Language barriers and patient safety risks in hospital care. A mixed methods study

Nurse Work Environment and Hospital Readmission Disparities Between Patients With and Without Limited English Proficiency

Minimal progress has been made in narrowing disparities between patients with and without limited English proficiency (LEP). Using 2016 data from RN4CAST-US, New Jersey Discharge Data Collection System, and AHA Annual Hospital Survey, multivariable logistic regression models were employed to examine whether and to what extent the hospital nurse work environment, defined as the conditions that nurses work in, is associated with decreased disparities in 7-day hospital readmissions between patients with and without LEP. Existing literature has established associations between nurse work environments and outcomes disparities of various minoritized populations; however, no literature has examined this relationship in the context of hospitalized patients with LEP. In a sample of 424,745 hospitalized adults (n = 38,906 with LEP), patients with LEP, compared to those without LEP, were younger (63.4 vs 64 years old, p < 0.001), more likely to be insured by Medicaid (8.9% vs 5.5%) or uninsured (7.5% vs 2%, p < 0.001), and readmitted (4.5% vs 3.9%, p < 0.001). Adjusting for patient and hospital characteristics, LEP patients had 33% higher odds of a 7-day readmission, as compared to patients without LEP (OR 1.33, 95% CI [1.19-1.47]). A significant interaction was found between patients' LEP status and the nurse work environment (OR 0.83, 95% CI [0.70-0.99]), such that patients with LEP experienced lower odds of 7-day readmission in more favorable nurse work environments, compared to patients without LEP. Hospitals dedicated to providing equitable healthcare may consider enhancing nurses' working conditions as a potential way to reduce disparities in readmission rates.

English-Only Policies and Allegations of Racism in Nursing: Safety, Culture and Respect Prevail

AIMS

To provide a critical analysis of the allegation that introduction of workplace English-Only policies for nurses may be racist. To provide guidance to inform policy development in this field.

METHODS

The intertwined complexities informing English-Only policy development are explored inclusive of the complicated relationship between patient safety, human rights, cultural context, ethics and the social norms which guide manners and respect.

RESULTS

Communication failures are confirmed as a major cause of patient harm incidences with adverse events extensively exacerbated in the absence of shared language between nurses, patients, families and the broader healthcare team. The combined global movement of nurses and increasing diversity within clinical teams points to heightened risk of communication failure.

CONCLUSION

Unequivocally, patient safety (inclusive of cultural safety) confirms the necessity for policies related to shared language in health. Safety-orientated English-Only policies are neither racist nor a breach of human rights. Whether it be in the skies, on the sea, or in a healthcare context, shared language policies and standards (most commonly English-Only policies) are needed to protect human safety and avoid harm.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The demographic profile of most western and many developing nations has changed significantly over the last two decades adding new complexity in healthcare contexts. Need exists for shared language policy in nursing with priority to safety, human rights, respect, ethical recruitment and to the social and cultural dimensions of the workforce.

"Because I couldn't understand and respond": A mixed-method study examining the impact of language barriers on patient experiences of intensive care unit outreach team care

BACKGROUND

Almost 10% of hospitalised patients experience acute deterioration requiring emergency intervention. Language barriers can impede patient assessment and health outcomes.

OBJECTIVE

The objective of this study was to explore the experiences of adult inpatients whose preferred language was not English, who received care from the intensive care unit (ICU) outreach team.

METHODS

An explanatory sequential two-phase mixed-method design was used. A retrospective audit was undertaken to explore characteristics of and outcomes for recipients of ICU outreach team care, according to preferred language. In phase two, interpreter-mediated interviews were conducted with former patients whose preferred language was not English to explore their experience of critical illness and care by the ICU outreach team.

RESULTS

From 4234 inpatients who received care from the ICU outreach team in 2022, there was a mean of 3.54 episodes of care (1-565) per patient. Those whose preferred language was not English had a higher proportion of admissions from the emergency department and were more likely to have a medical emergency team call as their first outreach episode of care but less likely to be admitted to the ICU. Vietnamese and Mandarin were the next most common languages spoken after English. Twenty-two former patients or delegated relatives were interviewed. Not all recalled receiving care from the ICU outreach team. There was strong support for involvement of professional interpreters for critical conversations and to aid autonomy. Family members acted as lay interpreters and fulfilled familial and cultural obligations, but visitor restrictions impeded this.

CONCLUSION

Patient deterioration requires an emergent response. This research demonstrates the importance of identifying and overcoming language barriers for patients in a way that protects and preserves patient autonomy and ensures information accuracy. Where time and the patient's condition allows, use of professional interpreters must become the norm.

Antimicrobial Resistance and Migration: Interrelation Between Two Hot Topics in Global Health

Background: Antimicrobial resistance (AMR) and migration are two interlinked issues and both pose an escalating threat to global health. With an increasing trend, there are 281 million migrants globally, while AMR is contributing to over 5 million deaths annually, with a projected rise to 10 million by 2050 if left unaddressed. Both AMR and migration are multifaceted problems that extend beyond human health, involving animals, plants, and the environment-a fact highlighted by the One Health approach. Objective: The aim of this work is: (1) to examine the complex relationship between migration and AMR, drawing on epidemiological data, surveillance strategies, and healthcare access challenges and (2) to address an interventional strategy proposal. Methods: We performed a narrative review of the most updated literature about migration and AMR using three primary databases: PubMed, Scopus, and Embase. Findings: Migrants, particularly from low‑ and middle‑income countries, represent a unique group at increased risk of AMR due to factors such as overcrowded living conditions, limited access to healthcare, uncontrolled use of antibiotics, and high prevalence of AMR in origin countries. Studies reveal higher rates of AMR colonization and infection among migrants compared with native populations, with specific pathogens such as MRSA and multidrug‑resistant gram‑negative bacteria posing significant risks. Migratory conditions, socioeconomic vulnerability, and healthcare barriers contribute to this heightened risk. Conclusion: To address the intersection of migration and AMR, interventions must focus on improving living conditions, enhancing healthcare access, promoting appropriate antibiotic use, and strengthening microbiological surveillance. Multisectoral collaboration is essential to mitigate the spread of AMR and safeguard both migrant and global public health.

Usability of technological tools to overcome language barriers in healthcare- a scoping review

INTRODUCTION

In many healthcare contexts globally, where the languages of care providers and service users do not match, miscommunication can lead to inaccurate diagnoses and subpar treatment outcomes. The development and use of technological tools to overcome language barriers are increasing, but usability and evaluation of these tools vary widely.

OBJECTIVES

This scoping review's objectives are (i) to identify and describe the technological tools used in direct service user-provider communication to overcome language barriers in a healthcare setting, (ii) to identify how the usability of these tools was evaluated, and (iii) to identify the challenges and benefits of using such technological tools.

METHODS AND ANALYSIS

The scoping review followed the JBI methodology. Studies published between January 2019 and July 2024 were identified using a search strategy with variations of the keywords "technological tools," "language barrier," and "health care" in the following six databases and research platforms: PubMed, PsycArticle, Scopus, EBSCOhost, ProQuest, and Web of Science. All literature on individuals using a technological tool to overcome language barriers in a healthcare context was included and exported into the screening assistant software Rayyan. The search was limited to articles written in German or English. The literature was screened twice by three independent reviewers in a blinded fashion, and all relevant data were presented in a descriptive summary.

RESULTS

Based on 16 publications, this scoping review identified 16 technological tools, categorized as fixed-phrase or machine translation apps, to overcome language barriers in a healthcare setting. Usability was assessed in 13 publications applying diverse methods, i.e., surveys, observations, and application data analysis. Technological tools hold potential as a means to address language barriers in healthcare by facilitating communication and supporting diagnostic processes. However, their usability is often constrained by challenges related to translation accuracy, accessibility, and learnability.

CONCLUSION

Future research and policy efforts should focus on standardizing evaluation methods and diversifying development regionally, linguistically, and interdisciplinary. Rather than broadly promoting these tools, emphasis should be placed on ensuring they are reliable and efficient for their intended use to maximize their effectiveness and relevance in specific healthcare contexts.

Empowering medical students with AI writing co-pilots: design and validation of AI self-assessment toolkit

BACKGROUND AND OBJECTIVES

Assessing and improving academic writing skills is a crucial component of higher education. To support students in this endeavor, a comprehensive self-assessment toolkit was developed to provide personalized feedback and guide their writing improvement. The current study aimed to rigorously evaluate the validity and reliability of this academic writing self-assessment toolkit.

