Carola Skott

General practitioners' views on consultations with interpreters: A triad situation with complex issues

Objective. To study a group of general practitioners’ (GPs) views on cross-cultural consultations through interpreters in primary healthcare in Sweden. Design. Two group interviews and three personal interviews with experienced GPs regarding clinical consultation through interpreters were carried out. The interviews were transcribed and analysed and the text was categorized according to content analysis. Setting. Primary healthcare. Subjects. Eight GPs were interviewed. Main outcome measures. The response and opinions of the GPs. Results. In the analysis it appeared that an optimal clinical encounter demands an active role by all participants involved in the consultation. The interpreter has to strive after being a stable neutral information bridge, and has a balancing role between the GP and the patient. The GP has to be open to cultural inequalities and recognize consultation through an interpreter as a part of her/his job. The patient needs to be an active and visible participant, not hiding behind the interpreter. Common obstacles and imperfections to reach the best possible triad were discussed. Additionally, practical assets in the encounter were delineated. Accurate physical placing of the persons in the room, adequate length of consultation time, and using the same interpreter from one visit to another were mentioned as factors influencing the outcome of the consultation. Conclusion. Barriers in cross-cultural communications could originate from all persons involved, the interpreter, the GP, and the patient, as well as from tangible factors. Ways to reduce misunderstandings in GP–patient encounters through interpreters are suggested.

Developing Clinical Knowledge through a Narrative-Based Method of Interpretation

The results of research using a narrative analysis provide new clinical knowledge, but the methods used are unknown to many readers. In this paper we present an example of how an analysis may be performed in practice. The purpose of the interpretation of this specific story was to develop clinical knowledge of how it is to live with chronic heart failure from a daily life perspective. The steps in the interpretation process, within the framework of Paul Ricoeurs Interpretation theory, were: (1) general or naïve reading, (2) distancing, (3) examination of discourse, (4) conjectures and questions, and (5) reflection over the whole. The demonstrated interpretation of the interview resulted in a theme called: “Struggling to comprehend medical information”. This systematic way of working with narratives makes implicit assumptions about the relationship between meaning and language explicit. These themes can be used in everyday practice as clinical tools. Because of the interpretative nature of human understanding the experienced health professional will be capable of integrating evidence-based research findings and individual illness experience.

Interpreters’ experiences of general practitioner–patient encounters

Objective. To study interpreters’ experiences of problems in cross-cultural communication with special regard to the general practitioner (GP)–patient encounter. Design. A focus-group interview with authorized interpreters was carried out. A phenomenographic method was used in the analysis.Setting. Primary health care.Results. The interpreters displayed a number of problems mainly related to the difficulty in balancing the triad relation (GP–patient–interpreter), the role of the interpreter in relation to other healthcare staff, the time aspects of the translation procedure, and the problems of diverse health beliefs and cultural inequalities.Conclusion. The interpreters notice a set of difficulties that need to be highlighted in order to improve consultations with cross-cultural GP–patient encounters.

‘A person of two countries’. Life and health in exile: Somali refugees in Sweden

Meeting and treating patients from other countries and cultures constitutes a challenge for health care. The number of immigrants and refugees has seen a rapid increase in recent years in Sweden. Expectations and experiences of health and illness often differ among these immigrant groups compared with the inhabitants of the majority society. This paper examines the situation of Somali refugees living in a multicultural suburban area of a large city in southern Sweden, and the aim was to illuminate and document their thoughts and experiences in relation to health and illness. Thirteen interviews with Somalis of different sexes and ages were conducted in the informants homes. A hermeneutic-phenomenological approach was used in the analysis. The findings revealed an essential theme – a life in exile – that permeated every subject that was discussed and talked about. This was expressed in the following aspects: longing for the homeland, pain – a companion in exile, prejudice and discrimination, family – comfort and trouble, religion and beliefs in Jinns. Complex feelings of bi-nationality and of being uprooted were expressed. Prior knowledge about the hardships involved in a life as a refugee may allow and increase the possibilities for better communication, increased trust and mutual respect in order to achieve a meaningful encounter with health care personnel.

The nature of nursing research: dissertations in the Nordic countries, 2003

Nursing and caring research has followed various paths in different countries and there are diverse views regarding the central phenomena in nursing science. An overview of Nordic nursing and caring science from 1974 to 2000 revealed that conceptualizations and design of enquiry differed. It therefore was of interest to investigate the overall picture regarding more recent and present doctoral dissertations on this subject. The aim of this study was to investigate the locus of interest and the content of current nursing and caring research in Nordic doctoral dissertations within the field presented during 2003. A total of 26 doctoral dissertations were read and studied. The analysis was inspired by Kims metaparadigmatic typology of four domains for structuring nursing knowledge. The investigation shows that the research in these dissertations, with some exceptions, was oriented towards phenomena belonging to the client domain (18 dissertations). Less knowledge has been gained in the client-nurse (two dissertations); four dissertations were categorized within the practice domain and environment domain includes two dissertations. The research conducted was primarily oriented towards pragmatic aspects and the practical application of knowledge, whereas basic research aiming at defining an autonomous science is exceptional. This means that scientific knowledge regarding and forming the disciplines unique perspective and value system could still be in evolution. A combination of a carefully and well-designed research practice, reflecting the need to further research and investigate new theoretical regions would appear to constitute the direction forward.

Transcultural Encounters in a Medical Ward in Sweden: Experiences of Health Care Practitioners

The aim of this study was to explore the approach adopted by health care practitioners when handling transcultural encounters. The study was performed by means of action research, a reflective process led by practitioners and researchers working together to improve practice and solve problems. Data were collected through participant observations at a coronary unit in Sweden and group discussions with the health care professionals and were analyzed and interpreted using a hermeneutic approach. The narratives in the interview text illustrated a switch between three levels of understanding human behavior: the individual level (personality), the collective or group level (what is termed culture), and the universal level (human nature), focusing on differences in the first two and similarities in the third. This study highlights the importance of practitioners comprehending the complex relationship between individuality and cultural context and understanding cultural identity as being fluid and coexisting with other differences, such as class, education, gender, and age.

Home Care Encounters in a Multicultural Context - A Diverse Space for Caring

The aim of this study was to explore care encounters in homes of patients living in a multicultural area. The shadowing method enabled researchers to closely follow nurses in their everyday work. Complexities in the care environment, ambivalent roles played by the family, and varying meanings of care encounters were found. Despite difficulties in communication, nurses and patients created mutual space for caring. Regular meetings were essential for creation of trust, support, and consolation. Nurses’ sensitivity regarding patients’ needs and awareness of diversity of space for caring gave insights into the complexity of home care encounters in multicultural contexts.

Symptoms beyond diagnosis- a case study

The aim of this paper was to discuss how words for symptoms relate to experience and to find out how seriously ill patients two years after diagnosis and treatment articulated suffering. Nine patients who have had a cancer tumour of the central nervous system were interviewed in their homes and the findings were interpreted in a hermeneutic process. Bodily, obstructive, emotive and metaphorical expressions of symptoms appeared. The transformed life situation involved inability to perform everyday tasks and a feeling of frustration of needs and desires. The words for symptoms conveyed individual embodied experience connected to a discourse of shared meanings. The relationship between individuality and culture means that words for symptoms are created and understood in a process between patient and listener, between discourse, culture and history.