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Overcoming barriers in Emergency  

Tuesday 20 July 2021

Communication comes in several forms including verbal, non-verbal and written, and in an emergency health context ensuring communication is clear and understood by all parties is highly important.

A new research project made possible by the PA Research Foundation is examining communication between health practitioners and their patients in the PA Hospital's emergency department, with the goal of overcoming language barriers and improving understanding.

Led by Queensland University of Technology (QUT) Ph.D. student Vanda Nissen and entitled Towards overcoming language barriers to the risk and certainly in an emergency health context, the project is currently underway with patient interactions with their healthcare staff recorded for analysis.

Queensland University of Technology (QUT) Ph.D. student, Vanda Nissen

Patients who consent to being recorded are identified by staff and drawn from those who present with lower triaged conditions and injuries, defined as needing ambulatory care. Aspects of communication being assessed include word and language choices made in speech, and communication strategies people use to make sure they are understood, among others.

Vanda said she believes the emergency department presents a unique chance to understand where confusion in communication can occur.

"In terms of communication, emergency situations are completely different from other hospital settings because you never know beforehand what and who you can expect and it can be a space where things change very quickly," Vanda said.

"There are a lot of different practitioners and staff involved all at the same time, this makes it not only interesting to study but also very important because studies show patients, especially in Queensland are not really happy with the level of communication in emergency settings. They are happy with the level of treatment they receive but they have indicated that the communication could be better."

Vanda stressed that her research is not about assessing the performance of health staff, but about understanding where language barriers and cultural differences may impact comprehension between patient and practitioner. Also being studied is whether the presence of an interpreter changes the way communication flows and perhaps also the interpretation of what is being said, something Vanda has unique insight into as she is fluent in multiple languages and works as a medical interpreter.

"The purpose of our research is not to evaluate how practitioners perform. We just want to see what happens when people talk to each other about a health condition to see if we can find and understand elements in their communication that work well, which can help with improving communication between both parties," she said.

"We are particularly interested in understanding when either the practitioner or the patient can speak another language and when they come from a different cultural background, whether the communication is exactly the same when both parties speak English only or whether communication moves in a different direction when one of them speaks a different language as their first language.

"For example, if a nurse is from a Vietnamese background and that is her first language, and she is treating a patient from an English speaking background, would it be the same type of communication than if the nurse were only speaking English and vice versa if you have a patient from a different language background and a nurse who only speaks English.

"We are very interested in communication when there is uncertainty around and there is a lot of uncertainty in the emergency setting because sometimes patients don't know if they are going home or going to be admitted.

"Especially now with Covid-19 people are also asking questions about it so we are also looking at how people are communicating this, and whether there are any differences when you say words like probably, and possibly, when you have a patient who a native Australian English speaker or if you have a patient whose first language is not English, we want to know if they understand practitioners in the exact same way."

Once completed the QUT Ph.D. student said she felt confident the PA Research Foundation Rethinking Emergency Medicine project would contribute to improved communication across the health sector.

"There is a lot of uncertainty involved when we need to communicate uncertainty in health situations and the more research we do, the more helpful it will be for practitioners," she said.

"Our research already shows certainty is understood in the same way, it's mostly when it comes to uncertainty, so it's going to be helpful for more than just the emergency department.

"Hopefully, it's also going to help health practitioners who also come from diverse backgrounds themselves, they are going to be more aware of their English, because even if they are fluent, there is always synonyms and it's better for them if they are aware of these synonyms and aware of different types of uncertainty and if they can foresee these types of communication issues with their patients.

"It goes both ways: it's going to help our health practitioners because more and more our health practitioners are from diverse backgrounds because we are multicultural country and its also going to help patients from diverse backgrounds.

Vanda said she is grateful to the PAH's emergency department's staff and to the Foundation's donors for making novel research like the Rethinking Emergency Medicine grants possible.

"All of the PA's emergency staff are truly amazing and have been super helpful with my research, I can't thank them enough," she said.

"Health communication is crucial because more and more people use health services, and our ultimate goal is for people to receive better healthcare services."