LANGUAGE BARRIERS
THE ETHICAL AND LEGAL ISSUES SURROUNDING TRANSLATION
John Sok
Boston College Connell School of Nursing
Keys to Inclusive Leadership in Nursing
PURPOSE STATEMENT & OBJECTIVES

The purpose of this presentation is to inform
and educate fellow nursing peers and faculty
about language barriers and cultural
competency

Objectives:
 Identify
current issues regarding language barriers
 Evaluate the importance of certified interpretation
 Highlight intervention to facilitate communication
JOSEPH M. SMITH COMMUNITY HEALTH CENTER



Serves Brighton, Allston,
Waltham
Diverse patient
populations
Offers medical, dental,
counseling, vision, and
pharmacy services
DEMOGRAPHICS –ALLSTON/BRIGHTON
2000 U.S. CENSUS
Total Population
43,887
Caucasian
33,768
75.1%
Black/ African American
1,965
12.3%
Hispanic/Latino
3,260
7.4%
American India/Alaska
Native
91
0.9%
Asian
5,218
3.6%
Native Hawaiian/ Other
Pacific Islander
31
0.1%
Other races
1,485
5.5%
Two or more races
1,329
2.4%
MENTORING EXPERIENCE
June & Olga
 Monthly Meetings

 Medication
adherence (Merk Tool)
 Language Interpreter Service

Nursing Staff Meetings
 Every
second Thursday
 staffing,
clinical/ethical problems, changes and
implementations, feedback
LANGUAGE BARRIER, A PROBLEM?
Increase number of diverse patient population
 Limited English Proficient Patients =
Communication issue
 Discrepancy in language translation

 Need
for more medically certified interpreter usage
 Current practice utilizes family members and/or
other health care personnel
LEGAL AND ETHICAL RESPONSIBILITY
Advocate for patient
autonomy
 Accurate translation
 Facilitate
communication
 Maintain
Confidentiality
 Culturally
competent directed
care

LANGUAGE INTERPRETING AS SOCIAL JUSTICE
(MESSIAS ET AL., 2009)
Purpose: Exploring how informal and formal
interpreters conceptualize and implement their
role
 Methods: interviewed 27 interpreters (13 formal)


U.S., Puerto Rico, Mexico, Columbia, Brazil, Venezuela,
Panama
 Could
you describe your work as an interpreter to me?
 Please tell me your relationship and interaction with patients
 What is the most difficult part of the job is for you?
LANGUAGE INTERPRETING AS SOCIAL JUSTICE

Results:

Informal: lack of preparation, inadequate cultural
competent care, inconsistent
 felt
that it was their personal responsibility to ensure
understanding on the part of the patient and to advocate on
behalf of the patient with the physicians

Formal: supportive, more trusted, confident
 “…
professional interpreters viewed their role as one of
information transfer while maintaining professional
boundaries”

Implications:

A need for improve language access and qualified
interpreting service
DO WE REALLY NEED TRANSLATORS?
OPPOSITION
ADVOCATORS


Legal and ethical issues
Certified



Understands medical
concepts/terminology
Reduces biases
24hours/7 days


Available as needed via IPOP
Continuity of care


Convenience
Live Interpreters



Cost effective?
Demoralizing
Difficult to use/ confusing
INTERPRETER PHONE ON A POLE (IPOP)



System similar to speaker
phone system
Providers dial the Language
Line, input authorization code
(specific to floor/unit), ask for
specific language, connected
Reference numbers for
interpreter and event
interaction
CLINICAL CASE EXAMPLE

http://www.youtube.com/watch?v=hzOP7Eex7Q
CREATING CHANGE
Increase in IPOP and Language Line usage
 Hiring full time certified translators (Thai)
 Patients are asking more questions

 Increase
in medical adherence
 Proactive disease management
 Diabetes
Mellitus, Hyperlipidemia, STDs
REFERENCES



02135 - Fact Sheet - American FactFinder. American
FactFinder. Retrieved April 11, 2011, from
http://factfinder.census.gov/servlet/SAFFFacts?_ev
ent=Search&geo_id=01000US&_geoContext=0100
0US&_street=&_county=&_cityTown=&_state=&_zip
=02135&_lang=en&_sse=on&ActiveGeoDiv=geoSel
ect&_useEV=&pctxt=fph&pgsl=010&_submenuId=f
actsheet_1&ds_name=ACS_2009_5YR_
lynnekelly2000. YouTube - A Few Minutes In The Life Of A Sign
Language Interpreter. YouTube- Broadcast Yourself. Retrieved
April 11, 2011, from
http://www.youtube.com/watch?v=hzOP7Ee-x7Q
Messias, DeAnne K, Liz McDowell, and Robin D Estrada. "Language
interpreting as social justice work perspective of formal and
informal healthcare
interpreters." Advances in Nursing
Science 32.2 (2009): 128-143.