Sooo...I had a patient the other day who spoke NO English. At least she didn't let on if she did. You'll understand why I say this in a moment. I used the phone translator to communicate with the patient and while it was extremely helpful, it was also extremely awkward! I would look at the patient and talk to the translator as if I were talking directly to the patient. For example, instead of saying, "Can you ask her if she needs anything?" I would say (while looking at her) "Do you need anything?" I was just trying to make a tough situation a little more intimate. It didn't work. She didn't look at me EVER. Whatever...I made it through the shift A-okay.
Fast forward a couple of days....I had another patient who I didn't even need the phone translator for. It was a little difficult to communicate, but not so much that I couldn't do my job. She understood simple questions and I used gestures, etc. At one point her family was there and they would say "thank you" and usually "gracias" at the same time. When this patient was alone (and when her family was there) I would walk in and ask her questions like, "Do you need anything? Would you like me to get you a toothbrush?" or more important questions like, "Are you having any pain? How would you rate it from 0-10?" She had NOOOO PROBLEMO anwering my questions. She would say, "No, I'm okay," or "Not bad. 3-4 maybe." heavy accent, but it was clear she understood and I had no trouble understanding. Fast forward....her daughter shows up. It's a little girl (maybe 12) who speaks perfect English along with fluent Spanish. From the moment the daughter arrived, all of the mother's English/communication STOPPED. I would ask, "are you having any pain?" and the girl would start speaking in Spanish to her mother. The mother in turn would respond to the girl who would then speak to me. I found that SOOOO weird!! I can understand translating obviously when it's necessary, but being as though this lady clearly understood and communicated with me half of the day, I fully expected that she would answer me directly and instruct her daughter of her ability to do so that she would stop translating for and IMO hindering her mother. Here's an example...I mentioned earlier that I had asked the patient when she was alone (and when her adult visitors were present) "how would you rate your pain" and she would answer immediately, "not bad. 3-4 maybe." I asked the SAME question with the daughter present and the daughter spoke up, "are you talking about the board?" because we have a board with the smiley faces to help patients rate their pain. She then pointed to the board and started speaking in Spanish to her mother and then her mother responded to her in Spanish. Then her daughter told me, "she said it's the second one on the board." Okay, so when she was alone she was able to understand and without hesitation say "3-4" but now she needs a translator to use gestures and translation to say "the second one on the board"? What happened to 3-4 without all the back and forth? I don't get it. Why do you think this mother would stop communicating with me and allow this unnecessary translating once her child was present? It was truly odd to me as a mother. I almost felt it was rude and expected her to say to her daughter (even in Spanish) that she could speak for herself because she COULD and DID. By the way, she and her family spoke to each other in Spanish the whole time I was in the room (which I also found a little rude) but they never attempted to speak or translate for her and they were adults. What am I missing?
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I agree with everyone especially wispera.....we need to recognize others cultural beliefs and habbits and respect that......MOST of the time peopIle are not trying to be rude or disrespectful. There is of course the occasional play dumb "speak no english" and you KNOW they are yanking your chain......but thankfully that is the exception and not the rule.
Respect and enjoy our differences and similarities.
Specializes in Trauma Surgery, Nursing Management.
I imagine this little 12 year old girl thought she was helping out her Mom. Purely from her perspective, she more than likely feels scared and helpless that her mother is in the hospital. She is doing the only thing that she can do to help-translate. She is probably very proud that she did this for her Mom. Let her be the hero
English is her second language and she can communicate as best as she can if need be but even under the best of circumstances it is exhausting to try to process information in a different language. The patient was in a health crisis, in an unfamiliar environment, surrounded by people and noises and invasive interactions. She could do the best she could while alone but I imagine it would have been much easier to take advantage of having someone there, who was someone she knew had her best interests at heart, who could handle the communication piece of the experience. I don't see anything unusual with that.
I once had to have emergency surgery in a country where people didn't speak English, I was bilingual and so could manage the language, but I was in a crisis situation and was not able to process anything -- even if it had been in my native language. I would have given anything to have someone by my side who cared about me and who could navigate the language, the medical system, the drs, and nurses in my language. (the people who were with me didn't speak English either).
Also, dealing with a telephone translator doesn't make it any easier, imagine being in a position where the only person speaking your language is a disembodied voice, attached to someone you can't see, and that the nurse can't see.
That situation makes complete sense. Unfortunate that her 12-year old daughter was in that position, that's why it is important to have actual human beings doing the interpreting.
I found when I was backpacking in South America (I speak conversational Spanish) that there were a few times when I could get by on my own but was with someone who was fluent and I ended up relying on them at times- even to order something for me in a restaurant! I could order myself but I knew that my grammar and vocabulary weren't perfect and I was a little self-conscious to stumble along when I was with someone who spoke the language very well.
I imagine it was probably a similar situation with your patient. She likely knew that she spoke enough to get by, but with a fluent speaker to translate for her, there would be no risk of error in understanding for either of you. This way she wouldn't misinterpret anything you were saying :)
It was probably just more comfortable for her to speak in her native tongue. I get this alot but it really doesnt bother me. In fact I prefer when they bring someone in to translate for them even if they can do a decent job themselves. I'm the same way though, while I can understand alot of spanish, I really dont like to speak it just because I feel silly and worry about saying things wrong. Probably silly to think that, but I have heard it alot from spanish speaking folks, that they feel embarassed if their english isnt perfect and dont like to speak it if they can get around it. I hate using the translator phones personally.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i think it is cultural. and i wouldn't expect them to refrain from speaking their native tongue in front of you. that's silly, why would they? don't take offense where none is intended.
if they also spoke english, it would be rude to speak another language in front of someone who doesn't understand it. i know people don't consider being rude to the nurse or not, but maybe they ought to.
