Transcultural Concepts in Nursing Care

Evidence-Based Practice 11-3

The Patient Care Experience as Perceived by Hispanic Patients With Chronic Illness Undergoing Transplant: A Grounded Theory

Hispanic people make up one of the largest-growing minority groups, yet little is understood of the patient experience from their perspective. As of 2019, 60.6 million persons identifying as Hispanic reside in the United States. While Spanish-speaking populations in the United States can be very diverse, as a general statement, Hispanic people face economic, social, and political barriers limiting access to healthcare services. Historically, “patient experience” has been measured through a survey known as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Currently, hospitals that participate in the Hospital Value-Based Purchasing programs are required by the Centers for Medicare & Medicaid Services to administer the HCAHPS survey at discharge. Inadequate representation of diverse cultures such as Hispanic communities are often not represented in the development of research instruments and perceptions of care might be influenced by elements not currently assessed by this instrument. This study provides informa tion on which factors are necessary and which should be avoided to promote a positive hospital experience for Hispanic transplant patients. Twenty participants were interviewed for the study. A theo retical model was developed with four interdepen dent and co-occurring concepts: they are Comfort, Communication, Connection, and Care. ●● Comfort represented a state of ease. Partici pants described efforts by providers to ease their angst, distress, or pain as key to a positive hospital experience. Providers acted in certain ways or stated certain things that imbued con solation in the moment, which was expressed as physical or emotional comfort. One participant said, “Everyone is very, very cordial, very very attentive, just kindness.” ●● Communication was the process of exchanging information through use of shared verbal and nonverbal symbols. The role of communication in the nurse–patient relationship dominated the discourse of each interview. It included having questions answered and having the diagnosis and treatment explained in familiar and under standable terms. Participants considered the

provider’s nonverbal communication such as tone, attitude, and body language as important components of the encounter. ●● Connection represents a link, a relationship be tween persons that remedied patient feelings of being alone. Connection invited expressions of faith and shared prayer and served as an ac knowledgment that the patient was worthy of at tention and respect. One patient described how nurses and doctors would pray with her—they wanted her to recover and not be sad. ●● Care that is authentic along with the perception of attentiveness of staff and behaviors that build trust have long been components of a nurse–patient relationship. Mexican-born (traditional) participants had more trust in their providers when patient–­ provider dialogues with personable discussions occurring before clinical affairs were discussed. The friendliness and the way in which the women were talked to by their provider were considered the most important components of patient-centered care. Clinical Implications ●● When patients have positive hospital experi ences with their providers, they leave the hos pital receptive to clinical guidance, which leads to better quality health outcomes and decreased morbidity and mortality. ●● Many hospitals and educational staff focus their efforts on the clinical aspects of care but neglect the communication competencies that estab lish and enhance the nurse–patient relationship. Focusing on the emotional needs of patients, customer service, and communication skills will support nurse–patient relationships. ●● Concerted efforts to understand the health care experience of patients can affect clinical practice, research, and policy and improve care delivery for historically marginalized populations. Reference: Cuizon, S. G. & Fry-Bowers, E. K. (2022). The patient care experience as perceived by Hispanic Patients with chronic illness undergoing transplant: A grounded the ory. Advances in Nursing Science, 45 (4),335–350. https://doi. org/10.1097/ANS.0000000000000429

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