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      Enabling Nurse-Patient Communication With a Mobile App: Controlled Pretest-Posttest Study With Nurses and Non–English-Speaking Patients

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          Abstract

          Background

          There is growing concern regarding the implications of miscommunication in health care settings, the results of which can have serious detrimental impacts on patient safety and health outcomes. Effective communication between nurses and patients is integral in the delivery of timely, competent, and safe care. In a hospital environment where care is delivered 24 hours a day, interpreters are not always available. In 2014, we developed a communication app to support patients’ interactions with allied health clinicians when interpreters are not present. In 2017, we expanded this app to meet the needs of the nursing workforce. The app contains a fixed set of phrases translated into common languages, and communication is supported by text, images, audio content, and video content.

          Objective

          This study aims to evaluate the efficacy of the communication app to support nursing staff during the provision of standard care to patients from non–English-speaking backgrounds when an interpreter is not available.

          Methods

          This study used a one-group pretest-posttest sequential explanatory mixed methods research design, with quantitative data analyzed using inferential statistics and qualitative data analyzed via thematic content analysis. A total of 134 observation sessions (82 pretest and 52 posttest) of everyday nurse-patient interactions and 396 app use sessions were recorded. In addition, a total of 134 surveys (82 pretest and 52 posttest) with nursing staff, 7 interviews with patients, and 3 focus groups with a total of 9 nursing staff participants were held between January and November 2017.

          Results

          In the absence of the app, baseline interactions with patients from English-speaking backgrounds were rated as more successful (t 80=5.69; P<.001) than interactions with patients from non–English-speaking backgrounds. When staff used the app during the live trial, interactions with patients from non–English-speaking backgrounds were rated as more successful than interactions without the app ( F 2,119=8.17; P<.001; η 2=0.37). In addition, the level of staff frustration was rated lower when the app was used to communicate (t 80=2.71; P=.008; r=0.29). Most participants indicated that the app assisted them in communicating.

          Conclusions

          Through the use of the app, a number of patients from non–English-speaking backgrounds experienced better provision of standard care, similar to their English-speaking peers. Thus, the app can be seen as contributing to the delivery of equitable health care.

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          Most cited references18

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          Communication failures: an insidious contributor to medical mishaps.

          To describe how communication failures contribute to many medical mishaps. In late 1999, a sample of 26 residents stratified by medical specialty, year of residency, and gender was randomly selected from a population of 85 residents at a 600-bed U.S. teaching hospital. The study design involved semistructured face-to-face interviews with the residents about their routine work environments and activities, the medical mishaps in which they recently had been involved, and a description of both the individual and organizational contributory factors. The themes reported here emerged from inductive analyses of the data. Residents reported a total of 70 mishap incidents. Aspects of "communication" and "patient management" were the two most commonly cited contributing factors. Residents described themselves as embedded in a complex network of relationships, playing a pivotal role in patient management vis-à-vis other medical staff and health care providers from within the hospital and from the community. Recurring patterns of communication difficulties occur within these relationships and appear to be associated with the occurrence of medical mishaps. The occurrence of everyday medical mishaps in this study is associated with faulty communication; but, poor communication is not simply the result of poor transmission or exchange of information. Communication failures are far more complex and relate to hierarchical differences, concerns with upward influence, conflicting roles and role ambiguity, and interpersonal power and conflict. A clearer understanding of these dynamics highlights possibilities for appropriate interventions in medical education and in health care organizations aimed at improving patient safety.
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            Language proficiency and adverse events in US hospitals: a pilot study.

