Many of our patients speak a language other than English, which can pose a challenge when we try to teach them information that is key for their well being after discharge. To facilitate communication, we often find it necessary to have written information translated and spoken information interpreted. In fact, Title VI of the Civil Rights Act of 1964 and the Hill-Burton Act enacted in 1946 are federal laws that mandate language assistance to those in need. Hospitals may meet those mandates by providing professional medical interpreters. By partnering with interpreters, you can ensure patients receive the information they need before they are discharged.
Interpreters are trained in medical terminology and present unbiased information, so it’s important to use them for tranlation instead of the patient’s bilingual friends or family members. Consider some key points related to teaching and interpreters, including basic principles, teaching aids, and strategies for ensuring understanding.
Here are some principles to keep in mind when working with interpreters.
- Show consideration for the interpreter’s time. Be prepared before you call for assistance. Know that it may take two to three times longer to teach with an interpreter. If possible, talk with the interpreter ahead of time so he or she can be familiar with the type of information to be presented.
- Sit with your patient when you are teaching. Have the interpreter sit beside and slightly behind you so the patient can see both of you. This way you can look directly at the patient, rather than the interpreter when speaking. You can hear the interpreter but looking at your patient shows respect. It also enables you to pick up on visual clues to understanding.
- Have forms completed, gather your teaching materials, and organize your thoughts so that information is presented in a logical manner. Jumping from subject to subject and back again can be confusing and difficult to interpret.
- Focus on need-to-know information. Keep background or nice-to-know information at a minimum. Use common terms rather than medical jargon. Do not use slang or acronyms.
Remember that teaching aids help to relay the message.
- Whenever possible, use pictures to illustrate what you are trying to teach. Break down procedures to essential steps, and number the steps. Allow white space so the interpreter can write the translation under each step.
- When teaching about medications, use pictures of the measuring device and color in the amount. Be clear about the frequency and when the next dose is due.
- Use colored highlighters to color code medication bottles and instructions.
- Whenever possible, assemble props ahead of time—calibrated measuring cups, pill splitters, or other devices. If you have a measuring device, use a permanent marker to mark levels or amounts. Stress the importance of using correctly calibrated devices rather than spoons from the family flatware. Encourage the patient to request measuring devices from the pharmacist if you cannot provide them. Show the patient devices that can be purchased at a pharmacy for a nominal cost.
- Be sure to explain what the patient can expect from home nursing companies, medical equipment companies, and others. Write down contact numbers for each company. For example: This is the company that brings you your oxygen supply and oxygen tubing. Here is the number to call. Make sure patients understand that not all supplies come from the same source. Write the company name and contact number on one of the wrappings so patients understand where to call for additional supplies.
Communicate information about follow-up appointments.
- Make a list of follow-up appointments. Explain what the appointment is for by using simple terms. For example, “This appointment is with Dr. Jones. He is your heart doctor. He will check your heart and make sure your medicine is working well.”
- Many physicians’ offices have websites with maps and contact information. Print them out and write the appointment time and date on the printout. Explain that the patient can have someone call the office with questions or to change the appointment if necessary because of transportation or other problems. Stress the importance of follow-up.
- Encourage patients to take an adult who speaks English to the appointment. Private offices may not have access to interpreters. Requirements regarding language assistance in private offices or other facilities may not be the same as for hospitals.
- Encourage your patient to take discharge forms and instructions to follow-up appointments. This will help communication with caregivers in the community.
- Ask open-ended questions to verify understanding because some cultures consider giving a negative reponse rude even if he or she doesn’t understand. Say something like, “I want to be sure you understand…Will you tell me, or will you show me…”
- If you have videos in the patient’s language use those as an introduction but stress the important points. For instance, “Remember in the video when they explained … let’s go through it one more time.”
Consider which forms you use.
- If possible, use forms and instruction sheets that have been translated by your hospital. If a required form leaves no space for translation, most facilities allow you to attach an addendum. Have the interpreter write on the addendum, and note on the original form that there is an addendum.
- If you are designing a form, be aware that English is considered a “tighter” language than others. By comparison, Spanish will require 20% to 30% more space.
- Make copies of all forms and addendums for the patient record. This will provide documentation of the information given to the patient and how it was translated.
With some advance planning and the help of an interpreter, you can effectively prepare your patients for discharge. In doing so, you have empowered them to care for themselves, despite language differences.
Ellen Maday is a retired nurse.
Osborne H. Health Literacy from A to Z: Practical Ways to Communicate Your Health Message. Burlington, MA: Jones & Bartlett Publishers, Inc; 2011.