… Having people talk to you and about you with no idea what is being said… Seeing looks, smiles, frowns, gestures that you think might be related to you, but you are uncertain… Having people approach and touch you without a means to explain… Being injected, or washed, or any other private or invasive procedure without being able to ask questions or state your preferences or limitations… Hearing discharge instructions and teaching in a foreign language while someone points to a paper for you to sign… Hearing medical advice contrary to your deep religious beliefs… Not having enough money for medical care or food… Page 20 of 74 Back Page 21 of 80 Next If the shoe were on the other foot… Would you feel respected? Would you consider that being treated in a dignified manner? Would you trust your caretakers? How would you know what was wrong and how to get better? Would you feel as though you had rights? Page 21 of 74 Back Page 22 of 80 Next Culture… defined: The values, beliefs, norms and practices of a particular group that are learned and shared and that guide thinking, decisions and actions in a patterned way Source: Dynamics of Diversity, Pollar & Gonzalez Page 22 of 74 Back Page 23 of 80 Next Diversity… defined: The Diversity Coalition defines diversity as encompassing the following categories: ability & disability, age, color, ethnicity, religion, gender, job category, class status, national origin, race and sexual orientation Source: http://www.diversitycoalition.org/general_diversity_resources Page 23 of 74 Back Page 24 of 80 Next Important Terms to know to be “culturally diverse”: Environmental Control refers to perceptions that a person has about the ability to direct factors in the environment and the systems and processes that are part of it. Health behaviors and disease patterns differ with cultural groups. Page 24 of 74 Back Page 25 of 80 Next How do I become “Culturally Competent?” It is impossible to memorize all the specific information about every culture. However, many resources exist at Children’s Hospital to help you. Know what they are and how to use them: Cultural Care Guides and books – they provide information about various groups and give practical and immediately useful advice Interpretive Services – know how to access and use both live and telephone services (see CBL “Interpretive Services”) Language Services – printed materials, visual aids The Pediatric Medical Library Social Work and Pastoral Care Departments HIPAA Guidelines – each institution has specific guidelines that ensure confidentiality for patients’ health information. All employees, students, and volunteers are responsible for following these guidelines, which state that confidentiality can be maintained by only sharing MINIMUM information necessary. Outside Resources – accessed through Social Work Page 25 of 74 Back Page 26 of 80 Next Some Basic Tips for Overcoming Initial Cultural or Communication Barriers Greet patients with their names – avoid being too casual or familiar Introduce yourself by pointing to yourself and saying your name Note and observe any hesitations or special requests (ie, no male caregivers for a female patient) Determine understanding by hearing person repeat or demonstrate instructions Do not talk to other staff in patient’s area using a language he/she will not understand Do not make assumptions about eye contact, space, gender issues or any other cultural factor based on your opinions. Seek understanding and resources! Page 26 of 74 Back Page 27 of 80 Next Tips for Overcoming Initial Cultural or Communication Barriers Pay special attention to any efforts made by the patient or family to communicate Use an available resource to get a “quick glimpse” into the patient’s culture or language Use available visual aids If language barrier exists that prevents this communication, seek interpretive services – continual attempts will only fail and add to frustration Maintain confidentiality by using “minimum necessary information” even with interpreter Continue to provide nonjudgmental care! Page 27 of 74 Back Page 28 of 80 Next Are there other Barriers? Religious preferences/differences can be a barrier. Socio economic status as well as educational level can be a barrier. Differences in family structure, function, and composition are common barriers. Page 28 of 74 Back Page 29 of 80 Next Know about Family-Centered Care This is part of the special care we provide to children. Our interventions are structured around the entire family unit – with the patient as the center We must respect the various styles, abilities, resources, communication patterns and values that all families exhibit differently. Our goal is to Individualize patient care to best support the family structure – without prejudice or judgment on our part. Page 29 of 74 Back Page 30 of 80 Next R-E-S-P-E-C-T Find out what it means to YOU! Know yourself – your own attitudes, beliefs, and even