Health promotion for Vietnamese women and their families

When asides become central: small talk and big talk in interpreted health interactions

OBJECTIVE

In health interactions which require an interpreter, there are occasions when there are uninterpreted asides between participants. These are often construed to be features which hinder the interpreting process. However they have potential to yield critical information in certain health care contexts.

METHODS

This paper examines 17 instances of asides in interpreted interactions which took place in 3 intercultural health care contexts in South Africa. The asides were transcribed, translated and analysed based on conversation analysis principles.

RESULTS

The topics of the asides as well as who initiates them appear highly dependent on contextual features. There is evidence for the emergence of 'small talk' which serves the purpose of framing comfort levels, aligning the interpreter and patient or offering guidance for example, and the emergence of 'big talk' or engagement on topics which for cultural and historical reasons and power imbalances between the health practitioner and patient may be too difficult to raise directly. Such information also yields critical diagnostic and therapeutic information.

CONCLUSION

Our findings suggest evidence for the presence of multiple patterns and roles that the interpreter may assume in such interactions.

PRACTICE IMPLICATIONS

Implications for team training and practice are provided.

Providing the family-nurse partnership programme through interpreters in England

This study looks at the delivery of the Family-Nurse Partnership (FNP) in England with interpreters. This home-visiting programme for vulnerable, young first-time mothers is known in the USA as the Nurse-Family Partnership (NFP). FNP is manualised with a number of fidelity targets and stretch objectives. This study covers the first two phases, pregnancy and infancy (up to 12 months). The programme relies on the development of a close nurse-client relationship. Interpreters can be a barrier for therapeutic work with vulnerable groups. The aims are to determine from quantitative and qualitative data whether the FNP programme can be delivered with fidelity in the presence of an interpreter and to explore issues concerned with the impact of interpreters on relationships. Statistical comparisons were made of delivery objectives over 2 years, from April 2007 to February 2009, in the 10 sites in England, spread across all nine Government Office Regions providing FNP. Forty-three clients had an interpreter at some point and 1261 did not. Qualitative interviews were conducted between April and May 2009 with 30 stakeholders (nurses, clients, interpreters). In relation to quantitative indicators, the percentage of planned content covered in visits was lower with interpreters (pregnancy 90% vs. 94%; infancy 88% vs. 93%) and both understanding and involvement of clients, as judged by nurses on 5-point scales, were lower (understanding, pregnancy 4.3 vs. 4.6, infancy 3.8 vs. 4.5; involvement, pregnancy 4.4 vs. 4.7, infancy 3.7 vs. 4.5). The interpreter was not thought by nurses to impede the development of a collaborative client-nurse relationship unless the interpreter and client became too close, but some nurses and clients reported that they would rather manage without an interpreter. Some stress was noted for nurses delivering the programme with an interpreter. More research is needed to determine the extent to which interpreters accurately convey the programme's strength-based approach.

If I was going to kill myself, I wouldn't be calling you. I am asking for help: challenges influencing immigrant and refugee women's mental health

It is estimated that 37% of Canadians experience some types of mental health problem. As a result of the migration process, many immigrant and refugee women suffer serious mental illness such as depression, schizophrenia, posttraumatic stress disorder, suicide, and psychosis. The purpose of this exploratory qualitative study, informed by the ecological conceptual framework and postcolonial feminist perspectives, was to increase understanding of the mental health care experiences of immigrant and refugee women by acquiring information regarding factors that either support or inhibit coping. Ten women (five born in China and five born in Sudan) who were living with mental illness were interviewed. Analysis revealed that (a) women's personal experience with biomedicine, fear, and lack of awareness about mental health issues influences how they seek help to manage mental illness; (b) lack of appropriate services that suit their needs are barriers for these women to access mental health care; and (c) the women often draw upon informal support systems and practices and self-care strategies to cope with their mental illnesses and its related problems. The authors discuss implications for practice and make recommendations for intervention strategies that will facilitate women's mental health care and future research.

"She will hear me": how a flexible interpreting style enables patients to manage the inclusion of interpreters in mediated pharmacy interactions

Interpreters are frequently called upon to assist with communication across language barriers in health care contexts. Research has neglected the voice of the patient, and interpreting practices are often dominated by assumptions about how best to include an interpreter in interactions. Data from a South African study of interpreted pharmacy interactions provide some novel insights into how a flexible interpreting style may enable patients to initiate and manage the inclusion of interpreters in health care interactions. This study confirms the inappropriateness of the conduit model of interpreting and suggests that a flexible approach based on patient preferences and communicative needs may be more successful in realizing communication goals and achieving patient-centered interactions. Recommendations for how this style might be implemented are provided.

Communicating with culturally and linguistically diverse patients in an acute care setting: nurses' experiences

Communication with culturally and linguistically diverse (CLD) patients has been shown to be difficult. This study describes nurses' experiences of communicating with CLD patients in an acute care setting. A purposive sample of registered nurses and certified midwives (n=23) were interviewed. Main findings were: interpreters, bilingual health workers and combinations of different strategies were used to communicate with CLD patients; some nurses showed empathy, respect and a willingness to make an effort in the communication process with others showing an ethnocentric orientation. Main recommendations were: prioritising access to appropriate linguistic services, providing nurses with support from health care workers, e.g., bilingual health care workers who are able to provide more in-depth information, increasing nurses' understanding of legal issues within patient encounters, supporting nurses to translate their awareness of cultural diversity into acceptance of, appreciation for and commitment to CLD patients and their families.

Interpreters: a double-edged sword in nursing practice

The provision of health services for all Australians is based on equality of access to health care services, regardless of cultural origin or linguistic skill, and on the responsibility of the health system to respond appropriately. Lack of fluency in the English language and lack of bilingual or multilingual nurses are major sources of miscommunication, even with the use of interpreters and translated health information. Many immigrant women find the use of interpreters unacceptable. Nurses are concerned with legal issues. These two viewpoints make the use of interpreters a double-edged sword in practice. The findings of recent research and the literature in relation to language skills and the use of interpreters and translations in the Australian context are explored. Potential resolutions for transcultural nursing practice are provided.