Melissa Leung, RN, BSN, still remembers the day she encountered an elderly patient who was resisting her medication. The woman, a native of China, had balked when given her pills and a glass of cold water, and it was noted on her chart that she was “medically noncompliant.” Leung, who is fluent in Mandarin, gently spoke to the woman in her native language to determine why she was reluctant to take her medicine.
“Like many Chinese immigrants, she had been taught to drink hot water with meals,” says Leung, who works in the cardiac catheterization lab at Einstein Medical Center in Philadelphia. “In China, some people are taught to boil water before drinking it to remove germs, and others believe that drinking cold water is bad for the stomach.”
Leung noted on her patient’s chart that she preferred to take her medications with hot water. As a bilingual nurse, Leung was able not only to communicate with her patient in her native language, but also to provide culturally specific care by being sensitive and responsive to her patient’s cultural beliefs and traditions.
As immigration increases, the demand for bilingual and multilingual nurses continues to grow. According to the US Census, between 1980 and 2010, the number of people speaking a language other than English climbed 158%. In addition to English and Spanish, the 2011 Census showed there were six languages spoken at home by at least 1 million people: Chinese (2.9 million); Tagalog (1.6 million); Vietnamese (1.4 million); French (1.3 million); German (1.1 million); and Korean (1.1 million).
Hospitals across the country are seeing more patients with different language needs, cultural sensitivities, and religions. While interpreters are employed by many hospitals, bilingual and multilingual nurses provide another way of bridging the cultural gap.
Because factors such as language, unfamiliar customs, and misconceptions about health care can keep foreign residents from seeking medical care, bilingual nurses can help to ease a patient’s fears and even reduce barriers to clinical preventative care.
There are also professional benefits to learning another language: Some bilingual employees can earn more than their single-language colleagues.
Providing Culturally Sensitive Care
Jimmy Andres Reyes, RN, MSN, DNP, AGNP, of Cedar Rapids, Iowa, an instructor in advanced practice nursing with Kaplan University School of Nursing and the dean of nursing at Kirkwood Community College, says he was inspired to become a nurse after watching the work of his grandmother, who was a community health nurse in Santiago, Chile.
Five years ago, Reyes received a predoctoral scholarship award to study diabetes self-management in Latino older adults. Fluent in both Spanish and English, Reyes says that being bilingual allowed him to hold focus groups in Spanish that helped staff determine the stressors and barriers that prevented the patients from keeping their diabetes under control.
“We learned many of these older adults would simply nod and agree with their health care providers, even if they didn’t understand the instructions they were being given,” explains Reyes. “For them, it was simply easier to be cordial, but as a result, they weren’t learning the tools and information needed to manage their diabetes.”
Reyes and his colleagues were able to take the information gleaned in talking with Latino immigrants and to pilot several programs. The information they gathered was not only translated into Spanish, but also designed to be culturally sensitive and relevant.
Reyes also believes that nurses can learn about different cultures through medical missions and studying abroad. He recently accompanied a group of nursing students to Costa Rica and plans to take another group to Ecuador later this year.
“Traveling to Costa Rica changed the world view of all of our students, and even those who didn’t speak Spanish returned to the US with a better understanding of the health care barriers and challenges that many immigrants face,” says Reyes.
As a bilingual nurse educator, Reyes believes his job in providing culturally sensitive care isn’t to change the beliefs of his patients, but rather to provide them with all of the facts they need to manage their condition.
“We have recently started working on a cancer prevention project with Latino and Burmese immigrants,” he explains. “Most of the people we spoke with weren’t aware of the new HPV vaccine that can be given to teens to protect them against the virus that causes cervical cancer and some other forms of cancer. We’re not mandating they vaccinate their kids, but rather providing them with the information to make an informed decision.”
Reyes is a member of several professional organizations, including the National League for Nursing, the American Academy of Nurse Practitioners, the Gamma Chapter of Sigma Theta Tau International, and the National Association of Hispanic Nurses, to name a few. He encourages nurses to become involved in organizations and associations that can give them a better understanding of the diverse patients they serve, as well as to consider learning a second language to better communicate with their patient population.
“We have nurses who are not Latino or Burmese who have picked up on the languages, and the patients just beam when they hear the nurse interacting with them in their native language,” says Reyes. “It not only shows they care; it’s also the first step in building trust.”
Addressing Patients’ Unique Cultural Beliefs and Concerns
Shency Varughese, MSN, RN, an immigrant nurse from India, works in the Inpatient Surgical Unit at the Cancer Treatment Centers of America, Midwestern Regional Medical Center, in Zion, Illinois. She has found that speaking a familiar language with patients helps earn their trust and respect.