prejudices… Keep an open mind… Acknowledge and celebrate differences – all cultures and groups have strengths and weaknesses… IT STARTS WITH YOU Page 30 of 74 Back Page 31 of 80 Next No Two People are Created Alike What are some key cultural differences to think about? – Communication – language, patterns, gestures and facial expressions, decision-making – Personal Space – how close is too close? – Social Organization – how a group mourns, celebrates, learns, lives, etc. – Time – past, present, or future orientation – Environmental Control – nature versus nurture Page 31 of 74 Back Page 32 of 80 Next Important Terms to know to be “culturally diverse”: Communication and culture are intertwined. Written and oral language, gestures, facial expressions, and body language are the means by which culture is transmitted and preserved. Patterns are developed early and affect an individual’s entire life. Healthcare providers should recognize common cultural patterns, but not assume that all members of a cultural group use the same means of expression. Page 32 of 74 Back Page 33 of 80 Next Important Terms to know to be “culturally diverse”: Personal Space – is the area surrounding a person’s body. It includes the space and objects within that designated area. This differs with culture and is important to know and respect when providing physical care. Page 33 of 74 Back Page 34 of 80 Next Important Terms to know to be “culturally diverse”: Social Organization takes into account patterns of behavior that people of various cultures may exhibit during such life events as birth, puberty, childbearing, illness, disease, and death. Healthcare workers need to understand the profound impact this can have. Beliefs, values, and attitudes related to these events result in traditions and rituals that follow an individual through life. Page 34 of 74 Back Page 35 of 80 Next Important Terms to know to be “culturally diverse”: Time –Time can be perceived as concrete or abstract. Cultural groups may be differentiated according to whether their time orientation or behavior is related primarily to the past, the present, or the future. Page 35 of 74 Back Page 36 of 80 Next Examples of Health Care Related Diversity Southern African Americans – health is considered a gift from God and illness retribution for sin. Chinese believe that health is based on the balance of female energy (yin) and male energy (yang.) Disharmony between the two is thought to disturb the body’s functioning. Mexican patients may believe in “hot” and “cold” forces that may be thrown out of balance in illness. In many Western cultures, calling an elderly person by his first name is considered rude. (Ask a patient how he wishes to be addressed.) Page 36 of 74 Back Page 37 of 80 Next Examples of Health Care Related Diversity Some families especially in rural Appalachian areas, may be challenged for basic necessities such as heat, water, and food. Native Americans or Southeast Asians may view expressions of caring, such as hugging, as intrusions of personal space. They may view it as discourteous to make direct eye contact or to stand too close. Thais or Filipinos may nod their head in a “yes” manner, but it does not necessarily mean they understand. People in these cultural groups VALUE preserving harmonious relationships and avoiding confrontation. They may nod to avoid offending or embarrassing anyone. Page 37 of 74 Back Page 38 of 80 Next Examples of Health Care Related Diversity Jehovah’s Witnesses do not accept blood transfusions and refuse to eat foods that contain blood. Muslim and Hindu patients may also follow religious dietary restrictions. Muslims pray five times a day and must face east when doing so Strictly observant Jews may obey dietary laws, that prevent the mixing of milk and meat, and forbid pork or shellfish. Page 38 of 74 Back Page 39 of 80 Next Your Responsibility… Offer culturally competent care Respect differences Maintain confidentiality Know and use your resources Ensure patient appropriate communication Page 39 of 74 Back Page 40 of 80 Next More about our ETCH Child & Family Population Page 40 of 74 Back Page 41 of 74 Next Page 41 of 80 Demographic Changes in Tennessee 7000000 6000000 5000000 Non-Latino Population 4000000 3000000 Latino Population 2000000 1000000 0 1990 2000 2008 2010 Back Page 42 of 80 Next Child Population Projection 2000 Population 2010 Projection Age Group Tennessee Latino Total Percent Tennessee of Total Total Latino Percent 0-9 Years 770,693 24,563 3.2% 822,557 45,087 5.5% 10-19 Years 790,339 20,349 2.6% 845,487 37,526 4.4% of Total Page 42 of 74 Back Page 43 of 80 Next Patient Population at ETCH 2003 Total 134,119 Latino 1,736 2004 Total 131,554 Latino 1,967 2005 Total 137,316 Latino 2,516 2006 Total 137,635 Latino 3,378 2007 Total 143,077 Latino 3,964 228% Increase in Spanish speaking population since 2003 Page 43 of 74 Back Page 44 of 80 Next IMPORTANT INFORMATION