Experiences of language barriers by homoeopathy student interns providing health services at the University of Johannesburg

Background

South Africa is a multilingual society, and therefore, the likelihood of healthcare providers (HCPs), including students training to be HCPs, encountering language barriers with patients is high.

Aim

To explore and describe the experiences of homoeopathy student interns regarding language barriers in the delivery of health services and to provide guidance towards overcoming language barriers in homoeopathic practice at the University of Johannesburg (UJ).

Setting

The interviews and focus group discussions were conducted in English and at a private location that was convenient for the participants in Johannesburg, Gauteng.

Methods

This qualitative study used a phenomenological approach. Ten individual interviews were conducted with registered homoeopathy student interns (HSIs) from the UJ. The central question: ‘What has your experience been regarding language barriers between you and your patients at the UJ Homoeopathy clinics?’ was asked and responses were recorded and transcribed for later analysis. The interview results were presented to a focus group for discussion to validate findings that arose from the analysis and to provide an opportunity to add any insight, comment or recommendations that were not expressed in individual interviews and verification of emergent themes.

Results

Participants described how language barriers create challenges in understanding between patients and HSIs. Descriptions of the experiences of the intrapersonal and interpersonal effects that are associated with language barriers were provided. Participants also described the influence of language barriers on the various aspects of the health service process. Finally, participants described the mitigation of language barriers through various strategies.

Conclusion

Participants reported their experiences of language barriers as challenging. Language barriers were found to adversely affect the various aspects of the health service process as well as the practitioner’s personal feelings and the patient–practitioner relationship. Language acquisition and awareness modules introduced early on in the syllabus is a proposed solution to the mitigation of language barriers.

A "Third Wheel" Effect in Health Decision Making Involving Artificial Entities: A Psychological Perspective

In the near future, Artificial Intelligence (AI) is expected to participate more and more in decision making processes, in contexts ranging from healthcare to politics. For example, in the healthcare context, doctors will increasingly use AI and machine learning devices to improve precision in diagnosis and to identify therapy regimens. One hot topic regards the necessity for health professionals to adapt shared decision making with patients to include the contribution of AI into clinical practice, such as acting as mediators between the patient with his or her healthcare needs and the recommendations coming from artificial entities. In this scenario, a "third wheel" effect may intervene, potentially affecting the effectiveness of shared decision making in three different ways: first, clinical decisions could be delayed or paralyzed when AI recommendations are difficult to understand or to explain to patients; second, patients' symptomatology and medical diagnosis could be misinterpreted when adapting them to AI classifications; third, there may be confusion about the roles and responsibilities of the protagonists in the healthcare process (e.g., Who really has authority?). This contribution delineates such effects and tries to identify the impact of AI technology on the healthcare process, with a focus on future medical practice.

Barriers and enablers in the implementation of a standardised process for nutrition care: findings from a multinational survey of dietetic professionals in 10 countries

BACKGROUND

To explore the barriers and enablers experienced by nutrition and dietetic professionals in the implementation of the standardised Nutrition Care Process (NCP) across 10 different countries. NCP related beliefs, motivations and values were investigated and compared.

METHODS

A validated online survey was disseminated to nutrition and dietetics professionals in 10 countries in the local language during 2017. Cross-sectional associations and differences between countries were explored for level of implementation, barriers/enablers and attitudes/motivation among the respondents.

RESULTS

Higher NCP implementation was associated with greater occurrence of enabling aspects, as well as fewer occurrences of barriers. The most common enabler was 'recommendation by the national dietetic association' (69%) and the most common barrier was 'lack of time' (39%). A longer experience of NCP use was associated with a more positive attitude towards all NCP aspects. Differences between countries were identified, regarding both the occurrence of barriers/enablers and attitudes/motivations.

CONCLUSIONS

Implementation efforts need to be tailored to country-specific contexts when implementing a new standard of care framework among nutrition and dietetic professionals. Additional research is needed to further assess the management and workplace strategies to support the development of nutrition and dietetics professionals in multidisciplinary healthcare organisations.

Healthcare processes of laboratory tests for the prediction of mortality in the intensive care unit: a retrospective study based on electronic healthcare records in the USA

OBJECTIVES

Healthcare process carries important prognostic information for patients, but the healthcare processes of laboratory tests have not yet been investigated for patients in the intensive care unit (ICU). The study aimed to investigate the effect of healthcare processes of laboratory tests on hospital mortality, with the hypothesis that the addition of healthcare processes could improve the discrimination for mortality outcome.

DESIGN

The study included 12 laboratory tests. There were two dimensions for each laboratory test. One was the pathophysiology value; and the other was the healthcare process variables including the clock hour, the number of measurements and the measurement time from ICU admission. Generalised additive model was employed to investigate the effect of continuous variables on mortality. Generalised linear models with and without healthcare process variables were compared for their discrimination power.

SETTING

ICUs in an US-based hospital.

PARTICIPANTS

Adult patients included in the critical care big data Medical Information Mart for Intensive Care.

PRIMARY AND SECONDARY OUTCOME MEASURES

The hospital mortality was the primary outcome.

RESULTS

A total of 52 963 adult patients with complete ICU stay information were included for analysis. The mortality rate was 12.3%. Lower number of tests such as 1-3 times were associated with the lowest mortality for most laboratory tests. However, the hematocrit, glucose and potassium required 6-10 measurements for the first 24 hours to reach the lowest mortality rate. In n of the 12 prediction models involving laboratory tests, the addition of healthcare process variables was associated with significantly increased area under receiver operating characteristics.

CONCLUSIONS

The study showed that healthcare processes of laboratory tests were independently associated with hospital mortality. The addition of healthcare processes to the pathophysiology value could increase the discrimination for mortality outcome.