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.

Related collections

Most cited references 18

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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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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

David Silvera-Tawil:

ORCID: https://orcid.org/0000-0003-2653-0141

Australian e-Health Research CentreCommonwealth Scientific and Industrial Research OrganisationCnr Vimiera and Pembroke RoadsMarsfield, 2121Australia61 293724282david.silvera-tawil@csiro.au

Journal

Journal ID (nlm-ta): JMIR Nurs

Journal ID (iso-abbrev): JMIR Nurs

Journal ID (publisher-id): JN

Title: JMIR Nursing

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2562-7600

Publication date Collection: Jul-Sep 2021

Publication date (Electronic): 30 July 2021

Volume: 4

Issue: 3

Electronic Location Identifier: 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

David Silvera-Tawil https://orcid.org/0000-0003-2653-0141

Courtney Pocock https://orcid.org/0000-0003-2720-4057

DanaKai Bradford https://orcid.org/0000-0002-2939-3018

Andrea Donnell https://orcid.org/0000-0002-2114-1756

Jill Freyne https://orcid.org/0000-0001-7659-0535

Karen Harrap https://orcid.org/0000-0002-6792-2910

Sally Brinkmann https://orcid.org/0000-0002-3842-2183

Article

Publisher ID: v4i3e19709

DOI: 10.2196/19709

PMC ID: 8373371

PubMed ID: 34406964

SO-VID: 58231f78-3307-430b-b8a4-c9a494b52d96

Copyright © ©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.

License:

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

Date received : 29 April 2020

Date revision requested : 26 October 2020

Date revision received : 17 December 2020

Date accepted : 10 June 2021

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