Caring for Patients With Non-English Language Preferences

One of the unique characteristics of the United States is its highly diverse population. A long and complex immigration history has woven together many ethnicities, races and cultures to form a rich tapestry of traditions. Immigrating families have positively and significantly impacted American society in many fields, including medicine, the arts, economics and politics. With a growing population of people who speak a language other than English at home, nurses and other healthcare professionals must work toward providing better language-inclusive medical care.

Challenges to Access

When patients with non-English language preference (NELP) seek medical care, they meet barriers to equitable and appropriate care that patients who speak English do not experience. NELP patients are often denied precise, transparent and reliable language access services. Language-incongruent encounters, typically described as encounters between patients and healthcare providers who do not speak the same language, increase the risk of misdiagnosis, adverse medication events, procedural complications and possibly death. Language access bridges medical-related knowledge gaps and improves patient outcomes; furthermore, it is a regulatory requirement set forth by The Joint Commission, an organization that sets quality standards for effective care. Providers are ethically and legally responsible for delivering equitable, inclusive care to diverse patient groups. Nurses and other clinical providers must be well-informed regarding the lifesaving nature of language access in healthcare despite any personal bias against or perceived inconvenience of using interpreter services.

Barriers Lead to Inequity

Various literature illuminates barriers to language access from the provider's perspective, including lack of readily available in-person interpreters, long wait times for telephone interpreters, and poor connectivity during video interpreting sessions. Although these obstacles are real, the needs of patients take priority, and they deserve professional interpreter service. In a 2021 California study, Spanish-speaking parents of pediatric patients reported receiving inaccurate information about medications and other vital matters from nonfluent providers attempting to speak Spanish instead of using a facility-approved and validated interpreter. Inaccurate information can lead to inequitable patient outcomes and inadvertent nonadherence to treatment plans. Patients have the right to understand their medical conditions, treatment options, and the potential risks and benefits associated with interventions. Further, miscommunication can cause providers to collect inaccurate medical histories and give instructions that are then misunderstood. Patients being treated in critical care areas of the hospital are at increased risk for infection, respiratory complications and adverse medication reactions. These risks urge high vigilance regarding language accessibility.

It’s Required.

Language access is not only an imperative component of equitable healthcare, it’s required. Regulatory organizations such as The Joint Commission emphasize that healthcare workers must provide communication methods that the patient fully understands. The Department of Justice seeks to enforce federal regulations, such as the Americans with Disabilities Act, that require covered entities to provide effective communication to all, including those who speak different languages.

How You Can Help

Nurses are uniquely positioned to influence healthcare delivery at the bedside. We can help ensure that patients with NELP experience equitable healthcare in the following ways:

• Speak up for your patient if you see a provider attempting to communicate with them without a facility-approved interpreter.
• Be intentional when investigating a patient’s language preference, and document it appropriately in the EHR.
• When using a language access resource, speak slowly and clearly.
• Always speak directly to the patient when working with an interpreter service.
• Debrief your patient using the language access resource to determine any questions or concerns they may have.
• Ensure that patient education materials are printed in the patient’s preferred language. If you are unsure how, speak with your charge nurse or supervisor.

Learn more about best practices when working with medical interpreters.

When caring for patients with NELP or patients who may have limited English proficiency:

• Minimize personal unconscious bias based on language preferences in patient assessments.
• Avoid referring to the patient in the third person. Instead, speak directly to them.
• Use simple terms. Try not to use complicated medical terminology.
• Engage fully in the patient’s care despite any language differences.
• Steer clear of making cultural assumptions about your patient.
• Avoid asking anyone who is not a certified language interpreter (e.g., family, friends, colleagues) to interpret.

Read more information about negative attitudes on language equity.

Looking Forward

Language access is an imperative component of healthcare delivery, ensuring not only regulatory compliance, but also equitable, inclusive care. Equitable healthcare means that we, as healthcare professionals, provide patients and families, regardless of their backgrounds, with the tools and resources they need to have the best possible outcomes. Understanding what resources are available to accommodate patients with language differences with empathy and compassion improves the patient experience and, ultimately, their quality of care and life.

Nurses can and should advocate for language access and awareness of language barriers for patients in their departments, hospitals and other professional settings. Nurses must advocate for patients to ensure they understand their care. We must consider the key impact language access can have across diverse communities. It is up to us to resist what is often the status quo and move toward a healthier society.

How are nurses positioned to improve language access for patients and clinicians in your facility?