A patient-centred, culturally safe approach is essential when conducting assessments. Engage patients, families and carers in a respectful and inclusive way, and clearly explain the purpose of the assessment and what to expect throughout the process.
Assessing non-English-speaking patients
For patients who cannot speak English, conduct testing via an interpreter who is preferably present in person:
- Instruct the interpreter to relay the questions exactly as stated by the assessor. The patient’s answers should then be relayed by the interpreter without embellishment.
- The interpreter is not permitted to offer extra help to the patient. The interpreter assists with rehearsing what needs to be remembered for the following day.
- Note in the medical record that an interpreter was used.
When an interpreter is not available:
- Use a staff member or family to translate; noting, there are risks associated with using a non-professional interpreter that need to be managed. The translator may inadvertently change the nature of the question or prompt the patient. While not ideal, the need to complete daily assessment is the priority.
- Consider using a telephone interpreter.
- Provide the test instructions in languages common to the locality. This will rely on the patient being able to read the instructions for themselves.
Date of birth considerations
Some patients may have difficulty providing a date of birth for a range of reasons. Different cultures may express date of birth in different ways. Childhood circumstances may mean a person does not know their actual date of birth through separation from family and/or records not being available or accessible to them. This is particularly relevant for Aboriginal or Torres Strait Islander people who are members of the Stolen Generations and for refugees.
Assessors may need to ask the family what the patient would have given as their date of birth before the injury and use this as the correct answer throughout testing.
Use of culturally appropriate photos and names
It may be helpful to keep several sets of staff photographs (different genders) and names of people from a range of cultural backgrounds. Having people’s faces and names from the same or similar cultural background as the patient can be helpful to aid their recall.
There may be other considerations when assessing people from diverse cultures and backgrounds. Consider the relevant recommendations and principles for that region when undertaking the assessment.
For further guidance, Cultural Perspectives is a tool developed in the United States of America to help healthcare professionals provide culturally competent care to diverse patient populations.
Caring for Aboriginal people
There are no published adaptations to the standard procedures for the Westmead PTA Scale for use when assessing Aboriginal people. Language considerations are essential for people who do not use English as their first language.
Assessors can consider having a set of photographs that depict Aboriginal people in health worker roles for use in the facial recognition item.
The range of factors that can impact successful completion of PTA testing for Aboriginal people means that clinicians may need to rely more heavily on informal assessment or observations, contextual information and clinical judgement in determining PTA status.
Providing culturally safe care
- Follow clinical yarning principles to ensure you are engaging in a culturally appropriate way that establishes trust. The patient’s PTA may affect recognition of the assessor and social yarning from previous assessment days, so the assessor needs to start with social yarning each time they engage with the patient. However, do not prompt the patient with your name or any other orientation or memory items during the social yarn.
- Understand the cultural need to have family members and/or other community supports present at the time of testing and involved in shared decision-making. These people may need help to understand PTA, and the purpose and process of testing.
- Delivering trauma-informed care is critical as TBI is a significant injury and may trigger responses from the patient and/or their family and community related to past trauma. The WellMob website has a range of resources and fact sheets to assist clinicians, patients, their families and communities to navigate trauma.
- Where possible, engage an Aboriginal Liaison Officer, Aboriginal Health Worker or Practitioner to assist in explaining PTA; provide reassurance; and ensure the family understands the importance of not prompting or coaching the patient.
- Where PTA scores suggest the patient has had a moderate to severe brain injury, involving an Aboriginal health professional early can help to establish a collaborative and supportive relationship as the patient is likely to have a prolonged interaction with health and rehabilitation services.