Running Head: LANGUAGE BARRIERS AND CONTINUITY 1 Language Barriers and Continuity of Care in Healthcare and Nursing Roles Constance Contreras Kent State University
LANGUAGE BARRIERS AND CONTINUITY 2 Language Barriers and Continuity of Care in Healthcare and Nursing Roles In today s society, it is a well known fact that many barriers exist throughout the healthcare community. Nurses are at the forefront in the healthcare community and experience the brunt of these barriers. A major barrier that exists in the healthcare community between patients and healthcare providers in the United States is the barrier of language. Since 1 in 6 children in the US is Latino, and the growth rate of the Latino population is expected to continue at more than three times the rate of the total US population 38, training and continuing education must include language proficiency and cultural competence (Davies, Larson, Contro, & Cabrera, 2011, p. 74). Nurses must be highly aware of the existence of this barrier and be prepared to overcome the barrier for the sake of the patient. Language barriers are often perceived differently by the healthcare provider, the patient, and even the nurse, who is the advocate for the patient. This can affect the care plan, well-being, healing, and continuity of care for the patient leading to many other problems during care and after. Therefore, overcoming language barriers should be a major goal for the nurse and other healthcare community members. The fact of the matter being that the United States is a diversely populated country, there are going to be times that patients will come to the healthcare community in need but will require certain elements of service that the healthcare community is not prepared for immediately. Patients that come into the emergency room, in immediate need of care, yet cannot speak the mainstream language are hindered in receiving timely and correct care for their issue. Emergency room nurses should be aware of the issue in their own community concerning the population of the service area. There will be times that the language barrier will rear its head in the ER. The first objective of the ER nurse should be to assure that the patient has a translator that can assist in the immediate need for the patient. Some parents in this study attributed
LANGUAGE BARRIERS AND CONTINUITY 3 language as contributing to discrimination. They felt unheard and unsupported, and that some HCPs did not attempt to understand or connect with them (Davies, Larson, Contro, Cabrera, p. 74). Many English as Second Language (ESL) or English-limited proficient (ELP) patients will appear in the ER with their own translator, who often is a family member or friend. The family member that is most often used is a child. This presents and often compounds the healthcare dilemma in the emergency room. According to Davies, Larson, Contro, and Cabrera (2011), In a survey of pediatricians in states with large numbers of Spanish-speaking patients, 30.9% reported using professional interpreters, 72.6% reported using bilingual family members, 74.7% reported using bilingual staff, and 63.5% reported using bilingual physicians. 7 Using family members and bilingual staff as interpreters is problematic 2,5,7,36 because communication barriers may impede the care of dying children and their families (p. 74). The main concern of the nurse should be the accuracy of the translation. The emergency nurse should exhaust all means in an attempt to provide for appropriate communication with the patient (Hamm, 2008, p. 241). Care plans and diagnoses are not always politically or developmentally appropriate for children translators. The nurse must be especially tender when delivering questions or information to the child to translate to a parent or other family member. This information may not always be properly translated from nurse to child by sheer developmental age and understanding; from child to adult family member out of respect or fear of repercussions of delivery of inappropriate questioning or sensitive information. The opposite occurs when the adult patient sends the information to the child translator back to the nurse. Special considerations must be used when dealing with child and family member translators and they should be only used as a final resort when there are no other options. Residents reported
LANGUAGE BARRIERS AND CONTINUITY 4 using family members more frequently than hospital interpreters even though family members were less effective because of interpreter unavailability, wait times, awkward communication between families and interpreters, and lack of interpreters medical knowledge (Davies, Larson, Contro, & Cabrera, 2011, p. 74). In hospital translators that are used, the accuracy can be checked from nurse to translator to patient and reverse. There are a couple of other options that the nurse can use to assure the advocating for the ESL patient. The nurse can become fluent in a second language; thus, making the language barrier itself no longer an obstacle. The translator is a professional with no connection to the patient therefore the translation of information should be basically accurate. However, some translators may know the language but not the cultural affect of the language. For example, in Spanish there are words, in one country, meaning something harmless and in another country meaning something extremely vulgar and disrespectful. If the professional translator is literally competent but culturally incompetent, it can cause strife for the patient and the nurse as well. This leads us to the next concern of language barriers. Limited cultural knowledge of the translator and/or nurse in the treatment of the ESL patient and the patient s family can problematic in the healthcare environment. First, the language may not translate literally from English to the second language word for word. If the translator is not particularly adept in the translation of the spoken word from English to the second language, the message may not be accurate. Also, if the patient is not culturally aware, especially being aware of the patient s cultural background and how that background relays into the language, the message will not be accurate either. As previously stated, the message may even come across as vulgar or disrespectful. There are cultural dynamics within the patient s life that will affect the outcome of communication and treatment decisions. In the case of the Mexican patient and family, are three cultural considerations to take into accord. These include the large family
LANGUAGE BARRIERS AND CONTINUITY 5 dynamic, Catholicism, and their immigration status. In the Mexican family, a large family may attend the care plan meeting with the nurse or healthcare provider. Everyone listens, has questions, has an opinion and will voice their opinion, yet in all reality the male head of household (i.e. father, grandfather) will make the ultimate decision. If the family are devote Catholics, their religion may play a major role in their treatment decisions. Also, if the patient is not of legal immigration status, treatment and continuation of treatment may be hindered because of fear of immigration or that their treatment will be based upon their legal status. Establishing respect with the patient and their family is extremely important with the necessity of follow-up care. If the nurse is able to gain respeto with the family and the patient, the more likely the patient is going to continue with the care plan established. The same is true with confianza. Establishing trust and confidence between the patient and family and the nurse will assure the patient that they are not being discriminated against or ignored because they are ESL. If the nurse tries to use minor or basic second language with the ESL patient, the nurse will gain some respeto and confianza of the patient and their family. Davies, Larson, Contro, and Cabrera (2011) report this in their study in following: Having Spanish-speaking HCPs did not eliminate the perception of discrimination. One mother reported that a Spanish-speaking nurse said she spoke Spanish when she felt like it. And when she didn t feel like it, she said she didn t speak Spanish. In contrast, an English-speaking physician who met with the family attempted to speak Spanish and use simple sign language. His attempts to communicate were greatly appreciated. (p. 73) In the nursing field, as well as all healthcare fields, a great awareness to all cultural and language barriers needs to be held. Nurses, especially, need to be aware of these differences and be prepared to adjust their manner of care when they encounter these types of cases. Urgency
LANGUAGE BARRIERS AND CONTINUITY 6 during language barriers can cause a lot of strife for the healthcare provider and the patient during treatment and for the continuity of care that may be needed in the future. With language barriers, nurses can utilize a variety of options that may be available to them. These options may include, in house staff translation services, such as bilingual staff members, phone translation services, or professional translators through services offered through the hospital. Patients may bring their own translators, which can be friends, family, or even their own children. This can pose accuracy and privacy problems. The nurse needs to be especially careful in these cases. With the cultural differences, nurses need to be aware that there are certain specificities to know about each culture. Within the Mexican culture, personalismo, confianza, and respeto among family and the healthcare provider are very important. Once these are gained, it is much easier to develop an effective healthcare plan and goals that the patient will conform to. To overcome the barriers that language poses to the continuity of care, nurses should do everything that they can to be prepared. They should know that there never is a time that one is over prepared.
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