The qualitative study of
Landmark and her team was participated by Norwegian physicians and patients as
they explored series of recordings of physician’s prescribed therapy to their
respective patients. Through these records, the presence of a patient-centered
care and a shared decision making approaches were analyzed using 380
video-recorded patient-doctor interactions. Of these, 18 records became the
primary source of information. The study was conducted in a Norwegian teaching
hospital from 2007 to 2008. Video records and transcripts were analyzed using
conversation analysis or interactional machinery (where thematic analysis
includes). Findings revealed that understanding was “seemed” to be ensured both
by patient-centered care and shared decision making as portrayed in their
actual or routine practices in the clinical area. On the other hand, potential
disagreement or misunderstanding occurs when physicians and patients use their
non-native language or when neutral responses by the patients were interpreted
by the physicians as either agreeing or disagreeing. The major implication of
the findings of this study highlighted language barrier as potential cause of
non-understanding/non-agreement. Moreover, the researchers emphasized that the
observed good patient-centered approach in the actual clinical scenario may not
be adequately sufficed especially when physicians encountered misunderstanding/disagreement
and non-participation of patients in decision making process. Supportive to
this include the origin of the native language of both participants and
misinterpretation of patient’s neutral responses (e.g. agreeing/disagreeing,
instead of misunderstanding/non-understanding). Although difficult and
challenging, it is recommended that a model of “actual best practice” be
developed with regard to the concept of patient understanding. Such actual best
practice must not only be in terms of conversation but also reflect in
patient’s actions or adherence to prescribed treatment. Lastly, formulating
trainings (regarding communication strategies) which aim to address patient’s
non-responsiveness, non-understanding, disagreement, or non-participation in
decision making is essential in resolving language barriers, understanding
patient’s needs and achieving a patient-centered decision-making.

Schwei and her fellow
researchers claimed that language barriers in healthcare is a worldwide concern,
particularly in Europe, Australia and Canada (other than the United States).
These states have one thing in common – immigrants who experience language
barriers in healthcare settings. In 2003, the Bush administration has
implemented a change in US’ services for LEP (limited English proficiency)
individuals. From this perspective, they aimed to describe the state of the
language barrier literature in and out of the US (from 2003 to 2010) and
compare studies which were conducted before and after such policy change. In
addition, literature and studies outside US were reviewed to assess the global
trends. Literature review and cross-sectional analysis were employed in their methodology.
They had two-phase review. Phase 1 only included annotated bibliographies of
2003 (starting 1974, prior to Bush’ implementation of changes) and phase 2
involved analysis from 2003 to 2011 (after Bush’ implementation of changes).
Furthermore, criteria and parameters set in search and classification were
similar in both phases. In their result, they found that the areas highlighted
in their review included (a) access barrier, (b) comparison study, (c)
interpreting practices, (d) outcomes, and (e) patient satisfaction. As they
expected, studies focusing on language barriers have increased (since 2003) and
this could be attributed to the policy change by the Bush administration. Also,
in terms of perspectives in dealing with clients who have language barriers,
the researchers revealed that it is more physician-focused within the US but
nurse-focused outside the US. As a recommendation, problems pertaining to
language barriers in healthcare delivery system around the world must be
well-documented in order to accurately identify the problem and provide
evidence-based solutions.

van Rose and her
colleagues investigated the risks involved in patient safety caused by language
barriers during their hospitalization period. Moreover, they explored how
language barriers were detected, reported, and bridged in a Dutch hospital care
setting. In their methodology, they combined quantitative and qualitative
research approaches in a sample of 576 ethnic minority in-patients. The study
was participated by four urban hospitals in Netherlands. Nursing and medical
records of concerned patients were reviewed and analyzed. Supplemental, yet,
in-depth interviews with healthcare providers and in-patients were also
conducted. The outputs, were compared to patients’ self-reported Dutch language
proficiency tool. Aside from this, experts in language interpreters also aided
in data analysis and interpretation. As a result, the researchers found that
certain hospital care situations where there is language barrier include
nursing-related activities such as administering drugs, pain and fluid balance
management. Physician-related language barrier also exists in patient-doctor
conversations regarding diagnosis, risk communications and acute situations.
More often, the relatives and significant others of these patients served as
interpreters. In such cases, professional interpreters were not much used which
could mean that professional interpreters were not as effective (as expected)
to help in resolving language-barrier-related patient safety issues. These
situations showed that risks were possible in hospitals with patients who
experience language barriers. This gap could be serious when timeliness and
promptness of delivering healthcare services of addressing patient’s needs is not
addressed. As a general comment on this study, regardless of the nurse’s competent
level of knowledge and skills, promptness in identifying language barrier is
primordial to collecting accurate data and delivering safe nursing and medical
management. Documentations of these must be secured for future study references
concerning policy reviews and updates and in-service trainings regarding communication,
language barrier and safety-related health issues.

