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Tjan TE, Wong LY, Rixon A. Conflict in emergency medicine: A systematic review. Acad Emerg Med 2024; 31:538-546. [PMID: 38415363 DOI: 10.1111/acem.14874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND The emergency department (ED) is a demanding and time-pressured environment where doctors must navigate numerous team interactions. Conflicts between health care professionals frequently arise in these settings. We aim to synthesize the individual-, team-, and systemic-level factors that contribute to conflict between clinicians within the ED and explore strategies and opportunities for future research. METHODS Online databases PubMed and Web of Science were systematically searched for relevant peer-reviewed journal articles in English with keywords relating to "conflict" and "emergency department," yielding a total of 29 articles. RESULTS Narrative analysis showed that conflict often occurred during referrals or admissions from ED to inpatient or admitting units. Individual-level contributors to conflict include a lack of trust in ED workup and staff inexperience. Team-level contributors include perceptions of bias between groups, patient complexity, communication errors, and difference in practice. Systems-level contributors include high workload/time pressures, ambiguities around patient responsibility, power imbalances, and workplace culture. Among identified solutions to mitigate conflict are better communication training, standardizing admission guidelines, and improving interdepartmental relationships. CONCLUSIONS In emergency medicine, conflict is common and occurs at multiple levels, reflecting the complex interface of tasks and relationships within ED.
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Affiliation(s)
- Timothy Edward Tjan
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lee Yung Wong
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
- School of Business, Law and Entrepreneurship, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Andrew Rixon
- Department of Business, Strategy and Innovation, Griffith Business School, Griffith University, Brisbane, Queensland, Australia
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Liu J, Chen J, Tian L, Tang C, Shuai W, Lin F, Luo S, Xu X, An J. Translation, cultural adaptation, and validation of Numerical Pain Rating Scale and Global Rating of Change in Tibetan musculoskeletal trauma patients. Sci Rep 2024; 14:11961. [PMID: 38796571 PMCID: PMC11127991 DOI: 10.1038/s41598-024-62777-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/21/2024] [Indexed: 05/28/2024] Open
Abstract
Tibetan-speaking patients seeking care in predominantly Mandarin-speaking healthcare settings frequently face communication barriers, leading to potential disparities and difficulties in accessing care. To address this issue, we translated, culturally adapted, and validated the Numerical Pain Rating Scale (NPRS) and the Global Rating of Change (GRoC) into Tibetan (NPRS-Tib and GRoC-Tib), aiming to facilitate cross-linguistic and cross-cultural interactions while examining potential challenges in the adaptation process. Using standard translation-backward translation methods, expert review, pilot testing, and validation through a cross-sectional study with a short-term longitudinal component, we engaged 100 Tibetan patients with musculoskeletal trauma for psychometric validation, including 37 women (aged 22-60 years, mean age 39.1 years). The NPRS-Tib and GRoC-Tib exhibited outstanding psychometric properties, with an Intraclass Correlation Coefficient (ICC) of 0.983 for NPRS-Tib indicating superb test-retest reliability, and expert review confirming good content validity for both instruments. A Spearman's correlation coefficient (Rho) of -0.261 (P = 0.0087) revealed a significant, albeit weak, correlation between changes in NPRS-Tib scores and GRoC-Tib scores. The adaptation process also presented notable challenges, including translation discrepancies from translators' diverse backgrounds and levels of expertise, ambiguity in scale options, and the lack of established tools for criterion validity assessment in Tibetan.
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Affiliation(s)
- Jinling Liu
- Department of Operating Room, West China Hospital, West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Juncheng Chen
- Southwest Minzu University, No. 16 Section 4 First Ring Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Leilei Tian
- Department of Operating Room, West China Hospital, West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Chuan Tang
- CCU Department of Cardiology, West China Hospital, West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Wenbin Shuai
- Department of Operating Room, West China Hospital, West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Fang Lin
- Department of Operating Room, West China Hospital, West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Shilin Luo
- Department of Operating Room, West China Hospital, West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Xinxin Xu
- Department of Operating Room, West China Hospital, West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Jingjing An
- Department of Operating Room, West China Hospital, West China School of Nursing, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.