“According to the nurse theorist Dr. Madeleine Leininger, nursing care must be customized to fit with the patient’s own cultural values, beliefs, traditions, practices, and lifestyle,” says Varughese. “I was able to put this into practice recently while caring for a patient who had a special request for a specific Indian tea that contained natural immunizers such as ginger and cardamom.”
Varughese notes the tea needed to be prepared in a special way and was very important to the patient. Although she acknowledges the act of preparing tea wasn’t earth shattering and could have been performed even with a language barrier, the act allowed her the chance to connect with the patient and provide culturally sensitive care.
“Our shared Hindi language allowed me to truly listen and understand his request and respect his needs,” explains Varughese. “I was able to understand how the preparation and drinking of the tea was an important part of this patient’s life.”
Varughese says being multilingual has also helped in her nursing career: “My peers know that they can count on me if a patient has a need or request. We have a translation service that our patients use to help communicate anything related to their medical needs; however, I am more than happy to step in and help with all non-medical patient requests.”
Nenette Ebalo, RN, has found that her ability to speak Tagalog provides an extra layer of comfort to the Filipino patients she sees in her job as service unit manager for the Head and Neck Surgery department at Kaiser Permanente’s Oakland Medical Center. In addition, Ebalo notes that in-person communication allows her to take cues from a patient’s body language that may be lost over the phone. It also allows for easier communication with elderly patients who may be hard of hearing.
“As a bilingual nurse, I don’t replace our medical center’s interpreting staff, but I am able to help patients who might prefer an in-person interaction with a nurse,” says Ebalo. “This can be helpful, especially for those who have complex medical conditions and may not understand the medical terminology.”
Ebalo remembers a recent case when she encountered an older couple waiting to see a speech pathologist. The wife told Ebalo she was concerned because her husband was suddenly having speech problems, and after speaking with Ebalo in Tagalog, they asked if she could accompany them to their appointment. After a consultation with the speech pathologist, Ebalo was able to explain to the wife that her husband’s condition was a side effect of the radiation he had been given.
“They were very appreciative of my help and returned later that week with Ensaymada, a traditional Filipino sweet bread to thank me,” says Ebalo.
In addition to her work at the hospital, Ebalo has worked on several medical missions and has found that her language skills prove beneficial when caring for patients abroad.
“I recently accompanied some of our physicians on a medical mission to the Philippines where I worked as a bedside nurse in the recovery room,” says Ebalo. “The doctors were repairing cleft lips and palates, and they relied on me to help them to understand both the language and the culture.”
Breaking Communication Barriers
Michelle Moore, BSN, RN, HN-BC, inpatient care manager at the Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, Illinois, first learned American Sign Language (ASL) to communicate with her daughter who was born deaf. Since then, Moore has found that knowing ASL has also helped her in her job.
“Deaf individuals are unique in that they cannot use a language line to talk with the hearing community,” says Moore. “Deaf people use electronic devices—mostly smartphones now—to communicate with the hearing world. Years ago, I was part of the committee that helped bring devices [such as TTY, the flashing door bell, and the bed alarm] to the hospital.”
In addition, Moore says that although she is not a certified ASL interpreter, she has had general conversations with deaf patients and their caregivers, which allows them to feel comfortable with a culture they are familiar with.
“Having the ability to speak with people in their common language is such a gift,” says Moore. “Years ago, we had a new patient who was deaf, and her interpreter was running late. I remember sitting in the lobby waiting with the patient and just carrying on a normal conversation with her. The patient felt comfortable that someone in a strange environment was available and familiar with her language.”
Moore notes that every time the patient would return to the hospital, she would ask to see her. “She often shared with me how grateful she was that I was with her on her very first visit and how it allowed her fear to decrease and put her mind at ease,” says Moore.
Becoming a Certified Medical Interpreter
While many bilingual nurses help patients in an unofficial capacity, some nurses are taking their translating skills to the next level and becoming certified medical interpreters. Having credentials provides documentation that nurses have the necessary skills required to translate or interpret professionally.
Yelena Tuerk, RN, BSN, MS, manager, patient care services, for the Rose D. and Joseph W. Lazinsky Neuroscience Center at Sinai Hospital in Baltimore, was born in Russia and is fluent in both Russian and English. After seeing a large influx of Russian patients at her medical center, Tuerk decided to become a certified medical interpreter in order to assist patients in a more official capacity.
Tuerk enrolled in the three-day Qualified Bilingual Staff program offered through the Maryland Healthcare Education Institute, which covered many areas including legal requirements, cultural competency, and privacy laws.
“The course taught the specific way to translate for nurses to ensure that we provide high quality care,” explains Tuerk. “The training goes beyond just speaking a second language; it also covers how to best convey medical terminology, and how to serve as the voice of the patient to ensure that all of their questions are addressed.”