Cultural Effectiveness: Working with LEP Patients

1
Cultural Effectiveness Working with LEP
Patients Interpreters

• Jason Roberson, MA, BA
• MUSC Interpreter Services
• MUSC College of Nursing,
• Hispanic Health Initiative

2
Our Changing Community
3
Objectives

• Define ethnicity, race, and language status
  according to national guidelines
• Identify social and cultural variations within
  the local Hispanic community
• Identify and eliminate stereotypes in delivering
  health care
• Avoid use of non-qualified interpreters and
  computer-generated translations
• Discuss how to work effectively with
  MUSC-approved interpreters

4
National CLAS Standards (March 2001)

• The CLAS Challenge
• Being Culturally and Linguistically
• Competent in Health Care
• C Culturally
• L Linguistically
• A Appropriate
• S Services in Health Care

5
Cultural and Linguistic Issues

• NEGATIVE EFFECTS OF NO LANGUAGE SERVICES
• 1) Less access to health care and
  preventive services
• 2) Greater Emergency Room use
• 3) Lack of comprehension of diagnoses by
• the patient
• MISUNDERSTANDINGS OF CULTURAL PRACTICES BELIEFS
  CAN RESULT IN ERRORS NEGATIVE HEALTH OUTCOMES

6
CULTURAL EFFECTIVENESS

• Cultural competency is the genuine sensitivity
  and respect given to all people regardless of
  their ethnicity, race, language, culture, sexual
  orientation, or religion.
• Ability to anticipate and recognize
  misunderstandings that arise from differing
  cultural assumptions and to respond to such
  issues appropriately
• Continued self-assessment of culture paying
  attention to the ever-changing dynamics of
  culture and sources of bias and disparities

7
Patient-Provider Communication

• How do we link communication to outcomes?
• COMMUNICATION
• PATIENT SATISFACTION
• ADHERENCE
• HEALTH OUTCOMES
• (Betancourt, 1997)

8
Ethnicity, Race, and Language Status

• Standard for U.S. Classifications for Data
  Collection
• Only 2 ethnic categories Hispanic and
  Non-Hispanic
• Race (1) American Indian/ Alaskan Native (2)
  Asian (3) Black/ African American (4) Native
  Hawaiian/ Other Pacific Islander (5) White (6)
  Multiracial

9
Hispanic or Latino?

• The terms Latino and Hispanic refer to people
  whose ancestry originates in Mexico, Central or
  South America, and other Spanish-speaking
  countries (Caribbean, Spain, etc.).
• Hispanics can be of any race White, Black,
  Indian, Asian
• The term Spanish ONLY refers to the
  language or to people from Spain!!

10
Language Status

• The US Census uses a standard dialogue for
  identifying language status
• (1) Do you speak a language other than English at
  home? (If yes,.2)
• (2) How well do you speak English?... very
  well?...well?...not well?...not at all?
• All who answer below very well need a trained,
  certified interpreter.

11
Hispanics in South Carolina

• Estimated 400,000 Hispanics living in South
  Carolina
• ( 10 of the population)
• Approximately 75,000 Hispanics in the Charleston
  area

12
Spanish Speaking Population at MUSC Hospital

• Approx. 25,000 Spanish-speaking patients in 2006
• 85 from Mexico
• Of these, some are Amerindian and speak Mixteco
  or other indigenous languages.
• 15 from other countries (Central, South America,
  the Caribbean)

13
Global Health Belief Systems
Social system Differing resources
practices within home country

• Scientific/Biomedical
• Life/health is controlled by
• physical and biological
• processes that can be studied
• and manipulated

Magic/Religious The world (health) is an arena
in which supernatural forces dominate fate
(well-being)
Holistic health The forces in a natural
balance or harmony (to protect health)
Leinenger, 1978
14
Beliefs of Some Hispanics

• Good health may be considered a matter of luck
  sick persons as victims of fate
• Illness may be considered the result of negative
  forces or punishment.
• Involve the family in decision-making and care
  la familia in most Hispanic cultures also
  includes grandparents, cousins, aunts uncles,
  close family friends, and god-parents.

15
Healers or Curanderos

• Some Hispanics consult folk healers or
  curanderos to treat some traditional and
  unnatural diseases.
• This is a system of care derived from a mixture
  of Aztec, Spanish, spiritualistic, homeopathic,
  and modern medicine.
• Curanderismo plays a major role in health
  beliefs and practices of some Hispanics
  providers should beware of dismissing it as
  irrelevant.

16
Folk Healers (Curanderos)
17
Keys to a Good Professional Relationship with
Hispanic Patients

• Make eye contact with the patient, NOT with the
  interpreter however, some patients (especially
  rural) may consider it disrespectful to look the
  healthcare provider, an authority figure, in the
  eye.
• Also, nodding may signify respect rather than
  comprehension.

18
Keys to a Good Professional Relationship (cont.)

• Accept a different sense of time some Hispanics
  have a global or indefinite sense of time
  (rather than an exact sense of day and hour)

19
Order of Names

• Hispanics have a double last name fathers last
  name plus mothers maiden name
• BOTH last names must be included in the patients
  record and on the stamp plate.
• Jesus Martinez Vega (father)
• Maria Lopez Gomez (mother)
• Babys name Flor Martinez Lopez

20
When is an interpreter needed?Mandated by
federal law
21
MUSC Policy A-30 Foreign Language Interpreters

• ONLY employees, students and medical staff who
  have completed the MUSC language competency
  screening are approved to provide interpreter
  services.
• All use of interpreters MUST be documented in the
  patients medical record.

22
Spanish Interpreters

• ALL Spanish Interpreters are to be contacted on
  Simon Pager 17080.

23
Accessing The Language Line

• Access
• Use a speaker phone
• Call toll-free number for connection to Language
  Line
• Have client ID and unit ID ready
• Specify language needed

24
Internet Translation Websites

• Babel Fish at altavista.com is a website for
  translations.
• DO NOT use any websites to translate ANY medical
  documents, e.g., discharge instructions,
  medications, etc.
• Please call an interpreter to translate the
  written discharge instructions and any other
  written documents.

25
Working with an interpreter

• Speak directly to the patient, not to the
  interpreter.
• DO NOT shout the patient is NOT hard of
  hearing!!
• Make a complete thought, then pause to allow time
  for the interpreter to speak.
• Avoid side conversations. Everything said by
  all persons will be interpreted.
• Respect the interpreters judgment about what is
  culturally appropriate or inappropriate.

26
(No Transcript)
27
Links

• MUSC Interpreter Services
• http//www.musc.edu/interpreter
• College of Nursing Office of Hispanic Health
  Initiatives
• http//www.musc.edu/nursing/departments/facultypra
  ctice/hispanichealth.htm