Collaborating with an interpreter
it is discussion board response for two posts , one paragraph each and one reference for each
Collaborating with an interpreter
While working in the labor and delivery area I have heard many different types of languages. It is very challenging trying to provide quality care for these patients even when interpreters are present. However, well trained nurse-interpreters have been very helpful and make a big difference. There are times when we have to settle with interpreters who do not have as much experience. Adequate communication and understanding is key to positive client outcomes.
There are things I see as the greatest challenge to providing care when the client does not speak English. For my specific area of nursing which is Labor and Delivery (L&D), I find the greatest challenge to providing care to a non-English speaking client is the lack of communication. For example, many clients request a spinal epidural for labor and pain management and comfort are very important to the nurses and staff. Many times the client has a difficult time explaining how they are feeling and what they would like done to help the client cope. This does apply to all clients, but seems to be common in non-English speaking clients. Another challenge is ensuring I am accommodating their cultural requests correctly and to the best of my ability. The breakdown in communication that can occur can cause time delays which can be crucial in labor and delivery. Even when every effort is made to ensure effective interpretation, neither the nurse nor the interpreter can completely be sure that accurate communication has been accomplished (Giger, 2008).
There are times we have had to use a family member during an emergency while waiting on an interpreter to come. This still does not mean the information was correctly translated to the client. Often information or explanations are given by families, which might mean that important information is never translated because of limitations in language ability, cultural barriers or social ties to next of kin (Hadziabdic & Hjelm, 2013). Lastly, I think a challenge to providing care to non-English speaking clients is the time it requires. Many times nurses and physicians are pressed for time and can take the easier route and use a family member to translate. It takes longer to see a patient with an interpreter, and detailed explanations may be cut short (Edison, Jeanetta, & Staiculescu, 2011). Ensuring proper communication will decrease misdiagnosis. Ensuring the client understands all information presented can be very timely.
The facility I work for uses the Pacific interpreters, but we have recently purchased a tablet that allows a face-to-face interaction with an interpreter at the bedside. This has saved us a lot of time, but it can also be challenging ensuring the client understands and can hear what is being said. We do use a family member if it is an emergency or if they patient declines an interpreter and the family member speaks and understands English well. There are times when the client declines an interpreter due to not understanding the importance of proper communication or for privacy. If the patient agrees to an interpreter we always provide them with an interpreter at the bedside, over the phone, or an interpreter by using the tablet at bedside.
I think there are things that can be done to improve the process of providing care to non-English speaking clients. I think ensuring the client has an interpreter present if needed should not be as complicating as it is at times. Research suggests that compassionate nursing may increase patient satisfaction in non-English-speaking patients (Phan & Dean, 2015). I think taking time and showing compassion will help improve client care. It will also allow the client to trust the nurse and establish a client-nurse relationship. An example would be if a nurse and interpreter are having problems helping the client understand medical information and the nurse remains patient and kind through the long process. I think this sends a message to the client saying we care and helps to ease any anxiety there is. I think it is important for healthcare facilities to continuously look for ways to ensure adequate client care to non-English speaking clients. Another way to improve the process of providing care for non-English speaking clients is to have an interpreter available twenty-four hours at the facility itself. I can see how this would be costly, but I think the benefits from having an interpreter around the clock in house would decreases cost in other areas. For example, millions are spent on hospital acquired infections which could be related to the lack of understanding. So if a non-English speaking clients gets their point across at the beginning of visit perhaps they will do what is needed to be discharged sooner. Sometimes the wait for an interpreter causes a breakdown in communication.
Hadziabdic, E., & Hjelm, K. Working with interpreters: practical advice for use of an interpreter in healthcare. International Journal of Evidence-Based Healthcare, 11, 69-76. http://dx.doi.org/10.1111/1744-1609.12005
Edison, K., Jeanetta, S., & Staiculescu, I. (2011). PRACTICE GAPS—Providing Appropriate Patient Education Materials for Non–English-Speaking Patients. JAMA Dermatol, 147, 244. http://dx.doi.org/10.1001/archdermatol.2011.2.
