Communicating with patients that don't speak English

[CalidthreeN]

How do you go about communicating with and delivering care to patients that don't speak English when you also don't speak their native language? Does your facility have traslators readily available(by phone or in person), what resources do you use if any to communicate with non-English speaking patients? Do you use the family or your co-workers to communicate if they speak both lanuguages? What do you do?

[Reno1978, BSN, RN]

We have Spanish, Vietnamese, Russian, and ASL interpreters available. The Spanish ones are FT and are in the hospital until about 10pm at night. Afterwards, and at all times for the other ones, we call them in. If it's a language we don't have a person to interpret for, we use the language line.

[Pepper The Cat, BSN, RN]

Its not easy. Although there is a phone translation line availalbe, we don't often use it. To start with - you need a working phone and not everyone will pay for that!

Some families are good about translating. We will also get families to write down basic things/requests in their language and then in English. So we can point to "do you have pain" and the pt can read it and understand.

A lot of sign language is also involve sometimes!

Its great when there is someone on staff who speaks the language.

A big problem though is that while they may speak the language, they don't necessarily know how to say the medical words in their second language.

Another big, big problem we are starting to run into is that we are finding 2nd and 3rd Generation Canadians that still don't speak English well. This is very common with those that speak Mandarin or Cantonese - the two most common languages we run into with non-English speaking patients.

its a challenge!

[Altra, BSN, RN]

We frequently use the AT&T language line.

But if there are bi-lingual family present, or bi-lingual staff, we will use this avenue to get the patient's basic story and/or conduct the routine stuff. But "professional, unaffiliated" interpretation is required for consents and so forth.

[classicdame, MSN, EdD]

Do not use family or co-workers as this could be a HIPAA violation. Also, if they are not licensed medical interpreters the patient is not receiving an INFORMED consent, because the questions and answers may be mis-interpreted. We use a translator service thru ATT. Every phone has the capability. Staff just needs the codes. Business office and others use it as well. However, I did have a patient recently who spoke only Choctaw (they live communally nearby). The language service did not support that language so we did use family, but had the son sign a HIPAA form, etc. and we got interpreter from family referral. He was certified as interpreter but not licensed as medical interpreter, so we had to hope for the best.

[HouTx, BSN, MSN, EdD]

This is becoming a very important issue. The Joint Commission has a new set of standards that address it - they went into effect in January 2011.

Basically, JC accredited agencies have to formally address culture & language preferences upon admission & provide certified medical interpreters (by nationally recognized certification agency) for patients who are not English proficient in order to ensure that they understand treatment options & can make informed decisions. It is no longer permissable to use 'casual' interpreters or even family members for some types of communcations. Be sure to check with your own policies & procedures to see how it is supposed to be handled at your organization.

I think most organizations are still struggling to define which types of communications are casual (do not require cetified interpreters) and how to document the qualifications & use of the official interpreters. If there is a very large population of non-English speakers, I wonder how this will impact the role & compensation structure of bilingual nurses. Do medical interpreters have to be third parties or can clinical providers fulfill that role? Will they be paid more? Will they need to become certified in order to get additional pay? Lots of unknowns.

To make it even more challenging -- standards require written communications (including consents) to be in the 'language of choice' for a specific population if they make up >5% of the total patient population. For most hospitals in my part of the country, that means Spanish for sure... but I'm wondering - are there actually any certified medical interpreters available for Cajun French???

[flashpoint]

It can be really tough..especially when you aren't sure what language the person speaks and they can't tell you (even with the little flip chart thing from AT&T)!

We once had a patient who spoke a Chinese dialect but no one at AT&T spoke both that dialect and English. We ended up with the patient talking to an interpreter who spoke that dialect, the interpreter translated that to Tagalog, and an interpreter who spoke Tagalog and English relayed the message to us. Far from ideal, but it worked...

[RNperdiem, RN]

I will always call the interpreter for important things like surgical consents.

Often an English-speaking family member will remain with the patient most of the time for routine communication.

Otherwise I can use the foreign languages I studied in school and do what I can. Recently I had a patient who spoke almost no English.

When his wife was present, she could translate my English into Portugese.

At times the wife was not around, the patient and I would speak Spanish which was a not a first language for either of us.

[optimist]

Unfortunetly in LTC we dont have access to interpreters. At my facility we only have one resident that does not speak english. We have learned the basic phrases to meet her needs (bathroom,pain,food,etc.) When she has something she needs to tell us she will occasionally call her family and put us on the phone with them. Once I needed to investigate the cause of a skin tear and had to find a lady in housekeeping to interpret for me. I know this violates HIPAA and all but thats one of the challenges of working LTC; you work with what limited resources you have.

[Ruby Vee, BSN]

another big, big problem we are starting to run into is that we are finding 2nd and 3rd generation canadians that still don't speak english well. this is very common with those that speak mandarin or cantonese - the two most common languages we run into with non-english speaking patients.

its a challenge!

seriously? second and third generation canadians that don't speak english. do they speak french? do you have a national language?

anyone that decides to live in an english-speaking country ought to learn to speak english. or make them responsible for finding (and paying) their own interpreter. i have enough trouble with immigrants who have lived here twenty or forty years or so without learning the language, but their kids not learning? sheesh!

[AngelicDarkness]

I used family if they are the POA for translating in the retirement home setting. Never had a problem with that so far. In the hospital there was no translators that I knew of in my areas, so ... good old fashioned google translator worked for me:) I tried, but I know they were laughing at my pronounciations reading from the page.

[Pepper The Cat, BSN, RN]

seriously? second and third generation canadians that don't speak english. do they speak french? do you have a national language?

yep, scary isn't it? they live in a chinese community, shop at chinese stores, etc. they have some english but very minimal. i've had to use a 10 year old boy as a interpretor because he was the only one that spoke english. i asked his mother how long she had been in canada - she told me she was born here.