Language barriers can negatively impact a patient’s health literacy (Murray, Elmer & Elkhair) making it more challenging for the patient to understand, often times, complex medical diagnoses and treatments (Hu, 2018). These challenges can contribute to the adverse outcomes due to poor communication among the patient and the provider (Hu, 2018).
What is the impact of language barriers in healthcare?
It has been demonstrated that, for patients from culturally and linguistically diverse backgrounds, language barriers contribute to poorer quality of care and patient safety ( 3 – 6 ).
Is language a barrier to parental involvement?
Language can be a barrier to engaging parents in different forms of involvement. Meehan uses homework as an example. While parents may have the abilities or skill sets to complete certain assignments, because they do not understand what is written in the assignment, they may be unable to help as much as they would like to.
Do language and cultural barriers jeopardize a system's effectiveness?
There is plenty of anecdotal and empirical evidence that language and cultural barriers jeopardize a system’s effectiveness and disadvantage people who do not speak or are not fluent speakers of English.
What is it like to face a language barrier?
If you have ever been in a situation where you do not speak the language of the land and cannot understand or make yourself understood, you know what it is like to face a language barrier. Imagine needing medical attention in that environment. In any given setting, the inability to effectively communicate can be very limiting and stressful.
How do language barriers affect nursing care?
Conclusions: Language barriers, in any country or setting, can negatively affect nurses' ability to communicate effectively with their patients and thereby have a negative impact on the provision of appropriate, timely, safe and effective care to meet patient's needs.
Do cultural differences and language barriers have an impact on healthcare compliance?
Among other things, they found: Safety issues related to language tend to be easier to recognize than those related to culture. Twice more hospitals reported identifying a direct relationship between patient safety issues and patients' linguistic needs than cultural needs.
How do you educate patients with language barriers?
How to Overcome Language Barriers in Health CareUse Google Translate and Interpreters. Doctors have a number of tools at their disposal, ranging from using Google Translate to having interpreters on hand to help. ... Try to Avoid Family-Member Translators. ... Don't Just Be Bilingual, Be Bicultural.
What are the effects of language barriers?
They can cause misunderstandings that lead to conflict, frustration, offense, violence, hurt feelings, and wasting time, effort, money, and lives of the people. Summary, language barriers are semantic problems that arise during the process of encoding and/ordecoding the message into words and ideas, respectively.
How does a language barrier affect patient safety?
Inadequate language proficiency poses patient safety risks, with the potential for patient harm or inadequate care. Such shortfalls are not routinely annotated in patient records in the Netherlands. van Rosse and colleagues address this by identifying such shortfalls, when they occur and how they are addressed.
How does language barriers affect health literacy?
Research indicates that limited language skills and low literacy skills are associated with lower educational attainment and worse health outcomes.
How can you communicate effectively with language barriers?
10 Strategies for Overcoming Language Barriers. By Kate Berardo.Speak slowly and clearly. Focus on clearly enunciating and slowing down your speech. ... Ask for clarification. ... Frequently check for understanding. ... Avoid idioms. ... Be careful of jargon. ... Define the basics of business. ... Be specific.More items...
Why is language barrier a problem?
They can cause unnecessary misunderstandings, and many people get frustrated or irritated easily which can even lead to conflict. Language Barriers limit the knowledge of individuals too. Indeed, they cause a big impact on our lives, and getting rid of them completely might be impossible.
What are some examples of language barriers?
Some common examples of linguistic barriers include people from different countries interacting with one another, people in some countries having a different way of greeting others and people having the same language speaking in different dialects. Culture has a significant role to play in linguistic barriers.
What are language barriers in health and social care?
Language barriers can prevent patients from engaging in conversations with their clinicians – so how can healthcare providers deliver a quality care service to someone, if they can't understand what their clinician is telling them?
How can language affect learning?
Studies have shown that learning another language can enhance knowledge of English structure and vocabulary, as well as help students score significantly higher in math and language arts.
Why is language important in healthcare?
Language concordance between physicians and patients has been shown to improve care through fewer medical errors, increased understanding of illness and the treatment plan, adherence to the treatment plan, and satisfaction with care [15].
How does language barrier affect health?
