Part Three

1
Part Three

• Developing Age Specific and Cultural
  Competencies

2
Developing Age-Specific Competencies
3
What are age-specific competencies?

• Theyre skills you use to give care that meets
  each patients unique needs

• Every patient is an individual.
• Each has his or her own
• likes and dislikes
• feelings, thoughts and beliefs
• limitations and abilities
• life experience

• But everyone grows and develops in a similar
  way..
• Experts generally believe that people
• grow and develop in stages that are related to
  their age
• share certain qualities at each stage.

Understanding these stages of life is the key to
age-specific competencies.
4
Age-specific competencies benefit you, your
patients and your facility

• They help to

Meet JCAHO standards Age-specific competencies
are a key area of focus for the JCAHO (Joint
Commission on Accreditation of Healthcare
Organizations

• Ensure quality care
• With age-specific competencies, each patient
• Gets the individual care he or she needs and
  deserves.
• Becomes a partner in his or her own health care.

Improve job performance and satisfaction Putting
age-specific competencies into practice can be a
challenge. But the rewards are great improved
patient care, relationships and teamwork.
Age-specific competencies enable you to care for
the individual at every stage of life.
5
How much do you know about growth and development?

• Take this self-assessment quiz to find out.
• Infants and toddlers (ages 0-3 years) cannot
  communicate their needs or feelings?..............
  ...
• Young children (4-6) lack active imaginations..
• Older children (7-12) need to feel competent and
  useful...
• Adolescents (13-20) can only understand
  information and examples that are concrete
• Young adults (21-39) have nutritional needs for
  continued growth...
• Middle adults (40-64) use their life experiences
  to learn new information..
• Older adults (65-79) naturally decline in all
  physical and mental abilities
• Adults ages 80 and older can remain independent
  with proper support

• True ? False ?
• True ? False ?
• True ? False ?
• True ? False ?
• True ? False ?
• True ? False ?
• True ? False ?
• True ? False ?

6
How did you do?

• False See page 7
• False See page 8
• True See page 9
• False See page 10
• False See page 11
• True See page 12
• False See page 13
• True See page 14

7
In the pages that follow, youll learn some basic
facts about human growth and development. Use
this information as a starting point to develop
the age-specific competencies you need for your
job.
As you read, keep in mind that everyone develops
at his or her own rate. The age groupings, or
stages, in this booklet are just one of many ways
to divide human growth and development. They are
intended only as a general guideline.

• After reading, be sure to
• 1. Avoid stereotyping a patient based on his or
  her age.
• Treat each patient as an individual.
• Remember, no matter what the patients age, he or
  she is unique.
• A key part of your job is learning to recognize
  each
• patients own needs and abilities.

8
Infants and toddlers(ages 0 to 3 years are
curious)

• Healthy growth and development
• physical grows at a rapid rate, especially
  brain size.
• mental learns through senses, exploring,
  playing communicates by crying, babbling, then
  baby talk, simple sentences
• social/emotional seeks to build trust in
  others dependent beginning to develop a sense
  of self.

• Key health-care issues
• communication provide security, physical
  closeness promote healthy parent-child bonds
• health keep immunizations/checkups on schedule
  provide proper nutrition, sleep, skin care, oral
  health, routine screenings
• safety ensure a safe environment for exploring,
  playing, sleeping.

• Examples of age-specific care for infants and
  toddlers
• Involve child and parent(s) in care.
• Provide safe toys and opportunities to play.
• Encourage child to communicate smile, talk
  softly to him or her etc.
• Get down to their eye level.

9
Young children(ages 4 to 6 years) are active.

• Key health-care issues
• communication give praise, rewards, clear rules
• health keep immunizations/checkups on schedule
  promote healthy habits (good nutrition, personal
  hygiene, etc.)
• safety promote safety habits (use of bike
  helmets, safety belts, etc.)

• Healthy growth and development
• physical grows at a slower rate improving
  motor skills dresses self toilet trained
• mental begins to use symbols improving memory
  vivid imagination, fears likes stories
• social/emotional identifies with parent(s)
  becomes more independent sensitive to others
  feelings

• Examples of age-specific care for young children
• Involve parent(s) and child in care and let
  child make some choices.
• Use toys, games, etc., to teach child, reduce
  fear.
• Encourage child to ask questions, play with
  others, talk about feelings.

