Let’s face it, it is often hard for a patient whose first language is English to navigate the technical medical vocabulary that we use in our healthcare system. Patients who don’t speak English well—or at all—are considered to have low health literacy. This is not necessarily a reflection of their intelligence, but rather of how hard it can be to educate them about their medical status, treatment plans, etc.

A language barrier can also make it hard for nurses to honor patient preferences, answer questions, and establish a trusting relationship—particularly when cultural differences exist regarding the patient’s concepts of wellness and illness. Perhaps most troubling is the fact that informed consent becomes a sticky issue, both legally and ethically, when a patient cannot understand his condition or ask questions about treatment options.

In regions with large Hispanic or Asian populations, many healthcare facilities have staff nurses who are bilingual. But what happens when you are caring for a patient that you can’t communicate easily with?

The ideal situation would be to use a professional translator who has training in medical vocabularies. These professionals are often available through a staffing service or a 24-hour telephone translation line. If you have access to these services, be sure to take advantage of them. And if you frequently encounter situations in which you feel a translator is required but none is available, you can encourage your hospital to contract with a translation service.

Often, friends or family members of the patient can step up to bridge the language gap. It’s advisable to use these ad hoc interpreters only as a last resort, because these non-professionals are more likely to make mistakes that can affect clinical outcomes. Friends or family members may have low health literacy themselves, may not fully understand a medical term that has no direct translation, or may inject their own personal views into the dialogue to the patient as an attempt to be helpful. The more complicated the medical case, the higher the likelihood of translation errors.

If you are communicating through a translator of any sort, there are a few things to keep in mind:

• Begin by briefly advising the translator what you need from him/her: to translate the words of both parties as literally as possible, without adding or leaving out anything.
• Ask the translator if he/she knows of any general cultural beliefs that might come into play during medical treatment—such as a cultural preference for avoiding conflict, avoiding interactions with a person of the opposite gender, or avoiding anything that might seem like questioning the authority of a clinician.
• If the translator contracts with your employer, there is probably already a signed HIPAA agreement in place. If a family member or friend is translating, advise that person that the information being translated is considered confidential.
• Document the name of the person translating in the patient chart.
• Use the “teach back” method to convey medical information. You’ll be doing it through a translator, but the process can still help you assess how well the patient has understood the information being provided.

Census statistics indicate that nearly 47 million U.S. residents speak a foreign language at home, with a quarter of them reporting limited proficiency in English. These numbers practically ensure that you will encounter a language barrier at some point. Despite the difficulty in communicating, remember that you, as a nurse, are still responsible for providing a quality experience for the patient, including protecting his dignity, ensuring comfort, and advocating on his behalf. You also have to be diligent about assuring the data you document is as accurate.