METHODS

The development and validation of the academic writing self-assessment toolkit involved several key steps. First, a thorough review of the literature was conducted to identify the essential criteria for authentic assessment. Next, an analysis of medical students' reflection papers was undertaken to gain insights into their experiences using AI-powered tools for writing feedback. Based on these initial steps, a preliminary version of the self-assessment toolkit was devised. An expert focus group discussion was then convened to refine the questions and content of the toolkit. To assess content validity, the toolkit was evaluated by a panel of 22 medical student participants. They were asked to review each item and provide feedback on the relevance and comprehensiveness of the toolkit for evaluating academic writing skills. Face validity was also examined, with the students assessing the clarity, wording, and appropriateness of the toolkit items.

RESULTS

The content validity evaluation revealed that 95% of the toolkit items were rated as highly relevant, and 88% were deemed comprehensive in assessing key aspects of academic writing. Minor wording changes were suggested by the students to enhance clarity and interpretability. The face validity assessment found that 92% of the items were rated as unambiguous, with 90% considered appropriate and relevant for self-assessment. Feedback from the students led to the refinement of a few items to improve their clarity in the context of the Persian language. The robust reliability testing demonstrated the consistency and stability of the academic writing self-assessment toolkit in measuring students' writing skills over time.

CONCLUSION

The comprehensive evaluation process has established the academic writing self-assessment toolkit as a robust and credible instrument for supporting students' writing improvement. The toolkit's strong psychometric properties and user-centered design make it a valuable resource for enhancing academic writing skills in higher education.

A Role for Health Literacy in Protecting People With Limited English Proficiency Against Falling: A Retrospective, Cohort Study

OBJECTIVE

To identify risk factors related to falls within the scope of speech-language pathology (SLP) using assessments from the Inpatient Rehabilitation Facility-Patient Assessment Instrument over a 4-month period in 4 inpatient rehabilitation facilities (IRFs).

DESIGN

Observational retrospective cohort study.

SETTING

Four IRFs as part of a larger learning health system.

PARTICIPANTS

Adults aged ≥18 years admitted to the IRFs from October 1, 2022 to February 28, 2023 were included.

INTERVENTION

N/A.

MAIN OUTCOME MEASURES

Occurrence of falls.

RESULTS

Analyses of 631 patient records revealed that the odds of falling were almost 3 times greater in people with limited English proficiency than in English speakers (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.09-6.85). People with limited English proficiency who reported poorer health literacy had 4 times higher odds of falling (OR, 3.90; 95% CI, 1.13-13.44) than English speakers who reported adequate health literacy. People with limited English proficiency who reported adequate health literacy had the same risk of falling as English speakers (OR, 0.98; 95% CI, 0.16-6.12), suggesting the protective role of health literacy for people with limited English proficiency.

CONCLUSIONS

Language barriers have a significant effect on falls among patients in IRFs. SLPs improving health literacy and providing language support may play a crucial role in mitigating fall risk, thereby enhancing patient safety and outcomes.

Disparities in tuberculosis diagnostic delays between native and migrant populations in Italy: A multicenter study

BACKGROUND

Tuberculosis (TB) remains a Global Health challenge, with diagnostic delays contributing significantly to its spread. This study investigates the differences in diagnostic delays between native and migrant TB patients in Italy, examining patient-related diagnostic delay (PDD), health system-related diagnostic delay (HDD), and total diagnostic delay (TDD).

METHODS

We conducted a retrospective, multicenter, cross-sectional study of TB cases in 10 Italian hospitals from 2018 to 2023. We compared PDD, HDD, and TDD between native and migrant populations. Socio-demographic data and clinical histories were analyzed to identify factors contributing to diagnostic delays.

RESULTS

We included 669 TB patients (390 migrants and 279 natives). Migrants experienced significantly longer PDD (median 90 vs 10 days, P < 0.0001) but shorter HDD (median 5 vs 40 days, P < 0.0001) compared to natives, resulting in a longer TDD (median 96 vs 65 days, P < 0.0001). Furthermore, migrants had higher Timika scores, longer sputum conversion times, and were more frequently lost to follow-up.

CONCLUSION

Migrants face longer PDD, emphasizing substantial barriers to healthcare access. Natives experience longer HDD, reflecting neglect of TB in low-endemic regions. Future research should focus on the impact of social determinants and training for healthcare providers on TB diagnosis and develop strategies to reduce diagnostic delays.

Demographic Differences in Emergency Room Epistaxis Treatment Patterns and Outcomes

OBJECTIVE

Investigate the association between demographic characteristics and emergency department (ED) epistaxis management and outcomes.

STUDY DESIGN

Retrospective cohort study.

SETTING

TriNetX US collaborative database.

METHODS

Adults presenting to the ED for epistaxis were retrospectively followed for 7 days. Spanish-speaking patients were propensity score matched to English-speaking patients by demographics and medical history. Outcomes included use of nasal decongestant, nasal packing or cautery, diagnostic nasal endoscopy, endoscopic control of hemorrhage, hospital admission, and mortality. The analysis was also performed with stratification by race and ethnicity.

RESULTS

Spanish-speaking patients were less likely to receive nasal packing or cautery [odds ratio, OR: 0.78; 95% confidence interval, CI: (0.68; 0.90)] or diagnostic nasal endoscopy [OR: 0.72; 95% CI: (0.52; 0.98)] compared to English-speaking patients. Black patients were more likely to receive treatment with a nasal decongestant spray [OR: 1.31; 95% CI: (1.27, 1.36)], but less likely to receive any other treatment compared to White patients. Asian patients were less likely to undergo nasal packing or cautery [OR: 0.90; 95% CI: (0.82; 0.99)], but had more ED visits [(1.37; 1.32) P < .01] compared to White patients. Hispanic patients were less likely to be admitted [OR: 0.93; 95% CI: (0.87; 0.98)], and averaged fewer ED visits [(1.27; 1.30) P = <.0001] compared to non-Hispanic patients.

CONCLUSION

While demographic trends in ED epistaxis management are nuanced, our results suggest that Spanish-speaking, Black, Asian, and Hispanic patients are less likely to receive diagnostic and epistaxis control procedures. Additional research is needed to determine the etiology of these differences.

Interpreter services for immigrants in European healthcare systems: a systematic review of access barriers and facilitators

BACKGROUND

Language barriers have been identified as a key access barrier to healthcare services for immigrants. The aim of this study was twofold: to investigate immigrants' and healthcare professionals' experiences with barriers and facilitators of interpreter services, and to examine the influence of barriers to interpreter services on the quality of care from immigrant and healthcare professional perspectives.

METHODS

We searched PubMed, Embase, The Cochrane Library, Scopus, SocINDEX and PsycINFO, resulting in 1425 studies. A total of 21 original quantitative, qualitative and mixed methods studies published between 1996 and 2021 were assessed as eligible for inclusion.

RESULTS

Identified barriers included: lack of immediately available interpreter services, cost, lack of knowledge about availability, and attitude towards interpreter services. Facilitators included: a high number of interpreters in the requested language, awareness among healthcare professionals and patients of the patient's rights to interpreters, and a positive attitude towards use of interpreter services. Regarding quality of care, language barriers created safety risks for the patients, made patients feel unsafe, or delayed patient contact with the healthcare system.

CONCLUSIONS

Immigrant patients and healthcare professionals experience barriers in using interpreter services due to restrictive policies regarding user fees and limitations to entitlement to interpreters, a limited number of qualified interpreters and lack of knowledge. Medical encounters with unaddressed language barriers can put patients at risk and reduce quality of care for immigrants, which calls for strengthening formal and informal access to interpreters.

Psychometric validation of a patient-reported experience measure for older adults attending the emergency department: the PREM-ED 65 study

INTRODUCTION

Optimising emergency department (ED) patient experience is vital to ensure care quality. However, there are few validated instruments to measure the experiences of specific patient groups, including older adults. We previously developed a draft 82-item Patient Reported Experience Measure (PREM-ED 65) for adults ≥65 attending the ED. This study aimed to derive a final item list and provide initial validation of the PREM-ED 65 survey.

METHODS

A cross-sectional study involving patients in 18 EDs in England. Adults aged 65 years or over, deemed eligible for ED discharge, were recruited between May and August 2021 and asked to complete the 82-item PREM at the end of the ED visit and 7-10 days post discharge. Test-retest reliability was assessed 7-10 days following initial attendance. Analysis included descriptive statistics, including per-item proportions of responses, hierarchical item reduction, exploratory factor analysis (EFA), reliability testing and assessment of criterion validity.