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Bakhsh NM, Fatani OA, Melybari RZ, Alabdullah R, Bahakeem RF, Alsharif SH, Alharbi JK, Fatani OA. Language and Communication Barriers in Emergency Departments in Makkah: Physicians' Perspective. Cureus 2024; 16:e58987. [PMID: 38800163 PMCID: PMC11127613 DOI: 10.7759/cureus.58987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 05/29/2024] Open
Abstract
Background Communication is essential in the medical sector, particularly in the emergency departments (ED), to provide appropriate patient care. Lack of patient history and large patient numbers, cultural variations, inadequate health literacy, and language difficulties can impact effective communication. Aim This study aims to examine language and communication barriers experienced by ED physicians in Makkah, Saudi Arabia, as well as to determine the effect of language barriers on patient care and explore possible methods to deal with language and communication barriers. Methods This cross-sectional study was conducted from April 8 to June 6, 2023. A total of 136 responses were collected from ED physicians at the six Ministry of Health Hospitals (MOH) in Makkah through a validated online survey. The data analysis was implemented using RStudio (R version 4.1.1). Result In this study, 136 participants' data were examined. Of note, one-quarter of ED physicians (25%; n=34) under study stated that they always experienced language barriers, whereas 64.7% (n=88) of them sometimes experienced these difficulties. More than half of the ED physicians (54.4%; n=74) stated that their patients had poor outcomes because of poor communication. Among those who responded positively to poor outcomes, ED physicians' suggestions to improve communication with patients included providing labels of the common scientific terminologies in different languages (59.6%; n=81) and providing courses to communicate in foreign languages (48.5%; n=66). Conclusion Exposure to language barriers among ED physicians in Makkah was slightly high. This may impact the patient's outcomes. Therefore, strategies to improve patient-physician communication are needed.
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Affiliation(s)
- Noura M Bakhsh
- Emergency Medicine, King Fahad General Hospital, Makkah, SAU
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Collins LC, Gablasova D, Pill J. 'Doing Questioning' in the Emergency Department (ED). HEALTH COMMUNICATION 2023; 38:2721-2729. [PMID: 35999189 DOI: 10.1080/10410236.2022.2111630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Eliciting information from patients is fundamental to medical professionals' capacity to deliver good healthcare outcomes in Emergency Departments (EDs). There are different kinds of utterances that "do questioning", and health professionals can variously attend to the medical agenda and the interpersonal aspects of their interactions with those attending the ED in the way that they construct these utterances. We investigate a corpus of ED interactions to determine the prevalence and range of utterances produced by doctors and directed at patients that "do questioning." We developed a questioning utterance typology, informed by previous research on the formulation of such utterances and extended according to observations of our data. We subsequently manually coded 4,355 questioning utterances and report the variety of forms that such utterances can take, considering how these are distributed across doctors at different levels of seniority. We found that doctors at different seniority levels favored similar questioning utterance types and the most frequently used appeared to restrict the contributions of patients. We conclude that our extended typology of questioning utterances has value for understanding the ways in which doctors may encourage patients to provide more extensive responses.
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Affiliation(s)
- Luke C Collins
- ESRC Centre for Corpus Approaches to Social Science, Lancaster University
| | | | - John Pill
- Linguistics and English Language, Lancaster University
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Chan HY, Cheung KKC, Erduran S. Science communication in the media and human mobility during the COVID-19 pandemic: a time series and content analysis. Public Health 2023; 218:106-113. [PMID: 37011443 PMCID: PMC9986118 DOI: 10.1016/j.puhe.2023.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/03/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVES The relationship between human mobility and nature of science (NOS) salience in the UK news media was examined. STUDY DESIGN This is a mixed-method study. METHODS A time series NOS salience data set was established from the content analysis of 1520 news articles related to non-pharmaceutical interventions of COVID-19. Data were taken from articles published between November 2021 and February 2022, which correlates with period of the change from pandemic to endemic status. Vector autoregressive model fitting with human mobility took place. RESULTS The findings suggest that it was not the number of COVID-19 news articles nor the actual number of cases/deaths, but the specific NOS content that was associated with mobility change during the pandemic. Data indicate a Granger causal negative direction (P < 0.1) for the effect of the NOS salience represented in the news media on mobility in parks, as well as the effect of scientific practice, scientific knowledge and professional activities communicated in news media on recreational activities and grocery shopping. NOS salience was not associated with the mobility for transit, work or residential locations (P > 0.1). CONCLUSIONS The findings of the study suggest that the ways in which the news media discuss epidemics can influence changes in human mobility. It is therefore essential that public health communicators emphasise the basis of scientific evidence to eliminate potential media bias in health and science communication for the promotion of public health policy. The present study approach, which combines time series and content analysis and uses an interdisciplinary lens from science communication, could also be adopted to other interdisciplinary health-related topics.
