Unit 4: Ways of Knowing

Our readings about health literacy and the imperative barriers to it has given me a lot of food for thought.  It’s made me quite reflective of my work and responsibilities as a healthcare provider in respects to making sure my patients are fully aware of their health status. 

The most recent epiphany occurred to me last week that there is still a very real and strong cultural barrier and resistance to healthcare, especially in my own culture, the Hmong.

This particular story is of a relative who was hospitalized for a stroke.  His blood pressures were normal with some mild elevation in his LDL, nothing too alarming.  He was started on a statin, ASA and Plavix.  However, on a routine transthoracic ECHO prior to discharge there was a small patent foramen ovale (PFO) found that could possibly have been a contributing factor to his stroke.  Naturally, the attending neuro team was concerned and subsequently ordered a transesophageal echocardiogram (TEE) and Cardiology consult, to be done the next day.

Nonetheless, there was quite some resistance with going forward with more testing.  The reasoning being fear and annoyance of the medical staff finding more issues with the patient.  Also, stating that the hospital was purposely finding more tests to do, to keep them in the hospital longer in order to collect more money.  He even stated that health care providers “don’t know what they’re doing”.

…So, I have to take a step back and hold my breath because now I’m getting a little offended by their comments. And yes, they know I’m a nurse.  The NP discussed her concerns utilizing an interpreter and myself to re-explain their concerns and the reasons for their recommendations for further testing.  Initially, the patient and his son was adamant about refusing further testing and resolute on being discharged home.  However, they did become agreeable to waiting for Cardiology’s input about the PFO.  Cardiology was luckily on the floor and was able to review his chart and see him.  They weren’t too concerned and was okay with him going home but recommended following up for an outpatient TEE.

The Asian culture, like all other cultures, is unique and has their own philosophy on healing.  As described in our text, there are four common values that are strongly reflected in the Asian culture as a whole, that being: “male authority and dominance, saving face, strong family ties and respect for parents, elders, teachers and other authority figures” (Kitchie, 2014).

 As a Hmong nurse, I hope to use my medical knowledge to teach the Hmong people of the necessity of healthcare maintenance and prevention and to seek out professional help earlier rather than waiting until a person is acutely ill or septic.  As I read the book, even my own experiences within my family concurs with the books statement that medical intervention is usually sought out in an emergency or dire situations, often almost being too late for the patient.

I live these issues everyday with my elder mother-in-law with her herbal medication cures and non-DEA approved medications that she purchases at Asian markets.  Even tonight, I received a message from my siblings that my mom is very sick and has been having fevers, chills, weakness and vomiting since last week Friday.  I called my Dad right away for an update and learned that my Mom has not improved, she probably had a UTI that’s now pyelonephritis, but they were going to wait until tomorrow to go to the ER. Oh boy, luckily I was able to iterate the severity of her condition and need for IV hydration and IV antibiotics before things got worse and that things were only going to get worse without medical intervention.  Thank goodness my dad took her to the ER tonight and she is still currently receiving treatment.

This is why it is so important to bridge the gap between healthcare literacy and different cultures.  An easy UTI could have been treated when minimum symptoms were present.  And truth be told, with a much smaller medical bill too.

Unit 3: Self-Efficacy

Bandura’s Self-Efficacy Theory

Bandura’s Self-Efficacy Theory is a social cognitive theory which is essentially, “the self-perceptions that individuals hold about their capabilities” (Pajares, 2009).

There are 4 sources that affect self-efficacy, including (Kitchie, 2014):

1.)    Mastery Experience—Previous achievement of a similar task

2.)    Vicarious Experience – Observing the success or failure of others attributes to the belief    of ones’ own capabilities (Peer Modeling)

3.)    Social or Verbal Persuasions – Positive verbal encouragement from others

4.)    Physiologic Reactions – Including somatic and emotional states (anxiety, stress and  mood)

Self-efficacy is a vital piece of teaching because it stands as a strong indicator for whether a particular health behavior will be carried out or not.  We, as health educators, need to be aware of what level a patient’s self-efficacy level is at.  We can play on the 4 sources of efficacy to increase the likelihood of our patients following their intended health plan. 

Since mastery experience is proven to be one of the biggest motivating factors for optimal self-efficacy, we need to investigate what other medical triumphs they have had in the past (Kitchie, 2014).  If we can relate the two behaviors with both positive outcomes, the chances of the patient coming through with the care plan will be much higher. 

Our greatest strength as a provider is to provide the necessary support and genuine encouragement and positive reinforcement to empower the patient to make a change.  I often use the analogy of “mind over matter”, keeping an open and positive mind set to overcome physical restraints brought on by medical illness.

  

 SELF-BELIEF (increased self-confidence) = SELF-EFFICACY 

Self-Efficacy in the ICU

I recently had a patient in the ICU with newly (within 2 months) diagnosed of pancreatic cancer with metastasis.  She was a 30 day readmit for recurrent bowel obstructions with severe deconditioning secondary to weakness and immobility.  On the second day of her hospital stay, her acute medical issues were resolving and we were progressing diet and implementing early mobility in hopes of overall improvement in her condition.  She was quite hesitant about getting out of bed because she was feeling so weak for so many days. 

To think of it, I couldn’t apply the mastery experience with her in regards to research on the pros of initiating early mobility in hospitalized patients on the first day but once we got out of bed with sufficient assistance to make her feel comfortable about not falling she felt much more motivated to get up the next day.  

From her mastery experience on getting up on day one, even though it was just to the edge of the bed, it highly motivated her to get up to the chair the next day.  I also used verbal persuasion with reasonable outcomes for her.  Physiologically, we managed her pain and kept her stress at a minimal, which also empowered her to increase her activity even more the next day.

References

Kitchie, S. (2014). Determinants of Learning, in S. Bastable (Ed.), Nurse as Educator: Principles of Teaching and Learning for Nursing Practice (pp. 113-158) Boston, Jones and Bartlett Publishers.

Pajares, F. (2009). Self-Efficacy Theory. Retrieved October 3, 2015, from http://www.education.com/reference/article/self-efficacy-theory/