A fundamental tenet of culturally competent care for patients is providing clinically and personally pertinent information to patients in a language that they understand. As the diversity of non-English language speakers increases in the United States, nurses may find a new area of priority in advocating for their patients to overcome language barriers.
Fortunately, the Office for Civil Rights within
the U.S. Department of Health & Human Services (HHS), serves to protect
non-English speaking or limited English-speaking patients. Nurses,
however, can do this on a smaller scale in their daily work.
In accordance with Title VI of the Civil Rights Act of 1964, and the guidelines for developing a language access plan by HHS, health care institutions that receive federal funding must provide language assistance services suitable to the communities that they serve. This is assessed and implemented based on a stepwise approach appropriate for the patient population, qualified language service personnel, and interpretation devices and technology. Furthermore, health care personnel will be trained sufficiently and regularly to maintain an understanding of both the logistics and necessity of utilizing these services. This is especially true for nurses, who often have initial and ongoing close contact with patients.
Patients who speak limited or no English may be unwilling to admit that they do not understand the nature of their health care visit or its intended outcome. This is a detriment to both the provider and patient as the provider may proceed with a treatment plan with the belief that the patient is cooperating. It is easy to see how this can create increased stress and fear for the patient when actions are taken on behalf of their health that they did not corroborate and may not agree with. Regardless of the reasons for the patient’s decision to withhold their lack of understanding, health care professionals can take responsibility for establishing mutual understanding and help prevent these occurrences.
Utilize Available Technology
Fortunately, technology provides many resources today that allow for effective interpretation between providers and patients. Most hospitals have a team of on-site personnel that are credentialed interpreters in languages appropriate for the patient population of that site. For those languages that are less common, there are many devices, including phones and tablets, that provide immediate 24-hour access to remote medical translators in virtually every language. Many of the written documents that patients are exposed to are now offered in languages other than English as well.
Find a (Qualified) Translator
With a full understanding of the services offered, patients may decide that they prefer a family member to translate. Although it is not ideal because family members may lack health literacy, it is the patient’s prerogative to make that choice. If the patient requests that a bilingual nurse translate, he or she can only do so if the nurse has been credentialed in accordance with their facility’s policies related to medical interpreting. This is especially true regarding important documentation such as informed consent and does not include casual conversations or explanations.
It’s not a lack of resources, but a lack of understanding, that prevents non- or limited English speakers from getting what they need in health care today. Despite all of the services offered, providers may still try to take shortcuts for the sake of efficiency. As patient advocates, nurses can be mindful of patients and ensure that understanding is complete by utilizing interpreter services and reminding providers of the services available.
The key to being an amazing preceptor to a new graduate nurse is to always remember what it’s like to be a brand new nurse. The idea that “nurses eat their young,” if true, is neither helpful to the new nurse nor to the patients that they care for. Starting a new job is stressful enough, so facing untoward behavior from a preceptor or new colleagues only further discourages the new nurse, and potentially hinders their skills development and patient care. Here are seven ways to be an amazing preceptor and support new nurses and their patients.
1. Assume they don’t know.
One of the most problematic instances between preceptors
and new nurses is
the preceptor’s assumption that the new nurse knows something they don’t. This
could involve speaking in jargon specific to a specialty, teaching complex
skills without a basic understanding, or delegating tasks to a preceptee that
they are not capable of carrying out. Keep in mind that no matter how many
hours the new nurse spent in clinical, learning to be a nurse and being a nurse
are two very different things. Use language that a layperson could understand
and explain terminology in a non-patronizing way before using it.
2. Answer questions objectively.
Even if a new nurse asks a question that seems too
elementary, never express judgment or criticism toward them for asking. The
last thing a patient needs is a nurse who is too frightened to ask questions
for fear of being ridiculed. It is essential to every nurse’s growth that they
learn and practice in an environment that supports their learning and
3.Address the social atmosphere.
