May 25, 2018
Listening for Patient Safety
With a large percentage of expatriate workers from around the world, English has become a lingua franca in Qatar’s health care system. While having a common language is essential for interactions between professionals of different linguistic backgrounds, miscommunications, errors, or a lack of intelligibility among the varieties of English have raised concerns over patient safety.
Language barriers can complicate physician-patient communication, access to care, and patient satisfaction. In some instances, these issues can pose a danger to patients, if medical concerns or treatments are not clearly expressed. In medical contexts where English is used as a lingua franca, ensuring that all staff are prepared with strategies to overcome communication challenges is therefore a critical concern.
Dr. Greg Tweedie, with Dr. Robert Johnson from the UCalgary campus in Qatar, used a recorded interaction between two international nurses to see how nursing students and instructors responded to issues of misunderstanding. The audio scenario, acted by two upper-year nursing students, involved a shift handover between nurses with two different English variations. The scene used common medical terms and phrases, but the scenario was designed to be one where misunderstandings might affect patient care.
This scenario was first played to three senior nursing instructors, who were interviewed to explore their views on the role of language-based miscommunications. The recording was then played for Bachelor of Nursing students from different first languages, who completed a set of 10 listening comprehension questions to see how they understood the scenario.
According to the three instructors, patient safety was threatened by language issues. While their expertise and experience allowed them to compensate for gaps in the scenario, these issues were seen as considerable. For the 14 nursing students, while many reported understanding the situation, which aligned with their number of correct responses, there were areas of misunderstanding that could affect the quality of health care provided.
Among the various issues, word choice and recognition were primary concerns for the instructors. Issues communicating the medication name, amounts, and frequency were noted, as well as the actors using imprecise descriptors – such as using “crazy” instead of “disoriented” – which might delay a diagnosis.
While the nursing students perceived that accent would affect their understanding, the number of correct answers to the questions indicated that it only had a minor impact in this case. While they did not report issues with the word choice (e.g. “crazy”), they might not yet have the experience to recognize this problem.
However, the students did not identify two key phrases correctly. 13/14 students heard the patient had a ‘regular’ heartbeat (when it was said as ‘irregular’), and 5/14 responded that the patient’s blood sugar level was ‘normal’ (though it had not been tested). These issues might therefore impede their response to a significant health concern.
Many students stated that the need to hear and understand different Englishes was familiar, given the realities of their workplace. While some students used their background and linguistic knowledge to draw meaning from the scenario, the potential danger in the mistakes made by several students highlights areas that require further attention.
While all medical situations require precise and targeted communication, contexts where English is used as a lingua franca heightens the difficulties in ensuring accurate care is provided to patients. Linguistic training that promotes comprehension across a wide variety of Englishes is particularly important for these practitioners.
Rather than seeing listening as a passive, receptive activity, these nurses can benefit from collaborative and interactive strategies – such as repetition, clarification, self-correction and questioning – which can help work through language barriers. These strategies can also play a more prominent role in simulation training, rather than being considered a precursor to the nursing program.
Tweedie, M. G., & Johnson, R. C. (2018). Listening instruction and patient safety: Exploring medical English as a lingua franca (MELF) for nursing education. Journal of Belonging, Identity, Language and Diversity, 2(1). Available Online.
Tweedie, M. G., & Johnson, R. C. (2018). Listening instruction for ESP: Exploring nursing education where English is a lingua franca. In J. Siegel & A. Burns (Eds.), International Perspectives on Teaching the Four Skills in ELT(pp. 65–77). London: Palgrave. https://doi.org/10.1007/978-3-319-63444-9_5