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Language Barriers in Healthcare: A Major Challenge

Question:

Discuss about the Minimizing Language Barriers.

Language barriers are used to refer to linguistic barriers that arise during communication generally experienced by an individual or group of individuals, who speak different dialects or different languages. It is commonly observed that two or more individuals engage in very little communication, until both of them learn a common language. This requires investing considerable amount of time as well as effort. Such language barriers are commonly observed when people visit a new country, where learning a new language becomes a cumbersome process (Karliner et al. 2012). Similar difficulties are also experienced while participating in multinational meetings for conferences. This calls for the need of hiring interpreting services, and results in miscommunication. Lack of proficiency in speaking English is considered as a major concern for people as it serves as a barrier in the process of gathering information and seeking assistance (Taylor, Nicolle and Maguire 2013). This can be attributed to the fact that if the speaker and receiver fail to use same language, intended meaning of conversation often go misunderstood and misinterpreted. This makes communication ineffective and prevents the actual message from getting conveyed (Meuter et al. 2015). Due to increase in diversity of a nation, a huge number of people belonging to type of linguistic and cultural backgrounds are employed in the healthcare workforce. This results in healthcare providers facing challenges in caring for people speaking different language.

Reasons for undertaking research- Removing language barriers has been chosen as the research activity since they create hindrances in the process of delivering equitable and effective health care to all patients. Healthcare professionals most often include migrants who do not speak English as their first language. Most patients belonging to linguistic minority groups also use a different language to communicate during healthcare encounters. Often they have to rely on ability of interpreters in order to understand what treatment is being offered to them (Tenzer, Pudelko and Harzing 2014). Such language discrepancy results in an increase in psychological stress, and gives rise to communication errors in medically significant scenarios. Therefore, it is essential to understand a basic language while communicating details of a disease or its treatment. This research activity will therefore enhance my knowledge on the potential waste that can be explored to remove these barriers. It will increase my awareness on instances that contribute to failure in communication. Miscommunication often results in negative consequences, which lead to failure of the patients to show compliance with prescribed medication (McCarthy et al. 2013). Hence, the research activity will also strengthen nursing practice by eliminating all kinds of barriers that are likely to occur when nursing professionals use a language different from the widely accepted once.

Importance of Communication in Healthcare Services

Creating provisions for communication skills training for nursing staff will help in reducing medical errors due to miscommunication in the hospital setting.

Research objective- Miscommunication in healthcare sector is often life threatening due to the fact that increase number of migrant patients and healthcare staff trained in foreign lands fail to communicate with each other appropriately. Such language barriers not only threaten ability of healthcare professionals to deliver high-quality patient service but also impose various legal risks. Cultural barriers, limited proficiency in English, and lowest literacy has been identified as triple threats that create barriers in effective health communication (Betancourt et al. 2016). Seeking help from nurses who do not speak the official language of English results in lack of access to healthcare services (Mirza et al. 2014). Therefore, patterns of communication and culture are imperative to delivery of holistic health outcomes to every patient. Language is described as the most essential technology of medicine, needed for conducting health care service. Establishing effective communication provides the opportunity to all patients present in a health encounter to explore the underlying factors that might have contributed to their disease or illness (Visser, Deliens and Houttekier 2014). It also facilitates their participation with healthcare professionals in determining which aspects of their culture should be kept in mind while formulating therapeutic interventions. Most often first language barriers are overcome by using translators and interpreters. However, presence of such interpreters complicates healthcare encounters by resulting in loss of important communication components like, body language, voice tone, and posture (van Rosse et al. 2016). It also results in a loss of opportunity of the concerned healthcare providers and the client to connect on a personal level beyond spoken words. Thus, language barriers lead to a failure in establishing good rapport and trust between nurse and their clients. Therefore, the research aims to identify effectiveness of communication skills training in eliminating language barriers in nursing. It will also explore the impact of such training in preventing medication error and miscommunication, which in turn will directly reduce adverse health events.

Another discipline that can be correlated to this particular research activity is associated with patient safety. The discipline of patient safety puts emphasis on safeguarding all patients in healthcare setting, regardless of their cultural and linguistic backgrounds (Okuyama, Wagner and Bijnen 2014). This discipline focuses on adoption of appropriate strategies that reduce rates of medication errors and miscommunication between health care staff and patients (Blume and Board 2013). Effective communication with patients is often considered crucial to their safety. Therefore, barriers in such communication predispose them to adverse health outcomes. Stereotyping patients according to their culture or underestimating effect of cultural differences will interfere in effective communication and result in risky situations (Lindholm et al. 2012). Thus, there is a need to involve the patient safety discipline as well.

