New perspectives on understanding cultural diversity in nurse­patient communication.

Effective communication is essential in developing rapport with patients, and many nursing roles such as patient assessment, education, and counselling consist only of dialogue. With increasing cultural diversity among nurses and patients in Australia, there are growing concerns relating to the potential for miscommunication, as differences in language and culture can cause misunderstandings which can have serious impacts on health outcomes and patient safety (Hamilton & Woodward-Kron, 2010). According to Grant and Luxford (2011)) there is little research into the way health professionals approach working with cultural difference or how this impacts on their everyday practice. Furthermore, there has been minimal examination of intercultural nurse­patient communication from a linguistic perspective. Applying linguistic frameworks to nursing practice can help nurses understand what is happening in their communication with patients, particularly where people from different cultures are interacting. This paper discusses intercultural nurse­patient communication and refers to theoretical frameworks from applied linguistics to explain how miscommunication may occur. It illustrates how such approaches will help to raise awareness of underlying causes and potentially lead to more effective communication skills, therapeutic relationships and therefore patient satisfaction and safety.

The interactional consequences of 'empowering discourse' in intercultural patient education.

OBJECTIVE: Patient education is an important part of nurses' roles; however the inconsistent quality of communication skills, including those of registered nurses (RNs) from culturally and linguistically diverse (CALD) backgrounds, risk patient safety. Empowerment in patient education has been found to influence patients' self-efficacy and participation in decision-making. Discourse analysis of a whole interaction is used in this paper to trace the consequences of patient education where empowering discourse is displayed by an RN from a CALD background. METHODS: Ethnographic techniques of participant observation and audio recordings of naturally occurring interactions between nurses from CALD backgrounds and their patients were conducted and analysed using interactional sociolinguistic (IS) and theme oriented discourse analytic approaches. RESULTS: The interactional consequences of the nurse's empowering approach are readily observable in the data. The RN addresses the patient's education needs through a respectful encounter that illustrates the patient's active involvement. CONCLUSION: Examining the interactional consequences of empowering discourse demonstrates its effectiveness, and illustrates how empowering behaviour can be integrated into patient education, thus offering an alternative to traditional approaches. PRACTICAL IMPLICATIONS: Greater awareness of how to use empowering discourse will offer an alternative and consistent approach that enables nurses to facilitate patient-centred education.

'Are we on the same wavelength?' International nurses and the process of confronting and adjusting to clinical communication in Australia.

Effective communication skills are important in the health care setting in order to develop rapport and trust with patients, provide reassurance, assess patients effectively and provide education in a way that patients easily understand (Candlin and Candlin, 2003). However with many nurses from culturally and linguistically diverse (CALD) backgrounds being recruited to fill the workforce shortfall in Australia, communication across cultures with the potential for miscommunication and ensuing risks to patient safety has gained increasing focus in recent years (Shakya and Horsefall, 2000; Chiang and Crickmore, 2009). This paper reports on the first phase of a study that examines intercultural nurse patient communication from the perspective of four Registered Nurses from CALD backgrounds working in Australia. Five interrelating themes that were derived from thematic analysis of semi-structured interviews are discussed. The central theme of 'adjustment' was identified as fundamental to the experiences of the RNs and this theme interrelated with each of the other themes that emerged: professional experiences with communication, ways of showing respect, displaying empathy, and vulnerability.

Investigating the language needs of culturally and linguistically diverse nursing students to assist their completion of the bachelor of nursing programme to become safe and effective practitioners.

BACKGROUND: Australia has an increasing number of nursing students from culturally and linguistically diverse backgrounds however problems communicating in the clinical setting, difficulty with academic writing and a tendency to achieve lower grades have been reported. OBJECTIVES: To identify the language needs of culturally and linguistically diverse students, and evaluate the English language support programme to develop appropriate strategies and assist academic progression and clinical communication skills. DESIGN AND METHODS: An action research approach was adopted and this paper reports findings from the first round of semi-structured individual interviews. The strategies suggested by the participants will subsequently be implemented and evaluated during the first cycle of action research. SETTING: An Australian Bachelor of Nursing programme which has students from culturally and linguistically diverse backgrounds. PARTICIPANTS: Eight second and third year students who have a primary language other than English. RESULTS: Four strategies emerged from initial student interviews. The English language support programme to be conducted during semester breaks, ongoing focus on reading and writing but also to include some International English Language Testing System exam strategies and practice, increase the use of nursing specific language and context in the English language support programme, and informing or reminding lecturers of the impact of their lecture delivery style on learning for students from diverse backgrounds. CONCLUSION: Themes emerging from the initial round of interviews inform both the implementation of the English language support programme and teacher delivery. It is hoped that implementing these strategies will support the English language development of nurses from diverse backgrounds. Proficient communication will more likely contribute to providing safe and effective culturally sensitive care in a culturally diverse health care environment. Additional cycles of action research may be conducted to further improve the programme.

A literature review of the language needs of nursing students who have English as a second/other language and the effectiveness of English language support programmes.

Australia is increasingly becoming a culturally diverse country, with this trend being reflected in nursing education as significant numbers of students enrol from backgrounds where English is a second/other language (ESL). These students will enable the provision of culturally competent care that a culturally diverse health system requires (Ohr et al., 2010), however they require significant levels of support to not only achieve academically in their nursing programme, but also to perform at the expected level during clinical placements (Boughton et al., 2010). Difficulties communicating with colleagues, patients and their families in the clinical setting have been identified among the challenges that ESL nurses face (Boughton et al., 2010; Jeong et al., 2011). A review of the literature indicates sporadic research into the education of nurses from ESL backgrounds. This paper discusses and raises awareness of common themes such as the challenges of adjusting to Western culture and using the advanced and technical English required by higher education and healthcare. This paper also discusses mixed results reported from a number of English language support programmes. This indicates a need for further research in this area to strengthen support for these nurses who can assist in the provision of culturally competent care.

"Elicitation hooks": a discourse analysis of chaplain-patient interaction in pastoral and spiritual care.

The article considers the communicative role of the hospital chaplain and maps some of the language strategies deployed to facilitate disclosure of the patients' concerns and achieve enhanced spiritual care. These include: i) involvement, ii) politeness and iii) encouraging disclosure or exploring emotion.