Gerrish K
School of Nursing and Midwifery, University of Sheffield, Sheffield, UK.
J Adv Nurs. 2001 Mar;33(5):566-74. doi: 10.1046/j.1365-2648.2001.01674.x.
The overall aim of the study was to examine how policy directives concerning the provision of individualized care were modified in their transformation into practice and the implications this carried for the care provided to patients from different ethnic backgrounds. This paper is concerned with one aspect, namely, examining the nature and effects of communication difficulties between the nurses and South Asian patients and their carers.
An ethnographic approach was used. The study was undertaken in an English community National Health Service (NHS) Trust serving an ethnically diverse population. It comprised two stages. First, an organizational profile of the trust was undertaken in order to analyse the local policy context. Data were collected by means of in-depth interviews with managers and a review of policy documentation and caseload profiles. Second, a participant observational study was undertaken focusing on six district nursing teams. Purposive sampling was used to identify four teams with high ethnic minority caseloads and two teams with predominantly white ethnic majority caseloads. Interview transcripts and fieldnotes were analysed by drawing upon the principles of dimensional analysis.
Over half of South Asian patients had little or no understanding of spoken English with women and older people the least likely to speak English. The limited use of professional interpreters and the concomitant heavy reliance on family members to translate highlighted how ethnic minority patients and carers who were not fluent in English were disadvantaged. The observed language barriers suggested that the content of advice on matters such as compliance with treatment regimes might not be fully understood. Psychological support of patients and carers was severely restricted. Moreover, the fact that follow-up visits were on occasions made to patients for whom there was no one available to interpret constrained on-going assessment of patients' needs.
The findings raise concerns regarding the quality of care provided to patients and carers who are nonusers of English and provide evidence of inequalities in service provision. However, not speaking English should not be a barrier to appropriate and effective nursing care. District nurses need to appreciate their responsibility to provide equitable services irrespective of a patient's linguistic background and seek to overcome the disadvantage experienced by ethnic minority patients.
本研究的总体目标是考察有关提供个性化护理的政策指令在转化为实际操作过程中是如何被修改的，以及这对为不同种族背景患者提供的护理有何影响。本文关注其中一个方面，即考察护士与南亚患者及其护理人员之间沟通困难的性质和影响。
采用人种志研究方法。该研究在一个为多民族人口服务的英国社区国民健康服务（NHS）信托机构中进行。研究包括两个阶段。首先，对该信托机构进行组织概况分析，以剖析当地政策背景。通过对管理人员进行深度访谈以及查阅政策文件和病例量概况来收集数据。其次，开展一项参与观察研究，重点关注六个社区护理团队。采用目的抽样法确定四个少数民族病例量高的团队和两个主要为白人多数族裔病例量的团队。依据维度分析原则对访谈记录和实地笔记进行分析。
超过一半的南亚患者对英语口语几乎不懂或完全不懂，女性和老年人最不太可能说英语。专业口译员使用有限，同时严重依赖家庭成员进行翻译，这凸显了英语不流利的少数民族患者及其护理人员处于不利地位。观察到的语言障碍表明，关于诸如遵守治疗方案等事项的建议内容可能未被充分理解。患者和护理人员的心理支持受到严重限制。此外，有时会对没有可用口译人员的患者进行随访，这限制了对患者需求的持续评估。
研究结果引发了对为非英语使用者的患者及其护理人员提供护理质量的担忧，并提供了服务提供不平等的证据。然而，不会说英语不应成为获得适当和有效护理的障碍。社区护士需要认识到，无论患者的语言背景如何，他们都有责任提供公平的服务，并努力克服少数民族患者所面临的不利处境。
