- Email: [email protected]
Use of interpreters in the emergency department
||T
st eine Person hier wer Deutsch sprechen
A kahn? Ich habe unglaubliche Brustkasten schmerzen!" Who does not relate to the sinking feeling caused by the frustrating inability to communicate with an emergency patient? Currently there are more than 300 languages and dialects spoken within the United States, and 8.7% of the population is foreign born; the foreign-born population has doubled in 25 years. 1 All will eventually need health care and could be addressing you. "War stories" about language miscommunication abound. An obese, screaming woman was immediately checked for crowning when it was assumed that childbirth was imminent, but she was not even pregnant. A potentially more lethal situation involved a Laotian couple who brought a written note in English stating, "please cheek baby cough." On-thespot interpretation revealed that, more importantly, their 3-week-old infant had a high fever and had refused to nurse that day. Communicating with non-English-speaking patients is a growing problem, and most hospitals are still working toward a satisfactory solution. In addition to quality-of-care concerns, legal and regulatory issues also exist. The Civil Rights Act of 1964 requires that institutions that receive federal funding must make a reasonable attempt to provide interpreter services. The Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) latest patient rights emphasize accurate and clear language communication, 2 which means "being translated into an understood language" (Dr. Niederee, personal communication, November 22, 1995). Polly Gerber Zimmermann is staff nurse III, Swedish Covenant Hospital, Chicago, Illinois. For reprints, write Polly Gerber Zimmermann, 4200 N. Francisco, Chicago, IL 60618. J Emerg Nuts 1996;22:225-7. Copyright 9 1996 by the Emergency Nurses Association. 0099-1767/96 $5.00+ 0 18/9/71689
Emergency departments use several solutions to cope with this issue: bilingual literature, amateur verbal interpreters, and professional interpreters.
Bilingual literature In addition to foreign language dictionaries, some books have more health care-related assessment and directional phrases. For Spanish patients, Joyce and Villanueva's S a y It in Spanish: A Guide for Health Career Professionals is recommended. 3. For use with the more diversified population at the Millard Fillmore Suburban Hospital in Williamsville, New York, the staff uses Kelland and Jordon's Multilingual Patient A s s e s s m e n t Manual. 4 t Its side-by-side format allows the provider to point to the question in many less common languages. Continuity is aided in that prehospital providers, ED, and inpatient staff all use the same resource. Many institutions have bilingual printed instructions translated either professionally or by their bilingual staff. LOGICARE Corporation has a fully translated side-by-side English-Spanish discharge instruction system entitled CHECKOUT. 5 The software supports other translations added by the user provided the language uses the IBM character set.$ Verbal interpretation
No nationwide standards for language interpreters exist, although some states (e.g., Washington) have instituted testing and certification (M. Michalczyk, personal communication; November 21, 1995). An inherent issue can be detecting the fine differences be ~ tween interpretation of meaning versus literal, wordfor-word translation. For example, a febrile child was brought to the emergency department after a 911 call for "fainting," but the interpreter correctly perceived *Ordering information: W.B. Saunders, 6277 Sea Harbor Drive, Orlando, FL 32821-9989; cost $15. tOrdering information: Mosby-Year Book, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146; (800) 325-4177, ext. 4554; cost $23.95.
CLOGICARECorporation, (800) 848-0099.
June 1996 225
JOURNAL OF EMERGENCY NURSING/Zillmlermann
that the mother's descriptive words are commonly used to describe a seizure. Use of native speakers for interpreters often enhances the patient's level of trust, depth of answers, and staff's insights of cultural treatments.1 One Asian w o m a n with circular ecchymotic marks was a suspected abuse victim until the native interpreter correctly identified them as "cupping," a folk healing procedure. Another interpreter was able to accurately identify that the "Russian heart medicine" being taken was similar to nifedipine (Procardia). In addition, it is helpful to honor a patient's preference for an interpreter's gender.
