Speaking my patient's language: bilingual nurses’ perspective about provision of language concordant care to patients with limited English proficiency

Communicating With Spanish-Speaking Families of Hospitalized Children With Medical Complexity

BACKGROUND AND OBJECTIVES

Hospitalized families who use languages other than English (LOE) for care encounter unique communication challenges, as do children with medical complexity (CMC). We sought to better understand communication challenges and opportunities to improve care of families who use LOE from the perspectives of hospital staff and Spanish-speaking parents of CMC.

METHODS

This qualitative project involved secondary analysis of transcripts from a study on family safety reporting at 2 quaternary care children's hospitals and additional primary data collection (interviews) of staff and parents. Bilingual researchers conducted audio-recorded, semistructured interviews with staff and Spanish-speaking parents of CMC during/after hospitalization. We professionally transcribed and translated interviews and developed, iteratively refined, and validated a codebook. Three independent researchers coded interviews using qualitative descriptive methodology and identified emerging themes through thematic analysis.

RESULTS

We coded 49 interviews (13 parents, 11 physicians, 13 nurses, 6 allied health professionals, 6 leaders). Five themes emerged: (1) assumptions and bias regarding specific groups who use LOE for care, (2) importance of trust and relationships, (3) importance of language-concordant care, (4) workarounds to address communication challenges, and (5) the "double-edged" sword of technology. Participant-suggested strategies to improve communication included increasing interpreter access for parents and staff, optimizing technology use, and minimizing bias and assumptions through training.

CONCLUSIONS

Parents of CMC and staff identified challenges and opportunities related to communicating with hospitalized families who use LOE for care. Solutions to improve communication and safety for these families should be attuned to needs of all parties involved.

The experiences of culturally and linguistically diverse health practitioners in dominant culture practice: a scoping review

Increasing the proportion of culturally and linguistically diverse (CALD) health practitioners is identified as one strategy to address healthcare disparities that individuals from minority or under-represented backgrounds experience. However, professional and institutional cultures and structures are known to contribute to the challenges for CALD practitioners who work in dominant culture practice contexts. This scoping review used the theory of Legitimate Peripheral Participation to describe and interpret literature about the experiences of CALD health practitioners in view of informing strategies to increase their representation. A systematised search was conducted across four allied health, medicine and nursing databases. Following abstract and full text screening, articles which fit the inclusion criteria (n = 124) proceeded to data extraction. Categories relating to the experiences of practitioners were extracted, and three themes were identified that were subsequently theoretically interpreted: Discrimination, Consequences and Hierarchy. Discrimination functioned as a barrier to CALD practitioners being legitimised and able to participate equally in healthcare practice, retaining their position at the periphery of the practice community; Consequences reinforced this peripheral position and further impeded legitimation and participation; and Hierarchy was maintained through structures that reinforced and reproduced these barriers. The findings summarise how these barriers are reinforced through the intersections of professional and racial hierarchies, and highlight a need for strategies to address discrimination and structures that marginalise CALD practitioners' identity, practices and participation in their health professional communities.

Pilot Testing Transcreated Spanish-Language Study Materials for Symptom Research With Infants and Parents in the Neonatal Intensive Care Unit

BACKGROUND

Rising admission rates of Hispanic/Latinx families to the neonatal intensive care unit (NICU) have increased the number of non-English-speaking individuals who may wish to participate in research studies. However, a lack of appropriately translated research study materials may limit the opportunity for these families to be involved in research that could impact the care that infants and families receive in the NICU.

PURPOSE

The primary purpose was to pilot test study materials that were transcreated from English to Spanish with the assistance of a bilingual community advisory board with Spanish-speaking parents of NICU infants.

METHODS

A total of 19 Spanish-speaking parents (15 mothers and 4 fathers) who were representative of the population of interest completed paper-and-pencil surveys, along with a cognitive interview. Preliminary data related to decision-making and goals of care, infant symptoms, and their experiences in the NICU were also collected.

RESULTS

The internal reliability of the transcreated study instruments ranged from good to excellent (α= 0.82-0.99). Participants reported that study materials were not offensive and did not make them feel uncomfortable; however, they found some words/phrases to be confusing. Parents had the opportunity to provide suggested wording changes.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Language barriers and a lack of cultural responsiveness can affect the care that infants and their families receive. More accurate and culturally appropriate transcreation of study materials can remove barriers to research participation and facilitate better communication with non-English-speaking families, which may lead to the development of better-informed evidence-based interventions and clinical practices in the NICU.

Measuring pain intensity through physical interaction in an experimental model of cold-induced pain: A method comparison study

OBJECTIVES

Assessment of pain is challenging given its subjective nature. Standard pain assessment tools have limitations. We aimed to compare the verbal numeric rating scale (NRS) and Grasp, a novel handheld electronic device that reports pain by squeezing.

METHODS

To compare Grasp and NRS, healthy adult volunteers were invited to undergo two subsequent standardised tests of cold-triggered pain using a cold pressor test (CPT) at a temperature of 3°C. Pain intensity was in a randomised manner reported by NRS (scale 0-10) or by squeezing Grasp (0-3 V) during the two CPTs. A third CPT was performed 1 to 14 days later where subjects reported pain by Grasp a second time in order to study the association of repeated Grasp measurements. Acceptable association was a priori considered as mean Kendall's τ-b coefficient (τ-b) ≥ 0.7. The subjects reported their experience of using Grasp in a purpose-made questionnaire.

RESULTS

In total, 102 subjects were included, and 96 subjects (56 females) completed all three tests. The association of pain intensity reported by Grasp and NRS was moderate with a mean τ-b of 0.53 (95% confidence interval [CI] 0.47-0.58). The association between the repeated Grasp measurements was weak with a mean τ-b of 0.43 (95% CI 0.37-0.48). Most subjects reported that Grasp was intuitive and easy to use.

CONCLUSIONS

Pain intensity reported by squeezing Grasp did not show acceptable association with pain intensity reported by NRS during CPTs. The association between pain intensity reported by Grasp during two CPTs on separate days was weak. Further improvements of the Grasp ball are needed before use in clinical settings.

