Language as a barrier to patient education : a view from behind the desk

Three factors provide the background for this research study, the efficacy of patient education in influencing health outcomes, the significant growth of immigration and the change in predominant countries of origin for immigrants and the Canadian ideal of equity and quality in health care. Together these factors combine to create a dilemma, of how does a predominantly 'white', 'western', and European, nursing tradition meet the educational needs of non-English speaking patients particularly those from a culture with origins different from those o f the majority. Although there is a relatively recent accumulation of health literature about the difficulties encountered by non-English speaking patients when attempting to access health care, there appears to be a profound lack of research and information relating to teaching non-English speaking patients. Using interpretive description, a qualitative research method designed by nurses, this study explored the experiences and perceptions of seven nurse educators about the barriers that language can create in the process of health education. The findings presented an inventory of concerns germane to the participants, from not being aware of specific cultural health beliefs to lack of support for professional interpreters and an inability to effectively assess comprehension of a non-English speaking patient. Participants spoke of difficulty in ascertaining i f the answer to a question was the response of the patient or of the friend doing the interpretation. The educators were concerned that patients might not disclose important sensitive matters when a family member or family member was the only means of communication. Feelings of inadequacy were reported when cultural differences, of which the participants had no prior knowledge, were a source of misunderstandings. Another major factor that affected the participants was the perceived lack of administrative support for and knowledge about patient education of non-English speaking patients. In the analysis o f the findings, it became evident that these factors that affected not only the encounter between the educator and the patient but also affected the educator directly and contributed to an overall negative perception of teaching non-English speaking patients. This perception, which was generated by the factors affecting the educators, in turn produced unintended outcomes of the patient-educator encounter including possible decrease in patient self care and ongoing health status well as educator frustration, sense of inadequacy and self-directed blame. The result of these outcomes produced an ongoing struggle for the educators to find avenues for increasing their knowledge of diverse cultures and health beliefs and to improve their understanding of the basic principles of adult learning. This study has highlighted several aspects of the current practice of education for non-English speaking patients, which have nursing implications for practice, education, research, and administration.Applied Science, Faculty ofNursing, School ofGraduat