Research Question: what are midwives’ experiences of communicating with non-English
Central to midwifery practice is
good communication skills (Nicholls and Webb, 2006). When messages become
distorted, due to the ‘sender’ and ‘receiver’ speaking a different language
errors in communication occur (Dysart-Gale, 2007). This has led to detrimental
consequences according to Saving Mothers Lives (2011). With the increasing
diversity of society, it has become increasingly common for midwives to care
for women who speak a language other than English. There are many tools and
resources available to help interpret, such as interpreters, language line, and
many apps available online. Due to gaps
and lack of research and literature available on the experiences of midwives
communicating with non-English speaking women, the research question “what are midwives’ experiences of communicating with non-English
speaking women?” was developed.
Aim of this study: This study aims to explore midwives’ experiences of communicating with non-English
speaking women to identify areas of communication skills, which can be
improved or developed to provide
safe and essential maternity care.
Methods: The research method is a descriptive
qualitative research and the methodology chosen and best suited to this study phenomenology.
Sample: The researcher intends to use 10-12 registered midwivesL1 who fit the
outlined criteria chosen through purposive samplingL2 . It is
proposed that that the clinical manager of the chosen midwifery led team will
distribute letters of invitation and consent forms to registered midwivesL3 .
Data collection- The proposed method for data
collection is open-ended
semi-structured interviewsL4 which will be audio taped to maintain accurateL5 accounts of
information givenL6 .
Data Analysis: The researcher proposes
to make use of …(method….….
data analysis approach following the transcription of audio recorded informationL7 .
Findings: It is hoped that the outcome of this
study raises awareness of diverse needs of women with in regards to
communication skills and issues. Hopefully with the knowledge gained from
midwives’ experiences and perceptions improve standard and quality
communication and its skills for women whose first language is not English
does ethics come into this? How will you seek ethical approval?
In the UK as the population is
becoming increasingly diverse, languages are also becoming very diverse.
fundamental to midwifery is good communication skills (Nicholls and Webb,
2006). One of the greatest threats to patient safety as disclosed by Paul and
Schyye (2007), is poor communication between members of staff and pregnant
women. Between years 2006-2008 26 women died and their death has been linked to
language barriers as suggested by CMACE (2011). What attributed to this was
that, those women were not able to provide a full medical history, which then
adversely resulted in poor decision making by the multi-disciplinary team
It has become increasingly common for midwives to care for women who do
not speak English, and UK interpreting services are often inadequate and
underused. Persistent language barriers have been found to contribute to
maternal and perinatal mortality thus it is essential that these barriers are
overcome to provide safe maternity care.
suggest, that, trained translators are not always approached by staff members
(Gerrish et al, 2004). And there are many reason for this, such as availability
of interpreters at a given and chosen time (Gerrish et al, 2004) and limited
time and budgets by teams (MacFarlane et al, 2009). Evidence also shows that when interpreters
are required at a certain, given time, they may not always attend, this may be
due to travelling issues; or even overbooking issues (Hadziabdic et al, 2010).
Due to the shortages of interpreters, a lot of the time friends and family
members of patients are relied on to interpret. However, this is conflicting to what the national
recommendations by NICE, 2010 say and guided by the NMC code of conduct health
professionals are aware of the potential ethical and legal results of their
use. According to Meddings and Haith-Cooper, (2008) by doing this patient
confidentiality, safety and privacy can be held at stake. This can then also lead
to negative effects on the relationships between family members when
information is being passed over (Gerrish et al, 2004). Also by using friends
and family to interpret the information may be edited, misinterpreted and
misunderstood whilst translating, (Dysart-Gale, 2007). As a result of this
insufficient informal interpreting, previous studies carried out have shown
that misinterpretation has led to wrong-diagnosis of illnesses and also incorrect
treatment of conditions (Gerrish et al, 2004).
UK, approximately 10% of babies are born to non-English-speaking women (NICE, 2010). According to Saving Mothers
Lives it found an increase in the numbers of births to migrant women, and a
corresponding increase in perinatal deaths among migrant women arriving in the
UK in poor health, 10% of the deaths were in women who could not speak
English (Lewis, 2007). Women from non-English speaking backgrounds were seen less
likely to use written and online resources regarding their pregnancy as stated
by Grimes, Forster, & Newton (2014). Which suggest
that it is vital for women to communicate their needs to ensure safe maternity
care is obtained.
the cost implications of providing interpreters, the limitations of current
interpreting services and
the link between language barriers and health outcomes, there is an urgent need
to develop novel and sustainable approaches to overcome language barriers for
non-English-speaking women who access maternity services. With the gathering of
experiences and perceptions of midwives on communicating with these ladies, it
can be identified if there remain inadequate resources. As available resources
are quite outdated, collecting this new data can reveal if changes have
occurred and more measures are being out in place to avoid any
misunderstanding and miss-communications.
Aims and Objectives
The overall purpose of the research is therefore to find an
answer to the research question.
This study aims to explore midwives’ experiences of communicating with non-English
speaking women to identify areas of communication skills, which can be
improved or developed to provide
safe and essential maternity care. And to end these barriers which could
result in inadequate care for women.
