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Slade IR, Avery AD, Gonzalez C, Chung C, Qiu Q, Simpson YM, Ector C, Vavilala MS. Effective Use of Interpreter Services for Diverse Patients in a Safety-Net Hospital: Provider Perceptions of Barriers and Solutions. Jt Comm J Qual Patient Saf 2024:S1553-7250(24)00212-5. [PMID: 39183078 DOI: 10.1016/j.jcjq.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 07/02/2024] [Accepted: 07/15/2024] [Indexed: 08/27/2024]
Abstract
INTRODUCTION Culturally and linguistically diverse (CALD) patients should but do not routinely receive professional interpretation. The authors examined provider perceptions of barriers and solutions to interpreter services (IS) in a safety-net hospital to inform quality improvement (QI). METHODS A 13-item survey was distributed to 750 clinicians representing 10 services across professional roles, including social workers. Closed- and open-ended questions addressed accessing IS, IS value, and care for CALD patients. Respondents ranked eight barriers to routine IS use and provided ideas for improvement. Descriptive statistics characterized survey results in aggregate and by professional role and care team. Quantitative and qualitative results were triangulated for agreement between survey domains and coded free-text response themes. RESULTS A total of 221 responses were analyzed (29.5% response rate). Cost was the lowest-ranked barrier across roles. Leading barriers were efficiency pressures and cumbersome access. Free-text responses agreed with these findings. CALD patients were perceived to have higher complication risk by 87.5% of social workers but by 56.8% of other roles. Recommendations to increase IS varied by team: streamlined access process (46.2% emergency, 37.8% inpatient respondents), expanded in-person interpretation (55.6% inpatient, 45.8% perioperative respondents), and better equipment (44.4% outpatient, 35.9% emergency, 25.0% perioperative respondents). CONCLUSION Provider experiences vary by care team and interpretation modality. Interpretation services are cumbersome to access and compete with efficiency pressures, leading to shortcuts that fail to provide adequate language access. Three initial QI efforts resulted: increased video interpretation equipment, a new language access committee, and a new language access leadership role.
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Russell EA, Hsu D, Camp EA, Soto-Ruiz K, Leaming-Van Zandt K. Spanish-Speaking Caregivers' Perception of Emergency Physicians' Interpersonal and Communication Skills in a Pediatric Emergency Department. Pediatr Emerg Care 2023; 39:253-258. [PMID: 36999987 DOI: 10.1097/pec.0000000000002681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Medical communication is more than just the delivery of information; language differences between physicians and patients/caregivers create a challenge to providing effective care in the pediatric emergency department (ED). Overcoming this barrier is vital to providing high-quality care. We evaluated Spanish- versus English-speaking caregivers' perception of their pediatric ED physicians' interpersonal and communication skills. We also compared perceptions of Spanish- versus English-speaking caregivers who self-identified as Hispanic. METHODS This study is a retrospective analysis of data from surveys administered in an urban, free-standing children's hospital ED. Surveys were administered in English and Spanish to pediatric patient caregivers. In person, video, and telephonic interpretations were available during patient encounters. RESULTS There were 2542 (82.4%) surveys completed in English and 543 (17.6%) in Spanish. There were significant differences in demographic data of English versus Spanish survey respondents, including level of education, insurance status, and rates of nonpublic insurance. Spanish survey respondents rated their physicians' interpersonal skills lower than English survey respondents. There were 1455 (47%) surveys completed by the respondents who self-identified as Hispanic. Within this group, 928 (63.8%) respondents completed the survey in English and 527 (36.2%) in Spanish. Among this Hispanic population, the Spanish survey respondents rated their physicians' interpersonal and communication skills lower than English survey respondents. After adjusting for education level and insurance type, these differences persisted. CONCLUSIONS Language barriers have a meaningful impact on physician ability to communicate effectively in the pediatric ED. Improving physicians' ability to overcome this barrier is essential toward enriching patient outcomes and experience in the ED.
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Affiliation(s)
- Eric A Russell
- From the Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
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Keller MS, Carrascoza-Bolanos J. Pharmacists, nurses, and physicians' perspectives and use of formal and informal interpreters during medication management in the inpatient setting. PATIENT EDUCATION AND COUNSELING 2023; 108:107607. [PMID: 36566119 PMCID: PMC9877185 DOI: 10.1016/j.pec.2022.107607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Language barriers during inpatient medication management can occur during medication reconciliation on admission and discharge, and during the hospitalization. Understanding inpatient clinicians' experiences with language barriers and use of interpreters can help inform interventions aimed at improving medication management with Limited English Proficient (LEP) patients. Our objective was to examine clinicians' experiences with language barriers around inpatient medication management. METHODS We used semi-structured interviews with pharmacist technicians, pharmacists, nurses, and physicians working in a tertiary care hospital. We used the constant comparison method to guide data collection and analysis. RESULTS We interviewed 14 providers. Nurses and physicians perceived lack of time to use formal interpreters, particularly during busy or night shifts. Clinicians strongly preferred virtual and in-person interpreter services over telephonic services, and highlighted communication challenges with patients with low health literacy, concerns about the quality of interpretation, and inconsistencies in the use of translated materials. CONCLUSIONS Ensuring access to formal interpreters during all shifts, translation of materials into the patient/caregiver's language, and access to in-person/virtual services would improve quality of care for LEP patients. PRACTICE IMPLICATIONS Current laws require use of interpreters, but do not provide for their reimbursement, resulting in suboptimal use. Reimbursement for interpreter services may increase their availability.
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Affiliation(s)
- Michelle S Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA; Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, USA; Department of Health Policy and Management, University of California-Los Angeles, Los Angeles, USA.
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Pirhofer J, Bükki J, Vaismoradi M, Glarcher M, Paal P. A qualitative exploration of cultural safety in nursing from the perspectives of Advanced Practice Nurses: meaning, barriers, and prospects. BMC Nurs 2022; 21:178. [PMID: 35787799 PMCID: PMC9251927 DOI: 10.1186/s12912-022-00960-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cultural safety requires healthcare professionals and organisations to improve healthcare, facilitate patient access to healthcare, and achieve equity within the workforce. METHODS This ethnomethodological study, which consisted of two phases, explored the concept of cultural safety from the perspective of Advanced Practice Nurses. Semi-structured interviews and the nominal group technique were used to prioritise challenges related to cultural safety, identify barriers to clinical practise and assess educational needs. The data collected was subjected to thematic analysis. RESULTS Nurses working in Austria, Germany and Switzerland were recruited (N = 29). Accordingly, the phenomenon of cultural safety in health care is not generally known and there is little prior knowledge about it. The most frequently discussed themes were communication difficulties, lack of knowledge, the treatment of people with insufficient language skills and expectations of treatment goals and outcomes, which can lead to conflicts and accusations of unequal treatment due to diverse cultural backgrounds. CONCLUSION Diverse cultures are encountered in German-speaking healthcare settings. Cultural safety is also about healthcare staff, as nurses with different socialisations encounter prejudice, discrimination and racism. Although the issue of power was not discussed, academic nurses were willing to make an effort to change. Only a minority were aware that lasting change requires challenging one's own cultural structures and adapted behaviours, rather than pushing for the mere acquisition of cultural competence. Organisations were encouraged to introduce self-reflection sessions and provide better access to translation services to improve equity and support nurses.
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Affiliation(s)
- Jacqueline Pirhofer
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Johannes Bükki
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
- Diakonie-Klinikum Stuttgart, Rosenbergstrasse 38, 70176, Stuttgart, Germany
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, 8049, Bodø, Norway
| | - Manela Glarcher
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Piret Paal
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
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Ahmed NH, Greaney ML, Cohen SA. Moderation of the Association between Primary Language and Health by Race and Gender: An Intersectional Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137750. [PMID: 35805412 PMCID: PMC9265264 DOI: 10.3390/ijerph19137750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 02/04/2023]
Abstract
In the United States (US), limited English proficiency is associated with a higher risk of obesity and diabetes. “Intersectionality”, or the interconnected nature of social categorizations, such as race/ethnicity and gender, creates interdependent systems of disadvantage, which impact health and create complex health inequities. How these patterns are associated with language-based health inequities is not well understood. The study objective was to assess the potential for race/ethnicity, gender, and socioeconomic status to jointly moderate the association between primary language (English/Spanish) and having obesity and diabetes. Using the 2018 Behavioral Risk Factor Surveillance System (n = 431,045), weighted generalized linear models with a logistic link were used to estimate the associations between primary language (English/Spanish) and obesity and diabetes status, adjusting for confounders using stratification for the intersections of gender and race/ethnicity (White, Black, Other). Respondents whose primary language was Spanish were 11.6% more likely to have obesity (95% CI 7.4%, 15.9%) and 15.1% more likely to have diabetes (95% CI 10.1%, 20.3%) compared to English speakers. Compared to English speakers, Spanish speakers were more likely to have both obesity (p < 0.001) and diabetes (p < 0.001) among White females. Spanish speakers were also more likely to have obesity among males and females of other races/ethnicities (p < 0.001 for both), and White females (p = 0.042). Among males of other racial/ethnic classifications, Spanish speakers were less likely to have both obesity (p = 0.011) and diabetes (p = 0.005) than English speakers. Health promotion efforts need to recognize these differences and critical systems−change efforts designed to fundamentally transform underlying conditions that lead to health inequities should also consider these critical sociodemographic factors to maximize their effectiveness.