A qualitative study exploring nurses' experiences of supporting South Asian people with dementia and their family carers

AIMS

To explore nurses' experiences of providing support to South Asian (SA) people with dementia and their family carers and to identify barriers and enablers of good transcultural care.

DESIGN

A qualitative, phenomenological design was used.

METHODS

Fifteen registered community and in-patient nurses were recruited via one NHS Mental Health Foundation Trust. Nurses were from diverse backgrounds (Black, Ghanaian, Irish, Mauritian and White), 13 females and 2 males, and had been qualified from between 2 and 49 years. One-to-one semi-structured interviews were conducted between July and October 2019.

RESULTS

A thematic analysis identified three themes. 'Communication challenges' highlighted the impact of language barriers and the consequences of misunderstandings due to a dissonance in cultural values between nurses and interpreters. 'The bi-directional impact of culture' identified the two-way dynamics of transcultural work, the process of countering mutual stigma, and revealed an original perspective on how 'cultural desire' grows through practice experiences rather than being a prior motivation for learning. 'Learning experiences' showed that most learning was informal, experiential and prolonged, with nurses feeling they had unmet learning needs.

CONCLUSION

Nurses have minimal training opportunities and are under-supported in their transcultural work, potentially perpetuating the disadvantages that SA people with dementia and their families face in relation to healthcare. Enhanced cultural understanding of self and others and application of specific communication strategies could support nurses, together with interpreters, to build rapport and effective working relationships with each other and service users.

IMPACT

Transcultural nursing is a key competency, but nurses experience difficulties with providing care which is recognized as effective by SA family carers. The development of more acceptable and effective services requires improved mutual cultural understanding between nurses, interpreters and families, underpinned by joint brief training interventions, leading to more effective professional communication, better care outcomes and improved satisfaction with services.

Does pain hurt more in Spanish? The neurobiology of pain among Spanish-English bilingual adults

We previously found Spanish-English bilingual adults reported higher pain intensity when exposed to painful heat in the language of their stronger cultural orientation. Here, we elucidate brain systems involved in language-driven alterations in pain responses. During separate English- and Spanish-speaking fMRI scanning runs, 39 (21 female) bilingual adults rated painful heat intermixed between culturally evocative images and completed sentence reading tasks. Surveys of cultural identity and language use measured relative preference for US-American vs Hispanic culture (cultural orientation). Participants produced higher intensity ratings in Spanish compared to English. Group-level whole-brain differences in pain-evoked activity between languages emerged in somatosensory, cingulate, precuneus and cerebellar cortex. Regions of interest associated with semantic, attention and somatosensory processing showed higher average pain-evoked responses in participants' culturally preferred language, as did expression of a multivariate pain-predictive pattern. Follow-up moderated mediation analyses showed somatosensory activity mediated language effects on pain intensity, particularly for Hispanic oriented participants. These findings relate to distinct ('meddler', 'spotlight' and 'inducer') hypotheses about the nature of language effects on perception and cognition. Knowledge of language influences on pain could improve efficacy of culturally sensitive treatment approaches across the diversity of Hispanic adults to mitigate documented health disparities in this population.

The Impact of Standardized Recovery Pathways on Language Barriers and Inpatient Pain Management

BACKGROUND AND OBJECTIVES

Inpatient postoperative care is reliant upon clear, open communication between providers and patient-families, and thus is particularly vulnerable to disparities when discordant languages exist. It is not yet understood how standardized postoperative protocols may mitigate disparities related to language discordance.

METHODS

This is a retrospective cohort study among adolescent idiopathic scoliosis patients who underwent posterior spinal fusion at a tertiary care children's hospital in Bronx, New York after implementation of a postoperative pathway in 2017. Outcomes reliant upon communication between patient-families and providers were measured, including measures of pain management (number and type of pain medications requested, daily pain assessments, total opioids consumed), as well as outpatient pain scores.

RESULTS

A total of 160 patients were included (39 language other than English [LOE]). Between patient cohorts, there were no significant differences in demographic or operative characteristics. On univariate analyses, LOE patients were more likely to be given a basal dosing of patient-controlled analgesia or additional boluses (26% vs 12%, P = .03), consumed 0.53 fewer benzodiazepine medications per day (P = .01), and were more likely to have pain at outpatient follow-up (67% vs 43%, P = .03). On multivariate analyses, LOE patients were more likely to be placed on basally dosed or receive additional boluses of patient-controlled analgesia (odds ratio 3.19, 95% confidence interval 1.15-8.85).

CONCLUSIONS

As standardized pathways become more common in health care, it is critical to monitor for components of these protocols that may be vulnerable to language-related disparities, such as therapies reliant on symptom description and outpatient follow-up.

Bilingual modified flipped learning in international nursing education: A discursive approach

Finland is experiencing a nurse shortage, leading to the recruitment of internationally educated nurses (IENs). The Finnish education system aims to attract more international students, including those in healthcare. International nursing students (INS) face challenges due to language barriers and cultural differences. This paper introduced the bilingual modified flipped learning (BMFL) approach to address these issues. The BMFL, grounded in constructivist learning theory, incorporated flipped learning and learning stations to facilitate INS integration. It emphasized autonomy and collaboration, with students engaging in pre-class content and in-class interactive activities. The strategy enhanced language skills, clinical decision-making, and communication. Policy and practice recommendations were proposed to support the integration of BMFL, targeting the alleviation of nurse shortages and facilitating the harmonious integration of INS into the Finnish healthcare workforce.

Agency in change: Learning experiences of international midwifery students in South Australia

PROBLEM

While literature reports broadly on the experiences of international students of health professions in higher education, the experience of students undertaking an undergraduate midwifery program outside their country of origin has not previously been reported.

BACKGROUND

Midwifery studies incorporate distinct clinical practice and discipline-specific therapeutic relationships which can challenge students familiar with the health system, so it is necessary to understand their impact on the learning needs of international students, who contribute to the diversity of our workforce.

AIM

To explore learning experiences of international students of an undergraduate midwifery program to identify their perceptions and personal strategies which impacted their participation in the program.

METHODS

A qualitative descriptive study, with a purposive sample of nine current international students and recent graduates of a midwifery program at a South Australian university. Participants attended a focus group or individual phone interview to explore their learning experiences, and data were thematically analysed.

