Author: Hanna C. Korhonen, BSc student, Bachelor of Health Care, Nursing, Novia UAS  

Supervisor: Anita Wikberg, RN, RM, PhD, Senior Lecturer, Novia UAS 

Abstract  

Communication plays a crucial role when providing high-quality healthcare services to patients in hospital settings. The quality of care is affected by nurse-patient communication. Nurses are often the first contacts with patients. The difference in spoken language, with non-verbal communication, and cultural differences can build barriers and challenge nurse-patient communication. Trained communication skills, use of professional interpreters, and other positive practices would decrease nurses' workload.   

Barriers can be reduced through shared information, education and increased awareness of nurses and patients. Resources pointed directly to the nurse-patient language barrier would improve the situation, add the satisfaction for both nurses and patients, enabling the use of professional interpreters and other tools and solutions available, without at the same time adding the nurses’ daily basis workload.   

Introduction  

This article describes the language and communication barriers between the nurse and the patient, and what and how we could ease the situation in busy hospitals with overloaded working nurses. The improved nurse-patient interaction can positively affect the outcomes of health care services, for the quality, satisfaction, and safety of care.  

A language or communication barrier takes place in healthcare when the healthcare professionals and the patients do not share the same language, including the situation with patients who are hearing-impaired (Slade & Sergent, 2022).  Language barriers, with different types of miscommunication, are reducing the quality of healthcare, and affect the safety of the patients (Al Shamsi, 2020; Kwame & Petrucka, 2021). Language barriers are in many cases the reality for patients that are seeking medical care and treatment. Language barriers need to be removed, and situations globally improved in hospitals to optimize satisfying patient outcomes (Slade & Sergeant, 2022).  

 Language barriers in Finland  

In Finland, we have two national languages Finnish and Swedish, and Sámi languages (North Sámi, Inari Sámi and Skolt Sámi). The law from the year 2021 (Finlex 644/2021, 24§) provides the government's language rules for all government-based or government-related services in Finland. This Finlex law also applies to the Finnish social- and healthcare system.   

According to this law, “Laki kielilain muuttamisesta”, in areas where only one language is spoken in Finland, people can be served with the one local language. In areas, which use two- or more national languages, there is a need to serve people as well with their other national languages (Finlex 644/2021, 6§). These areas in Finland that are using more than one national language, need to establish “a board of language” to present and monitor the language position and strategies in the area (Kansalliskielistrategia, 2021). Bilingual hospital employees are valuable resources for interpretation (Slade & Sergent, 2022). In Finland, in the areas where Finnish and Swedish are both common languages, the bilingual nurses working at the hospital have been found as a very beneficial resource to erase the nurse-patient language barrier. Global migration increases language diversity. The traditional national language skills seem insufficient in this increasing globalization, and other language resources are urgently needed and warmly welcomed. In Finland, at the end of year 2021, 8,3% of the population were speaking other than national languages (stat.fi, 2022).   

Language Barriers and the Quality of Health Care 

Language or communication barriers may negatively affect, and even harm the quality of the medical care. Untrained interpreters used ad hoc, for example, the family members or other unqualified persons, can translate up to a quarter of all given information incorrectly (Slade & Sergent, 2022). Language barriers can have even serious impacts to patients' safety (Al Shamsi, 2020). Patients who face language barriers are found to be more likely to receive larger amounts of diagnostic examinations and tests, as well as longer hospital emergency room stays. All this with increased medical charges (Slade & Sergeant, 2022), or costs for public healthcare. Understandable communication benefits both patients and health care professionals (Bello, 2021).  

The Common Language Barriers in Hospital Ward  

Patients and other hospital visitors, for example, the family, need to be able to communicate their needs and at the same time receive enough understandable relevant information from the hospital staff in order to look for best available treatment and recovery for illness. Understanding and sharing patients' language was reported by more than 94% of nurses to be a very important aspect in their everyday healthcare work (Pytel et al., 2009). Effective and proper communication between healthcare providers and patients improves patients´ achievement and well-being (Norouzinia et al., 2016).  

Communication barriers can occur when patients do not feel comfortable to share sensitive information about their health conditions.  