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Affiliation(s)
- Neelam H. Ahmed
- Department of Biological Sciences, College of the Environment and Life Sciences, University of Rhode Island, Kingston, RI 02881, USA;
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA;
| | - Mary L. Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA;
| | - Steven A. Cohen
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA;
- Correspondence: ; Tel.: +1-401-874-4301
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Shiner CT, Bramah V, Wu J, Faux SG, Watanabe Y. Health care interpreter use in an inpatient rehabilitation setting: examining patterns of use and associated clinical outcomes. Disabil Rehabil 2022:1-11. [PMID: 35705483 DOI: 10.1080/09638288.2022.2086637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Professional interpreters can improve healthcare quality and outcomes when there is language discordance between patients and health care providers. Multidisciplinary rehabilitation relies on nuanced communication; however, the use of interpreters in rehabilitation is underexplored. This study aimed to examine patterns of health care interpreter use in an inpatient rehabilitation setting. METHODS A retrospective cohort study was conducted including patients admitted for subacute rehabilitation during 2019-2020 identified as having limited English proficiency. Patterns of interpreter use (professional and "ad hoc") and rehabilitation outcomes were evaluated via medical record review. RESULTS Eighty-five participants were included. During inpatient rehabilitation (median 17 [12-28] days), most clinical interactions (95%) occurred without an interpreter present. Patterns of interpreter use were variable; with greater use of ad hoc versus professional interpreters (received by 60% versus 49% of the cohort, respectively). Those who interacted with a professional interpreter had a longer length-of-stay, larger Functional Independence Measure (FIM) gain, and lower rate of hospital readmission six months post-discharge. The number of professional interpreter sessions correlated positively with FIM gain. CONCLUSIONS Access to professional interpreters in inpatient rehabilitation was variable, with some patients having no or minimal access. These findings provide preliminary evidence that professional interpreter use may be associated with clinical rehabilitation outcomes. Implications for rehabilitationProfessional health care interpreters can be used to overcome language barriers in rehabilitation.In an inpatient rehabilitation setting, professional interpreters appeared to be underutilized, with many patients having no or minimal access to interpreters.Use of ad hoc, untrained interpreters and informal communication strategies was common during rehabilitation.Use of professional interpreters appeared to be associated with favorable rehabilitation outcomes.
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Affiliation(s)
- Christine T Shiner
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia.,Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Valerie Bramah
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Jane Wu
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Steven G Faux
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia.,Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Yuriko Watanabe
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia
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Kiblinger T, Gettis M, Brown AM. Facilitating Communication in a Pediatric Surgery Center: Implementation of an Interactive Communication Board. J Dr Nurs Pract 2022; 15:18-25. [DOI: 10.1891/jdnp-2021-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundIncreasing linguistic diversity has important implications for providers serving limited English proficiency (LEP) populations. LEP patients have decreased understanding, increased risk for adverse events, and lower healthcare satisfaction. Limited interpreting methods affect nurses’ ability to provide efficient, culturally competent care.ObjectiveAn interactive communication board was implemented to evaluate the perceived effectiveness of LEP patient communication and increase nurse satisfaction with communication in a pediatric ambulatory surgery center.MethodsA pre-post survey design evaluated the implementation of an interactive communication board. After a 3-month implementation period, post-surveys assessed nurse satisfaction, perception of time required to interpret nursing tasks, and feasibility of the tool.ResultsNurses reported a 64% increase (2.27 ± 0.88 pre; 3.57 ± 0.76 post; p = 0.0007) in satisfaction with the interpretation process and a 43% increase (2.07 ± 0.70 pre; 3.50 ± 0.76 post; p = 0.0001) in their self-perceived ability to communicate with LEP populations post-intervention.ConclusionCommunication boards and similar tools can improve nurse satisfaction and streamline the interpretation process in peri-operative periods.Implications for NursingSimilar tools could be implemented in other healthcare settings to increase communication efficiency between nurses and LEP populations. Further projects must be conducted to evaluate the experience and efficacy of this tool from the patient/caregiver perspective.
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Clark JR, Shlobin NA, Batra A, Liotta EM. The Relationship Between Limited English Proficiency and Outcomes in Stroke Prevention, Management, and Rehabilitation: A Systematic Review. Front Neurol 2022; 13:790553. [PMID: 35185760 PMCID: PMC8850381 DOI: 10.3389/fneur.2022.790553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/11/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Individuals with limited English proficiency (LEP) face structural challenges to communication in English-speaking healthcare environments. We performed a systematic review to characterize the relationship between LEP and outcomes in stroke prevention, management, and recovery. Methods A systematic review was conducted using the PubMed, Embase, Scopus, and Web of Science databases. Titles and abstracts from articles identified were read and selected for full text review. Studies meeting inclusion criteria were reviewed in full for study design, aim, and outcomes. Results Of 891 unique articles, 20 were included. Eleven articles did not provide information about interpreter availability or usage, limiting the ability to draw conclusions about the effect of LEP on measured outcomes in these studies. Overall, studies demonstrated that English proficiency is associated with better outcomes in preventive aspects of stroke care such as stroke symptom awareness, anticoagulation maintenance, and knowledge of warfarin indication. Some acute stroke care metrics were independent of English proficiency in seven studies while other evidence showed associations between interpreter requirement and quality of inpatient care received. LEP and English-proficient groups show similar mortality despite greater lengths of stay and greater proportions of care in dedicated stroke units for LEP patients. Post-stroke quality of life can be worse for those with LEP, and language barriers can negatively impact patient and provider experiences of rehabilitation. Conclusions Stroke patients with LEP face barriers to equitable care at multiple stages. While some studies demonstrate worse outcomes for LEP patients, equitable care was shown in multiple studies frequently in the setting of a high degree of interpreter availability. Patients with LEP will benefit from tailored education regarding stroke symptom recognition and medication regimens, and from provision of translated written educational material. Inequities in inpatient care and rehabilitation exist despite similar mortality rates in four studies. Future studies should report interpreter availability and usage within LEP groups and whether patient interactions were language-concordant or discordant in order to allow for more generalizable and reliable conclusions.
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Newly Arrived Migrant Women's Experience of Maternity Health Information: A Face-to-Face Questionnaire Study in Norway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147523. [PMID: 34299974 PMCID: PMC8307311 DOI: 10.3390/ijerph18147523] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 01/23/2023]
Abstract
Limited understanding of health information may contribute to an increased risk of adverse maternal outcomes among migrant women. We explored factors associated with migrant women's understanding of the information provided by maternity staff, and determined which maternal health topics the women had received insufficient coverage of. We included 401 newly migrated women (≤5 years) who gave birth in Oslo, excluding migrants born in high-income countries. Using a modified version of the Migrant Friendly Maternity Care Questionnaire, we face-to-face interviewed the women postnatally. The risk of poor understanding of the information provided by maternity staff was assessed in logistic regression models, presented as adjusted odds ratios (aORs), with 95% confidence intervals (CI). The majority of the 401 women were born in European and Central Asian regions, followed by South Asia and North Africa/the Middle East. One-third (33.4%) reported a poor understanding of the information given to them. Low Norwegian language proficiency, refugee status, no completed education, unemployment, and reported interpreter need were associated with poor understanding. Refugee status (aOR 2.23, 95% CI 1.01-4.91), as well as a reported interpreter need, were independently associated with poor understanding. Women who needed but did not get a professional interpreter were at the highest risk (aOR 2.83, 95% CI 1.59-5.02). Family planning, infant formula feeding, and postpartum mood changes were reported as the most frequent insufficiently covered topics. To achieve optimal understanding, increased awareness of the needs of a growing, linguistically diverse population, and the benefits of interpretation services in health service policies and among healthcare workers, are needed.
