communicating health and safety in the context of cultural and linguistic diversity in aged care dr...
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Communicating health and safety in the context of cultural and linguistic diversity in aged careDr Valerie O’Keeffe, Centre for Applied Psychological Research
Fiona O’Neill, Research Centre for Languages and Cultures
All workers have the right to a healthy and safe workplace.
Fundamental to this is the dissemination of information,
instruction and the provision of training and supervision in a
form that workers can understand.
Origins of the study
• This study has been motivated by the increasing
presence of culturally and linguistically diverse workers in
aged care and the impact on WHS
• Our findings might be generalisable to other industries
where there is increasing linguistic and cultural diversity.
The study
How is WHS information disseminated to aged care
workers, and how is this information interpreted, understood
and carried out in residential aged care in the context of
increasing cultural and linguistic diversity?
The research question
• A rapidly ageing population, and a growing need for
people to care for the elderly in residential settings in
Australia (Fine &Mitchell 2007, Hugo 2007, 2009)
• ‘The ageing of the aged’ (Hugo 2007, p170): Aged care
residents presenting with more complex health profiles
including dementia (communication issues, aggression)
Background research
• Increasing cultural and linguistic diversity amongst aged
care residents (Jeffries 2006, Orb 2002) and more
recently the workers employed to care for them
• Often these two groups are not from the same linguistic
and cultural backgrounds
(Pearson et al. 2007, King et al. 2012, Fine & Mitchell 2007,
Hugo 2009)
Background research
• Ageing of the workforce (mean age of sample = 41 yrs)
• 60% of aged care workers > 45 years old
• Decreased reporting by CALD workers
(WorkSafe SA 2008, WorkCover NSW 2002)
• Higher injury rates /psychological risk due to
language/communication issues?
(Johnstone & Kanitsaki 2007, King et al. 2012, VicHealth,
2007)
Background research
• Post world-war II: “New Australians”
• 1970’s: “ethnic” or “migrant”
• 1980’s – 1990’s: Non-English speaking background
(NESB)
• 2000’s: Culturally and linguistically diverse (CALD)
Garret et al. (2010: 1)
Cultural and linguistic diversity
• ILO 1975 requires workplaces to protect workers in terms
of their occupational health and safety. As a minimum,
this requires addressing them in a language that they can
understand and providing labels and signs to warn of
dangers in the workplace.
Work health and safety
• WHS/OHS legislation places duties on employers to
provide a safe workplace for their employees. Where
those workers speak different languages, the employer
must provide information, instruction and training in a
form that can be reasonably understood by the workforce
Work health and safety
• 2 locations – A and B residential aged care facilities
• Participants – Residents, Managers, nurses and carers
• Process – interviews with participants from each group,
ethnographic observations of the various sites of
communication
• Thematic analysis
• Interventions
Study design
Interviews
• 43 carers and nurses
• 9 managers
• 22 residents
Field notes and observations across morning and afternoon
shifts across two sites for 76 shifts (36 and 40 respectively)
Data
• Induction training, WHS training days, intranet, memos
and noticeboards
• Meetings – Health and Safety committee, clinical
nurse/manager meetings, carer meetings
• Handovers between shifts and between levels of staff –
changes in residents’ conditions
Health and safety:Sites of communication
• Documentation – resident care plans and clinical records
• Documentation and reporting – hazards, near misses and
incidents, auditing
• Informal communication between staff – “backstage”
conversations, notes in the nurses’ station
• Interaction between staff and residents
Health and safety:Sites of communication
Languages other than English spoken by staff
• Cantonese, Mandarin, Malay, Sinhalese, Korean,
Tagalog, Vietnamese, Japanese, Samoan, Farsi, Hindi,
Punjabi, Gujarati, Yoruba (West Africa), Dutch, Italian,
German, French, Bosnian, Serbian, Croatian…
Languages other than English spoken by residents
• Hindi (x1), Cantonese (x1), French, German, Croation,
Italian, Greek…
Cultural and linguistic diversity
That’s when I would seek help from my EN or RN. And just
raise the question of whether they are listening or not …
Raising the question of whether they are actually
understanding first because if they are not understanding,
then it appears that they are not listening
(Australian carer: p 96, lines 196-199)
Language barrier?
