The communication challenges posed by diversity in consumers and health workers prompted these researchers to seek information about how bilingual staff use their language skills in patient encounters. Content analysis, using the NUD•IST (Nonnumerical Unstructured Data Indexing, Searching, and Theory-Building) program, of the transcripts from 18 focus groups (n = 81) has resulted in new notions about bilingualism. Four types of bilingual workers were defined within the Bilingual Health Communication Model, based on level of fluency (no fluency to complex verbalizer) and the context of the interaction (social engagement to complex health information transference). These forms of communicators were found to be active and purposeful in language skill clusters, language exchange programs, and individual bilingual worker roles (direct caregiver, communication facilitator or consultant, and cultural advocate or broker). Implementing the systems and roles proposed might transform the communication or indeed miscommunication patterns that are widespread in our health care systems.
HI-6 (1-2-hydroxyiminomethyl-1-pyridino-3-(4-carbamoyl-1-pyridino -2- oxapropane dichloride) has been evaluated as an oxime alternative to pralidoxime, and toxogonin in the treatment of organophosphorus (OP) poisoning. The dose response effects of atropine (ATR) and HI-6 were investigated to more fully explore the interaction of these compounds in the treatment of OP poisoning. ATR, HI-6 and various combinations of the two drugs were evaluated against lethal poisoning by soman (GD) and tabun (GA) in guinea pigs. The effect of adjunctive diazepam treatment on the efficacy of atropine and HI-6 against soman was also investigated. Animals of either sex were challenged s.c. with OP and treated i.m. 1 min later with ATR and/or HI-6. When used, diazepam was injected immediately after ATR+HI6. LD50s of each treatment were calculated from probit models based on 24-hour survival against 5 levels of nerve agent and 6 animals per challenge level. A protective index (PI) was calculated by dividing the nerve agent LD50 in the presence of treatment by the LD50 in the absence of treatment. Treatment with HI6 alone had little effect on the toxicity of either OP. Treatment with ATR alone was more effective than HI-6 alone and was significantly more effective against soman than against tabun. When used in combination atropine and HI-6 had a strong synergistic effect against both agents. The dose of atropine used with HI-6 was critical in determining the efficacy of HI-6 against either agent. The slopes of the dose-lethality curves were minimally affected by the dose of ATR or HI-6. Adjunctive treatment with diazepam enhanced the efficacy of HI-6 and atropine against soman. It is concluded that 1) ATR has a large effect on the efficacy of HI-6 against OP poisoning, 2) the dose of ATR must be carefully selected in studies investigating the efficacy of HI-6 against OP poisoning, 3) the effective dose of ATR in the guinea pig is approximately 16 mg/kg, and 4) diazepam is a useful adjunct to atropine and HI-6.
Managers of health care services are seeking new opportunities to improve communication with clients who have limited English proficiency. An increase in bilingual health
The role of ethnic health staff in hospitals has not been clearly articulated for managers and practitioners. This paper describes findings from a study based on ethnic and allied health staff interviews and observations of ethnic health staff interactions. Care was provided to language concordant patients directly and by assisting practitioners to work within the patient's cultural paradigms and family schema. The scope of practice involved: engaging patients in a therapeutic relationship, patient assessment, linking assessment with care options, facilitating communication between patients and practitioners, education, smoothing hospital experiences, referral and interpreting. Ethnic health staff displayed a range of specialised skills that managers need to harness within multidisciplinary teams to reach patients from diverse back- AUSTRALIA IS A COUNTRY of great diversity. In 2001 almost 50% of its people were born overseas or had one or both parents born overseas. 1The diversity of language, culture and religion across the country stands in stark contrast to the dominance of Anglo-Celtic traditions in Australian institutions, including health care organisations. Misunderstandings and miscommunication related to this diversity have been found to impede quality of care, such as lack of recognition of the need for particular tests, misdiagnosis, patient misunderstanding of their diagnosis and This study aimed to further understanding of the practice of ethnic health staff, and found that ethnic health staff had a range of specialised skills that were respected by the practitioners they worked with. The ethnic health staff demonstrated dual roles of direct care provider and paraprofessional or communication facilitator, which corroborated previous assessments of the role. What are the implications for practitioners?Health care managers need an understanding of the competencies, skills and expertise of ethnic health staff and to consider their employment in health teams (for example, in diabetes care, maternal and child health, renal, cardiac, or disability services). Ethnic health staff have been shown to be an effective bridge that is, by mediating the patientpractitioner-organisation divide, enhancing patient capacity to negotiate the unfamiliar world of the hospital, informing better case management by exposing practitioners to the patient world view, and providing one-to-one and group education. Australian Health Review May 2008 Vol 32 No 2 237Human Resource Management treatment, ineffective education and poor compliance with treatment, 1-6 increasing costs through lengthened hospital stays and greater reliance on tests.7 Further, ignoring optimal communication with patients who have limited English language proficiency and cultural and religious values that differ from the dominant host society poses serious threats to the provision of culturally safe practice, appropriate health outcomes and patient satisfaction. [8][9][10] In Australia, barriers to care for migrants were formally acknowledged in th...
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