Also to gain an understanding if midwifes have a
positive or negative experience communicating with non-English speaking women.
There is an absence of both British
and international research into this chosen area, and to address this issue the
author proposes to carry out this study. The researcher will outline and
discuss the most appropriate methods of design, sample selection, data
collection and analysis. There will also be a description of the ethical
considerations necessary to complete the proposed study.
In Midwifery many questions arise that require
answers, and for that there are many research approaches to cover this (Rees,
1997). Two approaches are used in midwifery research; quantitative and qualitative
(The NHS Executive, 1998). The design
selected for research should be the one most suited to provide an answer to the
proposed research question (Parahoo, 2006). Qualitative studies allow
researchers to explore behaviours, perspectives, feelings, and experiences in
depth, quality and complexity of a situation through a holistic framework
(Holloway and Wheeler 2002). For this reason,
to obtain an answer for the purposed question the researcher has chosen to
carry out a qualitative research design. Qualitative research is a systematic,
subjective approach to describe life experiences, it uses a holistic approach
which makes it seem to have greater validity (Burns and Grove 2009). In
contrast quantitative research is a formal systematic approach which
incorporates numerical data (Burns and Grove 2009), which would not be suitable
to gain the information required for this study. Rather
than statistics, the aim is to find out people’s feelings and experiences (Rees,
qualitative research can produce limited data, which makes the findings not very
widely generalizable (Burns & Grove, 2009). Usually the research topic, is
quite close to the researcher, for that reason researchers should be cautious, to
ensure that they themselves do not bring in their personal bias views to interpret
findings and have a negative effect on the results of the research (Rees,1997).
There are four common approaches within
qualitative research, phenomenology, grounded theory, ethnography, and historiography.
Whereas, Phenomenological studies
examine human experiences through lived experiences (Donalek, 2004, p.
35) ethnography means “learning from people” (Cameron, 1990). According to
Leininger (1985), ethnography can be defined as “the systematic process of
observing, detailing, describing, documenting, and analysing the lifeways or
particular patterns of a culture to grasp the lifeways or patterns of the
people in their familiar environment”. Developed
by two sociologists, Glaser and Strauss (1967), Grounded theory studies are
studies in which data are gathered and analysed and then a theory is developed
that is grounded in the data. Grounded
theory is more concerned with the data gathered that the hypotheses. Within this,
data are constantly compared to data that have already been gathered know as
the process of constant comparison. Even though difficult to conduct than some
of the other types of research, historiography concern the identification,
location, evaluation, and synthesis of data from the past. In Historical research as well as discovering
events of the past, these events are also compared to the present and to the
future. Leininger (1985, p. 109) wrote, “Without a past, there is no meaning to
the present, nor can we develop a sense of ourselves as individuals and as
members of groups”.
the literature review demonstrates the lack of research, on the researchers
chosen question, phenomenological research is suitable to use on such a study area; in which there is
little knowledge and literature available (Donalek, 2004).
advantages of phenomenological research are as following (Crotty, 1996);
Help to give a
better understanding of real life situation and experiences
Good at surfacing
deep issues and making voices heard.
The ability to
query and probe in-depth issue of a phenomenon
of data – time consuming.
Sample size – it
can be hard to get over to people that a single-figure sample is valid.
gaining access to participants for more than a single session of an hour or
originated within the phenomenology tradition, however is misinterpreted by
many. Bracketing is a process used to ease the possibly harmful effects of
preconceptions that may alter the research process. Due to the confusion and
debate around bracketing; there is a lack of a uniform definition. Different authors associate bracketing with;
beliefs and values (Beech, 1999); biases (Creswell and Miller, 2000); emotions
(Drew, 2004) preconceptions and assumptions (Charmaz, 2006) about the
phenomenon under study.
effective method of bracketing would be to involve non-clinical related individuals
from an outside source to engage in the interviews, this would elevate any biases
and preconceptions present (Rolls & Relf, 2006).
idea of a phenomenological approach is not to collect numerical data but to
understand and acknowledge the experiences midwives have whilst communicating
with non- English-speaking women. And for this reason, the proposed method for
data collection is open-ended semi-structured interviews which will be audio
taped to maintain accurate accounts of information given.
the sampling strategy in a qualitative research there includes; purposive,
convenience, snowball and theoretical. Convenience being the easiest, least rigorous
technique, which involves selecting the most accessible people; which, conversely
may result in biased, poor quality and unmeaningful data which could lead to
doubtful credibility (Malterud, 2001).
Even though this strategy may be economical friendly for the researcher as it requires
the least effort, time and money from the researcher it is doubtful.
sampling is entirely controlled by the developing theory. A technique of collecting
data for creating a theory whereby the analyst jointly “collects, codes,
and analyses his data and decides what data to collect next and where to find
them, in order to develop the theory as it emerges” (Glaser and Strauss, 1967).
sampling includes approaching those who fit the characteristics required to
take part in the study; this again would lead to bias result (Marshall, 1996).
the sampling strategy most suitable for this study would be the purposive strategy
as the researcher would try to obtain a sample the would be a representation of
a wider population (Coyne, 1997).