Minimising Language Barrier in Healthcare Communication

This research topic focuses on the challenges faced by healthcare workers due to language barriers when explaining health conditions to patients from diverse cultural and linguistic backgrounds. The objective is to learn the impact of language barriers on patient health and how training on cross-cultural skills can help overcome them. The research question is whether training and education on cross-cultural skills can help overcome language barriers in emergency wards and prevent misdiagnosis. The study is connected with the discipline of medical interpretation. Relevant sources for this research include PubMed and Cochrane Library. The most relevant paper found is a randomised control trial by Brock et al. (2013) that focuses on the efficacy of a communication training model named TeamSTEPPS in reducing the frequency of misdiagnosis.

Research Topic 2
Minimising language barrier when communicating with clients
Topic 2 – Background
Read before starting your assignment
You are a new enrolled nurse working in a public hospital located in a big city. A large number of the hospital’s clients do not speak
English fluently and some of your colleagues find it difficult to communicate with those clients.
In order to improve communication with non-English speakers, your nurse manager has asked you to research ways to minimise
language barrier in the workplace and to inform your colleagues about your findings.
Plan the research activity
1. In order to complete this assessment, you need to identify TWO (2) areas related to the topic below where research can
help support and improve your own practice as an EN.
Topic: Minimising language barrier when communicating with clients
Australia is the multicultural society; therefore health care workers face challenges due to language barrier when explaining health conditions to
the patients. Two of the areas that can be used to improve the nurse’s practice would be –
 Communication with non-English speaking patients
 Communicating with patients of diverse cultural norms and linguistic needs
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2. Identify the reason(s) for undertaking your research from the list below.
 You may select several reasons.
 Provide a brief rationale for each.
E.g. reasons: Comparison / hypothesis testing / trend identification / own knowledge extension / strengthen quality of own
practice.
The reason to undertake this research is to enhance personal awareness of communication issues in multicultural health care setting. It will
help overcome the issue of misdiagnosis in future and possible medication error due to miscommunication with culturally diverse patients. It will
help in gaining insights into communication skills required to deliver safe and high quality care. The purpose of this study is to learn the impact of
the language barriers and the patient’s health outcomes. It will help me learn strategies to overcome this issue
According to Norouzinia et al. (2016) patients coming from countries like Iran may have one formal language but multiple dialects that acts as
language barrier between nurse and patients. Moreover, there is bulk of literature highlighting the high level of communication barriers existing
when dealing with the patients from the diverse ethnic, cultural and linguistic barriers. It was also highlighted by Mapedzahama et al. (2012) that
the black migrant nurses in Australia reclaim challenges when dealing with the patients from the non English-speaking background. Language
barriers leads to wide variety of risky situations related to the pain management, medication management, and patient- nurse interaction
concerning diagnosis, fluid-balance management as well as risk communication and acute situations (van Rosse et al. 2016).
3. Write a clear statement highlighting your research question or hypothesis.
It may include:
 Nursing interventions applicable to the topic
 Client perceptions of the provision of this topic
 Political issues confronting nursing practice and health care provision in relation to the topic
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An example of a question (the student can NOT use this example), would be:
Does a ward communication tool is time efficient to communicate with CALD people?
An example of a hypothesis (the student can NOT use this example), would be:
CALD clients are less likely to complain about pain than English speaking clients.
Q). Can training and education on cross cultural skills help overcome language barriers in emergency ward and prevent wrong diagnosis?
Hypothesis
Nurses may face difficulty in explaining the heath conditions to patients from non-English background. The patients are less likely to experience
the positive health care outcomes due to language barriers between them and nurses. They may undergo misdiagnosis. Communication skills
training for nurses may help better communicate with the culturally diverse patients about the health conditions and improve the health
outcomes.
4. Establish and define the general research objective.
Tips:
 A research objective summarises what is to be achieved by the study.
 Ensure your objective is S.M.A.R.T and relevant, logical, feasible, observable and measurable.
 The objective should be clearly phrased – use verbs, e.g. to assess, to establish, to determine, to compare, etc.
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If non-English speaking patients are not able to communicate their needs, nurses may develop misconceptions regarding the symptoms,
ailments, medical history, which, may lead to misconceptions. Extreme misconceptions may create high chance of medical error. The likeliness of
the medical error is high if there is no medical interpreter available. Poor communication due to language barrier or low proficiency to speak
English may prevent patient to discuss their cultural needs or health beliefs (Flores et al. 2012).