FINDINGS

Five themes and sub-themes were identified, built around a core concept of the international midwifery student experience as agency in change: language and culture, teaching and learning, isolation and integration, services and support, and motivation and resilience. Studying abroad was associated with personal and professional growth. Continuity of care for women presented challenges and produced learnings unique to this cohort.

CONCLUSION

Tailored support, such as specialized clinical facilitation and organized peer networking, is required for international midwifery students in Australia. Additionally, effective approaches to facilitate bilingualism to support language concordant care are needed.

Health professionals interface with cultural conflict in the delivery of type 2 diabetes care

OBJECTIVE

This study explored the knowledge and experiences of health professionals (HPs) caring for South Asian patients with type 2 diabetes (T2D).

DESIGN

Fourteen HPs, who supported patients with T2D, were interviewed. The recruitment strategy employed purposeful and theoretical sampling methods to recruit HPs who worked across primary and secondary care settings.

MAIN OUTCOME MEASURES

Grounded Theory (GT) methodology and analysis generated a theoretical framework that explored HP's perceptions and experiences of providing diabetes care for South Asian patients.

RESULTS

A GT, presenting a core category of Cultural Conflict in T2D care, explores the influences of HP's interactions and delivery of care for South Asian patients. This analysis is informed by four categories: (1) Patient Comparisons: South Asian vs White; (2) Recognising the Heterogeneous Nature of South Asian Patients; (3) Language and Communication; (4) HPs' Training and Experience.

CONCLUSIONS

The findings consider how the role of social comparison, social norms, and diminished responsibility in patient self-management behaviours influence HPs' perceptions, implicit and explicit bias towards the delivery of care for South Asian patients. There was a clear call for further support and training to help HPs recognise the cultural-ethnic needs of their patients.

Development and Validation of the Soft Skills Questionnaire for Nurses

Introduction

Skills challenge has been given great attention for its impact on employees' performance. Various approaches have been put forward to design professional development programs that help in preparing nurses to work in the field and ongoing training programs to keep them up to each new method and technique at the interpersonal improvement level.

Objective

To develop and validate a questionnaire that tests the communication and management skills, emotional intelligence, and confidentiality of nurses in Lebanon.

Methods

The questionnaire, consisting of 25 statements, was generated and developed by experts in the field of nursing, soft skills, and questionnaire development. The items of the questionnaire were assessed using face, content, and construct validity and data validation was examined through psychometric properties at the final stage of the validation. Internal consistency and reliability were assessed through Cronbach alpha ( α ). Further analyses were carried out to decide on the number of factors to be extracted using Oblimin Rotation method. All statistical tests were performed using Statistical Package for the Social Sciences (SPSS 20.0).

Results

Nineteen items of the 25-item scale had an I-CVI of 1.00 and the remaining six items had an I-CVI of 0.87. The S-CVI/UA was 0.76 and the S-CVI/Ave was 0.97, which meant that the items were good for the underlying construct. For the psychometric measures, the results were quite accepted and satisfactory. The Kaiser-Meyer-Oklin measure of sampling adequacy and the significance for the Bartlett's test for the whole questionnaire were quite acceptable with 0.680 and 0.000, respectively. Furthermore, the Cronbach alpha (α) value was 0.824 indicating a high internal consistency between the items of the questionnaire. While obtaining exploratory factor analysis for each section, results showed that Oblimin Rotation method should be applied to the last section in which three items were eliminated to maintain a simple factor structure.

Conclusion

This study shows that the 25-item Soft Skills Questionnaire is a valid and reliable tool for evaluating the level of communication of nurses, their emotional intelligence, confidentiality, and management.

Efficacy of a language-concordant health coaching intervention for latinx with diabetes

OBJECTIVE

To describe the effect of a language-concordant health coaching intervention for Spanish-speaking patients with limited English proficiency (LEP) and uncontrolled Type 2 Diabetes (T2D) on glycemic control, anxiety, depression, and diabetes self-efficacy.

METHODS

64 patients with T2D were randomly assigned to a control or intervention group. Outcomes were assessed by blood work and surveys pre and post intervention.

RESULTS

The mean sample age was 47.8 years (SD=11.3) and 81% were female. HbA1c was not significantly different between groups at baseline. The intervention group's HbA1c was significantly lower at times 2 and 3 than in the control arm (p < .01 and p < .001). There were significant reductions in the intervention group's mean HbA1c levels from baseline 10.37 to midpoint 9.20, p < .001; and from baseline 10.42 to study end 8.14, p < .001. Depression and anxiety scores significantly decreased (p < .05 and p < .001), and diabetes self-efficacy significantly increased (p < .001).

CONCLUSION

Health coaching led to statistically significant and clinically meaningful decreases in HbA1c, depression, and anxiety scores among LEP Latinx adults with uncontrolled T2D.

PRACTICE IMPLICATIONS

Heath coaching can be conducted in primary care clinics by nurses or advanced practice nurses. The short-term intervention tested here could be adapted to the clinical setting.

Limited English proficiency in the labor and delivery unit

PURPOSE OF REVIEW

Limited English proficiency (LEP) impacts patient access to safe and comprehensive care during the antepartum, intrapartum, and postpartum periods. In this review, we explore disparities in care delivery and outcomes that LEP women experience, and discuss the importance of providing language concordant care and using interpretation services appropriately.

RECENT FINDINGS

The number of individuals with LEP is steadily increasing in the United States. Pregnant women with LEP suffer disparities in obstetric care and are at risk for postpartum depression, breastfeeding difficulties, and substandard newborn care after neonatal ICU discharge because of insufficient education. Addressing these issues requires the implementation of language concordant care and education, along with the utilization of medically trained interpreters. Although further evidence is needed, the authors support these interventions to improve patient satisfaction, decrease medical errors, and curtail misdiagnoses.

SUMMARY

The pregnant woman with limited English proficiency is at risk of receiving suboptimal care and experiencing negative outcomes during the antepartum, intrapartum, and postpartum periods. The use of medically trained interpreters and the provision of language concordant care, through workforce diversification and the creation of forms and educational materials in diverse languages, can improve patient safety, outcomes, and quality of care.