Language barriers can negatively impact a patient’s health literacy (Murray, Elmer & Elkhair) making it more challenging for the patient to understand, often times, complex medical diagnoses and treatments (Hu, 2018). These challenges can contribute to the adverse outcomes due to poor communication among the patient and the provider (Hu, 2018).
How can language barriers be addressed?
There are many ways in which language barriers can be addressed. However, these techniques are not enough to prevent problems with communication. Availability of new technology to empower patients to actively participate in their care, is not always available due to limited hospital budgets. Professional medical interpreters are available and can alleviate some communication barriers, however, they may not necessarily prevent patient safety risks (Ali & Watson, 2018). Interpreting services may also stifle the nurse-patient relationship, as speaking through an interpreter is not as effective or satisfying as having a direct conversation with a health care member (Ali & Watson, 2018). Not having access to an interpreter can lead to serious consequences. For instance, a patient in California underwent a nephrectomy in which the healthy kidney was removed instead of the diseased one. It was discovered that the patient signed a consent form in English and was not provided an interpreter (Goodwin, 2018). Medical errors are prevalent due to the inappropriate use or disregard of interpreting services (Goodwin, 2018).
How does language affect LEP patients?
Hospital administration has taken steps to decrease the impact of language barriers with LEP patients. Language barriers can lead to ineffective communication with healthcare providers, which in turn, can lead to uncertainty, stress, and hurdles that affect the implementation of culturally competent and patient-centered care (Ali & Johnson, 2017). In order to provide holistic care, it is important to adapt care models to fit the patient’s culture and language preference (Shesser, 2017). A study conducted by Ali and Johnson (2017) explored the impact of the bilingual nurse in providing language concordant care to LEP patients. Nurses who were involved in the study were able to speak at least one other language fluently, which proved to be an asset when caring for the LEP patients. Speaking the same language with the patient can provide them with comfort and reassurance, enhanced nurse-patient relationship, improved treatment compliance, higher patient satisfaction, decreased cost of care, and fewer emergency room visits (Ali & Johnson., 2017). It facilitates the development of trust and gives the patient a chance to communicate their needs effectively and directly to the nurse. Providing care to patients in their primary language can enhance the healthcare experience of the patient whilst also being an invaluable asset to the healthcare team (Ali & Johnson., 2017). It highlights the importance of providing language concordant care. It is important to make the patient an active participant in their care and to provide culturally congruent care (Shesser, 2017). Title VI of the Civil Rights Act of 1964, under Federal and state law require that health care organizations that receive Medicare and Medicaid reimbursement take reasonable steps to provide language assistance services to LEP, Deaf and Hard of Hearing patients that is free of charge, accurate, timely and in accordance with HIPAA guidelines (U. S. Department of Health and Human Services [DHHS], n.d). A program established by Children’s Hospital of Philadelphia attempts to bridge the gap in LEP patient-provider communication. It provides professional interpreter services rather than relying on ad hoc interpreters, recognizing that it may lead to preventable serious medical errors and miscommunication (Shesser, 2017). Nurses provide bedside inpatient teaching prior to discharge, in order to assess the patient and family’s understanding of medications, medical equipment use, and treatment, allowing the patient to demonstrate skills and ask questions. Visiting nurses are able to provide linguistically appropriate continuity of care by performing medication reconciliation, assessing treatment adherence, and inspecting the environment for safety risks (Shesser, 2017).
How does LEP impact patients?
LEP impacts all aspects of care, including assessment. Another safety issue related to patients that have limited English proficiency is pain management (Rosse et al., 2016). A great deal of patient teaching is involved when explaining the pain scale. When patients do not understand how to rate their pain because of their limited comprehension of English, the reported pain level may be inaccurate. Pain and distress can also be described in different ways by different cultural groups (Meuter, Gallois, Segalowitz, Ryder, & Hocking, 2015). Because pain is subjective, miscommunication can greatly impact quality of care (Rosse et al., 2016). The inaccurate pain rating can lead to either overmedication or undermedication, which may result in poor pain management (Rosse et al., 2016). Similarly, there are multiple health conditions that require the strict measurements such as urine, stool, and daily fluid intake of a patient. To be able to accurately measure intake and output, it is essential that the patient can correctly utilize the necessary instruments, such as a urinal or urine collection hat. Inaccurate measurements greatly impact the course of treatment prescribed, which may lead to the exacerbation of existing conditions. Incorrect fluid balance management can lead to adverse outcomes, such as dehydration and renal or heart failure, and inappropriate treatment plans that can greatly impact the overall patient health (Rosse et al., 2016) and quality of life.
