Download ¡Ayúdame! Mi esposo esta inconsciente!

¡Ayúdame!
Mi esposo esta inconsciente!
By Patricia A. Dettenmeier, DNP, MSN, FNP
CAN YOU IMAGINE what it’s like
to live in a country and not be able
to speak the language, particularly
when healthcare is involved? In the
United States, patients with limited
English proficiency (LEP) deal with
this barrier to healthcare every day
in hospitals, clinics, and physician
offices. An LEP person is defined as
an individual whose primary language
isn’t English and who has a limited
ability to read, write, speak, and understand English.1
What role do language barriers
play in healthcare disparities and
how can healthcare professionals
(HCPs) overcome them? This article
describes ways nurses can prepare to
care for patients with LEP.
Can you repeat that?
The American Community Survey
Reports conclude that roughly 80%
of people in the United States over
age 5 speak only English at home.2
The remaining 20% speak a language
other than English at home, and
over 20% of this population speak
English “not well” or “not at all.”
Most of this percentage speaks
Spanish (62%/37.6 million). For
a breakdown on other languages
spoken in the United States, see
People are talking.
These culturally, racially, and lingually diverse people are our patients
now, and we may see them more fre-
quently in the future as language
variety increases due to recent and
future immigration patterns.3
I don’t understand
For patients, LEP is a risk factor for
healthcare disparities. For healthcare
providers, a lack of knowledge
about certain cultures and language
contributes to these same disparities.4 LEP can result in multiple
problems, including decreased
access to preventive health services,
dissatisfaction with care, difficulty
understanding instructions and/or
information about medications and
follow-up care, longer hospital stays,
and medical errors or misdiagnosis.4
These real or potential problems
need to be addressed in all settings
and healthcare facilities, and even
within the 911 operating system.5
Imagine being an 911 operator who
can hear but not understand the
foreign words for “help me!”
Speak a little slower
Access to minority language-speaking
medical interpreters is one option for
improved communication, but they
may not be available or affordable,
especially in rural areas.6 In 2000,
President Clinton issued an Executive
order (#13166) to improve access
to services for all persons with LEP
regardless of location.7 This order
included federally assisted or
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No hablo ingles!
M IKE L ATHROP/I LLUSTRATION S OURCE
Help me! My husband is unconscious! I don’t speak English!
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conducted agencies, programs, and
activities in urban, suburban, and
rural areas. Further information about
the executive order, resources, and
patient rights can be found at a federal interagency website, www.lep.gov.
While LEP services have improved
since this executive order, they’re not
consistently available. In the absence
of minority language-speaking medical interpreters, healthcare providers
may try one of the following activities recommended by the Agency for
Healthcare Research and Quality.4,8,9
Simple phrases or instructions can
be translated using a translation website when no interpreter assistance is
available, but this is time consuming,
sometimes inaccurate, and may be
difficult or even impossible for some
HCPs or patients to do. Using pictures is another option, but having a
photo for every situation is impossible. Patients with some English
knowledge who are involved in a
teach-back method of learning (for
example, metered-dose inhaler use)
may be able to understand enough
English to write instructions in their
native tongue.8,9
Healthcare agencies and providers
who receive federal funding are obligated to provide reasonable access to
LEP persons.7 Medical literature is
sometimes available in English and
Spanish, but not all languages. Some
facilities may have employees who
fluently speak a non-English language
and could assist in translating; however, it should be noted that using
staff members or family members
as interpreters at healthcare visits
should be avoided because privacy
Preparing for an LEP visit
•
Look directly at the patient and speak slowly, but not loudly unless the patient is
hearing impaired.
• Ask what languages the patient speaks. There may be a common secondary language.
• Use picture cards illustrating objects and concepts appropriate to your practice, such as
common body parts, foods, household items, people, pain intensity levels, and feelings.
• Watch for clues of confusion, such as facial expressions, that indicate the patient
may not understand what you’re saying and/or explaining.
• If using an interpreter, don’t exclude the LEP patient and make sure the patient’s
comfortable with the interpreter.
• Translate vital forms or documents into languages commonly spoken within the
healthcare system’s community.
• Consider creating a separate call line for LEP patients/families with instructions in
different languages.
For additional resources, visit www.LEP.gov/resources, www.hhs.gov/ocr/civilrights/
resources/specialtopics/lep/index.html, or http://www.ahrq.gov/professionals/
systems/hospital/toolkit/redtool4.html#Teaching.
10 sample questions to have prepared for an LEP visit*
1. What brings you here today?
2. Do you have any other major concerns?
3. Do you have any questions?
4. Do you understand everything I told you about the problem and the treatment?
5. How do you feel about your visit? Was everything OK?
6. Is there anything else I can help you with?
7. Tell me about your family (or community) support for your care.
8. Do you need a referral to another healthcare provider or agency?
9. Do you have any questions about your medications?
10. Do you have any financial concerns?
*These are just examples of possible questions. Questions will vary for each facility.
and openness could be compromised
and the interpreter could insert personal bias into the translation.6
There are certain documents that
must be translated, according to
Health and Human Services guidelines.10 These documents are vital to
patients’ healthcare and include:
• consent and complaint forms
• documents that must be provided
by law
People are talking
Additional languages spoken in the United States include:
•
Indo-European languages such as German, Scandinavian, Slavic, Indian, or Romance
languages (17.8%/10.8 million).