10
Older Children(ages 7 to 12 years) are doers.

• Key health-care issues
• communication help child to feel competent,
  useful
• health keep immunizations/checkups on schedule
  give information on alcohol, tobacco, other
  drugs, sexuality.
• safety promote safety habits (playground
  safety, resolving conflicts peacefully etc.

• Healthy growth and development
• physical grows slowly until a spurt at
  puberty.
• mental active, eager learner understands cause
  and effect can read, write and do math
• social/emotional develops greater sense of
  self focuses on school activities, fitting in
  with peers negotiated for greater independence

• Examples of age-specific care for older children
• Allow child to make some care decisions (in
  which arm do you want the injection?)
• Build self-esteem ask child to help you do the
  task, recognize his or her achievements, etc.
• Stay open to conversations on peer pressure,
  sexuality, alcohol, tobacco etc.

11
Adolescents(ages 13 to 20 years) are in
transition.

• Healthy growth and development
• physical grows in spurts matures physically
  able to reproduce
• mental becomes an abstract thinker (goes beyond
  simple solutions, can consider many options,
  etc.) chooses own values
• social/emotional develops own identity builds
  close relationships tries to balance peer group
  with family interests concerned about
  appearances challenges authority.

• Key health-care issues
• communication provide acceptance, privacy build
  teamwork, respect
• health encourage regular checkups promote
  sexual responsibility advise against substance
  abuse update immunizations
• safety discourage risk-taking (promote safe
  driving, violence prevention, etc.)

• Examples of age-specific care for adolescents
• Treat more as an adult than a child. Avoid
  authoritarian approaches.
• Show respect be considerate of how procedures,
  treatments, etc., may effect appearances,
  relationships.
• Encourage open communication between parent(s),
  teen, peers.
• Parents do not have the right to information on
  patients 18 years old or older.

12
Young adults(ages 21 to 39 years) build
connections.

• Key health-care issues
• communication be supportive and honest respect
  personal values
• health encourage regular checkups promote
  healthy lifestyle (proper nutrition, exercise,
  weight control, etc.) inform about health risks
  (heart disease, cancer, etc.) update
  immunizations
• safety provide information on hazards at home,
  work.

• Healthy growth and development
• physical reaches physical and sexual maturity
  nutritional needs are for maintenance, not
  growth.
• mental acquires new skills, information uses
  these to solve problems
• social/emotional seeks closeness with others
  sets career goals chooses lifestyle, community
  may start own family.

• Examples of age-specific care for young adults
• This group often uses the intranet for medical
  information it may not all be medically
  factual.
• Patient teaching is very important.

13
Middle adults(ages 40 to 64 years) seek personal
growth.

• Key health-care issues
• communication keep a hopeful attitude focus on
  strengths, not limitations
• health encourage regular checkups and
  preventative exams address age-related changes
  monitor health risks update immunizations
• safety address age-related changes (effects on
  senses, reflexes, etc.)

• Healthy growth and development
• physical begins to age experiences menopause
  (women) may develop chronic health problems
• mental uses life experiences to learn, create,
  solve problems.
• social/emotional hopes to contribute to future
  generations stays productive, avoids feeling
  stuck in life balances dreams with reality
  plans retirement may care for children and
  parents.

• Examples of age-specific care for middle adults
• Recognize the persons physical, mental, social
  abilities, contributions.
• Encourage questions sometimes this age group
  accepts what the MD says without question, even
  if the patient has information to the contrary.
• Stay alert to changes in capabilities. The
  patient may not be aware or may not want to
  recognize for fear of losing independence.

14
Older adults(ages 65 to 79 years) enjoy new
opportunities

• Key health-care issues
• communication give respect prevent isolation
  encourage acceptance of aging
• health monitor health closely promote
  physical, mental, social activity guard against
  depression, apathy update immunizations
• safety promote home safety, especially
  preventing falls

• Healthy growth and development
• physical ages gradually natural decline in
  some physical abilities, senses
• mental continues to be an active learner,
  thinker memory skills may start to decline
• social/emotional takes on new roles
  (grandparent, widow/er, etc.) balances
  independence, dependence reviews life.

• Examples of age-specific care for older adults
• Allow time for the patient to process questions
  and information.
• Ask how family or others are involved in their
  care.

