HLST 4010 Chapter Notes - Chapter 3: Hiv, Aids, Pneumocystis Pneumonia
14 Oct 2020
School
Department
Course
Professor
Week 3 Reading- Dead Wrong!: Ortiz and Casey
September 24, 2020
2:16 PM
Jacqueline Ortiz, Donna Casey, “Dead Wrong! The Ethics of Culturally Competent
Care” MedSurg Nursing 26:4 (July/August 2017): 279-282. Available at York
University Library web site.
• Cultural competence is the ability of healthcare systems to tailor care delivery based on
patients’ values, beliefs, and behaviors (Gray, 2016). Culture describes the set of activities,
values, and experiences that surround the involved people (1)
• Cultural competence in healthcare delivery involves the provider’s insight into personal
values and beliefs, and the ability to care for patients with different values and beliefs.
Respecting alternative cultural beliefs is imperative, but respect does not require agreement
with alternative beliefs (Jonsen, Siegler, & Winslade, 2015).
The Case:
• Ms. C., age 39, was diagnosed with human immunodeficiency virus (HIV) and acquired
immunodeficiency syndrome approximately 5 years ago. She is admitted with worsening
renal function and pneumocystis pneumonia. Her last admission was less than 2 months
ago, when she experienced central nervous system toxicity from her disease. She adheres
inconsistently to the medication regimen. She is at risk for multi-system organ failure, and
her capacity to participate in medical decision making is expected to deteriorate.
• Ms. C. speaks Haitian Creole with very limited English and has very limited health literacy.
During her treatment, a variety of interpreting methods have been used. A trained medical
interpreter from the staff was used toward the end of her hospitalization. Ms. C. lives with
her mother; she has never married and does not have children. Based on the state
HealthCare Decisions Act, Ms. C.’s mother would assume decision-making responsibility
if the patient loses capacity (State of Delaware, n.d.). Providers have had difficulty
determining her capacity for making medical decisions because of the language barrier as
well as cultural beliefs incongruent with medical science.
• An ethics consult has been requested because of concern for the patient’s mental condition.
In discussions held with the assistance of a telephonic interpreter, the patient reported
“speaking to God” and rejected the assumption treatment plans in the hospital would cure
her. She also expressed a desire to leave the hospital to seek care in Haiti, stating only the
“medicine” she could receive there would cure her true problem. Psychiatric services also
were consulted, and the provider recognized the possible influence of cultural issues on the
patient’s decisional capacity. (1)
Cultural and Linguistic Barriers:
• Culture impacts how patients understand their bodies, think about health, and pursue care
for what they define as treatable disease. The way culture impacts an individual’s thinking
about health is highly variable, depending to a large extent on the degree to which that
person has adapted to the wider culture in the United States (Leavitt, 2010). (2)
• With an increase in patient diversity comes a need for health institutions and practitioners
to bridge barriers to safe and effective health care when they do not share a culture with
their patients. Effectively bridging culture requires accommodation on various institutional
levels, including organizational factors (provider diversity, policies), structural factors
Document Summary
University library web site: cultural competence is the ability of healthcare systems to tailor care delivery based on patients" values, beliefs, and behaviors (gray, 2016). Respecting alternative cultural beliefs is imperative, but respect does not require agreement with alternative beliefs (jonsen, siegler, & winslade, 2015). The case: ms. c. , age 39, was diagnosed with human immunodeficiency virus (hiv) and acquired immunodeficiency syndrome approximately 5 years ago. She is admitted with worsening renal function and pneumocystis pneumonia. Her last admission was less than 2 months ago, when she experienced central nervous system toxicity from her disease. She is at risk for multi-system organ failure, and her capacity to participate in medical decision making is expected to deteriorate: ms. c. speaks haitian creole with very limited english and has very limited health literacy. During her treatment, a variety of interpreting methods have been used. A trained medical interpreter from the staff was used toward the end of her hospitalization.