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Affiliation(s)
- H-Y Chan
- Transport Studies Unit, School of Geography and the Environment, University of Oxford, South Parks Road, Oxford OX1 3QY, UK.
| | - K K C Cheung
- Department of Education, University of Oxford, 15 Norham Gardens, Oxford OX2 6PY, UK
| | - S Erduran
- Department of Education, University of Oxford, 15 Norham Gardens, Oxford OX2 6PY, UK
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Edelman DS, Palmer DM, Romero EK, Chang BP, Kronish IM. Impact of Native Language, English Proficiency, and Language Concordance on Interpersonal Care During Evaluation of Acute Coronary Syndrome. J Gen Intern Med 2023; 38:946-953. [PMID: 36127540 PMCID: PMC10039209 DOI: 10.1007/s11606-022-07794-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/07/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND High-quality interpersonal interactions between clinicians and patients can improve communication and reduce health disparities among patients with novice English proficiency (NEP). Yet, little is known about the impact of native language, NEP, and native language concordance on patient on perceptions of interpersonal care in the emergency department (ED). OBJECTIVE To determine the associations of native language, NEP, and native language concordance with patient perceptions of interpersonal care among patients undergoing evaluation for suspected acute coronary syndrome (ACS) in the ED. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 1000 patients undergoing evaluation for suspected ACS at an urban ED from 2013 to 2016. MAIN MEASURES English- and Spanish-speaking patients were surveyed to identify native language, English proficiency (classified as advanced, intermediate, or novice), and perceived language of the treating ED clinician. Patient perceptions of interpersonal care were assessed using the Interpersonal Processes of Care (IPC) survey, a validated 18-item tool for assessing social-psychological domains of patient-clinician interactions. IPC scores ≤ 4 were categorized as sub-optimal (range, 1-5). The associations between native language, English proficiency, and native language concordance with sub-optimal communication were assessed using hierarchical logistic regression adjusted for all three language variables, sociodemographic characteristics, and depression. KEY RESULTS Nine hundred thirty-three patients (48.0% native non-English-speaking, 55.7% Hispanic) completed the IPC; 522 (57.4%) perceived native language concordance. In unadjusted analyses, non-English native language (OR 1.38, 95% CI 1.04-1.82) and NEP (OR 1.45, 95% CI 1.06-1.98) were associated with sub-optimal communication, whereas language concordance was protective (OR 0.61, 95% CI 0.46-0.81). In fully adjusted analyses, only language concordance remained significantly associated with sub-optimal communication (AOR 0.62, 95% CI 0.42-0.93). CONCLUSIONS This study suggests that perceived native language concordance acts as a protective factor for patient-clinician interpersonal care in the acute setting, regardless of native language or English proficiency.
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Affiliation(s)
- David S Edelman
- Primary Care/Social Internal Medicine Residency Program, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Dana M Palmer
- Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Emily K Romero
- Teachers College, Columbia University, New York, NY, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, PH9-311, New York, NY, 10032, USA.
