Pamela Garrett - Academia.edu (original) (raw)

Papers by Pamela Garrett

Benjamins Translation Library, 2009

This chapter explores healthcare interpreter policy in the wider context of broader healthcare ag... more This chapter explores healthcare interpreter policy in the wider context of broader healthcare agendas and changing multicultural policies. It questions whether the interpreter policy objective of universal access for limited English speakers is viable in the context of the rapidly changing modern healthcare environment. This chapter reviews some interesting new material derived from my research on modes of language facilitation in a pilot hospital and the experiences of patients with limited English proficiency. The chapter makes a series of challenging suggestions for future healthcare interpreter service policy.

Ethnicity & Health, 2008

To investigate the level of healthcare complexity of patients with limited English and the probab... more To investigate the level of healthcare complexity of patients with limited English and the probability of use of professional interpreters, at a tertiary hospital in a multicultural area of Sydney, Australia. A multilingual telephone survey was matched with medical record reviews to assess modes of communication in a sample of 258 patients with limited English from nine language groups. The Model of Interpreter Usage and Complexity was used to explain the association between clinical complexity and interpreter usage. To measure clinical complexity, a summative rating scale, the Communication Complexity Score (CCS) was constructed comprising eight weighted scores related to admission status, urgency of admission, triage category, medical emergencies/events, HDU/ICU admission, numbers of medications, invasiveness of procedures, and diagnosis. Robust Multiple Logistic Regression was used for modelling the likelihood of interpreter usage with different levels of complexity. Of the 205 patients (79%) who spoke little or no English, 31% reported usage of professional interpreters. There was a positive association between CCS and usage of interpreters. Patients with high and moderate CCSs were significantly more likely to have used interpreters (OR=32.9, 95% CI 12.4-87.1 and OR=10.8, 95% CI 3.2-36.5, respectively). The CCS was found to have good psychometric properties and to be internally consistent (Cronbach's Alpha 0.84). The model was found to have good predictive power (Area under the Receiver Operating Characteristic curve 0.90). While most patients (69%) had no interpreter, patients with high or moderate CCSs were more likely to have an interpreter, demonstrating a robust relationship between these two variables. Poor usage of interpreters in the Emergency Department was observed. Family and friends had a significant role in communication. These findings have important safety, policy, and practice implications for patients with limited English proficiency.

Ethnicity & Health, 2008

Objective. The purpose of this research was to locate cultural competence within the experiential... more Objective. The purpose of this research was to locate cultural competence within the experiential domain of the non-English-speaking patient. Design. Seven language-specific focus groups were held with 59 hospital patients and carers of patients with limited English to better understand their experience and to identify critical factors leading to their constructions of care. Grounded theory analysis within a constructivist perspective was undertaken. Results. While the majority of patients were positive about their hospital experience, the theme of powerlessness appeared central to many patient experiences. Language facilitation was the most common issue. Inattention to specific cultural mores and racism in some instances contributed to negative experiences. Patients primarily valued positive engagement, information and involvement, compassionate, kind and respectful treatment, and the negotiated involvement of their family. Conclusion. Because of the specific nature of each patientÁprovider interaction within its particular social and political environment, culturally competent behaviour in one context may be culturally incompetent in another. We propose a model of cultural empowerment that reflects the phenomenological basis of cultural competence in that cultural competence must be consistently renegotiated with any particular patient in a particular healthcare context. Similarly, ongoing community consultations are needed for health services and organisations to retain cultural competence.

Australian Health Review, 2008

Access to care for patients remains a concern for all parties in the provision of hospital servic... more Access to care for patients remains a concern for all parties in the provision of hospital services. It is the subject of patient complaints, large investments of funds and vigorous debate in the community, hospitals and the political arena. This is a common problem in developed nations. There has been little achievement in information technology solutions to this significant problem in Australia. This paper presents a case study of the development and implementation of an organisational access display system intended to provide realtime, or near to real-time information and feedback on access for staff on the floor. This is believed to be one of the first times such a development has been reported in the Australian literature, albeit limited to the context of a single organisation.

