Panesar and Sheik
To effectively communicate with the patient the nurse should explore the individual patient’s communication needs. (Bergen 1992; Booth et al. , 1996 cited in McCabe 2004). Patient centred communication is communication which assists the individual patient to be actively involved in their care and treatment decisions. (Langewitz et al cited in mcCabe 2004). As most Nurses in the UK will be involved in the care of non English patients on a regular basis.
(Black 2008) and there are approximately 150 languages used in Scotland beside English, this essay will explore the communication needs of Adults who speak little or no English and who are receiving post operative nursing care, while discussing the role of the nurse in facilitating these. The individual needs of each patient within a patient group will vary, however those needs which are almost universal to most post operative patients may be even more challenging when the patient speaks a different language from nursing staff.
Every patient has the right to be involved in decisions about their care, however involvement in the decision making process is difficult without effective communication. The nurse should protect this right by ensuring that information requested or needed about the patient’s health is given in a format that they can understand (NMC 2008). Ledger (2002) suggests that involvement leads to more successful post operative outcomes for the patient.
Where a patient speaks little or no English a trained health interpreter can empower them to discuss such decisions, and reduce both the communication barrier between nurse and patient (Paneser and sheik cited in Pellatt 2007) and the potential for ineffective or inappropriate treatment. Patients may need to be informed that they are entitled to free interpretation, as they may be new to the healthcare system and be unaware of this (Health Scotland 2008).
Ineffective interpretation in an acute setting such as post operative care can endanger the patient because of the increased risk of misdiagnosis and poor compliance or understanding of post discharge treatment regimes, creating inequalities in non English speaking patients (Jones and Gill cited in Ledger 2002). The limited availability of professional interpreters and increasing demand upon their services can be a barrier to meeting the patients communication needs quickly.
A delay in accessing a translator for the patient can increase feelings of isolation, anger and frustration especially if the patient is anxious to discuss the outcomes of surgery or related worries (Gerrish et al, 1996 cited in Black 2004). These feelings can be temporarily eased by the nurse talking to the patient in a friendly or comforting tone. The patient may not understand the context of the conversation but they may be calmed by the attempt to communicate (Wynia and Matiasek 2006).
An interpreter should meanwhile be arranged as quickly as possible as it is the nurses moral and legal duty to support a patient to access an appropriate interpreter according to the NMC code of conduct (2008) and the race Relations (Amendment) Act 2000. Maintaining continuity by requesting the same interpreter where possible can help build trust and enable a patient to be more open in their disclosures and questioning especially when sensitive information is being discussed (Hepinstall 2004).
The nurse should also be aware of how to work most effectively with an interpreter and prepare the interpreter for what may be involved (Health Scotland 2008) as poor communication between the nurse and interpreter can prove to be a further barrier to communication for the patient. When using professional interpreters it is important to ensure that an appropriate interpreter is used, so that communication is patient centred and tailored to the individual.
The interpreting guidelines for staff of NHS Scotland state that it is important to know which language or dialect that the patient speaks, and correctly record this in their case notes to ensure continuity of care and reduce delay in accessing appropriate interpreters. If the patient requires a same sex interpreter this should also be noted as some non English speaking women will decline the services of an interpreter who is male, particularly post gynaecological or breast surgery (Blackford and Street cited in Pellatt 2007).
Good discharge planning is both essential to the decision making process in which the patient should be involved and also to the patients long term recovery after surgery. Evidence suggests that providing patients with information and knowledge reduces the instance of readmission and poor outcomes (Mamon at al 1992 cited by Henderson 2001). Presently non English speaking patients are less likely to correctly follow treatment regimes (Oliva 2008) which could suggest they do not always understand the information given or the implications of non compliance.
(Feber 2000; and Dropkin 2001 cited by Bowers 2008) stated that part of the nurses role in post operative care is supporting and teaching patients to undertake self care as patients who have a newly formed stoma or prosthesis will need to learn new self care skills and may be anxious about this. Bowers (2008) concurs and suggests that by involving the patient in their own self care soon after surgery, the nurse can help them to confront and accept impairments, reducing distress and increasing the ability to cope post surgery.
To facilitate the teaching of patients with limited English to participate in these new skills may be challenging, as it requires efficient communication and the nurse should be aware of the resources available in the patient’s language to assist with educating and informing the patient adequately as poor resources can be a barrier to communication (Health Scotland 2008). When working with patients who do not speak English, Speirs (2003) suggests that the nurse allocates more time to make sure that the patient fully understands the information being given.
She also recommends that clear, slow and consistent language is used in conjunction with pictures, word cards and appropriate literature. When providing written information in the patient’s language it should be remembered that some patients may also have literacy difficulties (Bradby; Panesar and Sheik cited in Pellatt 2007). Patients often use verbal communication to seek reassurance from nursing staff, and many patients express the need to feel cared for in both a medical and surgical setting.