Kerrigan V1,4, McGrath S1, Majoni S1,2,4,5, Walker M3, Ahmat M3, Lee B4, Hefler M1,4, Cass A1,4, Ralph A1,4
1Menzies School of Health Research, Darwin, Australia, 2Royal Darwin Hospital, Darwin , Australia, 3Aboriginal Interpreter Services, Northern Territory Government, Darwin, Australia, 4Charles Darwin University, Darwin, Australia, 5Flinders University, Northern Territory Medical Program, Darwin, Australia
AIMS: To assess changes from embedding Aboriginal language interpreters with renal doctors during ward rounds to improve communication.
To assess the impact of consistent access to interpreter mediated communication on hospitalised Aboriginal language speakers.
BACKGROUND: Patient-centred communication can be difficult particularly where healthcare providers and patients speak different languages. Interpreters are underused. Low uptake of interpreters is commonly attributed to limited interpreter availability, time constraints and thinking that interpreters are not essential for quality care. At the Royal Darwin Hospital (RDH), 50% of Aboriginal patients would benefit from an interpreter, yet 17% get access.
METHODS: This research was embedded in a larger study examining cultural safety and communication at RDH. Six Aboriginal language speaking patients, three non-Indigenous doctors and five Aboriginal interpreter staff were purposefully sampled. Data sources included participant interviews conducted in either the patient’s language or English, researcher field notes from shadowing doctors, doctors’ reflective journals, interpreter job logs and patient language lists. Inductive narrative analysis, guided by critical theory and Aboriginal knowledges, was conducted.
RESULTS: Patient experience was transformed through consistent access to interpreters. Patients could freely express their needs. Patients who felt “stuck” and disempowered when forced to communicate in English felt “satisfied” with interpreter-mediated, patient provider communication. Providers understood patient concerns and priorities. Patient trajectories improved. Self-discharge rates dropped. Cultural competency improved. Doctors adapted routines to suit patient needs. Attitudes towards culturally safe communication changed. However, some resistance to interpreter use remained.
CONCLUSIONS: Embedding Aboriginal interpreters changes practice, improving cultural competence.
A system which restricted people’s ability to receive healthcare in their first language was overturned. Institutions can improve the level of cultural safety experienced by patients by improving communication.
A/Prof William Majoni a Senior Staff Specialist and Director of Renal Services for Top End Health Service at the Royal Darwin Hospital in Darwin. He is also a Clinical Fellow with the Menzies School of Health Research and A/Prof with the Flinders University Northern Territory Medical Program. His research interests include Indigenous health, the epidemiology of renal, infectious and cardiovascular diseases and clinical trials to improve the evidence base for treatment of renal and cardiovascular disease