Some Gentle Reminders for Ensuring Appropriate Language Interpretation for Patients

When I began nursing school, I never could have imagined how quickly I would be thrust into the heart of health care, quite literally. During my first semester, I started clinical rotations on a cardiovascular unit, where I began to understand the phenomenal intricacies of the human heart. It was a time of discovery, as I learned to navigate the complexities of blood pressure readings, mean arterial pressures (MAP), electrocardiograms (ECGs), cardiac catheterizations, and even the life-changing left ventricular assistive devices (LVADs).

By the time I began my second semester, I found myself in a cardiovascular surgical intermediate care unit, a place that would push me further into the depths of cardiac care. There, under the watchful eye of my clinical preceptor, I had the responsibility of caring for patients who had undergone some of the most intricate and high-stakes procedures imaginable. It was during this semester that I encountered a powerful lesson that has stayed with me long after graduation and well into my early years as a registered nurse.

A lesson in why clear communication really matters.

A Spanish-speaking Hispanic woman with coronary artery disease was admitted to our cardiac unit. Her electronic medical record noted Spanish as her primary language, requiring the use of a professional interpreter to ensure clear communication between the health care providers and our patient. During the shift, she underwent a coronary angiography—a minimally invasive cardiac catheterization, in which a catheter is threaded from the wrist or groin to the heart to visualize its coronary arteries. As part of this process, the provider obtained her informed consent and confirmed her understanding of the procedure. Our patient was wheeled off the unit to the cardiac catheterization lab for the procedure.

To our shock and dismay, she returned to the unit less than 30 minutes after the procedure, shaken and teary-eyed. When we inquired, the cath-lab nurse who had assisted with her transport explained that the patient had chosen to decline the procedure when she was midway through it. When the process began, the patient expressed concern when a catheter was inserted through her wrist via the radial artery, as she did not fully understand why her wrist was involved in a procedure meant for her heart. Although she had signed documentation providing informed consent, it seemed that she had not been clearly informed about the role of the wrist. Feeling unsettled, she ultimately decided to stop the procedure.

‘Another layer of stress and tension’ for patients.

This experience drilled into me the huge communication gap that exists when patients who have limited proficiency in English or who speak English as a second language seek medical attention. It also showed me how these language barriers not only affect patient outcomes, but also erode trust in the health care system and providers. For physicians, nurses, and health care staff, understanding diagnoses, treatments, and surgical procedures may feel second nature. However, for a patient in the hospital bed who is already anxious and uncomfortable, being unable to speak the language of their health care providers adds another significant layer of stress and tension. Given this, how can we work to improve health communication with all our patients? Here are some ideas we may reflect on.

A legal requirement.

First, many health care institutions are legally required to provide interpreter services to patients with limited English proficiency/patients who have a preferred language. In the United States, the foundation of this right is established in Title VI of the landmark Civil Rights Act of 1964. As enforced by executive order, this establishes that patients have a legal right to access health care in their preferred language. These services are often delivered through a virtual interpretation system, or through in-person interpreters who are trained professionals or competent medical staff fluent in the patient’s language.

When nurses omit documentation or take shortcuts.

Often due to time constraints or convenience, many nurses fall into the trap of not appropriately asking and documenting a patient’s preferred language, or utilizing family members or bilingual staff on the unit during certain conversations. Health care has its own language, and the use of trained and qualified interpreters—not family members or staff on the unit—is important to emphasize, as these interpreters are trained in ethics, confidentiality, accuracy, and medical vocabulary.

Ensuring patient trust in confidentiality.

In addition, interpreters, like health care providers, are bound by the same privacy and confidentiality standards. Informing a patient who speaks English as a second language about this at the beginning of the conversation can help establish a foundation of ease, trust and comfort. If we choose to use a family member as an interpreter, how can we ensure that both the patient and the family member are comfortable with divulging the confidentiality or sensitivity of the medical information being shared?

Addressing the patient, not the interpreter.

Another common mistake I’ve observed is that health care providers make direct communication to the interpreter rather than the patient. This often happens when providers assume that the patient cannot understand English, leading them to speak directly to the translator instead. When communicating with patients through an interpreter, it’s important to use shorter sentences and allow ample time for responses between the patient, the nurse, and the interpreter. Even if there is a delay in the response, resist the urge to interrupt the communication process. Maintaining this triadic exchange ensures clarity, accuracy, and respect in the conversation. Our primary responsibility is to the patient, and this includes addressing them directly, just as we would with a patient who is proficient in English (unless there is a need to obtain clarification of what the interpreter stated).

Documenting the use of interpreter services ensures care continuity.

Finally, it’s essential to document the use of interpreter services, just as you would document any other clinical procedure, such as changing a wound dressing. Documenting interpreter services is crucial for ensuring the safe continuity of care among health care providers. It provides up-to-date information about the patient’s needs and ensures that treatment interventions are tailored to meet those needs effectively.

I often reflect on this moment from my nursing education, and I’m fascinated by how it has not only stayed with me over the years but also challenged me to be more attentive to the needs of my patients requiring interpreter services. Effective communication between health care providers and patients is the cornerstone of a strong, trustworthy health care system, one where patients are not burdened by language barriers when seeking care. As nurses, we bear the responsibility of ensuring that every patient receives the highest quality of care possible, without compromising their safety or well-being.

Chidiebere M. Iwunwa, BSPH, MSN, RN, is a clinical nurse at Mercy Medical Center, Baltimore, MD.