So I find that some of them will nod their head as if they are
listening and understand but sometimes they don’t really
understand what you’re actually trying to get across to them
… some cultures will not speak up, they will just like stand
back and just watch, but you don’t really understand whether
or not you don’t really know if they’re actually understanding
what’s happening, or if that’s just their way of being polite
(Australian nurse: p35, lines 355-363)
Language or culture?
One of the residents asked me who I was and why I was
there. I explained about the project. He offered his insight:
“there are many Africans, they stand out but their care is as
good as the white ones. It’s just that the dark ones don’t
show much personality”
(Australian resident field notes NA p.9 lines 104-107)
Language and (their) culture
Q. You’re not shy but people interpret you as shy?
A. Yeah just because of my culture……...The only thing I could add is a lot of people still
need to like listen closely to you before they answer quickly, it’s not like a racist or
something. Some people they see that you’re black, they’ve already made up their mind
that they won’t understand whatever I’ve got to say. So you know people need to listen
first before they judge.
Q. So for you, you feel sometimes that people are judging?
A. Sometimes before I speak they are like “What are you saying?”, I say “Why don’t you
just listen first so then we understand what I was about to say”, so you have to listen
before you understand yeah there is no way you understand something if you don’t listen.
(African carer: p100, lines 185-200)
Language and (my) culture
Safety is a big concern especially with some of the cultures
that we deal with they don’t understand maybe how to do
something and they won’t ask” (AUS RN, p28, lines 38-39)
Language and professional culture
Q. So if you see someone doing the wrong thing or if you’re worried about someone getting hurt what can
you do?
A. That’s the very good question because its happening here now but I don’t like to tell you because so
many people they don’t like to be told. I went downstairs and I told them and they called me bitchy bossy
because I’ve been here, I’m more experienced and when I see new staff they come as soon as they know
what to do and they make so many things wrong and when you go to tell them, like for example I’ve seen
staff they’re giving wash to resident and putting the dirty flannel back, like not rinsing or wet flannel on the
towel and I said excuse me that’s wrong, that’s a cross infection and they gave me horrible looking you
know you think I’m bossy but no, if I go to RN that person goes back to behind me and said she’s bossy but
I’m not bossy I’m saying for residents safety and I’ve seen wrong things doing with the lifter we had a
argument they don’t want to do it you know its so many things we haven’t got that power to you know no
one listening just not enough people to understand us and I just shut my mouth and I said well what way
they want to do it do it, I give up.
(Middle Eastern carer: p101, lines 41-54)
Language and professional culture
There is a perception that nurses are busy, I’m very busy here, I’m not that
busy in hospital but there is a code there is a client code which is defined there.
In hospital if you are good, it’s good … if you are rough, if you swear to me I’m
not coming to you “I’m sorry you calm down then I’ll talk to you” … as a nurse I
don’t take any shit there … in hospital it’s written if you behave properly you’re
being treated if you don’t “I’m sorry I can’t do it, somebody else can” … I’ll say
“Look he called me a black Indian go away I’m not going there” and nobody will
question me …that’s it alright “Look after yourself mate somebody else will go
there” but in aged care it doesn’t happen, oh they can call you anything and we
to do counseling with them but they keep on doing those things.
(Indian nurse, p61, lines 320-329)
Language and institutional culture
Nothing, you can’t do anything about it, it’s this way I will
explain. There is a highway, everyone else is going over the
speed of 100k per hour and you’re just trying to enter this
highway and your speed is probably 45. What do you do? You
can’t take your car there and let them smash into you so what
do you do? You just drive carefully around the corner and try to
get to the speed 100k and then when you have 100k you
manipulate yourself. You can’t fight with everyone can you?