RESULTS

Five hundred and ten initial surveys and 52 retest surveys were completed. The median respondent age was 76. A similar gender mix (men 47.5% vs women 50.7%) and reason for attendance (40.3% injury vs 49.0% illness) was observed. Most participants self-reported their ethnicity as white (88.6%).Hierarchical item reduction identified 53/82 (64.6%) items for exclusion, due to inadequate engagement (n=33), ceiling effects (n=5), excessive inter-item correlation (n=12) or significant differential validity (n=3). Twenty-nine items were retained.EFA revealed 25 out of the 29 items demonstrating high factor loadings (>0.4) across four scales with an Eigenvalue >1. These scales were interpreted as measuring 'relational care', 'the ED environment', 'staying informed' and 'pain assessment'. Cronbach alpha for the scales ranged from 0.786 to 0.944, indicating good internal consistency. Test-retest reliability was adequate (intraclass correlation coefficient 0.67). Criterion validity was fair (r=0.397) when measured against the Friends and Families Test question.

CONCLUSIONS

Psychometric testing demonstrates that the 25-item PREM-ED 65 is suitable for administration to adults ≥65 years old up to 10 days following ED discharge.

Communication Skills of Medical Interpreters: A Qualitative Explanatory Study of Healthcare Professionals' and Medical Interpreters' Perceptions

Background/Objectives: Medical interpreters support communication between medical professionals and foreign patients. However, the communication skills required of medical interpreters in the field are currently unclear. The purpose of this study was to investigate what medical professionals and medical interpreters consider to be most important communication skills of medical interpreters, and whether there are differences in perceptions between medical professionals and medical interpreters. Methods: From December 2023 to February 2024, we interviewed 10 medical professionals and medical interpreters (five medical professionals and five medical interpreters) working throughout Japan and in the United States. The narratives collected in the interviews were analyzed and evaluated in a conceptual framework. Results: Healthcare professionals and medical interpreters exhibited differences in perceptions regarding the most important communication skills for medical interpreters. The narratives of medical professionals and medical interpreters regarding medical interpreters' communication skills were divided into a 2 × 2 grid consisting of four quadrants with two axes (intervention and perspective). Regarding the communication skills of medical interpreters, medical professionals were primarily concerned with the transmission of medical information and felt that it was necessary for interpreters to understand medical professionals' perspectives and what they wanted to say in order to convey it accurately. In contrast, medical interpreters emphasized the importance of empathy and communication skills for respecting the other person and understanding the other person's opinion and perspective. Additionally, to understand the patient's perspective, medical interpreters reported that it was important to understand the cultural background of the patient and to maintain good relationships with all of the people around the patient. Conclusions: We explored the communication skills of medical interpreters and the characteristics of the perceptions and narratives of medical professionals and medical interpreters. Concepts regarding the communication skills of medical interpreters were divided into two axes (intervention and perspective) and presented as a 2 × 2 grid with four quadrants. The results of our study suggested that medical interpreters should actively intervene in interpretation situations involving foreign patients.

Doctors' experience providing primary care for refugee women living with chronic pain: a qualitative study

BACKGROUND

The experiences of GPs in Australia highlight key considerations regarding workload demands, remuneration incentives and the practical implications of working in regions with high ethnic density. This exploration helps to understand the elements that influence GPs delivery of care, particular for refugee women who exhibit disproportionately higher rates of chronic pain. This qualitative study explored the experiences of GPs providing care for refugee women living with chronic pain.

METHODS

Semi-structured interviews were undertaken with 10 GPs (9 female and 1 male) practicing across metropolitan Melbourne, Australia. GPs were recruited via purposive sampling and a snowballing strategy. Participants work experience ranged from one to 32 years. Audio recordings of the interviews were transcribed verbatim and stored in qualitative data Nvivo 12 software for coding. Transcripts of interviews were analysed thematically using a phenomenological approach.

RESULTS

Three overarching themes were identified: (1) meeting the needs of refugee women living with chronic pain; (2) the role of the GP; and (3) the challenges of the health care system. These themes reflected the complexity of consultations which arose, in part, from factors such as trust, the competencies of clinician's and the limitations posed by time, funding and interpreter use.

CONCLUSION

GPs acknowledged the uniqueness of refugee women's chronic pain needs and whilst doctors welcomed care, many were often challenged by the complex nature of consultations. Those that worked in settings that aligned with refugee women's needs highlighted the importance of cultivating culturally safe clinical environments and listening to their patients' stories. However, system level challenges such as time, funding and resource constraints created significant challenges for GPs. Exploring GPs experiences allows for a better understanding of how vectors of disadvantage intersect in health care and highlights the need to better support doctors to improve health care provision for refugee women living with chronic pain.

The patients' lived experiences with equitable nursing care

BACKGROUND

Equitable care is a fundamental value in the nursing profession. Healthcare workers have both a moral and professional duty to ensure that they do not discriminate.

AIM

This study aimed to explore how patients perceive equitable nursing care.

RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT

This descriptive phenomenological qualitative research study used purposeful sampling to select 17 patients from various departments of a general hospital in southern Iran. The participants were then interviewed using a semi-structured in-depth interview format, which aimed to delve into their experiences with equitable nursing care. The collected data were analyzed using Colaizzi's seven-step method and MAXQDA20 software.

ETHICAL CONSIDERATIONS

Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Ethics Committee of Jiroft University of Medical Sciences.

FINDINGS

The data analysis of the study identified three main themes and six subthemes that were related to the experiences of patients with equitable nursing care. The first theme, equitable care, encompassed subthemes such as nurses' dedicated efforts to facilitate patient recovery and adherence to ethical behavior. The second theme, unconscious causes of inequitable nursing care, included subthemes such as unintentional discrimination stemming from organizational constraints and unconscious biases resulting from a lack of knowledge and skills. The third theme, discriminatory care, comprised subthemes such as deliberate discrimination based on personal traits and selective discrimination.

CONCLUSION

The study findings indicate that achieving equitable nursing care requires a multifaceted approach. This includes effective hospital management, organizational reforms, and regulatory enhancements. Additionally, it is crucial to pay close attention to the needs of patients, enhance nurses' theoretical and practical skills in providing equitable care, fostering a culture of equality within healthcare settings, and consider the personality dimensions and moral characteristics of nurses.

Patient and caregiver perspectives on causes and prevention of ambulatory adverse events: multilingual qualitative study

CONTEXT

Ambulatory adverse events (AEs) affect up to 25% of the global population and cause over 7 million preventable hospital admissions around the world. Though patients and caregivers are key actors in promoting and monitoring their own ambulatory safety, healthcare teams do not traditionally partner with patients in safety efforts. We sought to identify what patients and caregivers contribute when engaged in ambulatory AE review, focusing on under-resourced care settings.

METHODS

We recruited adult patients, caregivers and patient advisors who spoke English, Spanish and/or Cantonese, from primary care clinics affiliated with a public health network in the USA. All had experience taking or managing a high-risk medication (blood thinners, insulin or opioid). We presented two exemplar ambulatory AEs: one involving a warfarin drug-drug interaction, and one involving delayed diagnosis of colon cancer. We conducted semistructured focus groups and interviews to elicit participants' perceptions of causal factors and potential preventative measures for similar AEs. The study team conducted a mixed inductive-deductive qualitative analysis to derive major themes.

FINDINGS

The sample included 6 English-speaking patients (2 in the focus group, 4 individual interviews), 6 Spanish-speaking patients (individual interviews), 4 Cantonese-speaking patients (2 in the focus group, 2 interviews), and 6 English-speaking patient advisors (focus group). Themes included: (1) Patients and teams have specific safety responsibilities; (2) Proactive communication drives safe ambulatory care; (3) Barriers related to limited resources contribute to ambulatory AEs. Patients and caregivers offered ideas for operational changes that could drive new safety projects.

CONCLUSIONS

An ethnically and linguistically diverse group of primary care patients and caregivers defined their agency in ensuring ambulatory safety and offered pragmatic ideas to prevent AEs they did not directly experience. Patients and caregivers in a safety net health system can feasibly participate in AE review to ensure that safety initiatives include their valuable perspectives.

Social determinants of health influencing the choice of dialysis modality in advanced chronic kidney disease: Need of an interdisciplinary approach

INTRODUCTION

The influence of socioeconomic and cultural barriers in the choice of renal replacement therapy (RRT) techniques in advanced chronic kidney disease (ACKD) has been scarcely explored, which can generate problems of inequity, frequently unnoticed in health care. The aim of this study is to identify the "non-medical" barriers that influence the choice of RRT in an advanced chronic kidney disease (ACKD) consultation in Spain.