Research Objective

Sources- Two sources that will be used for gathering information on articles relevant to minimizing language barriers in Healthcare sector are:

  • Cochrane Library- https://www.cochranelibrary.com/
  • PubMed- https://www.ncbi.nlm.nih.gov/pubmed/

Methods of gathering information- Information gathering will be based on searching appropriate articles from the above-mentioned two sources. The research hypothesis has been kept extremely specific and comprehensive. Literature research will involve use of specific keyword that will help in extracting articles. These keywords include “language”, “linguistic”, “barriers”, “hindrances”, “miscommunication”, “effective communication”, “healthcare”, “nursing”, “medical error”, and “medication error”. A wide range of Boolean operators such as OR, AND, and NOT will be used to exclude articles that are not relevant to the research hypothesis or have not been published yet.

Collection of information on removing language barrier will be based on systematic review owing to the fact that such reviews contain a collection and summarization of several empirical evidences, which meet their eligibility criteria. Furthermore, they investigate validity of findings and risk of bias.

A systematic review was conducted to determine the effects of communication skills training on conversation between doctors and their patients. Articles were retrieved from 6 electronic data bases. 20 articles were found to meet the inclusion criteria and focused on communication skills using didactic component strategy, in combination with feedback and practical rehearsal. Although the articles married in the duration of training period, most of the studies showed statistically significant improvement in communication enhancement between doctors and patients. Therefore, results of the systematic review suggested that enhanced communication between patients and doctors should be considered as a public health priority, which requires effective training programs. These trainings enhance communication skills and create an empathetic relationship between doctors and their clients, thereby preventing miscommunication. The systematic review is particularly important for the research activity because it will facilitate better understanding of the skills on which healthcare professionals need to be provided training, in order to minimize language barriers (Liu et al. 2015).

Another systematic review was conducted to investigate effects of communication skills training while interacting with patients suffering from dementia. An exhaustive search of several electronic data bases such as, AMED, MEDLINE, PsychInfo, and CINAHL resulted in inclusion of 12 trials focused on 831 dementia patients, and more than 500 professional caregivers. Thorough analysis of the results of included trials suggested that communication competencies skills and knowledge of professional, as well as caregivers, while providing health care services to dementia patients, increase positive health outcomes. Professional caregivers also displayed an interest in learning more about their patients, along with an increased enthusiasm on importance of communication. This directly benefited dementia patients and resulted in satisfying interaction (Eggenberger, Heimerl and Bennett 2013).

Training to Overcome Language Barriers

Impacts of communication training model on healthcare services were explored by another study that attempted to evaluate implications of the training on interprofessional communication. The study recruited 306 medical to student and subjected them to a 4 hour long training, which included simulation, didactic session, and feedback. The students were made to work in paediatric, obstetrics and acute words. Significant improvements were found in attitude of the students towards communication, self-motivation, and utility of the provided training. Hence, the study was able to demonstrate positive effects of communication training programs in healthcare settings (Brock et al. 2013).

Another observational study was conducted that examined impact of physician communication skills on patient satisfaction. It recruited 1537 physician and subjected them to communication skills that included group skill practice sessions, interactive didactics, and video or life skill demonstrations. An analysis of the results suggested that overall communications scores were higher for physicians present in the intervention group, compared to control. The participants also reported higher satisfaction and showed improvement in empathy and reduced rates of burnout in the intervention group. Hence, the study was able to establish the fact that communication skills training improve patient satisfaction, and reduce physician burnouts (Boissy et al. 2016).

Comparison of two studies, namely, one on effectiveness of communication training model and the other observational study is given in the appendix.

Conclusion- Thus, it can be concluded that communication is an essential practice in nursing in order to maintain patient safety, overall health and wellbeing. Due to the fact that nurses form the centre of patient care, it is their primary responsibility to facilitate effective dialogue with clients and their family members. With the aim of assuming more complex roles and caring for culturally diverse clients, nurses will have to strengthen their communication skills. Poor communication skills might result in serious errors, which can directly cost a patient life. In addition to proper speaking and writing, active listening forms another basic component of interpersonal communication. Listening the preferences and demands of patients and communicating with them in a universal language will help the letter to understand that their needs are being cared for. Effective communication is therefore essential to achieve successful outcome of nursing care. Hence, it is imperative for all nurses to undergo communication skills training that will improve their proficiency in English and help them demonstrate courtesy and sincerity towards their patients.

Impact- In order to prevent miscommunication that might lead to medication errors, all nurses should get enrolled in short term communication skills training programs. It will assist them to improve their personal communication in English language for successful interactions (Lebrun 2012). Such training programs will improve their leadership skills, negotiation capabilities and assertiveness. They will be able to better utilize their emotional intelligence and potential in order to end communication conflicts and improve patient satisfaction (Lee, Lee and Ng 2012). It will also help them verbalized exactly what they intend to say, thereby improving clarity.

Sources and Methods of Gathering Information

The gathered information can be used in workplace by making the hospital administration and higher authorities understand the need to create provisions for the communication skill training or workshop for all healthcare professionals. This will make nurses more competitive by improving their English and will provide them the opportunity to understand how to give presentation and interact with patients while explaining diagnosis and proposed intervention (Lion et al. 2013). It will also help in understanding proper use of voice tone, gestures and body language, thereby increasing capability of handling conflicting situations.

