Cross cultural communication barriers in provision of health care are global problems have been reported in various parts of the world. In provision of personalized care, it is necessary for nurses to consider the cultural identity and needs of patients in their care. It is therefore imperative for the nurse to play an ethical role in providing culturally acceptable care to the patients. The establishment of nurse patient therapeutic connection is dependent on the ability to communicate and share a common interpretation (McCarthy, Cassidy, Graham & Tuohy, 2013). Consequently, the therapeutic communication ought to be a focused and objective association that takes place in a caring environment. Language is among the important aspects of communication, and the quality of communication bears a direct impact on the level of care provided. In cases when the nurse and patient do not share similar first language, there is an obvious barrier to communication. This may have a consequential effect on the clinical diagnosis, treatment or care options as well as available choices for intervention (McCarthy, Cassidy, Graham & Tuohy, 2013).
Patients who do not share the same first language like their nurses have been shown to have reduced rapport and possess minimal information recall. Poor communication between the nurse and the patient leads to inability of the patient to understand his or her health problem. Moreover, the poor communication results in a lack of definite treatment regimens for such patients, which has a potential harm regarding the health outcomes and prognosis (McCarthy, Cassidy, Graham & Tuohy, 2013).
Effective communication is very important to make sure that patient safety, compliance, precise diagnosis and health promotion are achieved. Within the healthcare setting, language and literacy obstacles have adverse effects on clinical efficacy, medical decision making and drug adherence. Furthermore, these barriers adversely impact on the patients’ understanding of and access to services and such patients are reluctant in admitting that they have difficulties in language and literacy. Despite the medical practitioners’ interventions of using jargons to counter language and literacy barriers, these patients have a high likelihood of hospitalization compared to others (Taylor, 2013).
According to Garcia & Duckett (2009), audible speech is a critical mode of communication in the United States. This is augmented by the fact that speaking English increases ability to determine and access health care in most areas in the US. For a majority of non-English speakers, the national objective of access to quality health care is not realized, hence existence of health disparities. Accessibility to health care services is a leading precedence and recurring issue in local, state and national governments. Inadequate access to the prolonged health disparities among the majority population and all the minority in the United States persist for prevalence of chronic diseases such as diabetes. Apart from the health insurance coverage, other factors exist that directly bear an impact on health care access (Garcia and Duckett 2009).
These factors are exemplified by cultural and linguistic obstacles towards accessibility of care. While considering the current immigration trends in the United States, the problems linked to language barriers are of great importance. The divide in accessibility to health care has been projected to broaden with projected increases in Hispanic population. Another significant problem in health care accessibility among Hispanics is language barrier. Hispanics who are capable of speaking English are more likely to have health insurance and access a physician when in need. Duran (2012) reported that a high number of Hispanics did not have access to primary care particularly to a physician. When they sought medical care, these people, Hispanics required the assistance of a translator because they are not able to communicate in English (Duran, 2012).
In their symbolic interactionism guided study, Garcia and Duckett (2009) documented the descriptions immigrant Mexican-origin adolescents experienced while accessing health care in the United States. With a focus on ethnographic methods, they listed language barriers an integral impediment in care provision among this group of individuals. As a response, the participants indicated that it was hard to get care when you are incapable of speaking English. Most of the participants connected with several aspects of health care access including setting up appointments via phone and interaction with care providers. Other aspects of language barriers typified were planning of discharge and follow up after discharge (Garcia and Duckett 2009).
The impact of language barriers can lead to negative perceptions towards health care provision as evidenced by long wait times to see the providers and perceived lack of caring by providers (Garcia and Duckett, 2009). In order to counter language barriers in healthcare provision among minority groups, healthcare providers can facilitate the access to culturally competent care. Bilingual and multilingual healthcare providers play a significant role in addressing the obstacles faced by minority groups. The health care delivery system management should implement strategies to assist health care providers and support staff to have competency in bilingual capabilities. Moreover, they should recruit qualified personnel with language and ethnicity same as that of patients seeking care (Garcia and Duckett, 2009).
There exists a well documentation of health care accessibility problem for rural minorities in the United States. Inadequate access to primary, secondary and tertiary levels of care, poor minority population groups become medically susceptible. Particularly, the rural Hispanics are at a risk of going through chronic health complications at a higher rate than other ethnicities. The major reasons for the disparity in health care accessibility among rural Hispanics include lack of health insurance and not having a usual source of care b(Duran, 2012).
Numerous studies have shed light on the health outcomes of Hispanic women who live in the United States, specifically in North Carolina. The Hispanic comprise a minority group in the U.S whose population continue to rise significantly. The upward trend in the demographics of Hispanics, especially women calls for health care providers to address the health care needs of these Hispanic women. Hispanic women report minimal levels of knowledge on prevention of AIDS and Human Papilloma Virus (HPV), and display increased infant mortality rates compared to non-Hispanic white women. The major reasons for the inadequate or lack of knowledge is communication obstacles among themselves and healthcare providers. Other significant reasons are typified by financial instability and lack of culturally knowledgeable care providers and workers (Durham & Polland, 2008).
