Nursing Practices that Improve Care for Children and Families
with Limited English Proficiency Anna Zimmerman, MSW Seattle
Childrens Hospital
Slide 2
Background 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.
Slide 3
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)
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What role do nurses play in providing interpretation? 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
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Objective This study explored pediatric nurse practices and
perceptions of current nursing use of interpretation services.
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Methods 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
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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.
Slide 8
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 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.
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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 I definitely receive less contact from
LEP families. That may be because they dont know the numbers to
call..[or] that they can use an interpreter to contact us. They
might not feel as involved in the care.
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Results: Nurse or family decision to use interpretation? 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
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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 Phone Used for start of shifts,
for basic & quick topics, questions from family, rare
languages, when unable to schedule in person
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Phone Interpretation Instantly available Simple to use Well
liked by those who use regularly Critical for use on less important
topics Nurses concerned about resource utilization and time Rare
languages When unable to plan ahead Strengths
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Emergency DepartmentInpatient Room Examples of phone
interpretation
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In-Person Interpretation Captures non-verbal communication
Needed for teaching for care/discharge Quicker for rounds Dedicated
professional interpreters Timely Service Important for admission,
discharge, emotional discussions Strengths
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Conclusions 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
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Conclusions 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 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
