Cultural Competence in Using and Assessing for an
Interpreter: A Best Practice Implementation Project
Janice Davidson, DNP Student
Doctor of Nursing Practice Program
Chamberlain College of Nursing
This program has been developed solely for the purposes of
describing nurse practitioner (NP) provider knowledge, skills,
and practice compliance specific to cultural competence in
using and assessing for an interpreter, before and after
participation in an online multi-modal quality improvement
project. The program is posted as a part of this project’s
educational intervention and is intended only for such use.
The study has been approved for this purpose by the
Chamberlain College of Nursing Institutional Review Board.
You may download copies of the interventions contained
within or contact the author jdavidson@chamberlain.edu to
obtain a hard-copy of the interventional resources.
Project Background
• Best practice evidence indicates that using and
assessing for an interpreter to improve patient
outcomes is recommended across all healthcare
settings (Gray, Hilder, & Donaldson, 2011; Giese,
Uyar, Uslucan, Becker, & Henning, 2013). However,
evidence reveals that many providers lack the
necessary cultural competence skills and resources
necessary to support using and assessing for an
interpreter (Okrainec, Miller, Holcroft, Boivin, &
Greenaway, 2014; Lie, Bereknyei, Braddock, Encinas,
Ahearn, & Boker, 2009).
Project Objectives
• To determine current compliance with evidencebased Joanna Briggs Institute (JBI) audit criteria
specific to using and assessing for an interpreter.
• To improve knowledge regarding best practices
specific to cultural competence in using and
assessing for an interpreter.
• To improve compliance with evidence-based JBI
audit criteria specific to using and assessing for an
interpreter.
• To improve practice outcomes regarding cultural
competence in using and assessing for an
interpreter.
JBI Audit Criteria for Using and
Assessing for an Interpreter
1. Accredited interpreters are utilised to obtain informed
consent for treatment (medical, surgical, pharmaceutical,
therapy, etc.).
2. Individuals are assessed for communication or cultural
barriers.
3. Interpreters are utilised for persons with limited English
proficiency in accordance with local organisational policy
(i.e. interpreter protocols).
4. Standardized methods for identifying individuals with
limited English proficiency exist.
5. Verbal or written consent is obtained and documented in
the medical record when using an interpreter.
Need for Cultural Competence
to Inform Using and Assessing
for an Interpreter
• Attributes for cultural competence
• Family assessment skills
• Cultural heritage assessment skills
• Cultural diversity awareness
• Cultural diversity knowledge
• Cultural sensitivity
• Transcultural caring integrative abilities
Understanding Acculturation
• Gradual changes produced in one culture
through influence of another
Understanding Assimilation
• Absorption of one culture by another, leading
to extinct behaviors
The next slide is provided as an interventional resource for
those providers interested in downloading a brochure that
organizational representatives and providers can use to
establish interpreter protocols and methods to access and
establish interpreters using verbal or written consent. You
may download copies of the interventions contained within
or contact the author jdavidson@chamberlain.edu to obtain
further evidence in support of the interventional resources.
• Protocol for using
and assessing for
an interpreter
(Towers & Harfield,
2013; Jayasekara,
2014).
• The brochure at
right can be
downloaded so
organizational
representatives
and providers can
establish the
protocol in situ.
Family assessment instruments
in advanced practice nursing
• Overview of FAMTOOL – A Family Health
Assessment Tool
• Overview of FAMCHAT – A Family Cultural
Heritage Assessment Tool
• History and Development
• Design
• Psychometrics
The next slide is provided as an interventional resource for
those providers interested in downloading a copy of two
assessment tools – one to assess culturally-diverse families
(FAMTOOL) and the other to assess cultural heritage of
individuals within the family (FAMCHAT). You may download
copies of the interventions contained within or contact the
author jdavidson@chamberlain.edu to obtain further
psychometric data and/or a hard-copy of the interventional
resources.
Companion Tool Development
History of FAMCHAT Validation
and Psychometrics
•
•
•
•
•
Tertiary validation with elderly Mennonite
immigrants from the Ukraine (Davidson,
1994)
Secondary validation with Mennonite family
members (ages 8-80) from Kansas
(Davidson, Regier, & Boos, 2001)
Primary validation in village-based nurse
practitioner practice in Haiti
indicating tool and knowledgebase
convergence of international
FNP cultural competence (Davidson &
DeJong, 2002)
Secondary validation with hospitalized
patients in Canada (Higginbottom et al., 2012;
Higginbottom et al., 2011)
Further model explication (Davidson, 20122015)
An additional resource that will be made available to
participants upon request at the end of the project is a
“Getting Research into Practice” (GRiP) report. The GRiP
report will offer the results of the clinical audit, selected
strategies for improving compliance, and documentation of
barriers and required resources to encourage sustainable
engagement of stakeholders. If interested, please contact
the author jdavidson@chamberlain.edu to obtain a hardcopy of the results of the project and GRiP report.