Nurses' experiences of providing transcultural nursing care to minority patients in Yunnan province: A descriptive qualitative study

Cultural competency is essential for providing transcultural nursing care. This qualitative study explores nurses' experiences of providing transcultural nursing care to patients from ethnic minority in Yunnan province, China, with the aim of supplementing and enriching previous quantitative research. Yunnan is home to 25 ethnic minorities with the highest proportion (33.1%) of people from ethnic minorities in China. A descriptive qualitative method was used to describe the experiences of 12 nurses. Data were collected in October 2020 through semistructured interviews and analyzed using conventional content analysis methods. Three themes were generated, including limitations of resources to provide transcultural nursing care, challenges in providing transcultural nursing care, and concerns about the quality of nursing care. The results suggest that there is scope for improving cultural competence of nurses in Yunnan through education that would enable them to provide high-quality transcultural nursing care. Training topics could include transcultural knowledge, cultural sensitivity, minority languages, and immersive multicultural experiences. Other suggested improvements include a resource room for transcultural care, the accommodation of religious and dietary needs, and dedicated staff who lead transcultural care in hospitals.

Linguistic barriers and healthcare in China: Chaoshan vs. Mandarin

BACKGROUND

China has 129 dialects with Mandarin as the standard and Chaoshan as the major dialect of the Chaoshan region in Guangdong. This study aimed to describe the dialect competence and usage, communication difficulty, impact of linguistic barriers, and subjective experience in healthcare.

METHODS

Healthcare providers (n = 234) and healthcare consumers (n = 483) at two tertiary teaching hospitals in Shantou, Chaoshan region participated in an anonymous survey.

RESULTS

Chaoshan and Mandarin were spoken respectively by ca. 80% and 6.1% of the participants. Monolinguals accounted for 28.5%, including 16.8% of Chaoshan-speaking healthcare providers and 18% of Mandarin-speaking healthcare consumers. The monolinguals preferentially used their competent dialect (Ps < 0.001) and had significant communication difficulties (Ps < 0.0001), with the mean (SD) score of 3.06 (0.96) out of 4 with Mandarin for healthcare providers and 2.18 (1.78) and 1.64 (1.40) with Mandarin and Chaoshan, respectively, for healthcare consumers. The monolingual healthcare providers perceived significant negative impacts of linguistic barriers on the entire healthcare delivery process (Ps < 0.0001). Regression analyses showed the length of stay in the Chaoshan region as a protective factor of linguistic barrier with a limited protective effect.

CONCLUSIONS

This is the first report of significant linguistic barriers in healthcare imposed by Mandarin and Chaoshan dialects in Chaoshan, China. With perceived adverse impacts on the entire healthcare delivery and risks to the healthcare quality and burden, interventions such as professional interpreter service, service-learning interpreter program, or mobile interpreting apps that are medically accurate and culturally sensitive are suggested for dialectally diverse China.

Nurses' Working Experiences of Their Provision of Cross-Cultural Services to Tibetan Patients With Kashin-Beck Disease: A Qualitative Study

INTRODUCTION

Limited qualitative studies exist on nurses' experience in terms of communicating with and caring for patients with endemic diseases. The purpose of this study was to describe the working experiences of nurses caring for Tibetan patients with Kashin-Beck disease in China.

METHOD

A qualitative design was used in this study. Sixteen nurses who worked in the orthopedics department of a large tertiary general hospital in Wuhan, China, constituting a purposive sample, were interviewed face-to-face using semi-structured guided questions.

RESULTS

Three major themes and nine subthemes were identified. Major themes included the challenge in cross-cultural nursing, stress adjustment in cross-cultural nursing, and reshaping competencies in cross-cultural nursing.

DISCUSSION

This study revealed that nurses encountered multifaceted challenges when caring for Tibetan patients with Kashin-Beck disease. In a multiethnic society, communication and language skills, cultural competency and cultural sensitivity, and diverse training methods to improve cross-cultural knowledge could increase ethnic minority patient satisfaction with cross-cultural care.

Development and perceptions of an academic success tool for pharmacy students

OBJECTIVE

Some students may face challenges with graduate-level reading and writing, particularly in certain active learning pedagogies, such as team-based learning or peer instruction, which require extensive pre-reading. The objective of this study is to determine the perceived utility of an academic literacy (reading/writing) test for first professional year student pharmacists (P1s).

METHODS

In a collaboration between pharmacy and linguistics faculty, an academic literacy assessment tool was developed using fall P1 course materials. After pilot testing and adjustments, the revised test was administered to all P1 students by trained facilitators, then scored. Students needing literacy support were identified, met with individually to debrief on the assessment, and offered a year-long, one-on-one tutoring program. P1 faculty participated in an end-of-semester focus group session to determine whether the assessment correctly identified students who benefited from literacy support, and to decide on the impact of subsequent support. Thematic analysis was performed on the data.

RESULTS

A total of 13 students were identified as at-risk through the assessment. Since tutoring was optional, eight students met at least once, and two students met weekly during the ensuing semester. Faculty from the end-of-semester focus group 1) stated that the assessment accurately pre-identified students who struggled with literacy components of P1 coursework, and 2) expressed a wish for earlier identification of students with required instead of optional tutoring.

CONCLUSIONS

Faculty perceived that the tool accurately identified students, but the timing and the volunteer nature of the follow-up tutoring limited the success of the assessment effort.

Enabling Nurse-Patient Communication With a Mobile App: Controlled Pretest-Posttest Study With Nurses and Non-English-Speaking Patients

BACKGROUND

There is growing concern regarding the implications of miscommunication in health care settings, the results of which can have serious detrimental impacts on patient safety and health outcomes. Effective communication between nurses and patients is integral in the delivery of timely, competent, and safe care. In a hospital environment where care is delivered 24 hours a day, interpreters are not always available. In 2014, we developed a communication app to support patients' interactions with allied health clinicians when interpreters are not present. In 2017, we expanded this app to meet the needs of the nursing workforce. The app contains a fixed set of phrases translated into common languages, and communication is supported by text, images, audio content, and video content.

OBJECTIVE

This study aims to evaluate the efficacy of the communication app to support nursing staff during the provision of standard care to patients from non-English-speaking backgrounds when an interpreter is not available.