15
Adults ages 80 and oldermove to acceptance

• Key health-care issues
• communication encourage the person to express
  feelings, thoughts, avoid despair use humor,
  stay positive
• health monitor health closely promote
  self-care ensure proper nutrition, activity
  level, rest reduce stress update immunizations
• safety prevent injury, ensure safe living
  environment.

• Healthy growth and development
• physical continues to decline in physical
  abilities at increasing risk for chronic
  illness, major health problems
• mental continues to learn memory skills and/or
  speed of learning may decline confusion often
  signals illness or a medication problem
• social/emotional accepts end of life and
  personal losses lives as independently as
  possible

• Examples of age-specific care for adults 80 and
  older
• Support end-of-life decisions provide
  information, resources, etc.
• Assist the person in self-care. Assist the
  patient in maintaining whatever level of self
  care they can.
• Promote medication safety.
• Be alert to fall potential and other safety
  hazards.
• Explore the roles that care givers, such as
  friends and family might be providing.

16
Recognize roadblocks to communication
Assess every patient you deal with for possible

• Physical impairments
• Does the patient have a speech, hearing or sight
  disability?
• Is his or her confusion due to illness or
  physical disability?
• Learning difficulties
• At what approximate grade level can the patient
  understand instruction?
• Has he or she been tested for a learning
  disability?
• Cultural differences
• What is the patients cultural background?

• Emotional stresses
• Could the patients depression, anxiety or fear
  be a sign of a physical or mental illness?
• Is he or she worried about how health-care
  decisions may affect abilities, family, school,
  job, etc.?
• Language barriers
• What is the patients primary language?
• Could he or she benefit from a translators
  services?
• Remember to give the person your full attention
  listen and observe.

17
Test your knowledgeof age-specific competencies
by checking True or False.

• Its important to provide a safe learning
  environment for infants and toddlers.
  ....
• Young children should never be given
  choices..
• Older children are concerned with school, fitting
  in and being useful.
• Its important to involve the teenager as a
  partner in his or her care.
• Addressing concerns about family, money or job
  issues is not a factor when caring for young
  adults...
• Middle adults need to feel productive and avoid
  feeling stuck in life..

True ? False ? True ? False ? True ?
False ? True ? False ? True ? False
? True ? False ?
18
Test your knowledgeof age-specific competencies
by checking True or False. (continued)

• Older adults should be encouraged to talk about
  their feelings of loss.
• For adults ages 80 and older, confusion is a
  definite sign of permanent loss of mental
  capabilities..
• You shouldnt let a patients emotional state or
  cultural background affect how you communicate
  with him or her.
• Age-specific competencies means treating every
  patient the same
• Now, put your knowledge to work by
  developing age-specific competencies for your
  job!!!

True ? False ? True ? False ? True ?
False ? True ? False ?
19
Answers to page 17 test

• True
• False
• True
• True
• False
• True
• True
• False
• False
• False

20
Developing Cultural Competencies
21
What are cultural competencies?

• Theyre skills you use to work well with
  patients of all cultures. These skills involve

Considering every patients culture when giving
care Culture the values, beliefs and practices
shared by a group can affect how a patient
views health care. A patient may belong to
different ethnic, regional, religious and other
groups.

• Treating every patient as an individual
• Its important to consider culture. But its
  also important to
• Avoid stereotyping.
• Consider other factors that may affect care, such
  as age.
• Learn about each patients unique views on health
  care.

22
Why learn about cultural competencies?

• Because developing cultural competencies
  benefits everyone. You can

Help patients receive more effective care Taking
patients cultural views on health into account
helps maintain their right to be treated with
respect. They also respond better to their care.
Improve your job performance Age-specific
competencies are a key area of focus for the
JCAHO (Joint Commission on Accreditation of
Healthcare Organizations.
Help your facility meet JCAHO standards Awareness
of cultural factors can improve patient and
family education one area of focus for the
JCAHO (Joint Commission on Accreditation of
Healthcare Organizations) survey. Caring for
patients from many cultures is an important part
of health care today!
23
Cultural competencies require self-awareness.
Examine your assumptions about culture.

• True ? False ?
• True ? False ?
• True ? False ?
• True ? False ?
• True ? False ?
• True ? False ?
• True ? False ?

