Non-English speaking patients

  1. I am just beside myself trying to take care of patients who speak NO English. I work in Neuro. Last night, fully 10% of our patients were Spanish only. It's driving me crazy, mostly because I can't do my job. I can't make assessments of subtle changes in language and understanding, word slurring, short term memory, any number of things that are just basic. I can't do an NIH stroke scale. I can't assess for receptive or expressive aphasia...

    I can't explain to the wife that her little old demented husband with chronic renal failure will undergo a full code if his heart stops and does she want him to have a tube put in his throat and does she want us to shock his heart to make it start again and would she want her husband supported on a ventilator if it came to that.

    I can't explain to a Latino man that I must put a catheter up his urethra and into his bladder, or why we're starting an IV, or putting an NG tube in his stomach.

    I find out days later that the family thinks dad is unresponsive because we are giving him medicines that make him groggy. I can't tell them that it's his disease not his treatments doing this.

    And on and on and on.

    We get by (barely) because usually (but not always) we have a CNA who speaks Spanish.

    I've tried the tapes. I've tried the books. I'm thinking about going to the local Community College and starting classes. It's so tedious, it feels so futile.

    Why... oh, why can't people who come here make learning English a top priority? How is it that we have so many in the hospital who don't?
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  2. 13 Comments

  3. by   caroladybelle
    And how much of the nuances that you are trying to communicate to them, will actually come across to them, from English learned from a course, if they are not using it among their own community.
  4. by   VivaLasViejas
    I agree that people coming to live in the U.S. should learn English. The fact that many of them do not makes caring for them very challenging indeed. However, it's our responsibility as nurses to ensure that those entrusted to our care understand what is being done for them (or to them), so it's up to us to be proactive. In the case of Hispanic patients especially---since they are a rapidly growing segment of the population---that may mean taking a course in 'medical Spanish' so that we can communicate at a basic level, e.g. perform pain assessments and explain what we are doing. It may mean finding a translator or interpreter, or using telecommunications devices, to help the patient ask questions and understand procedures.

    I know, sometimes it's a PITA when we can't understand our patients and they can't understand us. But we should try not to judge or be resentful of them; after all, they don't come to our healthcare facilities purposely to make life harder for us than it already is. They come because they are ill and they need our services. It's up to us to provide them, in the best way we know how.
  5. by   traumaRUs
    Our hospital is in central IL and we have many folks who do not speak English. We use the AT&T interpreter line. It is an expensive service for the hospital but they have medical translators who assist via the phone with languages. THey will also provide a written transcript of the interpretation for the medical record - a must have nowadays.
  6. by   SmilingBluEyes
    Have access to a language line? you SHOULD. They have over 50 languages for tranlation services available. I speak fluent Spanish, but no Russian, Vietnamese, Korean, Thai or Arabic, which many of our patients DO speak. If you have a language line, you will do much better, and you will cover the consent process in the legal means-----in a way that they understand clearly what they are consenting for and explanation of treatments you will carry out. As far as I know, all hospitals in the USA are required to provide some sort of translation services for non-English-speakers.
  7. by   NaomieRN
    Hospital does not have translation service?
  8. by   1Tulip
    Yes...

    We use the AT&T translator services. We try to find that one friend or relative who is bilingual, and we have a list of employees who are willing to come in and translate for us, whether it's French or Japanese or Italian or Spanish.

    BUT this does me no good when it's just me there, and the call light goes on. It doesn't help me when I go in the room and the pt. is just "different" and I need to know why. It doesn't help me when my closed head injury patient is trying to slug me.

    Please read my original post. I am not being judgemental. I'm not angry at these patients... I'm scared for them. I'm scared for me. I'm worried about their family members. And I have a "Medical Spanish" book and tape series on my book shelf right behind me as I write this post. I have hit the books, but it's still futile. I try. I really do. But I am NOT Hispanic and I canNOT give these people the same level of care that I can give my English speaking patients. It's just not possible.

    Especially (IMO) on a neuroscience unit.
  9. by   URO-RN
    [quote=mjlrn97]I agree that people coming to live in the U.S. should learn English. The fact that many of them do not makes caring for them very challenging indeed. However, it's our responsibility as nurses to ensure that those entrusted to our care understand what is being done for them (or to them), so it's up to us to be proactive. In the case of Hispanic patients especially---since they are a rapidly growing segment of the population---that may mean taking a course in 'medical Spanish' so that we can communicate at a basic level, e.g. perform pain assessments and explain what we are doing. It may mean finding a translator or interpreter, or using telecommunications devices, to help the patient ask questions and understand procedures.