ABOUT OUR ETCH LATINO FAMILIES It is important to understand the family roles, family dynamics, and the role faith plays within our Latino families. Page 44 of 74 Back Page 45 of 80 Next FAMILY DYNAMICS Understanding “La familia” – We must understand roles and relationships within the Latino family to help foster positive communication, patient/family cooperation and interaction with ETCH staff. This understanding will also assist compliance with treatment or treatment outcomes. The importance of extended family – Latino families believe it is valuable to have extended family support and presence during times of crisis. Page 45 of 74 Back Page 46 of 80 Next GENDER ROLES Mother’s Role Determines when a family member is ill and needs care “The Nurturer” Father’s Role Holds the greatest power in the majority of Hispanic families and gives the permission to seek treatment. “The Decision Maker” Page 46 of 74 Back Page 47 of 80 Next FAITH, RELIGION AND TRADITION Faith and the Church are powerful sources of hope and strength for many Hispanic families. – This may also impact how they interpret and accept our help Roles of faith, religion, and tradition in healthcare – Religious beliefs of a family may require practices that are unfamiliar to ETCH staff. We must respect the families need to uphold their belief while continuing to provide the best possible care for our patients. – There are many traditional religious home “treatments” that can impact patient outcomes Page 47 of 74 Back Page 48 of 80 Next COMMUNICATION AND RESPECT Verbal and Nonverbal Communication – REFRAIN from hand gestures. Different hand gestures can have different meanings across cultures. – Please make eye-contact. – Head nodding could mean respect for authority not necessarily understanding. Touch, Hugging – Should be done only after establishing a relationship with a family. Authority – Encourage questions. Healthcare workers are considered authority and asking questions could be viewed as disrespectful. Doctor/Patient Relationship – Needs to be based upon mutual respect. – Once established will lead to better treatment outcomes. Page 48 of 74 Back Page 49 of 80 Next CAUSES AND HOW ILLNESS IS PERCEIVED Opposite Concepts Collide – (Hot and Cold) For example, a culture could treat fever with blankets to sweat it out, whereas our treatment is to remove layers to cool the body. “Mal de Ojo”- Strictly interpreted as “the evil eye” – Be very careful how we look at patients. Can be interpreted as looking down upon. Make other contact as well by talking or interacting. Safety – Patients and families may use bracelets or beads as protection against the “Mal de Ojo” (Evil Eye). Page 49 of 74 Back Page 50 of 80 Next APPROACHES TO TREATMENT Can vary from culture to culture Page 50 of 74 Back Page 51 of 80 Next DIET AND ALTERNATIVE REMEDIES What have they been using at home or here as their treatment of choice? Herbs Vitamins Fruits Spices Teas Plants Prayer These are services often depended upon and may be consulted after leaving ETCH Healers Herbalists Midwives Massage Therapists Priests Page 51 of 74 Back Page 52 of 80 Next EXPLAINING TREATMENT AND AVOIDING MISUNDERSTANDING Filtering Information to families – When explaining treatments/medications, be extra careful to help families understand what is happening and what to expect. – Some families’ inability to read and write requires special labeling and instructions for at-home treatment. Reactions of families with misunderstood expectations – Compliance to discharge instructions is not certain. Sometimes families will go back to home remedies initially or misunderstand treatment side effects as ineffective treatment. Impact on the Family System when a misunderstanding occurs – Can breakdown established trust with healthcare staff when treatment is unclear to the family and their expectations are not being met. Page 52 of 74 Back Page 53 of 80 Next BRIDGING THE GAP Interpreters, Translators, Advocates, and Resources For complete information regarding access to Interpretive Services, all staff must complete the Interpretive Services NetL CBL. Page 53 of 74 Back Page 54 of 80 Next IMPERFECT SCIENCE Interpretations and translations are not always simple or clear cut. Religion, diet, family structure all play a part in our interactions. We have to bridge the gap between us as a hospital and healthcare providers and the Latino community we serve. Page 54 of 74 Back Page 55 of 80 Next OTHER POPULATION-SPECIFIC CONSIDERATIONS APPALACHIAN HERITAGE IMPORTANT BELIEFS AFFECTING HEALTHCARE… Self-reliance activities and nature predominate over people, many believe that it is best to let nature heal Bureaucratic forms foster fear and suspicion of health-care providers June 2008 55 Page 55 of 74 Back Page 56 of 80 Next OTHER POPULATION-SPECIFIC… APPALACHIAN HERITAGE For many, pain is something that is to be endured and accepted stoically it is important for health-care