Transcript DiversityRX (2)

Nursing Practices that Improve Care
for Children and Families with Limited
English Proficiency
Anna Zimmerman, MSW
Seattle Children’s Hospital
Background
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Children in LEP families often receive medical care
without professional interpretation, despite
increased risks of medical error, excessive testing
and family discontent.
Poor communication is associated with poor care,
especially for critically ill children.
Background

United States law and Joint Commission require
health care organizations to offer and provide
language assistance services at no cost to each
patient with LEP.
(DSHS 2001, Joint Commission 2010)
What role do nurses play
in providing interpretation?
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Inpatient nurses communicate with patients and
families throughout the day
Nurses are challenged to assess patient and family
language need
Nurses must decide when and how to use
interpretation resources
Objective
 This
study explored pediatric
nurse practices and perceptions
of current nursing use of
interpretation services.
Methods
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13 nurses interviewed from 5 pediatric units
Nurses selected based on availability
Interviewed15- 20 minutes, audiotaped, transcribed
Open-ended questions explored how nurses care
for LEP families
 Decisionmaking
process on providing interpreters
 Exploring value of communication in patient care

Transcripts coded into distinct units of meaning and
categorized
Results: Interpreted communication improves nursing care
for LEP patients and families
 Families
understand care plan
and are less stressed
 Supports
family involvement in
decision making
 Strengthens
nurse-family
therapeutic alliance
 “Non-medical” conversations
are opportunity to build
relationship with family
Every time I use [an
interpreter] I feel like
parents are happy
because they know who I
am. I am not just some
stranger coming in and
messing with the pumps
when they are sleeping.
Results: When are families less likely to
receive interpretation
“Getting by” for
perceived non-medical
issues
 Use family member or
patient as interpreter
 Parental refusal
 Barriers to using in-person
interpretation on
weekend/night
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Dad had limited English
skills and mom had no
English. I asked Dad if he
wanted to use the phone
interpreter and he said,
just tell me the
information and if I feel
like I need more
explanation I can get on
the phone. So, I did that
and Dad spoke to the wife
to tell her the information.
Results: Consequences of inadequate
interpretation
Delays in care
 Misunderstandings and
cultural barriers
 Parental waiting
without news
 Risk of medical error
 Less connection with
family members who
are not present
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I definitely receive less
contact from LEP families.
That may be because they
don’t know the numbers to
call..[or] that they can use
an interpreter to contact
us. They might not feel as
involved in the care.
Results: Nurse or family decision to use
interpretation?
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Half of nurses believed that the nurse herself needed an
interpreter to provide quality care
 Interpretation enabling the nurse to do his/her job
 These nurses better able to navigate difficult situations
The other nurses believed that the family should dictate
when interpretation is used
 This results in more ‘ad hoc’ interpretation and lack of use
of interpreters
Results: Phone vs. in-person interpretation

In-Person
 Used
for rounds, consent, medical protocol,
admission/discharge, change in plan of care,
teaching/demonstrations, care conferences, emotionally
charged conversations
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Phone
 Used
for start of shifts, for basic & quick topics,
questions from family, rare languages, when unable to
schedule in person
Phone Interpretation
Strengths
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Instantly available
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Simple to use
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Well liked by those who
use regularly
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Critical for use on “less
important” topics
Nurses concerned about
resource utilization and
time
Rare languages
When unable to plan
ahead
Examples of phone interpretation
Emergency Department
Inpatient Room
In-Person Interpretation
Strengths
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Captures non-verbal
communication
Needed for teaching for
care/discharge
Quicker for rounds
Dedicated professional
interpreters
Timely Service
Important for admission,
discharge, emotional
discussions
Conclusions
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Nurses felt interpretation strengthened therapeutic
relationship, improved quality of care and reduced
risk of medical error
Availability of interpreter services does not
guarantee use
Interpretation critical to communication and effective
nursing care
Conclusions
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Opportunities for improvement
building rapport
 avoiding use of non-professional
interpretation
 telephone for quick communication
 Whether to use an interpreter is not
just the family choice but is central to
core nursing role
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Implications for nursing practice
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Regular measurement of interpretation being
provided to LEP families on each nursing unit
Feedback on interpreter use to nursing units
Promote telephone interpretation as essential tool
for timely and frequent communication
Developed toll-free access line for LEP families
Hospital emphasis on medical interpretation as a
core service with professional standards
Thanks!