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Using telephone interpreters to communicate with patients

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  • Typically, nurses use sign language, translated materials and family and friends when working with patients whose first language is not English. Using bilingual workers and professional interpreters is still relatively rare in healthcare.
  • Sign language and improvisation are often used to establish rapport and assess understanding. However, this is an unsatisfactory way of communicating health information.
  • Using family and friends to interpret is the most popular means of addressing language barriers (Gerrish, 2004). While they may be seen as patients’ chosen advocates, they are not appropriate. Interpretation is a complex skill (McGee and Johnson, 2008).
  • Using a professional interpreter service increases patient satisfaction, reduces error rates and potentially improves health outcomes (Divi et al, 2007).

Natasha Thom, PGCHE, BSc, RGN
, is lecturer, School of Nursing, Midwifery and Physiotherapy, University of Nottingham.

Thom, N.
(2008) Using telephone interpreters to communicate with patients. Nursing Times; 104: 46, 28–29.

Language barriers can affect patients’ psychological and physical health. To meet these challenges, nurses need to implement strategies to promote accurate communication. This article discusses how health visitors sought to improve communication by using a telephone interpreter service. Its implementation and evaluation were part of an action research study. Fourteen health visitors took part and were interviewed before and after implementation. This article focuses on recommendations from the research, offering guidance on using such a service.


This study aimed to address the issue of language barriers by introducing a telephone interpreter service for health visitors. The service would allow rapid access to an interpreter and cater for a range of languages.

East Lincolnshire has seen an influx of migrant workers. Since health visitors carry out complex assessments on all new patients they were concerned that they were not obtaining accurate information and were unable to fully support families whose first language is not English. By improving communication, the quality of support and information provision could be enhanced.

East Lincolnshire PCT has a contract with Language Line Services to provide healthcare workers with access to interpreters via a telephone. The PCT has access to 170 languages and the service is available 24/7. It takes approximately a minute to access an interpreter via an operator. A call-back or pre-booking service is also available.

Dual-handset telephone systems can be bought from interpreting service companies to enable patient and nurse to use the telephone at the same time. More commonly a single handset is passed between nurse and patient. Mobile phones or landlines can be used to access this service.

The training package

Training to use an interpreter service is essential (Karliner et al, 2004), as are protocols and guidelines to encourage
use. Managers need to ensure these are in place. Before this study, the trust had invested in the interpreter system but many staff were unaware of it and had not received training.

At the start of the study, health visitors were interviewed to find out what they thought training should include. They wanted practical instruction on how to use the system and to know if it would work with a mobile phone, as many patients did not have a landline. They also wanted guidance on when they should use the system and on structuring questions for
the interpreter.

The final training package comprised practical guidance from the service provider, information on criteria for use
and on how to structure questions when using interpreters.

Training was evaluated through qualitative interviews. The health visitors found it easy to understand, and valuable and necessary to encourage staff to use the service. However, they did feel that they would have benefited from opportunities to practise developing the necessary skills through role-play or from using the system under supervision. This will be addressed in recommendations for future training.


Carrying out assessment on patients needing an interpreter is often overlooked. All patients who do not speak English as a first language should be offered the interpreter service. From my own experience and the recommendations of Gonzalez (2005) the following are criteria for implementing the service:

  • Offer it to all patients whose first language is not English;
  • Do not assume actions such as head nodding and smiling indicate sufficient understanding;
  • A basic level of English is not sufficient to understand technical information, especially when patients may be feeling stressed;
  • Use the service for all stages of the communication process, including assessment, prescription, initiating treatments and evaluating care.

While these criteria may appear costly and unnecessary, it is a basic right for people to be able to access services.

Goldstein (2000) argued that questions should be asked to ascertain relevant information including:

  • Patients’ self-report of English proficiency;
  • Their understanding of written and spoken English;
  • Their preferred language at home and work.

Certain religions may preclude female patients from having a male interpreter; however, nurses can request a gender preference at the time of booking.