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Führer A, Brzoska P. [The Importance of Language Interpretation in the Health Care System]. DAS GESUNDHEITSWESEN 2020; 84:474-478. [PMID: 33184807 DOI: 10.1055/a-1276-0897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Many people in German-speaking countries have a limited proficiency in the German language. In the health care system, this may result in barriers to accessing and utilization of health services. The aim of this review was to present the current state of research on the relevance of language barriers in medical care and to explain strategies used to address language-related communication problems. METHODS The review is based on a synthesis of German- and English-language systematic reviews on the topic of 'language interpretation in the health care sector', including also all original papers from Germany published since 2015. RESULTS The most common method used in hospitals for language problems was interpretation by relatives of patients or by bilingual staff of the hospital. The quality of this language mediation by untrained laypersons was often limited, which can affect health care outcomes. Using professional interpreters was associated with significantly better health care outcomes and, particularly in the form of interpretation via telephone, was a flexible and cost-effective approach. CONCLUSION Language-based communication is an important prerequisite for patient-centered care and must be ensured by the health care system for ethical, social and legal reasons. In this context, professional interpretation solutions should be used, for which the required financial resources and infrastructure must also be made available.
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Affiliation(s)
- Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle
| | - Patrick Brzoska
- Lehrstuhl für Versorgungsforschung, Fakultät für Gesundheit/Department für Humanmedizin Universität Witten/Herdecke
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Bischoff A. The evolution of a healthcare interpreting service mapped against the bilingual health communication model: a historical qualitative case study. Public Health Rev 2020; 41:19. [PMID: 32774991 PMCID: PMC7401237 DOI: 10.1186/s40985-020-00123-8] [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: 01/08/2019] [Accepted: 04/07/2020] [Indexed: 11/20/2022] Open
Abstract
Background Twenty-five years ago, the need for health care interpreting in Switzerland increased due to the sharp influx of asylum seekers from war zones and countries of political unrest. Due to complex health needs, there was a need to move away from using volunteers as interpreters towards qualified interpreter services. Methods A historical qualitative case study design was used to describe the evolution of the language assistance programmes at Geneva University Hospitals, between 1992 and 2017. The aim was to map the evolution of the interpreter services against the Bilingual Health Communication Model with the constructs—Communicative Goals, Individual Agency, System Norms and Quality and Equality of Care—while identifying key factors to optimise interpreter service and patient care. Results and discussion Five phases were identified during the 25 years of service evolution studied: (1) Service initiation—the interpreter services were first used in a small service that cared for refugees and asylum seekers. (2) Growth and formalisation—due to the arrival of high numbers of Albanian-speaking asylum seekers, Albanian-speaking interpreters were provided to all departments of the Geneva University Hospitals. This helped roll out the use of interpreters among doctors and nurses. (3) Ensuring quality—the care for all patients, whether foreign-language speaking or not, became an issue and led to research into the quality of patient-provider communication. (4) Institutionalisation—this phase dealt with challenges including the lack of interpreter financing regulation and the clarification of interpreter roles. (5) Equity—healthcare interpreter services were put in an overall framework of equity standards. The Bilingual Health Communication Model was applied and showed that some items were not implemented: clear shifts (i) towards a culturally sensitive focus, (ii) towards community interpreting, (iii) towards triadic communication, (iv) towards spelling out the right to have an interpreter and (v) towards the involvement of insurance companies. Finally, the inclusion of healthcare interpreting as an essential ingredient in healthcare provision, including chronic disease management, is incomplete or missing. Conclusions Healthcare interpreting at Geneva University Hospitals has evolved from a ‘muddling-through’ approach towards an institutional approach by addressing quality of care, by focussing on the mental health of asylum seekers, training of both interpreters and users of interpreters and institutional policy based on equity.
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Affiliation(s)
- Alexander Bischoff
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Route des Cliniques 15, CH-1700 Fribourg, Switzerland.,Institute of Global Health, Faculty of Medicine, University of Geneva, 24 rue du Général-Dufour, 1211 Genève 4, Switzerland
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Schouten BC, Cox A, Duran G, Kerremans K, Banning LK, Lahdidioui A, van den Muijsenbergh M, Schinkel S, Sungur H, Suurmond J, Zendedel R, Krystallidou D. Mitigating language and cultural barriers in healthcare communication: Toward a holistic approach. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30242-1. [PMID: 32423835 DOI: 10.1016/j.pec.2020.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
Due to ongoing globalization and migration waves, healthcare providers are increasingly caring for patients from diverse cultural and/or ethnic minority backgrounds. Adequate health communication with migrants and ethnic minorities is often more difficult to establish compared to people belonging to the majority groups of a given society, because of a combination of language and cultural barriers. To address this topic, in December 2018 a symposium was organized-under the auspices of the Amsterdam Center for Health Communication-during which speakers from both academia and professional practice discussed the current state-of-the-art and brought forward innovative solutions to improve intercultural communication in healthcare. Main questions that were discussed during this symposium included: "How can language barriers in intercultural health communication be mitigated?" and "Which innovations can contribute to improving intercultural health communication?" In this paper, we discuss some answers to these questions and propose that in order to enhance intercultural communication and healthcare for migrant and ethnic minority patients, a more holistic approach to studying when, how, and for what purposes (a combination of) communication strategies should be utilized in mitigating both language and cultural barriers to decrease health disparities and improve health care for migrant and ethnic minority patients.
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Affiliation(s)
- Barbara C Schouten
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Antoon Cox
- Interpreting Studies, Antwerp Campus, KU, Leuven, Belgium.
| | - Gözde Duran
- Expertise Centre Dementia for Professionals, University College Windesheim, the Netherlands.
| | - Koen Kerremans
- Department of Linguistics & Literary Studies, Free University Brussels, Belgium.
| | | | - Ali Lahdidioui
- Dutch Association Moroccan Physicians [AMAN], the Netherlands.
| | - Maria van den Muijsenbergh
- Radboud University Medical Centre, Department of Primary and Community Care Health Disparities Group, Nijmegen, the Netherlands; Pharos, Centre of Expertise on Health Disparities, Utrecht, the Netherlands.
| | - Sanne Schinkel
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Hande Sungur
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Jeanine Suurmond
- Department of Social Medicine, Amsterdam University Medical Centre, the Netherlands.
| | - Rena Zendedel
- Department of Languages, Literature and Communication, Utrecht University, the Netherlands.
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Rajpoot A, Rehman S, Ali P. Emotional and Psychological Impact of Interpreting for Clients with Traumatic Histories on interpreters: a review of qualitative articles. WIKIJOURNAL OF MEDICINE 2020. [DOI: 10.15347/wjm/2020.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jaeger FN, Pellaud N, Laville B, Klauser P. The migration-related language barrier and professional interpreter use in primary health care in Switzerland. BMC Health Serv Res 2019; 19:429. [PMID: 31248420 PMCID: PMC6598246 DOI: 10.1186/s12913-019-4164-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 05/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background With increased international migration, language barriers are likely becoming more relevant in primary care. The aim of this study was to investigate the language barrier in paediatric and adult primary care, present its consequences, reveal how it is overcome, as well as highlight the use of and potential unmet needs for professional interpreters, using Switzerland as a case study. Methods Primary healthcare providers were invited nation-wide to participate in an online questionnaire on language barriers faced and interpreter use. Results More than 90% of the 599 participants in this nation-wide cross-sectional study face relevant language barriers at least once a year, 30.0% even once a week. Using family members and friends for translations is reported as the most frequent resort for overcoming the language barrier (60.1% report it for more than 50% of encounters), followed by “using gestures” (32.0%) or just accepting the insufficient communication (22.9%). Minors interpret frequently (frequent use: 23.3%). Two thirds of physicians facing language barriers never have access to a professional interpreter, the majority (87.8%) though would appreciate their presence and approximately one quarter of these even see a cost-saving potential. Multiple consequences affecting quality of care in the absence of professional interpreters are identified. Conclusion Language barriers are relevant in primary care. Improved access to professional interpreters is warranted.
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Affiliation(s)
- Fabienne N Jaeger
- Kollegium für Hausarztmedizin, Bern, Switzerland. .,Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland. .,Kollegium für Hausarztmedizin (KHM), Rue de l'Hôpital 15, CH-1701, Fribourg, Switzerland. .,Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4002, Basel, Switzerland.
