Vickers Caroline H, Lindfelt Christopher, Dodd-Butera Teresa
Caroline H. Vickers, PhD, is Professor, Department of English, and Co-Director, Center for Health Equity, at California State University, San Bernardino. Christopher Lindfelt, PsyD, is Associate Dean, Undergraduate Studies, at California State University, San Bernardino. Teresa Dodd-Butera, PhD, RN/DABAT, is Associate Professor, Department of Nursing; Co-Director, Center for Health Equity; and Coordinator, CSUSB Graduate Nursing Program, at California State University, San Bernardino.
Nurs Res. 2016 Jul-Aug;65(4):306-17. doi: 10.1097/NNR.0000000000000166.
Patient history-taking sequences may be repeated across medical speech events with different healthcare providers and subsequently co-constructed differently, which can lead to disparate patient history information with implications for patient care outcomes. Encounters that include language discordance between patients with limited English language proficiency and healthcare workers can also impact patient outcomes.
We examined the repetition of patient history-taking sequences in consultations in which healthcare providers used Spanish as a first and second language with monolingual Spanish-speaking patients. The aim was to understand how repetition affects patient care processes and outcomes.
Conversation analysis was used. The target population was bilingual healthcare providers and monolingual Spanish-speaking patients. The accessible population was composed of healthcare providers and patients from an urban, low-income, community health clinic in Southern California. In three exemplar cases from among 50 that were studied, instances of repetition in the history-taking segment of clinical consultations were located. We identified which aspects of patient reports were repeated across intake nurse-patient consultations and nurse practitioner-patient consultations, as well as how patient reports were differently co-constructed across these events.
Information elicited during the intake nurse-patient history event may be elicited again when a nurse practitioner repeats the elicitation of particular aspects of the patient's complaints and health history. Repetition of patient history information was co-constructed differently by different healthcare providers, sometimes led to seamless teamwork, and sometimes led to time wasting. Healthcare provider second language use of Spanish did not substantially impact how patient history information was co-constructed.
This analysis sheds light on the effects of repetition across medical events and assessed the effects of repetition on communication among members of a healthcare team and patient care outcomes. It also informs how medical provider second language use may affect how information is conveyed. Our study has implications for understandings of medical consultations that involve nurse triage prior to consultation time in multilingual settings.
患者病史采集序列可能在与不同医疗服务提供者的医疗言语事件中重复出现，且随后的构建方式也有所不同，这可能导致患者病史信息存在差异，进而影响患者的护理结果。英语水平有限的患者与医护人员之间存在语言不一致的会诊也会影响患者的治疗结果。
我们研究了在医疗服务提供者将西班牙语作为第一语言和第二语言与只会说西班牙语的患者进行会诊时，患者病史采集序列的重复情况。目的是了解重复如何影响患者护理过程和结果。
采用会话分析方法。目标人群是双语医疗服务提供者和只会说西班牙语的患者。可及人群由来自南加州一家城市低收入社区健康诊所的医疗服务提供者和患者组成。在研究的50个案例中的3个典型案例中，找出了临床会诊病史采集部分的重复实例。我们确定了患者报告的哪些方面在接诊护士与患者的会诊以及执业护士与患者的会诊中被重复提及，以及这些事件中患者报告是如何以不同方式共同构建的。
当执业护士重复询问患者投诉和健康史的特定方面时，可能会再次引出在接诊护士与患者病史事件中获取的信息。不同的医疗服务提供者对患者病史信息的重复构建方式不同，有时会促成无缝协作，有时则会导致时间浪费。医疗服务提供者使用西班牙语作为第二语言对患者病史信息的共同构建方式影响不大。
本分析揭示了医疗事件中重复的影响，并评估了重复对医疗团队成员之间沟通和患者护理结果的影响。它还说明了医疗服务提供者使用第二语言可能如何影响信息的传递。我们的研究对于理解多语言环境中在会诊前进行护士分诊的医疗会诊具有启示意义。
