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Collaborating with Medical Interpreters: Best Practices for LEP Patients

Limited English proficiency and adverse event risk.

As a native San Franciscan, I grew up surrounded by bilingual people who represented cultures from all over the world. It is a privilege for me to be surrounded by such rich diversity, but many patients who are limited English proficient (LEP) are at risk for adverse events once they enter a health care setting. Identifying a patient’s preferred language at the initial point of entry can ensure that resources are available to support the patient as they navigate the health care system. Medical interpreters are vital to our LEP patients and serve as a bridge for translating both language and other crucial cross-cultural elements of communication.

Letting patients and families know their rights.

Providing interpreting services reduces health inequities for LEP patients and is also required by Title VI of the U.S. Civil Rights Act (1964). This law states that hospitals that receive funding from the U.S. Department of Health and Human Services must notify LEP patients of the availability of free interpreting services, which should not include their own friends and family. As nurses, we must advocate for our patients who may not be aware of their rights and may have fears about perceived consequences if they admit to not being proficient in English. Perform a quick […]

2023-02-13T10:32:40-05:00February 13th, 2023|Nursing, patient engagement, Patients|1 Comment
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When Studying Mental Illness in Nurses Means Studying Yourself

Carrying the burden of depression as a nurse.

As I read Anna’s (not her real name) description of how much effort it took to drag herself into work, how much she felt like a burden to her family, and her fear of being “found out,” tears welled up.

“I know,” I said to myself.

I was analyzing an interview transcript for a qualitative study of psychiatric-mental health nurses (PMHNs) who have experienced mental illness. More specifically, my colleagues and I wanted to know how their illnesses impacted their work as nurses.

I have been a PMHN for over 40 years, with an even longer experience of a mental illness. I recognized many of the participants’ stories in my study as my own, but none affected me the way hers did. An alarm bell inside my head went off. If I couldn’t create a clear boundary in my mind between Anna’s experiences and my own, I might be at risk of unduly influencing the study results.

Reflecting on shared experiences of depression.

I was grateful that a colleague was also analyzing these transcripts; to minimize the effects of my own potential bias, I took the opportunity to write down my thoughts and feelings in my reflexivity journal. This is a […]

2023-02-02T10:33:57-05:00February 2nd, 2023|mental illness, Nursing, patient experience|1 Comment
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Cross-Sector Collaboration and the New York City Involuntary Hospitalization Policy

Although currently living upstate, I’ve closely followed news of Mayor Eric Adams’ policy for removing residents who appear mentally ill on city streets. As a nurse with a background in health care administration, I find this policy ethically problematic. As a PhD candidate studying how organizations collaborate to transition patients lacking homes at discharge, I know the complexities of implementing this policy.

Mayor Adams is proposing a close read of section 9.58 of Article 9 of the New York State Mental Hygiene law, which is the state’s legislation pertaining to involuntary hospitalization of people experiencing acute mental illness. To “939” someone, as it is often informally termed, means to place them under involuntary psychiatric hospitalization because they pose an imminent threat to themselves or others; ‘imminent threat’ is usually interpreted to mean active suicidal ideations or homicidal threats or actions. What Mayor Adams proposes is to allow peace officers and mobile outreach units to apply a wider interpretation of this clause such that it includes any behavior that might threaten an individual’s ability to take care of their daily living needs.

I believe that housing first policies are the bare minimum for giving a person with serious mental illness or any significant chronic […]

2023-01-30T10:31:58-05:00January 25th, 2023|mental illness, Nursing, nursing roles, Public health|0 Comments
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Death by PTSD: When Patients Are Afraid of Health Care

“I pleaded with her to go to the hospital.” Don’s voice is suffused with sadness as he sits at the bedside of his dying 39-year-old partner, Clarisse. “She was terrified of medical tests and procedures. By the time she saw a doctor the cancer had spread. She was so overwhelmed she refused any treatments.”

Over the years, I’ve had several patients like Clarisse; younger people who refused to seek medical care or declined treatments that might have cured them. Some were depressed, others worried about the financial burden. But there was a common thread: all were intensely distrustful, avoidant, and afraid.

Depressive thoughts, distrust, avoidance, and fear are all common features of post-traumatic stress disorder (PTSD) and every one of these patients had either been diagnosed with PTSD or would have if they’d sought psychological care.

Effects of PTSD in patient response to health care.

Clarisse had survived childhood sexual abuse at the hands of one of her mother’s boyfriends. This had left her intensely sensitive to intrusions into her personal space, terrified of being touched or probed by medical staff, and distrustful of men and authority figures. There were a number other common effects of PTSD evident in my work with Clarisse.

2023-01-18T09:55:42-05:00January 17th, 2023|Nursing|0 Comments
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Every Patient Needs an IV, or Do They?

(This post is by an author of AJN‘s January CE feature, “Evidence-Based Practice for Peripheral Intravenous Catheter Management.”)

Questioning the status quo.

As a former critical care nurse and now a vascular access nurse researcher, I’ve had the good fortune to travel widely and work with nurses from around the globe on multiple projects. As a researcher, part of my role is to question clinical practices we often take for granted and to ask, “Is this the best way? Could there be a better way?” Identifying practice that may not always be evidence-based is how research often begins.

Prior to the Covid-19 pandemic, I undertook a two-month fellowship in the US and visited several hospitals where, time and again, I noticed the majority of hospital patients had a peripheral intravenous catheter (PIVC) in place, but many were not in use. When I asked the nursing and medical staff why patients had a PIVC that was not in use, I was repeatedly told, “Every patient needs an IV, just in case.” When I pointed out that some patients had two or three PIVCs not in use, or a central venous access device as well, it became obvious that this is a common problem.

An ‘idle’ catheter is a PIVC that has not been […]

2023-01-11T11:41:34-05:00January 11th, 2023|Nursing, patient safety|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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