Why is it important to acknowledge linguistic differences with LEP patients?
Lack of awareness regarding the communication barrier between nurses and LEP patients can lead to improper use of resources, potentially contributing to severe consequences. The communication gap can result in compromised quality and safety and increased medical errors. Therefore, it is important for all nurses, present and future, to acknowledge linguistic differences with LEP patients to prevent further health disparities.
How many people have limited English proficiency?
According to the U.S. Census Bureau, nearly 25 million people in the U.S. have limited English proficiency (LEP) (as cited in Wasserman et al., 2014). Therefore, effective communication with a LEP patient becomes central to the provision of successful care.
What happens if a patient does not understand a diagnosis?
If a patient does not understand a new diagnosis, or if a provider is not able to accurately explain the associated risk factors, the patient is not likely to make informed decisions, which may be life threatening (Meuter et al., 2015). Comprehending medical information represents a challenge for any patient.
What is it like to not speak the language of the land?
If you have ever been in a situation where you do not speak the language of the land and cannot understand or make yourself understood, you know what it is like to face a language barrier. Imagine needing medical attention in that environment. In any given setting, the inability to effectively communicate can be very limiting and stressful. ...
What is the importance of integrity of communication in healthcare?
Integrity of communication is a crucial key to the system’s success. When that integrity is compromised, so is the system’s ability to provide safe and effective care.
Why is ineffective communication important?
There is plenty of anecdotal and empirical evidence that language and cultural barriers jeopardize a system’s effectiveness and disadvantage people who do not speak or are not fluent speakers of English. Researchers from Boston Medical Center and Boston University School of Public Health found that individuals who do not speak English at home are less likely to receive colorectal cancer screenings than those who do. Their findings [5] demonstrate that language barriers contribute to health disparities. This has important implications. Colorectal cancer is the third most common cancer in the U.S. It is the second leading cause of cancer-related deaths in men, and third in women. Examples abound of medical errors with devastating effects resulting from failure to address these barriers. That is particularly unfortunate, because these are largely avoidable risks.
How did the Midwest improve the emergency department?
A Midwest region hospital improved their Emergency Department flow by increasing language services and working to better understand the community they serve.
What is the ntegrity of communication?
NTEGRITY OF COMMUNICATION IS A CRUCIAL KEY. Language is at the heart of communication and any exchange of information. When there is a breakdown, vital information that both patients and providers rely on is not captured, not delivered, not accurate, delayed, or just plain incorrect.
Why is it important to include patients in the conversation?
The idea to include patients in the important conversation around improving communication was a great one. The people for whom the medical industry exists in the first place have traditionally not been given a seat at the table. Your customers are always the best people to tell you what they need, as well as if and how well their needs are being met. This is a good one to keep in mind. The patient’s perspective is, more often than not, neglected. As many involved in quality improvement efforts are discovering, it can be the most valuable.
How many people speak other than English?
One out of five, or over 60 million people in the United States, speak a language other than English at home [1]. Forty-two percent of this group is Limited English Proficient (LEP) [2], meaning they speak English less than “very well.” This segment of the U.S. population is at risk for adverse events because of impediments associated with their language ability.
What are the factors that affect language discordance?
As we listened to how the role of the interpreter was conceptualized, observed interpreter-mediated speech, and, in particular, studied translated text from English into Spanish we identified three factors inherent in language-discordant communication: (1) language and culture are inextricably linked; (2) relationship building is hindered with interpreter-mediated communication; and (3) cultural competency and effective communication are interdependent. Understanding how these factors affect communication with patients whose proficiency in English is limited can raise awareness of potential failures in communication with all patients.
What are the communication challenges of a patient?
Communication challenges when patients and doctors do not speak the same language is not surprising, but, according to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the skills required to comprehend typical health information exceed the abilities of the average American [2]. Like the canary in the coal shaft warning miners of impending danger, patients with limited English proficiency may be the harbinger of challenges that go beyond language differences. This article takes the perspective that learning how to effectively communicate with patients when there are language differences may offer insights and skills transferable to communicating with English-speaking patients.
