Without qualified interpretation Spanish-speaking patients experienced miscommunication confusion and anger during hospital stays

Description #

Across the interviews, nurses reported that Spanish-speaking patients who were not afforded interpretation services — or who received it from someone other than a qualified interpreter — underwent major miscommunication, and that this miscommunication led to patient frustration, confusion, apprehension, and anger and to an unpleasant hospital stay (L, 2023). Nurses described patients arriving already upset because no one had explained their care to them. As a qualitative study, this reports nurse-perceived consequences of language discordance rather than quantified outcomes.

"According to the nurses, patients that do not have interpretation services or are not afforded those services during their hospital stay, undergo major miscommunication. Miscommunication in the nurse participants' experience also leads to patient frustration and as a result an unpleasant hospital stay." (L, 2023)

"Participants discussed how patients experienced confusion, apprehension and anger associated with not being able to communicate their needs to the healthcare system." (L, 2023)

"A lot of them is a language thing you can already tell cuz they'll start telling you they didn't explain this to me, they didn't explain this and I don't know what that is… the patient is already upset… (DRN‐3)" (L, 2023)

Methods Context #

What? #ⓘ

The observable: nurse-reported patient experiences (miscommunication, confusion, apprehension, anger, dissatisfaction) attributed to the absence of qualified interpretation during the inpatient stay, captured under the "lost in translation" sub-theme.

"Patients that are Spanish‐speakers and are unable to speak English experience communication barriers in the hospital setting." (L, 2023)

How? #ⓘ

Qualitative descriptive case study; significant statements drawn from in-depth semi-structured interviews were coded thematically (Boyatzis, 1998) and presented through narrative analysis (Riessman, 1993). The "patient experience" theme and its "lost in translation" sub-theme emerged from this coding (Table 2).

"Significant statements of nurse participants' extensive interviews were drawn out during the raw data analysis and were then coded thematically (Boyatzis, 1998)." (L, 2023)

Who? #ⓘ

The equivalence class: four Spanish-certified dual-role nurse interpreters reporting on non-native-English Spanish-speaking patients at a single United States Southwest borderland county hospital; participants reported at least one encounter with a patient afforded no interpretation or only unqualified interpretation.

"Participants reported having at least one encounter with a Spanish‐speaking patient that was not afforded interpretation services or had interpretation from someone other than a qualified interpreter." (L, 2023)

Other Notes #

In the discussion, nurses connected language barriers to downstream care quality: a provider's ability to accurately diagnose can be "jeopardized by untrained ad hoc interpreters who are prone to omission, additions, substitutions, and volunteer opinions" (L, 2023), framing miscommunication as a pathway to diagnostic and treatment error.

Caveats #

• Four dual-role nurses at a single Southwest hospital limit generalizability of the interpreter-experience findings Owing to multiple attrition factors (changes in hospital administration, time constraints, nurse–patient ratios, and changes in nursing assignments), the study was conducted with only four dual-role nurses from a single hospital in the Southwest region of the United States. The authors state the findings cannot necessarily be generalized to all acute-care hospital dual-role nurses. The evidence is also indirect with respect to patients: outcomes (patient relief, confusion, empowerment, communication) are reported through the nurses' perceptions and recounted narratives, not measured on patients, and the single-researcher narrative design is subject to acknowledged researcher cultural assumptions and bias.