Professional providers of language in medicine or medical interpreters are often portrayed as invisible language facilitators (Angelelli 7). This means that their role is to convey the meaning into the other language between parties in the interaction which is accomplished through a conduit role or message converter role. The incremental intervention model of interpreting lets interpreters use a variety of roles including cultural broker and advocate role. Advocacy is a role that an interpreter takes that moves from interpreting the communication between speakers to acting on behalf of one of the speakers based on the interpreter’s understanding of what the speaker’s intended outcome is (NCIHC). It is challenging for medical interpreters to judge when to switch from their role as message converters to become patient advocates, and speak out in their own voice on behalf of a patient maintaining, at all times, high ethical and professional standards. When interpreters step in the role of patient advocate they become visible in the interaction going beyond the conduit role and becoming co-participants in the triad. What is the ethical role of the medical interpreter as an advocate for the Latino patient?; when is it appropriate to use advocacy?; how to make the decision?; what are the consequences of inappropriate use of advocacy role?; what are the boundaries?
To answer all these questions is necessary to define advocacy. The meaning of advocacy in medical interpretation is “an action taken on behalf of an individual that goes beyond facilitating communication, with the intention of supporting good health outcomes” (NCIHC 3). According to CHIA standards for healthcare interpreters, “interpreters enter into the patient advocate...
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...terpreters Association IMIA http://www.imiaweb.org/uploads/pages/376_2.pdf
Hsieh, Eleine. “Health literacy and patient empowerment: The role of medical interpreters in bilingual health care”. Reducing health disparities: Communication intervention. M. Dutta & G. Kreps, 2013 (pp. 35-58). New York: Peter Lang. [invited contribution] Web. 1 November 2013, from http://faculty-staff.ou.edu/H/Elaine.K.Hsieh- 1/download/Hsieh2013-Dutta%20Chapter.pdf
International Medical Interpreters Association & Education Development Center, Inc. Medical Interpreting Standards of Parctice http://www.imiaweb.org/uploads/pages/102.pdf
The National Council on Interpreting in Health Care (NCHIC). A National Code of Ethics for Interpreters in Health Care. July 2004. Web. 15 September 2013. http://www.ncihc.org/assets/documents/publications/NCIHC%20National%20Code %20of%20Ethics.pdf
There is a need for a diverse workforce and appropriate interpreters for providing the best patient care. It is often seen that bilingual interpreters are hired by healthcare organizations without much skills. This can lead to medical errors putting patient safety at risk. Therefore, hiring appropriate interpreters with assessment of their skills is critical in healthcare organization. Interpreters can help healthcare organizations by:
...ulture is changing, Hmong are not all the same, importance of family, privacy issues, mental health issues, and small talk is important (Barrett et al., 1998, 181-182) . Overall, Barrett and others concluded that in order to improve interaction between patient and doctor all they have to do is follow these easy steps. First, is to be kind and have a positive attitude towards the patient and interpreter. Second, learn about each other’s cultures prior to meeting, to better understand each other. Third, better explain diagnosis and treatment options to patients. Fourth, improve translation providers need to get better interpreters who could concisely explain the consultation. Fifth, involve the family to make more thorough decisions. Sixth, respect patient’s decisions and there are still other alternatives to improve interaction (Barrett et al., 1998, 182-183).
Gedge, E., & Waluchow, W. (2012). Readings in health care ethics (2nd ed.). Toronto, Ontario: Broadview Press.
Winland-Brown, J. L. (2015). The New "Code of Ethics for Nursing With Interpretive Statements". Practical Clinical Applications Part I. MEDSURG Nursing 24(4),
“Patient advocacy is a process that involves a series of actions, behaviors and/or practices for preserving and safeguarding the rights, values, wellbeing and best interests of patients in the healthcare system” (Vaarito et al 2006, Bu and Jezewski 2007, Zomorodi and Foley 2009). Vaartio & Leino-Kilpi describe patient advocacy into two sectors; proactive advocacy and reactive advocacy (2004). Proactive advocacy includes actions aimed at aiding the patients in informed decision making and the protection of patient rights; reactive advocacy is focused on addressing safety concerns (Vaartio & Leino-Kilpi, 2004). Further concept analyses from Baldwin 2003 & Bu and Jezewski 2007, include four main sectors of patient advocacy: Protecting and empowering patient autonomy, protecting and representing the best interests of vulnerable patients, ensuring educated decision making while acting as a mediator for the patient to healthcare services, and lastly acting upon social justice to help create equitable access to adequate healthcare (CPD, 2015). Using Tanners model of clinical judgment; the process of patient advocacy begins with assessing for the need to advocate. The assessment should include the patient, environment, situation, resources and possible risks (Ellis
Effective communication prevents medical errors, improve patient- therapist relationship, as well as prevents disappointments and friction. It is essential to find out the level of health literacy of an individual, as well as the proficiency in English. According to Divi, Koss, Schmaltz & Loeb (2007), there is a risk of patient 's safety due to the language barrier. Based on the study of Divi et al. (2007), among 832 English speaking patients and 251 patients with limited English fluency, 49% of the patients of their study have limited English fluency that associated with physical harm with a rate of 29.5% patients that are fluent in English are physically injured. Partially injured and death occurs with patients with constrained English proficiency (52.4%), as compared to patients with English fluency (35.9%) (Divi et al., 2007). Divi et al. (2007) suggested providing access to qualified language interpreters for patients with limited English proficiency to prevent more harm. Effective communicating is not only important to patients with limited, or inadequate English proficiency but also to individuals with impaired vision, hearing, and people that unable to speak.It is also important about the patient 's privacy. Another knowledge from the book mentioned above is effective communication regardless of individuals culture.