Australian and New Zealand Journal of Public Health, 2006

Since the rise of al-Qaeda and the 11 September 2001 attacks in the United States, an increase in... more Since the rise of al-Qaeda and the 11 September 2001 attacks in the United States, an increase in the anecdotal evidence of antiMuslim prejudice, discrimination and race-related incidents in Australia has been documented. The media’s reaction in linking negative representations of asylum seekers, globalised terrorism and local crime has been described as “a moral panic” contributing to community vilification and discrimination. The Cronulla riots in Sydney in December 2005 have further polarised community opinion related to the settlement of Muslim Australians. In December 2004, we conducted a qualitative study of 64 patients and 10 carers in a western Sydney area servicing a large Arabic-speaking population. Patients were drawn from seven language groups including Vietnamese, Spanish, Italian, Croatian, Serbian, Chinese and Arabic. The aim was to understand their acute hospital experience. Information on racism or prejudice was not specifically sought. It emerged, however, but only within the Arabic-speaking group, which had 11 participants. Racism was deemed to be present when a patient considered they/their family were treated less fairly or respectfully because of their race or ethnic origin. Arabic-speaking patients at times articulated a sense of separateness or difference based on particular cultural beliefs, particularly related to female modesty, the wearing of the hijab (scarf), mixed gender wards, and examination of females by male providers. Others believed that Muslims or Arabic-speaking people were perceived negatively, and consequently may be treated inequitably. The following quotes were extracted as exemplars illustrative of this from the translated transcripts. “I never saw the nurse again. Opposite me there was an Australian patient and she treated her the best, contrary to how she was treating me. – Elderly Muslim woman

Australia and New Zealand Health Policy, 2010

Background: No recent Australian studies or literature, provide evidence of the extent of coverag... more Background: No recent Australian studies or literature, provide evidence of the extent of coverage of multicultural health issues in Australian healthcare research. A series of systematic literature reviews in three major Australian healthcare journals were undertaken to discover the level, content, coverage and overall quality of research on multicultural health. Australian healthcare journals selected for the study were The Medical Journal of Australia (MJA), The Australian Health Review (AHR), and The Australian and New Zealand Journal of Public Health (ANZPH). Reviews were undertaken of the last twelve (12) years (1996-August 2008) of journal articles using six standard search terms: 'non-English-speaking', 'ethnic', 'migrant', 'immigrant', 'refugee' and 'multicultural'. Results: In total there were 4,146 articles published in these journals over the 12-year period. A total of 90 or 2.2% of the total articles were articles primarily based on multicultural issues. A further 62 articles contained a major or a moderate level of consideration of multicultural issues, and 107 had a minor mention. Conclusions: The quantum and range of multicultural health research and evidence required for equity in policy, services, interventions and implementation is limited and uneven. Most of the original multicultural health research articles focused on newly arrived refugees, asylum seekers, Vietnamese or South East Asian communities. While there is some seminal research in respect of these represented groups, there are other communities and health issues that are essentially invisible or unrepresented in research. The limited coverage and representation of multicultural populations in research studies has implications for evidence-based health and human services policy.

Benjamins Translation Library, 2009

This chapter explores healthcare interpreter policy in the wider context of broader healthcare ag... more This chapter explores healthcare interpreter policy in the wider context of broader healthcare agendas and changing multicultural policies. It questions whether the interpreter policy objective of universal access for limited English speakers is viable in the context of the rapidly changing modern healthcare environment. This chapter reviews some interesting new material derived from my research on modes of language facilitation in a pilot hospital and the experiences of patients with limited English proficiency. The chapter makes a series of challenging suggestions for future healthcare interpreter service policy.

Ethnicity & Health, 2008

To investigate the level of healthcare complexity of patients with limited English and the probab... more To investigate the level of healthcare complexity of patients with limited English and the probability of use of professional interpreters, at a tertiary hospital in a multicultural area of Sydney, Australia. A multilingual telephone survey was matched with medical record reviews to assess modes of communication in a sample of 258 patients with limited English from nine language groups. The Model of Interpreter Usage and Complexity was used to explain the association between clinical complexity and interpreter usage. To measure clinical complexity, a summative rating scale, the Communication Complexity Score (CCS) was constructed comprising eight weighted scores related to admission status, urgency of admission, triage category, medical emergencies/events, HDU/ICU admission, numbers of medications, invasiveness of procedures, and diagnosis. Robust Multiple Logistic Regression was used for modelling the likelihood of interpreter usage with different levels of complexity. Of the 205 patients (79%) who spoke little or no English, 31% reported usage of professional interpreters. There was a positive association between CCS and usage of interpreters. Patients with high and moderate CCSs were significantly more likely to have used interpreters (OR=32.9, 95% CI 12.4-87.1 and OR=10.8, 95% CI 3.2-36.5, respectively). The CCS was found to have good psychometric properties and to be internally consistent (Cronbach's Alpha 0.84). The model was found to have good predictive power (Area under the Receiver Operating Characteristic curve 0.90). While most patients (69%) had no interpreter, patients with high or moderate CCSs were more likely to have an interpreter, demonstrating a robust relationship between these two variables. Poor usage of interpreters in the Emergency Department was observed. Family and friends had a significant role in communication. These findings have important safety, policy, and practice implications for patients with limited English proficiency.

