language barriers

  1. To all the RNs out there, I would like to inquire about some of your personal experiences with those patients that do not speak English. From my personal experience training as a CNA in a California nursing home, I found that those patients that did not speak English were not always treated as well. I don't believe that this was always due to abuse of the staff, but rather a lack of patience, resources, communication, and understanding.

    When I first started at the nursing home, there was an elderly Portuguese lady residing there. One morning the RN came in to give her meds. The other CNA assisting her began to pull off the woman's blankets and sheet. The woman kept complaining and trying to pull the blankets back but at this point she was quite weak and thus unable to do so. The CNA explained, in a more annoyed than calm and gentle manner, that it was "too hot" for more than one layer of blankets or sheets. At this point I had not told anyone that I could speak Portuguese and a bit of Spanish. Finally, I couldn't watch any longer. I asked the lady if she would please wait for a minute so that I could talk to the other CNA and that I would help her. The other CNA was a bit blown away and upset. I told her the woman was saying that she didn't feel well. She was still cold from the cool morning air because her window had been left open during the night.:heartbeat

    My coworker was quite disheartened that I had failed to mention that I was able to understand Portuguese. I truly was not trying to be rude; however, I always speak English at work/school as to not offend anyone. I feel that all of my experiences with patients who spoke Spanish and Portuguese were quite enjoyable. I consider that experience to be rather educating. It could have been someone speaking Vietnamese. I really showed me how important communication skills and patience are in the nursing field. If it were an emergency situation, not only would quick critical thinking skills be need but also the ability to communicate through body and sign language.

    I could see how stressful it was for the other CNA when she couldn't understand the patient. How do you deal with the stress of a language barrier; and how do you manage your time so that it's fair to everyone else when it takes longer to communicate? I am curious as to see what other people experiences have been like. How important do you think that speaking another language is? Do you make it known if you can speak a second language? Do you always try to use this info when you're seeking employment? Does it give you a bit of an advantage on others? How do your coworkers feel? Do you feel as thought it is a skill worth developing through school so that it might help me during clinicals and as a RN? Thank you! Good luck to all!
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    About jwenny

    Joined: Jun '09; Posts: 1; Likes: 1

    11 Comments

  3. by   Be_Moore
    Well living in Denver we have a large spanish speaking population. Presently I am studying spanish in an attempt to overcome the most common language barrier I see. I don't speak much, but I know enough to get my points across as well as most of the basic idiomatic expressions. If the patient is repeatedly saying something that i don't understand...I will go to my computer and google it! And come right back to the patient. With other languages (which we don't see quite as often) there is always the translator line.

    But I feel you on the problems created by language barriers. This is exactly why I am trying to learn a second language. I've also found that when you do try to communicate with a patient in their native tongue, they are usually quite appreciative and it usually serves to build rapport quite rapidly.

    I also feel that patients who are non-english speaking do get treated a good bit worse than patients who are english speaking. Part of it is probably that we can't understand their refusal of things and because of the barrier they can't easily get their point across. The other side of that coin is that even though the USA is a country of immigrants, we are still very ethnocentric when it comes to language. There seems to be a wide "We're in America, so speak English!" sentiment. I guess we actually forced the people who lived here before us to speak English, so it shouldn't be a surprise that we expect everyone else to speak English as well. This, however, is not a sentiment I share. Just for the record.

    As far as a skill that is worth developing in school. Yes! I think Americans should all be bilingual. We are in close proximity to a large population of Spanish speakers. Trilingual would be awesome as well, possibly English / Spanish / ASL. Other languages would be less useful. I hope to become fluent in Spanish, and should I ever have children, I will only speak to them in Spanish such that they will grow up bilingual.

