As we seek to identify the issues faced by nurses in caring for limited English proficient (LEP) patients, we have interacted with several healthcare providers who shared their experiences and also possessed literature regarding the issue.

When it comes to ensuring that patients comprehend their treatment plans, feel safe and cared for, and most importantly, comply, the nurse’s role is critical particularly in advocating for the patient’s education.

Challenges Faced by Nurses with LEP Patients

During the course of our discussions, stress was one of the frequent victims regarding language barriers and nurses’ care. Discussed below are some of the major challenges they tend to face in almost all of the disparities that we mentioned earlier:

Emotional Distress: Effective communication between LEP patients and nurses is a necessity; however many nurses have alluded that this is not always possible. Their communication frustrations caused many of these nurses to feel aggravated emotions of pervading despair, anger or simply feeling depleted in those efforts they made to communicate with their LEP patients.

Missed Connections: Rapport building with patients is a fundamental aspect of nursing care. When patients and their caregivers are on opposite ends of a language spectrum, nurses often have a hard time developing rapport where it is most needed. This may cause relationships to deteriorate as well as cause adverse effects in the quality of care provided.

Restricted Engagement of Medical Interpreters: Although medical interpreters are effective tools in many crucial communication events, it is common to find nurses in day-to-day clinical encounters not working with interpreters.

Role of the Medical Interpreter

Medical interpreters help in eliminating the communication barrier that exists between the nurses and the LEP patients. 

This all depends on the setting. Maybe in outpatient, though in the ED and inpatient, nurses spend far more time at patient bedsides. In the ED, one physician may see 20-30 patients in 8 hours. A nurse will have seen maybe 5-10 and do a long intake

Time Constraints: Poor nurse to patient ratio and the pain and discomfort that patients feel sometimes make nurses to use ad hoc interpreters or not use an interpreter at all. For instance, one of the nurses explained, “Sometimes, if there’s no time, you can’t wait for an interpreter. If you have five patients sitting in five rooms(…), timing out the process of getting an interpreter is not always an option.”

Communication Errors: It is sad to state that this is not the case. Interpreters who are not formally trained May hinder rather than ease the communication between patients and healthcare providers. These mistakes are particularly problematic when they entail significant information.

Similarities and Discrepancies in Nurse and Doctor Communication.

It is vitally important to recognize that the distinct roles of nurses and doctors in communication are geared toward one goal; which is focused on the care of the clients.

Nurses Communication: Nurses take care of the basic caring, reassuring, and observation of the patients. This involves describing procedures, medications, and care instructions to patients so that they comprehend. These are usually very short, for example telling someone who is being discharged that they need to follow this note to avoid being read to in a single sentence. For these short interactions, it is customary not to use live interpretation services because the exchanges are too short to use verbal interpretation services formally.

Doctors Communication: In comparison, what doctors do is more focused on the diagnosis, devising treatment strategies, and planning areas around patient care that influence patient outcomes. Such involvement is mainly of formal nature and is likely to take place during planned meetings or follow up visits. This can pose further challenges to LEP patients who may require clarifying medical treatment decisions made during these appointment meetings.

Relating this to LEP Patients

Since nurses have direct contact with patients at all times, they are considered the first line of contact with and for LEP patients and their subsequent care. In as much as the information needs to be conveyed, the personnel are always in quick exchanges and it is important to ensure adequate time for comfort and understanding is given.

In this scenario, although doctors have considerable roles in valuing patients through giving information such as diagnosis and treatment, physical contact between doctors on one side and the patients on the other may be less frequent and more formal. This is a situation that creates a communication breakdown that needs more ears than mouths to enhance understanding from LEP patients that are also in need of many explanations and encouragement.

Technological Advancements in Communication

New novel technologies such as AI medical interpreters allow nursing staff to use extremely low contact time with the LEP patients while still providing care services. For instance, while discharging a patient a nurse can be asked to summarize risk factors in one or two sentences and there is no need to connect with an interpreter to get that executed with the use of AI. This is very useful especially during micro encounters which can be governed by time.

Conclusion

With such challenges still existing, one of the targeted population by appropriate medical care is the people with limited English proficiency. It is nurses who are better placed to cope with this problem and its constraints since it involves physical and emotional challenges. To address these demands of the Limited English Proficiency, healthcare institutions must turn to use qualified medical translators and integrate AI innovations to improve patient-nurse interaction. It is apparent that caregivers, put differently, nurses and doctors play different roles when it comes to sharing information with patients and therefore coordination in patient management can be enhanced

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Resources

1. Nurses' Perceptions of Technology Used in Language Interpretation for Patients with Limited English Proficiency - here
2. Prevalent practices amongst healthcare professionals in paediatric settings in using medical interpreters for families with limited national language proficiency: A narrative scoping review  here
3. Patterns and Predictors of Professional Interpreter Use in the Pediatric Emergency Department -here‍
4. Pharmacists, nurses, and physicians’ perspectives and use of formal and informal interpreters during medication management in the inpatient setting - here

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