1. Effective Use of Interpreters Adopted from St. Mary’s Interpreter Services References: The Medical Interview Across Cultures, Debra Buchwald, MD: Patient Care April 1993. Working Effectively with Interpreters in the Primary Care Setting, Jane E. Poss, ANP, MSN: Nurse Practitioner, Dec 1995.

2. Interpreter Services Core Values Respect Social Justice Compassion Care of the Poor and Underserved Excellence

3. Interpreter Services Vision Statement We will be trusted partners in improving community health, especially among the poor and underserved.

4. Interpreter Services Title VI of the Civil Rights Act of 1964 requires St. Mary’s provide interpreter services, including certified interpreters for the deaf JCAHO requires St. Mary’s provide for the predominant languages in our service area

5. Interpreter Services Interpretation – verbal Translation - written

6. Interpreter Services The “old ways” of communicating Gesturing Few common words Written material Volunteer staff member Family members

7. Interpreter Services Problems with the “old ways” Competence of the interpreter No way to assure accuracy Unable to determine understanding May be illiterate Families put in uncomfortable situations Staff busy at their primary jobs

8. Communicating with non- English speaking patients Learn some basic words and phrases in the patient’s language, if possible. The purpose is to help the patient feel more comfortable. Know how to introduce yourself, say good morning, or ask how the patient is feeling in his or her language. Remember that some patients who require an interpreter may actually understand English quite well. Any comments you make to other providers or to the interpreter may be understood by the patient.

9. Setting up for success Brief the interpreter on the patient and the goals of the exam Ask the interpreter to suggest culturally appropriate strategies to use Use bilingual/bicultural interpreters whenever possible. Placing the patient, health care provider, and interpreter in a triangular relationship may be most conducive to good communication. The interpreter should be considered a member of the health care team. Document in the progress notes the name of the interpreter who translated for the patient.

10. Do not use the patient’s children as interpreters if at all possible. Most patients will not discuss problems of a personal nature in front of their children, and in many cultures using the child to interpret will upset the family’s social order.

11. Communication Basics Look at the patient when you speak Watch the patient during the interpretation

12. Working with an interpreter Speak slowly in a normal tone of voice Speak a sentence or two and then wait Be prepared to clarify for the interpreter

13. Working with an interpreter Use nouns rather than pronouns to avoid confusion Allow time for the patient and interpreter to respond Be sure to ask if the patient has any questions before you end the conversation Remember, the patient may understand English, just not speak it well

14. Working with an interpreter Provide written information for the patient just like you would for an English speaking patient Ask the interpreter to translate the written information if needed Do not ask questions that make the interpreter uncomfortable – part of their role is to be a patient advocate

15. When to use a professional interpreter Informed consent, surgery permits, procedure consents Notification of death and completion of all documents Admission assessment Explaining results of tests that are abnormal Patient teaching

16. Allow extra time because everything has to be said at least twice. Explanations will generally take longer, especially if the patient is not knowledgeable about western medicine. Always allow time for patients to ask questions and seek clarification.

18. Sentence-by-sentence translation works best. Expecting an interpreter to remember long explanations is unreasonable and will lead to omissions. Use simple language and straightforward sentences. Avoid metaphors, slang, and jargon. Explain all medical terms in simple language, especially if the interpreter is not knowledgeable about western medicine. Use nouns rather than pronouns whenever possible so the referent will be clear. Avoid abstractions, idiomatic expressions, similes, and metaphors. It is useful to learn about these usages in the target language.

19. Allow the interpreter to ask open-ended questions. if needed, to clarify what the patient says. Do not interrupt the translator. Question the interpreter if he or she seems to answer for the patient.

20. Collecting the case history Use short questions without complicated clauses. Make allowances for terms and concepts that do not exist in the target language.

21. Giving directions during the physical exam Learn some basic phrases so the translator may not be needed for much of the exam Look up, right, left, down When asked about the results politely defer to the end of the exam when you will discuss everything, BUT remember to discuss it.

23. Discussing the exam outcomes Use language that your interpreter can handle. Try to use plain English instead of technical terminology and professional jargon, such as workup.

24. Giving treatment instructions Always ask the patient to repeat instructions to you to be certain they have been properly translated and understood. Document in the progress notes the name of the interpreter who translated for the patient.