Understanding the experiences of healthcare workers in delivering emergency care to culturally and linguistically diverse patients: a qualitative study

Abstract Background : International migrants experience healthcare inequities in the Emergency Department (ED), and little is known about the care delivery of healthcare workers (HCWs) to this population. This study aimed to explore the experience of HCWs in delivering care to patients from racial and ethnic minority backgrounds in Emergency Department. Methods : This study was conducted during the first stage of a five-year experience-based codesign project, employing a qualitative approach. Eligible participants were Australian registered HCWs or non-clinical staff who support or manage clinical care delivery and had worked in the nominated EDs for at least three of the past 12 months. Semi-structured interviews and focus groups took place either in-person or via videoconference. Audio recordings were transcribed for inductive thematic analysis. The COREQ checklist was used to guide the design and conduct of the study. Results : A total of 39 participants (26% doctors, 46% nurses, 5% allied health professionals and 23% non-clinical staff) shared their experience in caring for racial and ethnic minority patients. Three overarching themes were generated: 1) language barriers; 2) diverse cultural norms; 3) poor health system literacy. All participants reported that the biggest challenge was lack of a common language, which presented a barrier to delivering quality care throughout the patient’s journey in the ED. Many HCWs tended to use informal and unregulated interpretation strategies, attributed to the episodic nature of patient communications and interactions and the relative inaccessibility, inconsistency, unavailability, unfeasibility and inaccuracy of formal interpretation services. The diverse cultural norms and poor understanding of ED care procedure were also raised as barriers to delivering person-centred ED care. Conclusions : Understanding HCW experiences of delivering care for this population provides the first step in system improvement to make care delivery safe, culturally sensitive and accessible. Opportunities to make ED care culturally sensitive include extending the capacity and ease of access to interpretation/translation, through both formal services and complementary strategies. Partnering with patients and cultural community centres could offer a feasible approach to co-design and disseminate health system literacy education. Registration Language barriers created a hindrance for ED clerks to collect basic information from CALD patients for registering them into the system.