Diversity

9


Diversity






Professional Profile



A sonographer in a busy hospital radiology department performed survey obstetric sonograms before the performance of amniocentesis procedures. She localized a preliminary site and requested that the radiologist come in and verify the amniocentesis site. The sonographer read several of the reports regarding the amniocentesis localization procedures and noticed that the radiologist dictated that the site was selected by the sonographer and included her name in the report.


During the amniocentesis procedure, the radiologist came into the room but would offer no advice to the obstetrician regarding the accuracy of the selected site. The rate of multiple sticks during amniocentesis procedures, as well as the morbidity and mortality rates, were above the national norms at this institution.


The sonographer was faced with a legal, moral, and ethical dilemma. The technical supervisor did not want to get involved. The sonographer realized that contact with the higher levels of the hospital’s administration, including legal counsel, could bring serious consequences, including dismissal. The ethical implications regarding the welfare of the patients, however, compelled the sonographer to arrange a meeting with the chief administrator and the hospital lawyer. After the meeting, the radiologist was told to cease these practices or risk losing his contract to provide services to the hospital. An in-service educational program was held for all obstetricians on staff to review amniocentesis procedures.


This physician was trying to transfer legal liability to the sonographer. Many court cases within the medical field have upheld the legal doctrine of respondeat superior, or the “captain of the ship” doctrine. The presence of the radiologist in the room during the procedure established his supervisory role. The lack of any guidance or response during the procedure does not diminish or transfer the legal responsibility. Including the name of the sonographer in the report does not transfer legal liability. Indeed, because the sonographer is an employee of the hospital, the physician in effect was trying to transfer liability to the hospital. The sonographer must stay within the limits of the institution’s job description and national scopes of practice.




ETHICAL ISSUES


Imaging students must prepare themselves for a variety of experiences, interactions, and problem solving in their careers. Every patient and situation is unique. This uniqueness may lead to dilemmas that require imaging professionals to employ ethical problem-solving skills.


Imaging professionals, as well as other health care professionals, should be able to identify and accept differences among people. These differences include much more than skin color or native language. Imaging professionals must be knowledgeable about patient attitudes and perceptions regarding imaging procedures. Their mission is not to change patients so that they are all similar but to better understand the differences of their patients as they go about their work.1


Imaging professionals should develop their interpersonal qualities at all educational levels. Educational programs should emphasize an appreciation and respect for diversity. According to the proceedings from the American Society of Radiologic Technologists (ASRT) National Education Consensus,2 issues of diversity will have an increasing impact on the imaging profession in this century. The ASRT House of Delegates has adopted a position statement consistent with the goals of cultural competency.3


Imaging professionals are challenged to provide imaging services to individuals and groups of people with diverse expectations, values, and backgrounds. They must be flexible in their approach—no single best method exists for providing imaging services to a diverse patient population with different ideas about what constitutes “caring.” Imaging professionals must be creative and innovative in providing acceptable, high-quality care for diverse patient populations. This chapter is devoted to defining diversity and enhancing understanding of its relationship to ethical and legal problem solving with the ultimate goal of delivering better patient care.



DIVERSITY DEFINED


Within this chapter, diversity is not defined merely as a variety of ethnicities. Rather, it includes differences that may be rooted in culture, age, experience, health status, gender, sexual orientation, racial identity, mental abilities, and other aspects of sociocultural organization and socioeconomic position.4 Issues in diversity may be divided into primary and secondary dimensions.5 Primary dimensions include physical and mental health, sexual orientation, age, ethnicity, and gender. Secondary dimensions include income, marital status, geographic location, education, and religion.



The encouragement of diversity is an inclusive process of appreciation of the unique contributions different individuals with differing backgrounds bring to an organization.5 For example, an educational program encouraging diversity values the differences among students and asserts that their uniqueness contributes to the formation of more knowledgeable and experienced professionals who will provide a higher standard of care for imaging patients.


The encouragement of diversity requires individuals to move beyond the Western tradition by broadening their learning and opening their minds to new forms of thought.6 As teachers mentor students through the educational process, they must also assist the students in moving beyond any self-centered worldviews. Even students from similar geographic locations and of similar races bring unique insights to the class as a result of their differing experiences and backgrounds. As they share these differences, they increase their knowledge base, which provides them with greater empathy for their patients and one another. This intellectual broadening is a crucial component in establishing an appropriate educational and working environment for people of many backgrounds.


Adaptation of resources for people of all backgrounds is termed multiculturalism. All the variables identified in issues relating to diversity also must be considered in discussions of multiculturalism.




Interaction Patterns


Imaging professionals should be able to recognize the interaction patterns commonly encountered when issues of diversity are discussed. These interaction patterns are labeled -isms because of their common word endings. Each -ism involves a tendency to judge others according to a standard considered ideal or presumed to be “normal.” The -isms are grounded in bias, prejudicial in attitude, and discriminatory in their behavioral expression. An -ism is centered on personal judgment, regardless of evidence (Box 9-1).7



BOX 9-1


THE -ISMS













From Creasia J, Parker B: Conceptual foundations of professional nursing practice, ed 2, St Louis, 1996, Mosby.





