The second theoreticalapproach looks at the conversational dynamics of patient & nurseinteractions. It explores the differences in terms of the balance of powerbetween the patient and nurse, as well as how the use of language could bothserve as an instrument that manipulates them and reflect the relationship. The framework ofCommunication Accommodation Theory (CAT) is the third theoreticalapproach. This approach carries weight particularly when comparinglanguage-congruent and language-discrepant communication.
The CommunicationAccommodation Theory puts forth the idea that speakers attempt to adjusttheir way of speaking to reach particular social goals that centre aroundgaining some sort of social identity, approval etc. Secondly, the CAT theorydescribes the efficiency of communication being indicated by the level in whichspeakers converge. Thirdly, convergence isseen as being both normative and positive and lastly to some extent, divergenceis typically received negatively and implies a specificintent. Furthermore, Communication Accommodation Theory (CAT) can also beused as a basis in which to study the dynamics of patient-practitionercommunication. If in certain instances convergence is not able to bereached (i.e. speech likenesses) this can not only impact the standard of theworking relationship between the patient and the professional but additionallythe way, the speakers subsequently regard one another. The key objectiveis recognising what are the exact affects that language discrepancy has inaddition to what the patient-nurse communication repercussions may be.
The fundamentality that isplaced on good communication between patients and nurses is something that hasbeen widely acknowledged. Schyve (2007) also states that, it is not simply afacilitator or an adjunct of health care, but it is also a core component.Furthermore, Jackson (1998) suggests that medicines most essential technologyis language, which is the principle instrument for conducting its work, thatonly acts to further reinforce this idea.
There has been reviews inliterature in regards to patient-provider communication, which specifies thatthere is a link between the effects on the satisfaction of patients in additionto the specific health outcomes for example how they recover from symptoms,pain, physiological measure of blood pressure and blood glucose (Kaplan et al,1989; Williams et al, 1998; Teutch, 2003; Stewart, 1995; Stewart et al, 1999; Stewartet al, 2000) as well as the quality of communication. Improved healthoutcomes have been connected to three basic communication processes. Thefirst process which has been identified is improved health outcomes; the secondprocess is the control of dialogue by the patient and the final process is theestablished rapport (Kaplan et al, 1989).
All of these processes areplaced into jeopardy in instances of language discordant. Nevertheless, other additional risks arepresented with language barrier. Assimple as it may seem to improve the nurses’ general communication skills it isnot enough to address the risk that patients who do not speak the same languageencounter.
An increased likelihood ofmalpractice complains and claims, risk to providers are all caused by poorcommunication (Domino et al, 2014; Lussier and Richard, 2005). There are many literatures focusing oncommunication between medical personnel, including patient handovers, but notmuch on the safety of patient literature relating to communication has focusedon miscommunication between patient and nurse. Even though these are different concepts,equally, there have been issues of cultural responsiveness or competence andlinguistic, which have often been conflated.
Between health care providers and patients, there have been manydifferent approaches addressing cultural differences. These approaches include, culturalcompetence, cultural proficiency, cultural appropriateness, congruence,cultural sensitivity and cultural awareness. All these approaches are based on different assumptions. Particularly cultural competence, which haspotential pitfalls and has been identified with several authors suggestingcultural safety (Coup, 1996) or cultural humility (Tervelon & Murray-Garcia,1998) as alternatives. In a culturally diverse society, theproposed preferred strategy for quality care is patient centered care (Epner& Baile, 2012). It has beenconcluded that if the ethnic and racial disparities are to be addressed, languagebarrier will be the target.
This is notbecause they are the most documented source of disparities but because for atruly patient-centered care, communication is a basic requirement (Saha , 2007). According to researchthat has been focused on mainly experiences with care by patients andcommunities, it has been identified that within the minority communitiesthemselves, language barriers is also a priority (Stevens, 1993; Ngwakongnwi etal, 2012). Fewer visits for non-urgent medial problemsand lower frequency of general check-ups are associated with a language barrier(Derose et al., 2000; Pearson et al. 2008). Fiscella et al (2002), also states that health care visits aresignificantly more likely to be fewer for individuals with limited Englishproficiency.
Studies conducted byAyanian et al (2005), found that patients with language barriers are lesscontent with communication from health professionals, such as nurses, staffhelpfulness as well as giving low assessment of psychosocial care. Individuals who experience problems inregards to their care have been identified to be the ones who experiencelanguage barriers with their providers according to studies.When language barrier is present, areview of literature has revealed that there is consistently a significantdifference in compliance and understanding. Lack of understanding of what has been said is usually the reason whypatients are not satisfied.
This resultsin lower adherence to the prescribed treatment. In the medical encounter, poor communication usually results toinaccurate and incomplete history, misinformation for treatment plans,misdiagnosis and the patient usually lacking understanding of their prescribedtreatment and condition. Language barriers can lead to poorercontrolling of disease outcomes and management, even if the diagnosis of acondition is correct. For example, inthe case of diet and physical activity there is less of a chance of the patientbeing counselled (Tjia et al, 2009). There are only a small number of patients who lack fluency in theEnglish language that have reported receiving counselling on health andlifestyle or for a patient suffering from hypotension, heart disease ordiabetes, getting the advice to have their blood pressure checked on a regularbasis (Kenik et al, 2014). In the area of reproductive health andsexuality, language barriers present additional challenges. According to Coronado et al (2007),counselling and testing for sexually transmitted diseases (STI) and human immunodeficiencyvirus (HIV) may be less likely received by limited English proficientindividuals. A particular concern inregards to the fear of loss of confidentiality leads to worries which may bestigmatizing or embarrassing.
Another particular area in which languagebarrier has a great impact on is pain management. Higher levels of pain control, greaterhelpfulness from their provider to treat their pain and timely pain treatmentwere reported by obstetrical patients who always received interpreters, in comparisonto those who do not always receive interpreters. This has been identified bythe study by Jimenez et al (2014). Further studies which have investigated ethnic/racial differences interms of management of pain, has also identified that language also contributesto the control of pain. An example ofthis is Cleeland et al (1997), who found that compared to 50% of non-minoritypatients, only 35% of minority patients with cancer received recommendedguideline analgesic prescriptions. The impact of language barriers onmanagement of chronic disease management has been the main focus of manystudies. However, the area that has received the most attention and aparticular concern at this current time is the management of asthma anddiabetes. Due to limited fluency in theEnglish language, risk factors have been noted in the management ofdiabetes.
These include fewer footchecks, less likelihood of a self-monitoring blood glucose being performed,less likelihood of receiving education on diabetes and also less wellcontrolled symptoms of diabetes (Tjia et al, 2009). Within the ageing population, it has beenidentified that increasing challenges around language access are being reportedby health providers, states Koehn (2009). Bouchard et al (2009) also states that concerns have been expressed byelderly minority language speakers around communication.
It has been observed that many clients whohave had a significantly high level of English proficiency throughout theirworking lives, as a result of the ageing process tend to lose this secondlanguage ability, even when dementia is absent (Clyne, 2011). When under stress, the first language of manyolder patients is more likely to return. In the case where a patient is suffering from a cognitive impairment,this attrition of second language may be more acute (Kieizer, 2011).
According to Murtagh (2011), there are noclear reasons for this attrition.