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A fundamental tenet of culturally competent care for patients is providing clinically and personally pertinent information to patients in a language that they understand. As the diversity of non-English language speakers increases in the United States, nurses may find a new area of priority in advocating for their patients to overcome language barriers.  

Fortunately, the Office for Civil Rights within the U.S. Department of Health & Human Services (HHS), serves to protect non-English speaking or limited English-speaking patients. Nurses, however, can do this on a smaller scale in their daily work.

In accordance with Title VI of the Civil Rights Act of 1964, and the guidelines for developing a language access plan by HHS, health care institutions that receive federal funding must provide language assistance services suitable to the communities that they serve. This is assessed and implemented based on a stepwise approach appropriate for the patient population, qualified language service personnel, and interpretation devices and technology. Furthermore, health care personnel will be trained sufficiently and regularly to maintain an understanding of both the logistics and necessity of utilizing these services. This is especially true for nurses, who often have initial and ongoing close contact with patients.

Be Mindful

Patients who speak limited or no English may be unwilling to admit that they do not understand the nature of their health care visit or its intended outcome. This is a detriment to both the provider and patient as the provider may proceed with a treatment plan with the belief that the patient is cooperating. It is easy to see how this can create increased stress and fear for the patient when actions are taken on behalf of their health that they did not corroborate and may not agree with. Regardless of the reasons for the patient’s decision to withhold their lack of understanding, health care professionals can take responsibility for establishing mutual understanding and help prevent these occurrences.

Utilize Available Technology

Fortunately, technology provides many resources today that allow for effective interpretation between providers and patients. Most hospitals have a team of on-site personnel that are credentialed interpreters in languages appropriate for the patient population of that site. For those languages that are less common, there are many devices, including phones and tablets, that provide immediate 24-hour access to remote medical translators in virtually every language. Many of the written documents that patients are exposed to are now offered in languages other than English as well.

Find a (Qualified) Translator

With a full understanding of the services offered, patients may decide that they prefer a family member to translate. Although it is not ideal because family members may lack health literacy, it is the patient’s prerogative to make that choice. If the patient requests that a bilingual nurse translate, he or she can only do so if the nurse has been credentialed in accordance with their facility’s policies related to medical interpreting. This is especially true regarding important documentation such as informed consent and does not include casual conversations or explanations.

It’s not a lack of resources, but a lack of understanding, that prevents non- or limited English speakers from getting what they need in health care today. Despite all of the services offered, providers may still try to take shortcuts for the sake of efficiency. As patient advocates, nurses can be mindful of patients and ensure that understanding is complete by utilizing interpreter services and reminding providers of the services available.

Nancy Swezey, BSN, RN, CNOR

Nancy Swezey received her BSN from Columbia University. She now practices in New York City in the operating room where she has worked as a staff nurse, and currently as a care coordinator specializing in head and neck surgery. Nancy is also pursuing her advanced practice degree at CUNY Hunter where she assists the faculty as a research assistant, focusing on nurse education and module development.

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