From language classroom to clinical context: the role of language and culture in communication for nurses using English as a second language: a thematic analysis

Background

This study explores the experiences of internationally educated nurses using English as a second language, recruited by advanced economies to supplement diminishing local workforces, as they progress from language learning programs to clinical settings.

Objective

Understanding the journey these nurses experience as language learners and professionals highlights ways in which they could be better supported in their adaptation and integration into the Australian workforce.

Design and methods

By means of semi-structured interviews, the nurses’ narratives were explored and documented. Thematic analysis was used to interpret their experiences as they move from the English language classroom to the clinical setting.

Setting

The participants had all completed studies in English as a second language in Australia and had experienced working in Australian as part of a competency based assessment program. At the time of the study, conducted in South Australia, six of the nurses had met the English language requirements of the Nurses Board of South Australia and had started working as Registered Nurses in Australia. Four participants were still to reach the mandatory English requirements, among whom three were to return to their home countries due to visa restrictions, and continue their efforts to attain the English language proficiency requirement.

Participants

There were six female participants and four male. Five participants were Indian, four Chinese, and one, Nepalese.

Results

In exploring their experiences, themes of identity and belonging, safety and competence and adapting to new roles and ways of communicating are revealed. In their own words, these nurses reveal the challenges they face as they concurrently manage the roles of language learners and professionals.

Conclusions

The journey from language classroom to clinical setting is a process that goes beyond the notions of language proficiency; these nurses are constructing new cultural and professional identities. Bridging the gap between preparation and practice involves making complex linguistic, cultural and social choices, often unsupported. Understanding their experience will better inform approaches to preparation and facilitate their adaptation and integration.     

Tailoring genetic information and services to clients' culture, knowledge and language level

This article discusses approaches to dealing with transcultural care. Patient treatment can be improved by considering various cultural differences, establishing empathy, and focused listening. Scenarios, points for reflection and suggestions for non-judgemental language are provided.     

In vitro culture of acute myelogenous leukemia blasts: a comparison of four different culture media

Proliferative responses and cytokine secretion were compared when AML blasts were cultured in the three serum-free media, X-Vivo 10, X-Vivo 15, and defined serum-free medium (IMDM with mercaptoethanol, low-density lipoprotein, albumin, and transferrin) and in media containing 10% inactivated fetal bovine serum (FBS). The following AML blast functions were investigated: (a) constitutive cytokine secretion, (b) autonomous and cytokine-dependent proliferation, and (c) accessory cell function during T cell activation. Constitutive cytokine secretion and accessory cell function differed markedly when using different culture media. For the constitutive AML blast secretion of IL-1beta, IL-6, and tumor necrosis factor (TNF)-alpha, no qualitative differences were seen, but quantitative differences were observed with decreased cytokine levels for cells cultured in X-Vivo 10 and X-Vivo 15. The accessory cell function of AML blasts was also decreased in the X-Vivo media, whereas differences were less pronounced when comparing AML blast proliferation. Our results clearly demonstrate that a well-characterized culture system is essential for in vitro studies of AML blast functions.     

East meets West: The influence of language and culture in clinical education

The marketing of education in South East Asia has become big business for Australian Universities. Physiotherapy programs are not exempt from this marketing push, with increases in foreign student enrollment becoming commonplace. This raises numerous opportunities and dilemmas for those involved in physiotherapy clinical education. This action research project investigated the influence of language and culture on clinical education practices. Nine South East Asian undergraduate physiotherapy students and 11 clinical instructors were involved in this qualitative research project. A variety of issues were identified which have important ramifications for academics and clinical instructors. Cultural membership, issues of authority and respect, and language proficiency were identified as having a direct influence on the clinical education process. Strategies for dealing with these cross cultural teaching and learning challenges are discussed.     