Reflection- The research activity helped me realize that in order to be a successful nurse, the primary criteria is related to effective communication skills. Excellent capability in connecting and communicating with patients helps in fostering healthy relationship, provide high level of healthcare services, and prevent medication errors. I understood that thousands of preventable medical errors according annually can be eliminated if nurses are engaged in efficient conversation with their clients. Therefore, I realize the need of implementing training programs in workplace that will help to prevent miscommunication and related events which worsen patient condition or cause permanent harm.

Issues- There is a need to conduct for the research on cost effectiveness of this communication skills program as various nurses might not be able to afford their services. Implementation of cost effective training programs will lead to enrolment of more number of nursing professionals thereby improving positive outcome and patient satisfaction.

References

Betancourt, J.R., Green, A.R., Carrillo, J.E. and Owusu Ananeh-Firempong, I.I., 2016. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports.

Binder, P., Borné, Y., Johnsdotter, S. and Essén, B., 2012. Shared language is essential: communication in a multiethnic obstetric care setting. Journal of health communication, 17(10), pp.1171-1186.

Blume, A. and Board, O., 2013. Language barriers. Econometrica, 81(2), pp.781-812.

Boissy, A., Windover, A.K., Bokar, D., Karafa, M., Neuendorf, K., Frankel, R.M., Merlino, J. and Rothberg, M.B., 2016. Communication skills training for physicians improves patient satisfaction. Journal of general internal medicine, 31(7), pp.755-761.

Brock, D., Abu-Rish, E., Chiu, C.R., Hammer, D., Wilson, S., Vorvick, L., Blondon, K., Schaad, D., Liner, D. and Zierler, B., 2013. Republished: interprofessional education in team communication: working together to improve patient safety. Postgraduate medical journal, 89(1057), pp.642-651.

Eggenberger, E., Heimerl, K. and Bennett, M.I., 2013. Communication skills training in dementia care: a systematic review of effectiveness, training content, and didactic methods in different care settings. International Psychogeriatrics, 25(3), pp.345-358.

Karliner, L.S., Auerbach, A., Nápoles, A., Schillinger, D., Nickleach, D. and Pérez-Stable, E.J., 2012. Language barriers and understanding of hospital discharge instructions. Medical care, 50(4), p.283.

Lebrun, L.A., 2012. Effects of length of stay and language proficiency on health care experiences among immigrants in Canada and the United States. Social science & medicine, 74(7), pp.1062-1072.

Lee, Y.K., Lee, P.Y. and Ng, C.J., 2012. A qualitative study on healthcare professionals’ perceived barriers to insulin initiation in a multi-ethnic population. BMC family practice, 13(1), p.28.

Lindholm, M., Hargraves, J.L., Ferguson, W.J. and Reed, G., 2012. Professional language interpretation and inpatient length of stay and readmission rates. Journal of general internal medicine, 27(10), pp.1294-1299.

Lion, K.C., Rafton, S.A., Shafii, J., Brownstein, D., Michel, E., Tolman, M. and Ebel, B.E., 2013. Association between language, serious adverse events, and length of stay among hospitalized children. Hospital pediatrics, 3(3), pp.219-225.

Liu, X., Rohrer, W., Luo, A., Fang, Z., He, T. and Xie, W., 2015. Doctor–patient communication skills training in mainland China: A systematic review of the literature. Patient education and counseling, 98(1), pp.3-14.

McCarthy, J., Cassidy, I., Graham, M.M. and Tuohy, D., 2013. Conversations through barriers of language and interpretation. British journal of nursing, 22(6), pp.335-339.

Meuter, R.F., Gallois, C., Segalowitz, N.S., Ryder, A.G. and Hocking, J., 2015. Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language. BMC health services research, 15(1), p.371.

Mirza, M., Luna, R., Mathews, B., Hasnain, R., Hebert, E., Niebauer, A. and Mishra, U.D., 2014. Barriers to healthcare access among refugees with disabilities and chronic health conditions resettled in the US Midwest. Journal of Immigrant and Minority Health, 16(4), pp.733-742.

Okuyama, A., Wagner, C. and Bijnen, B., 2014. Speaking up for patient safety by hospital-based health care professionals: a literature review. BMC health services research, 14(1), p.61.

Taylor, S.P., Nicolle, C. and Maguire, M., 2013. Cross-cultural communication barriers in health care. Nursing Standard (through 2013), 27(31), p.35.

Tenzer, H., Pudelko, M. and Harzing, A.W., 2014. The impact of language barriers on trust formation in multinational teams. Journal of International Business Studies, 45(5), pp.508-535.

van Rosse, F., de Bruijne, M., Suurmond, J., Essink-Bot, M.L. and Wagner, C., 2016. Language barriers and patient safety risks in hospital care. A mixed methods study. International journal of nursing studies, 54, pp.45-53.

Visser, M., Deliens, L. and Houttekier, D., 2014. Physician-related barriers to communication and patient-and family-centred decision-making towards the end of life in intensive care: a systematic review. Critical Care, 18(6), p.604.

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