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"Getting by" in a Swiss Tertiary Hospital: the Inconspicuous Complexity of Decision-making Around Patients' Limited Language Proficiency. J Gen Intern Med 2018; 33:1885-1891. [PMID: 30143979 PMCID: PMC6206329 DOI: 10.1007/s11606-018-4618-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/25/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND While the need to address language barriers to provide quality care for all is generally accepted, little is known about the complexities of decision-making around patients' limited language proficiency in everyday clinical encounters. OBJECTIVE To understand how linguistic complexities shape cross-cultural encounters by incorporating the perspective of both, patients and physicians. DESIGN A qualitative hospital study with semi-structured interviews and participant-observation in a Swiss University Hospital. Thirty-two encounters were observed and 94 interviews conducted. PARTICIPANTS Sixteen patients of Turkish and 16 of Albanian origin and all actors (administration, nurses, physicians, if required, interpreters) involved in the patients' entire process. MAIN APPROACH Interviews were audio-recorded and transcribed verbatim. A thematic content analysis was conducted using MAXQDA. For reporting, the COREQ guidelines were used. KEY RESULTS Three themes were relevant to patients and physicians alike: Assessment of the language situation, the use of interpreters, and dealing with conversational limits. Physicians tend to assess patients' language proficiency by their body language, individual demeanor, or adequacy of responses to questions. Physicians use professional interpreters for "high-stakes" conversations, and "get by" through "low-stakes" topics by resorting to bilingual family members, for example. Patients are driven by factors like fearing costs or the wish to manage on their own. High acceptance of conversational limits by patients and physicians alike stands in stark contrast to the availability of interpreters. CONCLUSIONS The decision for or against interpreter use in the "real world" of clinical care is complex and shaped by small, frequently inconspicuous decisions with potential for suboptimal health care. Physicians occupy a key position in the decision-making to initiate the process of medical interpreting. The development and testing of a conceptual framework close to practice is crucial for guiding physicians' assessment of patients' language proficiency and their decision-making on the use of interpreting services.
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Würth K, Langewitz W, Reiter-Theil S, Schuster S. Their view: difficulties and challenges of patients and physicians in cross-cultural encounters and a medical ethics perspective. BMC Med Ethics 2018; 19:70. [PMID: 29973220 PMCID: PMC6033281 DOI: 10.1186/s12910-018-0311-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 06/26/2018] [Indexed: 11/20/2022] Open
Abstract
Background In todays’ super-diverse societies, communication and interaction in clinical encounters are increasingly shaped by linguistic, cultural, social and ethnic complexities. It is crucial to better understand the difficulties patients with migration background and healthcare professionals experience in their shared clinical encounters and to explore ethical aspects involved. Methods We accompanied 32 migrant patients (16 of Albanian and Turkish origin each) during their medical encounters at two outpatient clinics using an ethnographic approach (participant observation and semi-structured interviews with patients and healthcare professionals). Overall, data of 34 interviews with patients and physicians on how they perceived their encounter and which difficulties they experienced are presented. We contrasted the perspectives on the difficult aspects and explore ethical questions surrounding the involved issues. Results Patients and physicians describe similar problem areas, but they have diverging perspectives on them. Two main themes were identified by both patients and physicians: >patients’ behaviour in relation to doctors’ advice< and > relationship issues<. Conclusions A deeper understanding of the difficulties and challenges that can arise in cross-cultural settings could be provided by bringing together healthcare professionals’ and patients’ perspectives on how a cross- cultural clinical encounter is perceived. Ethical aspects surrounding some of the difficulties could be highlighted and should get more attention in clinical practice and research.
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Affiliation(s)
- Kristina Würth
- Universitätsspital Basel, Hebelstrasse 2, CH-4031, Basel, Switzerland
| | - Wolf Langewitz
- Psychosomatic Medicine - Medical communication, University Hospital Basle, Hebelstrasse 2, CH-4031, Basel, Switzerland.
| | - Stella Reiter-Theil
- Department Clinical Ethics, Psychiatric Hospitals University Basel University Hospital Basel / University of Basel, Wilhelm Klein-Str. 27, CH-4012, Basel, Switzerland
| | - Sylvie Schuster
- Universitätsspital Basel, Hebelstrasse 2, CH-4031, Basel, Switzerland
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Vargas Pelaez AF, Ramirez SI, Valdes Sanchez C, Piedra Abusharar S, Romeu JC, Carmichael C, Bascoy S, Baron R, Pichardo-Lowden A, Albarracin N, Jones CC, Silveyra P. Implementing a medical student interpreter training program as a strategy to developing humanism. BMC MEDICAL EDUCATION 2018; 18:141. [PMID: 29914460 PMCID: PMC6006684 DOI: 10.1186/s12909-018-1254-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 06/11/2018] [Indexed: 05/19/2023]
Abstract
BACKGROUND Humanistic care in medicine has shown to improve healthcare outcomes. Language barriers are a significant obstacle to humanistic care, and trained medical interpreters have demonstrated to effectively bridge the gap for the vulnerable limited English proficiency (LEP) patient population. One way in which medical schools can train more humanistic physicians and provide language access is through the implementation of programs to train bilingual medical students as medical interpreters. The purpose of this prospective study was to evaluate whether such training had an impact on bilingual medical student's interpretation skills and humanistic traits. METHODS Between 2015 and 2017, whole-day (~ 8 h) workshops on medical interpretation were offered periodically to 80 bilingual medical students at the Penn State College of Medicine. Students completed a series of questionnaires before and after the training that assessed the program's effectiveness and its overall impact on interpretation skills and humanistic traits. Students also had the opportunity to become certified medical interpreters. RESULTS The 80 student participants were first- to third- year medical students representing 21 languages. Following training, most students felt more confident interpreting (98%) and more empathetic towards LEP patients (87.5%). Students' scores in the multiple-choice questions about medical interpretation/role of the interpreter were also significantly improved (Chi-Square test, p < 0.05). All students who decided to take the exam were able to successfully become certified interpreters. Ninety-two percent of participants reported they would recommend the program and would be willing to serve as a future "coaches" for interpreter training workshops delivered to peer students. CONCLUSIONS Our program was successful in increasing self-reported measures of empathy and humanism in medical students. Our data suggests that implementation of medical interpreter training programs can be a successful strategy to develop of humanism in medical students, and aid in the development of sustainable language access for LEP patients.
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Affiliation(s)
| | - Sarah I. Ramirez
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA USA
| | | | | | - Jose C. Romeu
- Department of Medicine, Penn State College of Medicine, Hershey, PA USA
| | | | | | - Rose Baron
- Penn State College of Medicine, Hershey, PA USA
| | | | | | | | - Patricia Silveyra
- Departments of Pediatrics, Biochemistry and Molecular Biology, and Humanities, Penn State College of Medicine, 500 University Drive, Mail Code H085, Hershey, PA 17033 USA
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Ali PA, Watson R. Language barriers and their impact on provision of care to patients with limited English proficiency: Nurses' perspectives. J Clin Nurs 2018; 27:e1152-e1160. [DOI: 10.1111/jocn.14204] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Parveen Azam Ali
- School of Nursing and Midwifery; University of Sheffield; Sheffield UK
| | - Roger Watson
- Faculty of Social Sciences; University of Hull; Hull UK
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Dominicé Dao M, Inglin S, Vilpert S, Hudelson P. The relevance of clinical ethnography: reflections on 10 years of a cultural consultation service. BMC Health Serv Res 2018; 18:19. [PMID: 29325569 PMCID: PMC5765648 DOI: 10.1186/s12913-017-2823-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/28/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Training health professionals in culturally sensitive medical interviewing has been widely promoted as a strategy for improving intercultural communication and for helping clinicians to consider patients' social and cultural contexts and improve patient outcomes. Clinical ethnography encourages clinicians to explore the patient's explanatory model of illness, recourse to traditional and alternative healing practices, healthcare expectations and social context, and to use this information to negotiate a mutually acceptable treatment plan. However, while clinical ethnographic interviewing skills can be successfully taught and learned, the "real-world" context of medical practice may impose barriers to such patient-centered interviewing. Creating opportunities for role modeling and critical reflection may help overcome some of these barriers, and contribute to improved intercultural communication in healthcare. We report and reflect on a retrospective analysis of 10 years experience with a "cultural consultation service" (CCS) whose aim is to provide direct support to clinicians who encounter intercultural difficulties and to model the usefulness of clinical ethnographic interviewing for patient care. METHODS We analyzed 236 cultural consultation requests in order to identify key patient, provider and consultation characteristics, as well as the cross cultural communication challenges that motivate health care professionals to request a cultural consultation. In addition, we interviewed 51 clinicians about their experience and satisfaction with the CCS. RESULTS Requests for cultural consultations tended to involve patient care situations with complex social, cultural and medical issues. All patients had a migration background, two-thirds spoke French less than fluently. In over half the cases, patients had a high degree of social vulnerability, compromising illness management. Effective communication was hindered by language barriers and undetected or underestimated patient/provider differences in health-related knowledge and beliefs. Clinicians were highly satisfied with the CCS, and appreciated both the opportunity to observe how clinical ethnographic interviewing is done and the increased knowledge they gained of their patients' context and perspective. CONCLUSIONS A cultural consultation service such as ours can contribute to institutional cultural competence by drawing attention to the challenges of caring for diverse patient populations, identifying the training needs of clinicians and gaps in resource provision, and providing hands-on experience with clinical ethnographic interviewing.
