Name: Michael Garrahy
Student Number: n8277907
Tutor: Katie Page

Topic:

Cultural Sensitivity, can health services 'feel'?


"The language barrier is probably the most difficult and the longest to overcome". ~Stephen Lee.


external image PatientThankingLance.jpgexternal image interpreting.jpg

















Artifact:
These pictures depict patients being spoken to by their consulting physicians in health services (such as hospitals, as seen in these images). One of the main barriers that hospitals have to tend with almost every day is the communication barrier of language. The first photo shows communication between a patient with speech difficulties, thus the need for a communication aid, which in this case is a speech board, which can help the physician assess the condition of the patient. The second photo, and main issue for this study, shows a woman using an interpreter to talk to her doctor, as because of her culture or ethnicity she is unable to directly communicate with the health officer and must use the aid of the interpreter. This particular scenario is one that can happen very frequently in many different countries. For example countries such as Australia, as it is a very diverse multicultural society, with dozens of different cultural and ethnic backgrounds.

Public health issue:
The above artifact represents the situation where health services need to recognize the cultural and ethnic differences in patients, and work through the many different barriers to effective communicate to their patients. This is a very important issue for health services, but it also a very complicated issue. With medical care there exists many boundaries with patient to medical officer interaction. The biggest barrier to this communication is language. Along with language, at the same time medical officers need to take care and respect a patients cultural and ethnic beliefs.

Literature review:

A language barrier is defined as, "a barrier to effective communication from speaking different languages". Through-out medical services all over the world, this single boundary is one of the greatest that exists as it can greatly affect the patients recovery and also affect their treating medical officers if they cannot adequately communicate to their patient.

According to Higginbotham, E (2003). "Finding a way to communicate with a patent who can't speak English isn't always easy, but it is essential". This statement is extremely important as it directly states how a communication barrier is vital to all health services. Higginbotham, E (2003) concludes by stating, "The consequences for failing to do so can be dire, from both a clinical and legal perspective". This study highlighted how 'false fluency' can result in a poor outcome for the patient. Higginbotham, E (2008), stated that during a seven month period where researchers who studied Spanish-speaking children, as well as their guardians at a pediatric clinic, that a very large number of medical interpretation errors resulted per visit. This study is important as it can help to show people the gaps that can occur as a result of misinterpretation. One of the errors that occurred during this study was during translation, when there was no direct translation for a term or word used by the patient. One final detail that the author mentioned in this study was the impact of having family or loved ones during the medical assessment, as "a loved one may omit information about side effects", this can have many psychological consequences for both the guardian and the patient.

Study conducted by Salamonson, Y, who is a lecturer at the University of Western Sydney, helped to show how students (in this study, nursing health students) with a low to medium English language proficiency are continually challenged on a day to day basis for interpretation of work. This study helped to provide students to allow them to improve their own academic writing skills, rather than research methodology and collating information. Biological sciences, or more importantly science regarding medical technology and health services is a very large topic, and students who use English as their second language tend to struggle more grasping the very specific details this subject entails. This study helped to conclude that even though communication was a barrier to these nursing students, specific workshops on the topics, can help their overall academic understanding of the subject.

O'Reilly, D (2009), helped to show research that directly impacted a group with obviously communication difficulties, this group being the deaf community. She helped to state that the deaf community have many issues when accessing health services, as well as communicating with health officials. This is one of the major examples of how communication with a medical professional can be greatly strained. Another major impact which O'Reilly, D (2009) encountered was the prevalence of deaf patients who also suffered from mental illnesses. She stated that some deaf people did not want to come to her support center due to the "stigma about mental illness in the deaf community". She was able to combat this problem by making the compromise of seeing patients at the closest GP practice to the patient.

A final study conducted by the School of Nursing and Midwifery at the University of Sheffield, helped to reiterate the fact that language barriers posed one of the biggest problems to communities when they try to access health care. This study helped to show that the ability to communicate fluently in English varies greatly across many different cultural and ethnic groups. But many people had the ability to overcome this issue by seeking out medical practitioners who spoke their own language. Unfortunately for many people this was a very unlikely option for primary health care. According to this study, there are extremely small amounts of UK nurses from ethnic backgrounds who were sought out by people within their own ethnic community for the primary need of health care. This is also attributed to the fact that patients cannot openly choose who treats them for their ailments. World wide it is recognized that the interpretation services that countless health care services currently possess is extremely inadequate to provide any kind of benefit to the patient, thus health services rely on bilingual family members of the patient to interpret the medical assessments etc. Unfortunately this means that communities, most importantly ethnic communities are greatly affected which in turn causes great issues for the patient. This study helped to put forth that many medical practitioners would not have received specific training to efficiently use an interpreter to ask their patients specific life and death questions.

As stated, the barrier of language is an very large barrier for medical officers to overcome, but there are many different ways that are present which can help aid them. The use of interpreters is vital as it can help to provide a vital link of communication so that health services can provide adequate treatment to their patients.

Cultural and Social Analysis:
There are many different cultural groups which are greatly affected by the communication issues that are present in health services today. Miscommunication or the misinterpretation of information to and from patients and health officers is of greatly concern to all parties involved as many different consequences can result because of this. The two main groups that are affected the most by this communication break down are the patients themselves and their treating medical officers.

