Rory Meyers College of Nursing, New York University, 433 First Avenue, Office 658, New York, NY, 10010, USA.
Wegmans School of Nursing, St. John Fisher College, Rochester, NY, USA.
Int J Nurs Stud. 2019 Nov;99:103394. doi: 10.1016/j.ijnurstu.2019.103394. Epub 2019 Aug 8.
Increasingly, patients with limited English proficiency are accessing home health care services in the United States. Few studies have examined how language barriers influence provider role implementation or workload in the home health care setting.
To explore home health care professionals' perspectives about how workload changes from managing language barriers influence quality and safety in home health care.
A qualitative secondary data analysis using a summative content analysis approach was used to analyze existing semi-structured interview data.
A large urban home health care agency located on the East Coast of the United States.
Thirty five home health care providers [31 registered nurses, 3 physical therapists, 1 occupational therapist].
A total of 142 discrete incidents emerged from the analysis. Overall, home health care providers experienced distinct shifts in how they implemented their roles that added to their workload and time spent with Limited English Proficiency patients and family members. Providers were concerned about interpretation accuracy and perceived it as potentially posing risks to patient safety. Changes in work patterns, therefore, sought to maximize patient safety.
Home health care providers decision-making about how they adapt practice when faced with a language barrier is a sequence of actions based on awareness of the patient's language preference and if they spoke another language. Subsequent choices showed proactive behaviors to manage increased workload shaped by their perceived risk of the threats posed by the quality of interpreter services. Future research should develop quantitative models examining differences in workload when caring for limited English proficiency versus English speaking patients as well as the relationship between visit length and patient outcomes to determine optimal quality models.
越来越多英语水平有限的患者正在使用美国的家庭保健服务。很少有研究探讨语言障碍如何影响家庭保健环境中的提供者角色实施或工作量。
探讨家庭保健专业人员对管理语言障碍如何影响家庭保健质量和安全的看法，了解工作量变化的情况。
使用总结性内容分析方法对现有的半结构化访谈数据进行定性二次数据分析。
位于美国东海岸的一家大型城市家庭保健机构。
35 名家庭保健提供者[31 名注册护士、3 名物理治疗师、1 名职业治疗师]。
从分析中总共出现了 142 个离散事件。总体而言，家庭保健提供者在实施角色方面经历了明显的转变，这增加了他们与英语水平有限的患者和家庭成员的工作量和时间。提供者担心口译准确性，并认为这可能对患者安全构成风险。因此，工作模式的变化旨在最大程度地提高患者的安全性。
家庭保健提供者在面对语言障碍时决定如何调整实践的决策是一系列基于对患者语言偏好的认识以及他们是否会说另一种语言的行动。随后的选择表现出积极主动的行为，以管理由口译服务质量带来的威胁的感知风险来增加工作量。未来的研究应该开发定量模型，以检查为英语水平有限的患者提供护理与为英语患者提供护理的工作量差异，以及就诊时间长短与患者结果之间的关系，以确定最佳的质量模型。
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