    And to all the naysayers...what is so wrong about wanting to be able to communicate more effectively with other human beings? Isn't that all that language is? A way to communicate and relate to other people? I don't care what language you speak...you are still a person of worth and it is worth it to me to communicate effectively with you.
  4. by   cardiacmadeline
    I have to disagree with the thought that all Americans should be bilingual. Yes, I am one of those people that believe if you live in America, you should learn how to speak English. I wouldn't move to Germany without learning German and I certainly wouldn't expect the German people to learn my language. Now, as far as learning another language, I think that is certainly a great skill to have in health care. We don't really get a huge amount of patients on our floor that speak different languages. A lot of the times the family is there and can interpret. I will only let them interpret simple things like "mom needs a blanket" or "mom needs a drink of water". If I need to explain something relating to their medical care, I either get an interpreter or the language line. It can be hard when there is a language barrier because it does take more time. But calling an interpreter to come up is very easy to do. Even calling the language line is very simple. I personally feel that the language line on my floor is underused. I think most of the charge nurses on my floor take into account when someone does not speak English when doing assignments, knowing that it takes a little bit longer to provide care for that patient. I once had a patient who spoke Spanish and her daughter could speak English. Well, I needed to expain something to the patient related to her medical care and the daughter said she could interpret and I think she was a little upset that I got an interpreter. Oh well, my job is to make sure the patient understands what is going on with their care, families should not be interpreting this kind of information.
  5. by   Be_Moore
    I feel that all Americans being bilingual is rapidly becoming a situation of necessity. The world gets smaller every day and ignoring that fact is inappropriate. Look at the examples of foreign countries that teach 4 languages. I recently took care of a patient from Belgium who spoke French, English, German, and Dutch. When you look at those as an example, is it really that outlandish to expect Americans to speak more than one language? Especially considering America does not have an official language. Unofficially it's English, but not officially.

    Don't you think that in keeping with your beliefs of "When in Rome, do as the Romans." that we should all be speaking many of the Native American languages?
  6. by   pagandeva2000
    I am empathetic towards the patients that do not speak English and believe that learning it would empower them. This does not mean that they deserve less care or consideration, but I don't think it is always wise for anyone to assume that the right things will be done by them. This does not apply to just language barriers, but towards any situation in life...not comprehending what is happening has led to the Ponzi schemes, credit debt and many other unfortunate situations.

    Using the language line has it's disadvantages; I am not sure I believe that every interpeter hired has been trained in medical jargon. In fact, most times, it seems that we are being connected to their homes, where I hear televisions, children crying, other conversations going on, etc... and I can tell by what response the interpeter is relaying to me that the break in communication is coming from THEM for not properly addressing the issue I asked them to. Some have told me in the middle of a session that they don't understand what the patient is saying either, have told me to find someone else and left me hanging, only to have to repeat the call to the language line and start the entire process over again. Also, I have seen many physicians short the care they give the patients by inappropriately slipping the explanations of diagnosis to the nurses (which we should not be the first to tell a patient what is their diagnosis is and the course of treatment, nor should we be obtaining consent for invasive procedures). The patient may not realize something is wrong, but I see it, and I know it is due to the lack of time and patience it takes for a provider to see a boatload of patients (and basic inconsideration of humans).

    I don't see anything wrong with America offering basic English classes and explaining to the patients the benefit of being more proactive than passive in this environment.
  7. by   UM Review RN
    America is such a wonderful melting pot that I don't think 2 languages would be sufficient. I'm in a tourist area. We have visitors and transplants from all over the world in our hospitals.

    There are even mechanical devices out there now that can translate with voice pronunciations, such as these. http://www.worldtravelguide.com/trav...ranslator.html
  8. by   chicookie
    I think everyone in the US should at least know two languages. Like Be Moore said other countries in the world speak more than one language. I have a friend in Bulgaria that speaks 3 languages and is working on her 4th! Most Japanese students learn Japanese and English. I feel that just making everyone speak one language is really limiting and makes us miss wonderful opportunities.
    But enough of that.