While the main role of the preceptor is to teach, observe, and assess a new nurse’s aptitude for working independently, it is also worthwhile to discuss the culture of the organization they work in and how to thrive in it. For example, if a boss is very lenient about swapping assignments but strict about tardiness, this is worth divulging to the new nurse. Some hospitals have policies about taking breaks that are interpreted very differently in each unit. Sharing this information with a preceptee could save them the potential embarrassment of breaking an unwritten rule. This would also further reinforce the idea that they are supported by their predecessors. Nurses who like the place they work and who trust their colleagues are generally better nurses.
4. Encourage work/life balance.
While it is not necessary to exchange personal details, it is worthwhile to encourage the new nurse to take care of themselves appropriately in their work. Many new nurses are so frightened when they start working, they may not want to ask where the restrooms are, where they can get a glass of water, or when lunch is for fear of seeming uninterested in the content of their training. One of the first activities any amazing preceptor should do with their new trainee is take them on a tour of the unit and show them the facilities available to them. Encourage the new nurse to speak up if they need to use them. Nurses who go without do not make better nurses.
5. “See one, do one, teach one.”
Having a simple outline for training a preceptee such as “see one, do one, teach one,” allows the trainee to fortify and demonstrate their understanding. Many new nurses find that their preceptors allow them to do too much, or not enough. Neither are optimal for allowing the nurse to practice new skills with the fundamental understanding to back it up. Showing the new nurse a skill, then having them perform it, and then having them teach it gives them understanding, skill practice, and a test of their complete understanding. Many hospitals now require nurses to complete documentation for each skill. “See one, do one, teach one,” is an effective way to work through training and skill assessment.
6. Don’t be afraid to pass on precepting.
Just as not every preceptor is made equal, so too with every
new nurse. If a preceptor finds that they cannot establish a positive
rapport with a new nurse or vice versa, they are empowered to request a
switch. If interactions between the preceptor and new nurse are not
founded on mutual understanding, the training will likely not be
optimal. Similarly, if a nurse has been inundated with precepting and
needs to take time between training nurses, they should honor that. A new
nurse would likely benefit more from a preceptor who can be enthusiastic about
7. Be open to new nurses’ observations and feedback.
Many nurses who have been in a job for a long time take for
granted the state of things without question. If a new nurse points out a
policy or system that seems ineffective or inefficient, it is worth considering
that it is coming from a fresh pair of eyes. Even if the temptation is
there to criticize the
nurse for being presumptuous or idealistic, consider the
value of a new nurse who is so enthusiastic about their work that they are
willing to critically think about ways to improve.
No experienced nurse got to where they are without a beginning. Ask the best nurses how they got to where they are and they will likely credit a preceptor who believed in them and pushed them to be their best. Any nurse can be an amazing preceptor, as long as they have an attitude of both compassion and tact in which a new nurse can thrive.
As with any disease process, the role of nurses is to be
ever vigilant about staying current on the latest advances with regards
to ovarian cancer and polycystic ovarian
syndrome (PCOS). As September is the awareness month for both of
these conditions, it’s a good time to brush up on understanding the nurses’
role as caregivers to women. Here
is a brief overview of each condition.
PCOS is a condition that involves a cluster of symptoms
related to the endocrine system, metabolism, and physical
appearance. Women with PCOS experience irregular or absent menses,
hormonal imbalance, and often infertility. Furthermore, PCOS is linked to
diabetes, hypertension, sleep apnea, depression, and endometrial cancer.
Although most of the symptoms are invisible, the symptoms related to appearance can be incredibly distressing. This includes hirsutism, (or excess body and facial hair), acne, abdominal fat, skin discoloration, and male-patterned baldness.
PCOS affects up to 10% of women with childbearing age
of all races and ethnicities. It is more common in women with obesity and
those who have family members with PCOS.