• People who are classified the same way (for
  example, as Hispanic) share one
  culture?................
• A gestures meaning can vary across cultures.
• A patient may or or smile while speaking with
  you, but not actually understand or
  agree.....
• A patient who refuses a certain type of care is
  just being difficult.
• A patient who does not answer a question right
  away needs you to ask it again.
• Considering a patients culture takes too much
  time..
• Culture may affect how much a patient tells you
  about his or her condition....

24
How did you do?

• False They may share some traits, but they may
  also belong to many different cultural groups
• True For example, the gesture for goodbye in
  one culture may mean come here in another.
• True Patients from some cultures may nod or
  smile to show respect, but this doesnt always
  mean they understand or agree.
• False A patients reasons may have to do with
  many cultural factors for example, religious
  beliefs about acceptable medical treatments.
• False Some cultures value periods of silence
  during talks. Give some time before asking
  again.
• False It saves time, because patients respond
  to care better from the start.
• True For example, a person who is used to
  obeying authority figures may not volunteer
  important information.

25
Use the information in this presentation as a
starting point to develop the skills you need for
your job.

• Know your own cultural beliefs and practices.
• Think about how your culture and upbringing
  affect you. For example, you may have certain
  ideas about
• How to show politeness when talking with someone
• Acceptable ways to express pain
• How often to seek medical care
• Appropriate ways to treat children or older
  people.

• Be aware of the culture of health care in the
  U.S.
• For example
• Patients are expected to arrive at exact
  appointment times. But some patients may think
  of a time as referring to a general part of the
  day for example, 215 as mid-afternoon.
• Self-care is often promoted in treatment. But in
  some cultures, family and others are expected to
  play a leading role.

26
There are many cultural factors to be aware of.
They include a patients

• Preferred language
• Patients who are encouraged to talk or read about
  care in their own language may
• feel more at ease
• Understand their care better

Country of origin Most people who live in the
U.S. have roots in other countries. How long a
person has lived here may affect his or her views
toward health.

• Communication style
• Nonverbal and verbal styles may differ. For
  example, culture may affect how or whether a
  patient expresses pain.

• Views of health
• The patient may see an illness as
• Having a supernatural cause, such as punishment
  for sins
• Needing a certain traditional cure, such as an
  herbal remedy or a specific diet.

27
There are many cultural factors to be aware of.
They include a patients (continued)

• Family and community relationships
• A patient may expect certain people to be
• involved in his or her care
• allowed to visit

• Religion
• A patients religion may affect his or her
• consent to treatment
• schedule of care or room arrangement (because of
  certain prayer practices, for example)
• birth and death practices

Food preferences Religious, healing and other
cultural practices all can affect what foods a
patient may eat or avoid.

• Developing cultural competencies does not mean
  knowing everything about every cultural group you
  work with. It does mean
• being aware of cultural factors
• taking appropriate steps to learn about each
  patient, such as asking questions

28
Take time to learn about each patient

• Learn the patients views about health.
• For example, ask
• What are you doing to care for your illness? How
  has it worked?
• Is anyone else treating your illness? What is he
  or she doing?
• Accept the patients practices whenever possible.
  (When needed, discuss any health risks of the
  patients remedies or diet including drug, or
  food and drug, interactions).

• Ask questions to avoid cultural stereotypes.
• Its important to have general knowledge about a
  culture. But its also important to assess each
  individual patient because
• Differences exist among members of the same
  cultural group.
• Cultures change over time
• Climate, war etc., in another country may have
  affected an immigrants health.

Learn about accepted ways to show respect. For
example, ask how a patient prefers to be
addressed.
29
Take time to learn about each patient(continued)

• Consider privacy needs.
• For example
• Ask about privacy concerns, such as being touched
  or being unclothed. Respect privacy as much as
  possible by letting a patient keep a certain
  garment on, bathe him or herself, etc.
• Build trust. A patient may need time to feel
  comfortable discussing a problem or undergoing a
  procedure.

• Understand relationships
• For example
• Ask about the patients family. Allow extended
  family to visit, take part in care or be present
  during death, if these are the expected
  practices.
• Ask about healers and spiritual leaders who may
  be involved in care and other ways the
  patients community may provide support.
• Ask whether the patient takes part in any support
  groups.

Work with the patient and others to find the best
approach to his or her care.
30
Communicate effectively.