The purpose of this discussion post is to talk about collaborating with interpreters and what my experience has been in working with patients who do not speak English and to answer a few questions on the issue of nurses being utilized as unofficial interpreters for non-English speaking patients. The use of an official interpreter should always be utilized unless one is not available and in that case a family member can be ok to use but a child should never be used as an interpreter (Giger & Davidhizar, 2013).
I feel, probably like other health care providers that the biggest challenge in treating people who speak a different language is simply making an error in treatment. If the medical staff is not getting a proper interpretation of the complaints and symptoms from the patient then inadequate or even wrong treatment and diagnoses could be performed/administered. It is always our number one goal as nurses to do no harm no matter the culture of the patient or their health issues. According to Elderkin-Thompson, Silver & Waitzkin (2001) there were numerous reasons that medical errors could occur when the nurse is the unofficial interpreter for the patient instead of utilizing a trained, official interpreter and included but were not limited to doctors not restating the issue for clarification and misunderstandings of how to interpret cultural metaphors not known to the English speakers.
I work at a very small, privately owned assisted living facility and I utilized our employee handbook to see if we had any policies on what our plan would be if we should have a resident that does not speak English and we do not currently have a policy on non-English speaking residents. At this time all of our residents speak English however we do have a handful of employees of whom English is not their first language and at times residents have trouble understanding them due to their accents. I will have to ask the owner what we would do should we admit a resident that does not speak English. I did work at another facility years ago where we did admit a female who did not speak English and she suffered from dementia among many other mental health issues and it was very difficult to administer any kind of medical treatment to her as it was difficult to speak to her. We did have to utilize family members to translate but even then that proved difficult as she was upset with them for placing her in an assisted living facility. I was eventually able to build a bit of a rapport with her through positive body and hand language and got her to trust me enough to take her medication.
I think that in a larger setting such as a hospital it would be beneficial to have a staff in-service meeting as often as necessary to discuss issues that staff nurses have run into with non-English speaking clients so that the staff can form ways to help prevent those issues in the future. Usually when a group of people come together with a common goal it helps others to speak up on their feelings on the issue (Bentancourt, Renfrew, Green, Lopez & Wasserman, 2012). This may seem childish but some places could also have interpretation cards made up to use in case time is of the essence or to use while they wait on the interpreter. The cards could have simple medical terms in another language with the English equivalent on them. I know it’s not 100% fool proof but it could be helpful especially in an emergency situation.
Bentancourt, J., Renfrew, M., Green, A., Lopez, L., & Wasserman, M. (2012, September). Improving Patient Safety Systems for Patients With Limited English Proficency [PDF]. Rockville, MD: AHRQ.
Elderkin-Thompson, V., Silver, R. C., & Waitzkin, H. (2001). When nurses double as interpreters: A study of Spanish-speaking patients in a US primary care setting. Social Science & Medicine, 52(9), 1343-1358. doi:10.1016/s0277-9536(00)00234-3
Giger, J. N., & Davidhizar, R. E. (2013). Transcultural nursing: Assessment and intervention. St. Louis, MO: Mosby Elsevier
Giger, J. (2008). Transcultural Nursing Assessment & Interventions (6th ed.). St.Louis, MO: Mosby Elsevier.
Hayes, V. (2016). The Road to Cultural Competency: Are We There Yet? Kansas Nurse, 91, 11-14. Retrieved from http://eds.b.ebscohost.com.proxy.library.ohiou.edu/eds/pdfviewer/pdfviewer?sid=2342f408-1fa0-4a99-91b5-071a1e0e7db4%40sessionmgr105&vid=3&hid=117
Phan, J., & Dean, P. (2015). The Effect of Compassionate Nursing on Non-English-Speaking Patients. International Journal for Human Caring, 19, 7-11. http://dx.doi.org/10.20467/1091-5710-19.3.7