Boundaries and Cultural Competence in Telehealth (Nursing)

00:01 While empathy and connection are vital, it's crucial to maintain professional boundaries and telehealth interactions.

00:08 Approach patient care with objectivity, adhering to evidence based practices and avoiding personal biases.

00:16 I'm reminded of Phyllis, who became very close with one of her patients, and wanted to help no matter what. She cared for her patients.

00:27 Unfortunately, this no matter what attitude meant that whenever this patient requested a meeting, she accepted, despite being in a non-private location.

00:39 The result was that she shared unintentionally patient information to people in the community.

00:47 Phyllis was unable to help her patient the way she needed to because she didn't set proper boundaries.

00:55 Here are a few boundaries you can consider in your telehealth practice.

01:01 Always uphold patient confidentiality, and adhere to data protection regulations.

01:07 Make sure that you are on both a private connection and in a private space.

01:14 If you are unable to attain both, it is better to reschedule the appointment so that you can be set up for success.

01:23 Also, recognize when a patient's needs extend beyond your scope of practice, and refer them to appropriate specialist or resources.

01:34 Sometimes the person needs to see a specialist, another provider, or go to a place with the resources necessary for their care.

01:43 Don't try to provide a quick fix when more detailed or different care is necessary.

01:50 Lastly, allocate adequate time for each patient while maintaining punctuality and adhering to scheduled appointments.

01:59 Set boundaries when conversations go far beyond the scope of your practice, and create time to discuss some matters in more depth as needed.

02:10 Sometimes people feel more comfortable or uncomfortable via telecommunications and boundaries need to be more clearly set.

02:20 So here's what I want you to do.

02:22 Consider and set boundaries in your telehealth practice in privacy practices, care practices, and time allocations.

02:31 Now consider this story.

02:34 Tejas was from India and was meeting with his telehealth provider.

02:39 The provider began the call by saying, “I have no idea how to say your name, Te..Tejas?” Tejas responded, “My name is Tejas.” The provider said, “Oh, I can’t pronounce that.

03:00 Do you have a nickname?” Tejas persisted, “I’m named after my grandfather.

03:06 It’s Te – like KaraTE and Jas like Jazz with an S” The provider rolled his eyes and said, “I’ll call you T.” In telehealth, providers may interact with patients from various geographic locations, ethnicities, religions, and socioeconomic backgrounds.

03:28 Cultural competence is vital for ensuring equitable and respectful healthcare interactions, regardless of these differences.

03:39 First, you should be aware of your own cultural beliefs and biases and recognize their potential impact on patient care.

03:47 Understanding different cultural practices, traditions, and healthcare beliefs of the patient populations you serve and adapting your communication and care approach to accommodate cultural differences and patient preferences.

04:02 Demonstrate respect for patient cultural values, privacy, and decision making autonomy.

04:09 Approach each patient encounter with humility and a willingness to learn from their unique experiences and perspectives.

04:17 Beyond recognizing difference, value, and celebrate others to create an environment where patients feel understood and included.

04:27 This includes adaptations and language for more inclusive healthcare.

04:33 Consider offering interpretation services for patients who speak languages other than your primary language.

04:40 Use clear and simple language to ensure patients understand medical information, especially whenever you are discussing complex concepts.

04:51 Also, avoid making assumptions about patient's beliefs or values based on stereotypes or generalizations.

05:00 If unsure about a patient's cultural beliefs or practices, ask open ended questions to seek clarification respectfully, especially without full context on a screen, it can be really easy to misinterpret situations and make assumptions.

05:21 Involve patients in decision making regarding their care, respecting their cultural preferences and treatment goals.

05:31 Be willing to learn about other cultures.

05:34 Make accommodations and adaptations in your communication to better connect with a wide variety of people and test your assumptions to provide great telehealth communication.

05:48 In an effort to be more mindful of your cultural competency, consider your gesticulation on screen.

05:55 Listen to the situation.

05:57 Kent was speaking with his provider virtually, and he was excited for the new information about his healthcare plan but it was difficult for him to concentrate on the information.

06:08 Their hand and arm movements, the finger crackling, or the annoying tapping it was so distracting that it took away from the message.

06:18 When you are speaking virtually, and in person for that matter, be mindful of your gesticulation - your hand and body movements.

06:28 Remember, you are in a small box.

06:32 When you move dramatically outside of the screen it can be incredibly distracting to your message.

06:40 So first, watch your hand and arm movements.

06:44 Hands can be used to emphasize and act as a visual aid.

06:49 Depending on the camera’s angle and frame the view and the hand motions might be cut off and you may appear as a flailing person.

07:00 It can be distracting. You can miss your point.

07:04 So keep your hands at a neutral position.

07:07 When you use your hands to emphasize a point, keep the movements reasonably within the frame, being mindful of your unique barriers.

07:18 Now, when you are listening, I want you to assume a neutral position.

07:24 If you are standing, keep your hands either to your side or across your belly.

07:31 Some people are tempted to pace, rock back and forth, or bob up and down.

07:37 And if that is your habit, it is preferred you take a seat.

07:42 Place your hands to your side in your lap or flat on a table.

07:46 Whenever you're listening.

07:48 Avoid tapping, fidgeting, looking around.

07:52 Stay concentrated on the video.

07:54 Now, you might utilize a fidget device to help you concentrate.

07:59 And if that's the case, that's great.

08:01 Keep the device below the camera angle.

08:05 Be mindful of possible noises in the background that can be picked up by your computer's microphone.

08:12 Any tapping rocking or background noise can be distracting to the conversation.

08:18 So try to find a private quiet place for conversation.

08:23 Small movements are combined to have a massive impact on the effectiveness of your communication with your patient.

08:32 So here's what I want you to do.

08:35 I want you have to be mindful of your movements whenever speaking with patients.