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Affiliation(s)
- Melissa Dominicé Dao
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland
- Institute of Primary Care Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Sarah Vilpert
- Institute of social and preventive medicine, University of Lausanne, Lausanne, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland
- Institute of Primary Care Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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22
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Luan Erfe BM, Siddiqui KA, Schwamm LH, Kirwan C, Nunes A, Mejia NI. Professional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English. J Am Heart Assoc 2017; 6:e006175. [PMID: 28935679 PMCID: PMC5634277 DOI: 10.1161/jaha.117.006175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/14/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The inability to communicate effectively in a common language can jeopardize clinicians' efforts to provide quality patient care. Professional medical interpreters (PMIs) can help provide linguistically appropriate health care, in particular for the >25 million Americans who identify speaking English less than very well. We aimed to evaluate the relationship between use of PMIs and quality of acute ischemic stroke care received by patients who preferred to have their medical care in languages other than English. METHODS AND RESULTS We analyzed data from 259 non-English-preferring acute ischemic stroke patients who participated in the American Heart Association Get With The Guidelines-Stroke program at our hospital from January 1, 2003, to April 30, 2014. We used descriptive statistics and logistic regression models to examine associations between involvement of PMIs and patients' receipt of defect-free stroke care. A total of 147 of 259 (57%) non-English-preferring patients received PMI services during their hospital stays. Multivariable analyses adjusting for other socioeconomic factors showed that acute ischemic stroke patients who did not receive PMIs had lower odds of receiving defect-free stroke care (odds ratio: 0.52; P=0.04). CONCLUSIONS Our findings suggest that PMIs may influence the quality of acute ischemic stroke care.
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Affiliation(s)
| | - Khawja A Siddiqui
- Massachusetts General Hospital, Boston, MA
- Baylor College of Medicine, Houston, TX
| | - Lee H Schwamm
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital, Boston, MA
| | | | | | - Nicte I Mejia
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital, Boston, MA
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The Absent Interpreter in Administrative Detention Center Medical Units. HEALTH CARE ANALYSIS 2017; 25:34-51. [PMID: 25189317 DOI: 10.1007/s10728-014-0285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The particular situation of the French administrative detention center (ADC) medical units appears to be an exemplary case to study the difficulties facing medical practice. Indeed, the starting point of our inquiry was an amazing observation that needed to be addressed and understood: why are professional interpreters so seldom requested in ADC medical units, where one would expect that they would be "naturally" present? Aiming to fully explore the meanings of the "absent interpreter", this article takes into account the possible meanings of this situation: the recourse to professional interpreters in France is far from expected given cumulative evidence of its benefits; perceptions of illegal immigrants and medical habitus itself may both hamper the use of a third party; the ADCs are a very stressful place for healthcare professionals, with conflicting missions, political issues enmeshed with medical goals, and heavy affective burden that may lead to self-protection. Silencing voices of suffering others might be seen as the hidden indecent truth of the "absent interpreter". These reflections open a window to a larger issue with regard to the full range of medicine: what are the place, the role and the function of patient's words and narratives in contemporary medicine? The highly invested somatic perspective and its political corollary giving primacy to bare life harbor potential risks of obscuring speeches and undervaluing narratives.
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Nakiwala D, Kellgren L, Herzmann C, Olaru ID, Brown M, Ferrand R, Khan P, Kranzer K. Language discordance between tuberculosis patients and healthcare providers challenging universal access. Eur Respir J 2017; 49:49/4/1700116. [PMID: 28424365 DOI: 10.1183/13993003.00116-2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 02/13/2017] [Indexed: 11/05/2022]
Affiliation(s)
| | - Lusha Kellgren
- North Central London South Hub TB Clinic, Whittington Health, London, UK
| | | | - Ioana D Olaru
- Center for Clinical Studies, Research Center Borstel, Borstel, Germany
| | - Mike Brown
- North Central London South Hub TB Clinic, Whittington Health, London, UK.,Hospital for Tropical Diseases, University College London Hospital, London, UK
| | | | - Palwasha Khan
- London School of Hygiene and Tropical Medicine, London, UK
| | - Katharina Kranzer
- London School of Hygiene and Tropical Medicine, London, UK .,National Mycobacterium Reference Laboratory, Research Center Borstel, Borstel, Germany
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Pun JK, Chan EA, Murray KA, Slade D, Matthiessen CM. Complexities of emergency communication: clinicians' perceptions of communication challenges in a trilingual emergency department. J Clin Nurs 2017; 26:3396-3407. [PMID: 28001321 DOI: 10.1111/jocn.13699] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To understand the challenges that clinicians face in communicating with patients and other clinicians within a Hong Kong trilingual emergency department. BACKGROUND Effective communication has long been recognised as fundamental to the delivery of quality health care, especially in high-risk and time-constrained environments such as emergency departments. The issue of effective communication is particularly relevant in Hong Kong emergency departments, due to the high volume of patients and the linguistic complexity of this healthcare context. In Hong Kong, emergency department clinicians are native speakers of Chinese, but have received their medical training in English. The clinicians read and record virtually all of their medical documentation in English, yet they communicate verbally with patients in Cantonese and Mandarin. In addition, communication between clinicians occurs in spoken Cantonese, mixed with medical English. Thus, medical information is translated numerous times within one patient journey. This complex linguistic environment creates the potential for miscommunication. DESIGN A mixed-methods design consisting of a quantitative survey with a sequential qualitative interview. METHODS Data were collected in a survey from a purposive sample of 58 clinicians and analysed through descriptive statistics. Eighteen of the clinicians were then invited to take part in semi-structured interviews, the data from which were then subjected to a manifest content analysis. RESULTS Nearly half of the clinicians surveyed believed that medical information may be omitted or altered through repeated translation in a trilingual emergency department. Eighty-three per cent of clinicians stated that there are communication problems at triage. Over 40% said that they have difficulties in documenting medical information. Around 50% believed that long work hours reduced their ability to communicate effectively with patients. In addition, 34% admitted that they rarely or never listen to patients during a consultation. CONCLUSION The findings reveal that the quality of communication in this Hong Kong emergency department is compromised by specific factors inherent in the linguistic complexity of Hong Kong emergency departments. These factors include the constant translation of medical information, inadequate documentation of medical information and significant professional and cultural pressures. Each of these issues increases the likelihood that healthcare communication will be difficult, incomplete or incorrect. This research provides empirical evidence for, and justifies the development of, an effective framework to enable clinicians to overcome communication challenges. RELEVANCE TO CLINICAL PRACTICE The findings of this study may shed light on the unique conditions faced by clinicians, particularly in relation to communication, in the complex trilingual healthcare context of an emergency department similar to those in Hong Kong, and provide potential policy solutions for barriers to improve communication in such settings.