A common language network for comprehension and production: a contribution to the definition of language epicenters with PET

In this paper, we report on a PET activation study designed to assess whether functional neuroimaging would help to uncover essential language areas in normal volunteers and to provide a more accurate definition of their localization. Regional cerebral blood flow was repeatedly monitored in eight right-handed male volunteers, while performing a language comprehension task (listening to factual stories) and a language production task (covert generation of verbs semantically related to heard nouns), using silent resting as a control condition. The conjunction analysis, conducted with SPM, was used to uncover the network of activations common to both task that included three left hemisphere areas, namely (1) the pars opercularis and triangularis of the inferior frontal gyrus, (2) the posterior part of the superior temporal cortex centered around the superior temporal sulcus, extending to the planum temporale posterior part but sparing the supramarginalis and angular gyri, and (3) the most anterior part of the left inferior temporal gyrus at the junction with the anterior fusiform gyrus. The inferior and lateral parts of the right cerebellar cortex were also included in the conjunction network. Each of the three cortical areas, when they are site of lesion or electrical stimulation, elicit impairment in both language comprehension and production and can thus be considered as essential to language. Accordingly, the present results provide conservative anatomofunctional definitions of the Broca, Wernicke, and basal language areas. Interestingly, contralateral homologues of Broca's and Wernicke's areas also lighted up in the conjunction analysis that could be related to the interindividual variability of hemispheric language dominance.     

A literature review of the language needs of nursing students who have English as a second/other language and the effectiveness of English language support programmes

Australia is increasingly becoming a culturally diverse country, with this trend being reflected in nursing education as significant numbers of students enrol from backgrounds where English is a second/other language (ESL). These students will enable the provision of culturally competent care that a culturally diverse health system requires (Ohr et al., 2010), however they require significant levels of support to not only achieve academically in their nursing programme, but also to perform at the expected level during clinical placements (Boughton et al., 2010). Difficulties communicating with colleagues, patients and their families in the clinical setting have been identified among the challenges that ESL nurses face (Boughton et al., 2010; Jeong et al., 2011). A review of the literature indicates sporadic research into the education of nurses from ESL backgrounds. This paper discusses and raises awareness of common themes such as the challenges of adjusting to Western culture and using the advanced and technical English required by higher education and healthcare. This paper also discusses mixed results reported from a number of English language support programmes. This indicates a need for further research in this area to strengthen support for these nurses who can assist in the provision of culturally competent care.     

Educational needs of nurses when nursing people of a different culture in Ireland

Background:  Over the last 10–15 years, there has been a dramatic change in the population of the Republic of Ireland (ROI). Because of strong economic growth, a buoyant economy and universal population migration, the ROI has moved from a mono to a multicultural society over a relatively short period of time. Therefore, nurses in this state have limited experience of caring for people of a different culture.
Aim:  To discuss registered nurses' experiences in the ROI of nursing people from a different culture.
Methods:  The study design was qualitative and participants were purposively sampled ( n  = 7). Data was collected through semi-structured interviews and thematically analysed.
Findings:  The main themes to emerge from the interviews were: dealing with cultural issues in practice; accessing and using the interpreter service; planning and taking action to improve nursing care for patients from a different culture.
Conclusion:  Support and education is needed by nurses to improve nursing care of people from a different culture.
Practice implications:  Recommendations for practice are to: develop transcultural nursing education; promote an ethos of providing culturally competent and culturally safe nursing to people of another culture; improve resources available to nurses; provide easier access to formal interpreter services with continuity of interpreters for patients and conduct further research into aspects of health care in multicultural Ireland.     

A language for nursing.

Nursing has no common language to describe precisely what nurses do, for what sort of problems or patient conditions, and with what results. Without a language to express our concepts we cannot know whether our understanding of their meaning is the same, so we cannot communicate them with any certainty to other people. This article discusses projects in the USA and the UK that are attempting to standardise nursing language, in particular the International Classification for Nursing Practice.     

