Communicating health and safety in the context of cultural and linguistic diversity in aged careDr Valerie O’Keeffe, Centre for Applied Psychological Research

Fiona O’Neill, Research Centre for Languages and Cultures

All workers have the right to a healthy and safe workplace.

Fundamental to this is the dissemination of information,

instruction and the provision of training and supervision in a

form that workers can understand.

Origins of the study

• This study has been motivated by the increasing

presence of culturally and linguistically diverse workers in

aged care and the impact on WHS

• Our findings might be generalisable to other industries

where there is increasing linguistic and cultural diversity.

The study

How is WHS information disseminated to aged care

workers, and how is this information interpreted, understood

and carried out in residential aged care in the context of

increasing cultural and linguistic diversity?

The research question

• A rapidly ageing population, and a growing need for

people to care for the elderly in residential settings in

Australia (Fine &Mitchell 2007, Hugo 2007, 2009)

• ‘The ageing of the aged’ (Hugo 2007, p170): Aged care

residents presenting with more complex health profiles

including dementia (communication issues, aggression)

Background research

• Increasing cultural and linguistic diversity amongst aged

care residents (Jeffries 2006, Orb 2002) and more

recently the workers employed to care for them

• Often these two groups are not from the same linguistic

and cultural backgrounds

(Pearson et al. 2007, King et al. 2012, Fine & Mitchell 2007,

Hugo 2009)

Background research

• Ageing of the workforce (mean age of sample = 41 yrs)

• 60% of aged care workers > 45 years old

• Decreased reporting by CALD workers

(WorkSafe SA 2008, WorkCover NSW 2002)

• Higher injury rates /psychological risk due to

language/communication issues?

(Johnstone & Kanitsaki 2007, King et al. 2012, VicHealth,

2007)

Background research

• Post world-war II: “New Australians”

• 1970’s: “ethnic” or “migrant”

• 1980’s – 1990’s: Non-English speaking background

(NESB)

• 2000’s: Culturally and linguistically diverse (CALD)

Garret et al. (2010: 1)

Cultural and linguistic diversity

• ILO 1975 requires workplaces to protect workers in terms

of their occupational health and safety. As a minimum,

this requires addressing them in a language that they can

understand and providing labels and signs to warn of

dangers in the workplace.

Work health and safety

• WHS/OHS legislation places duties on employers to

provide a safe workplace for their employees. Where

those workers speak different languages, the employer

must provide information, instruction and training in a

form that can be reasonably understood by the workforce

Work health and safety

• 2 locations – A and B residential aged care facilities

• Participants – Residents, Managers, nurses and carers

• Process – interviews with participants from each group,

ethnographic observations of the various sites of

communication

• Thematic analysis

• Interventions

Study design

Interviews

• 43 carers and nurses

• 9 managers

• 22 residents

Field notes and observations across morning and afternoon

shifts across two sites for 76 shifts (36 and 40 respectively)

Data

• Induction training, WHS training days, intranet, memos

and noticeboards

• Meetings – Health and Safety committee, clinical

nurse/manager meetings, carer meetings

• Handovers between shifts and between levels of staff –

changes in residents’ conditions

Health and safety:Sites of communication

• Documentation – resident care plans and clinical records

• Documentation and reporting – hazards, near misses and

incidents, auditing

• Informal communication between staff – “backstage”

conversations, notes in the nurses’ station

• Interaction between staff and residents

Health and safety:Sites of communication

Languages other than English spoken by staff

• Cantonese, Mandarin, Malay, Sinhalese, Korean,

Tagalog, Vietnamese, Japanese, Samoan, Farsi, Hindi,

Punjabi, Gujarati, Yoruba (West Africa), Dutch, Italian,

German, French, Bosnian, Serbian, Croatian…

Languages other than English spoken by residents

• Hindi (x1), Cantonese (x1), French, German, Croation,

Italian, Greek…

Cultural and linguistic diversity

That’s when I would seek help from my EN or RN. And just

raise the question of whether they are listening or not …

Raising the question of whether they are actually

understanding first because if they are not understanding,

then it appears that they are not listening

(Australian carer: p 96, lines 196-199)

Language barrier?

So I find that some of them will nod their head as if they are

listening and understand but sometimes they don’t really

understand what you’re actually trying to get across to them

… some cultures will not speak up, they will just like stand

back and just watch, but you don’t really understand whether

or not you don’t really know if they’re actually understanding

what’s happening, or if that’s just their way of being polite

(Australian nurse: p35, lines 355-363)

Language or culture?

One of the residents asked me who I was and why I was

there. I explained about the project. He offered his insight:

“there are many Africans, they stand out but their care is as

good as the white ones. It’s just that the dark ones don’t

show much personality”

(Australian resident field notes NA p.9 lines 104-107)

Language and (their) culture

Q. You’re not shy but people interpret you as shy?

A. Yeah just because of my culture……...The only thing I could add is a lot of people still

need to like listen closely to you before they answer quickly, it’s not like a racist or

something. Some people they see that you’re black, they’ve already made up their mind

that they won’t understand whatever I’ve got to say. So you know people need to listen

first before they judge.

Q. So for you, you feel sometimes that people are judging?

A. Sometimes before I speak they are like “What are you saying?”, I say “Why don’t you

just listen first so then we understand what I was about to say”, so you have to listen

before you understand yeah there is no way you understand something if you don’t listen.