How do interpreters learn their trade?
Unfortunately, most interpreters learn their trade through on-the-job training. Their language proficiency and how accurately intended meaning is conveyed from one party to the other is often not known. Using untrained interpreters or family members who are less skilled in being transparent and impartial can result in incomplete patient assessments. How are subtle nonverbal communication cues (e.g., emphasis, alarm, urgency, or emotions such as empathy or concern) conveyed from one speaker to the other? The skills of an interpreter are critical—they are the sender and receiver of our message and the patient's. Interpreter-mediated communication brings attention to how normal communication is altered and how the connection and trust important to an effective patient-physician relationship may be more difficult to develop.
How many English speaking Americans are unable to understand health information?
Ninety million English-speaking Americans have trouble understanding complex texts common in health care [3]. Among those unable to comprehend typical health information were college graduates and professionals such as teachers and engineers. Beyond reading and writing skills, health literacy includes listening, speaking, and conceptual knowledge that make it possible to understand health interactions, forms, and instructions. In essence, health care environments have cultures of their own, ways of doing things, and uses of language that are different than what average persons experience in their day to day lives.
What are some examples of cultural factors that must be negotiated in clinical encounters?
Moreover, beliefs, attitudes, intentions, and behaviors toward health care—all derived from a patient's culture—factor into the patient-physician relationship. Modesty, refusal to eat certain foods, and observance of religious rituals are examples of cultural factors that must be negotiated in clinical encounters.
What are cultural factors in medical education?
Graduate medical education now includes content on culturally determined aspects of patient care—different disease explanatory models, ways of interacting with health care professionals, communication style, whether patients make eye contact or not , and differences in decision-making styles and in understanding of disease and health. Moreover, beliefs, attitudes, intentions, and behaviors toward health care—all derived from a patient's culture—factor into the patient-physician relationship. Modesty, refusal to eat certain foods, and observance of religious rituals are examples of cultural factors that must be negotiated in clinical encounters. At the same time, variability from one group to another and within groups can be stunning, particularly as we consider acculturation, education, and other factors that serve to broaden a person's world view.
Why is clear communication important in healthcare?
Clear communication between caregivers and patients is essential to safe, high quality health care services. Developing rapport and gaining patient trust relies on understanding. When patient and doctor do not speak the same language, there is less opportunity to develop rapport or use "small talk" to obtain a comprehensive patient history, learn relevant clinical information, or increase emotional engagement in treatment. Rather than solving these problems the introduction of an interpreter may raise another set of questions.
What is the effect of poor understanding of prescribed treatment on patient confusion?
Poor understanding of prescribed treatment also contributed to patient confusion, resulting in failure to follow treatment instructions. As one participant with LEP explained: “The dermatologist had given me a medication that I was to apply in one spot, but I hadn’t understood, I administered the medication the wrong way” (P10).
What are the experiences of patients and interpreters-navigators?
Patients and interpreters-navigators described experiences where language barriers contributed to poorer patient assessment, misdiagnosis and/or delayed treatment, incomplete understanding of patient condition and prescribed treatment, and impaired confidence in services received. Reliance on Google Translate and ad hoc, untrained interpreters are commonly reported, in spite of evidence highlighting the risks associated with such practice.
Why is communication important in health care?
Effective communication between health-care provider, patient, and families is critical for provision of safe high-quality care. Language barriers, and their associated risks, are also experienced by OML speakers in Canada. Health-care organizations should be supported, at all levels, in their efforts to increase awareness of the impact of language barriers and developing and implementing practical strategies to reduce them. Only then can we ensure equity in quality of care and patient safety for official language minority populations.
What are some examples of poor understanding of diagnosis?
For example, one patient understood that her condition was much more serious than the actual diagnosis. The interpreter who accompanied her in a subsequent appointment was able to rectify the patient’s understanding of her diagnosis and reduce her anxiety.
Can Lean Library solve it?
Accessing resources off campus can be a challenge. Lean Library can solve it
Can you get diagnostic testing in French in Canada?
Some patients preferred accessing services in French elsewhere in Canada. One participant accessed diagnostic testing in French in Quebec for her autistic child; traveling costs and salary loss incurred were not reimbursed. Others relied on previously consulted bilingual providers in Quebec or France for prescriptions when services were not available in French in their own province.