METHODS

This study used a one-group pretest-posttest sequential explanatory mixed methods research design, with quantitative data analyzed using inferential statistics and qualitative data analyzed via thematic content analysis. A total of 134 observation sessions (82 pretest and 52 posttest) of everyday nurse-patient interactions and 396 app use sessions were recorded. In addition, a total of 134 surveys (82 pretest and 52 posttest) with nursing staff, 7 interviews with patients, and 3 focus groups with a total of 9 nursing staff participants were held between January and November 2017.

RESULTS

In the absence of the app, baseline interactions with patients from English-speaking backgrounds were rated as more successful (t₈₀=5.69; P<.001) than interactions with patients from non-English-speaking backgrounds. When staff used the app during the live trial, interactions with patients from non-English-speaking backgrounds were rated as more successful than interactions without the app (F_2,119=8.17; P<.001; η²=0.37). In addition, the level of staff frustration was rated lower when the app was used to communicate (t₈₀=2.71; P=.008; r=0.29). Most participants indicated that the app assisted them in communicating.

CONCLUSIONS

Through the use of the app, a number of patients from non-English-speaking backgrounds experienced better provision of standard care, similar to their English-speaking peers. Thus, the app can be seen as contributing to the delivery of equitable health care.

Interpersonal Communication in Transcultural Nursing Care in India: A Descriptive Qualitative Study

Introduction: Good communication is crucial for safe and effective nursing care and is necessary in building interpersonal relationships with patients. The increase of global interactions in health care adds to the necessity of developing culturally competent communication in nursing. The purpose of the study was to gain a deeper understanding of interpersonal communication as experienced by nurses working in culturally diverse hospitals in India. Method: A descriptive qualitative method, analyzing 12 semistructured interviews conducted with nurses at two hospitals. Results: The study's themes focus on tools and techniques for working with culturally diverse patients and how to sustain the quality of care in diverse hospital settings. Language resources, language tools, and cultural knowledge were useful aids for nurses when communicating with transcultural patients. It helped the nurses gain confidence and foresee patient needs. Discussion: Highlighting transcultural interpersonal communication techniques within nursing offers a safer and more productive practice of nursing care.

Feasibility and Acceptability of a Language Concordant Health Coaching Intervention Delivered by Nurses for Latinx With Type 2 Diabetes

BACKGROUND

Latinx immigrants have high rates of type 2 diabetes (T2D), exhibit out-of-range glycemic control, and have higher rates of diabetes-related complications than non-Latinx whites, with limited English proficiency (LEP) being a major barrier to care.

AIMS

We tested the feasibility and acceptability of a language concordant (provider that is proficient in the patient's preferred language) health coaching intervention delivered by nurse and nurse practitioner students in a pilot study of Latinx immigrants with T2D and LEP.

METHODS

A sample of 17 Latinx immigrants with T2D and LEP were split into intervention and control groups. The control group received basic diabetes care and written educational materials on diabetes self-management in Spanish. Individuals in the intervention group received the standard diabetes care offered by the clinic and six biweekly health coaching sessions (intervention) with a trained language concordant health coach.

RESULTS

The language concordant health coaching intervention was both feasible (delivery) and acceptable (satisfactory) to Latinx immigrants with T2D and LEP and resulted in clinically meaningful differences in key diabetes-related outcomes.

LINKING EVIDENCE TO ACTION

Our findings suggest that lack of language concordance between provider and patient has an important and meaningful impact on the ability of an LEP Latinx patient to receive, and perhaps act upon, adequate education for T2D management. Receiving biweekly coaching calls could have offered further emotional support for participants to discuss living with T2D, which may have helped to alleviate symptoms of depression and anxiety that individuals with T2D frequently endure.

How does culture influence work experience in a foreign country? An umbrella review of the cultural challenges faced by internationally educated nurses

BACKGROUND

Internationally educated nurses experience multidimensional challenges affecting their acculturation process in a foreign country. Cultural differences have been highlighted by research as a common barrier. There is a need to understand the cross-cultural challenges experienced by internationally educated nurses to promote a culturally inclusive workplace, particularly when these nurses practice in another country wherein cultural attitudes and beliefs are different from their own.

OBJECTIVES

To identify and synthesise the challenges to cultural values, beliefs, and practices of internationally educated nurses working in a foreign country.

DESIGN

An umbrella review was undertaken by synthesising evidence from systematic reviews.

DATA SOURCES

Databases searched were MEDLINE, Embase, PsychINFO, CINAHL and Scopus. Reviews published between 2000-2019 were considered.

METHODS

The review protocol was guided by the guidelines from the Joanna Briggs Institute. The Joanna Briggs Institute Critical Appraisal Instrument for Systematic Reviews and Research Syntheses was used to evaluate the methodological quality of the retrieved reviews. The extracted findings were tabulated, categorised into themes, and presented in a narrative synthesis.

RESULTS

Ten reviews met the inclusion criteria. These reviews examined the experiences of internationally educated nurses from different countries. The reviews highlighted that cultural differences had impacted the adaptation and professional experiences of internationally educated nurses. Four themes were identified: cultural differences lead to the feeling of being an outsider, intercultural communication issues transcend beyond fluency, differing nursing cultures complicate adaptation, and ethnic identity challenges work adjustment.

CONCLUSIONS

Despite having a great interest in the literature on the experiences and issues faced by internationally educated nurses, a distinct gap still exists. There is an absence of knowledge on the challenges experienced by internationally educated nurses concerning their cultural beliefs, values, and practices. Further work is needed to enhance understanding and to promote a culturally sensitive workplace.

Developing Bilingualism in Nursing Students: Learning Foreign Languages beyond the Nursing Curriculum

Nursing curriculum usually focuses on vocational development to train students to become nursing professionals after graduation. However, due to the packed major schedule and curriculum, many students are not required to take additional foreign language courses for their associate degree. Based on the lens of social cognitive career theory, the researcher sought to understand the motivations and reasons behind the learning behaviours. One research question was guided in this study, which was, what are the motivations and reasons for taking foreign language courses beyond their (i.e., nursing students) major curriculum and coursework plan? A qualitative research method was employed to collect interview data from 60 nursing students. The finding of this study indicated that the interest in career development and personal consideration were two of the most important factors for foreign language learning for these groups of nursing students. The results of this study provided recommendations for college leaders, government agencies, and policymakers to reform and polish foreign language courses and offer directions to contemporary students of the nursing curriculum. Students may also be benefitted as the study outlined the motivations and reasons for foreign language learning. Therefore, all parties may take this study as a blueprint to exercise their future developments.