I work with a lot of Spanish speaking patients and they often are able to communicate enough to get by....but there are also times when I realize after three hours (or three days) that they have no idea what's going on- even though it seemed like they did.
I wouldn't let this behavior make you feel too offended. The patient may have even let the English-speaking daughter take over because she thought it would be easier for you. :)
And might i add, it can be exhausting for someone who is not a native speaker to converse constantly in English. Perhaps your patient just felt most comfortable communicating in her own language, especially since her daughter spoke perfect English. Many non-native speakers are very self-conscious of their accent and their grammer. English is a hard language to learn.
And as for it being a "professional setting", a hospital is only a professional setting for the professionals that are working their. For everyone else it can be threatening and frightening. People are not at their best. Given the option to take a few minutes to relax and speak in their own language i think most people would take it. As for why they were speaking Spanish in front of you, why not? It's their first language. I would have issues with *staff* speaking another language in front of me while at work, but never a patient. I think you need to give your patient a huge break.
My gf is Spanish & had to go EVERYWHERE with her parents when she was young 2 translate. Her Mum made a HUGE effort to learn English, but her Dad only ever ended up speaking some words, & basic sentences. They always had work & own their own house. This woman felt more comfortable with her daughter there, & my gf said when you have to speak Spanish & you know English,have to re-arrange it all in ur head. So it was probably a bit exhausting doing this, since she is in hospital. IMO and experience ONLY, many people I know from other countries/cultures (& I've known a lot), can't be bothered learning English. They are not made to & don't really have to so why put the effort in? One nurse on here I think said his neighbours had been in an English speaking country for many, many years and they knew NO ENGLISH. And I think it's lazy to a certain extent and can be dangerous, as when someone has severe pain they can't tell you.
ADD: My gf's parents always tried to speak English around me, but I could see they weren't comfortable, so when they reverted back to Spanish her Mum said thanks & my gf translated, cos it's exhausting trying to think of English words. Also there are no English translations for some Spanish words, apparently. Having them speaking Spanish around me all the time didn't bother me one bit, but it can be frustrating in a hospital environment.
And as for it being a "professional setting", a hospital is only a professional setting for the professionals that are working their. For everyone else it can be threatening and frightening. People are not at their best. Given the option to take a few minutes to relax and speak in their own language i think most people would take it. As for why they were speaking Spanish in front of you, why not? It's their first language. I would have issues with *staff* speaking another language in front of me while at work, but never a patient. I think you need to give your patient a huge break.
Wow, you really hit the nail right on the head with that. Very well said.
I would look at the patient and talk to the translator as if I were talking directly to the patient. For example, instead of saying, "Can you ask her if she needs anything?" I would say (while looking at her) "Do you need anything?" I was just trying to make a tough situation a little more intimate. It didn't work. She didn't look at me EVER. Whatever...I made it through the shift A-okay.
Eye contact is also very much determined by culture. In some cultures, making eye contact indicated an authority or a confrontation. It is much more respectful to avoid eye contact. This is hard for Americans to grasp, since in our culture making eye contact is a sign of respect. In other cultures it is a sign of disrespect. You followed correct translator etiquette by addressing the patient. She was probably showing respect by not looking at you.
The other posts have illustrated extememly well how culture and language barriers can affect communication in your second example. It might be helpful for you to read a little bit about the cultures of patients that you commonly care. For example, did you know that in some Asian cultures it is considered inappropriate to touch an infant's head? Many well-meaning American nurses could offend their Asian patients by commenting on and stroking the soft hair on a newborn's head.
Specializes in Infectious Disease, Neuro, Research.
Hmmm. I grew up in SW Colorado & was raised "bi-lingual" through the 6th grade- I was the only "gringo" in my elementary, sooo...
1) It is exceedingly shaky legal ground to have family translate. Period. At all.
2) Having grown up with Hispanos, Mejicanos, Navajos and Hopis, I don't swallow the "respect" pill too readily. Yes, there are cultural differences, yes, they need to be considered, but much of this has been created by the sociologist groupies, starting in the 60s and 70s. For all their fine intents, they were not held in high esteem by the cultures they "championed" because they didn't live the culture(much less being born into it), they play-acted. Sincerely, but play-acting nonetheless. We don't live in the 1400s, where culture shock isn't dissipated daily by the internet and TV.
Unfortunately, the racial barrier is not infrequently a two-way street. I'm not saying that's the case here, but it is absolutely present.
Thanks for the responses. I was afraid it might turn ugly, but it didn't - YAY!
To the poster who said something about being familiar with people from cultures I frequently deal with, this isn't a frequent situation. I rarely have patients who speak anything other than English, and when I do, it's Spanish. Even then, we have the telephone translator, but in this case it wasn't needed. That's why I found the situation to be odd. She was able to communicate with me (without translation) but "allowed" her child to translate questions/comments we had discussed previously and successfully several times. I think if you don't speak the language of the country you live in that the best way to learn that language and become proficient is through practice. I felt like allowing someone to translate scenarios that she was capable of doing successfully took those opportunities away. It was a YOUNG woman. If she plans on living the rest of her life here, I think it would be a good idea to speak English to the best of her ability when she's able, but that's just my biased opinion.
Esme12, ASN, BSN, RN
20,908 Posts
I agree with everyone especially wispera.....we need to recognize others cultural beliefs and habbits and respect that......MOST of the time peopIle are not trying to be rude or disrespectful. There is of course the occasional play dumb "speak no english" and you KNOW they are yanking your chain......but thankfully that is the exception and not the rule.
Respect and enjoy our differences and similarities.