Language barriers between patients and nurses are not only frustrating but can also compromise patient safety. Because clear communication and adherence to a prescribed treatment plan play a key role in patient recovery, nurses must assess when a patient's health or recovery is compromised due to limited English proficiency in the healthcare setting. Once language barriers are identified, the nurse can implement various strategies to overcome these barriers and improve communication with the patient.
What Impact Do Language Barriers Have on Patient Safety?
Not surprisingly, language barriers are a major factor in patient safety incidents. One study found that 59% of all serious adverse events were primarily due to communication errors. These communication errors predispose patients to a greater risk of complications as a result of unreliable or incorrect patient assessment, poor quality treatment, low patient comprehension, reduced compliance with recommended follow-ups and more medication errors.
For example, because certain medical conditions require precise monitoring of intake and output, patients with limited English language proficiency may not understand that the nurse needs to take these measurements or that they need to follow a particular diet or fluid restriction. As a result, the nurse and healthcare provider may not accurately monitor a patient's condition or ensure appropriate treatment is administered in a timely way.
How Do Language Barriers Affect Healthcare Providers?
According to Dr. Allison Squires (2018), "Patients with language barriers change how nurses work and organize patient care. These changes are needed not only to meet communication needs for the patient, but also for legal reasons." Miscommunication due to language barriers between patients and healthcare providers results in reduced quality of patient care, more patient safety issues and decreased satisfaction for patients and those providing care.
A survey also found that 41% of nurses polled believe language barriers negatively impact their communication with patients during patient teaching. Because of this, nurses in the study were not confident these patients understood how to manage their medications safely and effectively.
What Strategies Can Nurses and Healthcare Providers Use to Overcome Language Barriers?
When language barriers pose a threat to communication between patients and healthcare providers, the use of one or more of these strategies may be useful:
- Use professional interpreters provided through the healthcare organization
Although accessing a professional interpreter when needed may be difficult and uncomfortable for the patient due to personal information they need to disclose, most facilities have policies regarding the use of professional interpreters and how to access these professionals.
- Document when language barriers exist and what has been done to assist the patient with this issue
Providers should document the decision to use an interpreter, a staff member, or family or friends as interpreters in the patient's healthcare record, as well as what other policies they followed regarding language barriers with patients.
- Plan to use an interpreter at key times
If possible, use a professional interpreter during admission, discharge and patient teaching sessions, particularly when teaching about medications. Research shows these are critical moments of communication with the patient and the use of a professional interpreter reduces readmissions and the risk of medical errors.
- Employ the use of staff members as interpreters cautiously
If access to a professional interpreter is not possible, consider using a nurse or other healthcare provider as an interpreter who speaks the patient's language. You can also follow the Agency for Healthcare Research and Quality (AHRQ) guidelines for this when possible.
- Strategically hire professional staff members who speak the patients' languages
By reviewing the facility census of non-English-speaking patients, nurse managers can identify what languages are most commonly spoken by patients other than English and
hire more nurses who speak these languages.
- Use family and friends for language interpretation as a last resort
In an emergency or when necessary, the use of a patient's family member or friend as an interpreter may be unavoidable for the patient's safety and well-being. In these situations, avoid using individuals under the age of 18 years as interpreters.
Overcoming language barriers can be a challenge for healthcare providers and patients alike. However, patient safety, high-quality care and satisfaction for both patients and nurses depend on it. By employing some key strategies with patients with limited English proficiency, nurses and healthcare providers are more likely to contribute to better patient outcomes and a more satisfying healthcare experience for those involved.
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