Ovarian cancer is often asymptomatic until it has progressed
significantly. Furthermore, symptoms of ovarian cancer are often the same as
symptoms of noncancerous conditions, such as bloating, fullness, pain during
sex, constipation, and urinary urgency and frequency. For these reasons, it is
often diagnosed at a later, potentially more fatal stage of the disease.
survival rate for ovarian cancer varies significantly by
stage and tumor type, ranging from 47% to 93% for all stages combined.
Risk factors for ovarian cancer according to the National
Cancer Institute are a family history of ovarian cancer,
breast cancer, certain types of colorectal cancer, and certain changes in the
BRCA1, BRCA2 genes, hormone replacement therapy, endometriosis,
and obesity. Protective factors include oral contraceptives, tubal
ligation, having given birth, history of salpingectomy, and
The nurse’s role for both PCOS and ovarian cancer are the
same: stay informed, educate patients, be alert for risk factors, encourage
screening, and treat them with compassionate care.
By understanding a patient’s family history and lifestyle,
the nurse can encourage patients to take action that supports their health and
potentially protects them from the long-term consequences of an undiagnosed or
All nurses, particularly those who work in oncology and women’s health, can take it upon themselves every September to revisit their understanding of both PCOS and ovarian cancer. Although studies have been inconclusive in looking at correlations between PCOS and ovarian cancer, it is worth mentioning that either can have a profound effect on the quality of life and morbidity for women.
Nurses are resilient in difficult situations such as grave illness, calamity, and chaos. However, many nurses can have difficult situations that can seem more frequent—which is the management of the difficult patient. The loss of control causes certain people to behave differently as a patient than they otherwise would. Difficult patients range from mildly uncooperative to downright belligerent.
The reasons for their attitudes vary, from mental health issues, organic sequelae of the disease process for which they seek treatment, to simply mistrust—sometimes justified mistrust—of health care professionals. It is important for the nurse to know how to work with, and “win over” the difficult patient for their own sanity and practice, and especially for the patient’s well-being.
1. Take the Time to Listen
Many patients don’t trust nurses, doctors, and other health care professionals. They may have had a bad experience or perhaps they are understandably frightened in giving the responsibility of their well-being to another. The first step in fostering trust is understanding, which begins with listening.
Even if the nurse can’t give a patient exactly what they want or change their treatment protocol, listening bridges the gap between the patient and the health care team. This engenders a cooperative spirit, where the patient feels empowered and more like a participant in their own care.
Although it’s important to help the patient understand the intricacies of their medical treatment, it is often more effective to just hear them out. This may not be easy for the acute care nurse who has five sick patients and a head full of tasks to complete, but even one or two minutes of meaningful, uninterrupted time with a patient can make a world of difference.
2. Be Culturally Aware
Cultural competence is a buzzword now in health care. Patient populations are incredibly diverse, particularly in urban institutions. This has become a notable challenge in the provision of care. For example, a foreign patient who is too proud to admit the significance of a language barrier doesn’t open themselves up to a health care team that is too obtuse to notice their lack of understanding. Many cultural traditions and practices have ranging effects on patient treatments, whether it’s a matter of etiquette, dietary restrictions, or the propriety of certain life-saving treatments.
No nurse is expected to be an expert on every culture, but it is their responsibility to be objective and professional. Even if a patient’s cultural beliefs go against the nurse’s beliefs, it is the professional’s duty to bridge that gap. Bringing objectivity, professionalism, kindness, compassion, and willingness to work with each patient’s cultural needs is essential to establishing a cooperative rapport with that patient.
3. Consider Their Emotional and Spiritual Needs
Many patients’ experience of illness is worsened by unmet
emotional and spiritual needs. This could be acute distress related to the
disease itself, or an exacerbated state of a preexisting psychological
condition. This cannot be ignored, even if the patient’s disease or injury
being treated is seemingly unrelated to their mental health. It is
important to utilize available resources when a patient’s condition suggests
that they may need assistance outside of their primary health team. This
includes counseling services, social work, and institutional chaplains.
