Crossing the Language Barrier: A Role-Playing Activity

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Empirical evidence reveals that linguistic barriers between nurse and patient can lead to discrimination that compromises care.1 A collaborative communication role-playing activity was created involving freshmen nursing students, in their first professional nursing course, and freshmen international students from the English as a second language (ESL) program. The goal was to create a practical application of communication skills learned in each setting.
International ESL students in this program of study focus on reading, writing, listening, speaking, and conversing for advanced beginner through intermediate levels. The ESL students and their instructors sought opportunities to interact with native English speakers. These ESL students found it challenging to socialize outside the classroom. By isolating themselves, the ESL students were unable to test their communication skills with their English-speaking peers.
Freshmen nursing students have little experience with therapeutic communication at this point in the curriculum. The first nursing course, professional practice in health and illness, is designed for students to learn about themselves as health care providers and gain respect for patients. Nursing students analyze the health care delivery system, gain awareness of cultural differences, and learn about their role as professional caregivers.
Nursing student preparation for this role-playing activity included a lecture and films about therapeutic communication and cultural sensitivity. The nursing students were taught basic therapeutic communication interviewing techniques: asking focused questions, sharing observations, providing information, and using silence to enhance the communication pathway. Several negative techniques were also explored: asking why, failing to listen, giving opinions, relying on stereotyped responses, and showing inappropriate approval or disapproval.
Nursing students learn that body language is important and can affect how a message is interpreted. Traditionally, nursing students have difficulty transforming their communication style from a social interaction to a therapeutic communication. This is especially challenging when the patient is from a different background where cultural and language barriers may exist.2
Carnevale et al1 examined ethical considerations in ESL communication in nursing. They identified 5 norms: (a) respect for the patient as a unique individual, (b) respect for each patient’s right to self-determination, (c) respect for patient confidentiality, (d) responsibility for one’s own judgment and action, and (e) accepting responsibility to better meet the needs of patients, families, and groups.
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