•
Asian/Pacific Island languages such as Chinese, Japanese, Vietnamese, or Philippine
languages (15.6%/9.5 million).
•
Other languages such as Semitic (Hebrew or Arabic), native Alaskan, American
Indian, or African languages (4.6%/2.6 million).1
Reference:
1. Ryan C. Language use in the United States: 2011. 2013. http://www.census.gov/prod/2013pubs/acs-22.pdf.
• notices about emergency preparedness and risk communications
• notices of eligibility for benefits
• notices about no-cost language
assistance.1,10
One more time
When a medical interpreter is used
in the clinic, communication is
more tedious as questions and information must first be communicated
to the interpreter and to the patient,
then back to the interpreter, and
finally to the HCP. This message
cycle is repeated numerous times to
gain understanding of the problem
and is then repeated again to complete the physical assessment and
discuss the treatment plan. This
procedure of back and forth with
the interpreter in the middle is,
however, still very necessary and
useful to effectively diagnose and
treat the patient.
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Improving communication with non-Englishspeaking patients also occurs when HCPs learn about
the language, cultures, values, and beliefs of the patient.
Improving the HCPs knowledge has the potential to
enhance quality care, improve racial and ethnic harmony, and lead to more knowledgeable, culturally competent HCPs.5 Cultural competency is supported by the
Institute of Medicine, which has recommended that
cross-cultural education be incorporated into HCPs’ education.11 Such education may improve distribution of
HCPs to areas of need, including rural and underserved
locations.12 Alternately, members of minority communities should be encouraged to become HCPs to help treat
all patients, including those from within their own
communities.13
How nurses can help
Nurses have a critical role in addressing the problems of
language-associated healthcare disparities to ensure that
access to quality care isn’t influenced by language disparities, socioeconomic status, or other demographic
characteristics.14 What can the nursing professional do
when a non-English-speaking patient appears at the
door?
First, prepare for this reality as soon as possible by developing a list of questions that can be translated using
an interpreter or the Internet. (See Preparing for an LEP
visit.) Provide a few options for typical answers, such as
colors, sizes, numbers, and so on, in the native tongue
with English translations. Make picture boards, focusing
on body pictures. Remember that many concepts can be
communicated without words. Be sure to use your hands
and facial expressions.
8.McClure DL. Training challenge: when the patient speaks a different
language. Adv Perit Dial. 2010;26:88-90.
9.Agency for Healthcare Research and Quality. Five key recommendations
to improve patient safety for LEP patients. In: Improving Patient Safety Systems
for Patients with Limited Enlgish Proficiency: A Guide for Hospitals. Rockville,
MD:Agency for Healthcare Research and Quality; 2012.
10.Department of Health and Human Services. Language access plan. 2013.
http://www.hhs.gov/open/execorders/2013-hhs-language-access-plan.pdf.
11.Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial
and Ethnic Disparities in Health Care. Washington, D.C.: The National Academies
Press; 2003.
12.Awosogba T, Belacourt JR, Conyers FG, et al. Prioritizing health disparities
in medical education to improve care. Ann N Y. Acad Sci. 2013;1287:
17-30
13.Zambrana RE, Carter-Pokras O. Role of acculturation research in advancing
science and practice in reducing health care disparities among Latinos. Am J
Public Health. 2010;100(1):18-23.
14. Danna D. Providing cuturally competent care during disasters: strategies
for nurses. J Contin Educ Nurs. 2013;44(4):151-152.
At Saint Louis University in Patricia A. Dettenmeier is an assistant professor of
Medicine and an adult NP in the division of Pulmonary, Critical Care, and Sleep
Medicine in St. Louis, MO.
The author has disclosed that she has no financial relationships related to this
article.
DOI-10.1097/01.NURSE.0000441883.72501.6d
Improving outcomes for all patients
Patients who don’t speak English may have limited access
to preventive, diagnostic, or therapeutic health services.
By meeting the challenge of caring for patients with LEP,
nurses can eliminate or significantly reduce language barriers to optimum healthcare. ■
REFERENCES
1. Limited English Proficiency. Frequently asked questions. http://www.lep.gov/
faqs/faqs.html#OneQ1.
2.Ryan C. Language use in the United States: 2011. 2013. http://www.census.
gov/prod/2013pubs/acs-22.pdf.
3. Martin P. U.S. immigration patterns and policies. 2012. http://migrationfiles.
ucdavis.edu/uploads/rs/files/2012/ciip/martin-immigration-patterns-policies.
pdf.
4.Diamond LC, Jacobs EA. Let’s not contribute to disparities: the best methods
for teaching clinicians how to overcome language barriers to health care. J Gen
Intern Med. 2010;25 Suppl 2:S189-S193.
5.Padela AI, Punekar IR. Emergency medical practice: advancing cultural
competence and reducing health care disparities. Acad Emerg Med.
2009;16(1):69-75.
6. Davis JR, Wilson S, Brock-Wilson A, Glover S, Svendsen ER. The impact of
disasters on populations with health and healthcare diaparities. Disaster Med
Public Health Prep. 2010;4(1):30-38.
7. Executive Order 13166. Improving access to services for for persons with
limited English proficiency. 2000. http://www.justice.gov/crt/lep/13166/eolep.
htm.
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June l Nursing2014 l 63
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