Challenges Related Language Barrier as Hindrance to Cooperation

Language Barriers in Nursing Practice
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1 Introduction
One of the issues affecting patient care has been identified as language barrier CITATION Squ14 \l 1033 (Squires & Jacobs, 2014). Language has been found as one of the biggest obstacles to holistic patient care globally CITATION Sch161 \l 1033 (Schwei, et al., 2016). It poses real challenge in assessment of patient's baseline and can cause continuity problems in healthcare. The problem of language barrier may be more serious in elderly people who may be confused   and could be scared by unfamiliar surroundings of the hospital CITATION van16 \l 1033 (van Rosse, de Bruijne, Suurmond, Essink-Bot, & Wagner, 2016). The problem may be aggravated by pre-existing mental health or dementia or conditions.
There can be incorrect assessments or interpretations in case a patient is not able to communicate needs and symptoms CITATION Pen16 \l 1033 (Penney, Poulter, Cole, & Wellard, 2016). If a patient is misunderstood based on cultural perspectives it may be difficult for nursing staff to effectively address his/her needs. On grounds of ethical issues, this can result into loss of autonomies and acquiring consent regarding treatments CITATION Squ14 \l 1033 (Squires & Jacobs, 2014).
This article discusses various ways in which language barrier can affect delivery of patient care and how the issues can be solved.
2 Challenges Related to Language Barrier
1 Language Barrier as Hindrance to Cooperation
The inability for patients, family members and nursing practitioners to cross language barriers is has been found to be brought about be a sense of helplessness CITATION Sad14 \l 1033 (Sadeghi‐Bazargani, Tabrizi, & Azami‐Aghdash, 2014). It can result in inadequate cooperation among staff and between staff patients. This may result in patients misunderstanding medical procedures and recommendation given explained to them by nurse who does not understand the patient’s language CITATION Hob17 \l 1033 (Hoben, et al., 2017). These language problems of exist in other hospitals where the official language English and patients or staff who are not conversant with the language find it difficult to communicate and fully cooperate within and with other hospitals concerning a patient.
An example of an hospital in Germany, Guam Hospital, where most nurses were Filipino and communicated Tagalog.  This resulted in other staff and nursing interns being left out of the system and thus it became difficult to cooperate CITATION Alm15 \l 1033 (Almutairi, 2015). The old staff were not comfortable to speak in English and would do so only when the colleagues insisted. It gave rise to distasteful situation in terms communication. The fellow staff and interns felt their Filipino colleagues were discussing them reading from their gestures CITATION Sch161 \l 1033 (Schwei, et al., 2016).
2 Patients with Hearing and Sight Impairments
The problem of language barrier is critical in patients with hearing impairments and/or blindness as well as persons with delayed development or without expressive language CITATION Bur17 \l 1033 (Burgess, 2017).  The problem may be aggravated when the individual does not have same concepts of the words as the nurse.  Nursing concepts are hard to get devoid of direct experiences. The case is worse for those without vision and hearing but since they have different concepts concerning the same issue CITATION Mun16 \l 1033 (Munro, 2016).  Effective way of providing understanding of surgical procedures is by giving pre-instructions prior to surgical process.  It is hard to develop touch signals that indicate patient movements especially when interpreter is absent.  Signal in the U.S.A. for emergency such as fire is to draw X on the back of deaf blind persons from shoulders to hips CITATION Mun16 \l 1033 (Munro, 2016).  
3 Interpreter and Patient’s Understanding of Procedure
It is important for patients to understand the procedure CITATION van16 \l 1033 (van Rosse, de Bruijne, Suurmond, Essink-Bot, & Wagner, 2016). The situation is difficult in case of hearing and sight impairment. It is near impossible to truly verify whether such a patient understood message conveyed. This may lead to the staff choosing not to go on procedure. Being unable to communicate positioning, expectation and needs has high chances of elevating pressures of everyone as well as the patient. To recommend endotracheal anesthetic in such a case may be insensitive some cultures. It is also difficult to establish the way the patient feels in such ordeals CITATION Ekl15 \l 1033 (Eklöf, Hupli, & Leino‐Kilpi, 2015).
4 Language Barrier and Culturally Competent Nursing Practice
Language barrier limits provision of culturally competent healthcare by nurse being unable to comprehend cultural safety which is based on attitude of the nursing practitioners CITATION Alm15 \l 1033 (Almutairi, 2015). In some area, especially in very religious countries like Saudi Arabia, it is challenging to pass information to patients or their families members. It could be difficult to pass the message directly to female patient without involving the parent or husband CITATION Alm15 \l 1033 (Almutairi, 2015).
5 Language Barrier and Gender
Type of language used to communicate to patients of same gender may differ in some cultures from those used to communicate to the opposite gender. In such cases it is important to ask CITATION Dit18 \l 1033 (Dittus, Harper, Becasen, Donatello, & Ethier, 2018). It is important for nurses not to offend anyone or make patient uncomfortable as a result of cultural differences. For instance, in certain cultures it is not proper for people of opposite sex to touch if they are not members of same family. In the U.S.A., the Hispanics are typically extraordinarily "touchy feely” which may offend a patient of other cultures CITATION Wag15 \l 1033 (Wagner, Brush, Castle, Eaton, & Capezuti, 2015).
6 Language Barrier and Low Health Literacy
Research has identified low health literacy and language as barriers to effectiveness of communication CITATION Pot18 \l 1033 (Pot, Keijzer, & De Bot, 2018). When patients have low health literacy it is related to language and cultural barri...