MATERIAL AND METHODS

Retrospective analysis including the total number of patients seen in the ACKD consultation in a tertiary hospital from 2009 to 2020. Inclusion in the ACKD consultation began with an eligibility test and a decision-making process, conducted by a specifically trained nurse. The variables considered for the study were: age, sex, etiology of CKD, level of dependence for basic activities of daily living (Barthel Scale) and instrumental activities of daily living (Lawton and Brody Scale), Spanish versus foreign nationality, socioeconomic level and language barrier. The socioeconomic level was extrapolated according to home and health district by primary care center to which the patients belonged.

RESULTS

A total of 673 persons were seen in the ACKD consultation during the study period, of whom 400 (59.4%) opted for hemodialysis (HD), 156 (23.1%) for peritoneal dialysis (PD), 4 (0.5%) for early living donor renal transplantation (LDRT) and 113 (16.7%) chose conservative care (CC). The choice of PD as the chosen RRT technique (vs. HD) was associated with people with a high socioeconomic level (38.7% vs. 22.5%) (p = 0.002), Spanish nationality (91% vs. 77.7%) (p < 0.001), to a lower language barrier (0.6% vs 10.5%) (p < 0.001), and to a higher score on the Barthel scale (97.4 vs 92.9) and on the Lawton and Brody scale (7 vs 6.1) (p < 0.001). Neither age nor sex showed significant differences in the choice of both techniques. Patients who opted for CC were significantly older (81.1 vs 67.7 years; p < 0.001), more dependent (p < 0.001), with a higher proportion of women (49.6% vs 35.2%; p = 0.006) and a higher proportion of Spaniards (94.7% vs 81%, p = 0.001) in relation to the choice of other techniques (PD and HD). Socioeconomic level did not influence the choice of CC.

CONCLUSION

Despite a regulated decision-making process, there are factors such as socioeconomic status, migration, language barrier and dependency of the population that influence the type of RRT chosen. To address these aspects that may cause inequity, an intersectoral and multilevel intervention is required with interdisciplinary teams that include, among others, social workers, to provide a more holistic and person-centered assessment.

Cross-cultural adaptation of the Arabic Version of the Disability Rating Scale among caregivers of patients with traumatic brain injury

Introduction

he Disability Rating Scale (DRS) is a short, efficient, rapid instrument for monitoring general functional recovery from moderate to severe traumatic brain injury (TBI). The 8-item DRS is a published and validated assessment instrument but has not yet been adapted to native Arabic-speaking caregivers of patients with TBI. This study aimed to translate, cross-culturally adapt, and test the reliability of the Arabic version of the DRS.

Methods

Cross-cultural adaptation and translation were performed according to the recommended guidelines: translation, back-translation, expert review, and pretesting. Reliability was assessed via a test-retest procedure at 2-week intervals using the Kappa coefficient among 42 caregivers of patients with TBI.

Results

The agreement among the raters was excellent, varying from 0.88 to 1. Translating the DRS into Arabic was easy based on the translators’ information. The test-retest reliability was excellent (interclass correlation coefficient = 0.99 with a 95% CI 0.998 to 0.999 [F(41) = 1100.7, p < 0.001]. The Cronbach’s alpha for the internal consistency of the DRS was 0.917. There was good agreement (convergent validity) between the DRS scores with the Short Form 36 Health Survey Questionnaire [rs(42) = 0.895, p = 0.001].

Conclusions

The Arabic version of the DRS can be used among Arabic-speaking caregivers of patients with TBI. The Arabic translated version of the DRS can be used among caregivers of patients with TBI telephonically by expert professional. The translated questionnaire was easy to comprehend among caregivers of patients with TBI, with excellent test re-test reliability and good convergent validity.

Limited English Proficiency and Outcomes in the Intensive Care Unit: An Integrated Review

INTRODUCTION

Language barriers place patients at risk of substandard care. Hospitalized patients with limited English proficiency (LEP) face unique challenges, especially in the intensive care unit (ICU). The purpose of this review is to critique and synthesize quantitative evidence on LEP and ICU outcomes.

METHODOLOGY

Quantitative studies published in English between 1999 and 2022 were queried using intentional terminology.

RESULTS

Searches yielded 138 results, with 12 meeting inclusion criteria. The analysis resulted in the extrapolation of five themes pertinent to outcomes of ICU patients or families with LEP: (a) knowledge deficit relating to conditions and care; (b) lack of language-appropriate care; (c) alienation from care process; (d) decreased confidence and ownership of care; and (e) relationship to clinical quality indicators.

DISCUSSION

Outcomes associated with LEP were largely negative and revealed unmet needs for ICU patients with LEP. More research is needed to improve linguistically and culturally congruent care in the ICU.

Midwives' Intercultural Effectiveness Levels and Influencing Factors

INTRODUCTION

Due to globalization, countries around the world are starting to notice diversity in their populations. It is crucial that midwives be able to communicate effectively with women from a variety of cultures to provide them with culturally effective health care.

METHOD

This cross-sectional study was conducted with 394 midwives who work in seven different regions of Türkiye. Data on the intercultural effectiveness and intercultural communication competence of midwives were collected. Data analysis was performed using descriptive statistics, t-tests, analysis of variance, and regression analysis.

RESULTS

Midwives' intercultural effectiveness was influenced by their foreign language proficiency, experiences abroad, having friends from different cultures, following social media platforms in different languages and cultures, providing care to individuals from diverse cultures, and their willingness to do so.

DISCUSSION

Findings suggest that exposure to different cultures enhances the level of intercultural effectiveness. Consequently, it is recommended to make plans to support midwives to have positive experiences with different cultures.

A Quality Improvement Project to Reduce Rapid Response System Inequities for Patients with Limited English Proficiency at a Quaternary Academic Medical Center

BACKGROUND

Recognition of clinically deteriorating hospitalized patients with activation of rapid response (RR) systems can prevent patient harm. Patients with limited English proficiency (LEP), however, experience less benefit from RR systems than do their English-speaking counterparts.

OBJECTIVE

To improve outcomes among hospitalized LEP patients experiencing clinical deteriorations.

DESIGN

Quasi-experimental pre-post design using quality improvement (QI) statistics.

PARTICIPANTS

All adult hospitalized non-intensive care patients with LEP who were admitted to a large academic medical center from May 2021 through March 2023 and experienced RR system activation were included in the evaluation. All patients included after May 2022 were exposed to the intervention.

INTERVENTIONS

Implementation of a modified RR system for LEP patients in May 2022 that included electronic dashboard monitoring of early warning scores (EWSs) based on electronic medical record data; RR nurse initiation of consults or full RR system activation; and systematic engagement of interpreters.

MAIN MEASURES

Process of care measures included monthly rates of RR system activation, critical response nurse consultations, and disease severity scores prior to activation. Main outcomes included average post-RR system activation length of stay, escalation of care, and in-hospital mortality. Analyses used QI statistics to identify special cause variation in pre-post control charts based on monthly data aggregates.

KEY RESULTS

In total, 222 patients experienced at least one RR system activation during the study period. We saw no special cause variation for process measures, or for length of hospitalization or escalation of care. There was, however, special cause variation in mortality rates with an overall pre-post decrease in average monthly mortality from 7.42% (n = 8/107) to 6.09% (n = 7/115).

CONCLUSIONS

In this pilot study, prioritized tracking, utilization of EWS-triggered evaluations, and interpreter integration into the RR system for LEP patients were feasible to implement and showed promise for reducing post-RR system activation mortality.

Usability of technological tools to overcome language barriers in health care: a scoping review protocol

INTRODUCTION

In many healthcare contexts globally, where the languages of care providers and patients do not match, miscommunication or non-communication can lead to inaccurate diagnoses and subpar treatment outcomes. In order to bridge these language barriers, a range of informal practices are used, such as family members or staff acting as interpreters, 'receptive multilingualism' or machine translation. The development and use of technological tools are increasing, but factors such as translation quality for complex health-related texts vary widely between languages. The objective of this scoping review is to (1) identify and describe the technological tools used in direct patient-provider communication to overcome a language barrier in a healthcare setting, (2) identify how the usability of these tools was evaluated and (3) assess the usability of the technological tools.

METHODS AND ANALYSIS

The scoping review will follow the Joanna Briggs Institute methodology. A search strategy using variations of the keywords 'technological tools', 'language barrier' and 'healthcare' will be applied in the following databases and research platforms: PubMed, PsycArticle, Scopus, EBSCOhost, ProQuest and Web of Science. All literature where individuals use a technological tool to overcome a language barrier in a healthcare context will be included and exported into the screening assistant software Rayyan. The search will be limited to articles written in German or English. Two independent reviewers will screen the articles, and all relevant extracted data will be presented in a descriptive summary.