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Pun J, Kong B. An exploratory study of communication training for Chinese medicine practitioners in Hong Kong to integrate patients' conventional medical history. BMC Complement Med Ther 2023; 23:10. [PMID: 36635666 PMCID: PMC9834674 DOI: 10.1186/s12906-022-03811-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/28/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Despite Traditional Chinese medicine's (TCM) historical roles in Chinese society, few research has been investigated the nature of TCM practitioner-patient interactions. Improved communication skills among TCM practitioners will result higher-quality interactions and better clinical outcomes. METHODS To investigate the changes in TCM practitioners' communication practices after communications training focused on promoting their awareness of integrating a patient's medical history from conventional medicine in TCM treatment, Eight registered Cantonese-speaking TCM practitioners in Hong Kong were randomly recruited from local clinics and randomised into control (n = 12) and experimental groups (n = 12), with a total of 24 consultations. The experimental group was given training focused on patient-centred communication, with an internationally recognised and communication framework validated in global consultation settings (i.e. the Calgary-Cambridge Guide) on how to take a patient's medical history from conventional medicine and communicate diagnosis and treatment plans. Consultations before and after training were audio-recorded and rated. The efficacy of the training was evaluated by comparing the two groups before training (pre-test), immediately after training (post-test) and after a 3-month delay (delayed post-test). Using validated scales, the primary outcomes were measured for the practitioners' clinical communication skills and the quality of interactions. RESULTS The communication training significantly improved the TCM providers' patient-centred communication and communication proficiency. The results indicate that the team developed an effective communication model for integrating TCM and conventional medicine in Hong Kong. The framework helps trained TCM practitioners to integrate their patients' conventional medical history when delivering patient care. The findings shed light on how interpersonal relationships between TCM practitioners and patients can be constructed after communication training to better care for patients' psychological concerns in addition to their physical needs. CONCLUSION Trained TCM practitioners can provide an integrated model that takes patients' conventional medical history into account when delivering a holistic patient-centred care. The findings can enhance our understanding of better ways to train the future TCM practitioners and to develop a continuing professional training for the current TCM practitioners to expand our understanding of TCM communication in acute clinical contexts and, thus offer a firm evidence-based foundation upon which to develop communication strategies that improve their clinical cpractices.
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Affiliation(s)
- Jack Pun
- Department of English, City University of Hong Kong, 83, Tat Chee Avenue, Kowloon Tong, Hong Kong SAR, China.
| | - Brandon Kong
- Department of English, City University of Hong Kong, 83, Tat Chee Avenue, Kowloon Tong, Hong Kong SAR, China
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Pun J. The priorities, challenges, and scope of clinical communication teaching perceived by clinicians from different disciplines: a Hong Kong case study. BMC PRIMARY CARE 2022; 23:158. [PMID: 35733087 PMCID: PMC9219208 DOI: 10.1186/s12875-022-01770-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022]
Abstract
Background In the absence of a well-rounded syllabus that emphasises both interpersonal and medical dimensions in clinical communication, medical students in the early stages of their career may find it challenging to effectively communicate with patients, especially when dealing with perceived priorities and challenges across different disciplines. Methods To explore the priorities, challenges, and scope of clinical communication teaching as perceived by clinicians from different clinical disciplines, we recruited nine medical educators, all experienced frontline clinicians, from eight disciplines across seven hospitals and two medical schools in Hong Kong. They were interviewed on their clinical communication teaching in the Hong Kong context, specifically its priorities, challenges, and scope. We then performed interpretative phenomenological analysis of the interview data. Results The interview data revealed five themes related to the priorities, challenges, and scope of clinical communication teaching across a wide range of disciplines in the Hong Kong context, namely (1) empathising with patients; (2) using technology to teach both the medical and interpersonal dimensions of clinical communication; (3) shared decision-making with patients and their families: the influence of Chinese collectivism and cultural attitudes towards death; (4) interdisciplinary communication between medical departments; and (5) the role of language in clinician–patient communication. Conclusions Coming from different clinical disciplines, the clinicians in this study approached the complex nature of clinical communication teaching in the Hong Kong context differently. The findings illustrate the need to teach clinical communication both specifically for a discipline as well as generically. This is particularly important in the intensive care unit, where clinicians from different departments frequently cooperate. This study also highlights how communication strategies, non-verbal social cues, and the understanding of clinical communication in the Hong Kong Chinese context operate differently from those in the West, because of differences in sociocultural factors such as family dynamics and hierarchical social structures. We recommend a dynamic teaching approach that uses role-playing tasks, scenario-based exercises, and similar activities to help medical students establish well-rounded clinical communication skills in preparation for their future clinical practice.
