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Clear Communication

Hospitals employ several strategies to help nurses conversing with non-English speaking patients

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When Maria R. was admitted to a city hospital, she worried nurses wouldn't understand her. Imagine her relief when her nurse conversed with her in Spanish, her native language.

Today 80 percent of hospital staff members communicate with non-English speaking patients, according to Healthcare Research and Quality (HHRQ). The U.S. Census Bureau reported 1 in 15 Americans can't speak English, and 1 in 5 speaks foreign languages at home.

Nurses from two award-winning hospitals, NewYork-Presbyterian Hospital (NYP)/Columbia University Medical Center, New York, NY, and Cambridge Health Alliance Hospital (CHA), Cambridge, MA, have employed strategies for nurses to communicate with non-English speaking patients.

"Whenever possible, we pair native speakers employed among our nurses, nursing attendants and techs with patients who speak the same language," said Marsha Sinanan-Vasishta, MBA, MSN, RN, a patient care director at NYP. "Our second choice is to use medically trained language interpreters, whether in person or via telephone. Eighty percent of department requests for language interpreters are covered by in-room interpreters. Our third choice, if the two prior are not available, is to ask patients for permission to use adult family members present (18 years or older) who speak their language."

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"Translating for a nurse while present in patient rooms is a great asset because they know they're listened to and someone is present to answer their questions in their primary language," said Bridgit Paula, RN, of CHA Women's Health Center. "It's especially helpful when patients know interpreters from an earlier experience."

Language Interpreter Services

At NYP, nurses and other professional staffs have on-site or telephone interpreter services options available and a caller has 13 foreign language choices plus access to more language choices assessable through the hospital's International Language Services Department, according to Sinanan-Vasishta.

Presbyterian's International Services Department employs native-speaking regional coordinators from Latin America, Asia and the Middle East who can also provide language service assistance for foreign patients. "Through our telephonic translation line, Pacific interpreters can provide us with more than 140 language choices," Sinanan-Vasishta said.

Wherever caregivers are caring for patients, they have a single point of access to get language assistance by calling one telephone number, said Mursal Khaliif, RN, senior director of multicultural affairs and patient services at CHA.

"A telephone prompting system provides two choices: press one for face-to-face interpreter services, or press two to connect with a phone interpreter," he explained.

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Marsha Sinanan-Vasishta, MBA, MSN, RN

When a face-to-face option is chosen, a dispatcher will work with the caregiver to coordinate the required language services and the caller will hear the following language choices: Portuguese, Spanish, Haitian, Creole and Hindi. Other languages are available upon request.

Telephone & Video Conferencing

Professional staffs at both hospitals have options to engage in three-way telephone conversations by using headsets, dual handle phones and cordless speaker phones on-hand in all patient care areas.

"When conversing with phone interpreters nurses use one handle while patients use a second handle to participate with an interpreter who is on the line," Khaliif explained.

"Our conferencing service is also used for non-English speaking patients," Sinanan-Vasishta said. "In these situations nurses ensure patients have a phone within reach, the nurse places a call to hospital's telephonic translation service line, and an interpreter will then 'three-way' call into the patient's room. This set up allows patient, nurse and interpreter to converse together."

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Mursal Khaliif, RN

A specially designed cart equipped with video conferencing equipment may be wheeled into a patient's room so healthcare providers may effectively communicate with deaf patients, according to Khaliif.

"Healthcare providers and support staff can access remotely located sign-language interpreters who are using the same type of video conferencing technology."

Medical sign-language translators interpret conversations and convert patient instructional materials into the desired language. They must be proficient in English and American Sign Language.

To maintain continuity of care, foreign-language coordinators set up blocks of time when interpreters are needed on nursing units.

"For example, interpreters may be assigned during morning hours to assist during physician visits, accompany patients for X-rays or medical tests, assist nurses dispensing medications, or engage in other activities that contribute to the hospital's professional services," Sinanan-Vasishta said.

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Bridgit Paula, RN, CHA Women's Health Center

Tips for Nurses

In addition to his present position, Mursal Khaliif has worked for UNICEF and the International Committee of the Red Cross and has shared tips when conversing with non-English speaking patients or family members:

Speak in your normal tone of voice neither too fast or two slow.

Establish eye contact with patients and families.

Don't say anything you don't want repeated by an interpreter because they're trained to repeat anything you say.

Interpreters will be monitoring your body language so be careful not to send a message that the information being explained is serious or upsetting. Should that circumstance be the case, speak with the interpreters outside patient rooms and alert them to the situation.

Be aware of cultural issues and question to clarify those that pertain to patients and their care.

Following Best Practice Standards for safety while communicating with non-English speaking patients ensures good patient care outcomes, Khaliif concluded.

Joan Fox Rose is a frequent contributor to ADVANCE.


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