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?

[asteph0301]

I am an ASL interpreter and I am starting nursing school in the fall. I am very glad this question is on here because to many people do not know what to do with a person that doesnt speak their language, especially in the medical field.

1st

NEVER USE FAMILY OR FRIENDS, THEY MUST BE A QUALIFIED INTERPRETER AND HAVE HAD MEDICAL EXPERIENCE!!!

This is very important because interperters are held by a code of ethics they must follow and if they do not delever the message the way the person intended then they could be held liable if anything happens. A family or friend however could not be held liable, the hospital would then be liable becasue they did not provide interpreter to make sure the message is understood. Family is there for support and should not have to worry about interpreting because legally if you are interpreting you are not allowed to advise or give your opinion in any way.

Many doctors and nurses think that if there is a Deaf patient that they can just write back and forth. This is very wrong and many people have died becasue they didnt understand what they were supposed to do after they left the hospital. ASL is a language of its own, it is not english so writing back in forth may not always work very well and too often the patient is to embarrassed to tell them they dont understand so they just bob their head and pretend to understand.

I will get off my soapbox now but this is something that has affected a dear friend of mine who was not provided an interpreter and instead his sister was aasked to interpret. He didnt know to refill his heart meds after he was done and by the time they found out it was too late.

2nd

THERE ARE ALWAYS INTERPRETERS AVAILABLE AND ALL HOSPITALS SHOULD HAVE A NUMBER TO A LOCAL AGENCY!

[traumaRUs, MSN, APRN]

I gotta tell you though that interpreters for the deaf are very hard to come by. I have two deaf pts that are frequent visitors to the local ERs. They demand an interpreter and though the nurses try 10-20 people, it is rare to get someone to come in.

Now, if its a scheduled visit for the interpreter, they are willing to do that, but not impromptu.

[Meraki]

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.

seeing as she spoke such minimal english that her son had to interpret it is quite possible she misunderstood you. i have lived in many parts of canada and have never come across 2nd and 3rd generation canadians who don't speak any english or french. they would have had to go through their entire education in english or french which would be impossible to do without learning or speaking the language. many still go to chinese school on weekends and evenings but their education is in english / french. even if they live in chinese communities and shop in chinese shops they would have been educated in english / french. most first generation chinese are pretty adamant that their children will have good educations and i have never met anyone who kept their children home and not in school and kept them from learning french / english. there may be an extreme case where they were homeschooled or not schooled at all but from my experience that is pretty rare in the chinese community.

[kcksk]

i just want to voice our struggles with an ASL interpreter. I work in an office and we had a family that needed an interpreter. There is only one place in the area to call and they supply all the interpreters. If they can't get one, you are out of luck. Ok for scheduled well visits but if you have a sick visit, you can't get anyone that fast, you have to give a certain amount of notice. Yes, it was our responsibility to provide one but there was no place to get one. We tried hospitals, etc and they all used the same line to get one. The family ended up leaving our practice but we spent days and days trying to work it out and no one could help us. What are people supposed to do in that case? It is a huge issue. Just a little vent when you try to do the right thing and hit a brick wall every way you turn. I even knew someone who was an ASL interpreter but she wasn't medically certified so couldn't help us. UGGH! I had forgotten all about that until I read this thread.

[asteph0301]

As an interpreter I understand that sometimes it is very hard to find one on an emergency basis. Using a family for friend for very basic questions until an interpreter can be there is ok. But going over detailed information that may require a decisison of some sort will need to be interpreted by someone that is experienced and qualified. You can always try you local DHS and ask them for the name of other agency's in the area. Even if it is an hour away or so, most interpreters should be willing to make the drive. It is part of our job to always be ready in case of an emergency, if the interpreters are not available then it wont hurt to ask if they have the number for another agency or someone you can contact. They are professionals and should alwasy be willing to help find an alternative solution if they can not be there.

I know from experience that alot of hospitals or Dr. offices do not like to pay the interpreter, they feel it should be the Deaf persons responsibility, but that is not the case at all. A Deaf person should never pay for interpreting services. ADA requires thaqt services but provided if needed to ensure equal access. Now I am not saying all places are like this but the ones I have had experience with do not feel they should have to pay. This could be a reason that the interpreters wont come on an emergency or at all if they have had problems with thay facility in the past.

But overall the best you can do is try your hardest to provide a qualified interpreter and if its just impossible to get one then you do what you can.

[kcksk]

ASL interpreters seem to be a little different around here. There is one place that EVERYONE goes to to get interpreters. Hospitals, drs office, etc. When we would call, they would say they had no one. If we asked what we were supposed to do, was there anyone else to try the answer was always the same--everyone goes through them. We called all local hospitals and they all gave us the same number. Tried someone I know is an interpreter and she said the same thing. She couldn't help us herself because she wasn't certified but to call that same main number. We had a nurse who knew sign language but she wasn't medically certified and it was a liability issue if we used her. So very frustrating. Our practice honestly spent days and days trying to work this out. Never happened for the family and they ended up going to a big city hospital because they have one on staff.