Nonprofessional interpreters Many hospitals have language "banks' '--lists of employees who are willing to serve as interpreters. Contact protocols include the individual unit, the nursing supervisor, personnel office, patient advocate office, admitting department, or an access service department. Institutions often seek to supplement language services and cultural diversity by specifically hiring bilingual employees or financially supporting language training. Key departments have at least one appropriate bilingual employee on duty 24 hours a day at Our Lady of the Resurrection Medical Center in Chicago for the large Polish clientele I and at Brigham & Women's Hospital in Boston for frequent Spanish needs. 2 A common misconception is that all bilingual people w a n t to interpret; in reality, some are reluctant. Problems can occur when a supervisor is not willing for the staff member to interrupt his or her primary job for interpreting. Sherman Hospital in Elgin, Illinois, and Parkland Memorial Hospital in Dallas have a partial solution to these issues. An extra hourly financial compensation and a blanket approval to prioritize interpretation needs over routine work is given to staff interpreters who are willing a n d w h o pass the hospital's translation qualifications. Outside volunteers are sometimes used. The Medical Center of Ocean County in Brick, New Jersey, recruits bilingual volunteers from the senior community outreach program (E1dermed) to be on call. The local university's large foreign student body volunteers to assist at the University of Missouri Hospital-Columbia. Volunteers from the local community are also used at Moses Cone Hospital in Greensboro, North Carolina. For nonurgent needs, local community resources include ethnic organizations such as Chicago's Polish Welfare Association and Hispanocare (referral network). 1 A lingering difficulty with nonprofessional translators is inconsistent availability.
226
Volume22, Number 3
Professional translation Telephone Language Line The American Telephone and Telegraph Language Line is instantly available with more than 140 languages. Rates, which vary by the language and the time of the call, are from $2.20 to $7.25 a minute (M. Cuno, personal communication; June 23, 1995). Translators have passed a proficiency examination but may not be native speakers or experienced in medical terminology.*
Professional interpreters Professional interpreters offer more reliable quality and ethics and avoid lingering nonprofessional issues of inconsistent availability, inadequate interpretation, and extraneous commentary. One staff member who was "just helping out" with his "high-school Spanish" interpreted that the patient was consenting to surgery when the patient was agreeing only to a hospital admission, n o t the surgery. In addition, amateur translators editorialize on occasion. In one case, the translator literally stated, "The doctor wants you to have this surgery but I wouldn't because I don't trust him." Not all bilingual personnel possess equal ability with verbal communication (i.e., interpretation) and written communication (translation). Individuals with appropriate language degrees are hired for interpretation and translation during the daytime hours at Parkland Memorial Hospital in Dallas. This arrangement best meets their greatest needs and is supplemented by qualified staff language assistants during off-hours. Swedish Covenant Hospital in Chicago met its changing community needs by hiring cultural liaisons for Russian-, Korean-, and Spanish-speaking patients; these groups represent the three largest ethnic p o p ulations in the area's ZIP codes. Liaisons not only help with language translation needs, but serve as a bridge with the growing local ethnic populations. Their activities include marketing and development, advertised availability to the community, and a bridge to assist and recruit bilingual physicians. Concerns of the bilingual physicians' patients heightened the hospital's awareness of the need for bilingual telephone operators. Other hospitals hire professional translators through agencies. Providence St. Vincent Hospital and Medical Center in Portland, Oregon, channels its 15 to 20 daily interpretation needs through a 24-hour access services department; a department employee calls one of the two contracted interpreter services. 2 The University of Missouri Hospital-Columbia calls on *For m o r e information, call (408) 648-5883.
Zimmermann/JOURNAL OF EMERGENCYNURSING
a local a s s i s t a n c e o r g a n i z a t i o n , A d v e n t , to help b y u s e of s i g n l a n g u a g e w i t h h e a r i n g - i m p a i r e d p a t i e n t s .