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Zhang D, Jiang Z, Xie Y, Wu W, Zhao Y, Huang A, Li T, Ba-Thein W. Linguistic barriers and healthcare in China: Chaoshan vs. Mandarin. BMC Health Serv Res 2022; 22:376. [PMID: 35317814 PMCID: PMC8941784 DOI: 10.1186/s12913-022-07744-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/08/2022] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Dangui Zhang
- Research Center of Translational Medicine, Second Affiliated Hospital of Shantou University Medical College, Shantou, P.R. China
| | - Zichun Jiang
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, P.R. China
| | - Yu Xie
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, P.R. China
| | - Weiming Wu
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, P.R. China
| | - Yixuan Zhao
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, P.R. China
| | - Anqi Huang
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, P.R. China
| | - Tumei Li
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, P.R. China
| | - William Ba-Thein
- Clinical Research Unit, Shantou University Medical College, Xinling Road 22, Shantou, 515041, P.R. China
- Department of Microbiology and Immunology, Shantou University Medical College, Xinling Road 22, Shantou, 515041, P.R. China
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Effectiveness of a Mobile App in Reducing Therapeutic Turnaround Time and Facilitating Communication between Caregivers in a Pediatric Emergency Department: A Randomized Controlled Pilot Trial. J Pers Med 2022; 12:jpm12030428. [PMID: 35330427 PMCID: PMC8948631 DOI: 10.3390/jpm12030428] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 01/27/2023] Open
Abstract
For maintaining collaboration and coordination among emergency department (ED) caregivers, it is essential to effectively share patient-centered information. Indirect activities on patients, such as searching for laboratory results and sharing information with scattered colleagues, waste resources to the detriment of patients and staff. Therefore, we conducted a pilot study to evaluate the initial efficacy of a mobile app to facilitate rapid mobile access to central laboratory results and remote interprofessional communication. A total of 10 ED residents and registered nurses were randomized regarding the use of the app versus conventional methods during semi-simulated scenarios in a pediatric ED (PED). The primary outcome was the elapsed time in minutes in each group from the availability of laboratory results to their consideration by participants. The secondary outcome was the elapsed time to find a colleague upon request. Time to consider laboratory results was significantly reduced from 23 min (IQR 10.5–49.0) to 1 min (IQR 0–5.0) with the use of the app compared to conventional methods (92.2% reduction in mean times, p = 0.0079). Time to find a colleague was reduced from 24 min to 1 min (i.e., 93.0% reduction). Dedicated mobile apps have the potential to improve information sharing and remote communication in emergency care.
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Douglass K, Narayan L, Allen R, Pandya J, Talib Z. Language diversity and challenges to communication in Indian emergency departments. Int J Emerg Med 2021; 14:57. [PMID: 34551712 PMCID: PMC8459521 DOI: 10.1186/s12245-021-00380-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 09/03/2021] [Indexed: 11/26/2022] Open
Abstract
Background Communication in emergency departments (ED) in India is complicated by the country’s immense language diversity. Prior research has revealed challenges in language and communication as barriers to care. Our objective was to quantify language diversity among clinicians in Indian EDs and better understand issues related to clinician-clinician and clinician-patient communication. Methodology A cross-sectional survey of ED clinicians was conducted. Survey participants were recruited in-person and through email at six partner sites in India. ANOVA and binary logistic regression were used for subgroup analysis. Semi-structured interviews were conducted with ED clinicians. Interview data was analyzed using the rapid assessment process to determine predominant themes. Results 106 clinicians completed the survey. On average, clinicians spoke 3.75 languages. Seventy-one percent used a non-English language to speak to fellow clinicians most of the time, and 53% reported at least one critical incident over the last year where poor communication played a part. Interviews revealed challenges including low health literacy, high patient volume, and workplace hierarchy. Conclusions This study is the first to document the impact of language diversity and communication barriers in Indian EDs. The results highlight the need for effective strategies to improve communication between the multiple languages spoken by clinicians and patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12245-021-00380-7.