[carolmaccas66, BSN, RN]

I had an indigenous patient in our ED not long ago. I was told no interpreters were available, or even used, it seemed. Luckily there was another indigenous lady who helped out, & my patient could speak some English.

But I'm getting really tired of families who don't teach their kids English. I've decided next time I get a patient I can't understand & there are no interpreters, I am going to refuse to care for them and the NUM can sort them out.

I'm tired of being abused and yelled at and (I'm sure) ridiculed because I don't speak someone else's language. It's all the nurses fault - apparently - but since I can't understand them, I can only assume they are angry at me for not understanding THEM. It all gets so incredibly complicated, what with hand gestures & pointing to body parts & families getting annoyed at us. Since when did it become the nurses' fault because YOU the patient don't speak English?

Give us a break for God's sake.

I've also had patients who's kids told me their parents have been in our country for 50 or 60 years - and the kids & grandkids have to go with them to appointments etc to interpret - because mama & papa might speak 2-3 words of English & that is it. I think that is pure, utter laziness & yes I've read all the past arguments on here as well about why they haven't learned English.

I for one am fed up with trying to work out what's wrong with someone - having a patient point at their limb or whatever is NOT a good indicator of their problem! And like I said we get the blame when we're not understood.

I've said for years it's dangerous & too hard for us to keep up with all these non-English speaking people. It's mentally exhausting as well, but how we can fix it, I don't know.

[Ruby Vee, BSN]

i had an indigenous patient in our ed not long ago. i was told no interpreters were available, or even used, it seemed. luckily there was another indigenous lady who helped out, & my patient could speak some english.

but i'm getting really tired of families who don't teach their kids english. i've decided next time i get a patient i can't understand & there are no interpreters, i am going to refuse to care for them and the num can sort them out.

i'm tired of being abused and yelled at and (i'm sure) ridiculed because i don't speak someone else's language. it's all the nurses fault - apparently - but since i can't understand them, i can only assume they are angry at me for not understanding them. it all gets so incredibly complicated, what with hand gestures & pointing to body parts & families getting annoyed at us. since when did it become the nurses' fault because you the patient don't speak english?

give us a break for god's sake.

i've also had patients who's kids told me their parents have been in our country for 50 or 60 years - and the kids & grandkids have to go with them to appointments etc to interpret - because mama & papa might speak 2-3 words of english & that is it. i think that is pure, utter laziness & yes i've read all the past arguments on here as well about why they haven't learned english.

i for one am fed up with trying to work out what's wrong with someone - having a patient point at their limb or whatever is not a good indicator of their problem! and like i said we get the blame when we're not understood.

i've said for years it's dangerous & too hard for us to keep up with all these non-english speaking people. it's mentally exhausting as well, but how we can fix it, i don't know.

you're so silly. didn't you know that everything is the nurse's fault?

[dudette10, MSN, RN]

We use the hospital interpreters for two main languages that are in our area and the language line for other languages or after hours. We use interpretive services for admissions, discharges, consents, and other times we deem appropriate.

For your run-of-the-mill stuff, we use family members in the room or "sign language" or other HCWs on the unit.

About the HIPAA violation in using family members for when the patient wants to tell the nurse something or assessing pain...how can it be a violation if the patient is clearly wanting the family member to translate? In those situations, it is implied that the patient doesn't mind if the family member is privy to the information.

[anotherone, BSN, RN]

There are some very rarely spoken languages that there might not be an english to that language translation via those phone services. i have heard of and seen these cases a couple of times. so a 3-4 way translation is not ideal either......what if the patient is deaf and uses sign language but not asl? has anyone run into that scenerio?

[CharmedJ7]

I feel bad, but I really don't like having non-English speaking patients because it slows things down so much. The translator phones can be good when you can find them (ours have all gone MIA in the past weeks) but realistically I can only use them for admissions, discharges, and consents, which leaves a whole lot of basic interactions in the zone of frantic gesturing. I try to learn the basics of whatever language they speak (Pain? Medicine? Breathe, etc) but god forbid they want something more complicated...

My facility is actually fantastic about deaf interpreters, but terrible for other languages. Lots of people do speak Spanish, but rarely at the level required to explain changes in plan of care, rationale for interventions, etc. It's not a good situation but I really don't think it will/can change, because 24/7 translators are too expensive and sporadic translation via language line is too time-consuming. For the most important things I think it's doable, but the reality is the bulk of other things (education primarily) is going to slip through the cracks.

[Ruby Vee, BSN]

about the hipaa violation in using family members for when the patient wants to tell the nurse something or assessing pain...how can it be a violation if the patient is clearly wanting the family member to translate? in those situations, it is implied that the patient doesn't mind if the family member is privy to the information.

i can see that it could be a hipaa violation if the nurse is using any old visitor to translate. (perhaps the patient doesn't want her mother-in-law to know she has an std.) or if they're using the visitor of another patient to translate -- i've seen that happen, too.