Language barriers between nurses and patients: A scoping review

OBJECTIVE

Global migration and linguistic diversity are at record highs, making healthcare language barriers more prevalent. Nurses, often the first contact with patients in the healthcare system, can improve outcomes including safety and satisfaction through how they manage language barriers. This review aimed to explore how research has examined the nursing workforce with respect to language barriers.

METHODS

A systematic scoping review of the literature was conducted using four databases. An iterative coding approach was used for data analysis. Study quality was appraised using the CASP checklists.

RESULTS

48 studies representing 16 countries were included. Diverse healthcare settings were represented, with the inpatient setting most commonly studied. The majority of studies were qualitative. Coding produced 4 themes: (1) Interpreter Use/Misuse, (2) Barriers to and Facilitators of Quality Care, (3) Cultural Competence, and (4) Interventions.

CONCLUSION

Generally, nurses noted like experiences and applied similar strategies regardless of setting, country, or language. Language barriers complicated care delivery while increasing stress and workload.

PRACTICE IMPLICATIONS

This review identified gaps which future research can investigate to better support nurses working through language barriers. Similarly, healthcare and government leaders have opportunities to enact policies which address bilingual proficiency, workload, and interpreter use.

Effects of Language Context and Cultural Identity on the Pain Experience of Spanish-English Bilinguals

While language and culture influence cognition, their role in shaping pain remains understudied. We tested whether language and cultural identification influence pain report among Spanish-English bilinguals. Eighty bilingual Hispanics/Latinos (40 female) experienced painful thermal stimulations, providing pain intensity and unpleasantness ratings, on separate English and Spanish testing days. Participants' skin conductance responses (SCRs) during stimulations served as measures of physiological arousal. Bilingual participants showed larger SCRs and higher pain intensity when speaking the language congruent with their dominant cultural identification. That is, those endorsing more Hispanic cultural identification showed higher pain in Spanish, while US-American-dominant participants demonstrated increased pain in English. Follow-up moderated mediation demonstrated that SCRs mediated language effects on pain ratings for participants endorsing greater Hispanic cultural identification. Together, our results suggest language, cultural associations, and bodily arousal synergistically influence pain evaluations among bilingual people, potentially contributing to well-documented health disparities between Hispanic and non-Hispanic communities.

Scoping review: Definitions and outcomes of patient-provider language concordance in healthcare

OBJECTIVE

To conduct a scoping literature review to understand the conceptualization and nature of the research on patient-provider language concordance (LC) in health care.

METHODS

We searched PubMed, EMBASE, CINAHL, PsycINFO, and Scopus to identify peer-reviewed articles between January 1961 and August 2018. We extracted study characteristics, content, definitions, and findings.

RESULTS

Fifty studies were included. Forty studies were quantitative, seven were qualitative, and three were mixed methods. Overall, the studies revealed inconsistent definitions and measures of patient-provider LC. Outcomes studied in connection to LC included: (1) interpersonal relationships, (2) access to health information, (3) access to care, (4) satisfaction and health-care experience, and (5) patient-related health outcomes. While four studies found that LC care had a negative or no impact on health outcomes, 46 studies reported positive outcomes associated with LC care.

CONCLUSIONS

The study findings highlight the need for more research on LC care and a consistent definition of LC using multiple measures of LC to capture the complex and multidimensional nature of language in social interaction.

PRACTICAL IMPLICATIONS

The study findings highlight the importance of how ideologies of language shape the perceptions of language and LC, thereby influence resource allocation and priorities.

The perceptions of translation apps for everyday health care in healthcare workers and older people: A multi-method study

AIMS AND OBJECTIVES

To understand the attitudes and perceptions of older people with limited English proficiency (LEP) and healthcare workers to using mobile translation technology for overcoming language barriers in the healthcare setting.

BACKGROUND

Australia's cohort of people aged 65 and over has a sizeable population with LEP. In healthcare settings, difficulties with communication may potentially result in inadequate care. Mobile language translation applications have been identified as a potential way to improve communication between patients and healthcare staff when used as an adjunct to professional interpreters in low-risk scenarios; however, the perceptions of the use of mobile translation applications for such communication is unknown.

METHODS

A multi-method design was used. Focus group discussions were conducted with older people from culturally and linguistically diverse (CALD) backgrounds and nursing and allied health professionals to understand their perceptions of translation technology. Qualitative data were analysed using inductive content analysis. Qualitative findings were reported using the Standards for Reporting of Qualitative Research (SRQR) checklist. Participants also appraised three existing translation apps via survey and results were analysed using descriptive statistics.

RESULTS

Overall, older people from CALD backgrounds (n = 12) and healthcare staff (n = 17) agreed that translation technology could play a role in reducing communication barriers. There was enthusiasm amongst older people to learn and use the technology, while healthcare staff saw the potential to address communication barriers in their own work. Barriers identified by older people and healthcare staff included: accuracy of translation and phrases, possible technological learning curves, risk of mistranslation in high-risk conversation and inability to check accuracy of translation. Fixed-phrase translation apps were seen as more favourable than real-time voice-to-voice mobile translation applications.

CONCLUSIONS

Older people from CALD backgrounds and healthcare staff were open to the use of mobile translation applications for everyday healthcare communications.

RELEVANCE TO CLINICAL PRACTICE

Translation applications may have a role in reducing language barriers in everyday healthcare communication but context, accuracy and ease of use need to be considered.

