cultures, their assumption of this role can be seen as a threat to parental authority and therefore serve as a barrier to care (National Association of Emergency Medical Technicians, 2000b).

The challenge goes beyond language barriers, however. Providers need to be aware of the various cultures residing in their catchment area so as to be prepared to serve them. Also, understanding different family structures can help avoid hostile reactions resulting from inadvertent disrespect toward families (National Association of Emergency Medical Technicians, 2000b). Providers’ actions can affect patient perceptions of care. A survey of adult patients presenting to an ED with one of six chief complaints found that non–English speakers were less satisfied with their care in the ED, were less willing to return to the same ED if they had a problem they felt required emergency care, and reported more problems with emergency care (Carrasquillo et al., 1999).

Failure to appreciate the importance of culture and language during pediatric emergencies can result in multiple adverse consequences, including difficulties with informed consent; miscommunication; inadequate understanding of diagnosis and treatment by families; dissatisfaction with care; preventable morbidity and mortality; unnecessary child abuse evaluations; lower-quality care; clinician bias; and ethnic disparities in prescriptions, analgesia, test ordering, and diagnostic evaluation (Flores et al., 2002). The National Association of Emergency Medical Technicians emphasizes the use of communication strategies to combat some of the cultural barriers to care that may arise. Examples of these strategies include identifying providers to the patient and family members, identifying a team member to interact with the family members on each call, asking how the patient and family would like to be addressed, using courtesy titles, and watching for verbal and nonverbal cues from families about the amount of information they want and whether they understand what is being explained to them (National Association of Emergency Medical Technicians, 2000b).

Care of Adolescents

Less research on patient- and family-centered care has been conducted for adolescents than for younger children. In fact, relatively little is known about adolescents’ health care preferences or expectations (Britto et al., 2004). Results of a study of adolescents with chronic illness suggest that aspects of interpersonal care are most important to their judgment of quality. Physicians’ honesty and attention to pain are deemed of critical importance. Adolescents also want to participate in their own care and have their views taken seriously by providers (Britto et al., 2004).

Adolescents tend to find the ED a fast-paced, confusing, and frightening place according to results from a focus group of teens in four cities.



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