Oregon Health Sciences University Hospital, Portland, Oregon 2 Maria Michalczyk, a registered nurse with a master's d e g r e e in a n t h r o p o l o g y , c o o r d i n a t e s t h e M e d i c a l Int e r p r e t e r S e r v i c e s for O r e g o n H e a l t h S c i e n c e s University Hospital, A s t h e n e e d for i n t e r p r e t e r s i n c r e a s e d , t h e s e r v i c e w a s m o v e d from t h e p a t i e n t a d v o c a t e ofrice to t h e a d m i t t i n g d e p a r t m e n t ; Ms. M i c h a l c z y k h a s b e e n m a n a g e r of t h e M e d i c a l I n t e r p r e t e r S e r v i c e s for 389 years. T h e s e r v i c e h a s its o w n policies a n d p r o c e dures, s t a n d a r d s , a n d t e s t i n g a n d is c o n s i d e r e d ins t r u m e n t a l in p r o v i d i n g b e t t e r , quality c a r e for t h e large n u m b e r s of n o n - E n g l i s h - s p e a k i n g p a t i e n t s . Professional i n t e r p r e t e r s are c o n s i d e r e d k e y to t h e p r o g r a m ' s effectiveness. M i c h a l c z y k s t r e s s e s t h a t a housekeeper may know Russian and may have been a h i g h l y t r a i n e d l a w y e r in h e r or his n a t i v e country, b u t s u c h k n o w l e d g e d o e s not e n s u r e t h e ability to p r o v i d e s a t i s f a c t o r y medical c o m m u n i c a t i o n . T h e p r o g r a m , w h i c h h a s a n a n n u a l b u d g e t of $860,000, is C o n s i d e r e d e s s e n t i a l in t e r m s of c o s t savi n g s d e s p i t e t h e fact t h a t m a n y p a t i e n t s w h o r e q u i r e i n t e r p r e t e r s are M e d i c a i d r e c i p i e n t s . P a t i e n t n o n c o m pliance, o r d e r i n g e x t r a t e s t s a s a result of a n i n a d e q u a t e history, or d e p e n d i n g solely on o u t s i d e s o u r c e s are c o n s i d e r e d m o r e e x p e n s i v e i n e v i t a b l e c o s t s w i t h out t h e i n t e r p r e t e r p r o g r a m . H o s p i t a l t r a n s l a t o r s are p a i d $10.50 to $12.74 p e r hour. W h e n t h e h o s p i t a l u s e d t h e t e l e p h o n e l a n g u a g e line, c o s t s a v e r a g e d $160 to $200 p e r hour. T h e m a i n l a n g u a g e n e e d s are Spanish, V i e t n a m ese, a n d Russian, b u t i n t e r p r e t e r s for other Pacific Rim l a n g u a g e s ( C a m b o d i a n , L a o t i a n / M i e n , C h i n e s e ) are f r e q u e n t l y n e e d e d . T h e p r o g r a m u s e s a total of 55 t r a n s l a t o r s to m e e t t h e 24-hour n e e d s of 3000 p a t i e n t s a month; 80% of t h e s e p a t i e n t s are s e e n in t h e o u t p a t i e n t clinic. In a d d i t i o n to t h e 15 full-time e q u i v a l e n t i n t e r p r e t e r s , a d d i t i o n a l on-call i n t e r p r e t i n g n e e d s are m e t t h r o u g h i n d i v i d u a l d i r e c t contracts, a n o u t s i d e t e m p o r a r y a g e n c y a s payer, or a n o u t s i d e a g e n c y int e r p r e t e r l a n g u a g e pool. Cellular s p e a k e r p h o n e s are u s e d for u r g e n t l y n e e d e d b e d s i d e translation. Bilingual staff m e m b e r s m a y t a k e a t e s t to qualify as i n t e r p r e t e r s , b u t t h e y m a y s e r v e in t h a t role only w h e n t h e y are n o t on regular duty. R e m o v i n g e m p l o y e e s from their p r i m a r y job is b e l i e v e d to c a u s e too m u c h conflict a n d c o m p r o m i s e . I n t e r p r e t e r s m u s t p a s s oral a n d w r i t t e n e x a m i n a tions, i n c l u d i n g a g r o u p i n t e r v i e w t h a t i n c l u d e s at l e a s t one b i l i n g u a l p h y s i c i a n or nurse. T h e p r o c e s s developed and coordinated by Michalczyk has been
