caring for Spanish speaking patients

[Faith Eyer]

How can you care for Spanish speaking patients? I live in a small town that does not dome in contact with Mexican/Spanish people often and in nursing it is hard to try to communicate. I need help with communication, religion,unique characteristic, etc.

Help!

[Always Learning, RN]

At my facility, and the others in my area where I have had clinicals, we have a 'Language Line'. This is a two hand-set phone that connects directly to an interpreting service, that has operators fluent in nearly every language you could imagine, and trained in medical interpretation. I just pick up the phone and hand the other handset to my patient. The operator asks what language and I talk directly to my patient through the phone interpreter.

I live in an area with a large Spanish population, but despite my efforts am very poor in the Spanish language. Even with our employees that are fluent we are still supposed to use the language line because of the finer points of medical interpretation.

Hope this helps,

__________________________________________

Waiting for December '07 :mortarboard:

[classicdame, MSN, EdD]

If your facility does not have a special phone you need to get the nursing adminstration to contact your phone company. AT&T and others offer a language line subscription service. I don't know the rates. It works like this: each phone in the facility is connected to that line by a phone number and password. Once you call you ask for the appropriate language. A certified medical interpreter will be connected to the line. You talk to them as if you were talking to the patient and they will interpret. To have family and co-workers interpret could create a HIPPA violation, not to mention incorrect/incomplete information being transferred. Other than that, I would recommend your educator consider an inservice on cultural competency.

[smoke over fire]

Hot & cold theory : Many Mexican's believe that cold "frio (Free-o)" makes you ill or worse.

Offer a warm-almost hot herbal tea. There are some who believe in specific herbs, but i find I can almost not go wrong with chamomile or a sleepy bear tea. Also chicken broth if available.

Cut and paste above your pain scale- How much pain (do you have) : Cuanto te duele?

STORY: My girlfriend/coworker is from Hong Kong-knows VERY little spanish and cared for a woman who was having alot of complications from a gastric bypass. My friend was so stressed out thinking "How can I care for this patient. First of all I don't speak spanish, and I am fat!" (My friend felt like she was given the assignment out of spite for being overweight, which is another story.) Anyhoo, over the course of her treatment my coworker asked me to translate. I was explaining some procedure to the woman when she told me "yakie es mi angelito" Jackie is my angel. I told my friend and she was shocked that the language and culture difference did not cloud the professional caring and presence.

[Dixielee, BSN, RN]

I know the language line subscription is fairly expensive and many smaller hospitals do not think it is worth the cost for minimal use.

I have found that most native Spanish speakers in this country speak better English than they want you to believe. I don't blame them for wanting an interpreter, but we are in the US last time I looked and most of them are working here. They should be picking up bits and pieces of the language just from being here, as we would if we were in a foreign country. Their children are in school here and while more and more businesses are catering to their needs, most things here are labeled in English.

I have found that if you provide an interpreter, they will only communicate in Spanish, but if we each try to communicate with their broken English and my limited Spanish, the message gets across. If they know there is not an interpreter available, most will bring a friend or family who speaks English. It is not a HIPPA violation if the patient is consenting to it.

Learn a few important words like pain? where? vomiting? allergies? medications? etc. and you can get by, at least in the beginning until either the hospital or the patients find an interpreter.

Flame me if you want, but we can not provide everything to everyone who comes here, even if we wanted to. Our system is already stretched to the brink.

[BillEDRN]

If your facility does not have a special phone you need to get the nursing adminstration to contact your phone company. AT&T and others offer a language line subscription service. I don't know the rates. It works like this: each phone in the facility is connected to that line by a phone number and password. Once you call you ask for the appropriate language. A certified medical interpreter will be connected to the line. You talk to them as if you were talking to the patient and they will interpret. To have family and co-workers interpret could create a HIPPA violation, not to mention incorrect/incomplete information being transferred. Other than that, I would recommend your educator consider an inservice on cultural competency.

Having family interpret is not, in and of itself a Healthcare Insurance Portability and Accountability Act (HIPAA) violation, and by the way, neither is giving basic medical information to family, unless the patient expressly states that you cannot. That being said, there is some liability exposure, as you correctly identified, in communication issues (the interpreter didn't interpret correctly, or did not understand your question), that result in problems.