Summary of Interventional
Resources
1.
2.
3.
4.
Educational intervention designed to increase knowledge about the
need for cultural competence to inform using and assessing for an
interpreter.
Downloadable tool that stakeholders organizational representatives
and providers can use to assess for communication or cultural
barriers.
Downloadable brochure that organizational representatives and
providers can use to establish interpreter protocols and methods to
access and establish interpreters using verbal or written consent.
Getting Research into Practice (GRiP) report for dissemination of
audit results, selected strategies for improving compliance, and
documentation of barriers and required resources to encourage
sustainable engagement.
References - continued
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Davidson, J. U. (2012). Patient-centered care using clinically-validated instrumentation. FAANP Forum,
3(1), 12.
Davidson, J. U. (1994). Portraits of Mennonite health: Selected stories from historical nursing research.
Mennonite Life, 49(1), 19-27.
Davidson, J. U. (1988). Health embodiment: The relationship between self-care agency and health
promoting behaviors. Dissertation Abstracts International, 49(08B). University of Michigan, MI.
Davidson, J. U. (1984). Historical perspective of self-care agency among elderly Mennonites at the turn of
the twentieth century. Masters Abstracts International. University of Michigan, MI.
Davidson, J. U., Regier, T., & Boos, S. (2001). Assessing family cultural heritage in Kansas: Research
and development of the FAMCHAT companion tool for family health assessment. The Kansas Nurse,
76(10), 5-7.
Giese, A., Uyar, M., Uslucan, H. H., Becker, S., & Henning, B. F. (2013). How do hospitalised patients
with Turkish migration background estimate their language skills and their comprehension of medical
information - a prospective cross-sectional study and comparison to native patients in Germany to assess
the language barrier and the need for translation. BMC Health Services Research, 13196.
Gray, B., Hilder, J., & Donaldson, H. (2011). Why do we not use trained interpreters for all patients with
limited English proficiency? Is there a place for using family members? Australian Journal of Primary
Health, 17(3), 240-249.
References - continued
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Higginbottom, G. M. A., Richter, M. S., Young, S., Ortiz, L. M., Callender, S. D., Forgeron, J. I., & Boyce,
M. L. (2012). Evaluating the utility of the FamCHAT ethnocultural nursing assessment tool at a Canadian
tertiary care hospital: A pilot study with recommendations for hospital management. Journal of Nursing
Education and Practice, 2(2), 1-17.
Higginbottom, G. M. A., Richter, M. S., Mogale, R. S., Ortiz, L., Young, S., & Mollel, O. (2011).
Identification of nursing assessment models/tools validated in clinical practice for use with diverse ethnocultural groups: An integrative review of the literature. BMC Nursing, 10(1), 16-26.
Jayasekara, R. (2014). Interpreter services: Clinician information. Adelaide, Australia: Joanna Briggs
Institute.
Lie, D., Bereknyei, S., Braddock, C., Encinas, J., Ahearn, S., & Boker, J. R. (2009). Assessing medical
students' skills in working with interpreters during patient encounters: A validation study of the Interpreter
Scale. Academic Medicine: Journal of the Association of American Medical Colleges, 84(5), 643-650.
Okrainec, K., Miller, M., Holcroft, C., Boivin, J., & Greenaway, C. (2014). Assessing the need for a
medical interpreter: Are all questions created equal? Journal of Immigrant & Minority Health, 16(4), 756760.
Towers, K., & Harfield, S. (2013). Interpreter services: Using and assessing for an interpreter. Adelaide,
Australia: Joanna Briggs Institute.
Weeks, S. K., & O’Connor, P. C. (1997). The FAMTOOL family health assessment tool. Rehabilitation
Nursing, 22(4), 188-191.
Weeks, S. K., & O’Connor, P. C. (1994). Concept analysis of family + health = a new definition of family
health. Rehabilitation Nursing, 19(4), 207-210.
Acknowledgements
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University of California San Francisco (UCSF) Centre for Evidence-Based
Patient and Family Care: An Affiliate of the Joanna Briggs Institute
Chamberlain College of Nursing:
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Dr. Valda Upenieks, Advisor
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Dr. Sue Fletcher, Preceptor
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Dr. Pat Fedorka, Mentor
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Dr. Ellen Poole, Coach