i n s t r u m e n t a l in s c r e e n i n g those, w h o t h o u g h fluent, are n o t p r o f i c i e n t in t r a n s l a t i n g m e d i c a l c o n c e p t s . For i n s t a n c e , one i n t e r v i e w c a n d i d a t e w h o w a s currently w o r k i n g a s a p r o f e s s i o n a l i n t e r p r e t e r could n o t correctly t r a n s l a t e t h e c o n c e p t of an a u t o p s y . In addition, t h e h o s p i t a l is p i o n e e r i n g a t r a i n i n g p r o g r a m in m e d i c a l i n t e r p r e t a t i o n w i t h Portland S t a t e University. Eventually t h e r e m a y b e s t a t e w i d e legisl a t e d s t a n d a r d s for t e s t i n g a n d c e r t i f i c a t i o n of m e d i cal i n t e r p r e t e r s , similar to t h e c u r r e n t s t a t e requirem e n t s for court i n t e r p r e t a t i o n . Medical interpretation needs may not always be e v i d e n t b u t are no less i m p o r t a n t t h a n other p a t i e n t n e e d s . I n t e r p r e t a t i o n n e e d s a r e b r o a d a n d complex, b u t s o l u t i o n s m u s t b e s o u g h t to p r o v i d e effective, c o m p a s s i o n a t e p a t i e n t c o m m u n i c a t i o n . By implem e n t i n g s o m e of t h e s e tried, s u c c e s s f u l m e a s u r e s , an ED t r i a g e n u r s e w o u l d learn t h a t t h e p a t i e n t in t h e o p e n i n g s c e n a r i o w a s d e s c r i b i n g his terrible, c r u s h i n g c h e s t pains. I thank Maria Michalczyk, RN, MA, at Oregon Health Sciences University Hospital, Portland. For more information on the copyrighted Oregon Health Sciences University test for medical interpreters, contact her at (503) 494-8720; Oregon Health Sciences University, Medical Interpreter Services, Mail Code L478, 3181 SW Sam Jackson Road, Portland, OR 97201. I also thank Dennis Stevens, BS, RN, of the Public Health Service/Indian Health Service, Zuni, New Mexico, for his invaluable input. Thanks also to Ann Marie Tyrefl, RN, MS, CEN (Millard Fillmore Suburban Hospital, Williamsville, N.Y.); Jackie Hjelm, RN, BSN (LOGICARE Corporation, Eau Claire, Wis.); Julia Yates, RN, CEN (Sherman Hospital, Elgin, Ill.); Theresa Meyers, RN, CEN, and Nancy Highduke, RN, CEN (Parkland Memorial Hospital, Dallas); Eloise Clawson, RN, CEN (Medical Center of Ocean County, Brick, N.J.); Gordon Rogers, RN, CEN (University of Missouri-Columbia), Janelle Bostic, RN (Moses Cone Hospital, Greensboro, N.C.); Admitting Director Nora Nikolich, RN, BA, Cindy Lee, MA, and Guadelupe Hernandez, LPN (Swedish Covenant Hospital, Chicago).
References 1. Zurlinden J. When English is the patient's second language. Nursing Spectrum 1995;8:9. 2. Moore LM, editor. Speaking the right language is a growing part of access duties. Hospital Access Management 1994;13:153-5. 3. Joyce E-Z, Villanueva ME. Say it in Spanish: a guide for health career professionals. Philadelphia: WB Saunders, 1995. 4. Kelland B, Jordon L. Multilingual patient assessment manual. St Louis: Mosby-Year Book, 1994. 5. CHECKOUT (computer program). Eau Claire, Wis.: LOGICARE Corporation, 1986.