(Indian nurse: p63, lines 195-201)
Learning language and culture(s)
they’re (workers for whom English is a second language)
very good at explaining if you can’t quite understand and
you give them a bit of help. “Do you mean this or do you
mean that?” Oh no they will tell you straight away and
there’s no difficulty there. I can’t think of any trap I fell into
by misinterpreting any question, I can’t think of any…
(Australian resident: p173, lines 29-33)
Bridging the gap
• The importance of communication to safety
• The reliance on a transmission model of communicating
information about safety
• Transmission model relies on one-way communication –
transmitting downwards – implications for work health and
safety?
Communicating safety in the context of linguistic and cultural diversity: Preliminary thoughts
• The complexity of communication within and between
groups e.g. assuming, second and third guessing of
intentions, competence and meaning among people of
different
– languages and cultures
– organisational roles
• How people are making sense of/what people are doing
to manage this complexity
Communicating safety in the context of linguistic and cultural diversity: Preliminary thoughts
• Intercultural understanding in communication
• Recognize language(s) and culture(s) as resources not
barriers
• Assess current health and safety information – what is
needed, the form & languages
• Use face to face communication where possible
• Not just “giving information” but communication as
interaction
What can be done to improve communication and safety?
• Use plain, simple language
• Demonstrate, use diagrams, charts, pictures
• Use audio-visual aids in appropriate languages
• Use consistent terms, symbols & standard signs
• Make information easily accessible
• Allow time for processing & discussion
• Check for understanding, paraphrase back
Communicate for understanding
Fine, M. D., & Mitchell, A. (2007). Immigration and the aged care workforce in Australia: Meeting the deficit. Australasian Journal in Ageing, 26(4),
157-161.
Garret, P., Dickson, H., Klinken Whelan, & A., Whyte, L. (2010). Representations and coverage on non-English speaking immigrants and multicultural
issues in three major Australian Healthcare publications Australia & New Zealand Health Policy http://www.anzhealthpolicy.com/content/7/1/1
Hugo, G. (2007). Contextualising the ‘crisis in aged care’: A demographic perspective, Australian Journal of Social Issues Australian Journal of Social
Issues, 42(2), 169-182.
Hugo, G. (2009). Care worker migration, Australia and development. Population, Space and Place, 15, 189-203. doi: 101 1002/psp
Jeffries, A. (2006). Language diversity and older Australians: Issues, special needs and the recognition of language/cultural rights in aged care
services. Paper presented at the Australian Association of Gerontology, Sydney.
Johnstone, M.-j., & Kanitsaki, O. (2007). An exploration of the notion and nature of the construct of cultural safety and its applicability to the
Australian health care context. Journal of Transcultural Nursing, 18(3), 247-256.
King, D., Mavromaras, K., Wei, Z., He, B., Healy, J., Macaitis, K., . . . Smith, L. (2012). The Aged Care Workforce Final Report 2012: Flinders
University.
Martin, B., & King, D. (2008). Who cares for older Australians? (Flinders University): National Institute for Labour Studies.
Orb, A. (2002). Health care needs of elderly migrants from culturally and linguistically diverse (CALD) backgrounds: A review of the literature. Perth:
Curtin University of Technology.
Pearson, A., Srivastava, R., Craig, D., Tucker, D., Grinspun, D., Bajnok, I., . . . Gi, A. A. (2007). Systematic review on embracing cultural diversity for
developing and sustaining a healthy work environment in healthcare. International Journal of Evidence Based Healthcare, 5, 54-91. doi:
10.1111/j.1479-6988.2007.00058.x
WorkCover NSW (2002) Improving health and safety information to immigrant workers in NSW, NSW Government: 1-188.
WorkSafe Victoria (2008) Communicating occupational health and safety across languages, Victorian WorkCover Authority: 1-28.
http://www.worksafe.vic.gov.au/forms-and-publications/forms-and-publications/communicating-occupational-health-and-safety-across-languages-co
mpliance-code
References