Social Support for Arab People with Chronic Conditions: A Scoping Review

Social support can play a crucial role in psycho-social well-being of people with chronic conditions. There is limited information about the experiences, barriers and sources of social support of Arab people affected by chronic conditions. The purpose of this review is to explore the experiences, barriers and sources of social support of Arab people affected by chronic conditions. A scoping review of the literature, based on Preferred Reporting Items for Scoping Reviews and Meta-Analyses (PRISMA) guidelines. Articles (n = 13) were identified for appraisal based on a group of inclusion and exclusion criteria. Eight articles were included in the final analysis. Three broad themes were identified: (a) Social support benefits-physical, emotional and financial benefits; (b) Source of social support-family and friends support, and (c) Support services utilization-cultural barrier, Arab migrants language and unfamiliarity with the health system barriers. Appropriate future support programs should be tailored based on Arab cultural beliefs and the inherent responsibility of the family together inside the Arab community.

Communication issues contributing to medication incidents: Mixed-method analysis of hospitals' incident reports using indicator phrases based on literature

AIM

To identify the types and frequencies of communication issues (communication pairs, person related, institutional, structural, process and prescription-related issues) detected in medication incident reports and to compare communication issues that caused moderate or serious harm to patients.

BACKGROUND

Communication issues have been found to be among the main contributing factors of medication incidents, thus necessitating communication enhancement.

DESIGN

A sequential exploratory mixed-method design.

METHODS

Medication incident reports from Finland (n = 500) for the year 2015 in which communication was marked as a contributing factor were used as the data source. Indicator phrases were used for searching communication issues from free texts of incident reports. The detected issues were analysed statistically, qualitatively and considering the harm caused to the patient. Citations from free texts were extracted as evidence of issues and were classified following main categories of indicator phrases. The EQUATOR's SRQR checklist was followed in reporting.

RESULTS

Twenty-eight communication pairs were identified, with nurse-nurse (68.2%; n = 341), nurse-physician (41.6%; n = 208) and nurse-patient (9.6%; n = 48) pairs being the most frequent. Communication issues existed mostly within unit (76.6%, n = 383). The most commonly identified issues were digital communication (68.2%; n = 341), lack of communication within a team (39.6%; n = 198), false assumptions about work processes (25.6%; n = 128) and being unaware of guidelines (25.0%; n = 125). Collegial feedback and communication from patients and relatives were the preventing issues. Moderate harm cases were often linked with lack of communication within the unit, digital communication and not following guidelines.

CONCLUSIONS

The interventions should be prioritised to (a) enhancing communication about work-processes, (b) verbal communication about digital prescriptions between professionals, (c) feedback among professionals and (f) encouraging patients to communicate about medication.

RELEVANCE TO CLINICAL PRACTICE

Upon identifying the most harmful and frequent communication issues, interventions to strengthen medication safety can be implemented.

Conditions for communication between health care professionals and parents on a neonatal ward in the presence of language barriers

Purpose: Family-centred neonatal care views parents and child as a unit, and aims to support each family on the basis of its specific needs. Good communication can increase parents' satisfaction and reduce tension, and is necessary to create a mutual trustful relation, but is influenced by language barriers. We aimed to describe communication between neonatal health care professionals and parents in the presence of language barriers. Methods: A field study using a hermeneutic lifeworld approach, participative observation, and interviews with parents and health care professionals. Results: The main theme, endeavouring to understand the meaning behind the words, comprised three themes. Wanting to speak for oneself meant that parents wanted to speak for themselves or call on a friend or multilingual health care professionals, in contrast to the health care professionals wish to use an interpreter. Being aware of cultural keys meant that some wards had access to a "cultural broker" to assist health care professionals and parents with both language translation and understanding of the Swedish health care environment. Understanding one another in the employees' arena reflected varying language skills among health care professionals. The health care professionals had the power to decide the level of access to communication, and decided both the intensity and the frequency of the conversations. Conclusions: Health care professionals preferred to use an interpreter when communicating with parents, while parents wished to be independent and speak for themselves. If an interpreter was used, parents preferred this to be a friend or health care professionals; this option was less popular among health care professionals.

The power of language-concordant care: a call to action for medical schools

We live in a world of incredible linguistic diversity; nearly 7000 languages are spoken globally and at least 350 are spoken in the United States. Language-concordant care enhances trust between patients and physicians, optimizes health outcomes, and advances health equity for diverse populations. However, historical and contemporary trauma have impaired trust between communities of color, including immigrants with limited English proficiency, and physicians in the U.S. Threats to informed consent among patients with limited English proficiency persist today. Language concordance has been shown to improve care and serves as a window to broader social determinants of health that disproportionately yield worse health outcomes among patients with limited English proficiency. Language concordance is also relevant for medical students engaged in health care around the world. Global health experiences among medical and dental students have quadrupled in the last 30 years. Yet, language proficiency and skills to address cultural aspects of clinical care, research and education are lacking in pre-departure trainings. We call on medical schools to increase opportunities for medical language courses and integrate them into the curriculum with evidence-based teaching strategies, content about health equity, and standardized language assessments. The languages offered should reflect the needs of the patient population both where the medical school is located and where the school is engaged globally. Key content areas should include how to conduct a history and physical exam; relevant health inequities that commonly affect patients who speak different languages; cultural sensitivity and humility, particularly around beliefs and practices that affect health and wellbeing; and how to work in language-discordant encounters with interpreters and other modalities. Rigorous language assessment is necessary to ensure equity in communication before allowing students or physicians to use their language skills in clinical encounters. Lastly, global health activities in medical schools should assess for language needs and competency prior to departure. By professionalizing language competency in medical schools, we can improve patients' trust in individual physicians and the profession as a whole; improve patient safety and health outcomes; and advance health equity for those we care for and collaborate with in the U.S. and around the world.

Development of clinical process measures for pediatric burn care: Understanding variation in practice patterns

BACKGROUND

There has been little systematic examination of variation in pediatric burn care clinical practices and its effect on outcomes. As a first step, current clinical care processes need to be operationally defined. The highly specialized burn care units of the Shriners Hospitals for Children system present an opportunity to describe the processes of care. The aim of this study was to develop a set of process-based measures for pediatric burn care and examine adherence to them by providers in a cohort of pediatric burn patients.

METHODS

We conducted a systematic literature review to compile a set of process-based indicators. These measures were refined by an expert panel of burn care providers, yielding 36 process-based indicators in four clinical areas: initial evaluation and resuscitation, acute excisional surgery and critical care, psychosocial and pain control, and reconstruction and aftercare. We assessed variability in adherence to the indicators in a cohort of 1,076 children with burns at four regional pediatric burn programs in the Shriners Hospital system. The percentages of the cohort at each of the four sites were as follows: Boston, 20.8%; Cincinnati, 21.1%; Galveston, 36.0%; and Sacramento, 22.1%. The cohort included children who received care between 2006 and 2010.