Effective relationship with patient is built when there is optimal communication despite cultural and linguist diversity. It helps people from
multicultural and diverse ethnic background to verbalise their health concerns. It will also help nurses to communicate about interventions
considering the diverse cultural values and beliefs.
I personally believe that the nurses must be culturally sensitive and demonstrate interest to learn the needs of the patients from multicultural
background. The objective here is having awareness will help nurses to learn the impact of miscommunication due to language barriers on the
patient health.
5. Identify ONE (1) other discipline that could be connected to this research activity.
 Briefly explain your choice of discipline.
Medical interpreters are recruited in various hospitals as they can well speak in English as well as other languages (Juckett and Unger 2014). They
help provide translations services to the patients in Emergency ward. Therefore, medical interpreters can be other discipline that aid in
communication issues between nurses and cultural and linguistically diverse patients. It means this research study is well connected with the
discipline of medical interpreter. It will facilitate the needs and concerns of the patients from multicultural background. This discipline may be
useful in overcoming the issue of medical or diagnostic errors.
6. In order to gather information about the research topic, you will need to access credible sources of data and evidence.
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 List two (2) sources you may use for this assignment.
 Copy the link address of the source and paste it next to the source’s name – this will provide the proof to your assessor
that you accessed it.
o E.g. PubMed - http://www.ncbi.nlm.nih.gov/pubmed
Source 1: PubMed- https://www.ncbi.nlm.nih.gov/pubmed/
Source 2: Cochrane Library- http://www.cochranelibrary.com/
The above two sources were used for the extraction of relevant research paper pertaining to the research topic. The rationale for choosing the
above two sources are- bulk of peer reviewed articles that are reliable and valid available on the area of interest that is language barrier and
communication issue between nurse and patient from multicultural background (Armstrong et al. 2011).
HINT: Contact your educator and discuss your research topic and verbally gain confirmation that you and your
partner are still on track.
Gather information for your research
7. Evaluate and select a maximum of two (2) methods of gathering information you think would be most appropriate to answer
your research question.
 Briefly explain why you have chosen a particular method over another, e.g. more time efficient.
Tips:
Methods of gathering include search engine using correct key words, literature reviews, systematic reviews, interviews,
surveys, seminars, and surveys.
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Google Scholar was one method of gathering information and the other method was JBI database that stands for Joanna Briggs Institute. The
first one was more effective than the second one as research paper of different methodology can be extracted such as qualitative, quantitative,
or mixed methods and opinion reports. In JBI database mainly systematic reviews are found (Smith et al. 2011). Through Google Scholar relevant
findings were extracted using key words such as “language barriers”, “misdiagnosis”, and Boolean operators like AND, OR for narrowing the
research.
8. You are now to gather information for your research topic using a systematic approach.
Stages for your information gathering activity
1. Statement of objective – you should have already completed that step
2. Data collection, i.e. a literature search
3. Data evaluation – critiquing articles to include or exclude them from the review. You may use the appraisal tools
developed by JBI to help you http://joannabriggs.org/research/critical-appraisal-tools.html
4. Analysis – comparing, contrasting, challenging & reflecting
5. Presentation of findings
At this stage, select four (4) sources
Please find below the hierarchy of evidence:
1. Systematic reviews and meta-analysis
2. Randomised controlled trials
3. Cohort studies
4. Case-control studies
5. Cross-sectional surveys
6. Case reports
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Statement of the objective- the objective statement for this research is that nurse training and education on the cross cultural communication
skills will help them develop awareness on the language barriers and its impact such as misdiagnosis on the patient health.
Data collection- The research papers mainly collected for this study are systematic reviews and peer reviewed articles. The rational for collecting
this data was validity of the research and credibility of the authors. The first study includes a systematic review as main piece of evidence as it
stands first on the given hierarchy of evidence. The second study includes a randomised control study as it is the next major piece of study as
per the given hierarchy of evidence
Data evaluation:
The first piece of evidence by Govere and Govere (2016) reviewed the need of training health care providers to develop cultural competence.
The author critically appraised the published articles in this domain in 2002 to 2014. As per the findings of the review, training on cultural
competence is an effective intervention that facilitates the delivery of culturally competent care by health care professionals, when dealing with
the patients from multicultural background. Five of the studies demonstrated an increase in patient satisfaction with cross cultural
communication training. All the seven studies showed a high degree of variabiity According to the findings misdiagnosis and inaccurate patient
outcomes have been associated with the nonspecific and invalidated assessment tools. Cultural competence training increased level of cultural
competence and henceforth patient satisfaction. It implies the need of developing provider-targeted cultural competence training protocols to
provide high quality care in culturally diverse setting.