Cultural competency has been identified as one of the hallmarks of midwifery; hence it remains a desirable proficiency among all the professional members. In a study to depict the experiences of certified nurse midwives in care provision to Hispanic women in North Carolina, language barrier (22.7%) was the major impediment in delivery of care. Other critical incidents were lack of extra time to complete interpretation and complication of language lines. Moreover, loss of information or miscommunication during translation by the interpreter was another incident that acted as a language barrier among the Hispanic women. Another closely related barrier is the male dominance portrayed by the husbands of the Hispanic women. Their male counterparts literally take over the role of patients even when the questions are directed to the patients (Durham & Polland, 2008).
In order to overcome such language barrier obstacles, the certified nurse midwives observed that resources such as use of Spanish-speaking health care providers would be beneficial. Moreover, the CNMs observed that the patients preferred using their family members as interpreters and translators. In order to provide a culturally competent care to Hispanic groups, communication classes focusing on different cultures be incorporated in the CNMs training (Durham & Polland, 2008).
As cited by Rees in Taylor (2013), the ethnic constitution of the United Kingdom population has been significantly affected by international migration hence increased cultural diversity. Consequently, within the health care sector, language and literacy barriers have adversely influenced clinical effectiveness. Language and cultural variables perceptions among individuals may affect their behaviors. In his study to investigate the perceptions of healthcare professionals in caring for ethnic minorities groups with poor English skills, Taylor (2013) showed that these patients encountered obstacles while accessing health care.
The fundamental findings of the study were categorized into two distinct groups as difficulties experienced and effect on workflow. Five related difficulties were encountered and identified. Of great importance include language barriers, low literacy and anxiety as well as retention of information. Others included lack of understanding, general health beliefs and attitudes. Language barriers were evident in aspects of providing accurate medical history, explaining the pains scores, arranging for appointments and communicating reasons for patient transport delays. Language barriers were also evident in the aspects of explaining medication, side effects, diagnosis and communicating the problems the patients were suffering from. As a downstream effect on the workflow, physicians and other involved health practitioners noted their work was hampered due to language barriers (Taylor, 2013).
The nurses noted that patients without English language skills affected the time required in care delivery as well as quantity of work and costs. Compounded with low literacy, the patients were unable to understand the healthcare setting. This prompted health care providers to adopt interventions such limiting and repeating information. Language barriers were observed to have a severe impact on the patients’ wellbeing and daily living. This led to minimal social integration and disempowerment among the patients, despite their families’ support (Taylor, 2013).
Therefore, it is paramount that all stakeholders, including the patients and health care providers contribute to achieving the experience of communication. First of all, the society could fully embrace translator-interpreter initiative while considering the costs associated with this option. Alternatively, the involvement of family could be increased as a strategy of countering language barriers. Lastly, communication in English could be promoted and encouraged in different ways. For instance, the use of visual communication aids to encourage more direct patient-staff dialogue. Moreover, patients could be encouraged to learn English while at home, with a major focus on health promotion. Subsequently, English promotion may prove to be the most cost effective and sustainable means to alleviate language barriers (Taylor, 2013).
The provision of care to pediatric intensive care unit by nurses is important both to the dying children as well as their families. Prevailing over communication and language barrier with the families of these children can greatly improve the end-of-life experience for dying children. Obstacles regarding communication in almost all clinical practice environments have been reported. However, communication difficulties between nurses and young children are even more pronounced (Beckstrand, Rawle, Callister & Mandleco, 2010).
In a study to quantitatively describe the perceptions of pediatric intensive care unit nurses on selected barriers and supportive behaviors in caring for dying children, Beckstrand (2010), language barriers had the highest perceived obstacle magnitude scores (POM). (POM score, 17.73). A family’s encounter could be altered greatly if members of the family have problems understanding English. Language and cultural differences are very influential in nurses’ involvement with patients’ families. Therefore, there is the need for cultural competence and increased nursing education in cultural humility (Beckstrand, Rawle, Callister & Mandleco, 2010).
Nurses must be responsive of their own values, understanding and comfort levels with the language of death before relaying such critical information to the patients’ families. Critical care nurses play a significant role in nurse-family communication in the intensive care unit. This is because nurses may be having important insights on the progress of an illness, family’s wishes and perceptions. More importantly, the families of patients usually rate communication skills of nurses as the most valuable skills in ICU care. The need to have translators in order to improve pediatric end-of-life is critical in provision of care. Moreover, special attention to particular words used by the families of children in end-of-life situations should be addressed (Beckstrand, Rawle, Callister & Mandleco, 2010).
The need for nurses to have a solid background in trans-cultural nursing and theory is also depicted among nurses providing care to children and parents from different cultures. The exploratory study conducted by Festini and his colleagues in 2011 elucidates the major difficulties perceived by Italian nurses in providing care to immigrant children and their families. Multiculturalism and immigration are recent developments in the Italian society, hence the society is trying to adapt to this new social dynamism. Language barrier is perceived as the major difficulty among nurses providing care to immigrant children including their families. When a nurse is not proficient in the language of the patient, there is a high risk of misunderstanding in medical diagnosis, prognosis and treatment outcome. Italian nurses displayed knowledge of other foreign language, in that one out of every three nurses can speak a second language. However, the ability to speak an additional language other than English seems not to simplify the matter. This is because most of the immigrant patients came from Arabic, Slavic, Chinese or Albanian countries (Festini, Focardi, Bisogni, Mannini & Neri, 2009).
