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Cultural and Linguistic Barriers for LEP Patients

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Cultural-and-linguistic-barriers-for-patients-with-limited-English-proficiency-(LEP)
15.01.2020
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Introduction

Cultural and linguistic barriers for patients with limited English proficiency (LEP) and health literacy is a significant problem, which requires deep research and constant improvement. The implementation of diverse programs, sharing of the learned lessons, and efficient interpretation is all necessary clauses. Cross-cultural communication problems can lead to medical errors and lower medical care quality. It is also important to modify tracking and reporting systems by forming the fields for identification of language preference. Misunderstanding of cultural problems can lead to serious, if not fatal, consequences.

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Cultural and Linguistic Barriers for Patients with Limited English Proficiency and Health Literacy

The research has to be done on health literacy and limited English proficiency among Brazilian people and refugees from other countries based on the analysis of professional medical literature and studies of appropriate agencies and commissions. The assessment of problematic issues also includes studying real-life examples, which help to identify efficient tools and methods for improvement of the safety of LEP patients. As a result, cross-cultural communication will be facilitated. Cultural barriers, low health literacy and limited English proficiency form a barrier to effective health communication. Studies of the language shift prove that Hispanics more than any other ethnic group tend to remain loyal to their native language (Davidson & Alpino, 2010). Even third-generation bilingualism is higher among Hispanics than among other ethnic groups. Data represented during the National Assessment of Adult Literacy seminar supports the fact that Brazilian and Indian American people have lower health literacy than Asian-Pacific people and Pacific Islanders. Native-born patients with low health literacy may communicate with the nurses or doctors with the aim to receive the necessary information for further self-management. A refugee cannot do the same because of the language barrier and cultural aspects. Andrews and Boyle represent health models, which correspond to the different cultural groups and may form barriers during the treatment process (Andrews & Boyle, 2008). The authors identified magico-religious, biometrical, and deterministic aspects. Magico-religious problems refer to the belief of the people in supernatural forces, which bring the illness upon the person as a punishment for the sins. Biometrical cases refer to the belief that appropriate specialists can control physical and biochemical processes. Determinism is based on the belief that God confers the illness.

It is also important to note that language barriers can lead to financial risks. Poor communication, which causes ineffective treatment of the patient, may lead to the rehospitalizations, which will not be reimbursed (Leininger & McFarland, 2002). Poor communication can also cause delays in the informed consent or postponement of procedures because of inappropriate preparation.

Analysis of Patient Safety as a Complex System

According to the Crossing the Quality Chasm report, the safety of LEP patients is one of the most essential components of high-quality health care. The main task of the hospitals is the identification of the root causes, which bring about risky scenarios and medical errors during the treatment of patients with limited English proficiency. The work project formed by the hospitals should comprise of several important methods. They include identification a role of the language and cultural barriers, which can negatively influence the patients’ safety; elaboration of the program related to the safety of the LEP and culturally diverse patients; provision of the guidance and tools, which can help hospitals address problematic issues (Galanti, 2008). The safety of the patients is a complex system, which includes language and cultural barriers, problems with interpretation, and comprehension of the patients’ health condition. For example, a great risk of the surgical delays is connected with difficulties understanding instructions, which include necessary information concerning preparation for the procedure and taking appropriate medications. Problems with interpretation are usually caused by the translation performed by family members who do not know medical terminology. The analysis also shows that untrained hospital staff often serves as interpreters for LEP patients and makes significant mistakes, which have a negative effect on the safety of the patients. Cultural beliefs and traditions, such as forbidding pain relief or gender roles, can also have an adverse effect on the patient’s safety (Joint Commission, 2007). That is why medical care professionals should study the cultural aspects of Brazilian people and other refugees with the aim to avoid emergencies. Risk management is also a critical concern, which is directly linked to safety. It is reflected in the patients’ comprehension of health conditions, complications, inaccurate medical histories, and treatment plans.

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Discussion of Tools and Methods, which Help Hospitals Solve Problems

Improving Cross-Cultural Communication

Overcoming language and cultural barriers should become a prominent mission for all hospitals, which work with people from different cultures. Medical care professionals should share learned lessons and based on those lessons build an appropriate strategy, which will help treat the LEP patients qualitatively. It is also important to implement electronic records of the medical data including race, ethnicity, and patient’s language, which will allow ongoing monitoring with the aim of medical care improvement (Crowley, 2010). Such a system can also help track the roles of language and culture in the patients’ safety.

Collaboration with the patients and their families is also a significant aspect, which can help improve cross-cultural communication and health literacy. Collaboration can be performed through the organization of the pieces of training for representatives of different cultures involving educational centers with the aim to enhance health literacy skills (Hubbel, 2014). Participants can ask various health-related questions and receive appropriate health guidance, which will help them react appropriately in case of health problems. It is also necessary to organize family advisory councils or cultural advisory groups that would incorporate patients’ perspectives.

Language Interpretation and Translation

Qualitative interpretation is a significant aspect, which can help prevent medical errors. It is important to develop services for medical interpretation, which include personal and telephonic tools. Hospital interpreters should continuously improve their knowledge and visit pieces of training, which consider cross-cultural aspects faced during translation. The interpreter should not only provide a qualitative translation but also mitigate cultural misunderstanding between the patient and medical personnel (Institute of Medicine, 2009). Instructions and informed consent should be submitted to the LEP patients in a written form with the appropriate translation. It is also advisable to explain to the LEP patients and their relatives that improper translation performed by an unqualified person can lead to irretrievable problems. As a result, they will be required to hire a qualified interpreter. They should be welcomed and treated as core members of the team.

Participatory Decision-Making

Participatory communication is a significant aspect, which will foster safety among LEP patients. That is why it is very important for every hospital to implement a TeamSTEPPS module (Agency for Healthcare Research and Quality, 2015). This module has been proposed by the Agency for Healthcare Research and Quality and the Department of Defense with the aim to monitor and prevent errors during treatment. The model is an evidence-based teamwork system designed to optimize patient outcomes through the improvement of communication and other interactive skills among health care professionals. Recent researches have shown that TeamSTEPPS is effective in multiple care settings. The purpose of the module is to train interprofessional care teams, who will work together in the hospitals with the aim to enhance safety for the LEP and culturally diverse patients. Sharing of the learned lessons also helps to identify gaps in the work of medical care professionals and design necessary training, which will help fix errors as they arise.

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Conclusion

Limited English proficiency and low health literacy are significant problems among Brazilian people and refugees from other countries, who need constant and thorough care. LEP patients require specific approaches because of language problems and multiple cultural aspects. They should not be excluded from learning the risks and making treatment choices, which might affect their health. The first task of the health professionals is to provide the LEP patient with interpreters and translated materials represented in plain language for more efficient collaboration. Another significant step in the analysis of previously committed errors and the design of an appropriate strategy with the aim to avoid these problems in the future. It is also necessary to integrate cultural, linguistic, and health literacy factors into the daily work of medical experts for more effective communication with culturally diverse patients.

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