The second study is a randomised control trial by Brock et al. (2013), which indicates the association between medical errors and misdiagnosis
with the communication failures. In this study, a communication training model named TeamSTEPPS has been used order to determine the
efficacy of the communication skills and its impact on health care outcomes. A total number of patients selected randomly are 306. The
participated in the 4 hour training along with one hour TeamSTEPPS didactic session. The training also includes 1 h team simulation and feedback
sessions in group settings. The results showed significant attitudinal shifts among the participants including improvement in team
communication, utility of training and motivation. The patients demonstrated high level of self efficacy in dealing with patients irrespective of
patient’s cultural background.
The third study was the survey on assessing the need of foreign language skills of the care providers working mainly for patient with no
proficiency in English speaking. The rational for the national representive survey in US is the increasingly diverse patients, discordant physician-
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patient relationship due to language barrier, misdiagnosis, inappropriate treatment and medical error. Only 18% of the US hospitals have
assessed the foreign language proficiency of their medical staff. A less than a third of hospitals gave any interpreter service training to the
medical residents. The author emphasise on cross cultural communication training needs due to increasing numbers of limited English
proficiency patients and language barriers. As per the survey results, language training programs when integrated in the medical curriculum
helps people develop language proficiency, improve accuracy of diagnosis and better understand use of interpreter services during emergency
(Tucker, Chen and Glass 2012).
The fourth study is the survey on mental health practioners with experiences of the linguistic diversity. The study is focused on the migrants
who do not speak official language of the native country. Heath care disparity is associated with the linguistic gap. Based on the survey, it was
found that the mental health practioners had to work with allophones clients. In this case the interpreters had to work beyond merely
translating the language. The practioners demonstrated the need of the training to deal with the language barriers. They demonstrate the need
to learn different roles played by the interpreters in health care delivery and ways to address the difference in communication dynamics. The
practioners perceived the benefits of communication training and education on language interpretation in improving accuracy of diagnosis.
According to this practioners the training on diverse language interoperation improves the access to the allophone clients (Brisset et al. 2014).
Analysis :
Based on the data collected from the two chosen methods, the above four articles were found to be most relevant in addressing the research
questions. Cross cultural ommunication training is effective for the health care providers in multicultural hospital setting to overcome language
barrier in emergency situation as well prevent misdiagnosis.
9. Distinguish between relevant and irrelevant information.
 Briefly explain why one (1) of your information sources is particularly relevant according to objectives and your
workplace requirements.
The most relevant paper found was randomised control trial by Brock et al. (2013) as it is focused on the specific communication model in
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enhancing the cultural competence of the health care providers and decreasing the language barriers. In addition this study also focused on
preventing misdiagnosis and medical errors due to language barriers. The findings of the study can be well correlated with the research
objectives. It indicated the efficacy of training model named TeamSTEPPS in reducing the frequency of misdiagnosis. The association between
misdiagnosis and medication error has also been well established in the study by Tucker, Chen and Glass (2012). The study results by Brock et al.
(2013) were reliable and valid. It is understood that the misdiagnosis is very common in the culturally diverse setting due to poor foreign
language skills of the health care providers.
10. In order to facilitate your analysis, organise the information you have found.
Tips:
 You may summarise each source of information using key words
 You may choose to order your articles by chronological order if your focus is to show an evolution of practices
 You may order your articles following the rules of evidence, i.e. RCT > case report
HINT: Contact your educator and discuss your research topic and verbally gain confirmation that you and your
partner are still on track.
Analyse the information
11. Prioritise information based on the research objectives.
 Using questions 9 and 10 to help you, select only TWO (2) articles that you will keep for the rest of this assignment.
The two research articles are the following:
1. Republished: Interprofessional education in team communication: working together to improve patient safety
2. Foreign language assessment and training in US medical education is a must.
12. Compare and contrast your two (2) sources of information.
 Use the table provided in Appendix A.
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 You must complete all the sections.
 Instructions in italics are to be removed.