Practical instruction guidelines

Before using telephone interpreters, health visitors had received a language chart from the service provider, which explains how an interpreter would be called. This information was also provided in the patient’s first language. Some health visitors also chose to point to the phone and use non-verbal communication to inform patients they would be calling an interpreter.

Working with interpreters

The interpreter’s role is to repeat questions and responses of healthcare professionals and patients without giving additional material. If they believe a question should be modified to make it acceptable or a situation needs clarification, they should discuss it with the healthcare professional. Interpreters should repeat the questions and responses maintaining the same meaning, tone and register as the original message (Gonzalez, 2005). The following are guidelines for working with interpreters:

  • Write down the questions in advance to keep focused;
  • Introduce yourself to the interpreter and establish a rapport by exchanging names;
  • Brief the interpreter on what you want to accomplish with the call;
  • Speak slowly, using short sentences and try to state one message at a time;
  • Where possible, avoid slang and professional jargon. Explain medical terms to the interpreter rather than rely on the interpreter to make up their own;
  • Maintain eye contact with the patient while working with the interpreter;
  • Use diagrams, pictures and translated written materials where appropriate;
  • Practitioners can conduct a cultural assessment to determine cultural beliefs;
  • Remember to ask the patient if they have any issues they would like to discuss;
  • At the end of the interview, thank the interpreter and say ‘end of call’.


United Lincolnshire Hospitals NHS Trust and Lincolnshire teaching PCT are reviewing their interpreting services. A collaborative equality and diversity group has been set up to address differences in clinical practices. It is also considering rolling out training for all healthcare staff within the trusts and introducing policies for use by practices. Training will be considered as a way
of preparing the future workforce to care for people from diverse backgrounds.

Training packages should include both practical instruction on using the system and guidance on working with interpreters. Staff will need support following training. I suggest nominating key people to act as mentors, encouraging use of the system and supporting staff when they first work with a telephone interpreter.


The training programme’s aims were met, in that staff developed the necessary skills to use the system and work with interpreters. However, we do need to raise awareness of when to use the system. Qualitative findings have suggested staff at times thought patients’ level of English was ‘good enough’ and that they could manage by using improvisation or with a relative or friend acting as the interpreter. Recommendations for training and further action research should include an empowerment approach, whereby staff are encouraged to identify attitudes that may serve as barriers to change.

Implications for practice

  • The telephone interpreter service is a practical and quick way of accessing interpreters for a range of languages.
  • Using professional interpreters ensures information is accurately translated and gives patients opportunities to ask their own questions. This is essential when providing nursing care within a legal and ethical framework.
  • Limitations include being unable to see the interpreter. In communication, we rely on body language and establishing rapport through facial expressions.
  • Certain topics might not be appropriate for telephone interpreter services. Sensitive areas such as domestic violence and child protection will require face-to-face interpreters.
  • This service provides a way of addressing language barriers, and training and policies will help support staff to use it effectively.


  • 1 Comment

Readers' comments (1)

  • SignTranslate, a company owned by SignHealth, the healthcare charity for Deaf people have just made available a new web-based communication program for use in hospitals with patients whose first language is not English.

    For too long non-English speaking people have to call upon relatives (including their children) or friends to help them communicate. And they are doing this at a most stressful time, when either unwell, in pain or receiving bad news. SignTranslate offers communication support for Deaf and non-English speaking patients and hospital staff without delay.

    The program translates over 500 medical questions into British Sign Language (BSL) using short video clips and also into 12 foreign languages in written and spoken form.

    The hospital program has been developed with advice from some of the country’s leading hospitals. It follows on from the success of SignTranslate’s GP program which is currently available FREE in all surgeries in England.

    Dr Kevin Reynolds, St Mary’s surgery, Southampton uses the GP program daily and claims that the program is easy to use with the questions being well defined and lead the clinician straight to the patient’s problem and this helps him keep control of the consultation. Dr Reynolds says that 1/3 of his patients use English as a second language he has found the foreign language translations invaluable.

    Unsuitable or offensive? Report this comment

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