            The annotated bibliographies
concerning language barrier, in relation to NSQHS’ communicating for safety
standard, have significance to Australian nursing practice despite conducting
such in healthcare settings of three different countries (Norway, United States
and Netherlands, respectively). Nowadays, standards on healthcare delivery
system are becoming uniformed at a considerable pace. Communication plays a
substantial role in unifying these standards and ensuring safe delivery of
healthcare services. Language barrier is an obvious obstacle to attaining this

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            Landmark, et. al. (2017) merely focused
on physician-initiated interactions with patients in assessing and planning
treatment regimen. Physicians could not generate genuine patient participation
because they did not stay with them more often. Furthermore, there were
physicians who assumed that the patient understood the prescribed treatment
regimen simply because he/she nodded or said “uhmm” or “yes.” These responses
sometimes did not translate into actions or actual patient compliance. After
conversing with patients, physicians would normally leave and just wait for
reports or developing responses.

On the other hand, nurses are great
instruments in bridging this gap because they stay with the patient throughout
his/her course of confinement. Considering the trust and rapport they
established with their patients, nurses are the ones who can more effectively
assess and empathize with them. At the same time, nurses are able to evaluate
the actual progress and treatment compliance of the patients to prescribed
treatment even before the physician does. As future Australian nurses who are
cognizant to patient’s safety, we play crucial role in clarifying patient’s
misunderstandings and relay these to the physicians even if they have already
left the unit. This intervention further validates patient’s response, ensure
full understanding of instructions and allows initiating modification of plan
(if any).

In another study, Schwei, et. al. (2016)
exposed a considerable increase in language barrier-themed studies after 2003
when Bush’s administration implemented access to healthcare services among
people who are limited English proficient (LEP). Among people who greatly
benefited included migrants.

Currently, migrants prefer highly
developed English-speaking countries. Among the advantages of choosing these
are quality of life and access to quality healthcare delivery system. However,
problem arises when they are not competent enough to speak and express
themselves using English language, most especially when they are sick.

Central to addressing this concern are the
nurses’ ability to grasp and understand patients’ health concerns regardless of
the language they use. In Australia, where key cities are also cultural melting
pots, dealing with patients who experience language barrier could occur. Since
poor interpretation of patient’s chief complaints could lead to unsafe delivery
of health interventions, nurses must be competent enough in analyzing such
complaints by not merely grounding his/her judgment on patient’s lingual claims.
As future Australian nurse, other interventions such as clinical eye (during
inspection), use of context clues and other assessment tools/tests are helpful
in clarifying confusions and refining patients claims until one arrives at
properly identified patient’s needs.

In the last cited
research, van Rosse, et. al. (2016) enumerated nursing interventions that may
be unsafely delivered if language barriers were not promptly identified and
resolved. They also mentioned the role of relatives as interpreter when
language barrier is identified.

In Australian healthcare
setting, the clientele are not the only culturally diverse members of the
population. Nurses and allied health professionals also come from different
cultural backgrounds. Although competent English is a requirement for
employment, miscommunications may still occur between and among conversing
parties if diction, accent, slang, pronunciation, enunciation or even dealing
with newly hired immigrant employee are considered. Moreover, the use of ISBAR
has established itself as an indispensable tool in significantly lowering or
solving misunderstanding between communicating members of the healthcare team.
Finally, the role of family and significant others in patient care must not be
ignored. They could serve as effective and efficient interpreters of patient’s


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