• Listen to how the patient talks about his or her
  condition.
• For example
• Ask how he or she refers to it. (For example,
  some cultures classify illnesses as hot or
  cold and treat each type differently.) Ask for
  any details you may need to understand better.
• Ask what he or she thinks is causing it.
• Some patients may expect you to have answers
  not questions. Explain that knowing the
  patients views helps you give better care.

Ask indirect questions, if needed. Direct
questions may make some patients uneasy. For
example, ask how a healer or someone else from
the culture would treat the illness.

• Look for clues.
• For example, take note of whether the patient
• Wears or displays objects that may be religious
• Makes or avoids eye contact
• Keeps a certain distance away or tries to be
  closer.

31
Communicate effectively.(continued)
Talk with others who know the patient. If a
spouse or other family or community member is
involved in care, ask for his or her views of the
condition.

• Ask for the patients views on treatment.
• Explain the recommended treatment and procedures.
• Ask the patient (and family, if necessary) if the
  approach sounds like it will work for him or her.
  Consider other approaches, if ended.

• Use interpreters effectively.
• For example
• Use a trained medical interpreter whenever
  possible.
• Avoid using family members. They may lack
  medical knowledge, or other issues may prevent
  full discussion of the patients condition.

Never assume you know something about a patient
even one who does not appear to have any cultural
differences from you.
32
Consider other factors that may affect care.
These include

• Age
• For example
• An older patient may assume certain problems are
  a normal part of aging and not mention them.
• An adolescent may be sensitive about privacy or
  how treatment will affect his or her appearance.

• Gender
• For example
• A patient may prefer to receive care from someone
  of the same sex.
• Cultural values may prohibit touching between
  members of the opposite sex including spouses
  during certain times, such as childbirth.

• Sexual orientation
• A patient who is unsure of a health-care
  providers response may not mention being gay,
  lesbian or bisexual. Asking questions that avoid
  assuming sexual orientation can help put him or
  her at ease.

33
Consider other factors that may affect care.
These include (continued)

• Socio-economic status
• For example
• Financial hardship may keep a patient from
  seeking or following treatment.
• Classes may exist within a cultural group, based
  on income or other factors. A patients beliefs
  and practices may be related to his or her class.

• Presence of a physical or mental disability
• Patients may have different views about
• how disabling a certain condition is
• how to explain a psychological condition for
  example, some may consider it a mental illness,
  others the result of a supernatural force.

• Use cultural competencies with co-workers, too.
• You may work with people from many cultures.
  When staff members make the effort to work well
  together
• Job satisfaction increases
• Patients receive the best care.

34
Learn more about cultural competencies in patient
care.

• Find out about cultural groups your facility
  serves.
• Borrow materials from your facilitys library, if
  there is one. Also check local libraries.
• Attend a groups event, such as a festival.
• Contact co-workers, community leaders and
  organizations from different groups. Ask if they
  have any information to share.

• Find out more about the skills involved in
  cultural competencies and the benefits they can
  bring.
• Contact the
• Center for Cross-Cultural Health
  1-612-379-3573, ccch_at_crosshealth.com
• www.crosshealth.com
• Office of Minority Health Resource Center
• 1-800-444-6472
• 1-301-230-7199 (TDD)
• Info _at_omhrc.gov
• www.omhrc.gov

35
Test your knowledge of cultural competencies by
checking true or false.

• You can always tell if a patient has cultural
  differences from you by how he or she looks....
• Cultural competencies are the skills used to work
  well with patients of all cultures..
• A patients views toward health are affected by
  culture and other factors...
• When asking a patient questions, always use
  direct questions..
• Emphasizing self-care may not be the best
  approach for all patients...

True ? False ? True ? False ? True ?
False ? True ? False ? True ? False ?
36
Test your knowledge of cultural competencies by
checking True or False. (continued)

• All human beings express pain the same
  way.
• Family members make the best interpreters
  ..
• Learning about cultural competencies can benefit
  employee relationships
• Always discourage patients from using traditional
  remedies and healers.
• Different cultures have different ideas about
  family involvement in patient care
  .
• Now, put your knowledge to work by developing
  age-specific competencies for your job!!!

True ? False ? True ? False ? True ?
False ? True ? False ? True ?
False?
37
Answers to page 35/36 test

• False
• True
• True
• False
• True
• False
• False
• True
• False
• True

38

• Congratulations, you have finished Part Three!
• Please turn in the checklist used for this
  training program to your manager.