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Affiliation(s)
- Katherine Douglass
- Department of Emergency Medicine, The George Washington University School of Medicine & Health Sciences, 2120 L St., NW Suite 450, Washington, DC, 20037, USA.
| | - Lalit Narayan
- Department of Internal Medicine, The George Washington University School of Medicine & Health Sciences, 2150 Pennslyvania Ave, NW, Suite 8-416, Washington, DC, 20037, USA
| | - Rebecca Allen
- Present Address: The George Washington University School of Medicine & Health Sciences, 2300 I St, NW, Washington, DC, 20052, USA.,Present Address: Anne Arundel Medical Center, 2001 Medical Parkway, Annapolis, MD, 21401, USA
| | - Jay Pandya
- Present Address: The George Washington University School of Medicine & Health Sciences, 2300 I St, NW, Washington, DC, 20052, USA.,Present Address: Kings County Hospital Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Zohray Talib
- Department of Internal Medicine, The George Washington University School of Medicine & Health Sciences, 2150 Pennslyvania Ave, NW, Suite 8-416, Washington, DC, 20037, USA.,Present Address: California University of Science and Medicine, 217 E Club Center Dr Suite A, San Bernadino, CA, 92408, USA
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Almualem J, Darwish A, AlFaraj A. The Relationship Between Language Barrier in Non-Arabic Nurses and Anxiety in Cardiovascular Patients: A Cross-Sectional Descriptive Study. J Patient Exp 2021; 8:2374373521989242. [PMID: 34179361 PMCID: PMC8205349 DOI: 10.1177/2374373521989242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Patients with cardiac conditions may suffer from anxiety related to prognosis and
further rehabilitation. Anxiety could be exacerbated by different factors
including miscommunication, which could be attributed to the linguistic barrier,
that exists among health care providers. At Saud Al-Babtain Cardiac Center
(SBCC), nurses who are non-native Arabic speakers could have difficulty
communicating disease-related information at different stages of nursing care.
Is it possible to identify the language barrier as a source of anxiety for
admitted patients with cardiac diseases? In this cross-sectional, descriptive
study, 50 patients were included following the diagnosis of cardiac disease and
post-cardiac surgery. A questionnaire that measures anxiety level showed that
patients who were handled by Arabic-speaking nurses reported less collective
mean for the anxiety domain statements of (20.08) versus those who were handled
by Non-Arabic-speaking nurses (28.55, P value = .041). Our
finding indicates that anxiety levels increased when there was a language
barrier between nurses and patients, which could affect the quality of care
delivery at SBCC.
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Affiliation(s)
- Jassem Almualem
- Adult Cardiology, Saud Albabtain Cardiac Centre, Dammam, Saudi Arabia
| | - Amal Darwish
- Optometry Department, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed AlFaraj
- Anesthesia Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Syyrilä T, Vehviläinen-Julkunen K, Härkänen M. Communication issues contributing to medication incidents: Mixed-method analysis of hospitals' incident reports using indicator phrases based on literature. J Clin Nurs 2020; 29:2466-2481. [PMID: 32243030 DOI: 10.1111/jocn.15263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/28/2020] [Accepted: 03/14/2020] [Indexed: 01/10/2023]
Abstract
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.
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Affiliation(s)
- Tiina Syyrilä
- Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland.,Helsinki University Hospital (HUS), Helsinki, Finland
| | - Katri Vehviläinen-Julkunen
- Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland.,Kuopio University Hospital (KUH), Kuopio, Finland
| | - Marja Härkänen
- Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland
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Kuan AS, Chen TJ, Lee WC. Barriers to health care services in migrants and potential strategies to improve accessibility: A qualitative analysis. J Chin Med Assoc 2020; 83:95-101. [PMID: 31714441 DOI: 10.1097/jcma.0000000000000224] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While migrants in Taiwan are entitled to universal health care, barriers to health care services exist. We aimed to explore challenges encountered by migrants when accessing health care services and potential strategies to overcome these barriers. METHODS Invitations to participate in the study were sent to all hospitals, 12 migrant organizations, one language school, and one language service company in Taiwan, and convenience sampling was used to recruit study participants. Focus group interviews were held with 111 migrants, clinicians, migrant organization coordinators, and representatives from the medical institutions, language school and language service company. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using a thematic approach. RESULTS The study participants acknowledged that the current support system for migrants in the health care sector is inadequate. Barriers to health care services were noted in three areas - language and information, sociocultural and economic, and policy and resources. Potential strategies to overcome these barriers included the provision of on-site or distant interpreting services, provision of multilingual instruction notes and forms, and establishing a multilingual medical assistance hotline. CONCLUSION While migrants benefit from the current support and welfare system, our study found substantial gaps that need to be filled including a lack of professional medical interpreters and training programs, a lack of legal framework for medical interpreting, and inadequacy in the dispersal of information on existing resources that may facilitate the integration of migrants into society and the health care system. Overcoming these barriers may improve migrants' access to health services.
