1. CREST Cultural Respect Encompassing Simulation Training Module 3 – Effective communication when English Proficiency is low “I don’t speak English…”

2. CREST Cultural Respect Encompassing Simulation Training This project was made possible using funding from Health Workforce Australia

3. CREST Cultural Respect Encompassing Simulation Training Outline of today’s session 1.Overview of Module 3 Health professionals’ ethical and professional obligations How to access an interpreter Importance of ethno-specific support 2.Effective communication without an interpreter 3.Effective Communication with an interpreter 4.Role Play (optional) 5.Simulation

4. CREST Cultural Respect Encompassing Simulation Training Overview of CREST Four modules: Module 1 – Introduction to Cultural Diversity Module 2 – Negotiating between different health beliefs Module 3 – Effective communication when English Proficiency is low Module 4 – Communicating culturally sensitive issues

5. CREST Cultural Respect Encompassing Simulation Training Effective communication when English proficiency is low Today, we will explore the principles of effective communication, and the skills and resources required for effective communication with linguistically diverse patients.

6. CREST Cultural Respect Encompassing Simulation Training Primary Learning Objectives: Gain an understanding of the principles of effective communication with linguistically diverse patients; the different ways to communicate with clients with low English proficiency; strategies to work effectively with an interpreter; the rationale for ethno-specific support groups.

7. CREST Cultural Respect Encompassing Simulation Training Impact of limited English proficiency on healthcare consultation limited ability to build rapport and trust with the healthcare provider difficulty understanding the explanation of the diagnosis or treatment choices difficulty understanding and confusion about how to use a recommended medication or treatment limited ability to ask questions or to understand the answers given confusion regarding when to return for follow-up care limited ability to provide informed consent etc.

8. CREST Cultural Respect Encompassing Simulation Training So when you combine two cultures (provider’s and patient’s) that are quite different with a patient with limited English proficiency … WHAT COULD HAPPEN?

9. CREST Cultural Respect Encompassing Simulation Training Health professionals’ ethical and professional obligations Each health profession board has profession- specific codes of ethics and conduct in accordance with the Health Professionals Regulations 2004. The standards form the legal benchmark of professional practice standards for the relevant profession. Code/Standards: To communicate clearly and effectively with patients If the patient requires an interpreter, it is your responsibility to ensure that this service is provided

10. CREST Cultural Respect Encompassing Simulation Training How to access an interpreter (Ref: Centre for Culture, Ethnicity and Health Tip Sheet) Identify the patient’s preferred language o If preferred language is not available, check whether patient can speak other languages and is willing to use an interpreter in another language Ask patient if s/he has any ethnic, religious or gender preferences for interpreters Decide telephone or on-site interpreting o telephone interpreting for basic communication o on-site interpreting for more complex and lengthy sessions Must use interpreters accredited by the National Accreditation Authority for Translators and Interpreters (NAATI) Booking is essential especially for on-site interpreters

11. CREST Cultural Respect Encompassing Simulation Training Why not use carers, friends and family members as interpreters? potential breaches of confidentiality; possible misinterpretation; conflict of interest potential for loss of objectivity conflict of roles

12. CREST Cultural Respect Encompassing Simulation Training Why Ethno-specific support groups? Mainstream services must work in partnership with ethno-specific services to deliver a responsive and effective health care system. This recognises and respects that there are differences between cultures is vital to meeting the diverse needs of different cultures reduces health inequality

13. CREST Cultural Respect Encompassing Simulation Training Effective communication without an interpreter (Ref: Centre for Culture, Ethnicity and Health Tip Sheet) Find out as much as you can about the patient before you start Allow sufficient time for the communication Be clear about what you want your patient to understand and make sure you can explain them simply Consider different ways to communicate your messages Provide written materials in English, in the client’s preferred language or both (preferably - WHY?)

14. CREST Cultural Respect Encompassing Simulation Training Some tips Speak clearly – o speak at a consistent measured pace o speak each word separately – do not slur o enunciate words clearly, particularly endings & tenses Speak simply – o do not use jargons, acronyms and slangs – explain if you do o make sentences short and clear o communicate one idea per sentence Face your patient when you speak Avoid closed questions A smile, a nod and a ‘yes’ or ‘no’ answer may not mean what you expect them to mean

15. CREST Cultural Respect Encompassing Simulation Training Some tips (contd) Check understanding o let patient know s/he can ask you to clarify or provide further explanations o observe body language and expressions ** o ask patient to repeat important points Allow patient time to listen, think and respond to you

16. CREST Cultural Respect Encompassing Simulation Training How to assess a patient’s need for interpreter? (Ref: Centre for Culture, Ethnicity and Health Tip Sheet) Ask the patient simple questions about their personal details Ask an open question or ask the patient to repeat something you have said in their own words Ask the patient if they need or want an interpreter o Advise that interpreters are available on request and are free of charge Ask the patient what main language they speak at home Decide with patient which type of interpreter is going to be most suitable

17. CREST Cultural Respect Encompassing Simulation Training Effective Communication with an interpreter (Ref: Centre for Culture, Ethnicity and Health Tip Sheet) Book the interpreter well in advance Allow extra time for the session Brief the interpreter about the nature of the appointment and any other relevant information

18. CREST Cultural Respect Encompassing Simulation Training Some tips Arrange the seating so that you can maintain eye contact with patient Speak to the client directly and in the first person Do not talk with the interpreter and exclude the client Speak in short intervals allowing time for the interpreter to interpret Everything that is said during the interview must be interpreted Always remember that you, not the interpreter, are in control of the interview

19. CREST Cultural Respect Encompassing Simulation Training Some tips (contd) Summarise discussion and provide opportunity for the client to ask questions Check whether the client is ready to end the session Debrief the interpreter if necessary Collect feedback and address concerns (if any) about the interpreter services

20. CREST Cultural Respect Encompassing Simulation Training Role Play Exercise (optional) break into groups of 3 or 4 choose one in the group to play a patient, and another to play a nurse, specifically a diabetes nurse educator if possible the remainder group members will be observers role-play for 10mins and spend 10mins giving feedback to one another

21. CREST Cultural Respect Encompassing Simulation Training Information for the ‘Nurse’ Chinese, 30+, referred by GP to the diabetes nurse educator at the local community health service. Diagnosed with Type II diabetes 4 months ago following a blood test (BSL 12.1mml/L) ordered by his GP when s/he presented with chronic tiredness. The GP commenced metformin but patient is not adhering to prescribed medication.

22. CREST Cultural Respect Encompassing Simulation Training Information for the ‘patient’ ONLY You have been referred by GP to the diabetes nurse educator at the local community health service. You were diagnosed with diabetes 4 months ago following a blood test when you saw your GP because of chronic tiredness. (The following information in red is not available to the ‘nurse’) The GP started you on a tablet but you prefer to take the medicines prescribed by the Chinese doctor. You did not tell your GP because you didn't think it was important. You also do not like the thought of changing your diet or do more exercise. Your diet consists of a lot of starch (rice, noodles, dumplings) and sugar and you exercise very little. You speak only a little English – good enough for simple conversations but inadequate for discussing complex issues.