Unfortunately, most healthcare workers do not fully understand the HIPAA's regulations and very often unnecessarily restrict information. There is no doubt that the laws are sometimes confusing, but to date, there have been only two criminal cases prosecuted, and no civil cases. For a law that has been in existence this long, that is pretty significant.

http://www.mtexpress.com/index2.php?ID=2005115979

http://www.medicalnewstoday.com/medicalnews.php?newsid=75936

http://www.medicalnewstoday.com/medicalnews.php?newsid=44585

[preciousbaby621]

I don't blame them for wanting an interpreter, but we are in the US last time I looked and most of them are working here. They should be picking up bits and pieces of the language just from being here, as we would if we were in a foreign country. Their children are in school here and while more and more businesses are catering to their needs, most things here are labeled in English.

You have to understand that alot immigrants who come to the U.S., mostly who are Spanish-speaking, will usually end up in a predominately hispanic area where everyone speaks Spanish. Therefore, they feel it isn't necessary to speak English. I also agree that they should be able know enough English. Also, when referring to Spanish-speakers, you should say Latino/ Hispanic, NOT Mexican, Cuban, etc. Some people will get offended, even over something trivial.

[RNtigerEMT]

I, too, live in a fairly rural area, but foreign language speakers are becoming more common, and not just Spanish speakers.

My story- working in a small very southern part of Ohio, almost WVa, had a pt (10 or 12 yo) and his mother come in twice in 2 weeks to the ED, Asian. The first time they brought an interpretor, which still didn't help much because the interprotor would not translate or speak to the mother, Asian culture. The son, the pt, also had some developmental problems, but because he is male, he was the boss. Dealt with that visit. The following week, the mother and son returned, no interpretor. The son, again the pt, was getting very combative, striking out at his mother whenever she would attempt to assist. because i had dealth with them the prior week, I was able to get a foot in the door so to speak. Very firmly spoke to the son in plain English, that his behavior would not be tolerated, and we wanted to help him. Was able to give the DR what bachground I had from the week prior, and the abusive behavior stopped. The son understood everything that we told him, verified by our intepretor that finally showed 2 hrs after my shift ended. I stayed because the son did respond to me, and let the Dr do what he needed to do as long as i was there.

They were very recent immigrants/or even visiting (never did find out which), and old school Asian culture in which the female is pretty much decorative and useless, not worthy to speak to a male. By speakin up and letting the son/pt know that here, I was in charge, he calmed down and respected that. Even speaking absolutely NO Korean, I think, the message got across. I was even thanked, by the son, before I left.

BTW, I no longer work there, I was deemed not good enough for this particular facility.

My point, 9 times out of 10 they do understand you well enough, they may not speak English, but with some perserverance and patience, foriegn speaking pts can be treated by non-foriegn speaking nurses. Learn some basic words in the language that is more predominate in your area, and it will help. Translators are a big help, but not always immediately available

[truern]

If I have a fast question or comment and there's no interpretor immediately available, I use babblefish.com

So far it's been pretty accurate.

[prmenrs, RN]

People who are in pain, distressed, worried, etc., may lose whatever English skills they may have had before their current situation. Also, IMO, whether they "should" speak English or not is really beside the point most of the time. I need to deal w/the pt in front of me right now.

I've gotten fairly decent @ d/c teaching and explaining things I need to over many years of trial and error, intermittent Spanish classes, etc. My pronounciation is not bad, my receptive understanding still needs a whole lot of work. If I could stomach watching "novelas" (Spanish soap operas), it would probably improve. In no way do I consider myself fluent, and I would never try to translate anything serious, but I really enjoy working w/the Hispanic clients. And most of them appreciate the effort.

[deehaverrn]

interestingly people of italian background used to be considered latino..but we seem to have been ousted! guess that's because our grandparents and parents had to learn english, so even though much of our culture is very similar to those of spanish descent no one needs any cultural competency classes to interact with us..nor do we merit any special treatment. thats my pet peeve..many of our hispanic pts. have learned how to use the system and expect special treatment.

also, i was turned off to the 'language line' a couple years ago when a korean couple requested i use it for my admission database. )i was admitting the woman for induction of labor. after over an hour with the interpreter helping with all my questions and teaching we concluded our session. i was entering everything in the computer as we went. i left the room and the husband (who was a graduate student at a local well known university) called me back in (his english was garbled but okay) and requested (again i had no problem understanding him) that i start over because they didnt like the regional dialect that the interpreter had used...i realize that this may have been a cultural issue that they didn't want to offend the translator (who was male) but one question that was asked at the beginning was whether the translator was acceptable..plus it costs the hospital money which for some reason is not billed to the pts..plus this meant that i had to invalidate all my charting and teaching, and take another hour to redo it! I had to leave the room to calm down before i could proceed.

i don't think i've used the language line since..