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The Small Talk Matters

Boyarsky, Katherine, BSN, RN

AJN The American Journal of Nursing: April 2019 - Volume 119 - Issue 4 - p 11
doi: 10.1097/01.NAJ.0000554530.32621.e3
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Improving patient care with multilingual health care providers.

Katherine Boyarsky is a staff nurse in the Hematology and Medical Oncology Divisions at Brigham and Women's Hospital, Boston. Contact author: katherine_boyarsky@dfci.harvard.edu. The author has disclosed no potential conflicts of interest, financial or otherwise.

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Figure.

In both inpatient and outpatient settings, health care providers use interpreters (on the phone and in person) to communicate with non-English-speaking patients. These interactions can seem formal and intimidating to the patient, creating a barrier to trust and comfort. When providers speak the patient's native language, however, there is room for small talk in addition to conveying and obtaining pertinent information. While small talk may seem superficial, it can make patients feel more comfortable, heard, and safe.

Consider this scenario. A young woman emigrates to the United States from El Salvador. She speaks only Spanish and is unfamiliar with American culture. She visits a primary care provider recommended by a friend who emigrated a few months prior. She brings her immunization record. The provider comes into the room, sees that the record says “Spanish,” and holds up a finger to indicate that the patient should wait while she calls for an interpreter on the phone. After five minutes of silence while the provider looks at the patient's paperwork, a male interpreter comes on the line. “Soy un intérprete médico. Mi nombre es Julio. Todo lo que dices es confidencial.” (“I am a medical interpreter. My name is Julio. Everything you say is confidential.”) She replies with a quiet “.” Using the interpreter, the provider learns a limited medical history and asks if the patient has any questions. She says no, and the interpreter hangs up. The provider uses hand gestures to indicate that she should wait, and mimes an injection.

The young woman is now scared, since she is not sure what injection she needs. Soon, a nurse who speaks Spanish enters. The young woman begins chatting with her and the nurse explains that she needs a tetanus booster. The patient tells the nurse that she has been having issues with her menstruation and is concerned. The nurse asks if she told her provider this, to which the patient responds that she didn't feel comfortable telling the interpreter. The nurse says she will relay this information to the provider.

According to the U.S. Census Bureau, over 26 million Americans speak English “less than very well.” Patients with limited proficiency in English have less access to and satisfaction with care. This contributes to health care disparities for these populations.

By contrast, while working at an urban community health facility, I witnessed the positive effects of having multilingual providers. Patients were more comfortable speaking with nurses or medical assistants who spoke their language. In addition, when interpreters were available, many patients appeared nervous and were less likely to ask questions than when speaking directly to a provider in their native language.

There's an urgent need for multilingual health care providers. In areas with a high percentage of patients with limited English proficiency, a more diverse nursing workforce should be recruited for both linguistic and cultural purposes. Additionally, more nurses should make efforts to learn other languages. In 2015, only 24% of U.S. RNs came from racial or ethnic minority groups (Nursing Economics, 2017).

Patients are more honest when interacting with health care professionals who speak their native language, resulting in better patient understanding and higher satisfaction (Journal of General Internal Medicine, 2007). While using trained medical interpreters is often the only option (or sometimes not an option at all), interpreters should be taught to ease into conversation and to ask if the patient has additional questions for the provider before ending the communication.

The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (www.thinkculturalhealth.hhs.gov/clas) mandate that patients receive care that is responsive to “cultural… beliefs and practices, preferred languages, health literacy, and other communication needs.” While research is needed on differences in care between using in-person interpreters, phone interpreters, and family members, increasing the availability of multilingual health care providers remains an ideal to aim for.

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