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 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
Divi, C. et al (2007) Language proficiency and adverse events in US hospitals: a pilot study. International Journal for Quality in Health Care; 19: 2, 60–67.
Gerrish, K. et al (2004) Bridging the language barrier: the use of interpreters in primary care nursing. Health and Social Care in the Community; 12: 5, 407–413.
Goldstein, B. (2000) Cultural and Linguistic Diversity Resource Guide for Speech-language Pathologists. San Diego, CA: Singular.
Gonzalez, J. (2005) How to use an interpreter effectively. Occupational Therapy Now; 7: 2, 7–9.
Karliner, L. et al (2004) The language divide: the importance of training in the use of interpreters in ambulatory practice. Journal of General Internal Medicine; 19: 2, 175–183.
McGee, P., Johnson, M. (2008) ‘I never needed to know the word for diabetes till I took this job.’ Diversity in Health and Social Care; 5: 1–3.