A Study in Diversity


A study conducted in a midwestern state concerned the incorporation of diversity topics into the imaging sciences curriculum.8 Researchers gathered information with a survey that asked a variety of questions of the program’s directors and students. The majority of respondents answered that topics relating to diversity were important and should be included in the curriculum. A sampling of the comments that were provided in answer to the survey and may be of interest to imaging professionals is included in Boxes 9-2 and 9-3. A small percentage of students enrolled in the programs believed that issues of multiculturalism and diversity are not important to the imaging curriculum. The researcher was concerned about this result. If students do not believe that an understanding of the differences among patients is important, patient care may suffer. Students who do not support multiculturalism may hold that all patients should be treated equally and medicine should be color blind or blind to other differences. This implies that all patients have the same needs. Imaging students would do well to remember that patients are unique and deserve imaging professionals able to recognize individual needs, but they do also all deserve quality imaging services. Program directors need to investigate issues of diversity early in the educational program. Caring requires an identification with and respect for the needs of all patients. When students respect differences, they are better able to care for patients.




BOX 9-3   STUDENTS’ UNEDITED INDIVIDUAL COMMENTS




“A lot of people don’t handle working with diverse people. People have been brought up to stay with their own kind of people, but today people need to learn to interact with different people.”


“I think everyone should learn more about how to communicate with different people. I know it would help me.”


“Everyone who works in the hospital needs to have a working knowledge of the different cultures. It would be a good idea to teach some beginning Spanish classes as we are in contact with many Hispanics that speak no or little English.”


“Since you deal with a variety of people you should be educated about them.”


“I believe everyone is different and has different needs. I do the best I can to meet these needs while producing the best possible x-ray.”


“I think this is important for people to be multiculturally educated, but it should be in your heart to treat people as if they were all the same.”


“I think overall patients have the same basic needs—but learning about specific cultures would be helpful to make the specific patient feel more comfortable.”


“Throughout my life I have personally went out to get to know other cultures and I enjoy them so much. But a lot of students maybe have not and I think it would be beneficial to have multicultural education. We need to know some cultural differences to help us communicate with patients better.”


“I’m not sure how multiculturalism and diversity relate to radiography except the fact that each radiographer should be able to relate to each patient effectively no matter what the race is. The family style, ability, appearance, etc. really shouldn’t matter to the radiographer. Treat each patient equally. We should be informed of the diversity in the radiography field. I agree with that 100 percent.”


“Some everyday actions to us can be insulting to people of different cultures. It would be helpful to know these.”


“It would probably be beneficial if more staff technologists or students had a basic knowledge of other languages, especially Spanish. This being the more common one that I’ve run into, there is a definite barrier there if there’s no communication—perhaps the hospital needs more interpreters or availability.”


“I think multiculturalism issues are important since patients are all unique and as we are placed in other areas of the United States we will be impacted by this. As a student who took classes that dealt with diversity and its issues, I have found much of this knowledge to be more useful than I expected. This is why I think multiculturalism is an important part of all education.”


“I think a course dealing with multiculturalism would be very useful in helping both to educate and break down barriers between cultures. Some multicultural education is needed.”


Program directors and students should be encouraged to become active in incorporating diversity into the curriculum to enhance patient care and make imaging professionals more sensitive to the needs of others. Sensitivity to the differences among individuals gives imaging professionals a better understanding of patients’ differing reactions to the imaging environment, the way patients make choices, and the need to employ ethical decision making. It also allows them to identify a variety of methods to explain imaging procedures to a diverse patient population. These methods may include fluency developed in language courses, visual aids, interpreters, patient advocates, and informational sessions presented as continuing education by a variety of presenters.


Imaging professionals should consider issues of diversity before performing imaging procedures to facilitate a more comfortable environment for communication between them and their patients. They must recognize their responsibility to adapt to the needs of patients from all backgrounds. This adaptation for diversity among patients will increase the reputation of the facility and be an asset for marketing and customer service.



DIVERSITY AND ETHICS


Many ethical issues are involved in dealing with a diverse patient population. By recognizing, accepting, and learning ways to accommodate this diversity, imaging professionals become much more adept at providing care that protects patient autonomy, right to information (informed consent process), and confidentiality.


The ages and mental abilities of patients often have an impact on the ethical challenges faced by imaging professionals. For example, an elderly patient who has Alzheimer’s disease and is scheduled to have a barium enema is most likely unable to have a truly informed consent process. Such a patient may require an advocate.



Truthfulness and confidentiality also enter into some diversity challenges. In some cultures the elders of the family make decisions for all family members. This hierarchy may affect the radiologist who is explaining the procedure and discussing alternatives to treatment. Confidentiality may be diminished or lost in situations in which patients are having life decisions made for them by others but need to share information with the radiologist that they do not wish the rest of the family to know.