(African carer: p100, lines 185-200)

Language and (my) culture

Safety is a big concern especially with some of the cultures

that we deal with they don’t understand maybe how to do

something and they won’t ask” (AUS RN, p28, lines 38-39)

Language and professional culture

Q. So if you see someone doing the wrong thing or if you’re worried about someone getting hurt what can

you do?

A. That’s the very good question because its happening here now but I don’t like to tell you because so

many people they don’t like to be told. I went downstairs and I told them and they called me bitchy bossy

because I’ve been here, I’m more experienced and when I see new staff they come as soon as they know

what to do and they make so many things wrong and when you go to tell them, like for example I’ve seen

staff they’re giving wash to resident and putting the dirty flannel back, like not rinsing or wet flannel on the

towel and I said excuse me that’s wrong, that’s a cross infection and they gave me horrible looking you

know you think I’m bossy but no, if I go to RN that person goes back to behind me and said she’s bossy but

I’m not bossy I’m saying for residents safety and I’ve seen wrong things doing with the lifter we had a

argument they don’t want to do it you know its so many things we haven’t got that power to you know no

one listening just not enough people to understand us and I just shut my mouth and I said well what way

they want to do it do it, I give up.

(Middle Eastern carer: p101, lines 41-54)

Language and professional culture

There is a perception that nurses are busy, I’m very busy here, I’m not that

busy in hospital but there is a code there is a client code which is defined there.

In hospital if you are good, it’s good … if you are rough, if you swear to me I’m

not coming to you “I’m sorry you calm down then I’ll talk to you” … as a nurse I

don’t take any shit there … in hospital it’s written if you behave properly you’re

being treated if you don’t “I’m sorry I can’t do it, somebody else can” … I’ll say

“Look he called me a black Indian go away I’m not going there” and nobody will

question me …that’s it alright “Look after yourself mate somebody else will go

there” but in aged care it doesn’t happen, oh they can call you anything and we

to do counseling with them but they keep on doing those things.

(Indian nurse, p61, lines 320-329)

Language and institutional culture

Nothing, you can’t do anything about it, it’s this way I will

explain. There is a highway, everyone else is going over the

speed of 100k per hour and you’re just trying to enter this

highway and your speed is probably 45. What do you do? You

can’t take your car there and let them smash into you so what

do you do? You just drive carefully around the corner and try to

get to the speed 100k and then when you have 100k you

manipulate yourself. You can’t fight with everyone can you?

(Indian nurse: p63, lines 195-201)

Learning language and culture(s)

they’re (workers for whom English is a second language)

very good at explaining if you can’t quite understand and

you give them a bit of help. “Do you mean this or do you

mean that?” Oh no they will tell you straight away and

there’s no difficulty there. I can’t think of any trap I fell into

by misinterpreting any question, I can’t think of any…

(Australian resident: p173, lines 29-33)

Bridging the gap

• The importance of communication to safety

• The reliance on a transmission model of communicating

information about safety

• Transmission model relies on one-way communication –

transmitting downwards – implications for work health and

safety?

Communicating safety in the context of linguistic and cultural diversity: Preliminary thoughts

• The complexity of communication within and between

groups e.g. assuming, second and third guessing of

intentions, competence and meaning among people of

different

– languages and cultures

– organisational roles

• How people are making sense of/what people are doing

to manage this complexity

Communicating safety in the context of linguistic and cultural diversity: Preliminary thoughts

• Intercultural understanding in communication

• Recognize language(s) and culture(s) as resources not

barriers

• Assess current health and safety information – what is

needed, the form & languages

• Use face to face communication where possible

• Not just “giving information” but communication as

interaction

What can be done to improve communication and safety?

• Use plain, simple language

• Demonstrate, use diagrams, charts, pictures

• Use audio-visual aids in appropriate languages

• Use consistent terms, symbols & standard signs

• Make information easily accessible

• Allow time for processing & discussion

• Check for understanding, paraphrase back

Communicate for understanding

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157-161.

Garret, P., Dickson, H., Klinken Whelan, & A., Whyte, L. (2010). Representations and coverage on non-English speaking immigrants and multicultural

issues in three major Australian Healthcare publications Australia & New Zealand Health Policy http://www.anzhealthpolicy.com/content/7/1/1

Hugo, G. (2007). Contextualising the ‘crisis in aged care’: A demographic perspective, Australian Journal of Social Issues Australian Journal of Social

Issues, 42(2), 169-182.

Hugo, G. (2009). Care worker migration, Australia and development. Population, Space and Place, 15, 189-203. doi: 101 1002/psp

Jeffries, A. (2006). Language diversity and older Australians: Issues, special needs and the recognition of language/cultural rights in aged care

services. Paper presented at the Australian Association of Gerontology, Sydney.

Johnstone, M.-j., & Kanitsaki, O. (2007). An exploration of the notion and nature of the construct of cultural safety and its applicability to the

Australian health care context. Journal of Transcultural Nursing, 18(3), 247-256.

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University.

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Curtin University of Technology.

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developing and sustaining a healthy work environment in healthcare. International Journal of Evidence Based Healthcare, 5, 54-91. doi:

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WorkCover NSW (2002) Improving health and safety information to immigrant workers in NSW, NSW Government: 1-188.

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http://www.worksafe.vic.gov.au/forms-and-publications/forms-and-publications/communicating-occupational-health-and-safety-across-languages-co

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References