4. Recognize the Importance of Recreation
For some patients, laughter truly is the best
medicine. Diversion may seem an unlikely intervention for the difficult
patient, but it is frequently an effective one. Establishing a rapport
with a patient that includes lightness and humor may generate a sense of ease
for them. Naturally, every nurse that employs humor must do so with
This is not a matter of the nurse entertaining the patient, so much as recognizing recreation as an integral part of every human’s well-being. Just because a patient is ill doesn’t mean they can’t enjoy a fun movie, their favorite music, a game, or camaraderie. The nurse may find themselves with a much easier patient when they’ve given them a little bit of diversion and fun.
5. Bump It Up
In no scenario is a nurse to tolerate abuse or inappropriate behavior from a patient. Every health care facility has policies in place to protect nurses from this kind of treatment. Nurses should know these policies and how and when to employ them.
Often the process begins with notifying the charge nurse
about an inappropriate patient from which they will use their discretion and
authority to handle the situation. It may be a matter of consulting psychiatry
or pain management to adjust the patient’s medication. The nurse may need to
call security if the patient is hostile or violent and danger is
imminent. No matter the circumstance, communication is key. No nurse
has to do it alone.
For every difficult patient, one important task of the nurse is to document thoroughly. No matter the cause of the patient’s behavior, the paper trail that leads to its resolution is a critical element of the patient’s well-being and the team taking care of them.
When a patient is described as having “coded,” this generally refers to cardiac arrest. In such a case, urgent life-saving measures are indicated. This can happen within and outside of medical facilities. The benefit of the occurrence in a professional health care setting is that policies and guidelines are in place to address this life-threatening crisis. What follows is the perspective of responding to a code from an ER nurse.
Just as every patient is different, so is every code. The causes and outcomes of every code have to do with the characteristics of the patient in question: the history of present illness and, of course, their comorbidities. Timothy Wrede, RN, is a long-time emergency and critical care nurse in the suburbs of New York City, as well as a former EMT who has seen his fair share of codes. According to Wrede, nothing matters during a code so much as the team that responds to it. “It is imperative to ensure that a good team of doctors, nurses, and ancillary staff are working together efficiently in order to achieve resuscitation of spontaneous circulation (ROSC),” says Wrede.
According to Wrede, a veteran of level-I trauma care, when
it comes to staffing a code, less is more. Studies suggest
that thirteen is the maximum number of personnel participating in an effective
code. Included in this number are professionals that go beyond those
immediately at the bedside, such as pharmacy, lab, and spiritual services.
“There’s nothing worse than 25 people crammed into a patient room trying
to coordinate resuscitation,” according to Wrede. For him, the minimum is
five ‘in the box’, or in direct proximity to the patient, as well as one team
member ‘outside of the box’. “One doctor, three nurses, and two aides
are more than sufficient to obtain or sustain an airway while maintaining a
clear line of vision of the patient, the patient’s monitor, and other team
members,” he says. This consists of one nurse on either side of the
patient responsible for gaining peripheral IV access, administering IV
medication, and obtaining blood samples for lab work. The code
recorder, usually an RN, documents everything that occurs, including every
medication given, timing, team actions, compressions, defibrillation, and
Wrede’s description of the ideal code team is very similar
to the American Heart Association’s recommendation for high-quality CPR
teams. It includes a “triangle” of providers doing chest
compressions, defibrillating, breathing for the patient, and providing
medications, in addition to a code recorder and a physician outside of the
triangle. The physician acts as a team leader by making high-quality
treatment decisions, providing feedback, and overseeing team actions.
For Wrede, the most important times for a code are before and after it. Having a competent team with pre-assigned roles, as well as the opportunity to review and debrief afterward to improve the process continuously, and allow for best patient outcomes. Many hospitals address this by establishing a code team that arrives every time a code is called, with well-established roles, and protocols. Wrede’s experiences describe codes in the ED, although codes are generally run the same regardless of where they take place. The biggest difference is the patient context.