ETHICS AND DISSEMINATION

This scoping review does not require ethical approval, as the study's methodology consists of collecting data from publicly available sources. The findings will be disseminated through publication in an open-access, peer-reviewed journal and presentations at scientific conferences. The scoping review results will also guide future research in a multinational project investigating multilingualism in providing (mental) healthcare to migrants.

[Pictograms for assessing pain quality in foreign language-speaking patients: a quality improvement study]

Pictograms for assessing pain quality in foreign language-speaking patients: a quality improvement study Abstract. Background: Numerical assessment instruments allow foreign language patients to quantify their pain. However, for a complete assessment of the pain situation, the description of pain quality is also important. Problem: To assess pain quality completely, the treatment team lacked a tool. Objective: Foreign language-speaking patients can communicate their pain to the treatment team and are actively involved in the treatment process. The treatment team develops tools for recording the quality of pain and reflects on their experiences. Method: In a practice development project, pictograms of the Iconic Pain Assessment Tool 2 (IPAT2) where chosen to assess pain quality. The pictograms were prepared for everyday use, tested, and evaluated. Results: With the help of pictograms, quality of pain of 72 patients was documented almost 50% more frequently than before the study. The nursing team experienced IPAT2 as helpful in obtaining information and deepening the quality of the relationship. A feeling of being seen and understood emerged. Discussion: Pictograms are a valid method for nonverbal pain assessment. However, there is a risk of misunderstanding. The study only allowed an external assessment of patient's perceptions. An empirical investigation of the patient's view would be desirable. Conclusions: Further use and development of pictograms for communicating with foreign language-speaking patients are recommended.

Point-of-care communication for patients with limited language proficiency: A scoping review of healthcare interpretation applications

OBJECTIVE

Linguistic diversity has the potential to create barriers for limited language proficiency (LLP) patients when navigating the healthcare system. When a verified interpretation method is utilized, there are improvements in LLP patient outcomes. The purpose of this scoping review is to identify articles that outline applications used for point-of-care tasks between LLP patients and providers.

METHODS

The Arksey and O'Malley methodologic framework was utilized for study selection, data charting and analysis. Each application was evaluated on patient and provider satisfaction, overall feasibility, and time associated with interpretation.

RESULTS

Eight peer-reviewed journals are included (four pilot studies, one prospective study, two participatory studies, and one mixed methods design). Applications ranged in number of unique phrases (32-1800 phrases) and number of languages supported (1-39 languages). Overall, the applications were feasible to use and assisted with basic communication between providers and patients.

CONCLUSIONS

As patients and families become more comfortable with using technology, interpretation applications provide an innovative approach to streamline the interpretation process for point-of-care healthcare encounters.

PRACTICE IMPLICATIONS

Interpretation applications may increase an LLP patient's access to interpretation tools which can improve outcomes. Further studies should focus on implementing robust evaluation methods to assess these tools and evaluate the LLP patient's perspectives of interpretation applications.

Creating safer cancer care with ethnic minority patients: A qualitative analysis of the experiences of cancer service staff

INTRODUCTION

Effective consumer engagement practices can enhance patient safety. This is important for consumers from ethnic minority backgrounds who are exposed to increased risk of patient safety events. Using the Systems Engineering Initiative for Patient Safety model, this study explored staff experiences of creating opportunities for engagement with consumers from ethnic minority backgrounds to contribute to their cancer care safety.

METHOD

A qualitative study was conducted using semistructured interviews with cancer service staff from four cancer services across two states in Australia. Purposive sampling was used to recruit healthcare staff from a diverse range of professions. Data were analysed using the Framework Analysis method.

RESULTS

Fifty-four interviews were conducted with healthcare staff. Analysis of the qualitative interview data identified enablers and associated challenges that contributed to creating a shared understanding between consumers and staff of the information, processes, expectations and problems arising in care. Enablers and challenges are reported in relation to four themes: (1) co-creating safety through shared understanding of care processes; (2) tools and technologies support planned communication; (3) organisational policy levers exist but lack implementation in direct care and (4) formal tasks incorporate consumer engagement more readily than informal interactions.

CONCLUSION

The availability of infrastructure and resources to support communication with consumers from ethnic minority backgrounds was limited to specific tasks across the cancer care continuum. Strategies implemented by health services to foster effective communication during formal interactions now require expansion to support and create conditions for effective consumer engagement during informal and everyday care tasks. The use of innovative language support tools and cultural considerations are required at the service and system level to support consumer engagement in all types of care interactions.

PUBLIC AND PATIENT INVOLVEMENT

The study was embedded within a larger project that included a consumer investigator and was guided by a consumer advisory group (CAG). These consumer team members have lived experience of cancer and are from diverse ethnic backgrounds. CAG members provided feedback on the draft interview guide and participant information for this study.

Experiences and Communication Preferences in Pregnancy Care Among Patients With a Spanish Language Preference: A Qualitative Study

OBJECTIVE

To explore Spanish-speaking patients' experiences and preferences regarding communication during pregnancy care with specific attention to language barriers.

METHODS

Patients with a Spanish language preference who gave birth between July 2022 and February 2023 at an academic medical center were invited to participate in focus groups. Focus groups were held over Zoom, audio-recorded, transcribed in Spanish, translated into English, and reviewed for translation accuracy. Thematic analysis was conducted with deductive and inductive approaches. Three investigators double-coded all transcripts, and discrepancies were resolved through team consensus.

RESULTS

Seven focus groups (27 total participants, range 2-6 per group) were held. Three key themes emerged regarding patient experiences and communication preferences when seeking pregnancy care: 1) language concordance and discordance between patients and clinicians are not binary-they exist on a continuum; 2) language-discordant care is common and presents communication challenges, even with qualified interpreters present; and 3) language discordance can be overcome with positive interpersonal dynamics between clinicians and patients.

CONCLUSION

Our findings highlight the importance of relationship to overcome language discordance among patients with limited English proficiency during pregnancy care. These findings inform potential structural change and patient-clinician dyad interventions to better meet the communication needs of patients with limited English proficiency.

Nursing students' experiences of communication in a multilingual and multicultural clinical environment: A qualitative study

AIM

The aim of this study was to investigate nursing students' experiences of communication in a multilingual and multicultural clinical environment.

BACKGROUND

Effective communication in a healthcare setting plays a crucial role in patient care. Yet, since universities, globally, have experienced an increase in the enrolment of both local and international students in various degree programmes, student populations have become increasingly multilingual and multicultural. This study was conducted in a multilingual country where many languages are not spoken by all citizens, which results in nursing students experiencing varied outcomes.

DESIGN

A qualitative, explorative, descriptive research design was used.

METHODS

Sixteen nursing students enrolled in either the Bachelor of Nursing Science (Clinical, Honours) or the Diploma in Nursing Science. Data were collected by means of in-depth, semi-structured interviews with a sample of 16 nursing students who were selected through convenience sampling. Data were analysed using thematic analysis.

RESULTS

The study revealed four themes: aspects that complicate communication; interesting aspects about communication; the need for communication assistance; and the need for policy intervention, which is key to addressing challenges in multilingual clinical environments.

Effective communication with linguistically diverse patients: A concept analysis

OBJECTIVE

Effective communication is essential to providing high-quality healthcare. For linguistically diverse patients, communication remains a barrier to receiving equitable healthcare throughout the globe. It is necessary to examine the concept of effective communication with linguistically diverse patients.

METHODS

The Walker and Avant method was used to analyze the concept.

RESULTS

We define effective communication with linguistically diverse patients as any verbal or written communication between two or more individuals who do not speak the same language that utilizes accurate translation techniques to reach a shared message or understanding, where all parties involved are listened to and actively engaged. The antecedents, attributes, consequences, and empirical referents are mapped.

CONCLUSION

Effective communication with linguistically diverse patients is limited by a lack of access to professional language assistance, structural racism/discrimination, and policy barriers.

PRACTICE IMPLICATIONS

Healthcare workers hold the power to provide language assistance to patients and should therefore receive training in cultural competency, cultural humility, and how to work with professional medical interpreters and language access programs. Institutions should invest in multimodal approaches to provide equitable healthcare to linguistically diverse patients.

The Challenges in the Care of Immigrant Children in the Clinic: A Phenomenological Study

INTRODUCTION

The aim of this study is to thoroughly examine the challenges experienced by pediatric nurses providing care for the children of immigrant families and to contribute to the solutions that can be provided.

METHOD

Phenomenological research design was used in this qualitative study. Semi-structured interviews were performed with face-to-face technique and individually.

