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Nursing Practices that Improve Care for Children and Families with Limited English Proficiency Anna Zimmerman, MSW Seattle Children’s Hospital.

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Presentation on theme: "Nursing Practices that Improve Care for Children and Families with Limited English Proficiency Anna Zimmerman, MSW Seattle Children’s Hospital."— Presentation transcript:

1 Nursing Practices that Improve Care for Children and Families with Limited English Proficiency Anna Zimmerman, MSW Seattle Children’s Hospital

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.

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)

4 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

5 Objective This study explored pediatric nurse practices and perceptions of current nursing use of interpretation services.

6 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

7 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.

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.

9 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 don’t know the numbers to call..[or] that they can use an interpreter to contact us. They might not feel as involved in the care.

10 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

11 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

12 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

13 Emergency DepartmentInpatient Room Examples of phone interpretation

14 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

15 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

16 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

17 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

18 Thanks!

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