    I speak Spanish and it really helps. Especially in cases were like Portuguese and Spanish are so close that if someone comes in that speaks that language, we might not understand each other 100% but we do understand each other alot. I also think its comforting to a patient to know that they have someone to relate too. No matter what language they speak, patients are patients and they should all be treated with the respect and dignity they deserve.
  9. by   KateRN1
    I have been on the other side of this issue--the patient who didn't speak the local language. I lived in Istanbul for three years with my Turkish husband and our son was born there two years ago. We had been planning a homebirth, but after 80 hours of labor, it was obvious that we were heading for a c-section. I was at a very nice private hospital, affiliated with Harvard Medical Center, and most of the staff was non-English speaking. My Turkish is elementary at best, I can bargain at the market and order at restaurants, have a basic pleased-to-meet-you conversation, but when it comes to medical situations, I'm just not at that level. Plus with the stress of 80 hours of labor, not having had any sleep or anything to eat for three days, my comprehension was miniscule at best. My husband is not the world's most reliable translator, but did his best. I had every intention of learning to speak Turkish when I arrived, but I'm here to tell you that language acquisition doesn't come so easily after 35.

    I was very fortunate that I am a nurse with L&D/Post-partum experience. I knew what was going to happen and was able to make my requests ahead of time. Still, I had issues with the nurses wanting to take my baby from me for routine care, wanting to keep him clothed in the isolette rather than naked and skin-to-skin. When my husband went home in the evenings (he was taking care of our then-13-year-old, our puppy, and his mother), I was left at the mercy of the staff. I was able to say that I was hungry, yet not understand their rationale for not bringing me anything to eat (they deny food 24hrs post-op!). Someone finally found an office-type person who had some limited English, and between her limited English and my limited Turkish, we limped through a 20-minute conversation that would've taken seconds had we understood one another. I was so overjoyed to have someone I could speak to and understand that it didn't matter. (And then had DH on the phone immediately to the doc to get me some food ordered!)

    My point to this long story--don't assume that the person who doesn't speak English well has not tried to learn. It's not easy to learn another language as an adult and many people (myself included) would rather not speak than to say what we do know and have it come out wrong. And if you speak the other person's language, however little, please don't be afraid to use it! You have no idea the effect that hearing your native language has on someone who is scared, frustrated, angry, and humiliated.

    It would behoove America to introduce multiple languages in schools much earlier than high school. Almost everyone that I've met living abroad speaks at least two languages, usually more. Being bi- and tri-lingual is the norm outside of North America. We have to stop thinking that the American way is the only way and figure out that we can learn from the rest of the world. But that's another rant altogether.
  10. by   Ruby Vee
    i realize that this is going to be an unpopular opinion in this thread, but we're in america. speak english.

    i know it's difficult to learn another language after "a certain age," and i've certainly passed that age. but if i'm to speak another language just to communicate better with my patients, which language should i learn? french, because we have a lot of french speaking patients from europe, canada and the carribean? spanish because of all the mexicans, latin americans and south americans we see? portugeuese? we get many asian patients as well, so should i make an effort to learn an asian language? which one?

    my husband's family is from latin america. all of them speak english (with varying degrees of fluency and variable accents), but my mother-in-law's generation (and there are 13 siblings) would refuse to actually speak english unless it benefitted them. if she didn't like what she was hearing, her english would disappear until she got what she wanted. it was a game that used to drive me batty when she played it on me. and then, when i had to take her to the doctor she'd shriek in spanish while people fell all over themselves to try to figure out what she wanted and get it for her. (she could have asked calmly in english but they told her "no", and mamita never took no for an answer.) she was very proud of the fact that she never had to speak english unless she chose to: the butcher, the dry cleaner, the dentist, the cardiologist all spoke spanish. she chose spanish speakers only with whom to do business.

    i suppose i'm somewhat disgruntled, but when someone has lived in the u.s. for decades (in mamita's case five of them), i think it's reasonable to expect them to speak english. now someone who was on a vacation from europe when they had the big mi and got hauled off to the hospital via ambulance is a different story.
  11. by   HmarieD
    Ruby Vee, your MIL's approach is very interesting to me. Some years ago as a new nurse I cared for a Spanish-speaking pt. I don't know any Spanish beyond what I learned on Sesame Street (Ola, agua, etc). I struggled for three days to communicate as best I could with this lady.

