Yesterday, a friend of mine who works as a primary care physician at a large community clinic in Brockton, Massachusetts, told me something interesting.  Of the 15 clients who sought his services on that ordinary Monday, none were English speakers.  Most of his patients brought family members along with them to their visits.  These children or wives were utilized as interpreters.  Other patients required staff translators. 

I remembered my own patient population at a similar clinic in New Haven, Connecticut.  During my time as a women's health provider there, I developed a sort of improvised Spanish, comprised almost exclusively of anatomical terms and simple directives.  When they were available, Spanish-speaking staff assisted me with communication, although this pulled them away from other essential duties.  And while we had translator phones, we rarely used them.  Doubtlessly, I missed important subtleties which would have helped guide my clinical decisions. 

How can we, as nurses, best care for patients despite frustrating language barriers? In certain geographic areas in the United States, Spanish speaking skills are, quite simply, a must.  In that New Haven clinic, for example, I was a substandard provider to my Hispanic patients.  I could have (and should have) joined my colleagues who took Spanish classes at local universities.  But what if you work in a hospital that cares for large numbers of Somali or Sudanese or Haitian immigrants?  Obtaining these language skills is admirable, but unrealistic.  Let's face it - we've got families, endless paperwork, and unread professional journals piling up on our office desks.  Some things just plain aren't going to happen. 

In most cases, qualified medical interpreters are the best option for nurses blocked by a language barrier.  Professional interpreters are people who have received specific training; they understand medical terminology, and the absolutely critical nature of both word accuracy and patient confidentiality. 

Neither my Brockton physician-friend nor I followed the by-the-book protocol.  My guess is that plenty of nurses and docs out there are flying by the seat of their pants with non-English speakers, as well.  Most of us fail in one outstanding way: patients' family and friends should not be used as interpreters.  While it is almost never appropriate to use minors as interpreters, even older family members are not ideal for this role. Patients may feel reluctant to share private or personal medical information via family members.  Also, translation errors or omissions are common among well-meaning family members or friends who have not been trained in medical interpretation.

We should not make assumptions about a patient's language competency.  If there is any doubt about the degree to which a patient understands English, directly ask her if she would prefer an interpreter.  If an in-house or telephone interpreter is used for a patient visit, make sure to document this service in the patient's chart.  Anticipate and allow for these visits to take longer than expected.  Also, remember that it is important to speak directly to patients, even when communicating through interpreters.  Information garnered from patients' non-verbal cues will support the verbal information gained through interpretation.

Strong interpersonal skills and effective communication techniques have long been nursing trademarks.  Appropriate use of medical interpreters is an integral part of extending the best nursing care to all patients. 

Copyright 2008- American Society of Registered Nurses (ASRN.ORG)-All Rights Reserved