Introduction
As an Arabic language speaker, the language barrier has more often not been a problem I have grappled with throughout my life. My reflection is on the issue of language experienced at a health care facility while attempting to receive medical care. As a patient waiting for a check-up, I was required to give my history details to a nurse, and later, describe my symptoms to the doctor for a diagnosis. In an English-speaking hospital, I had a difficult time to understand the questions asked and an even harder time articulating myself to respond promptly, all due to the scarcity of my knowledge of the English language. In effect, the nurse was unable to collect my information effectively and also found it difficult putting together and remembering what I said. In the end, it seemed impossible to obtain any relevant information and the nurse had to leave for a while to look for someone with the knowledge of Arabic who could offer assistance.
At the time, I felt extremely frustrated at the situation and what it was leading to. To begin with, I was feeling very ill, and the accompanying discomfort made me wish I could get medical help as soon as possible. However, the problem brought by the inability to communicate effectively significantly delayed the process. The struggle to find words to articulate me also added to my frustration. All the while, I kept thinking of how much easier it would have been if I knew how to speak in English in a better way. During the incident, I also felt embarrassed because I felt like I was making a scene. More and more people started looking our way and trying to listen in on the conversation, which made me feel even more insecure about how incoherent I sounded. People stared on with looks of judgment and contempt while others looked on with looks of empathy and understanding. I felt relieved when the nurse came back with another patient who could help translate my words. Help had arrived at last. I could tell that the nurse was quite relieved at having found another Arabic speaker due to the painstaking moments he had endured a while earlier.
What I remember most about the incident were the judgmental stares I got all around the room which made me feel even more of an outsider. I could feel them wondering what I was doing in that medical hospital without any critical knowledge of their native language. The fact that no one came forward to help make me feel very disregarded as a minority. After the incident, I felt encouraged to learn English with even more enthusiasm. Avoiding such uncomfortable and futile situations seemed like good enough reason to learn the language, and not just for its own sake. All is well that ends well as I successfully gave my information to the translating patient, who was of much further help during diagnosis and prescription. My heart swelled with gratitude towards the fellow patient, without whom I might have gone back home without receiving any medical assistance.
I thought that things went quite significant at the end. Despite my frustration, I am glad that I did not lose my cool or start crying. I did not also give up my quest for health care and go home. The nurse was also very patient with me, trying all manner of gestures to communicate with me and make me understand his questions. Some patients in the room felt uncomfortable, and I could not tell why. The alienation I felt during the incident was heart-breaking, and it can be reported as the worst part of the incident.
On the other hand, the professional patience displayed by the nurse was very commendable and heart-warming and is something to write home about. The relief of having another Arabic speaker translate my woes could not compare to anything else. The situation was sufficiently resolved afterwards, and the language barrier was broken.
The presence of a language barrier in any establishment is expected to bring problems since effective communication is not possible. Availability of a health care provider with the knowledge of Arabic would have helped with the situation and ensured smooth communication from the beginning. The absence of a patient with knowledge of the language would have significantly hindered the possibility of my receiving the medical care I needed. Servellen (2009) advocates for the assessment of communication between patients and health care providers to ensure that no critical points are missed. Missing a crucial point in health care could lead to compromised care. Competency and readiness to work for any health care provider is an essential factor in their communication with patients (Amudha and Annamma, 2018). Competency of the nurse also contributed to the events in a positive manner. Not knowing how to react in the situation or how to remedy it on the part of the nurse would have made things more difficult than they already were.
The nurse acted the entire time professionally and was very patient as well, attributes without which I might not have gotten any help. Sensitivity to patient needs is a factor that enhances communication between patients and health care providers (O'hagan et al., 2014). Sensitivity practiced by the nurse also helped the situation and made me feel more comfortable than if the nurse had made me feel inadequate as I was trying to articulate myself. Nurses might hinder effective communication between themselves and the patients due to their negative emotions towards patients they consider difficult (Sheldon et al., 2006). While it is understandable that it might be annoying and tiresome to deal with some difficult patients, professionalism and common courtesy should not be thrown out the window. Professionalism should be maintained at whatever cost. It was reassuring that despite the attention I got from people around the room, it did not result from the nurse complaining about the situation or making a scene about it. Non-verbal cues used between patients and health care providers make communication more effective (Silverman and Draper, 2005). Non-verbal cues used by the nurse in an attempt to make me understand what he was asking for made it easier for me. Cultural awareness, as well as active listening skills, ensure successful discussions between patients and health care providers (Fleischer et al., 2005) (Chant et al., 2002). The nurse's active listening skills and cultural awareness helped with his patience during the incident, and I did not end up feeling like I overwhelmed him too much.
