k of effective communication about the need to relocate to Darwin for treatment, away from family and community, could result in the patient's reluctance to accept dialysis in the future.
3: Sample interaction (B)
Setting: The open waiting area at the dialysis unit.
Participants: Ms "C", a 50-year-old woman who had been on dialysis for five years. She speaks Yolngu languages and is fluent in conversational English. She has graduate qualifications as a teacher.
Sr "D", a 31-year-old female nurse with 10 years' experience in renal services, both as a nurse and patient educator, but with little formal training in cultural awareness.
The interaction: The interaction, in English, was initiated by Sr D. She determined the timing and location to fit in with her work program and with the patient's dialysis schedule. The nurse did most of the talking and the patient asked few questions.
Communication goals: Sr D aimed to provide education through feedback and discussion of routine monthly test results. She aimed to integrate information about dialysis, medication and diet, specifically related to the test results.
Neither participant mentioned what Ms C might have wanted to communicate.
The participants' assessment: Both believed that the communication had, to some extent, been effective. Ms C said, "I could see it all clearly. . . . I didn't have any misunderstanding."
However, through analysis of the video with each participant and with further discussion, evidence of extensive miscommunication emerged. The nurse had emphasised, during the interaction, that Ms C's haemoglobin level was low and had discussed its significance in terms of her health and the use of erythropoietin. In the exit interview, Ms C indicated that she believed that all her results were normal.
Sr D had discussed results of biochemical tests and the use of specific medications. She said, "[The patient] knows a lot about medication and dialysis treatment. . . . She knows what medication she's on."
However, at exit interview, it became clear that Ms C had not understood key issues relating to the results, that she was unable to name most of her medications, and that her understanding of their actions was completely different from the biomedical explanations she was given. The absence of shared understanding of key concepts relating to results and medications was seen as an important source of miscommunication.
Consequences for clinical management: Both participants had perceived the communication to be effective. The discrepancy between perception and reality became evident only through triangulation of the data. Standard assessments of quality of care by the measurement of staff and patient satisfaction, in this case relating to education and staff–patient interaction, would not have revealed the miscommunication. This has important implications for clinical management. Best outcomes in the management of end-stage renal disease require adherence to a complex treatment regimen of regular dialysis, repeated tests, dietary restriction and daily medications.
4: Strategies for improving communication between non-Aboriginal healthcare staff and Aboriginal patients
Train staff in intercultural communication. It is the staff's responsibility to make this accommodation to enable Aboriginal people to make informed choices in the context of their own language and cultural environment.
Train Aboriginal interpreters to prepare them for work with healthcare workers.
Promote strategies to monitor the effectiveness of communication and to repair miscommunication.
Develop educational resources to facilitate a shared understanding of (a) physiological processes and treatment options; and (b) cultural, social and economic realities confronting Aboriginal patients and their families.