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Affiliation(s)
- Jack Kh Pun
- Department of English, The Hong Kong Polytechnic University, Hong Kong, China.,The International Research Centre for Communication in Healthcare, IRCCH, Hong Kong, China.,Department of Education, St Antony's College, University of Oxford, Oxford, UK
| | - Engle Angela Chan
- The International Research Centre for Communication in Healthcare, IRCCH, Hong Kong, China.,School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Kristen A Murray
- Department of English, The Hong Kong Polytechnic University, Hong Kong, China.,The International Research Centre for Communication in Healthcare, IRCCH, Hong Kong, China
| | - Diana Slade
- Department of English, The Hong Kong Polytechnic University, Hong Kong, China.,The International Research Centre for Communication in Healthcare, IRCCH, Hong Kong, China.,Department of Education, St Antony's College, University of Oxford, Oxford, UK.,Faculty of Arts and Social Science, The University of Technology Sydney, Australia
| | - Christian Mim Matthiessen
- Department of English, The Hong Kong Polytechnic University, Hong Kong, China.,The International Research Centre for Communication in Healthcare, IRCCH, Hong Kong, China
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Tang EW, Go J, Kwok A, Leung B, Lauck S, Wong ST, Taipale PG, Ratner PA. The relationship between language proficiency and surgical length of stay following cardiac bypass surgery. Eur J Cardiovasc Nurs 2016. [DOI: 10.1177/1474515115596645] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erin W Tang
- Vancouver General Hospital, Cardiac Services, Canada
| | - Jeremy Go
- Vancouver General Hospital, Cardiac Services, Canada
| | - Andrea Kwok
- Vancouver General Hospital, Cardiac Services, Canada
| | - Bonnie Leung
- Vancouver General Hospital, Cardiac Services, Canada
| | | | - Sabrina T Wong
- School of Nursing and Centre for Health Services and Policy Research, The University of British Columbia, Canada
| | | | - Pamela A Ratner
- Faculty of Education, The University of British Columbia, Canada
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Sevinç S, Ajghif M, Uzun Ö, Gülbil U. Expectations of relatives of Syrian patients in intensive care units in a state hospital in Turkey. J Clin Nurs 2016; 25:2232-41. [DOI: 10.1111/jocn.13254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Sibel Sevinç
- Nursing Department; School of Health; Kilis 7 Aralık University; Kilis Turkey
| | - Mohammad Ajghif
- Eastern Languages and Literatures Department (Arabic Language and Literature); Faculty of Art and Sciences; Kilis 7 Aralık University; Kilis Turkey
| | - Özge Uzun
- İzmir University, Faculty of Health Science; Nursing Department, Sağlık Kampüsü; Örnekköy Karşıyaka/İzmir
| | - Uğur Gülbil
- Eastern Languages and Literatures Department (Arabic Language and Literature); Faculty of Art and Sciences; Kilis 7 Aralık University; Kilis Turkey
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Guvenc G, Unver V, Basak T, Yuksel C, Ayhan H, Kok G, Konukbay D, Kose G, Aslan O, Tastan S, Iyigun E. Turkish Senior Nursing Students' Communication Experience With English-Speaking Patients. J Nurs Educ 2016; 55:73-81. [DOI: 10.3928/01484834-20160114-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 11/12/2015] [Indexed: 11/20/2022]
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Management of language discordance in clinical nursing practice--A critical review. Appl Nurs Res 2015; 30:158-63. [PMID: 27091272 DOI: 10.1016/j.apnr.2015.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/16/2015] [Accepted: 07/31/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Language plays an essential role in the provision of nursing care, since successful communication is a vital prerequisite to being able to provide appropriate nursing care efficiently and effectively. It is not known what kinds of interventions are effective in overcoming language discordance in nursing practice. OBJECTIVES This critical review aimed to examine the interventions that are most successfully used to overcome language discordance in nursing. DESIGN A critical review of the literature was performed and 24 relevant research papers were included. DATA SOURCES A search was carried out between January 2004 and September 2014 in MEDLINE, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychinfo, Germanistic online, Pragmatis and Linguistic & Language Behaviour Abstracts (LLBA). REVIEW METHODS Both authors independently screened the titles (n=299), abstracts and full texts to decide which articles should be chosen. The inclusion criteria were: (1) articles examine the problem of language discordance in various health care settings and (2) articles published in English, German, French or Italian. Articles were included irrespective of their design. Data were analysed using the Critical Appraisal Skills Program Tool (CASP). FINDINGS In total, 24 publications met the inclusion criteria. Most of the studies (n=20) were focused on the nursing intervention of using an interpreter and three were describing the nursing assessment. The study designs of the included studies were mainly non-experimental studies, qualitative studies or reviews. The only suggested intervention described in the articles is the use of ad-hoc or professional interpreters for communicating with patients who do not speak the local language. CONCLUSIONS Health care institutions should provide more strategies for clinical practice to overcome language discordance.
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Hudelson P, Dominice Dao M, Perneger T, Durieux-Paillard S. A "migrant friendly hospital" initiative in Geneva, Switzerland: evaluation of the effects on staff knowledge and practices. PLoS One 2014; 9:e106758. [PMID: 25198063 PMCID: PMC4157774 DOI: 10.1371/journal.pone.0106758] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 08/09/2014] [Indexed: 11/30/2022] Open
Abstract
Background International migration poses important challenges to European health care systems. The development of “migrant friendly hospitals” has been identified as a priority in both Europe and Switzerland. Methods A multi-pronged initiative was developed at Geneva University Hospitals (HUG) to improve staff knowledge and use of existing “migrant friendly” resources. A self-administered questionnaire was sent pre and post-intervention to random samples of 4 major professional groups with direct patient contact at the HUG. The questionnaire assessed staff knowledge, attitudes and reported practices regarding the care of migrant patients. Results Overall response rate was 51% (N = 1460) in 2010 but only 19% (N = 761) in 2013 owing to an institutionally imposed change in survey method. Despite these difficulties, and after adjusting for sample differences, we found that respondents in 2013 were significantly more likely to have received training in how to organize an appointment with an interpreter, how to work with an interpreter and about health and social services available for migrant patients. Respondents were also significantly more likely to have used several Migrant Friendly structures at the HUG. Use of, preference for and perceived skill at working with professional interpreters all improved, and respondents were both more likely to be encouraged by their supervisors to use professional interpreters, and less likely to be encouraged to look for alternative solutions for communicating with non francophone patients. Finally, 2013 respondents encountered fewer difficulties caring for migrant patients, although lack of time and language barriers continued to be the most important sources of difficulty. Conclusion Our results suggest that an institution-wide information campaign may contribute to increased awareness and use of migrant friendly resources by clinical staff. Hospital commitment and financing, along with inter-departmental participation in all activities were important in creating and maintaining project visibility, and in contributing to a migrant friendly institutional culture.
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Affiliation(s)
- Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
- * E-mail:
| | - Melissa Dominice Dao
- Primary Care Service, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Perneger
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Durieux-Paillard
- Programme Santé Migrants, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
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Nishikawa M, Niiya K, Okayasu M. Addressing practical issues related to nursing care for international visitors to Hiroshima. Rev Esc Enferm USP 2014; 48:299-307. [PMID: 24918890 DOI: 10.1590/s0080-6234201400002000015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 12/13/2013] [Indexed: 11/22/2022] Open
Abstract
When nine million foreigners visited Japan in 2013, the federal government set a goal to attract an additional two and a half million visitors including medical tourists by 2020. This research investigates the attitudes and concerns of Japanese nurses when they are in a situation dealing with foreign patients. The data were collected from March through September 2010, from 114 nurses at three hospitals, in close proximity to popular tourist destinations in Hiroshima. A questionnaire was developed for this research, named Mari Meter, which included a section to write answers to an open question for the nurses to express their opinions. These responses were examined statistically and by word analysis using Text Mining Studio. Japanese nurses expressed greatest concern about payment options, foreign language skills, and issues of informed consent, when dealing with foreigners. The results confirm that, in order to provide a high quality of patient care, extra preparation and a greater knowledge of international workers and visitors are required by nursing professionals in Japan.