June 1996
227
st eine Person hier wer Deutsch sprechen
A kahn? Ich habe unglaubliche Brustkasten schmerzen!" Who does not relate to the sinking feeling caused by the frustrating inability to communicate with an emergency patient? Currently there are more than 300 languages and dialects spoken within the United States, and 8.7% of the population is foreign born; the foreign-born population has doubled in 25 years. 1 All will eventually need health care and could be addressing you. "War stories" about language miscommunication abound. An obese, screaming woman was immediately checked for crowning when it was assumed that childbirth was imminent, but she was not even pregnant. A potentially more lethal situation involved a Laotian couple who brought a written note in English stating, "please cheek baby cough." On-thespot interpretation revealed that, more importantly, their 3-week-old infant had a high fever and had refused to nurse that day. Communicating with non-English-speaking patients is a growing problem, and most hospitals are still working toward a satisfactory solution. In addition to quality-of-care concerns, legal and regulatory issues also exist. The Civil Rights Act of 1964 requires that institutions that receive federal funding must make a reasonable attempt to provide interpreter services. The Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) latest patient rights emphasize accurate and clear language communication, 2 which means "being translated into an understood language" (Dr. Niederee, personal communication, November 22, 1995). Polly Gerber Zimmermann is staff nurse III, Swedish Covenant Hospital, Chicago, Illinois. For reprints, write Polly Gerber Zimmermann, 4200 N. Francisco, Chicago, IL 60618. J Emerg Nuts 1996;22:225-7. Copyright 9 1996 by the Emergency Nurses Association. 0099-1767/96 $5.00+ 0 18/9/71689
Emergency departments use several solutions to cope with this issue: bilingual literature, amateur verbal interpreters, and professional interpreters.
Bilingual literature In addition to foreign language dictionaries, some books have more health care-related assessment and directional phrases. For Spanish patients, Joyce and Villanueva's S a y It in Spanish: A Guide for Health Career Professionals is recommended. 3. For use with the more diversified population at the Millard Fillmore Suburban Hospital in Williamsville, New York, the staff uses Kelland and Jordon's Multilingual Patient A s s e s s m e n t Manual. 4 t Its side-by-side format allows the provider to point to the question in many less common languages. Continuity is aided in that prehospital providers, ED, and inpatient staff all use the same resource. Many institutions have bilingual printed instructions translated either professionally or by their bilingual staff. LOGICARE Corporation has a fully translated side-by-side English-Spanish discharge instruction system entitled CHECKOUT. 5 The software supports other translations added by the user provided the language uses the IBM character set.$ Verbal interpretation
No nationwide standards for language interpreters exist, although some states (e.g., Washington) have instituted testing and certification (M. Michalczyk, personal communication; November 21, 1995). An inherent issue can be detecting the fine differences be ~ tween interpretation of meaning versus literal, wordfor-word translation. For example, a febrile child was brought to the emergency department after a 911 call for "fainting," but the interpreter correctly perceived *Ordering information: W.B. Saunders, 6277 Sea Harbor Drive, Orlando, FL 32821-9989; cost $15. tOrdering information: Mosby-Year Book, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146; (800) 325-4177, ext. 4554; cost $23.95.
CLOGICARECorporation, (800) 848-0099.
June 1996 225
JOURNAL OF EMERGENCY NURSING/Zillmlermann
that the mother's descriptive words are commonly used to describe a seizure. Use of native speakers for interpreters often enhances the patient's level of trust, depth of answers, and staff's insights of cultural treatments.1 One Asian w o m a n with circular ecchymotic marks was a suspected abuse victim until the native interpreter correctly identified them as "cupping," a folk healing procedure. Another interpreter was able to accurately identify that the "Russian heart medicine" being taken was similar to nifedipine (Procardia). In addition, it is helpful to honor a patient's preference for an interpreter's gender.
