Patients who don’t speak English pose challenges
When a non-English-speaking patient entered an ED clutching his abdomen, nurses quickly ushered him into an examining room and took vital signs, because they were anticipating the need for possible abdominal surgery. While staff searched for a translator, the patient continued to point to his lower abdomen, recalls Ruth Davidhizar, RN, DNS, CS, FAAN, dean of nursing at Bethel College in Mishwaka, IN, and co-author of Transcultural Nursing: Assessment and Intervention. "No physical signs of distress appeared from the assessment," she adds.
When the translator finally arrived, he was rushed into the room to talk to the patient, says Davidhizar. "The translator turned and told the staff, This man came into the ED because he was looking for a bathroom. He only needs a bathroom.’" While humorous, this incident illustrates the importance of accurate translation for non-English-speaking patients, says Davidhizar.
"We need to do the best we can for the patient to elicit all of the history so nothing is missed, using the best source possible at the time," says Kathie Carlson, RN, MSN, CEN, patient care manager at New York United Hospital Medical Center in Port Chester.
Here are ways to improve care of non-English-speaking patients by using translators as appropriate:
• Try to use a translator with a medical background.
You need to have ready access to a medical translator, argues Davidhizar. "Many hospitals have a telephone service that allows them to call in and get a translator on the phone," she suggests. If you don’t subscribe to a telephone service, Davidhizar recommends having a list of resources in your community who can translate. "It is critical to have someone who can clearly explain what you need to communicate, if culturally competent care is to be delivered," she adds.
At New York United’s ED, a roster of personnel and the languages they speak is kept in a central location. "We’ve been very lucky finding individuals who can translate using the same dialect, while making the person feel comforted," Carlson reports. Obviously, the best interpreters are medical personnel, says Carlson. "Unfortunately, we don’t have many who are bilingual. I do have some nurse technicians who are fluent in Spanish," she says.
However, she cautions that using clinicians for translation has pros and cons. "At times, a lot of translation is necessary, pulling that technician away from their duties," she explains. "These tasks aren’t being done by anyone else, which causes animosity from other staff members."
• Use a translator who can relay nonverbal communication.
To ensure that no information is missed, a translator is needed who understands the verbal and nonverbal nuances of the language, Davidhizar explains.
If patients cannot read, the challenges are greater, says Carlson. "Many years ago, I worked in an area that had an influx of Cambodians. I thought I was smart and developed index cards with pertinent questions and found someone to write it in the Cambodian language," she says. "I then discovered that most Cambodians at the time were unable to read their own language."
Use ongoing communication
• Use translators throughout the ED visit.
Davidhizar emphasizes that translators are needed throughout the patient’s ED visit: when explaining procedures, when doing discharge planning, when consents are signed, when teaching is done, and to reassure patients regarding their concerns. "Culturally appropriate care cannot be provided without ongoing communication," she says.
• Use the most appropriate translator when possible.
When a non-English speaking patient arrives, the triage nurse needs to "feel out" the situation as best he or she can, says Carlson. "If the patient has a problem of a personal nature, it’s best to have a person of the same sex who is compassionate and caring doing the translation," she explains. "It could be awkward for the patient to share a personal problem with a security guard."
Carlson says she is "cautious" using family members for translation. "It may be embarrassing to the patient," she says. "Also, in some cultures, there is a dominance in the family, and you will only get the information the translator is willing to provide." Still, Carlson acknowledges that there are times when you must "settle" for anyone who can do the translation. "That’s unfortunate, but we are also dictated by time and volume constraints," she says.
Sources and resources
For more information about caring for non-English-speaking patients, contact:
• Kathie Carlson, RN, MSN, CEN, New York United Hospital Medical Center, 406 Boston Post Road, Port Chester, NY 10573. Telephone: (914) 934-3087. Fax: (914) 934-3586. E-mail: [email protected].
• Ruth Davidhizar, RN, DNS, CS, FAAN, Dean of Nursing, Bethel College, 1001 W. McKinley Ave., Mishwaka, IN 46545. Telephone: (219) 257-2594. E-mail: [email protected].
Here is a partial listing of companies that offer telephone translation services:
• America Translating Services, P.O. Box 800272, Santa Clarita, CA 91380. Tele- phone: (800) 535-0555. Fax: (800) 316-2230. E-mail: [email protected]. Web: www.am-translating.com.
• Language Line Services, One Lower Ragsdale Drive, Bldg 2, Monterey, CA 93940. Telephone: (800) 752-0093, ext. 196. E-mail: [email protected]. Web: www.languageline.com.
• New World Language Services, 165 W. Hospitality Lane, Suite 10, San Bernadino, CA 92408. Telephone: (800) 873-9865 or (909) 388-1798. Fax: (909) 388-1796. E-mail: [email protected]. Web: http://www.nwlang.com/.
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