Language is the foundation for effective nurse-patient relationships and is important for interpersonal and cross-cultural communication. Being able to communicate with a patient is vital for obtaining an accurate and comprehensive patient and family assessment, formulating and implementing a treatment plan, determining the effectiveness of nursing care, and evaluating outcomes of care.As result of dramatic demographic changes in the United States, nurses are increasingly faced with the challenge of communicating with the patient who cannot speak English or speaks English with limited proficiency.
People who speak English with limited proficiency are a significant percentage of the U.S. population. According to the U.S. Census Bureau, 14 percent of the population speak a language other than English at home. This percentage is greater than 40 percent in major cities such as New York, Los Angeles, Miami, Honolulu, and El Paso, Texas. Of all non-English speakers in the United States, 17.3 million (54 percent) speak Spanish at home, and 8.3 million Hispanics report that they speak English less than “very well.” People who speak Chinese rank second among people who speak English less than “very well.”
The vast majority of health care and human service institutions receive federal financial assistance such as Medicare, Medicaid, or Hill-Burton funds and thus are subject to Title VI mandates, requiring policies that do not limit access of limited English proficiency persons (LEP) to health care services. The Department of Health and Human Services requires that reasonable steps be taken to provide services and information in languages other than English to ensure that LEP patients are informed and can effectively participate and benefit from health care. The JCAHO requires that health care institutions make translation services available. Demographic changes; federal, state, and local laws; accreditation standards for health care organizations, and the potential for legal liability are all important reasons for nurses to incorporate in their practice appropriate strategies for communicating with LEP patients.
There are important differences between a translator and an interpreter. A translator is a person who can speak English and the patient’s native language. However, the translator often does not have equal fluency in both languages and may lose important cultural nuances and meanings. In contrast, an interpreter is a professionally trained person who interprets the meaning of words and phrases from the health care provider’s language to the patient’s language and provides the same services on behalf of the patient to the health care provider.