In this video example, a renal physician and a renal nurse discuss the issue of fluid a medical review with |aritjan, a Yolŋu patient who speaks very little English and has been on dialysis for just a few months.
Click here to watch the video.
In an interview after the interaction the physician gave his interpretation of their discussion about fluid:
I did try and talk to her about fluid intake although she's not putting on too much fluid between dialyses and we asked her and she explained quite clearly - she seemed to have quite a clear understanding about how much she should drink; I asked her how much water and she said she also drank tea and she went into some discussion of the amount she drank..
A very different picture emerged from discussions with the patient and and with her primary carer. Ŋaritjan explained:
..the whole night we drink tea.. they told me to have two cups of tea..
I have one cup of tea but it's a long day so how can I just have two cups
of tea.. I have one cup of tea then another one and drink it then another
one and drink it then another one..
Although these Yolŋu knew 'fluid' was an important issue for staff they clearly had little understanding about the concept or it's importance in renal care. The extent of this misunderstanding is illustrated further by this explanation about fluid from Ŋarritjan's carer (who is relatively fluent in English):
..if they drink fizzy drink the fluid goes up and they've got too much fluid on them..she's supposed to have fluid.. just right for the kidney .. everyday to drink is water, lots of water only or tea; if we make tea with sugar, too much fluid comes in to the body and it gets too big that means they are carrying too much fluid on them...water is alright because water can give them strength...drinking water is good, that's what they said, too much (i.e. a lot) water to keep the kidney flowing, (the doctor) explained - they've all explained about the kidneys and fluid....I don't know (how it builds up) - they haven't explained that to me ..
Ŋarritjan and her carer's misunderstanding about fluid had never been recognised - for a number of reasons.
Ŋarritjan worked hard to communicate effectively with the staff, despite her very limited English and the absence of an interpreter - and she gave the responses she thought they wanted which is appropriate behaviour in Yolŋu communication. This is again illustrated in the following examples:
Click here for an example of misunderstanding about time.
Click here for an example of unrecognised misunderstanding.
After participating in the video analysis the nurse involved in this encounter said:
..just from looking at that video - I just learnt so much from that; I never even considered that they might be saying 'yow' when they are really saying 'no', I never even thought of it; it was really, really interesting that they say they are understanding and they haven't got a clue..
Another strategy used by patients to help communication is repetition of some or all of the staff member's utterance. The next example again illustrates how the patient's efforts to communicate actually 'mask' the misunderstanding:
Click here to view the video.
When this section of video was reviewed with each of the participants they made the following comments:
The nurse said:
(the physician) asked the question about the cramps and she says 'yow'
but because he didn't go back into it - he went straight to his book..
and then I said about the cramps everywhere and she says 'cramps everywhere'-
she was letting me know that she understood what he said..
The physician was also convinced that the communication about cramps
was successful:
..she understood about the cramps by the end of that and was telling us
about her cramps..
However, later discussions and analysis of the videotape revealed that the patient did not understand the English term 'cramp' or the term 'dizzy' or the term 'phlegm', all of which the staff members assumed she understood.