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Affiliation(s)
- Ai Seon Kuan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzeng-Ji Chen
- Big Data Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wui-Chiang Lee
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Affairs and Planning, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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15
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Affiliation(s)
| | - Christopher See
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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16
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Pun J, Chor W, Zhong L. Delivery of patient-centered care in complementary medicine: Insights and evidence from the Chinese medical practitioners and patients in primary care consultations in Hong Kong. Complement Ther Med 2019; 45:198-204. [DOI: 10.1016/j.ctim.2019.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/15/2019] [Accepted: 06/18/2019] [Indexed: 12/30/2022] Open
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Husebø SE, Olsen ØE. Actual clinical leadership: a shadowing study of charge nurses and doctors on-call in the emergency department. Scand J Trauma Resusc Emerg Med 2019; 27:2. [PMID: 30621752 PMCID: PMC6323734 DOI: 10.1186/s13049-018-0581-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background The provision of safe, high quality healthcare in the Emergency Department (ED) requires frontline healthcare personnel with sufficient competence in clinical leadership. However, healthcare education curriculum infrequently features learning about clinical leadership, and there is an absence of experienced doctors and nurses as role models in EDs for younger and less experienced doctors and nurses. The purpose of this study was to explore the activities performed by clinical leaders and to identify similarities and differences between the activities performed by charge nurses and those performed by doctors on-call in the Emergency Department after completion of a Clinical Leadership course. Methods A qualitative exploratory design was chosen. Nine clinical leaders in the ED were shadowed. The data were analyzed using a thematic analysis. Results The analysis revealed seven themes: receiving an overview of the team and patients and planning the shift; ensuring resources; monitoring and ensuring appropriate patient flow; monitoring and securing information flow; securing patient care and treatment; securing and assuring the quality of diagnosis and treatment of patient; and securing the prioritization of patients. The last two themes were exclusive to doctors on-call, while the theme “securing patient care and treatment” was exclusive to charge nurses. Conclusions Charge nurses and doctors on-call perform multitasking and complement each other as clinical leaders in the ED. The findings in this study provide new insights into how clinical leadership is performed by charge nurses and doctors on-call in the ED, but also the similarities and differences that exist in clinical leadership performance between the two professions. Clinical leadership is necessary to the provision of safe, high quality care and treatment for patients with acute health needs, as well as the coordination of healthcare services in the ED. More evaluation studies of this Clinical Leadership course would be valuable.
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Affiliation(s)
- Sissel Eikeland Husebø
- Department of Quality and Health Technology, Faculty of Health Science, University of Stavanger, 4036, Stavanger, Norway. .,Department of Surgery, Stavanger University Hospital, Stavanger, Norway.
| | - Øystein Evjen Olsen
- Department of Research, Development and Education, Stavanger University Hospital, Stavanger, Norway.,Global Health Priorities Research Group, Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Innes K, Jackson D, Plummer V, Elliott D. A profile of the waiting room nurse in emergency departments: An online survey of Australian nurses exploring implementation and perceptions. Int Emerg Nurs 2018; 43:67-73. [PMID: 30381142 DOI: 10.1016/j.ienj.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/27/2018] [Accepted: 10/12/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND In response to increasing waiting times, adverse patient outcomes and patient dissatisfaction, some emergency departments introduced a Waiting Room Nurse role. Despite implementation into routine practice, there remains limited formal evaluation of the role. AIM To explore the implementation of a Waiting Room Nurse role in Australian emergency departments and emergency nurses' perceptions. METHODS Survey design. A 40-item survey was developed, piloted and then distributed to members of a professional College for online completion. Responses for closed-ended and open-ended items were reported using frequencies or proportions, and quantitative content analysis, respectively. RESULTS Respondents (n = 197) reported that 51 emergency departments allocated a Waiting Room Nurse, with varying hours of operation. Five key areas of responsibility were: patient care, patient safety, escalation of care, triage and communication. Role variations were identified in experience, preparation and supporting policies. Challenges, including workload and personal safety issues, were reported. CONCLUSIONS The role was perceived as vital, especially at times of high demand, in ensuring that patients were safe to wait, detecting deterioration and escalating care as needed. Communication and therapeutic relationships were key to effective performance. Challenges identified had clear implications for the welfare of nurses performing the role.