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Affiliation(s)
- Mariko Nishikawa
- Faculty of Nursing, Department of Nursing, Hiroshima International University, Hiroshima, Japan,
| | - Kiyoka Niiya
- Faculty of Nursing, Department of Nursing, Faculty of Nursing, Hiroshima International University, Hiroshima, Japan,
| | - Masako Okayasu
- Faculty of Nursing, Department of Nursing, University of Shimane, Shimane, Japan,
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Fernandez L, Rossouw T, Marcus T, Reinbrech-Schutte A, Smit N, Kinkel HF, Memon S, Hugo J. Factors associated with patients' understanding of their management plan in Tshwane clinics. Afr J Prim Health Care Fam Med 2014; 6:E1-9. [PMID: 26245390 PMCID: PMC4502834 DOI: 10.4102/phcfm.v6i1.560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 11/20/2013] [Accepted: 10/26/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This research focused on patients' views regarding healthcare services and identified factors associated with understanding of their management plan. AIM To develop a baseline for patient-clinician collaboration and the extent to which patients felt included and understood their treatment plan. SETTING Tshwane district (South Africa) public health outpatient clinics. METHOD Medical students interviewed 447 patients in 22 clinics in Tshwane district. Agreement was measured by the percentage of cases in which patients and clinicians were in accord about a particular aspect of the consultation. RESULTS About one-third of patients incorrectly answered questions on whether changes in lifestyle or diet were prescribed as part of their treatment. The likelihood that patients understood their plan was associated with seeing the same clinician three or more times;having a consultation in their same or a similar language; patient participation in the diagnosis;and feeling that the clinician had explained their health problems to them. CONCLUSIONS There is need for greater emphasis on continuity of care, the clinicians' ability to speak the patient's language and involving patients in the consultation.
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Language Barriers in Mental Health Care: A Survey of Primary Care Practitioners. J Immigr Minor Health 2013; 16:1238-46. [DOI: 10.1007/s10903-013-9971-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Santos M, Ravn-Fischer A, Karlsson T, Herlitz J, Bergman B. Is early treatment of acute chest pain provided sooner to patients who speak the national language? Int J Qual Health Care 2013; 25:582-9. [DOI: 10.1093/intqhc/mzt055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Hudelson P, Dominicé Dao M, Durieux-Paillard S. Quality in practice: integrating routine collection of patient language data into hospital practice. Int J Qual Health Care 2013; 25:437-42. [PMID: 23696580 DOI: 10.1093/intqhc/mzt035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
QUALITY PROBLEM Timely identification of patients' language needs can facilitate the provision of language-appropriate services and contribute to quality of care, clinical outcomes and patient satisfaction. INITIAL ASSESSMENT At the University Hospitals of Geneva, Switzerland, timely organization of interpreter services was hindered by the lack of systematic patient language data collection. CHOICE OF SOLUTION We explored the feasibility and acceptability of a procedure for collecting patient language data at the first point of contact, prior to its hospital-wide implementation. IMPLEMENTATION During a one-week period, receptionists and triage nurses in eight clinical services tested a new procedure for collecting patient language data. Patients were asked to identify their primary language and other languages they would be comfortable speaking with their doctor. Staff noted patients' answers on a paper form and provided informal feedback on their experience with the procedure. EVALUATION Registration staff encountered few difficulties collecting patient language data and thought that the two questions could easily be incorporated into existing administrative routines. Following the pilot test, two language fields with scroll-down language menus were added to the electronic patient file, and the subsequent filling-in of these fields has been rapid and hospital wide. LESSONS LEARNED Our experience suggests that routine collection of patient language data at first point of contact is both feasible and acceptable and that involving staff in a pilot project may facilitate hospital-wide implementation. Future efforts should focus on exploring the sensitivity and specificity of the proposed questions, as well as the impact of data collection on interpreter use.
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Affiliation(s)
- Patricia Hudelson
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
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Guglielminotti J, Mentré F, Gaillard J, Ghalayini M, Montravers P, Longrois D. Assessment of pain during labor with pupillometry: a prospective observational study. Anesth Analg 2013; 116:1057-1062. [PMID: 23477963 DOI: 10.1213/ane.0b013e31828a7218] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pain intensity is usually self-rated by patients with a numeric rating scale (NRS) but this scale cannot be used for noncommunicating patients. In anesthetized patients, experimental noxious stimulus increases pupillary diameter (PD) and pupillary light reflex amplitude (PLRA), the difference between PD before and after light stimulation. Labor pain is an intense acute nonexperimental stimulus, effectively relieved by epidural analgesia. In this prospective observational study, we therefore describe the effects of labor pain and pain relief with epidural analgesia on PD and PLRA, determine their association with pain intensity and determine the ability of a single measurement of PD or PLRA to assess pain. METHODS In the first stage, pain (11-point NRS), PD, and PLRA were measured in 4 conditions in 26 laboring women: before and after epidural analgesia and in the presence and absence of a uterine contraction. Pupillometry values among the 4 conditions were compared, and the strength of the association between absolute values of pain and PD or PLRA and between pain and changes in PD or PLRA brought about by uterine contraction was assessed with r(2). In the second stage, 1 measurement was performed in 104 laboring women. The strength of the association between pain and PD or PLRA was assessed with r(2). The ability of PD or PLRA to discriminate pain (NRS > 4) was also assessed. RESULTS In the first stage, a statistically significant increase in pain, PD, and PLRA was observed during a contraction, and this change was abolished after epidural analgesia. The r(2) for the association between pain and changes in PD (r(2) = 0.25 [95% confidence interval, 0.07-0.46] or PLRA (r(2) = 0.34 [0.14-0.56]) brought about by a uterine contraction was higher than the r(2) for the association between pain and absolute values of PD (r(2) = 0.14 [0.04-0.28]) or PLRA (r(2) = 0.22 [0.10-0.37]) suggesting a stronger association for changes than for absolute values. In the second stage, r(2) was 0.23 [0.10-0.38] for PD and 0.26 [0.11-0.40] for PLRA and the area under the receiver operating characteristics curve was 0.82 [0.73-0.91] and 0.80 [0.71-0.89], respectively. CONCLUSIONS Changes in PD and PLRA brought about by a uterine contraction may be used as a tool to assess analgesia in noncommunicating patients.
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Affiliation(s)
- Jean Guglielminotti
- From the INSERM, UMR 738, Paris, France; Département d'Anesthésie-Réanimation, AP-HP, Hôpital Bichat, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UMR 738, Paris, France; Service de Biostatistique, AP-HP, Hôpital Bichat, Paris, France; and INSERM, UMR 698, Paris, France
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Létourneau J, Alderson M, Caux C, Richard L. La déviance positive : analyse de concept selon l'approche évolutionniste de Rodgers. Rech Soins Infirm 2013. [DOI: 10.3917/rsi.113.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Zoraster RM. Working with interpreters during international health responses. Disaster Med Public Health Prep 2012; 5:159-63. [PMID: 21685310 DOI: 10.1001/dmp.2011.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Health care providers face multiple difficulties in providing care to a disaster-stricken community. Training, preparation, and a good attitude are important, as is adequate logistical support. An often-ignored issue is the difficulty encountered with language barriers during a response, and how using interpreters affects the quality and impact of the health care provided. This article reviews the use of interpreters and focuses on how they may affect an international health care response.
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Affiliation(s)
- Richard M Zoraster
- Center for Excellence in Disaster Management & Humanitarian Assistance, Tripler Army Medical Center, Honolulu, Hawaii , USA.
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Schwappach DLB, Meyer Massetti C, Gehring K. Communication barriers in counselling foreign-language patients in public pharmacies: threats to patient safety? Int J Clin Pharm 2012; 34:765-72. [PMID: 22821555 DOI: 10.1007/s11096-012-9674-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 07/10/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Foreign-language (FL) patients are at increased risk for adverse drug events. Evidence regarding communication barriers and the safety of pharmaceutical care of FL patients in European countries is scarce despite large migrant populations. OBJECTIVE To investigate Swiss public pharmacists' experiences and current practices in counselling FL patients with a focus on patient safety. METHOD In a cross-sectional study heads of public pharmacies in Switzerland were surveyed using an electronic questionnaire. MAIN OUTCOME MEASURE The survey assessed the frequency of communication barriers encountered in medication counselling of FL patients, perceptions of risks for adverse drug events, satisfaction with the quality of counselling provided to FL patients, current strategies to reduce risks, and preferences towards tools to improve safety for FL patients. RESULTS 498 pharmacists completed the survey (43 % response rate). More than every second pharmacist reported at least weekly encounters at which they cannot provide good medication counselling to FL patients in the regional Swiss language. Ad-hoc interpreting by minors is also common at a considerable number of pharmacies (26.5 % reported at least one weekly occurrence). Approximately 10 % of pharmacies reported that they fail at least weekly to explain the essentials of drug therapy (e.g. dosing of children's medications) to FL patients. 79.8 % perceived the risk of FL patients for adverse drug events to be somewhat or much higher compared to other patients. 22.5 % of pharmacists reported being concerned at least monthly about medication safety when FL patients leave their pharmacy. However, the majority of pharmacists were satisfied with the quality of care provided to FL patients in their pharmacy [78.6 % (very) satisfied]. The main strategy used to improve counselling for FL patients was the employment of multilingual staff. Participants would use software for printing foreign-language labels (41.2 %) and multilingual package inserts (42.0 %) if these were available. CONCLUSION Communication barriers with FL patients are frequent in Swiss pharmacies and pharmacists perceive FL patients to be at increased risk for adverse drug events. Development and dissemination of communication tools are needed to support pharmacists in counselling of a diverse migrant population.