RESULTS

Adherence to the process indicators varied both across sites and by clinical area. Adherence was lowest for the clinical areas of acute excisional surgery and critical care, with a range of 35% to 48% across sites, followed by initial evaluation and resuscitation (range, 34%-60%). In contrast, the clinical areas of psychosocial and pain control and reconstruction and aftercare had relatively high adherence across sites, with ranges of 62% to 93% and 71% to 87%, respectively. Of the 36 process indicators, 89% differed significantly in adherence between clinical sites (p < 0.05). Acute excisional surgery and critical care exhibited the most variability.

CONCLUSION

The development of this set of process-based measures represents an important step in the assessment of clinical practice in pediatric burn care. Substantial variation was observed in practices of pediatric burn care. However, further research is needed to link these process-based measures to clinical outcomes.

LEVEL OF EVIDENCE

Therapeutic/care management, level IV.

Migrants' Healthcare Experience: A Meta-Ethnography Review of the Literature

PURPOSE

Worldwide, more than 214 million people have left their country of origin. This unprecedented mass migration impacts health care in host countries. This article explores and synthesizes literature on the healthcare experiences of migrants.

DESIGN

A meta-ethnography study of qualitative studies was conducted.

METHODS

Eight databases (Medline, the Cumulative Index to Nursing and Allied Health Literature [CINAHL], PsycINFO, Embase, Web of Science, Migration Observatory, National Health Service Scotland Knowledge Network, and Adaptive Spectrum and Signal Alignment [ASSIA]) were searched for relevant full-text articles in English, published between January 2006 and June 2016. Articles were screened against inclusion criteria for eligibility. Included articles were assessed for quality and analyzed using Noblit and Hare's seven-step meta-ethnography process.

FINDINGS

Twenty-seven studies were included in the review. Five key contextualization dimensions were identified: personal factors, the healthcare system, accessing healthcare, the encounter, and the healthcare experience. These five areas all underlined the uniqueness of each individual migrant, emphasizing the need to treat a person rather than a population. Within a true person-centered approach, the individual's cultural background is fundamental to effective care.

CONCLUSIONS

From the findings, a model has been designed using the five dimensions and grounded in a person-centered care approach. This may help healthcare providers to identify weak points, as well as to improve the organization and healthcare professionals' ability to provide person-centered care to migrant patients.

CLINICAL RELEVANCE

The proposed model facilitates identification of points of weakness in the care of migrant patients. Employing a person-centered care approach may contribute to improve health outcomes for migrant patients.

CALD Assist-Nursing: Improving communication in the absence of interpreters

AIMS AND OBJECTIVES

To develop a communication app to support nursing staff during the provision of standard care of patients from non-English-speaking backgrounds (NESBs), when an interpreter is not available. This paper reports on the user needs analysis phase that informed the development, content and functionality of the app.

BACKGROUND

In 2014 we developed CALD Assist, a communication app to support patient interactions with allied health clinicians when interpreters are not present. It includes 95 commonly used phrases professionally interpreted into 10 languages and grouped by discipline. This work expands upon our previous app to meet the needs of the nursing workforce.

DESIGN

Qualitative through focus groups, observations and interviews, with a quantitative component from observational data and staff surveys.

METHODS

Four focus groups with hospital staff, ten interviews with patients from NESBs and 85 observation sessions of everyday patient-staff interactions followed by staff surveys (n = 85) were held between January and June 2017.

RESULTS

Baseline data prior to app development revealed that staff confidence of the patients' level of understanding and the success of the interaction were significantly greater for English-speaking (ES) patients, than for non-English-speaking patients. A total of 143 phrases were identified and subdivided into 16 categories for inclusion in the new app.

CONCLUSION

Staff participants highlighted that patients from NESBs are a challenging patient group to interact with. Patient and staff participants identified a range of areas where the nursing app could benefit, including pain management, mobility, hygiene and nutrition.

RELEVANCE TO CLINICAL PRACTICE

The proposed app can be used to reduce variances in practice and provide a timely and positive patient experience for patients from NESBs who are unable to communicate in English during hospital admissions.

Using root metaphors to analyze communication between nurses and patients: a qualitative study

BACKGROUND

Metaphors in communication can serve to convey individuals' backgrounds, contexts, experiences, and worldviews. Metaphors used in a health care setting can help achieve consensual communication in professional-patient relationships. Patients use metaphors to describe symptoms, or how disease affects them. Health professionals draw on shared understanding of such metaphors to better comprehend and meet patient needs, and to communicate information that patients can more easily integrate into their lives. This study incorporated a theoretical framework based on four worldviews, each with an underlying foundational metaphor (root metaphor). The use of these root metaphors (formism, mechanism, contextualism, and organicism) can have an explanatory function and serve to impart new meanings, as each type of metaphor can lead to a particular interpretation. The study aimed to extract and discuss the root metaphors, with a view to analyzing the communication between health professionals and patients.

METHODS

In a case study in Spain over a six-month period, we analyzed the content of recorded, transcribed interviews conducted by one nurse with 32 patients who had chronic illnesses. We inductively extracted five categories that emerged from the interviews: blood sugar, cholesterol, exercise, blood pressure, and diet. We then examined these categories from the standpoint of each of the four root metaphors using two approaches: A series (deductive) and an emergent (inductive) approach.

RESULTS

The results show that the nurse tended to primarily use two worldviews: mechanism and formism. In contrast, patients tended to favor mechanism when discussing cholesterol, blood pressure, and blood sugar levels, whereas contextualism was predominant when the category was diet or exercise.

CONCLUSIONS

This study adds to the existing literature on health professionals and patients' communication. It shows how the use of Pepper's root metaphors help to analyze the communication between the nurse and patients. Furthermore, it shows they are both using different root metaphors when they are talking about illness and treatments especially regarding blood sugar, cholesterol, exercise, blood pressure, and diet. Further qualitative and quantitative studies are needed to solidly these findings.