providers to approach individuals in an unhurried manner Slow pace is better received June 2008 Page 56 of 74 Back Page 57 of 80 Next OTHER POPULATION SPECIFIC CONSIDERATIONS.. Patients and families with Low Health Literacy Page 57 of 74 Back Page 58 of 80 Next HEALTH LITERACY “The ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Healthy People 2010 Prevalence across 85 medical studies – 26% low health literacy – 20% marginal health literacy Paasche-Orlow et al. (2005). J Gen Intern Med. Page 58 of 74 Back Page 59 of 80 Next 19 000 US adults; 16 years; residing in households or prisons Proficient Intermediate Basic Below Basic can perform complex and challenging literacy tasks can perform moderately challenging literacy tasks can perform simple everyday literacy tasks cannot perform basic tasks Page 59 of 74 Back Next Page 60 of 80 HOW DO TENNESSEE ADULTS COMPARE? Kingsport C larksville 155 M ississip p i Rive r 40 N ashville TENN ESSEE 65 M em phis C um b e rla nd Rive r Te nne sse e Rive r 24 75 40 Te nne sse e Rive r No rris La ke Knoxville 81 40 75 Chattanooga 54%* of adults function at Below Basic or Basic Page 60 of 74 Back Page 61 of 80 Next LOW HEALTH LITERACY=PROBLEMS WITH Pill bottles Appointment slips Informed consents Discharge instructions Patient/health education materials Insurance applications Medication Take as directed Dr. Literate Page 61 of 74 Page 62 of 74 Back Next Page 62 of 80 PROPER USE OF ASTHMA INHALER 3.5 3 2.5 Correct Steps 2 of 6 1.5 1 0.5 0 Low Adequate Health Literacy Skills Williams et al. (1998). Chest. Back Next Page 63 of 80 MOTHERS WITH LOW LITERACY Less knowledge about adverse effects of Arnold et al. (2001). Prev Med. smoking Less breast-feeding Kaufman et al. (2001). South Med J. Less able to read a thermometer Fredrickson et al. (1995). Kan Med. Page 63 of 74 Back Page 64 of 80 Next COMMON MEDICAL WORDS Common medical words that patients with limited literacy may not understand: Blood in the stool Bowel Colon Growth Lesion Polyp Rectum Screening Tumor Davis et al. (2002). Cancer Invest. Page 64 of 74 Back Page 65 of 80 Next EDUCATIONAL ATTAINMENT AND READING LEVEL Years of formal schooling tells us what people have been exposed to, NOT what skills they have acquired.” (Doak, Doak, & Root, 1996) Most American adults read 3-5 grade levels lower than the highest grade level of schooling completed. – Average reading level in US=6-8th grade Davis et al. (1996). Pediatrics.; Meade et al. (1994). Am J Pub Health. Page 65 of 74 Back Page 66 of 80 Next “AT RISK” GROUPS Elderly Minority Recent immigrants Non-English speakers Low-income School drop-outs Page 66 of 74 Back Page 67 of 80 Next POSSIBLE INDICATORS OF LOW HEALTH LITERACY Seek help only when illness is advanced. Have difficulty explaining medical concerns. Excuses: “I forgot my glasses.” Lack of follow-through with tests/appointments. Seldom or never have any questions. Identifies drugs by pill color and shape rather than by name. Does not know purpose of each medication. Page 67 of 74 Back Page 68 of 80 Next HEALTH LITERACY SCREENING ITEMS FOR PARENTS 3 items combined associated with 6th grade parental reading level: –<12th grade completion –nnot living with child’s other parent –Nnot reading for pleasure 2 items independently associated with adequate parent health literacy: >10 adults’ books in the home >10 children’s books in the home Bennett et al. (2004). Fam Med. Sanders et al. (2004). Ambul Pedriatr. Page 68 of 74 Back Page 69 of 80 Next STRATEGIES TO IMPROVE COMMUNICATION Limit information (3-5 key points) Use living room language Be specific and concrete, not general Demonstrate, draw pictures, use models Use a “Teach Back” or “Show Me” approach (confirm understanding) Be positive, respectful, caring, sensitive, empowering Page 69 of 74 Back Page 70 of 80 Next IN SUMMARY We are all advocates and professional allies and our goal is to treat the patient and help him or her achieve better health. Page 70 of 74 Back Page 71 of 80 Next IN SUMMARY Patient needs to trust you and believe what you are telling them is true. Patient needs to understand you. There MUST be mutual respect among the healthcare provider, the interpreter, and the patient. Towards all patients, we ALWAYS remain neutral and NEVER judgmental. Page 71 of 74 Back Page 72 of 80 Next IN SUMMARY Generalization is a beginning point and a stereotype is an ending point. Focus on similarities rather than pointing out differences. Do not allow cultural assumptions or prejudices to interfere with treatment. Page 72 of 74 Back Page 73 of 80 Next "Because Children are Special...they deserve the best possible health care given in a positive, child/family centered atmosphere of friendliness, cooperation, and support regardless of race, religion, or ability to pay." At ETCH, providing Population Specific Competent Care is essential to our vision of… “Leading The Way To Healthy Children”. Page 73 of 74