Nonprofessional interpreters Many hospitals have language "banks' '--lists of employees who are willing to serve as interpreters. Contact protocols include the individual unit, the nursing supervisor, personnel office, patient advocate office, admitting department, or an access service department. Institutions often seek to supplement language services and cultural diversity by specifically hiring bilingual employees or financially supporting language training. Key departments have at least one appropriate bilingual employee on duty 24 hours a day at Our Lady of the Resurrection Medical Center in Chicago for the large Polish clientele I and at Brigham & Women's Hospital in Boston for frequent Spanish needs. 2 A common misconception is that all bilingual people w a n t to interpret; in reality, some are reluctant. Problems can occur when a supervisor is not willing for the staff member to interrupt his or her primary job for interpreting. Sherman Hospital in Elgin, Illinois, and Parkland Memorial Hospital in Dallas have a partial solution to these issues. An extra hourly financial compensation and a blanket approval to prioritize interpretation needs over routine work is given to staff interpreters who are willing a n d w h o pass the hospital's translation qualifications. Outside volunteers are sometimes used. The Medical Center of Ocean County in Brick, New Jersey, recruits bilingual volunteers from the senior community outreach program (E1dermed) to be on call. The local university's large foreign student body volunteers to assist at the University of Missouri Hospital-Columbia. Volunteers from the local community are also used at Moses Cone Hospital in Greensboro, North Carolina. For nonurgent needs, local community resources include ethnic organizations such as Chicago's Polish Welfare Association and Hispanocare (referral network). 1 A lingering difficulty with nonprofessional translators is inconsistent availability.
226
Volume22, Number 3
Professional translation Telephone Language Line The American Telephone and Telegraph Language Line is instantly available with more than 140 languages. Rates, which vary by the language and the time of the call, are from $2.20 to $7.25 a minute (M. Cuno, personal communication; June 23, 1995). Translators have passed a proficiency examination but may not be native speakers or experienced in medical terminology.*
Professional interpreters Professional interpreters offer more reliable quality and ethics and avoid lingering nonprofessional issues of inconsistent availability, inadequate interpretation, and extraneous commentary. One staff member who was "just helping out" with his "high-school Spanish" interpreted that the patient was consenting to surgery when the patient was agreeing only to a hospital admission, n o t the surgery. In addition, amateur translators editorialize on occasion. In one case, the translator literally stated, "The doctor wants you to have this surgery but I wouldn't because I don't trust him." Not all bilingual personnel possess equal ability with verbal communication (i.e., interpretation) and written communication (translation). Individuals with appropriate language degrees are hired for interpretation and translation during the daytime hours at Parkland Memorial Hospital in Dallas. This arrangement best meets their greatest needs and is supplemented by qualified staff language assistants during off-hours. Swedish Covenant Hospital in Chicago met its changing community needs by hiring cultural liaisons for Russian-, Korean-, and Spanish-speaking patients; these groups represent the three largest ethnic p o p ulations in the area's ZIP codes. Liaisons not only help with language translation needs, but serve as a bridge with the growing local ethnic populations. Their activities include marketing and development, advertised availability to the community, and a bridge to assist and recruit bilingual physicians. Concerns of the bilingual physicians' patients heightened the hospital's awareness of the need for bilingual telephone operators. Other hospitals hire professional translators through agencies. Providence St. Vincent Hospital and Medical Center in Portland, Oregon, channels its 15 to 20 daily interpretation needs through a 24-hour access services department; a department employee calls one of the two contracted interpreter services. 2 The University of Missouri Hospital-Columbia calls on *For m o r e information, call (408) 648-5883.
Zimmermann/JOURNAL OF EMERGENCYNURSING
a local a s s i s t a n c e o r g a n i z a t i o n , A d v e n t , to help b y u s e of s i g n l a n g u a g e w i t h h e a r i n g - i m p a i r e d p a t i e n t s .