Lister, N (2005), a nursing student at the time reflects upon his placement where he was asked to look after a Chinese patient, he reflected greatly upon the troubles of helping someone with mental health issues who was said to be a low to medium risk of self harm. This is a prime example of someone in one of the two previously mentioned groups, that can be greatly affected of how a language barrier can be detrimental and cause many lasting effects. The author of this article showed that because of the lack of communication for language, he and others had to rely greatly on body posture and language to communicate, but with these results sometimes being hard to interpret. In this particular situation it was not only the medical officer who was affected, as the patient himself had no beneficial means of communicating how he was feeling towards his attending medical officers. This is another example of how literal the saying: "lost in translation" can become, as there is no exact Chinese translation for the word 'depression', thus he was in many ways left isolated from treatment.

Awareness of this issue is of the utmost importance due to the consequences that could result due to the lack of awareness. As previously stated, there are many groups that can be affected, but the group that is affected most by the lack of awareness and services to deal with this communication issue is the patients themselves. As Jirwe, Gerrish and Emami (2010), have stated, the problem exists primarily with the health services not being able to cater for the multicultural society that exists in the area that the hospital cares for. According to their research a patients issues are compounded greatly if they do not have a direct line of communication to their medical officer, and can lead to increased cases of nervousness or anxiety to a patient with medical issues. Unfortunately, according to research done by a UK study, it said that medical officers who had the ability to communicate in more than one language were so frequently asked to help translate that it impacted greatly on their ability to better learn clinical knowledge, thus another impact for health officers in regards to communication with patients.

From the previously mentioned studies it can be seen that it is vital that health professionals develop the skills to become more efficient and effective at communicating in a cross-cultural society, thus to decrease issues where language can become a major barrier. Collectively as a whole, one possible means of increasing the ability of health professionals to become confident when communicating in a cross cultural situation would be the introduction of courses into their curriculum to better help them to understand the differences in a persons background. By becoming aware of the consequences due to a lack of communication between patient and medical officers it will be very beneficial for all parties to seek information and education about this ever increasingly important issue.

Artifact analysis:

My artifacts I have used, are an extremely important representations of how communication is currently pictured in our health services. These images cause people to understand and realize how in a multicultural society, we need to be accepting that English is not the only language that is spoken. In my opinion this issue is one of the biggest problems that can affect the outcome of a patients health status, because if the communication with patients is not correct, then the consequences can be detrimental to their overall state of health.

By analysing this topic, I was able to come to the final conclusion that if health services do not educate the people they employ about the dangers of not being cross culturally efficient about communicating, then there can be many consequences both to them, and most importantly to the patients. As this issue will directly relate to me in the coming future as a public health student, it will help me to become more aware about other cultures and how being aware of this issue can make be a better public health officer, because if I do not become more aware about this growing issue, then my abilities to do a proficient job as a public health officer will be greatly hindered.

Responses:

It could truly be the end.
The artifact you have used could not have helped to highlight this issue any better. Many of us as students are directly related to our ever changing world, because with negative change it can really be "the end of the world as we know it". Very well researched article, and an extremely thought provoking read. This issue is vital as it can help students and people of our generation to become more aware of the decisions being made and how this can affect us as time goes on. Well done on the content.
Link: http://healthculturesociety.wikispaces.com/Climate+Change+and+Health+-+The+End+of+The+World+as+We+Know+It%3F

Multiculturalism.
The artifact you have used it an extremely important issue within our society. As public health students it is vital that we recognize the differences in the patients we give assistance to and culturally and ethnically compliant to all their different traditions. As a multicultural society is is also important that we understand that that we need to become more culturally sensitive. A very well researched wiki article!
Link: http://healthculturesociety.wikispaces.com/Ignorance%2C+or+cultural+misunderstanding%3F

References:

Unknown, Author, (2011). Definition of Language Barrier. Retrieved 27 October, from: http://www.wordwebonline.com/en/LANGUAGEBARRIER

Higginbotham, E. (2003). "Legally Speaking. How to overcome the language barrier". Nursing Journal. 66(10): 67-9, 76-7, 53 (13 ref).

Unknown Author, (2010). Quotes with Language Barrier. Retrieved 28th October, from: http://www.quotesea.com/quotes/with/language-barrier

Salamonson, Y. (2010). "Clearing the Language Barrier". Nursing Standard Journal. 25(5): 69.

Brown, C. (2011). "What makes multiculturalism great is mutual respect". Sydney Morning Herald. Retrieved 1st October 2011, from: http://www.smh.com.au/opinion/politics/what-makes-multiculturalism-great-is-mutual-respect-20110216-1awik.html

Trueland, J. (2009). "Breaking the language barrier". Mental health practise. 12(5): 7.

Gerrish, K., Chau, R., Sobowale, A., Birks, E. (2004) "Bridging the language barrier: The use of interpreters in primary care nursing". Health and Social care in the community. 12(5): 407-13 (21 ref).

Sheridan, G. (2011). "How I lost faith in multiculturalism". The Australian. Retrieved 1st October 2011, from: http://www.theaustralian.com.au/national-affairs/how-i-lost-faith-in-multiculturalism/story-fn59niix-1226031793805

Lister, N. (2005). "Starting out: student experiences in the real world of nursing. A language barrier isolates patients and can be harmful". Nursing standard. 19(44): 29.

Jirwe, M., Gerrish, K., Emami, A. (2010) "Student Nurses experiences of communication in cross-cultural care encounters" Scandinavian Journal of Caring Sciences. 24(3): 436-44. Doi: 10.1111/j.1471-6712.2009.00733.