In an effort to address the matter of language barrier, the nurses sought intervention of cultural mediators. Additionally, the usual mode of native Italians to employ gestures while talking was of great help (Festini, Focardi, Bisogni, Mannini & Neri, 2009).
The importance of communication in health care setting has been well depicted by Tse & So, (2008), specifically on the importance of preoperative teaching in provision of care. Preoperative teaching has been linked to positive outcomes after surgery including declined anxiety levels, reduced postoperative complications and recovery period. Preoperative information is critical for ambulatory surgical patients since it increases awareness and prepares such patients after the surgical procedure. However, the delivery of patient education to such patients remains a significant obstacle among nurses.
Language barrier is an important consideration that affects the amount of information given by nurses to patients. In most occasions, nurses use face-to-face oral explanation in delivery of preoperative information to their patients. When there is an existence of a language barrier, another strategy can be employed. Limited resources may affect the amount of information delivery and thus the quality of care. As such, in order to improve the efficacy of preoperative teaching and quality of care, current application of teaching methods, available resources and human resources should be assessed (Tse & So, 2008).
The provision of nursing care among cancer patients often involves emotional conversations, and the patient’s receptivity is largely impacted by the life-threatening disease. Consequently, effective communication is very crucial in delivery of care in oncology nursing. In a qualitative study investigating the factors affecting effective communication among registered oncology nurses and inpatient adults in Singapore, Tay et al (2011), asserts that language barriers are significant particularly among nurses trained overseas and patients who cannot speak English. Effective communication promotes the advancement of nurse-patient therapeutic relationships and improves patients’ perceptions about quality of life and outcomes. Importantly, in oncology nursing, effective communication helps in identification of patients’ psychosocial needs and enhancement of their psychological needs. On the other hand, emotional load among patients, nurses and families of cancer patients usually hamper effective communication. Burnout and fatigue among nurses in oncology setting lead to ineffective communication and impaired performance on their roles (Tay, Ang, & Hegney, 2012).
Among the patients receiving palliative care, nurses described them as unreasonable and demanding and whom they had difficulty while communicating. This was mainly due to the fact that the patients as well as their relatives did not understand the great workload nurses had. On the characteristics of nurses, there were inhibitive emotions that hampered their communication with the patients. This was the case in situations when the nurses were unable to provide answers to the questions asked by the patients (Tay, Ang, & Hegney, 2012).
Moreover, the inhibitive emotions were well brought out when the nurses were to deliver unfavorable feedback to the patient or the relatives. The nurse-patient relationship was hampered by lack of respect towards nurses by the patients, cultural and language differences. The patients’ negative attitude towards nurses specifically on their role and knowledge is a strong inhibitor to communication. It is essential that the Singapore society address issues on the Asian culture, the health care system and the multicultural nature of the society. It is highly beneficial for nurses to cater fully for the patients’ communication requirements. Special deliberation should be made so as to ensure nurses have ample time to assess the communication needs of patients. Nurses should take into consideration the vast cultural backgrounds of patients when addressing sensitive issues (Tay, Ang and Hegney, 2011).
In addressing the guidelines required to overcome language barriers while teaching health care providers, Welsh (2012), points at the understanding of terminology used as a starting point. This is because the fundamental aspect of managing group diversity is first encountered among these interprofessional groups. It is critical for educators and trainers to know who the participants are, and also give them adequate time to know each other. For instance, trainers on ACT and resuscitation courses have critical care exposure and are familiar with medical vocabulary terms. However, participants in training courses who have not had a chance to work in critical care are unfamiliar with such terminology. This study depicts the most convenient approach to interprofessional training so as to prepare health care staff for a team-based delivery of care (Welsh, 2012).
Language barrier remains a significant impediment in delivery of patient care to patients who speak different language from that of their healthcare providers. Language and literacy obstacles have adverse effects on clinical efficacy, medical decision making and drug adherence. Cross cultural communication barriers in provision of health care are global problems have been reported in various parts of the world. This problem has illustrated in the cases among Hispanics adolescents, Hispanic women in the United States, immigrants in Italy and the United Kingdom. Additionally, provision of care bears numerous perceptions to both the nurses and the patients who face these challenges thus affecting their ability to deliver quality care. Traditionally, cross-cultural disparities within the healthcare settings have been mediated by translators who may be patients’ family members. However, in order to fully address these issues, it is paramount that the training of nurses allow for second language learning within their curricula. Various ways have been put forward in the type of training offered to healthcare providers for effective communication to be achieved. Good communication not only enhances the nurse-patient or nurse-family relationships but also helps in improving the prognosis and treatment outcomes.
References
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