Introduction
Pacific populations in Aotearoa, New Zealand, suffer a disproportionate burden of long-term diseases. For example, these include type 2 diabetes, coronary heart disease, stroke, and several common cancers compared to non-Pacific groups (Schmidt-Busby et al., 2019; Southwick et al., 2012). Diabetes is common among Pacific peoples and leads to the early onset of complications such as end-stage renal disease, blindness, and dialysis (Southwick et al., 2012). Nevertheless, these risks can be prevented through education and working in partnership with patients and their families.
I work as a senior nurse in the emergency department at a rural hospital. The hospital serves 47,517 people in this region, composed of different ethnic groups with different cultures, religions, and languages (Ministry of Health, 2015). The service is staffed by only two Pacific nurses who can provide comprehensive care to Pacific patients. The reason is that identifying the contributing factors that harm people’s health and well-being is essential for treatment.
Hence, it is important to consider social and cultural factors when hiring nurses, which will effectively help people of various nationalities. In addition, special attention should be paid to health literacy and language barriers, as they affect the ability of Pacific Islanders to receive qualified medical care. Therefore, it is essential to analyze the impact of language barriers and lack of interpretation services on my nursing practice and establish the implications of potential strategies to address healthcare challenges.
Identification of the Health Problem
Through my work in this rural hospital for over 15 years, I have noticed that health literacy is one of the barriers that impact Pacific patients seeking health care. Health literacy is defined as how people can access, understand, evaluate, and communicate information to interact with the demands of various health contexts in order to promote and maintain good health across the lifespan (Geboers et al., 2016). Pacific Islanders have the highest rates of hospitalization for long-term conditions, including diabetes, gout, and cancer. Poor health literacy contributes to the low treatment of diabetes and other non-communicable diseases (NCDs) in Pacific Islanders (Southwick et al., 2012). Insufficient understanding of the information and implications of their health problems and treatments prevents individuals from accepting the treatment they need.
Moreover, there is a challenge that patients need more language understanding to receive information from healthcare professionals about their health condition. Accordingly, the proper translation of medical information enables healthcare professionals to provide effective care. The Ministry of Health (MOH) reports that Māori and Pacific’s people have significantly lower health literacy skills than other ethnic groups (Ministry of Health, 2015). Together with the language barrier created by the lack of medical translation, this has a serious impact on the health of Pacific people and the quality of care at this hospital. However, independent of language obstacles, healthcare providers are obliged to provide all their patients with high-quality medical care.
Impact on Nursing Practice, Patient and Community
The hospital where I operate has a significant issue with the translation system. Although, the administration has a list of volunteers who can help the staff communicate with Pacific people if needed. However, in general, Pacific Islanders who visit the emergency department (ED) face the challenge that all information is written and printed in English. For instance, registration forms are complex for patients to complete, especially for elderly patients. It also has a substantial impact on patients who do not understand the medical terms used by doctors and nurses (Kobayashi et al., 2014). Thus, Pacific Islanders suffer from a lack of health literacy when filling out health forms or accessing various health care services.
In addition, in the rural hospital that I manage, there are only 2 Pacific Islander nurses working in various departments. Thus, the hospital administration requests them to translate for other staff members or patients. The hospital sometimes phones me on my vacation day to help translate for patients during an outpatient appointment. As a result, the hospital puts Pacific nurses on overtime to interpret information for patients and doctors in multiple languages. The negative consequence for nurses is significant overwhelmed and fatigue (Slade & Sergent, 2022). In an emergency, if Pacific nurses are not available for translation, communication problems arise, leading to delays in treatment and complications.
Furthermore, communication is a challenge for people who have learned English as a second language or do not understand it. It is especially difficult to work with people of retirement age (Geboers et al., 2016). An example of this is when a patient from Tonga, who speaks limited English, was scheduled to attend a specialist for further observation and discussion of the results of his liver biopsy. I was asked by the outpatient nurse to attend this appointment as it was important that the patient understood the diagnosis and treatment options. I have left my patients in the ward, and this affects my medical duties. The reason is that my patients were unsupervised while I was performing translation work.
In emergency cases, the hospital contacts the translation service, and the translation is done over the phone. Since, in this case, the pre-interpreters know only a part of the language and do not have sufficient medical knowledge, they do not provide sufficiently high-quality services (Squires, 2017). Another problem that arises with telephone interpreting is that some patients find it very difficult to trust personal information to interpreters. Moreover, it is challenging for interpreters to communicate unsatisfactory patient health status information (Miller, 2016). Consequently, the lack of medical knowledge and the inability to guarantee the confidentiality of interpreters negatively affects patients’ health.
Furthermore, discharge planning for Pacific Islanders is very important in every hospital. The doctors, nurses, and multidisciplinary team (MDT) are responsible for making sure that the information they provide to the patient is clear (Miller, 2016). There are situations where patients do not want to give their address information to doctors if a Pacific Islander nurse is not present at discharg e. This is another barrier for Pacific patients, who sometimes feel culturally uncomfortable discussing health issues with a non-Pacific healthcare provider (Ministry of Health, 2015). Moreover, I have had the experience of a Tongan patient being repeatedly admitted to the hospital with the same condition.
After a family meeting organized by the hospice team, including me as an interpreter, I learned that the patient had not received her medication for several weeks because she did not know all her medications. The patient informed me that at her last appointment, the doctor changed her drugs, but she did not understand why she needed to take new ones. Thus, there was a serious health problem for the patient due to the lack of health literacy and translation services.
However, the hospital is trying to manage the problem of discharging the patient and using resources available in the region, for example, by calling a Tongan nurse as an interpreter and using the family as an interpreter. This does not negate the problem of missing resources such as brochures and information printed in different Pacific languages. As these resources affect the quality of care and allow patients who do not speak English to receive the necessary information (Al Shamsi et al., 2020). Moreover, the problem of language barriers due to the need for a healthcare interpreter system leads to miscommunication between healthcare providers and patients, which reduces the satisfaction of both parties and worsens the quality of care and patient safety.
Another issue that has a considerable impact on community health is the failure of patients to attend the hospital due to language barriers. I manage a small group of health issues for Pacific Islanders in this community. Part of this task is to encourage healthy eating and check blood sugar levels (BSL) and blood pressure. Some participants did not understand how to use the blood sugar machine. Participants with diabetes do not visit family doctors for regular medical screening. When they received a letter in their mailbox to call the health center and make an appointment for a health check, they did not know how to schedule an examination.
Conclusion
As a result, due to a lack of medical literacy and language barriers, people do not receive proper care, which causes common chronic diseases in the community. According to the Ministry of Health (2015), the three primary barriers for Pacific Islanders are cost, transportation, and language. Therefore, the hospital should create policies to reduce the pressure of these barriers on people and increase the health of Pacific Islanders.
References
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