时差成像干式培养与传统湿式培养应用于不同年龄胚胎发育的效果

【摘 要】 目的 评价时差成像技术(time—lapse,TL)干式培养与传统湿式培养对不同年龄组胚胎发育的影响。方法 回顾性分析2020 年 7月至2021年12月，2390例体外胚胎培养结果，其中TL组640个周期，传统湿式培养组(对照组，Control，C组)1750个周期，比较两组间正常受精率、正常卵裂率、有效胚胎率、优质胚胎率、囊胚形成率、和优质囊胚率的差异。结果 (1)两组在女方年龄、不孕类型、不孕因素、促排卵药物（Gonadotropins，Gn）用量、受精方式差异均无统计学意义(P>O．05)，(2)在20-29岁组：与C组比较,TL组有效胚胎率 (75.39％vs 70.15％)、优质胚胎率(49.79％vs 41.98％)，TL组均显著升高(P＜0.01）；在30-34岁组：与C组比较，TL组优质胚胎率(46.70％vs 41.43％)也显著升高(P＜0.01），囊胚形成率（57.14％vs 52.74％）、优质囊胚率(35.82％vs 32.26％)明确改善差异有统计学意义(P<0.05)；≥40岁组：与C组比较，TL组优质胚胎率(44.05％vs 48.96％，P<0.05)、囊胚形成率（16.11％vs21.77％，P＜0．01）及及优质囊胚率均显著降低(16.11％vs 21.77％，P<0.05)。结论 与常规湿式相比，在低年龄组（20-34岁），TL培养可显著提高优质胚胎率；而在高年龄组（≥40岁）则显著降低优质胚胎率，囊胚形成率和优质囊胚率，可能与培养基渗透压改变有关。     

Medical language proficiency: A discussion of interprofessional language competencies and potential for patient risk

In increasingly multilingual healthcare environments worldwide, ensuring accurate, effective communication is requisite. Language proficiency is essential, particularly medical language proficiency. Medical language is a universal construct in healthcare, the shared language of health and allied health professions. It is highly evolved, career-specific, technical and cultural-bound—a language for specific purposes. Its function differs significantly from that of a standard language. Proficiency requires at minimum, a common understanding of discipline-specific jargon, abstracts, euphemisms, abbreviations; acronyms. An optimal medical language situation demands a level of competency beyond the superficial wherein one can convey or interpret deeper meanings, distinguish themes, voice opinion, and follow directions precisely. It necessitates the use of clarity, and the ability to understand both lay and formal language—characteristics not essential to standard language. Proficiency influences professional discourse and can have the potential to positively or negatively affect patient outcomes. While risks have been identified when there is language discordance between care provider and patient, almost nothing has been said about this within care teams themselves. This article will do so in anticipation that care providers, regulators, employers, and researchers will acknowledge potential language-based communication barriers and work towards resolutions. This is predicated on the fact that the growing interest in language and communication in healthcare today appears to be rested in globalization and increasingly linguistically diverse patient populations. Consideration of the linguistically diverse healthcare workforce is absent. An argument will be posited that if potential risks to patient safety exist and there are potentials for disengagement from care by patients when health providers do not speak their languages then logically these language-based issues can also be true for a care team of mixed linguistic backgrounds. Members may disengage from each other or adverse events may occur as a result of misunderstanding or other language-based confounds. While the greater goal of the article is to address the issues of medical language across languages, English and medical English are used to illustrate points. Questions will be posed to stimulate thought and identify a need for research. Recommendations include collaboration between the health and language disciplines.     

Care and caring culture as experienced by nurses working in different care environments: A phenomenological-hermeneutic study

Aim

The aim is to understand and develop the concept of care and caring culture and to do so based on the empirical/phenomenological standpoint of nurses’ lived experiences of working in different environments.

Background

Culture, care and caring are significant concepts mentioned and used in connection with nursing practice. In the nursing literature, the ‘caring culture’ as a concept is mostly taken for granted, and it is up to the reader to determine what caring culture means.

Method

A phenomenological-hermeneutic method was used to uncover the meaning of lived experiences though interpretation of interviews transcribed as text. Seventeen nurses working on different wards were interviewed in 2006. A follow-up focus-group discussion was conducted with seven of the nurses 1 year later for validation of the findings.

Findings

Thematic analyses revealed five themes: you have to adapt to the existing care culture; seeing the invisible; being yourself; the strong personalities; the patients must adapt themselves to the circumstances. Adaptation to unwritten routines entails adaptation to the culture and the common value system. On wards described as “homelike”, nurses may act in a way that reflects their own values.

Discussion

The care and caring culture can be understood from the perspective of what it means to care and from the perspective of how care provision is accomplished. To attain a caring culture founded on certain values, for example caritas, love and charity, we must first understand how the organization and personnel understand caring.