RESULTS

Four categories, ten main themes and twenty-four sub-themes were obtained in the analysis of data. The themes included communication barriers and cultural differences in the category of difficulties that the nurses experienced with immigrant patients or their relatives, nurses' practices, communication barriers and cultural differences in the category of problems that the nurses experienced in the care.

DISCUSSION

It was determined that nurses experienced difficulty, especially in the areas of communication, culture and education. These difficulties were reported to cause disruptions in the care and treatment process of immigrant patients.

Professional Interpreter Services and the Impact on Hospital Care Outcomes: An Integrative Review of Literature

Migration patterns have rapidly changed in Australia and elsewhere, which have contributed to increasingly culturally and linguistically diverse societies. This requires healthcare sectors to provide professional interpreter services for patients with a language barrier to eliminate healthcare disparities. This integrative review aimed to investigate the impact of professional interpreter services on hospital care outcomes and the associated cost of service provision. A systematic search of five databases was conducted for peer-reviewed articles from January 1996 to December 2020. Data were extracted for the hospital setting, intervention, population, study design, outcomes and key findings. Following the PRISMA guidelines, full-text screening identified 37 articles that were analysed and included. Communication quality, hospital care outcomes and hospital costs were the three main themes identified. Closing the language gap should be a primary consideration to prevent adverse events that affect patient safety and the standard of care in hospitals. The findings of this review indicate the provision of professional interpreter services can enhance hospital care for linguistically diverse patients by improving patient-provider communication. To gain insight into the changing patterns on the outcomes of medical care, further research requires efforts by the hospital administrative system to document complete records of service usage.

Pharmacists, nurses, and physicians' perspectives and use of formal and informal interpreters during medication management in the inpatient setting

OBJECTIVE

Language barriers during inpatient medication management can occur during medication reconciliation on admission and discharge, and during the hospitalization. Understanding inpatient clinicians' experiences with language barriers and use of interpreters can help inform interventions aimed at improving medication management with Limited English Proficient (LEP) patients. Our objective was to examine clinicians' experiences with language barriers around inpatient medication management.

METHODS

We used semi-structured interviews with pharmacist technicians, pharmacists, nurses, and physicians working in a tertiary care hospital. We used the constant comparison method to guide data collection and analysis.

RESULTS

We interviewed 14 providers. Nurses and physicians perceived lack of time to use formal interpreters, particularly during busy or night shifts. Clinicians strongly preferred virtual and in-person interpreter services over telephonic services, and highlighted communication challenges with patients with low health literacy, concerns about the quality of interpretation, and inconsistencies in the use of translated materials.

CONCLUSIONS

Ensuring access to formal interpreters during all shifts, translation of materials into the patient/caregiver's language, and access to in-person/virtual services would improve quality of care for LEP patients.

PRACTICE IMPLICATIONS

Current laws require use of interpreters, but do not provide for their reimbursement, resulting in suboptimal use. Reimbursement for interpreter services may increase their availability.

The role of language barriers on efficacy of rapid response teams

OBJECTIVES

Rapid response (RR) systems are associated with decreased hospital mortality. Systemic biases and inequities can negatively impact RR outcomes. Language barriers between patients and providers are associated with worse outcomes, but it is unknown if language barriers are associated with RR outcomes.

METHODS

We analyzed all adult hospitalized patients who experienced a RR over one year (January 2020 to December 2020) at a tertiary care academic medical center. We used an objective scoring system to establish disease severity at the time of the event. We then compared disease severity and outcomes for patients who are primary language Spanish (PLS) and primary language English (PLE) using both univariable and multivariable analyses.

RESULTS

Of 1133 patients, 42 identified as PLS and 1091 as PLE. In multivariable analyses, PLS patients had significantly higher disease severity scores, as measured by deterioration index score (8.2, p = 0.021) at the time of their rapid responses. PLS patients also had 18.5% increase in length of stay (LOS) after RRs and this disparity was not mitigated when controlling for disease severity at the time of RRs. PLS was not a significant predictor for hospital mortality after RRs.

CONCLUSIONS

Our study found that PLS patients had increased disease severity at the time of RRs and increased LOS after RRs. However, the disparity in LOS was not mitigated when controlling for disease severity at the time of RRs. These findings suggest that language barriers may cause both delays in activation of RR systems, as well as the care provided during and after RRs.

Perioperative safety determinants in ethnic patient groups

Background

In a Dutch hospital, unexpectedly, safer perioperative care was found in non-western ethnic minority patients compared to Dutch ethnic majority patients undergoing high-risk surgery with a mortality risk >1%. We explored determinants in order to find tools for nurses and physicians to improve patients’ safety and safety experience during the perioperative period.

Methods

A qualitative grounded theory design was applied to understand patients’ perspective on their needs and safety in the perioperative period we interviewed patients ( n = 17).

Results

Three themes emerged: ‘Nurse & physician behaviour’, ‘Team performance’, and ‘Patient behaviour’. In the first theme ‘Nurse and physicians’ behaviour’, positive determinants related to an attitude of experienced professionals that provide patients with trust. On the other hand, negative determinants provide patients with experiences of unsafety. In the second theme ‘Team performance’, positive determinants involved effective communication and coordinated care of the nurses and physicians. Negative determinants related to visible disagreement about the treatment. In the third theme ‘Patient behaviour’, positive determinants related to seeking support from nurses, physicians, and family to recover and to endure an anxious period. Negative determinants related to missing appointments or not consulting the information provided.

Conclusion and practice implications

‘Nurse & physician behaviour’ and ‘Team performance’ are relevant determinants that contribute to patients’ experiences of safe care. Stimulating an active attitude of patients in seeking support may contribute to experiences of safe care. These results can be used to improve patients’ experience of safe care in an uncertain and vulnerable perioperative period.

Nurses' Experiences as Care Providers for Syrian Refugees With Noncommunicable Diseases: A Qualitative Study

INTRODUCTION

Noncommunicable diseases (NCDs) are the leading cause of disability and death in the world. In Syria, the incidence of NCDs in refugees is 45%. Cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and other NCDs are the most common causes of morbidity in Syria. Nurses have challenges caring for Syrian refugees with NCDs. The purpose of the study was to explore nurses' experiences of caring for Syrian refugees with NCDs in Turkey.

METHODOLOGY

A phenomenology design was used. Inclusion criteria were nurses working experience of more than 1 year, caring for Syrian refugees with NCDs, and willingness and ability to participate in an individual interview. The participants were 20 nurses who worked with Syrian refugees at a public hospital in Kilis Province the border with Syria. Data were collected using semistructured interviews and analyzed by the thematic analysis method of Braun and Clarke.

RESULTS

Three major themes and six subthemes were identified. Major themes included the communication experience, cultural differences, and Syrian refugees' lack of knowledge about NCDs.

DISCUSSION

The results provide insight related to nursing care in Turkey for Syrian refugees with NCDs. The study revealed that nurses encountered challenges when caring for Syrian refugees with NCDs. Culturally competent assessment and interventions for refugees with NCDs should be encouraged considering these three themes.

Social inequalities, length of hospital stay for chronic conditions and the mediating role of comorbidity and discharge destination: A multilevel analysis of hospital administrative data linked to the population census in Switzerland

Social factors are recognized determinants of morbidity and mortality and also have an impact on use of medical services. The objective of this study was to assess the associations of educational attainment, social and financial resources, and migration factors with length of hospital stays for chronic conditions. In addition, the study investigated the role of comorbidity and discharge destination in mediating these associations. The study made use of nationwide inpatient data that was linked with Swiss census data. The study sample included n = 141,307 records of n = 92,623 inpatients aged 25 to 84 years, hospitalized between 2010 and 2016 for a chronic condition. Cross-classified multilevel models and mediation analysis were performed. Patients with upper secondary and compulsory education stayed longer in hospital compared to those with tertiary education (β 0.24 days, 95% CI 0.14-0.33; β 0.37, 95% CI 0.27-0.47, respectively) when taking into account demographic factors, main diagnosis and clustering on patient and hospital level. However, these effects were almost fully mediated by burden of comorbidity. The effect of living alone on length of stay (β 0.60 days, 95% CI 0.50-0.70) was partially mediated by both burden of comorbidities (33%) and discharge destination (30.4%). (Semi-) private insurance was associated with prolonged stays, but an inverse effect was observed for colon and breast cancer. Allophone patients had also prolonged hospital stays (β 0.34, 95% CI 0.13-0.55). Hospital stays could be a window of opportunity to discern patients who need additional time and support to better cope with everyday life after discharge, reducing the risks of future hospital stays. However, inpatient care in Switzerland seems to take into account rather obvious individual needs due to lack of immediate support at home, but not necessarily more hidden needs of patients with low health literacy and less resources to assert their interests within the health system.