American Nurses Association. (2015, January 2015). Code of Ethics for Nurses With Interpretive Statements, 1-76. Retrieved from
When educating our patients it is important to make sure that all education is documented. Documentation of all patient education is important because this will provide legal record for the nurse. It is also important in documentation that this will validate that all standards of care are being met. The Joint Commission will review charts and audit for the proper documentation such as patient education. The result of proper charting will provide reimbursement for the hospital, along with creating a safe environment for the patients. When it comes to the Joint Commission it also brings importance to tactics for patients with low literacy. As part of making care patient-centered, healthy literacy comes into play. When documenting this is an area that nurses have accountability for in order to create a safe learning environment. There is a high rate of medical errors and adverse events related to communication breakdowns, now widely recognized, are also widely acknowledged to be untenable (Edwards). The Joint Commission allows for guidelines to establish patient-centered care in order to create the best outcomes for
Understanding that all patients needed to be treated justly and given the opportunity to make decisions in their care is important. Not causing harm and preventing them from harm is also the duty of health care workers. These ethical principles are essential to keep in mind with interdisciplinary communication. Ineffective communication has been associated with medical errors, patient harm, and increase length of stay. Failure to communicate properly has been associated with 79% of sentinel events (Dingley, Daugherty, Derieg & Persing, 2008). Good communication has been shown to improve patient satisfaction, increase in patient safety, as well as a decrease in health care costs (Paget et al.,
Merriam-Webster’s online dictionary defines an advocate as “one that pleads the cause of another,” or “one that supports or promotes the interest of another” (2014). Bu and Jezewski expanded on this by developing a mid-range theory of patient advocacy to implement into nursing (2007). They describe a patient as being “vulnerable and powerless” when stricken with illness and without knowledge of health care systems (Bu & Jezewski, 2007). The goal of the theory was to give the patient a voice in circumstances where they weren’t able to speak up for themselves and to maintain the patient’s integrity (Bu & Jezewski, 2007). They found three core attributes to what would make up
In Nursing, there will always be instances where the patient's nurse needs to advocate for their patient. There are numerous reasons why a nurse would advocate for their patient ranging from getting the doctor to change the patient’s orders, helping the patient’s treatment team understand what it is the patient is requiring for the day, to expressing the patient’s last wishes before death. In every situation, the nurse should do what is in the patient’s best interest. Tomajan (2012), “Advocacy skills are the ability to successfully support a cause or interest on one’s own behalf or that of another. Advocacy requires a set of skills that include problem solving, communication, influence, and collaboration”(p. 2). With those skills, the nursing staff will be able to work together to advocate for their patients. Along with those skills, nurses need to keep in mind the three core attributes that are: safeguarding patients’ autonomy; acting on behalf of patients; and championing social justice in the provision of health care. (Bu & Jezewski, 2006)
The most common areas of clinical practice where truth-telling and deception become an ethical dilemma are critical care, cancer and palliative care, mental health and general nursing practice (Tuckett, 2004). Other areas where it can raise potential ethical concerns are in placebo therapy, disclosure of human immunodeficiency virus and informed consent (Tuckett, 2004). Truth-telling is also an act of exchanging moral agents (patients, relatives, nurses) with their sets of values and norms, which in turn are derived from culture, personal and religious beliefs, and traditions (Dossa, 2010). For this reason, the issue of truth-telling is not only approached differently in the various clinical settings but also in different countries, cultures and religions (Kazdaglis et al., 2010). For example, in the United States of America (USA), England, Canada and Finland, the majority of patients are told of their diagnosis (Kazdaglis et al., 2010). Conversely, in Japan, family members play a major role in the decision of ...
The four fundamental nursing responsibilities of promoting health, preventing illness, optimizing health and alleviating the ill are represented in the code of ethics. (Arnold & Boggs, 2016) One can say that the code of ethics are rules that a nurse needs to follow in order to effectively communicate and protect the patients. The American Nurse Association provided the code of ethics to guide nurses to ensure that patient’s care, safety, rights and health are well cared for and well managed. Models like Utilitarian, deontological, and the human rights-based all contribute in answering dilemmas that can arise with a patient. Thus, explaining what some of the code of ethics are, and how the code of ethics influence our responsibilities as a nurse will impact the overall care of the
This causes problems about the diagnosis as well as how nurses may tell patients about issues with their care. A way a nurse can overcome this is by having an interpreter when they know that a patient doesn’t know English, but this is not always the case for most nurses as there are not a lot of interpreters around. In health practice language isn’t always to do with culture but it can be the way a nurse or doctor speaks to the patients so they may adopt certain types of jargon and the patients may feel intimidated. Madeleine Leininger, who is the founder of transcultural nursing, says that providing competent care across all cultures and to be customized to fit patient’s different beliefs and traditions and different languages that a patient may speak. Divi et al (2007) claims that language barriers increase the risk of patient care and safety as they will find it difficult to understand what is going on with their care, so it is important for patients to have access to language services such as an
Advocacy is a valuable element to the nursing profession. While some may think that advocacy is not a significant aspect of a nurse’s job, it should be made aware that the nurse is most often the primary point of contact between the client and the physician. With this being said, it is consequential for the nurse to develop a high-level of advocacy for the clients under his or her care.