    On day four, she had a visitor who came to the nurses station to report her friend was having pain. I went to assess her and without really thinking about it, said in English, "can you tell me where you are having pain?" She responded - IN ENGLISH - "Oh, yes, my head and my back are killing me!"

    I was shocked! I said, "Oh my goodness, you speak a lot more English than I speak Spanish!" and she just smiled at me. I have often wondered about that. Maybe she was doing what your MIL does. (Heck, maybe it was your MIL !)
  12. by   KateRN1
    Quote from ruby vee
    she was very proud of the fact that she never had to speak english unless she chose to: the butcher, the dry cleaner, the dentist, the cardiologist all spoke spanish. she chose spanish speakers only with whom to do business.
    i wouldn't say that i'm proud of it, but of course i patronized as many english-speaking businesses as i could when i lived abroad, simply because it was easier for me. i had enough turkish to get by in a pinch, but if given my 'druthers, i went where i could be understood. never underestimate the power of the mother tongue.

    hayirli olsun.
  13. by   pagandeva2000
    Quote from ruby vee
    i realize that this is going to be an unpopular opinion in this thread, but we're in america. speak english.

    i know it's difficult to learn another language after "a certain age," and i've certainly passed that age. but if i'm to speak another language just to communicate better with my patients, which language should i learn? french, because we have a lot of french speaking patients from europe, canada and the carribean? spanish because of all the mexicans, latin americans and south americans we see? portugeuese? we get many asian patients as well, so should i make an effort to learn an asian language? which one?

    my husband's family is from latin america. all of them speak english (with varying degrees of fluency and variable accents), but my mother-in-law's generation (and there are 13 siblings) would refuse to actually speak english unless it benefitted them. if she didn't like what she was hearing, her english would disappear until she got what she wanted. it was a game that used to drive me batty when she played it on me. and then, when i had to take her to the doctor she'd shriek in spanish while people fell all over themselves to try to figure out what she wanted and get it for her. (she could have asked calmly in english but they told her "no", and mamita never took no for an answer.) she was very proud of the fact that she never had to speak english unless she chose to: the butcher, the dry cleaner, the dentist, the cardiologist all spoke spanish. she chose spanish speakers only with whom to do business.

    i suppose i'm somewhat disgruntled, but when someone has lived in the u.s. for decades (in mamita's case five of them), i think it's reasonable to expect them to speak english. now someone who was on a vacation from europe when they had the big mi and got hauled off to the hospital via ambulance is a different story.
    i think it would be very difficult to begin learning to speak a new language fluently at this stage in my life, but i am in my comfort zone. i believe that if i made the decision to reside in a new country where the language and culture was different, i would have the incentive to learn the basics, at least.

    with all of the money that is being placed to aid in communication, i think that some can be set to the side to offer those that are interested in learning english to be able to do so because it empowers them. right now, many are in a passive position where they have to take what is doled out without understanding, and not everyone is going to take out the time to ensure that they receive their just due, and even those who will make an honest attempt may misinterpet what is needed.

    i have also seen situations where i was not able to articulate how or why, but i felt that somehow, i was being manipulated. we've had non-english speaking elderly patients dumped off at our clinic to remain until their families get off of work, with no phone number, address or name. in these cases, i blamed the families because how can you leave a confused (not demented, but frightened person) amongest strangers who cannot find the dialect needed to communicate? we have been forced to remain in the clinic until the family member comes and says "oh, you were supposed to make sure my mother/father, etc..is safe". enough to make anyone angry.

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