I employed active listening skills and control of my emotions during the frustrating incident. I also made use of voice management despite my poor coherence. Voice management helps to establish and maintain a rapport (Chan et al., 2011) (Bowles and Mackintosh, 2001). I also tried to make use of non-verbal cues since my spoken English was terrible. Non-verbal cues are sometimes considered to carry more weight regarding communication than actual words themselves (Candlin and Candlin, 2006) (Schirmet et al., 2005). Quite some ways of effective communication were interwoven during the incident. However, most of them were cut short due to the language barrier. Actors are enhancing useful communication work best if there is a mutual understanding in the language used between the two parties (Makoul, 2001).
The final turn of events was unexpected as I had already lost hope in passing my message across to the nurse. When he left to find someone who could interpret, I even thought that he was giving up on me and when I saw him come back with another party, I was delighted. I did not expect him to expend that much energy into knowing what I had to say. As I came to the hospital, I also did not expect that communicating with a language barrier would be that hard. I assumed that it would be quite comfortable with facial expressions, gestures and scanty words. As I came to find out, these non-verbal cues only enhance communication where there are sufficient similarity and understanding in the language spoken.
Conclusion
In conclusion, despite my and the nurse's effort to conquer the language barrier using other methods of effective communication, it became abundantly clear that the language was the most critical factor. Without a common language, all other skills do not get the message home. I could have done nothing more to improve the situation since there was still the language barrier. I would not have been able to respond differently should the same situation have arisen again, and as a result, I have learned that it is essential to learn the English language to make life easier while living in an English-speaking country. The main entry into my action plan is learning the English language in depth which I then plan to enhance by learning effective communication skills. In the event of a similar scenario, I will be better equipped to articulate myself and make myself fully understood.
References
Amudha P, Hamidah H, Annamma K, Ananth N (2018) Effective Communication between Nurses and Doctors: Barriers as Perceived by Nurses. J Nurs Care 7: 45
Bowles N., Mackintosh C. & Torn A. (2001) Nurses' communication skills: an evaluation of the impact of solution-focused communication training. Journal of Advanced Nursing 36, 347-354.
Candlin C.N. & Candlin S. (2003) Health care communication: a problematic site for applied linguistics research. Annual Review of Applied Linguistics 23, 134-154.
Chan E.A., Jones A., Fung S. & Wu S.C. (2011) Nurses' perception of time availability in patient communication in Hong Kong. Journal of Clinical Nursing 21, 1168-1177.
Chant S., Jenkinson T., Randle J. & Russell G. (2002) Communication skills: some problems in nursing education and practice. Journal of Clinical Nursing 11(1), 12-21.
Fleischer S., Berg A., Zimmermann M., WEURuste K. & Behrens J. (2009) Nurse-patient interaction and communication: a systematic literature review. Journal of Public Health 17, 339- 353.
Makoul G. (2001) The SEGUE framework for teaching and assessing communication skills. Patient Education and Counseling 45(1), 23-34.
O'hagan, S., Manias, E., Elder, C., Pill, J., WoodwardKron, R., McNamara, T., ... & McColl, G. (2014). What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients. Journal of advanced nursing, 70(6), 1344-1355.
Schirmer J.M., Mauksch L., Lang F., Marvel M.K., Zoppi K., Epstein R.M., Brock D. & Pryzbylski M. (2005) Assessing communication competence: a review of current tools. Family Medicine 37(3), 184-192.
Servellen, V. (2009). Communication skills for the health care professional: Concepts, practice, and evidence. Jones & Bartlett Publishers.
Sheldon L.K., Barrett R. & Ellington L. (2006) Difficult communication in nursing. Journal of Nursing Scholarship 38(2), 141-147.
Silverman J., Kurtz S. & Draper J. (2005) Skills for Communicating with Patients, 2nd edn. Radcliffe, Oxford
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