13. You have now thoroughly analysed the information available to you. Now draw conclusions based on your findings.
Based on the findings it can be concluded that cross-cultural communication skills is the basis of the patient-nurse relationship in multicultural
setting. Cultural and linguistically diverse patients have diverse needs. Miscommunication in emergency wards due to poor foreign language
skills of the care providers and the difficulty communicating with non-English speaking patients increases the frequency of misdiagnosis and
other risky situations such as death due to medical error. As per the study findings, training of health care providers on cross-cultural
communication skills decreases the frequency of such adverse events in emergency wards. Foreign language training skills and
education/training on interpreter services help health care providers better communicate with patients from multicultural background. The
importance of such training is also perceived by several practioners and nurses.
14. As your findings may be used to establish evidence-based practice, identify one (1) impact your conclusions may have in
terms of duty of care requirements.
 E.g. in order to do no harm to the clients and prevent disease transmission, all nurses should wear gloves when touching
the client.
In my duty of care, I would use effective cross cultural communication skills by uptaking training and education. On learning the different
approaches to deal with multilingual patients I can deliver patient centered care. All nurses must known about Model like STEPPs that will help
understand diverse client needs, accurate diagnosis and develop appropriate interventions
Contact your educator and discuss your research topic and verbally gain confirmation that you and your partner are still on
track.
Use information in practice
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15. Assess one (1) way in which different aspects of information may be used in your workplace.
The information about the benefits of the different communication skills training can be shared in the health care setting. The various
approaches and benefits can be used to engage in workshops and training programs. It can be applied in workplace while dealing with
patients and other co-workers from diverse cultural backgrounds to prevent discriminations on the basis of race, culture and ethnicity. It
can also be used for developing workplace protocols or guidelines.
16. Using and reflecting on what you have learnt from your research, identify one area for change in your workplace or current
practice.
I have learned from the research that there is need of communication training to deal with CALD patients. However, there is lack of awareness
among many care providers about its importance. Therefore, I feel there is need of creating awareness among staffs through pamphlets, regular
meetings, and social media campaign. Cross cultural communication training should be made an important aspect of continuous professional
development activities for professionals.
17. Identify issues that require further research and evaluation.
There is a need of in-depth study on assessment tools to determine the efficacy of the communication or foreign language training programs. It
will help determine the accuracy of the outcomes of such programs and impact on patient satisfaction.
18. Using one piece of A4 paper or PowerPoint (1 slide) (portrait format), develop a poster or a flyer to address outcomes of
research, i.e. select a method to disseminate your findings.
 You will be required to scan it and upload it on Blackboard with this assignment.
 Refer to your learning activities 11 and 12 for more ideas about how to do a poster or a flyer using PowerPoint.
Tips:
 Consider your audience, the time and resources available.
 It is recommended you adopt a flyer or poster style with a mix of text and pictures – do not put too much information.
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HINT: Contact your educator and discuss your actions to verbally gain confirmation that you and your partner
are still on track.
WORD COUNT: _______
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References
Armstrong, R., Hall, B.J., Doyle, J. and Waters, E., 2011. ‘Scoping the scope’of a cochrane review. Journal of Public Health, 33(1), pp.147-150.
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.
Brisset, C., Leanza, Y., Rosenberg, E., Vissandjée, B., Kirmayer, L.J., Muckle, G., Xenocostas, S. and Laforce, H., 2014. Language barriers in mental health care: A survey of
primary care practitioners. Journal of immigrant and minority health, 16(6), pp.1238-1246.
Butow, P.N., Lobb, E., Jefford, M., Goldstein, D., Eisenbruch, M., Girgis, A., King, M., Sze, M., Aldridge, L. and Schofield, P., 2012. A bridge between cultures: interpreters’
perspectives of consultations with migrant oncology patients. Supportive Care in Cancer, 20(2), pp.235-244.
Flores, G., Abreu, M., Barone, C.P., Bachur, R. and Lin, H., 2012. Errors of medical interpretation and their potential clinical consequences: a comparison of professional
versus ad hoc versus no interpreters. Annals of emergency medicine, 60(5), pp.545-553.
Govere, L. and Govere, E.M., 2016. How effective is cultural competence training of healthcare providers on improving patient satisfaction of minority groups? A systematic
review of literature. Worldviews on Evidence
‐Based Nursing, 13(6), pp.402-410.
Juckett, G. and Unger, K.E.N.D.R.A., 2014. Appropriate use of medical interpreters. Am Fam Physician, 90(7), pp.476-80.