    I know, sometimes it's a PITA when we can't understand our patients and they can't understand us. But we should try not to judge or be resentful of them; after all, they don't come to our healthcare facilities purposely to make life harder for us than it already is. They come because they are ill and they need our services. It's up to us to provide them, in the best way we know how.[/quote]


    :yeahthat: :yeahthat:
  10. by   Pepper The Cat
    I understand your frustration 1Tulip. We have similar problems where I work - only our most Non-English speaking pts our Chinese - Mandarin or Cantonese.
    Some things were have found that help - get an English speaking family member to write our a list of words - their language matched up with English. We use the most common things like Pain, toilet, cold, hungry etc. I can point to "pain" for example and they can nod or shake their head. Once little old lady has 'take me to my room" written on a card that she pulls out when she is tired of being in the hall or lounge. We get phone number for family members who can speak English and get them to help translate - this sometimes works better than other phone translaters because they are family and the pts will be more open with them.
    Still, it is very scary to have a non-English pt that needs invasive care such as a catheter or IV!
  11. by   fleur-de-lis
    Quote from 1Tulip
    Why... oh, why can't people who come here make learning English a top priority? How is it that we have so many in the hospital who don't?
    I honestly felt the same way until my mom moved to south texas a few miles from the border, and i had the pleasure to meet many of the folks there. Many of these people do not have the resources to learn English and have no one with the time or inclination to teach them. The majority, I have found, would like nothing more than to assimilate while still retaining their culture and heritage, but have little money and no good way to learn.

    Have you tried free online translation sites, like Altavista's babblefish? It works great for me. http://babelfish.altavista.com/ (although that only works if they can read or you have someone who can read it to them.)
  12. by   PANurseRN1
    Quote from SmilingBluEyes
    Have access to a language line? you SHOULD. They have over 50 languages for tranlation services available. I speak fluent Spanish, but no Russian, Vietnamese, Korean, Thai or Arabic, which many of our patients DO speak. If you have a language line, you will do much better, and you will cover the consent process in the legal means-----in a way that they understand clearly what they are consenting for and explanation of treatments you will carry out. As far as I know, all hospitals in the USA are required to provide some sort of translation services for non-English-speakers.
    The language line is good for getting consent forms, d/c instructions, etc., but it's nearly impossible to use it one each interaction with the pt. I don't know what the answer is. Just last week I had a pt who spoke absolutely no English and her native language was not a common one for this area.

    The one time I used a Cyra-Phone I had serious misgivings about the translator. His English skills didn't seem much better than the pt's, and he was rude, rude, rude.
  13. by   SmilingBluEyes
    Quote from 1Tulip
    Yes...

    We use the AT&T translator services. We try to find that one friend or relative who is bilingual, and we have a list of employees who are willing to come in and translate for us, whether it's French or Japanese or Italian or Spanish.

    BUT this does me no good when it's just me there, and the call light goes on. It doesn't help me when I go in the room and the pt. is just "different" and I need to know why. It doesn't help me when my closed head injury patient is trying to slug me.

    Please read my original post. I am not being judgemental. I'm not angry at these patients... I'm scared for them. I'm scared for me. I'm worried about their family members. And I have a "Medical Spanish" book and tape series on my book shelf right behind me as I write this post. I have hit the books, but it's still futile. I try. I really do. But I am NOT Hispanic and I canNOT give these people the same level of care that I can give my English speaking patients. It's just not possible.

    Especially (IMO) on a neuroscience unit.
    I know your frustration and I don't think you are being discriminatory. It's hard and takes much patience to care for folks who do not speak our language. I would advise having language lines set up for things like consents and explanations/expectations of treatments and meds, and then hopefully an adult family member or friend who can translate to tell you what your patient needs in between those times. Fortunately, these folks don't live in a vacuum. They do most of the time, have networks of friends and family who can speak English and smooth the way for us to care for their loved ones.

    Learning another language is never easy. I have to remind myself how little I know. Most of our neighbors across the waters speak MANY languages at once. I know, for example, in the Philippines, most speak at least 3 languages, English, Tagalog and Cebuano, for example. It's a challenge to speak other languages than native tongue. I don't see a whole lot of Americans who can do the same. Most of us speak ONLY English unless we were born elsewhere or have had classes in the past. It's tough, for them and for us.

    We just have to try and do our best.
  14. by   PANurseRN1
    Depending on the situation, having a family member translate isn't always the best idea. Unlike professional translation services, a family member may also seriously edit information.

    It's a sticky situation for everyone, that's for sure.

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