Hospital staff use of interpreter services for patients with limited english proficiency

Introduction: Effective communication is an integral component of patient safety, well informed health decisions and overall patient care. Our prior research suggests an underutilization of interpreter services by hospital staff caring for maternity patients. The purpose of this study was to develop an understanding of the attitudes and beliefs of the nursing staff regarding their experience caring for limited English proficiency (LEP) patients and their use of interpreter services.

Methods: A focus group study was conducted at a large community-based academic medical center where language services were provided by on-site Spanish interpreters during daytime hours and a telephone interpretation service 24 hours a day 7 days a week. Fifteen nurses from labor and delivery, maternity triage, postpartum, and the neonatal intensive care units participated in one of three independent 1 hour focus groups. Participants were asked scripted questions about their thoughts and experiences caring for LEP patients and utilizing interpreter services. Each was audio-recorded and transcribed verbatim. Thematic analysis was used to identify, analyze and report patterns within the focus group data. Three independent coders were used to identify themes.

Results: Analysis of transcripts indicated that nursing staff preferred in-person, qualified hospital interpreters, with telephone interpretation considered to be a sub-optimal alternative. Numerous logistical issues were reported as barriers to obtaining qualified interpretation for patients, making proper utilization of interpretation services on a consistent basis difficult. These included time constraints, high patient acuity, lack of advanced notification of the need for an interpreter, limited availability of in-person interpreters, long phone line waiting times, lack of portable interpretation devices, and a need for translated written information. Participants reported the use of hand gestures, key phrases in the patients' language, or family members, in order to facilitate communication. In addition, participants expressed feeling inadequate and nervous handling culturally sensitive situations with LEP patients.

Conclusion: Within an inpatient setting where on-site and telephone interpreters were available to health care providers, communication with LEP patients remained a challenge. Findings from this study suggest a multi-pronged intervention is needed to improve accessibility and use of language services by nursing staff. Staff training on cultural competence, process modifications, and the implementation of tools and resources to assist in providing culturally-appropriate educational materials to LEP patients is needed.