Mapedzahama, V., Rudge, T., West, S. and Perron, A., 2012. Black nurse in white space? Rethinking the in/visibility of race within the Australian nursing workplace. Nursing
inquiry, 19(2), pp.153-164.
Norouzinia, R., Aghabarari, M., Shiri, M., Karimi, M. and Samami, E., 2016. Communication barriers perceived by nurses and patients. Global journal of health science, 8(6),
p.65.
Smith, V., Devane, D., Begley, C.M. and Clarke, M., 2011. Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC medical
research methodology, 11(1), p.15.
Tucker, J.D., Chen, A.H. and Glass, R.I., 2012. Foreign language assessment and training in US medical education is a must. Academic Medicine, 87(3), p.257.
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.
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Appendix A – Comparing and contrasting information
Article 1 – 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.
Article 2 Tucker, J.D., Chen, A.H. and Glass, R.I., 2012. Foreign language
assessment and training in US medical education is a must. Academic
Medicine, 87(3), p.257.
Currency 2013 2012
Study findings Prevent language barrier by training though TeamSTEPPs
model and improve patient satisfaction
language training programs when integrated in the medical curriculum helps
people develop language proficiency, improve accuracy of diagnosis and
better understand use of interpreter services during emergency
Strength of study Randomized control trial (second in hierarchy of evidence ) Survey (fifth in hierarchy of evidence)
Relevance to
objectives
The article is relevant to objectives as it was found that
communication skills training help better communicate with the
culturally diverse patients about the health conditions and
improve the health outcomes.
The article met study objectives as it assessed the benefit of foreign
language training of nurses on improving patient outcomes culturally
diverse setting
Reliability On repeating the trial the similar study results may be obtained The results can be reliable when tested in different settings
Validity Internal validity: useful in healthcare setting where
communication issues lead to misdiagnosis
External validity: specific for decreasing the frequency of
misdiagnosis
Internal validity-only performed on nurse students
External validity: Specific to US hospital setting - multispecialty hospital
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Benefits Information can be shared in health care setting for developing
awareness among fellow nurses
A specific focus on understanding the importance of the foreign
language skills and interpret service training to deal with patients from
multicultural background.
Risks As the efficacy of the model is not tested in larger setting, its
integration in health care setting may be difficult
It is not too risky to integrate such training in medical curriculum.
Feasibility
associated with
information
The training outcomes can be integrated in CALD health care
setting
The outcomes of training can be linked with better patient outcomes and
decrease misdiagnosis in CALD health care setting
Conclusions There is increasing health care disparity due to rise in population of patients with multicultural background and patients with low proficiency of
English. This, there is high frequency of misdiagnosis and other adverse events. Cross cultural communication training and education may be
beneficial for nurses to prevent misdiagnosis in emergency ward and improve patient satisfaction.
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EDUCATOR
Assessment – Written Report
CHCPOL003 Research and apply evidence to practice
Marking guide Rubric for Research Assignments
Criteria Not satisfactory Satisfactory
Plan the research
activity
Does not identify area of research
for improved practice. Does not
identify reasons for undertaking
research. Does not provides
statement of question/hypothesis.
Does not define research
objective. Does not identify
another relevant discipline. Does
not list credible sources accessed.
Identifies area of research for
improved practice. Identifies
reasons for undertaking research.
Provides statement of
question/hypothesis. Defines
research objective. Identifies
another relevant discipline. Lists
credible sources accessed.
Gather information for
the research
Insufficiently evaluates 2 methods
of information gathering. Does not
use systematic approach to
information gathering. Does not
distinguish relevance of
information. Does not organise
information.
Evaluates 2 methods of
information gathering. Uses
systematic approach to
information gathering.
Distinguishes relevance of
information. Organises
information.
Analyse the
information
Does not prioritise information
based on objectives. Insufficiently
compares and contrasts sources.
Draws no conclusions on analysis.
Does not identify impacts of
research conclusions.
Prioritises information based on
objectives. Compares and
contrasts sources. Draws
conclusions on analysis. Identifies
impacts of research conclusions.
Use information in
practice
Does not assess use of information
in own practice. Poorly or
ineffectively reflects on learning
from research, areas of
applicability to practice. Cannot
identify issues for further
research. Does not develop
method for dissemination of
findings of research, or is poorly
presented.
Assesses use of information in
own practice. Reflects on learning
from research, areas of
applicability to practice. Identifies
issues for further research.
Develops method for
dissemination of findings of
research, and presents it clearly,
concisely and with appropriate
language, grammar, spelling.
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