Aim: The overall aim of the study was to examine how policy directives concerning the provision of individualized care were modified in their transformation into practice and the implications this carried for the care provided to patients from different ethnic backgrounds. This paper is concerned with one aspect, namely, examining the nature and effects of communication difficulties between the nurses and South Asian patients and their carers.
Methods: An ethnographic approach was used. The study was undertaken in an English community National Health Service (NHS) Trust serving an ethnically diverse population. It comprised two stages. First, an organizational profile of the trust was undertaken in order to analyse the local policy context. Data were collected by means of in-depth interviews with managers and a review of policy documentation and caseload profiles. Second, a participant observational study was undertaken focusing on six district nursing teams. Purposive sampling was used to identify four teams with high ethnic minority caseloads and two teams with predominantly white ethnic majority caseloads. Interview transcripts and fieldnotes were analysed by drawing upon the principles of dimensional analysis.
Findings: Over half of South Asian patients had little or no understanding of spoken English with women and older people the least likely to speak English. The limited use of professional interpreters and the concomitant heavy reliance on family members to translate highlighted how ethnic minority patients and carers who were not fluent in English were disadvantaged. The observed language barriers suggested that the content of advice on matters such as compliance with treatment regimes might not be fully understood. Psychological support of patients and carers was severely restricted. Moreover, the fact that follow-up visits were on occasions made to patients for whom there was no one available to interpret constrained on-going assessment of patients' needs.
Conclusions: The findings raise concerns regarding the quality of care provided to patients and carers who are nonusers of English and provide evidence of inequalities in service provision. However, not speaking English should not be a barrier to appropriate and effective nursing care. District nurses need to appreciate their responsibility to provide equitable services irrespective of a patient's linguistic background and seek to overcome the disadvantage experienced by ethnic minority patients.