            To examine differences in the characteristics of adverse events between English speaking patients and patients with limited English proficiency in US hospitals. Six Joint Commission accredited hospitals in the USA. Adverse event data on English speaking patients and patients with limited English proficiency were collected from six hospitals over 7 months in 2005 and classified using the National Quality Forum endorsed Patient Safety Event Taxonomy. About 49.1% of limited English proficient patient adverse events involved some physical harm whereas only 29.5% of adverse events for patients who speak English resulted in physical harm. Of those adverse events resulting in physical harm, 46.8% of the limited English proficient patient adverse events had a level of harm ranging from moderate temporary harm to death, compared with 24.4% of English speaking patient adverse events. The adverse events that occurred to limited English proficient patients were also more likely to be the result of communication errors (52.4%) than adverse events for English speaking patients (35.9%). Language barriers appear to increase the risks to patient safety. It is important for patients with language barriers to have ready access to competent language services. Providers need to collect reliable language data at the patient point of entry and document the language services provided during the patient-provider encounter.
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              Culture, language, and patient safety: Making the link.

              It has been well recognized internationally that hospitals are not as safe as they should be. In order to redress this situation, health care services around the world have turned their attention to strategically implementing robust patient safety and quality care programmes to identify circumstances that put patients at risk of harm and then acting to prevent or control those risks. Despite the progress that has been made in improving hospital safety in recent years, there is emerging evidence that patients of minority cultural and language backgrounds are disproportionately at risk of experiencing preventable adverse events while in hospital compared with mainstream patient groups. One reason for this is that patient safety programmes have tended to underestimate and understate the critical relationship that exists between culture, language, and the safety and quality of care of patients from minority racial, ethno-cultural, and language backgrounds. This article suggests that the failure to recognize the critical link between culture and language (of both the providers and recipients of health care) and patient safety stands as a 'resident pathogen' within the health care system that, if not addressed, unacceptably exposes patients from minority ethno-cultural and language backgrounds to preventable adverse events in hospital contexts. It is further suggested that in order to ensure that minority as well as majority patient interests in receiving safe and quality care are properly protected, the culture-language-patient-safety link needs to be formally recognized and the vulnerabilities of patients from minority cultural and language backgrounds explicitly identified and actively addressed in patient safety systems and processes.
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                Author and article information

                Contributors
                Journal
                JMIR Nurs
                JMIR Nurs
                JN
                JMIR Nursing
                JMIR Publications (Toronto, Canada )
                2562-7600
                Jul-Sep 2021
                30 July 2021
                : 4
                : 3
                : e19709
                Affiliations
                [1 ] Australian e-Health Research Centre Commonwealth Scientific and Industrial Research Organisation Marsfield Australia
                [2 ] Western Health Melbourne Australia
                [3 ] Australian e-Health Research Centre Commonwealth Scientific and Industrial Research Organisation Pullenvale Australia
                [4 ] Australian e-Health Research Centre Commonwealth Scientific and Industrial Research Organisation Herston Australia
                Author notes
                Corresponding Author: David Silvera-Tawil david.silvera-tawil@ 123456csiro.au
                Author information
                https://orcid.org/0000-0003-2653-0141
                https://orcid.org/0000-0003-2720-4057
                https://orcid.org/0000-0002-2939-3018
                https://orcid.org/0000-0002-2114-1756
                https://orcid.org/0000-0001-7659-0535
                https://orcid.org/0000-0002-6792-2910
                https://orcid.org/0000-0002-3842-2183
                Article
                v4i3e19709
                10.2196/19709
                8373371
                34406964
                58231f78-3307-430b-b8a4-c9a494b52d96
                ©David Silvera-Tawil, Courtney Pocock, DanaKai Bradford, Andrea Donnell, Jill Freyne, Karen Harrap, Sally Brinkmann. Originally published in JMIR Nursing (https://nursing.jmir.org), 30.07.2021.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Nursing, is properly cited. The complete bibliographic information, a link to the original publication on https://nursing.jmir.org/, as well as this copyright and license information must be included.

                History
                : 29 April 2020
                : 26 October 2020
                : 17 December 2020
                : 10 June 2021
                Categories
                Original Paper
                Original Paper

                nursing,interpersonal communication,mobile app,information technology,communication barrier,diversity,interpreters,mhealth,mobile phone

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