The Importance of “Easy Japanese”: Communicating Health Information to Foreigners in Japan

The number of foreign workers in Japan has been increasing in recent years. In Shimane Prefecture, people from non-English speaking countries account for most of the foreign resident population. Language barriers pose numerous challenges for this population. Their problems communicating in the medical context, in particular, contribute to their avoidance of hospitals. In addition to translation machines and English, "Easy Japanese" has been found to help Japanese healthcare workers communicate with foreign patients. “Easy Japanese" refers to easy-to-understand Japanese that involves rephrasing words and sentences. The use of Easy Japanese should be promoted among medical professionals in Japan as it is considered a communication skill that can be improved through practice. A voluntary study group was formed among medical students. During the first session, students were presented with background information, explaining why the need for Easy Japanese is increasing. In the second session, they practiced paraphrasing words. Finally, in the third session, they conducted simulated medical communication and practiced Easy Japanese with foreign residents to determine whether they were able to convey their intentions. Participants were recruited via social networking service, with five participants in the first session, five in the second, and eight in the third. Through this project, it became clear that for participants, the usual way of speaking Japanese came first in practice and that it was difficult for them to produce easy-to-understand phrases at the spur of the moment without practice. Additionally, medical students reported that the expressions they acquired through several practice sessions were helpful when talking with international students on campus. The final session involved a student-led Easy Japanese study group. Based on the students’ comments, we found that this study group was useful for them. Accordingly, Easy Japanese education should be continued and expanded to more students in the medical field and to the local community, including foreign residents, to measure its effectiveness.

A framework for evaluating health system surveillance sensitivity to support public health decision-making for malaria elimination: a case study from Indonesia

Background

The effectiveness of a surveillance system to detect infections in the population is paramount when confirming elimination. Estimating the sensitivity of a surveillance system requires identifying key steps in the care-seeking cascade, from initial infection to confirmed diagnosis, and quantifying the probability of appropriate action at each stage. Using malaria as an example, a framework was developed to estimate the sensitivity of key components of the malaria surveillance cascade.

Methods

Parameters to quantify the sensitivity of the surveillance system were derived from monthly malaria case data over a period of 36 months and semi-quantitative surveys in 46 health facilities on Java Island, Indonesia. Parameters were informed by the collected empirical data and estimated by modelling the flow of an infected individual through the system using a Bayesian framework. A model-driven health system survey was designed to collect empirical data to inform parameter estimates in the surveillance cascade.

Results

Heterogeneity across health facilities was observed in the estimated probability of care-seeking (range = 0.01–0.21, mean ± sd = 0.09 ± 0.05) and testing for malaria (range = 0.00–1.00, mean ± sd = 0.16 ± 0.29). Care-seeking was higher at facilities regularly providing antimalarial drugs (Odds Ratio [OR] = 2.98, 95% Credible Intervals [CI]: 1.54–3.16). Predictably, the availability of functioning microscopy equipment was associated with increased odds of being tested for malaria (OR = 7.33, 95% CI = 20.61).

Conclusions

The methods for estimating facility-level malaria surveillance sensitivity presented here can help provide a benchmark for what constitutes a strong system. The proposed approach also enables programs to identify components of the health system that can be improved to strengthen surveillance and support public-health decision-making.

Rural Easy Japanese as a Method of Mitigating Language Barriers Among Foreigners Seeking Medical Care in Rural Japan

Mitigating difficulties in communication is vital in multicultural societies. Particularly, foreigners face greater communication difficulties because of language barriers, posing a challenge to both themselves and indigenous people. In Japan, the increase in the number of foreigners has driven the use of Easy Japanese, a free online program of Japanese language lessons. Easy Japanese can facilitate communication between medical professionals and foreigners. Easy Japanese is mainly characterized by short sentences, an upfront conclusion, and avoiding polite Japanese words when collaborating with translators. This communication method should prevail not only in urban areas but also in rural areas, and can help individuals in rural contexts prepare for an increase in the number of foreigners.

Health care interpreter use in an inpatient rehabilitation setting: examining patterns of use and associated clinical outcomes

PURPOSE

Professional interpreters can improve healthcare quality and outcomes when there is language discordance between patients and health care providers. Multidisciplinary rehabilitation relies on nuanced communication; however, the use of interpreters in rehabilitation is underexplored. This study aimed to examine patterns of health care interpreter use in an inpatient rehabilitation setting.

METHODS

A retrospective cohort study was conducted including patients admitted for subacute rehabilitation during 2019-2020 identified as having limited English proficiency. Patterns of interpreter use (professional and "ad hoc") and rehabilitation outcomes were evaluated via medical record review.

RESULTS

Eighty-five participants were included. During inpatient rehabilitation (median 17 [12-28] days), most clinical interactions (95%) occurred without an interpreter present. Patterns of interpreter use were variable; with greater use of ad hoc versus professional interpreters (received by 60% versus 49% of the cohort, respectively). Those who interacted with a professional interpreter had a longer length-of-stay, larger Functional Independence Measure (FIM) gain, and lower rate of hospital readmission six months post-discharge. The number of professional interpreter sessions correlated positively with FIM gain.

CONCLUSIONS

Access to professional interpreters in inpatient rehabilitation was variable, with some patients having no or minimal access. These findings provide preliminary evidence that professional interpreter use may be associated with clinical rehabilitation outcomes. Implications for rehabilitationProfessional health care interpreters can be used to overcome language barriers in rehabilitation.In an inpatient rehabilitation setting, professional interpreters appeared to be underutilized, with many patients having no or minimal access to interpreters.Use of ad hoc, untrained interpreters and informal communication strategies was common during rehabilitation.Use of professional interpreters appeared to be associated with favorable rehabilitation outcomes.

Home medication management problems and associated factors among psychiatric patients using home care pharmacy services at government hospitals in western Malaysia

Background

Proper home medication management plays a role in improving medication adherence, preserving drug efficacy and ensuring safe medication practices, which is crucial to establish positive treatment outcomes. However, no published studies are available on home medication management among psychiatric patients. The study aimed to identify home medication management problems among psychiatric patients in Malaysia and to examine the associations of inappropriate medication storage and lack of a medication administration schedule with sociodemographic factors, disease insight, number of medications and type of home care pharmacy services (HCPS).

Methods

This multicentre cross-sectional study was conducted among psychiatric patients using HCPS in six government hospitals in western Malaysia. Data were extracted from the HCPS form used for each visit as per the protocol published by the Pharmaceutical Services Division, Ministry of Health Malaysia. A minimum sample size of 169 was needed. Proportional random sampling was applied. The associations of inappropriate medication storage and lack of medication administration schedule with study parameters were analysed using multiple logistic regressions.

Results

A total of 205 home visits were conducted with 229 home medication management problems identified; inappropriate medication storage and lack of medication administration schedule topped the list. Inappropriate medication storage was significantly associated with low income [AOR = 4.34 (95% CI 1.17:15.98), p = 0.027], alcohol consumption [AOR = 14.26 (95% CI 1.82:111.38), p = 0.011], poor insight [AOR = 2.34 (95% CI 1.08:5.06), p = 0.030] and part-time HCPS [AOR = 2.60 (95% CI 1.20:5.67), p = 0.016]. Lack of administration schedule was significantly associated with low income [AOR = 6.90 (95% CI 1.46:32.48), p = 0.014], smoking [AOR = 2.43 (95% CI 1.20:4.92), p = 0.013], poor insight [AOR = 5.32 (95% CI 2.45:11.56), p < 0.05] and part-time HCPS [AOR = 2.96 (95% CI 1.42:6.15), p = 0.004].

Conclusions

Inappropriate medication storage and a lack of a medication administration schedule are common among psychiatric patients. The study also highlighted the potential of HCPS to improve disease insight and home medication management among psychiatric patients if the service is utilized fully.

How Is Quality of Care in Home Healthcare Created? A Qualitative Study of Health Professionals' Perspectives

The demographic challenges with an increase in older adults in need of nursing care has put home healthcare services under pressure. However, research on what constitutes quality of home healthcare services and what factors influence good nursing care and patient safety is scarce. The aim of this study was to gain insight into health professionals' perceptions of how quality of care in home healthcare is created and what factors put patient safety at risk. The present study was a qualitative study with semi-structured interviews of eight health professionals working in home healthcare services. Qualitative content analysis was used. Four categories of factors the staff thought had to be present to provide good quality services were identified: (1) A workplace with adequate competence; (2) Communication, information flow and collaboration; (3) Continuity and organisation of care; and (4) Resources. Conclusions: The healthcare professionals perceived that the quality of the services overall was good, and if important factors were present, quality of care was achieved. However, they pointed out some factors that were important to prevent inadequate care and improve services, as quality of care was at risk when deficiencies in these areas occurred.

