Minimizing Language Barriers in Healthcare: Evidence-Based Nursing Research

This research activity aims to identify the effectiveness of communication skills training in eliminating language barriers in nursing and explore the impact of such training in preventing medication error and miscommunication, which in turn will directly reduce adverse health events.

Running head: EVIDENCE BASED NURSING RESEARCH
Research Topic 2- Minimizing language barriers
Name of the Student
Name of the University
Author Note

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EVIDENCE BASED NURSING RESEARCH
Introduction- 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,

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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.
Research question/hypothesis- 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

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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

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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.
Sources- Two sources that will be used for gathering information on articles relevant to
minimizing language barriers in Healthcare sector are:
 Cochrane Library- http://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.
Systematic approach- 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

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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).
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

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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- 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

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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.
Use- 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.

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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.

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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.

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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.

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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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Appendix
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- 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.
Currency 2013 2016
Study findings Effective team communication
increases positive attitude in
physicians and is important for
patient safety
Training on communication
skills improve patient
satisfaction
Strength of study It developed 2 instruments to
help students report
experiences of the training
Investing in communication
training will produce good
investment returns
Relevance to objectives It was able to determine
implication of effective
conversation on patient
It was able to determine
impact of communication
skills in patient scores and

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outcomes physician burnout rates
Reliability Consistent findings in student
reports establish
implementation of the study in
other trials
Showed consistency with
previous studies in improved
outpatient satisfaction scores
Validity It used a validated instrument,
the TAQ to determine the
responses. Thus, the results
did not have flaws
The R.E.D.E model utilized
an empirically validated skill
course in the setting
Benefits It addressed logistic
challenges. It also provided
students the ability to practice
their skills in realistic
simulations and made
opportunities for feedback
It was found to be effective for
all healthcare professionals,
who reported higher
satisfaction rates
Risks No defined control group
present.
Other reasons for improving
the scores could not be ruled
out. Study was conducted in
one organsation and contained
self-reports.
Feasibility associated with
information
The model can be easily
applied in real time setting
It can be easily implemented
in workplace
Conclusion Patient safety is enhanced Relationship-centered

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through effective
communication
communication skill improves
patient satisfaction and
reduces burnout.