How are the orienting/explanatory theory and the practice theory applied to a Hispanic female who is Spanish-speaking only, which has caused her to be unable to access behavioral health services...

How are the orienting/explanatory theory and the practice theory applied to a Hispanic female who is Spanish-speaking only, which has caused her to be unable to access behavioral health services due to the language barrier causing the individual to experience degeneration of her mental health?

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kipling2448 | (Level 3) Educator Emeritus

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An explanatory theory for the scenario presented in the student’s question involves three main barriers to effective communications and to a satisfactory resolution of the hypothetical individual’s problem.  The first barrier is linguistic; the individual in question is Spanish-speaking and knows little or no English.  The second barrier could involve gender; the individual is a female, and may not receive the attention or level of seriousness she needs, if the personnel with whom she interacts are male, because of primitive assumptions regarding women.  The third barrier is the nature of her condition.  She suffers from a mental disorder, which, combined with the language barrier, would make it extraordinarily difficult to communicate with facility staff.  Assuming, of course, that there are no Spanish-speaking individuals employed at the institution, her inability to communicate the nature of her concerns could result in her being ignored, misdiagnosed, properly diagnosed but poorly treated, or properly diagnosed and properly treated.  The last possibility is dispensed with, as the question presupposes an unsatisfactory resolution of her problem.

Explanatory theories, as the name suggests, seek to explain a situation.  As the U.S. National Institutes of Health defines “explanatory theory,”:

“Explanatory theory describes the reasons why a problem exists. It guides the search for factors that contribute to a problem (e.g., a lack of knowledge, self-efficacy, social support, or resources), and can be changed.” [U.S. Department of Health and Human Services, National Institutes of Health, Theory at a Glance: A Guide for Health Promotion Practice, 2005]

Belief systems that are a product of regional, ethnic, or religious cultures will seek to explain situations or problems through a prism specific to certain individuals or groups.  In the case of the Latina woman, the facility staff, individually or institutionally, may harbor certain prejudices regarding non-native-speaking patients.  Especially with immigration issues, overwhelmingly involving Spanish-speaking peoples, so heated, the appearance of probably economically lower-income non-English-speaking woman with emotional outbursts or erratic behavior could lead to prejudicial treatment from an overworked staff predisposed to judge individuals on the basis of race and income.  An individual such as described in the question could easily ‘fall through the cracks’ of the mental health system by virtue of her inability to communicate.  Now, it is entirely likely that a responsible staff would locate a Spanish-speaking translator able to assist the woman, but, depending upon workload and the possibility of mental exhaustion on the part of the staff, it is entirely possible she would not receive the level of attention required.  An inability to communicate due to a combination of linguistic and emotional or mental difficulties could result in the woman’s failure to receive treatment.

Practice theory is considerably more complicated than explanatory theory, encompassing a much broader array of variables.  In this educator’s opinion, there is no one good definition of practice theory, but one, provided in a paper presented at an academic and professional forum in Sweden, encapsulates it as follows:

“This theory describes and conceptualises workpractices as constellations of actors, actions and action objects (conditions/results). One important part of the theory is a generic model of workpractices.” [Göran Goldkuhl, Practice Theory vs Practical Theory: Combining Referential and Functional Pragmatism, Panel paper to the 4th International Conference on Action in Language, Organisations and Information Systems (ALOIS), 1-2 November 2006, Borås]

Goldkuhl, citing another source on the concept of practice theory, notes that a “practice is considered to be ‘embodied, materially mediated arrays of human activity centrally organized around shared practical understanding’.”  Applying practice theory to the scenario involving the mentally ill Spanish-speaking woman could involve institutional break-downs similar to those described above in the discussion of explanatory theory.  Major league screw-ups often involve systemic problems in which the whole is less than the sum of its parts.  In the case of the scenario, individual staffers at the medical facility could have all been diligent and well-intentioned, but negligent in responding to this individual’s condition.  As noted earlier, mental health and medical facilities tend to operate at a high level with unusual degrees of stress imposed upon overworked, mentally-exhausted personnel.  Even when operating conditions are relatively calm, the nature of the work involved allows little margin for error.  Errors do occur, however, because no system is perfect, and inevitably some step will be missed, some bit of information not conveyed to appropriate officials, etc. (see for a good recent example the failure of the hospital in Texas to properly administer to the patient who died from the Ebola virus.)

Organizations are composed of human beings, and human beings bring both skills and emotional baggage.  A mistake in entering admitting information on a hospital form, a failure of a nurse or physicians to diligently review patient information (for example, missing the reference to an allergy or sensitivity to a particular medication), a failure to double-check instructions involving the administration of medication, and a myriad of other potential errors all exist on a daily basis.  In the case of the hypothetical woman, the obstacles to communication noted above could easily result in her inability to attain the care she needs.  The mission of the hospital or mental health facility is universally understood and the institution’s operating principles acknowledged, but it takes only one deficient or overworked individual to create a dysfunctional environment in which the less-fortunate among us fall through the cracks.

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