Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia.
Royal Darwin Hospital, Darwin, NT, 0811, Australia.
Int J Equity Health. 2021 Jul 23;20(1):170. doi: 10.1186/s12939-021-01507-1.
In hospitals globally, patient centred communication is difficult to practice, and interpreters are underused. Low uptake of interpreters is commonly attributed to limited interpreter availability, time constraints and that interpreter-medicated communication in healthcare is an aberration. In Australia's Northern Territory at Royal Darwin Hospital, it is estimated around 50% of Aboriginal patients would benefit from an interpreter, yet approximately 17% get access. Recognising this contributes to a culturally unsafe system, Royal Darwin Hospital and the NT Aboriginal Interpreter Service embedded interpreters in a renal team during medical ward rounds for 4 weeks in 2019. This paper explores the attitudinal and behavioural changes that occurred amongst non-Indigenous doctors and Aboriginal language interpreters during the pilot.
This pilot was part of a larger Participatory Action Research study examining strategies to achieve culturally safe communication at Royal Darwin Hospital. Two Yolŋu and two Tiwi language interpreters were embedded in a team of renal doctors. Data sources included interviews with doctors, interpreters, and an interpreter trainer; reflective journals by doctors; and researcher field notes. Inductive thematic analysis, guided by critical theory, was conducted.
Before the pilot, frustrated doctors unable to communicate effectively with Aboriginal language speaking patients acknowledged their personal limitations and criticised hospital systems that prioritized perceived efficiency over interpreter access. During the pilot, knowledge of Aboriginal cultures improved and doctors adapted their work routines including lengthening the duration of bed side consults. Furthermore, attitudes towards culturally safe communication in the hospital changed: doctors recognised the limitations of clinically focussed communication and began prioritising patient needs and interpreters who previously felt unwelcome within the hospital reported feeling valued as skilled professionals. Despite these benefits, resistance to interpreter use remained amongst some members of the multi-disciplinary team.
Embedding Aboriginal interpreters in a hospital renal team which services predominantly Aboriginal peoples resulted in the delivery of culturally competent care. By working with interpreters, non-Indigenous doctors were prompted to reflect on their attitudes which deepened their critical consciousness resulting in behaviour change. Scale up of learnings from this pilot to broader implementation in the health service is the current focus of ongoing implementation research.
在全球范围内的医院中，以患者为中心的沟通难以实施，口译员的使用也不足。口译员使用率低通常归因于口译员的可用性有限、时间限制，以及医疗保健中的口译员介导沟通是一种反常现象。在澳大利亚北领地的达尔文皇家医院，估计约有 50%的原住民患者需要口译员，但只有约 17%的患者能够获得口译服务。认识到这一点会导致医疗系统缺乏文化安全性，因此，达尔文皇家医院和北领地原住民口译服务在 2019 年将口译员嵌入一个肾脏团队，在医疗病房进行四周的巡房。本文探讨了在试点期间，非原住民医生和原住民语言口译员在态度和行为上发生的变化。
该试点是更大规模的参与式行动研究的一部分，该研究旨在探讨在达尔文皇家医院实现文化安全沟通的策略。两名约鲁巴人和两名提维人语言口译员被嵌入一个肾脏医生团队中。数据来源包括对医生、口译员和口译培训师的访谈；医生的反思日志；以及研究人员的实地笔记。在批判性理论的指导下，采用了归纳主题分析。
在试点之前，无法与讲原住民语言的患者有效沟通的沮丧医生承认了他们的个人局限性，并批评了优先考虑效率而不是口译员获取的医院系统。在试点期间，他们对原住民文化的了解有所提高，医生们调整了他们的工作流程，包括延长床边咨询的时间。此外，他们对医院文化安全沟通的态度也发生了变化：医生们认识到以临床为重点的沟通的局限性，并开始优先考虑患者的需求，而以前在医院不受欢迎的口译员则感到自己作为熟练专业人员受到了重视。尽管有这些好处，但多学科团队中的一些成员仍然抵制使用口译员。
将原住民口译员嵌入一个主要为原住民服务的医院肾脏团队中，提供了文化上合适的护理。通过与口译员合作，非原住民医生被促使反思他们的态度，这加深了他们的批判意识，从而导致行为的改变。目前正在进行实施研究，以将从该试点中获得的经验推广到更广泛的卫生服务实施中。
