Abstract

Language diversity in rural Kansas is increasing, necessitating improved communication strategies in healthcare. This quality improvement project assessed the use of an electronic translation tool following the implementation of staff education and a door graphic reminder in a 25-bed critical access hospital. Pre- and post-surveys were conducted among 568 staff members, with 56 responding initially and 49 completing the post-survey. A 17% increase in knowledge of translation device locations was observed, and a 432% increase in translation tool usage was recorded after the interventions (p=0.0009). These findings suggest that targeted educational efforts and visual cues can enhance language concordant care in rural healthcare settings.

Background and Significance

Effective communication between healthcare providers and patients is crucial for accurate diagnoses and positive health outcomes (Institute for Healthcare Communication, 2023). Language barriers can lead to mistrust and reduced healthcare utilization (Barghadouch & Norredam, 2022). Health equity, as defined by the CDC, ensures fair opportunities for optimal health, yet individuals with limited English proficiency (LEP) face significant disparities (Centers for Disease Control and Prevention, 2023). Title VI of the Civil Rights Act mandates language services in federally funded programs, but barriers such as cost, accessibility, and staff training hinder compliance (U.S. Department of Justice, 2024).

In Kansas, Spanish is the second most prevalent language, but only 9% of healthcare workers speak Spanish fluently (Funk & Lopez, 2022). Advanced Practice Registered Nurses (APRNs) play a key role in reducing disparities through translation services. Addressing language barriers aligns with national health initiatives like Healthy People 2030, which prioritizes improving medical understanding among LEP populations (Office of Disease Prevention and Health Promotion, 2023).

Literature Review

A review of 20 primary research articles identified five key themes:

• Unmet Need for Spoken Language Assistance: Many LEP patients lack access to adequate translation services, leading to communication gaps (Taira & Orue, 2019).
• Impact of Language Concordant Care: Studies link language-concordant care with reduced hospital stays, lower readmission rates, and better health outcomes (Seale et al., 2022).
• LEP Populations as Vulnerable Groups: LEP individuals, often from immigrant communities, face challenges in navigating healthcare systems (Pandey et al., 2021).
• Resource Availability and Staff Knowledge: Facilities with trained staff and readily available translation tools report better patient outcomes (Lopez-Bushnell et al., 2020).
• Cultural Competency and Language Equity: Promoting language services improves provider-patient relationships and overall healthcare experiences (Villanueva, 2023).

Project Purpose and Methods

The project aimed to improve translation service use in a rural hospital by implementing staff education and a visual reminder system. Key research questions included:

• What barriers hinder translation service use?
• Can staff education increase translation tool utilization?
• Will a door graphic reminder improve translation service engagement?

A pre- and post-survey was conducted, and a door graphic was placed on patient rooms requiring translation services. Data from the Propio translation service line was collected over one year, including six months pre- and post-implementation.

Results

Of the 568 staff surveyed, 56 completed the pre-survey and 49 completed the post-survey. Findings included, 73% of staff were initially aware of translation devices, increasing to 89.7% post-education. 52% of respondents knew how to use the devices before education; 59% reported improved knowledge afterward. The likelihood of using translation tools increased, with 45% indicating they were “very likely” to use them post-education. The most common barriers identified were device unavailability (26.5%), reliance on coworkers for translation (20.4%), and perceived language concordance (20.4%) (Rawal et al., 2019). With the implementation of both interventions, usage of the translation service increased from an average of 22 calls per month to 95 post-intervention, a 432% increase (p=0.0009). 

Nursing Implications

Nurses play a critical role in eliminating language-related healthcare disparities. Increasing awareness of federal requirements, improving accessibility to translation tools, and implementing reminders like door graphics can significantly improve patient communication and care (Hsueh et al., 2019).

Sustainability measures include incorporating translation service training into annual competencies, recruiting bilingual staff, and incentivizing language certification for employees.

Discussion

Barriers identified in the study were congruent with research studies and include device accessibility, preference for in-person translation, and infrastructure limitations. Many staff were unaware of translation tool locations or had difficulty accessing the devices (Mulpur & Turner, 2021). Staff often relied on family members or coworkers instead of electronic devices (Jaeger et al., 2019). Rural hospitals struggle with translation service implementation due to funding and staffing constraints (Schiaffino et al., 2016). 

Strengths and Limitations

Strengths during the study include high staff engagement and willingness of staff to improve quality of service through language services. In addition to willingness to work on quality, this project aligns with the organizations efforts to enhance language equity. Due to the study’s focus on a single rural Kansas hospital, generalizability is a major limitation. In addition to small sample size, the study was limited in duration preventing long-term impact assessment. Final limitation to the study was the potential for response bias in self-reported survey data (Graves et al., 2020). 

Conclusion

Providing language-concordant care is essential to reducing healthcare disparities. While translation services are currently federally mandated, many hospitals struggle with implementation. This study demonstrated that staff education and simple visual reminders significantly increase the use of translation tools. Future research should explore additional strategies for rural settings, such as telehealth translation services, multilingual provider recruitment, and technology-driven solutions to bridge language gaps. n

References

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