Patients’ discomfort can arise from an attitude or by the differences of nurse-patient age, gender, sexual orientation, culture, religion, and use of unfamiliar words. Anxiety, pain, and lack of focus are patient-related barriers that affect the quality of the interaction (Norouzinia et al., 2016). Also, a patient's lack of knowledge of the nurse's duties and professional status can decrease the satisfaction for the nurse-patient communication (Gerchow et al., 2021).   

Every patient is unique, and healthcare providers should take care of many different situations, including the non-verbal language use and the possibility of the patient belonging to some disadvantaged groups or cultures (Kwame & Petrucka, 2021). Effective healthcare offers services that include patients´ social, cultural, and language needs. SOTE, the Social and Healthcare Reform in Finland, in effect year 2023, consider these as principles (valtioneuvosto,2022). 

Resources for the Improved Nurse-Patient Communication  

Healthcare and government leaders have opportunities to decrease nurses' workload by creating nursing strategies and adding resources to positively affect the quality of the outcomes of healthcare (Gershow et al., 2021). According to WHO publication from the year 2018 experienced healthcare professionals including doctors, nurses and other healthcare providers are necessary for:  ”... delivering effective, safe, people-centered health care that is timely, equitable, integrated” and also “...efficient  to individuals, families and communities”(WHO, 2019, 11). WHO is calling for healthcare that is people-centered and made to cover local health needs. Patient-centered care is meaningful and valuable care to the individual patient, and includes the listening to the patient, informing and the involvement of the patient in the care (O`Neill, 2022).   

Busy, overworked nurses prefer professional interpretation, if available, but often count on other communication methods (Gerchow et al., 2021). Nurses coming from different cultures need training in language and the cultural differences to decrease the risk for misunderstanding or being misunderstood (Kaihlanen et al., 2019). When untrained interpreters and family members are used as interpreters, there are concerns that can increase anxiety for patients: lack of confidentiality, lack of medical knowledge, unprofessional ideas and beliefs of the treatment, medicine, and evaluation (Slade & Sergant, 2021). In some cases, nurse-patient barriers could be excluded by sharing more information and rising awareness, and by creating a more satisfying hospital environment (Norouzinia et al., 2015). Even small everyday things might be effective in reducing patient’s communication anxiety, for example simply sitting down to talk with them. 

Tools and ideas to work with the nurse-patient language barriers   

Professional interpreters appear to raise the quality of clinical healthcare. The help of a professional interpreter has decreased errors and increased satisfaction in healthcare outcomes (Karliner et al., 2007). However, providing on-site trained medical interpreters is expensive, and these services are partly responsible for the increased cost of medical care as well as longer hospital stays (Slade & Sergent, 2022; Al Shamsi et al., 2020). More research is needed to confirm these critical healthcare interactions where professional interpreters should step in. We also need to decide and understand what acceptable basic communication in different situations are, where professional interpreters cannot be present ad hoc, and family, friends, and other uncertified translators are used as interpreters (Gerchow et al., 2021). Full-time interpreters as employees are expensive for the healthcare system (Slade & Sergeant, 2022). Nurses, or other hospital employees, with certified language skills would potentially save future healthcare costs (Gerchow et al., 2021, Slade & Sergeant, 2022).  

There are free non-person alternatives available to ease the nurse-patient communication. Online translation application tools could help the situation in hospitals, though new updates with more medical phrases and with more languages included are recommended (Al Shamsi, 2020). The question here is also about the patient's confidential information, and ethics, and how these principles are guaranteed.  

Essential hospital discharge papers and instructions should be printed out for patients using their own language, with detailed explanations by an interpreter, to minimize misunderstandings during the hospital stays (Slade & Sergent, 2022).       

 Conclusion  

Language barriers between nurses and patients are affecting the satisfaction and the quality of the provided health care. Resources should be pointed to this increasingly global problem, which is affecting nurses and patients more frequently also in Finland.   

Overworked nurses with little resources and time should get strategic institutional help, from the government or from the hospital resources to solve these language-barrier challenges. As WHO, World Bank and OECD pointed out in their publication (2018), healthcare should be people-centered and fair, and offer effective and safe care to individuals, families, and communities. The rules and policies vary around the globe about the required use of interpreters, language training, and certification. Language barrier problems in healthcare need to be resolved to provide fair, safe and effective healthcare for every patient independent of their native language.   

References