Ethnicity & Health, 2008

Objective. The purpose of this research was to locate cultural competence within the experiential... more Objective. The purpose of this research was to locate cultural competence within the experiential domain of the non-English-speaking patient. Design. Seven language-specific focus groups were held with 59 hospital patients and carers of patients with limited English to better understand their experience and to identify critical factors leading to their constructions of care. Grounded theory analysis within a constructivist perspective was undertaken. Results. While the majority of patients were positive about their hospital experience, the theme of powerlessness appeared central to many patient experiences. Language facilitation was the most common issue. Inattention to specific cultural mores and racism in some instances contributed to negative experiences. Patients primarily valued positive engagement, information and involvement, compassionate, kind and respectful treatment, and the negotiated involvement of their family. Conclusion. Because of the specific nature of each patientÁprovider interaction within its particular social and political environment, culturally competent behaviour in one context may be culturally incompetent in another. We propose a model of cultural empowerment that reflects the phenomenological basis of cultural competence in that cultural competence must be consistently renegotiated with any particular patient in a particular healthcare context. Similarly, ongoing community consultations are needed for health services and organisations to retain cultural competence.

Australian Health Review, 2008

Access to care for patients remains a concern for all parties in the provision of hospital servic... more Access to care for patients remains a concern for all parties in the provision of hospital services. It is the subject of patient complaints, large investments of funds and vigorous debate in the community, hospitals and the political arena. This is a common problem in developed nations. There has been little achievement in information technology solutions to this significant problem in Australia. This paper presents a case study of the development and implementation of an organisational access display system intended to provide realtime, or near to real-time information and feedback on access for staff on the floor. This is believed to be one of the first times such a development has been reported in the Australian literature, albeit limited to the context of a single organisation.

Australian and New Zealand Journal of Public Health, 2006

Since the rise of al-Qaeda and the 11 September 2001 attacks in the United States, an increase in... more Since the rise of al-Qaeda and the 11 September 2001 attacks in the United States, an increase in the anecdotal evidence of antiMuslim prejudice, discrimination and race-related incidents in Australia has been documented. The media’s reaction in linking negative representations of asylum seekers, globalised terrorism and local crime has been described as “a moral panic” contributing to community vilification and discrimination. The Cronulla riots in Sydney in December 2005 have further polarised community opinion related to the settlement of Muslim Australians. In December 2004, we conducted a qualitative study of 64 patients and 10 carers in a western Sydney area servicing a large Arabic-speaking population. Patients were drawn from seven language groups including Vietnamese, Spanish, Italian, Croatian, Serbian, Chinese and Arabic. The aim was to understand their acute hospital experience. Information on racism or prejudice was not specifically sought. It emerged, however, but only within the Arabic-speaking group, which had 11 participants. Racism was deemed to be present when a patient considered they/their family were treated less fairly or respectfully because of their race or ethnic origin. Arabic-speaking patients at times articulated a sense of separateness or difference based on particular cultural beliefs, particularly related to female modesty, the wearing of the hijab (scarf), mixed gender wards, and examination of females by male providers. Others believed that Muslims or Arabic-speaking people were perceived negatively, and consequently may be treated inequitably. The following quotes were extracted as exemplars illustrative of this from the translated transcripts. “I never saw the nurse again. Opposite me there was an Australian patient and she treated her the best, contrary to how she was treating me. – Elderly Muslim woman

Australia and New Zealand Health Policy, 2010

Background: No recent Australian studies or literature, provide evidence of the extent of coverag... more Background: No recent Australian studies or literature, provide evidence of the extent of coverage of multicultural health issues in Australian healthcare research. A series of systematic literature reviews in three major Australian healthcare journals were undertaken to discover the level, content, coverage and overall quality of research on multicultural health. Australian healthcare journals selected for the study were The Medical Journal of Australia (MJA), The Australian Health Review (AHR), and The Australian and New Zealand Journal of Public Health (ANZPH). Reviews were undertaken of the last twelve (12) years (1996-August 2008) of journal articles using six standard search terms: 'non-English-speaking', 'ethnic', 'migrant', 'immigrant', 'refugee' and 'multicultural'. Results: In total there were 4,146 articles published in these journals over the 12-year period. A total of 90 or 2.2% of the total articles were articles primarily based on multicultural issues. A further 62 articles contained a major or a moderate level of consideration of multicultural issues, and 107 had a minor mention. Conclusions: The quantum and range of multicultural health research and evidence required for equity in policy, services, interventions and implementation is limited and uneven. Most of the original multicultural health research articles focused on newly arrived refugees, asylum seekers, Vietnamese or South East Asian communities. While there is some seminal research in respect of these represented groups, there are other communities and health issues that are essentially invisible or unrepresented in research. The limited coverage and representation of multicultural populations in research studies has implications for evidence-based health and human services policy.