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Affiliation(s)
- Kelli Innes
- Faculty of Health University of Technology Sydney, 15 Broadway, Ultimo, N.S.W 2007, Australia; Nursing and Midwifery, Monash University, 47-49 Moorooduc Highway, Frankston, Victoria 3199, Australia.
| | - Debra Jackson
- Faculty of Health University of Technology Sydney, 15 Broadway, Ultimo, N.S.W 2007, Australia.
| | - Virginia Plummer
- Nursing and Midwifery, Monash University, 47-49 Moorooduc Highway, Frankston, Victoria 3199, Australia; Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia.
| | - Doug Elliott
- Faculty of Health University of Technology Sydney, 15 Broadway, Ultimo, N.S.W 2007, Australia.
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Slade D, Murray KA, Pun JKH, Eggins S. Nurses’ perceptions of mandatory bedside clinical handovers: An Australian hospital study. J Nurs Manag 2018; 27:161-171. [DOI: 10.1111/jonm.12661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/18/2018] [Accepted: 05/16/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Diana Slade
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences; Australian National University; Canberra ACT Australia
| | - Kristen A. Murray
- Department of English; The Hong Kong Polytechnic University; Hong Kong SAR China
| | - Jack K. H. Pun
- Department of English; City University of Hong Kong; Hong Kong SAR China
| | - Suzanne Eggins
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences; Australian National University; Canberra ACT Australia
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Pun JKH, Chan EA, Wang S, Slade D. Health professional-patient communication practices in East Asia: An integrative review of an emerging field of research and practice in Hong Kong, South Korea, Japan, Taiwan, and Mainland China. PATIENT EDUCATION AND COUNSELING 2018; 101:1193-1206. [PMID: 29422231 DOI: 10.1016/j.pec.2018.01.018] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/19/2018] [Accepted: 01/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To provide an integrative review of literature on health communication in East Asia and detail culturally-specific influences. METHODS Using PRISMA model, search of PubMed, PsychInfo, Web of Knowledge, ERIC and CINAHL databases were conducted for studies between January 2000 and March 2017, using the terms 'clinician/health professional-patient', 'nurse/doctor-patient, 'communication' and 'Asia'. RESULTS 38 studies were included: Mainland China, Hong Kong, Japan, South Korea, and Taiwan. The existing body of research on clinician patient communication in East Asia can be classified: 1) understanding the roles and expectations of the nurse, clinician, patient, and family in clinician-patient consultations: a) nurse-patient communication; b) doctor-patient communication; c) the role of family member; and 2) factors affecting quality of care: d) cultural attitudes towards death and terminal illnesses; e) communication preferences affecting trust, decision-making and patient satisfaction; f) the extent to which patient centred care is being implemented in practice; and g) communication practices in multilingual/multi-disciplinary environments. CONCLUSION The review detailed the complexity and heterogeneity of clinician-patient communication across East Asia. The studies reviewed indicate that research in East Asia is starting to move beyond a preference for Western-based communication practices. PRACTICE IMPLICATIONS There is a need to consider local culture in understanding and interpreting medical encounters in East Asia. The paper highlights the need for a specific culturally-appropriate model of health communication in East Asia which may significantly improve relationships between clinicians and patients.
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Affiliation(s)
- Jack K H Pun
- Department of English, The City University of Hong Kong, 83, Tat Chee Avenue, Kowloon, Hong Kong, China; Department of Education, St Antony's College, University of Oxford, 15 Norham Gardens, Oxford, United Kingdom; The Institute for Communication in Health Care, School of Languages, Literature and Linguistics, The Australian National University, Canberra, Australia.
| | - E Angela Chan
- The Institute for Communication in Health Care, School of Languages, Literature and Linguistics, The Australian National University, Canberra, Australia; School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Sophie Wang
- Faculty of Arts and Social Science, The University of Technology Sydney, Sydney, Australia
| | - Diana Slade
- The Institute for Communication in Health Care, School of Languages, Literature and Linguistics, The Australian National University, Canberra, Australia; School of Literature, Language and Linguistics, ANU College of Arts & Social Sciences, The Australian National University, Canberra, Australia
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