The Canadian Population:
Language barriers are a reality in the everyday lives of many people in Canada (Shahsiah and Gregoire, 2006).
The communities that continue to experience language barriers in the healthcare system include First Nations and Inuit communities, deaf communities, speakers of official languages who live as a minority in a given region, immigrants and refugees (Shahsiah and Gregoire, 2006; Bowen, 2001).
According to Statistics Canada (2001) 17% of Canadians have a mother tongue other than French or English and about 10% of the entire Canadian population speaks a language other than English and French at home (Shahsiah and Gregoire, 2006; Bowen, 2001).
Statistics Canada (2001) also states that the foreign born population in Canada has reached 18.4% with higher proportions in metropolitan areas such as in Toronto which has reached 43.7% (Shahsiah and Gregoire, 2006).
The number of Canadians that require an interpreter for healthcare is 1in 50 with it being higher in cities, like Toronto, where there are larger numbers of immigrants or in northern areas where Aboriginal people compromise a large percentage of the population (Bowen, 2001).
What Is The issue?
Communication is a fundamental part of nursing as nurses have the most direct and continuous contact with patients. Communication involves sharing information, caring conversations and having social interactions. It is through communication that nurses get to know and understand their patients, identify their needs and inform them (Jirwe, Gerrish, and Emami, 2010).
Communication is the primary medium for providing quality care to patients by ensuring that a trusting relationship is established, that consent is adequately obtained and that the patient’s dignity and self-determination is respected (Carnevale, et al., 2009).
Communication is much more than a linguistic component it requires the interpretation of speech, tone, facial expressions, body language, and gestures (Jirwe, Gerrish, and Emami, 2010).
Ineffective or inadequate communication between patients and healthcare providers is seen as a language barrier, this affects primarily those who do not share the same language and cultural background as the service provider. Language barriers are a major obstacle that can lead to insufficient information and poor quality nursing care (Jirwe, Gerrish, and Emami, 2010; Shahsiah and Gregoire, 2006).
Healthcare providers often lack the necessary knowledge and skills to respond to the needs of patients from a different cultural background to their own (Jirwe, Gerrish, and Emami, 2010).
How Are People Living in Canada Affected by Language Barriers?
This increasing diversity of the Canadian population has raised concern about the ability of the health care system to meet the needs of those with limited English or French language proficiency and of ethnical diverse cultures
Effects on Patients
- Language barriers are an obstacle to accessing, utilizing and receiving adequate health care services and may be the most significant barrier to initial contact with health services (Carnevale, et al., 2009; Jirwe, Gerrish, and Emami, 2010; Bowen, 2001)
- Decreased patient-centered care and/or development of a therapeutic nurse-client relationship (Aboul-Enein, & Ahmed, 2006; Greenhalgh, 2008)
- Decreased cultural sensitivity and/or culturally sensitive care (Aboul-Enein, & Ahmed, 2006)
- Low comprehension of medication instruction and low adherence to regimes (Gerrish, Chau, Sobowale, & Birls, 2004; Greenhalgh, 2008; Aboul-Enein, & Ahmed, 2006; Timmins, 2002; Bowen, 2001)
- Patients feel unable to express themselves and describe to the healthcare provider how they are feeling in regards to their physical, psychological and spiritual well-being. This causes a challenge of establishing a trusting therapeutic relationship with the patient, understanding the patient’s problems and unique needs and directing care appropriately (Jirwe, Gerrish, and Emami, 2010; Shahsiah and Gregoire, 2006; Dunckley et al., 2003)
- Language barriers affect diagnosis and treatment therefore affecting the quality of care the patient obtains (Bowen, 2001)
- Perpetuating discrimination and upholds power imbalances (Greenhalgh, 2008)
- Compromises nursing assessments and patient understanding of proposed interventions, and violates fundamental patient rights (Carnevale, et al., 2009; Gerrish, Chau, Sobowale, & Birls, 2004)
- Hinders recovery and compliance to treatment due to inadequate information given or discussion of preventative measures or lack of support and reassurance (Carnevale, et al., 2009; Dunckley et al., 2003; Bowen, 2001)
- Patients who do not share a common language with their healthcare provider are less satisfied with their care (Aboul-Enein, & Ahmed, 2006, Timmins, 2002;Jirwe, Gerrish, and Emami, 2010; Carnevale, et al., 2009Bowen, 2001)
Effects on Health Care Providers:
- Results in higher stress and lower job satisfaction (Bowen, 2001)
- Healthcare providers feel frustrated that they cannot deliver the high quality nursing care they want to give or use their skills properly (Dunckley et al., 2003)
- Provider care becomes more mechanical and impersonal (Jirwe, Gerrish, and Emami, 2010)
- Issues of ethics and law (informed consent, beneficence, non-malfeasance, justice) (Meddings, & Haith-Cooper, 2008; Aboul-Enein, & Ahmed, 2006; Kale & Syed, 2010; Bowen, 2001)
- Providers experience stress in attempting to meet ethical and professional standards of practice and therefore, places the provider at a greater risk of liability (Bowen, 2001)
Effects on Service Costs:
- Increased overall cost to care in healthcare institutions due to higher-intensive care because of misdiagnosis, missed pain management and less effective management of chronic diseases, and longer clinical encounters due to reduced health outcomes (Carnevale, et al., 2009; Bernard et al, 2006; Greenhalgh, 2008; Bowen, 2001)
- Inappropriate or excessive (high utilization) diagnosis and treatment as a result of language barriers increases cost(Collins, Gullette, & Schnepf, 2004; Greenhalgh, 2008; Aboul-Enein, & Ahmed, 2006; Timmins, 2002)
Therefore there are negative consequences for patients, healthcare service providers as well as healthcare institutions when language barriers are encountered in healthcare