CASE STUDIES


An Innovative response to developing resources to meet the health and social needs of people with Limited English Proficiency

Ireland has seen a very considerable rise in immigration over a relatively short period, with continuing inward migration into Ireland in spite of changing economic conditions (Census 2011). The trend toward re-uniting families and an increase of people born outside of Ireland aged 65+ now residing here has implications for current and future health care provision. A considerable number of this population, c. 80,000, have no English or limited ability in English, which can be challenging in health care service provision and especially so in palliative care contexts.

In the Palliative Care setting the type of information that needs to be conveyed can be difficult. Many patients wish to know about their diagnosis or prognosis, however, others may prefer to negotiate a gradual disclosure of information. This can be more difficult when a patient has Limited English Proficiency (LEP) and when communication is via an Interpreter.

Una MacConville & Associates were tasked with identifying the challenges for palliative care health care professionals in caring for patients with limited English proficiency and the challenges for interpreters working in these settings. The aim was to improve the quality of palliative care delivered to people with Limited English Proficiency (LEP) by improving the communication skills and cultural competence of health care providers in palliative care and by supporting the interpreters who work in these settings. The purpose of the project was to develop resources to meet the identifed needs.

Following an extensive information gathering process, some core issues were identifed.

Key challenges for Palliative Care professionals:
Core difficulties include the cultural appropriateness of talking about death and dying and knowing the proper rituals for people according to their ethnicity and religious affiliations.

Most palliative care professionals were aware of the range of resources published by the HSE National Social Inclusion Unit such as the Health Services Intercultural Guide: Responding to the Needs of Diverse Religious Communities and Cultures in Healthcare Settings. However, this extensive resource, and others such as the HSE National Social Inclusion Unit resources such as the On Speaking Terms: Good practice guidelines for HSE staff in the provision of interpreter services can be difficult to access easily when needed.

For interpreters working in palliative care contexts:
Attitudes to talking about death and dying can vary considerably across cultures and while palliative care services are well developed in Ireland, palliative care can have differing meanings and levels of service elsewhere.

Through interviews and involvement with training workshops for interpreters, Una MacConville & Associates identified a need for specific information about palliative care services and about interpreting in these contexts. There is also a need to help with some strategies for coping with the difficult emotional issues that may arise when interpreting for people who are dealing with a terminal illness.

Interpreters also need access to this information without the need to attend training workshops and courses as current working conditions for community interpreters can make it difficult to find time and money for continuing professional training and education.

An innovative response
Una MacConville & Associates established a partnership (Communicate Your Health) with the National Social Inclusion Unit (Health Service Executive Ireland) and Dr Regina McQuillan, Palliative Medicine Consultant to develop a number of mobile Apps to meet these identified needs, in collaboration with digital developer Catherine Trebble (http://www.catherinetrebble.com)

The Communicate Your Health Mobile Apps
The Apps
Understand Me mobile App for health care professionals

UNDERSTAND ME features information on caring for ill and dying patients from specific ethnic, religious and cultural groups based on the HSE National Social Inclusion Unit, Health Services Intercultural Guide: Responding to the Needs of Diverse Religious Communities and Cultures in Healthcare Settings.

The App also provides guidelines for healthcare professionals working with interpreters based on the HSE National Social Inclusion Unit On Speaking Terms: Good practice guidelines for HSE staff in the provision of interpreter services which includes definitions and standards for interpreting; different types of interpreting; assessing language needs of patients and working with interpreters in addition to information on palliative care.

Other features include in-app GPS directions to any of the listed Palliative Care services in Ireland and a facility for feedback via one-tap calling or email.

Important announcements about health related community events can be delivered straight to the app.

Speak To Me App for Community Interpreters
Speak To Me was developed with the assistance of the Irish Translators and Interpreters Association (ITIA) and Translator and Interpreter service providers.

The App features the ITIA Code of Ethics for Healthcare Interpreters; good practice guidelines and a guide to self care strategies for working in stressful interpreting contexts.

The App also features information about core aspects of Palliative Care with links to an information video about palliative care featured in the Irish Association of Palliative Care (IAPC) website.

A link to specific on-line tutorials about interpreting in Palliative Care, developed by the California Healthcare Foundation, is provided in addition to further resources about palliative care and for interpreting in Irish healthcare.

Other features include in-app GPS directions to any of the listed Palliative Care services in Ireland and a facility for feedback via one-tap calling or email.

Important announcements about health related community events can be delivered straight to the app.