Cultural Competence of Mental Health Nurses in Israel

Israel's diverse culture presents challenges to the nation's health care system; lack of culturally appropriate care adversely affects overall quality of care. Therefore, cultural competence needs strengthening, especially among mental health nurses, for whom communication is the essence of treatment. The current study aimed to examine and evaluate the degree of cultural competence of mental health nurses in Israel. We sought to determine whether demographic variables, such as age, sex, and other characteristics, have effects on cultural competence. This study used a structured self-report questionnaire to survey 107 Israeli mental health nurses about their perceptions of their own cultural competence. Most participants attributed great importance to sociocultural aspects of patient care (mean score = 4, SD = 0.628) and were knowledgeable, but a majority (mean score = 3, SD = 0.83) reported difficulties implementing their knowledge during treatment. Cultural knowledge and awareness correlated with personal characteristics, such as sex and country of origin. There were gaps between cultural knowledge and the ability to apply existing knowledge in practice. A need exists not only for ongoing training in and maintenance of cultural knowledge, but also for tools to implement culturally appropriate care. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Action on patient safety can reduce health inequalities

Providers and health systems should use ethnic differences in risk of harm from healthcare to reimagine their role in reducing health inequalities, write Cian Wade and colleagues

Barriers to Follow Up Care in the South Asian Immigrant Population at High Risk of Acute Coronary Syndrome at Elmhurst Hospital Center

We studied South Asian immigrant patients who did not return to Elmhurst Hospital Center (EHC) after emergent cardiac catheterization in order to propose interventions to improve follow up care. We identified 74 eligible patients, interviewed 30 about follow up practices, and analyzed findings. Most patients are Bangladeshi and 77% preferred a foreign language. Some were visiting the US during the admission without intent to follow up. Half were dissatisfied with EHC providers, complications, and inadequate care at follow up appointments. Some patients were unaware of scheduled appointments or the necessity of follow up. Most follow with private providers due to language accessibility, availability, and proximity. We found that language barriers contribute to loss to follow up and the true loss to follow up rate is lower than reported at EHC. This can inform practices at hospitals with immigrant populations, minimize resource waste, and improve quality of care.

Overcoming language barriers, enhancing collaboration with interpreters - an interprofessional learning intervention (Interpret2Improve)

BACKGROUND

Language barriers (LB) are common in patient care. They can negatively impact the quality of care, and increase costs. LB can be overcome by using interpreters. However, collaboration with interpreters is a professional activity which can and needs to be learnt. Interpret2Improve is an innovative educational intervention where medical and nursing students learn together how to address LB and effectively collaborate with interpreters.

METHODS

The three-hour course has two parts: After a short introduction on the relevance of LB and resulting issues of patient safety etc., students in interprofessional teams of two practice conversations with non-German-speaking simulated patients and professional interpreters. The course is evaluated in a pre-post format with the Freiburg Questionnaire for Interprofessional Learning Evaluation which has been validated in prior studies.

RESULTS

Fifty-one students (thirty of the participants were medical students, 21 participants were students in nursing care) participated from 11/2016-07/2018. Overall, the course was very well received (mean 1.73 (SD 0.85) on a five point scale: 1 = very good, 5 = insufficient). The evaluation by medical and nursing students differed significantly. Fourteen out of twenty-one items show a self-assessed increase in interprofessional knowledge or skills.

CONCLUSIONS

Students felt that their skills in addressing LB by effectively collaborating with interpreters increased during this interprofessional format. Further studies are needed to obtain further evidence beyond self-assessment and regarding the long-term outcomes.

Facilitating Communication in a Pediatric Surgery Center: Implementation of an Interactive Communication Board

Background

Increasing linguistic diversity has important implications for providers serving limited English proficiency (LEP) populations. LEP patients have decreased understanding, increased risk for adverse events, and lower healthcare satisfaction. Limited interpreting methods affect nurses’ ability to provide efficient, culturally competent care.

Objective

An interactive communication board was implemented to evaluate the perceived effectiveness of LEP patient communication and increase nurse satisfaction with communication in a pediatric ambulatory surgery center.

Methods

A pre-post survey design evaluated the implementation of an interactive communication board. After a 3-month implementation period, post-surveys assessed nurse satisfaction, perception of time required to interpret nursing tasks, and feasibility of the tool.

Results

Nurses reported a 64% increase (2.27 ± 0.88 pre; 3.57 ± 0.76 post; p = 0.0007) in satisfaction with the interpretation process and a 43% increase (2.07 ± 0.70 pre; 3.50 ± 0.76 post; p = 0.0001) in their self-perceived ability to communicate with LEP populations post-intervention.

Conclusion

Communication boards and similar tools can improve nurse satisfaction and streamline the interpretation process in peri-operative periods.

Implications for Nursing

Similar tools could be implemented in other healthcare settings to increase communication efficiency between nurses and LEP populations. Further projects must be conducted to evaluate the experience and efficacy of this tool from the patient/caregiver perspective.

Impact of language proficiency on mental health service use, treatment and outcomes: "Lost in Translation"

BACKGROUND

Mastery of a language is bound to place of origin; low language proficiency is thus related to migration and cultural differences, all of which influence access to mental health care, treatment and outcomes. Switzerland, being multilingual, allows the disentangling of language proficiency from migration and, to some extent, culture. This study uses propensity score matching to explore how language proficiency relates to help-seeking behaviour, service use, treatment and outcomes in patients with mental health disorders.

METHODS

We used the first admission of patients admitted to and discharged from an academic psychiatric hospital in Switzerland between January 1st, 2013 and December 31st, 2019, with an observation period of one-year post-discharge (until December 31st, 2020). We paired 2101 patients with low language proficiency to 2101 language proficient patients, balancing baseline sociodemographic and clinical characteristics using propensity score matching.

RESULTS

Patients with low language proficiency had a higher probability of compulsory admission (OR: 1.79, 99%CI: 1.60-2.02); which remained after adjustment for confounders (OR: 1.51; 99%CI: 1.21-1.89). Whilst in treatment, they had higher rates of compulsory medication (OR: 1.73, 99%CI: 1.16-2.59) and seclusion/restraint (OR: 1.87, 99%CI: 1.25-2.79). Furthermore, patients initially admitted voluntarily had a higher probability of being compulsorily retained (OR: 1.74, 99%CI: 1.24-2.46). Both groups showed similar clinical improvement rates and service use parameters.

CONCLUSIONS

Our results demonstrate that low language proficiency constitutes a risk factor for coercive measures throughout hospitalisation. The results demonstrate the need for an increase in language sensitivity in psychiatric care.

Development and implementation of a medication reconciliation during pediatric transitions of care in a public hospital

OBJECTIVES

To generate effective changes in the work processes of an institution, such as hospitals, strategies are needed for the implementation of services. These should be based on the needs of the practice scenario and evidence that may develop programs applied to the routine of health care. This study aimed to implement medication reconciliation (MR) at the transition of care in the pediatric department of a public hospital located in Northeast Brazil.

SETTING

A step-by-step approach was adopted to implement MR in the studied hospital and conducted from March 2019 to December 2019.

PRACTICE INNOVATION

The implementation of MR used the "Model for Improvement" framework. The processes were built and tested in the Plan-Do-Study-Act (PDSA) cycles. Children admitted to the hospital's pediatrics department were included in the study. The objective of the PDSA cycles was to reach 75% of the patients included, with the service performed in at least one transition of care episode.

EVALUATION

This study used the following indicators: number of steps performed, number of discrepancies identified, and resolution of discrepancies. Descriptive statistical analysis was performed for all variables.

RESULTS

In the first cycle, all patients (n = 34) had the best possible medication history (BPMH) completed, and 26.4% went through all the MR stages. Seventy-two discrepancies were identified and 90.3% of them were resolved. In the second cycle, all patients (n = 35) had the BPMH completed, and 20% went through all the stages. A total of 32 discrepancies were identified and 96.8% of them were resolved. In the third cycle, all patients (n = 30) had the BPMH completed, and 56.6% of patients went through all the stages. Twenty-four discrepancies were identified and resolved.

CONCLUSION

The use of the "Model for Improvement" framework effectively contributed to the implementation of the service according to the characteristics of the studied hospital.