What is the challenge of educating patients?
Educating patients: understanding barriers, learning styles, and teaching techniques. Health care delivery and education has become a challenge for providers. Nurses and other professionals are challenged daily to assure that the patient has the necessary information to make informed decisions.
What are the obstacles to health care?
Obstacles that prevent easy delivery of health care information include literacy, culture, language, and physiological barriers.
Why is health care delivery a challenge?
Nurses and other professionals are challenged daily to assure that the patient has the necessary information to make informed decisions. Patients and their families are given a multitude of information about their health and commonly must make important decisions ...
Why do bilingual educators need a degree?
Bilingual education expert Jessica Padrón Meehan, Ed.D., points out that for many cultures, an educator’s degree earns them a level of respect with parents, who will comply with much of what is asked of them. An educator imposing their views on whether English should be spoken at home, however, can cross a line.
How can educators make the school experience more accessible and accepting to all students?
By working closely and communicating openly with parents on how to navigate language barriers, educators can make the school experience more accessible and accepting to all students.
Why is it important to be mindful of students' cultural differences?
For any educator, being mindful of students’ cultural differences, including languages spoken with their families, is an essential part of creating a welcoming space that is optimal for learning.
What are some examples of conversation topics that may be better left to the parent and the teacher?
Sensitive information, academic struggles, and information related to behavior are examples of conversation topics that may be better left to the parent and the teacher.
What is the bridge between a teacher and a parent?
The obvious bridge between the teacher and the parent is the child. And being able to translate can be a positive skill for young people to learn.
What is community collaboration?
Collaborating with community: Connect families to broader community resources related to community health, social support services, and activities such as summer programs for students.
How to communicate effectively?
Use direct language. Avoid educational jargon, idioms, figurative language, and expressions, which can muddy the meaning of what you are trying to communicate.
How does language barrier affect nurses?
Language barriers, in any country or setting, can negatively affect nurses’ ability to communicate effectively with their patients and thereby have a negative impact on the provision of appropriate, timely, safe and effective care to meet patient's needs.
What is the purpose of the study of language barriers in nursing?
To explore nurses’ perspectives of language barriers and their impact on the provision of care to patients with limited English proficiency from diverse linguistic background.
Why is communication important in nursing?
Communication was identified as the most important aspect of care provision and an essential component of a nurse's professional role regardless of the clinical area or speciality. Language barriers were identified as the biggest obstacles in providing adequate, appropriate, effective and timely care to patients with limited English proficiency.
Is it useful to have a professional interpreter?
Use of professional interpreters was considered useful; however, the limitations associated with use of interpretation service, including arrangement difficulties, availability and accessibility of interpreters, convenience, confidentiality and privacy-related issues and impact on the patient's comfort were mentioned.
How does language barrier affect healthcare delivery?
(See Table 1 .) Patients with LEP have longer lengths of stay than English-speaking patients, even if they have a higher socioeconomic status. 16-18 They also have a higher risk of 30-day readmission, by as much as 25%. 18,19
Why are language barriers important?
Patients with language barriers change how nurses work and organize patient care. These changes are needed not only to meet communication needs for the patient, but also for legal reasons. In 1964, the U.S. Civil Rights Act helped ensure that a lack of English language skills wouldn't be a source of discrimination. 12,13 U.S. law requires that healthcare organizations provide interpreter services to patients with LEP. 14 Regulations implemented as part of the Affordable Care Act place new restrictions on the use of family members and validating language skills of healthcare workers. 15
What are interpreter resources?
Interpreter resources typically include in-person interpreters employed by an organization, in-person interpreters contracted through external agencies, and telephone- or technology-based interpreter services. (See Table 2 .)
What is a medical interpreter?
Aside from facilitating communication between patients and healthcare providers, medical interpreters can also serve as cultural brokers. 27-30 The medical interpreter helps bridge the cultural divide between patients and clinicians. The translation process ensures that what a nurse says is delivered not only with technical accuracy, but also with culturally specific phrasing. Nurses can assess the quality of medical interpreters' cultural brokerage by observing how the patient responds to the interpreter through his or her body language.
What is a patient with limited English proficiency?
