When a common language is missing: Nurse–mother communication in the NICU. A qualitative study

Abstract

Aims and objectives To explore how communication in neonatal intensive care units (NICUs) between immigrant mothers and nurses take place without having a common language, and how these mothers experience their NICU stay. Background Admission of infants to NICU affects both parents and infants. Immigrant mothers constitute a vulnerable hospital population in need of culturally, linguistically and individually tailored information. Design and methods The study had a qualitative design reported according to the COREQ criteria. Eight mothers who spoke neither Scandinavian nor English went through individual semi‐structured interviews. Six mother–nurse interactions were observed, and eight nurses' experiences were explored through focus‐group interviews. All interviews were audio recorded and transcribed verbatim. The analysis was thematic and hermeneutic in character. Results Interpreters were present during the consultations with the physicians, but rarely during the daily nurse‐mother interactions. Nurses focused on daily routines, infant care guidance and mother–infant attachment. The mothers learned through demonstrations and hands‐on guidance. Language barriers made it difficult to assess the mothers' understanding, but the mothers expressed that they felt adequately included in the care of their infant and well informed and guided. Even so, both mothers and nurses expressed desire to use interpreters more regularly. The pictorial communication boards available lacked important vocabulary needed in neonatal nursing contexts and their use furthermore interrupted the mother–nurse conversation. Conclusion Body language, simple words, guesswork, trial and error characterised the nurse–mother interaction. The nurses adopted various communication strategies to help the mothers understand and give them a voice. Competent interpreters were used during meetings with physicians, but not during daily bedside guidance and information giving by nurses. Relevance to clinical practice Knowledge of immigrant mothers' and nurses' communication strategies and how both parties think, feel and act to overcome communication problem is necessary to improve clinical practice and reduce communication barriers.

Barriers and facilitators in providing care for patients with a migration background

“…Additionally, following a course in an ethno‐diverse class setting, or following lessons by a teacher with a migration background, does not necessarily lead to a culturally sensitive attitude among the students (Seeleman et al, 2014). Although respondents also struggle with language, they undertake only limited action to overcome this barrier (Kynoe et al, 2020; Vissenberg et al, 2018). Instead of using official interpreters, our results show the often‐used practice of calling upon a multi‐lingual colleague healthcare provider to come over and translate.…”

Establishing a trusting nurse-immigrant mother relationship in the neonatal unit

“…8 Without a common language, daily communication and information giving between nurses and mothers admitted to the NICU must be carried out through non-verbal communication, eye contact and guesswork. 7 Creating trust as an ethical enterprise Løgstrup 11 claims that trust is an anthropological part of human existence. Trust is basic in all human relations and is an unspoken ethical demand, and only through negative experiences does distrust arise.…”

“…6 This asymmetry becomes even greater when the parents are immigrants who do not have a common language with the nurses and cannot communicate verbally without an interpreter present. 7 The maternal vulnerability challenges the nurse's awareness of the asymmetric distribution of power. To establish a trusting relationship with the mother, nurses need to be attentive towards the mother's needs.…”

Beyond challenges and enrichment: a qualitative account of cross-cultural experiences of nursing patients with an ethnic minority background in Norway

“…Previous studies show that nurses’ experiences in providing care for patients with an ethnic minority background consumes more time and energy than native patients [ 12 – 14 ]. Most of these challenges are cultural and communicational ones [ 10 , 15 – 17 ]. Patient care may be negatively impacted by the presence of cultural and communication barriers between patients and nursing staff [ 18 – 20 ].…”