1. Vesterlund, Martha BSE, RN, CN


Recognizing the needs of non-English speaking patients.


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The English language is one of the hardest to learn. Throw abbreviations such as ICU, CCU, or IVF into a sentence, and you'll confound someone trying to learn this language. Many native English speakers have difficulty understanding medical terminology, so why would we expect non-English speakers to understand it?


When I was 23 years old, I married my homesick college sweetheart, who was from Sweden. We moved there after our honeymoon, and I attended Linkoping University to learn Swedish. I worked hard and became fluent within six months. I taught English in middle school and high school for the six years we lived there. I also gave birth to two boys.


My first child, delivered by planned cesarean section, weighed about 6 kg. Before the surgery, I had an appointment with the anesthesiologist. I was not yet a nurse and had limited medical literacy in English. I had learned basic Swedish, but not medical terms. I kept thinking, "Six kilograms, how many pounds is that?" I did not know until I got home and checked online that you multiply 2.2 to get the pounds, and I was scared. I weighed 10 pounds at birth, but 12 or 13 lbs. sounded extreme. Did this mean that something was wrong?


While the anesthesiologist and my husband talked, I understood that I was having this procedure because, as the physician phrased it, I was 10 days overdue, the baby was big, and at some point my "mother's cake" would get hard and not work anymore. In addition, my "living mother" wasn't responding and wasn't starting to "expel" the baby as it should. (I understood through my husband, later, that "mother's cake" is the literal translation of placenta and the "living mother" was my uterus.) Confusion and fear made it virtually impossible for me to make a decision about my care. I exploded in tears and told the anesthesiologist to speak in English and with me, his patient. His English was excellent, but he was worried that it wasn't good enough. It took extra time for the appointment, but I started to feel better when he spoke to me in English and the conversation was directed at me and not at my husband.


As an RN, I assess patients' physical status and also their ability to understand medical terms and care plans. If my patient reads at the fourth-grade level, how can I expect her to read brochures written at the 10th-grade level? If she's not fluent in English, why would I assume that she understands discharge instructions and a new drug regimen? What if she can't describe the medications that she is already taking and then has new ones to take? Such a circumstance poses a danger to patients who aren't native English speakers. It's important for nurses to take the time to talk to them.

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According to Risa Lavizzo-Mourey, writing in a November 2007 supplement to the Journal of General Internal Medicine, "experts estimate that as many as 20 million people in America-about one in every 15 people in the [United States]-speak and understand little, if any, English." A hospital interpreter can help, although according to Gany and colleagues in the same supplement, "[h]ospitals often call upon untrained staff or bystanders to interpret. Untrained interpreters are prone to editing, polishing, omissions, additions, substitutions, volunteered opinions, and confidentiality breaches." Also, nurses should remember to speak to the patient, not just to the interpreter, and before discharge have the patient repeat back instructions.


You've no doubt heard someone say of immigrants, "They're in America now; they should speak English." But hospitals can't afford such bias. They should be a safe haven for all.