LANGUAGE BARRIERSTHE ETHICAL AND LEGAL ISSUES SURROUNDING

TRANSLATION

John SokBoston College Connell School of NursingKeys to Inclusive Leadership in Nursing

PURPOSE STATEMENT & OBJECTIVES

The purpose of this presentation is to inform and educate fellow nursing peers and faculty about language barriers and cultural competency

Objectives: Identify current issues regarding language

barriers Evaluate the importance of certified interpretation Highlight intervention to facilitate communication

JOSEPH M. SMITH COMMUNITY HEALTH CENTER

Serves Brighton, Allston, Waltham

Diverse patient populations

Offers medical, dental, counseling, vision, and pharmacy services

DEMOGRAPHICS –ALLSTON/BRIGHTON2000 U.S. CENSUS

Total Population 43,887

Caucasian 33,768 75.1%

Black/ African American

1,965 12.3%

Hispanic/Latino 3,260 7.4%

American India/Alaska Native

91 0.9%

Asian 5,218 3.6%

Native Hawaiian/ Other Pacific Islander

31 0.1%

Other races 1,485 5.5%

Two or more races 1,329 2.4%

MENTORING EXPERIENCE

June & Olga Monthly Meetings

Medication adherence (Merk Tool) Language Interpreter Service

Nursing Staff Meetings Every second Thursday

staffing, clinical/ethical problems, changes and implementations, feedback

LANGUAGE BARRIER, A PROBLEM?

Increase number of diverse patient population

Limited English Proficient Patients = Communication issue

Discrepancy in language translation Need for more medically certified

interpreter usage Current practice utilizes family members

and/or other health care personnel

LEGAL AND ETHICAL RESPONSIBILITY

Advocate for patient autonomy

Accurate translation

Facilitate communication

Maintain Confidentiality

Culturally competent directed care

LANGUAGE INTERPRETING AS SOCIAL JUSTICE (MESSIAS ET AL., 2009)

Purpose: Exploring how informal and formal interpreters conceptualize and implement their role

Methods: interviewed 27 interpreters (13 formal) U.S., Puerto Rico, Mexico, Columbia, Brazil,

Venezuela, Panama Could you describe your work as an interpreter to me? Please tell me your relationship and interaction with

patients What is the most difficult part of the job is for you?

LANGUAGE INTERPRETING AS SOCIAL JUSTICE

Results: Informal: lack of preparation, inadequate cultural

competent care, inconsistent felt that it was their personal responsibility to ensure

understanding on the part of the patient and to advocate on behalf of the patient with the physicians

Formal: supportive, more trusted, confident “… professional interpreters viewed their role as one of

information transfer while maintaining professional boundaries”

Implications: A need for improve language access and qualified

interpreting service

DO WE REALLY NEED TRANSLATORS?

ADVOCATORS OPPOSITION

Legal and ethical issues Certified

Understands medical concepts/terminology

Reduces biases 24hours/7 days

Available as needed via IPOP

Continuity of care

Convenience Live Interpreters

Cost effective? Demoralizing Difficult to use/

confusing

INTERPRETER PHONE ON A POLE (IPOP) System similar to speaker

phone system Providers dial the

Language Line, input authorization code (specific to floor/unit), ask for specific language, connected

Reference numbers for interpreter and event interaction

CLINICAL CASE EXAMPLE

http://www.youtube.com/watch?v=hzOP7Ee-x7Q

CREATING CHANGE

Increase in IPOP and Language Line usage

Hiring full time certified translators (Thai)

Patients are asking more questions Increase in medical adherence Proactive disease management

Diabetes Mellitus, Hyperlipidemia, STDs

REFERENCES

02135 - Fact Sheet - American FactFinder. American FactFinder. Retrieved April 11, 2011, from http://factfinder.census.gov/servlet/SAFFFacts?_event=Search&geo_id=01000US&_geoContext=01000US&_street=&_county=&_cityTown=&_state=&_zip=02135&_lang=en&_sse=on&ActiveGeoDiv=geoSelect&_useEV=&pctxt=fph&pgsl=010&_submenuId=factsheet_1&ds_name=ACS_2009_5YR_

lynnekelly2000. YouTube - A Few Minutes In The Life Of A Sign Language Interpreter. YouTube- Broadcast Yourself. Retrieved April 11, 2011, from http://www.youtube.com/watch?v=hzOP7Ee-x7Q

Messias, DeAnne K, Liz McDowell, and Robin D Estrada. "Language interpreting as social justice work perspective of formal and informal healthcare interpreters." Advances in Nursing

Science 32.2 (2009): 128-143.