Many situations require knowledge of the similarities and differences in patients and cultures. The more imaging professionals know about diversity, the more they can ready themselves for these interactions. Certain acceptable approaches are recommended for interactions of imaging professionals with all cultural groups (Box 9-4). In addition, categories for basic cultural assessment enable imaging professionals to provide high-quality imaging services for a variety of patients (Box 9-5).



BOX 9-4


APPROACHES RECOMMENDED FOR ALL CULTURAL GROUPS




Provide a feeling of acceptance.


Establish open communication.


Present yourself with confidence. Introduce yourself. Shake hands if appropriate.


Strive to gain your patient’s trust, but do not be resentful if you do not receive it.


Understand what “caring” means to members of the cultural or subcultural group, both attitudinally and behaviorally.


Understand the relationship between your patient and authority.


Understand patients’ desire to please you and their motivations to comply.


Anticipate diversity. Avoid stereotypes by gender, age, ethnicity, or socioeconomic status.


Do not make assumptions about where people come from. Let them tell you.


Understand the patient’s goals and expectations.


Make your own goals realistic.


Emphasize positive points and strengths of minority health beliefs and practices.


Show respect to all family members present, especially to men, even if the patient is a woman or child. Men often are decision makers regarding follow-up care.


Be prepared for the fact that children go everywhere with parents in some cultural groups and in poorer families, who may have few child care options. Include them.


Know the traditional health-related practices common to the group with which you are working. Do not discredit them unless you know they are harmful.


Know the folk illnesses and remedies common to the group with which you are working.


Try to make the clinic setting comfortable. Consider colors, music, atmosphere, scheduling expectations, pace, and seating arrangements.


Whenever possible and appropriate, involve the leaders of the local group.


Confidentiality is important, but community leaders know local problems and often can suggest acceptable interventions.


Respect values, beliefs, rights, and practices. Some may come into conflict with your own values or your determination to make changes. Nevertheless, every group and individual deserves to be treated with respect.


Learn to appreciate the richness of diversity as an asset rather than a hindrance in your work.


From Creasia J, Parker B: Conceptual foundations of professional nursing practice, ed 2, St Louis, 1996, Mosby.



BOX 9-5


CATEGORIES FOR A BASIC CULTURAL ASSESSMENT




Ethnic origin, identity, affiliation, values (ideas about health and illness, human nature, relationships between humankind and nature, time, activity, and interpersonal relationships), relevant rites of passage, customs, art and symbols, and history


Racial identity (ask, do not assume)


Place of birth; relocation and migration history


Habits, customs, and beliefs associated with health, disease, illness, health maintenance, illness prevention, and health promotion; explanatory models; connections between health and religion


Cultural sanctions and restrictions (behaviors that are encouraged or discouraged)


Language and communication processes (verbal and nonverbal patterns, eye contact, use of and toleration for touching, silence, tempo, styles of questioning and persuasion, styles of decision making)


Gender rules


Healing beliefs and practices (relationships with folk, popular, and professional health systems; symbolism related to health and illness; behaviors that are considered normal or abnormal; care associated with unusual or abnormal behavior; care associated with body fluids, excretions and secretions, and temperature; activities included in tending to one’s body; substances and practices used in rituals; myths about health; taboos [substances and events to be avoided]; and ideas and practices related to death, dying, and grief)


Nutritional factors; food preferences, preparation, and consumption patterns (kinds of foods and amounts, schedules and rituals, eating environments, utensils and implements, taboos, changes with illness)


Sleep routines, bedtime rituals, and environment (kinds of covering, sleepwear, comforting materials used, rules for sleeping and awakening)


Environmental resources and strains (the “fit” within the community)


Economic status, resources, and living situation


Educational history and background


Occupational history and background


Social network (types and amount of support available from family, other individuals, and group resources; who and where extended family and significant others are; what is expected and expectable from them; social interaction patterns)


Self-identity or self-concept and sense of well-being


Religious history, background, and beliefs


Other spiritual beliefs and practices


Usual response to stress and discomfort


Meaning of care and caring (expectations, beliefs, and practices related to care; relationships between providers and patients as cultural seekers of health care and between patients and the health care system)


From Creasia J, Parker B: Conceptual foundations of professional nursing practice, ed 2, St Louis, 1996, Mosby.



DIVERSITY AND VALUES


So far this chapter has discussed the importance of respecting the ways in which human beings differ from one another, but imaging professionals also should realize that individuals are more alike than they are different. Every group and individual must manage the same basic requirements of living to survive and thrive; to do so, they choose and follow a set of values. These universal values include orientation toward nature (including the supernatural), time, activity, relationships with other people, and the nature of humankind.9 Imaging professionals should understand their place and that of the patient in the continua of values. They also should consider the ways in which others’ worldviews differ from their own. This consideration enables imaging professionals to understand themselves, their colleagues, and their patients better and in doing so to become more effective in recognizing their own and others’ perspectives and the ways in which these perspectives influence relationships.4


Imaging professionals must be able to understand their patients’ values and worldviews. Ethical decision making requires an acceptance that human beings share values and worldviews, often in spite of other differences. This realization provides a foundation for empathy and truly ethical problem solving.


Feb 27, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Diversity
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