In the United States, a language other than English is now spoken at home in one of five households, the highest level since just after World War I. 1 Patients with limited English skills are referred to as patients with limited English proficiency (LEP).
When should nurses use interpreters?
Research shows that the three critical times when nurses should use interpreters are at admission, during patient teaching, and at discharge. Using interpreters at these times decreases the risks of medical errors and hospital readmissions. 18,36,44-46.
Do healthcare organizations need interpreters?
However, many healthcare organizations are seeing more diversity and have a greater need for interpreters. Most organizations begin with interpreter phone services and, if the demand becomes high enough, hire full-time interpreters. Telephone interpretation can work if implemented well.
What are the three priority projects in the verbal education subcommittee?
The verbal education subcommittee consisted of a physician, a nurse, and a dietitian. The three projects were assessed through an impact matrix for their feasibility, cost not to fix (this includes monetary and public health costs), and impact on the problem.
How to provide the highest quality verbal education?
To offer the highest quality verbal education, a healthcare provider must understand the patient's background, reading level, and how he or she learns best. Different people have different abilities to learn, and providers need to understand what distinct learning preferences and needs the patient may have (Anonymous, 2000; Montin et al., 2010; Posma et al., 2009). After the provider understands the patient's optimal method of learning, he or she can adjust the teaching and training strategy to incorporate many techniques, including demonstrations, diagrams, reinforcement, review, teach-back, support, etc. (Anonymous, 2000).
What is BWFH patient education?
The Brigham and Women's Faulkner Hospital (BWFH) Patient/Family Education Committee set out to explore literature on verbal education and barriers to effective education. Our goal was to share our own internal methodologies and develop a new model of verbal education that included recommendations for best practices for healthcare institutions and providers. While verbal education should be just one part of an integrated, multimodal patient education session, it is vital that it be delivered in a fashion that augments the patient's learning, comprehension, and retention.
How to communicate with deaf patients?
Cultural, cognitive, and physical differences require different educational approaches (Goody & Drago, 2009). For example, Lieu et al. (2007) recommended that providers communicating with deaf patients should make eye contact, may need to write to communicate, but never assume that there is an exact translation of medical terms into sign language. In another study focusing on hearing-impaired patients, Tye-Murray (1992) empathized that it helps if the provider anticipates hearing loss and the patient may be able to prepare for communication by reading or writing words that he or she wants to know about. For patients whose preferred learning style is not verbal communication, Behar-Horenstein et al. (2005) recommended that providers broaden the use of alternative instructional aids and methods of delivery that utilize auditory, visual, and kinesthetic modalities. Pictures on paper or a screen may serve as simple visual aids to supplement verbal education.
Why is face to face communication the best way to communicate?
Face-to-face is the best way to communicate because a provider can assess if the patient really understands
Why is patient education important?
The need for patient education is widely recognized in the medical community (Behar-Horenstein et al., 2005). Well-educated patients are better able to understand and manage their own health and medical care throughout their lives. Patient–provider communication is a key element of patient education and is often used in conjunction with other teaching practices. Communication is effective when patients receive accurate, timely, complete, and unambiguous messages from providers in ways that enable them to participate responsibly in their care. Patient understanding of information communicated by healthcare providers can lead to enhanced patient satisfaction, better compliance with treatment instructions, improved outcomes, and decreased treatment times and costs (Behar-Horenstein et al., 2005; The Joint Commission, 2010). Patient education is also a requirement for accreditation of healthcare facilities.
Is patient education successful?
Not all patient education is successful. In reality, communication is often partially understood, misunderstood, or misinterpreted. Even with the best of intentions, patient education that fails to educate can lead to adverse events or poor outcomes. The Joint Commission studied patient–provider communication as the root cause of sentinel events and found that poor oral communication caused 10% of these events (The Joint Commission, 2010).
Consequences of Language Barriers
Medication Errors
Inaccurate Assessment
Treatment and Follow-Up
Role of Nurses in Enhancing Communication
- Hospital administration has taken steps to decrease the impact of language barriers with LEP patients. Language barriers can lead to ineffective communication with healthcare providers, which in turn, can lead to uncertainty, stress, and hurdles that affect the implementation of culturally competent and patient-centered care (Ali & Johnson, 2017). ...
Conclusion
References