Lisa H

Thank you so much! I will email you today!

Hello! I just wanted to express my appreciation to those who have participated in my research. It's been such a privilege to gain so much insight from nurse managers throughout the United States! I am winding down with the information-gathering phase, but feel that one or two more interviews would help to fortify the information I've already collected. So if you are a current or recent nurse manager or assistant nurse manager that has been held accountable for HCAHPS, you might be interested in participating. Those who participate will receive a $75 Amazon gift card. I will conduct interviews until May 19. Simply complete the questionnaire at this link and I will connect with you: https://uky.az1.qualtrics.com/jfe/form/SV_3qTekUkxf7sP5Ua Again, thanks so much! I look forward to sharing my results!

Hello, and thanks again to those who have requested to participate in this study. It is coming along nicely and I'm enriched by all of the insight I am receiving! I still do need another 5 or 6 interviews (35 to 40 minutes long), so again invite any nurse managers or assistant nurse managers to share their experiences managing and being accountable for patient experience scores. Those who participate will receive a $75 Amazon gift card. If interested you may indicate such through completion of an interest questionnaire at this link: https://uky.az1.qualtrics.com/jfe/form/SV_3qTekUkxf7sP5Ua. Again, thanks so much for considering this research!

Hello! I've had three responses -- a good start for a qualitative exploration (though I would value additional insight from others). Thanks for asking!

Thanks so much to those who have requested to participate in this relevant research! I'm really learning alot from nurse managers about what it's like to be accountable for HCAHPS scores. To ensure that a diversity of perspectives is reflected, I would really value weigh-in on this topic from others who qualify to participate. Simply complete the interest questionnaire at the link above (within the initial post). Or with questions, reply to this post and I will gladly respond. Again, thanks for the response so far!

I know that I myself read and write better when I have certain types of music playing in the background. So to me music therapy in the NICU makes sense and is definitely a topic that merits further exploration. This subject has piqued my interest -- makes me wonder to what extent my own hospital uses it. Thanks for addressing this topic!

It's a shame that some foods that are so healthy can prove to also be embarrassing. At least now I better understand why the elderly people in my life have a tendency to let them rip (and all the more motivation for me to keep exercising)!

Much food for thought here, and very enlightening. Hitting home with the point that nurses are revenue generators is perhaps the type of language that the C-suite can better understand.

Hello! I am a doctoral candidate at the University of Kentucky, and am conducting dissertation research. I am seeking inpatient unit nurse managers or assistant nurse managers (current or within the last 5 years) to take part in a 35- to 45-minute virtual Zoom interview sharing experiences about being accountable for patient experience scores (e.g., HCAHPS). All interviews will be confidential, and those who participate in an interview will receive a $75 Amazon gift card. Those interested may indicate such through completion of an interest questionnaire at this link: https://uky.az1.qualtrics.com/jfe/form/SV_3qTekUkxf7sP5Ua. This is an IRB-approved study and detailed informed consent documentation will be provided prior to interviews. Feel free to share this link to those who may qualify. You may respond to this post with additional questions. Thank you so much for considering this research opportunity!