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Hudelson P, Perneger T, Kolly V, Perron NJ. Self-assessed competency at working with a medical interpreter is not associated with knowledge of good practice. PLoS One 2012; 7:e38973. [PMID: 22715421 PMCID: PMC3370995 DOI: 10.1371/journal.pone.0038973] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 05/15/2012] [Indexed: 11/29/2022] Open
Abstract
Background Specific knowledge and skills are needed to work effectively with an interpreter, but most doctors have received limited training. Self-assessed competency may not accurately identify training needs. Purposes The purpose of this study is to explore the association between self-assessed competency at working with an interpreter and the ability to identify elements of good practice, using a written vignette. Methods A mailed questionnaire was sent to 619 doctors and medical students in Geneva, Switzerland. Results 58.6% of respondents considered themselves to be highly competent at working with a professional interpreter, but 22% failed to mention even one element of good practice in response to the vignette, and only 39% could name more than one. There was no association between self-rated competency and number of elements mentioned. Conclusions Training efforts should challenge the assumption that working with an interpreter is intuitive. Evaluation of clinicians' ability to work with an interpreter should not be limited to self-ratings. In the context of large-scale surveys, written vignettes may provide a simple method for identifying knowledge of good practice and topics requiring further training.
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Affiliation(s)
- Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland.
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Tuot DS, Lopez M, Miller C, Karliner LS. Impact of an easy-access telephonic interpreter program in the acute care setting: an evaluation of a quality improvement intervention. Jt Comm J Qual Patient Saf 2012; 38:81-8. [PMID: 22372255 DOI: 10.1016/s1553-7250(12)38011-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Language barriers render interaction with the health care system difficult and lead to health disparities for patients with limited English proficiency (LEP). Despite a long-standing legal obligation for large health care organizations in the United States to try to provide free language access services for patients with LEP, professional interpretation is not always widely accessible, and even when it is, its use is often suboptimal. A dual-handset phone with 24-hour access to professional telephonic interpretation was placed at the bedside of all patients admitted to the general medicine floor of a tertiary care academic hospital. METHODS Nurses and physicians were surveyed before and after the easy-access interpretation program's implementation. RESULTS Distribution of pre- and postimplementation surveys to 127 and 122 nurses, respectively, yielded a total of 163 completed surveys (overall participation rate, 65%). Distribution of surveys to 96 and 78 physicians, respectively, yielded 116 completed surveys (overall participation rate, 67%). After implementation, use of professional telephonic interpreters for communication with LEP patients increased fourfold, without a decrease in use of professional in-person interpreters. There were significant increases in professional interpreter use during brief communications with high error potential, including medication administration (odds ratio [OR] = 1.9, 95% confidence interval [CI] 1.1-3.2) and pre-rounding (OR = 3.4, 95% CI 1.2-9.8). CONCLUSIONS Increasing ease of access to dual-handset interpreter telephones promotes use of professional interpreters in the acute care setting. Future hospital policy should focus on further integrating language services into the hospital environment, accompanied by an educational program to assist in shifting professional norms toward use of professional interpreters.
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Affiliation(s)
- Delphine S Tuot
- Division of Nephrology, Department of Medicine, University of California, San Francisco, USA
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Flores G, Abreu M, Barone CP, Bachur R, Lin H. Errors of medical interpretation and their potential clinical consequences: a comparison of professional versus ad hoc versus no interpreters. Ann Emerg Med 2012; 60:545-53. [PMID: 22424655 DOI: 10.1016/j.annemergmed.2012.01.025] [Citation(s) in RCA: 259] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 01/11/2012] [Accepted: 01/25/2012] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVE To compare interpreter errors and their potential consequences in encounters with professional versus ad hoc versus no interpreters. METHODS This was a cross-sectional error analysis of audiotaped emergency department (ED) visits during 30 months in the 2 largest pediatric EDs in Massachusetts. Participants were Spanish-speaking limited-English-proficient patients, caregivers, and their interpreters. Outcome measures included interpreter error numbers, types, and potential consequences. RESULTS The 57 encounters included 20 with professional interpreters, 27 with ad hoc interpreters, and 10 with no interpreters; 1,884 interpreter errors were noted, and 18% had potential clinical consequences. The proportion of errors of potential consequence was significantly lower for professional (12%) versus ad hoc (22%) versus no interpreters (20%). Among professional interpreters, previous hours of interpreter training, but not years of experience, were significantly associated with error numbers, types, and potential consequences. The median errors by professional interpreters with greater than or equal to 100 hours of training was significantly lower, at 12, versus 33 for those with fewer than 100 hours of training. Those with greater than or equal to 100 hours of training committed significantly lower proportions of errors of potential consequence overall (2% versus 12%) and in every error category. CONCLUSION Professional interpreters result in a significantly lower likelihood of errors of potential consequence than ad hoc and no interpreters. Among professional interpreters, hours of previous training, but not years of experience, are associated with error numbers, types, and consequences. These findings suggest that requiring at least 100 hours of training for interpreters might have a major impact on reducing interpreter errors and their consequences in health care while improving quality and patient safety.
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Affiliation(s)
- Glenn Flores
- Division of General Pediatrics, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA.
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Barriers to participation in a patient satisfaction survey: who are we missing? PLoS One 2011; 6:e26852. [PMID: 22046382 PMCID: PMC3202588 DOI: 10.1371/journal.pone.0026852] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 10/05/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A common weakness of patient satisfaction surveys is a suboptimal participation rate. Some patients may be unable to participate, because of language barriers, physical limitations, or mental problems. As the role of these barriers is poorly understood, we aimed to identify patient characteristics that are associated with non-participation in a patient satisfaction survey. METHODOLOGY At the University Hospitals of Geneva, Switzerland, a patient satisfaction survey is regularly conducted among all adult patients hospitalized for >24 hours on a one-month period in the departments of internal medicine, geriatrics, surgery, neurosciences, psychiatry, and gynaecology-obstetrics. In order to assess the factors associated with non-participation to the patient satisfaction survey, a case-control study was conducted among patients selected for the 2005 survey. Cases (non respondents, n = 195) and controls (respondents, n = 205) were randomly selected from the satisfaction survey, and information about potential barriers to participation was abstracted in a blinded fashion from the patients' medical and nursing charts. PRINCIPAL FINDINGS Non-participation in the satisfaction survey was independently associated with the presence of a language barrier (odds ratio [OR] 4.53, 95% confidence interval [CI95%]: 2.14-9.59), substance abuse (OR 3.75, CI95%: 1.97-7.14), cognitive limitations (OR 3.72, CI95%: 1.64-8.42), a psychiatric diagnosis (OR 1.99, CI95%: 1.23-3.23) and a sight deficiency (OR 2.07, CI95%: 0.98-4.36). The odds ratio for non-participation increased gradually with the number of predictors. CONCLUSIONS Five barriers to non-participation in a mail survey were identified. Gathering patient feedback through mailed surveys may lead to an under-representation of some patient subgroups.
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Hadziabdic E, Heikkilä K, Albin B, Hjelm K. Problems and consequences in the use of professional interpreters: qualitative analysis of incidents from primary healthcare. Nurs Inq 2011; 18:253-61. [PMID: 21790876 DOI: 10.1111/j.1440-1800.2011.00542.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to explore what problems are reported by healthcare professionals in primary healthcare concerning the use of interpreters and what the problems lead to. The study involved a single case in a real-life situation with qualitative content analysis of 60 incident reports written by different healthcare professionals. The main problems documented were related to language, such as lack of the interpreters with proficiency in a particular language, and to organisational routines, with difficulties in the availability of interpreters and access to the interpreter agency. The problems reported led to incorrect use of time and resources, which increased the workload and thus delayed treatment. Other consequences were limited possibilities to communicate and thus consultation was carried out without a professional interpreter, using family members instead. The results highlight the importance of developing good co-operation between the interpreter agency and the primary healthcare centre in order to fulfil the existing policy of using professional interpreters to provide the right interpreter at the right time and guarantee high-quality care.
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Affiliation(s)
- Emina Hadziabdic
- School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
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