Oregon Health Sciences University Hospital, Portland, Oregon 2 Maria Michalczyk, a registered nurse with a master's d e g r e e in a n t h r o p o l o g y , c o o r d i n a t e s t h e M e d i c a l Int e r p r e t e r S e r v i c e s for O r e g o n H e a l t h S c i e n c e s University Hospital, A s t h e n e e d for i n t e r p r e t e r s i n c r e a s e d , t h e s e r v i c e w a s m o v e d from t h e p a t i e n t a d v o c a t e ofrice to t h e a d m i t t i n g d e p a r t m e n t ; Ms. M i c h a l c z y k h a s b e e n m a n a g e r of t h e M e d i c a l I n t e r p r e t e r S e r v i c e s for 389 years. T h e s e r v i c e h a s its o w n policies a n d p r o c e dures, s t a n d a r d s , a n d t e s t i n g a n d is c o n s i d e r e d ins t r u m e n t a l in p r o v i d i n g b e t t e r , quality c a r e for t h e large n u m b e r s of n o n - E n g l i s h - s p e a k i n g p a t i e n t s . Professional i n t e r p r e t e r s are c o n s i d e r e d k e y to t h e p r o g r a m ' s effectiveness. M i c h a l c z y k s t r e s s e s t h a t a housekeeper may know Russian and may have been a h i g h l y t r a i n e d l a w y e r in h e r or his n a t i v e country, b u t s u c h k n o w l e d g e d o e s not e n s u r e t h e ability to p r o v i d e s a t i s f a c t o r y medical c o m m u n i c a t i o n . T h e p r o g r a m , w h i c h h a s a n a n n u a l b u d g e t of $860,000, is C o n s i d e r e d e s s e n t i a l in t e r m s of c o s t savi n g s d e s p i t e t h e fact t h a t m a n y p a t i e n t s w h o r e q u i r e i n t e r p r e t e r s are M e d i c a i d r e c i p i e n t s . P a t i e n t n o n c o m pliance, o r d e r i n g e x t r a t e s t s a s a result of a n i n a d e q u a t e history, or d e p e n d i n g solely on o u t s i d e s o u r c e s are c o n s i d e r e d m o r e e x p e n s i v e i n e v i t a b l e c o s t s w i t h out t h e i n t e r p r e t e r p r o g r a m . H o s p i t a l t r a n s l a t o r s are p a i d $10.50 to $12.74 p e r hour. W h e n t h e h o s p i t a l u s e d t h e t e l e p h o n e l a n g u a g e line, c o s t s a v e r a g e d $160 to $200 p e r hour. T h e m a i n l a n g u a g e n e e d s are Spanish, V i e t n a m ese, a n d Russian, b u t i n t e r p r e t e r s for other Pacific Rim l a n g u a g e s ( C a m b o d i a n , L a o t i a n / M i e n , C h i n e s e ) are f r e q u e n t l y n e e d e d . T h e p r o g r a m u s e s a total of 55 t r a n s l a t o r s to m e e t t h e 24-hour n e e d s of 3000 p a t i e n t s a month; 80% of t h e s e p a t i e n t s are s e e n in t h e o u t p a t i e n t clinic. In a d d i t i o n to t h e 15 full-time e q u i v a l e n t i n t e r p r e t e r s , a d d i t i o n a l on-call i n t e r p r e t i n g n e e d s are m e t t h r o u g h i n d i v i d u a l d i r e c t contracts, a n o u t s i d e t e m p o r a r y a g e n c y a s payer, or a n o u t s i d e a g e n c y int e r p r e t e r l a n g u a g e pool. Cellular s p e a k e r p h o n e s are u s e d for u r g e n t l y n e e d e d b e d s i d e translation. Bilingual staff m e m b e r s m a y t a k e a t e s t to qualify as i n t e r p r e t e r s , b u t t h e y m a y s e r v e in t h a t role only w h e n t h e y are n o t on regular duty. R e m o v i n g e m p l o y e e s from their p r i m a r y job is b e l i e v e d to c a u s e too m u c h conflict a n d c o m p r o m i s e . I n t e r p r e t e r s m u s t p a s s oral a n d w r i t t e n e x a m i n a tions, i n c l u d i n g a g r o u p i n t e r v i e w t h a t i n c l u d e s at l e a s t one b i l i n g u a l p h y s i c i a n or nurse. T h e p r o c e s s developed and coordinated by Michalczyk has been
