Language Barriers.

[katc90]

I recently took care of a patient from a different country who spoke no English. What are some suggestions that would make the relationship between nurse and patient more comfortable with such a communication barrier. Especially when you don't always have an interpreter available?

[Silverdragon102, BSN]

I would say picture board would be useful

[Pepper The Cat, BSN, RN]

I work in a region where we get a lot of Non-English speaking pts. A lot of them speak either Mandarin or Cantonese - languages that are not easy to learn!

One thing we find very helpful is to get the family to write out needs in Chinese and English.

Either a list of Chinese on one side with English on the other or flash cards. The pt can point to what they need ie "I have Pain" and the nurses can look at the English translation.

We had one family make up a huge pile of flash cards for their mother. It was great. She would flip through them, find the one that best suited her need and hand it to her nurse. the nurse would flip it over, see the English translation and respond. They had everything from the most basic - " I am cold" to the more complex "I have pain in my hip".

[itsmejuli]

I developed a wonderful relationship with an older Vietnamese lady who spoke no english. We communicated through smiles, gestures, touching hands and basic translation cards. Whenever an english speaking family member came in, I'd take the opportunity to more thoroughly interview my patient about her concerns.

[AMN74]

Our company uses a telephone interpreter. It's called Pacific Interpreters. Your company/hospital/agency would have to set up an agreement with them because they charge by the minute or something crazy, but it is 800# (800.264.1545) and they will ask for your ID code (hince you need an account) and then you tell them the language you think the patient speaks and they get someone on the phone pretty quickly. I tell the interpreter in english what I need the patient to know, and hand the patient the phone...they jibber jabber, the patient gives me back the phone and if there are no questions we are done, or it can take a long time if you have a lot of material to cover. We have a lot of teaching guides in spanish, and my niece speaks fluent spanish so if I need her I call her instead of the interpreter. But just 2 weeks ago I had some people from I don't even remember where they were from, but the interpreter service works well. BY law, it is the health care giver's responsibility to provide education and teaching needs/questions etc IN that patient language.

Good Luck

[dancinglamb]

For official translations (admissions, consents, explaining the pain scale, etc.), our hospital uses a translation phone similar to the one AMN74 describes. But for small stuff, the Google Translate app is an absolute lifesaver (if you have a Droid or iPhone).

You enter in what you want to say and it will either speak what you want to say to the patient or you can show him/her the screen (depending on your phone's abilities). The program works in both 'directions', and I've used it in a few different languages (supposedly over 60 available, but I've never played with enough to really count). It may not be 100% grammatically correct, but you are still able to get the idea across and my patients have been able to tell me that they've appreciated the effort.

Hope that helps!

[nurseprnRN, BSN, RN]

many people look to the next of kin or the housekeeping lady or the lab tech a translator, but this is a bad practice. family members may not be able or willing to translate what you say accurately due to cultural taboos or lack of education (in any language), and the patient may not be willing to have the family member know the answer, either. the housekeeping lady or the lab tech may not have the ability to translate you accurately, and may be laboring under even more taboos about what's appropriate to discuss with a non-family member. there is also a hipaa aspect to this.

there are translation services in the phone book in many areas. translators are fully bilingual and many are certified medical translators. a translator should not say, "he says,..." the translator should use the same words the patient uses, and your exact words to the patient. there should never be any side-conversation between the pt and the translator, or between the translator and the healthcare provider; either one feels exclusionary to the one(s) left out, and the translator, if s/he feels the patient is not understanding, should be providing an accurate translation which makes this clear. the provider should be speaking face to face with the patient, using regular speech, not using words like, "tell him that..."

i have worked with some wonderful medical translators and learned a lot more about the patient than i ever did with a random, well-meaning lay person.

[Vespertinas]

While a translator service is ideal, it sounds as if the OP's facility does not provide such a service.

For the record, even in my facility which does have translator services, it has been made clear that it is acceptable to use a layperson for translating assistance if the content is not medical information. For example, we used our housekeeper to translate things like "Your clear liquid diet does not include milk or Ensure, we apologize." but NOT "You are on a clear liquid diet because we are trying to eliminate formed stool from entering your recto-lady partsl fistula"

[bagladyrn, RN]

We have a lot of teaching guides in spanish, and my niece speaks fluent spanish so if I need her I call her instead of the interpreter. But just 2 weeks ago I had some people from I don't even remember where they were from, but the interpreter service works well. BY law, it is the health care giver's responsibility to provide education and teaching needs/questions etc IN that patient language.

Good Luck

I hope I'm just misunderstanding here - does your niece work in a clinical capacity at your hospital? If not, this sounds like a huge potential HIPAA violation if you are calling her to translate for you. If community member volunteers are used to translate it should only be those on a facility approved list who have been tested for their ability to accurately translate and who have been given education in confidentiality which has been documented.

[HouTx, BSN, MSN, EdD]

FYI Y'all - there are a new set of "Patient Centered" Joint Commission standards that became effective on Jan 1. In order to comply with these standards, organization have to have a defined system for providing competent medical interpreters for all significant discussions with non English-speaking patients... no more casual translation from family or housekeeping. They also have to provide documents in the 'preferred language' of patients for any group that comprises > 5% of the patient population. This includes patient teaching & discharge instructions.

Many organizations are struggling with how to validate & maintain competency of medical interpreters. External interpreters should be certified (there are 2 US groups that do this), but how do we incorporate the services of our multi-lingual staff in a way that satisfies JC? If anyone has some great ideas, please post them.

[classicdame, MSN, EdD]

Should have a language phone available. Talk to your supervisor. ATT has a "Language Line" that allows you to use any phone. Do not know the cost, however