According to the Joint Commission, breakdowns in communication cause approximately 80 percent of all medical errors. Although this is a daunting number, those with limited English proficiency (LEP) are more prone to patient safety events than English-speaking patients. These events tend to be more severe and are more often attributed to communication errors. With more than 25 million people in the U.S. being LEP (approximately 8 percent of the population), the need to address the communication needs of LEP patients and their families is paramount. Accommodating these communication needs is mandated by law, initially with the Civil Rights Act of 1964 and the Americans with Disabilities Act of 1990, and most recently with Section 1557 of the Affordable Care Act of 2010. Moreover, the Department of Health and Human Service's national CLAS (culturally and linguistically appropriate services) standards are in place to advance health equity and eliminate healthcare disparities. The CLAS standards not only direct organizations to offer language assistance (such as interpreter services) to LEP individuals, but also emphasize the importance that those providing language assistance are qualified to do so. Risking Medical Errors Unfortunately, too many untrained individuals do attempt to provide language assistance, particularly with interpreting (defined as acting as a third party to facilitate a conversation between patient and provider). In fact, the Agency for Healthcare Research and Quality (AHRQ) has found that there are three primary scenarios that lead to medical errors impacting LEP patients: Scenario #1: Accompanying adults, such as friends or family members, acting as interpreters for patients Although friends and family members may be bilingual, being bilingual is not the same as being an interpreter. Professional interpreters are trained individuals with a specialized skill set. Although friends and family members may mean well and are eager to help, several factors inhibit their abilities to interpret effectively: Lack of knowledge about medical issues and medical terminology Hesitancy to relay information (or the tendency to sugarcoat information) about sensitive issues, perhaps due to cultural issues Not enough familiarity with the English language themselves to understand and communicate complicated information Emotional investment that adversely impacts their abilities to be impartial Scenario #2: Staff who feel they can "get by" with their own limited skills or tools that are not completely accurate This could be a slippery slope, as a couple of years of taking a targeted language in school does not make an individual proficient enough in the language to be an effective interpreter. In fact, relying on limited bilingual skills could be likened to "knowing just enough to be dangerous.” Similarly, reliance on machine translation tools such as Google Translate is discouraged. Google Translate is not a secure platform; thus, inputting protected health information (PHI) with the use of the Google Translate tool could pose issues with HIPAA. Additionally, Google Translate is not always accurate and should not be trusted for medical conversations. And although machine translation programs are becoming more sophisticated, one minor glitch in communication via a wrongly interpreted phrase can lead to medical errors. Scenario #3: Cultural issues that are unknown to healthcare staff For instance, individuals in many cultures may perceive a power differential between healthcare providers and themselves. As such, patients may nod out of deference to healthcare staff, but staff may perceive that nod to be the patient's confirmation that they understand their treatment plan or discharge instructions (when in fact, they don't). What Can You Do? Ensure that LEP patients know that they have the right to a professional medical interpreter Taglines that communicate this message are available in many different languages from the Department of Health and Human Services. Rely on professional medical interpreters to communicate with LEP patients Even if patients may speak some English, it is best to employ interpreter services to ensure optimal communication. Professional medical interpreters are specially trained. They possess superior concentration and memorization skills and are familiar with how to best interpret medical terminology. Furthermore, they are neutral third parties who can convey information in a less biased way. Although some larger hospitals and practices employ full-time interpreters who can assist onsite, remote interpreter services—accessed via telephone or video—are available from numerous language vendors. Recognize and respect the interpreter as part of the patient's care team You are not only relying on the interpreter to convey words, but also to act as a cultural broker to detect cultural misunderstandings that could impede care. To facilitate seamless interpretation, ask one question at a time, avoid slang or jargon, and speak in complete sentences. Also, do not make the interpreter accountable for what a patient might or might not say, as the interpreter is the medium—not the source—of the message. If an LEP patient refuses interpreter services, document it Often LEP individuals may waive their right to a professional medical interpreter and instead request accompanying adults to assist. Be sure to reiterate to these patients that they have a right to a professional interpreter free of charge. If patients insist on using friends or family, then document it. One of the proposed changes to Section 1557 of the Affordable Care Act is that LEP patients' requests to use accompanying adults must be documented. Additionally, consent by the accompanying adults to act as an interpreter should also be documented, and use of the accompanying adult should be appropriate under the circumstances. Do not use minors in any way to interpret except in emergencies where patients risk imminent harm. In an increasingly diverse society, the demand for language services that include interpreter services is certain to increase. Anticipating this need and addressing it in a proactive way constitutes a forward step in ensuring safe and high-quality care for LEP patients. References/Resources Joint Commission Confronts Deadly Miscommunications: Healthcare IT News Improving Patient Safety Systems for Patients With Limited English Proficiency: Agency for Healthcare Research and Quality (AHRQ) Fact Sheet: Nondiscrimination in Health Programs and Activities Proposed Rule Section 1557 of the Affordable Care Act: U.S. Department of Health & Human Services National Culturally and Linguistically Appropriate Services Standards (CLAS): Department of Health & Human Services Translated Resources for Covered Entities: U.S. Department of Health & Human Services Use of Google Translate in Medical Communication: Evaluation of Accuracy: BMJ Publishing Group Ltd How the Proposed Changes to Section 1557 Affect Individuals with Limited English proficiency (LEP): National Health Law Program

I currently manage language services for the hospital system I work for and have been working from home since the pandemic started. For the most part I really like it. It requires discipline and organization. I can say I'm actually more productive than being onsite. I do sometimes miss the face-to-face social interaction, but I don't feel too isolated because I spend a lot of time on the phone or on video conferences. Besides, if I get too lonely I always have my dog, who enjoys laying next to me while I work!

As a child I remember my mom having to work every Christmas. Lunch in the hospital cafeteria was our Christmas day tradition. Most of these occasions my mom, a nursing supervisor, would get called away in the middle of the meal. At the time it was just our reality. I didn't realize until later just how special she was for working on those holidays!