i n s t r u m e n t a l in s c r e e n i n g those, w h o t h o u g h fluent, are n o t p r o f i c i e n t in t r a n s l a t i n g m e d i c a l c o n c e p t s . For i n s t a n c e , one i n t e r v i e w c a n d i d a t e w h o w a s currently w o r k i n g a s a p r o f e s s i o n a l i n t e r p r e t e r could n o t correctly t r a n s l a t e t h e c o n c e p t of an a u t o p s y . In addition, t h e h o s p i t a l is p i o n e e r i n g a t r a i n i n g p r o g r a m in m e d i c a l i n t e r p r e t a t i o n w i t h Portland S t a t e University. Eventually t h e r e m a y b e s t a t e w i d e legisl a t e d s t a n d a r d s for t e s t i n g a n d c e r t i f i c a t i o n of m e d i cal i n t e r p r e t e r s , similar to t h e c u r r e n t s t a t e requirem e n t s for court i n t e r p r e t a t i o n . Medical interpretation needs may not always be e v i d e n t b u t are no less i m p o r t a n t t h a n other p a t i e n t n e e d s . I n t e r p r e t a t i o n n e e d s a r e b r o a d a n d complex, b u t s o l u t i o n s m u s t b e s o u g h t to p r o v i d e effective, c o m p a s s i o n a t e p a t i e n t c o m m u n i c a t i o n . By implem e n t i n g s o m e of t h e s e tried, s u c c e s s f u l m e a s u r e s , an ED t r i a g e n u r s e w o u l d learn t h a t t h e p a t i e n t in t h e o p e n i n g s c e n a r i o w a s d e s c r i b i n g his terrible, c r u s h i n g c h e s t pains. I thank Maria Michalczyk, RN, MA, at Oregon Health Sciences University Hospital, Portland. For more information on the copyrighted Oregon Health Sciences University test for medical interpreters, contact her at (503) 494-8720; Oregon Health Sciences University, Medical Interpreter Services, Mail Code L478, 3181 SW Sam Jackson Road, Portland, OR 97201. I also thank Dennis Stevens, BS, RN, of the Public Health Service/Indian Health Service, Zuni, New Mexico, for his invaluable input. Thanks also to Ann Marie Tyrefl, RN, MS, CEN (Millard Fillmore Suburban Hospital, Williamsville, N.Y.); Jackie Hjelm, RN, BSN (LOGICARE Corporation, Eau Claire, Wis.); Julia Yates, RN, CEN (Sherman Hospital, Elgin, Ill.); Theresa Meyers, RN, CEN, and Nancy Highduke, RN, CEN (Parkland Memorial Hospital, Dallas); Eloise Clawson, RN, CEN (Medical Center of Ocean County, Brick, N.J.); Gordon Rogers, RN, CEN (University of Missouri-Columbia), Janelle Bostic, RN (Moses Cone Hospital, Greensboro, N.C.); Admitting Director Nora Nikolich, RN, BA, Cindy Lee, MA, and Guadelupe Hernandez, LPN (Swedish Covenant Hospital, Chicago).
References 1. Zurlinden J. When English is the patient's second language. Nursing Spectrum 1995;8:9. 2. Moore LM, editor. Speaking the right language is a growing part of access duties. Hospital Access Management 1994;13:153-5. 3. Joyce E-Z, Villanueva ME. Say it in Spanish: a guide for health career professionals. Philadelphia: WB Saunders, 1995. 4. Kelland B, Jordon L. Multilingual patient assessment manual. St Louis: Mosby-Year Book, 1994. 5. CHECKOUT (computer program). Eau Claire, Wis.: LOGICARE Corporation, 1986.
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