Targeting Spanish- speaking patients

Alter teaching to fit culture

To address the needs of its large Spanish-speaking community — estimated at 87.8% —Thomason Hospital in El Paso, TX, created a patient education resource committee. The purpose of the bilingual committee was to review and approve patient education materials for use in the hospital with a goal to accumulate a large variety of materials produced in Spanish.

"What the committee found was that a lot of the materials we would like to use for our patients weren’t available in Spanish, or the Spanish wasn’t appropriate," says Mary Ann Friesen, MSN, RN, CPHQ, patient education coordinator at Thomason Hospital.

The Hispanic community in El Paso, on the Mexico-U.S. Border, does not speak proper Spanish. Instead, Hispanics speak in spanglish, a combination of Spanish and English. Therefore, the committee has had to develop a lot of materials specific to the patient group.

With 12% of its patients Hispanic, several years ago University of Texas M.D. Anderson Cancer Center in Houston established a bilingual advisory group to foster Spanish-language activities.

To determine what was appropriate, the group conducted focus groups with members of the Hispanic community, explains Louise Villejo, MPH, CHES, director of patient education at M.D. Anderson. As a result, education classes on such topics as chemotherapy were developed and conducted in Spanish. Also, the institution published 175 printed and audiovisual materials in Spanish and purchased others from such organizations as the National Cancer Institute based in Bethesda, MD.

Once the group had completed the needs assessment, looked at what resources were available to meet the needs of the Hispanic population, and determined what resources were needed, it disbanded. The work of meeting the needs of Hispanic patients continues, however.

"Whenever we begin developing a patient education program, we include the cost of Spanish language translations," says Villejo. Costs vary according to length of the material. A chemotherapy drug sheet might run $50, while an 18-page care path document is $825. Also, the learning center developed a list of Spanish books, videos, and Internet sites for patients. (See copy of the sites, pp. 34-35.)

Education methods and materials must be tailored to the needs of the patient population, says Frieson. For example, one outreach program at Thomason teaches participants how to prepare heart-healthy meals using ingredients commonly eaten along the border.

"There is no point in trying to teach people to cook something that is totally foreign to their culture," she explains.

The hospital has had to alter many of its practices to better serve its large Hispanic population, says Patricia Ramirez Moreno, CHES, education supervisor for Family Planning Services at Thomason Hospital. For example, when illness strikes, extended family members, rather than just the immediate family, arrive at the hospital. These family members include aunts, uncles, and cousins, as well as brothers, sisters, parents, and children.

To help patients in the intensive care unit (ICU) get well, the hospital revised its visitation policy. Families work with the nurse caring for the patient to create visiting hours that suit the patient and extended family.

This flexibility is important when serving patients of diverse cultures.

"We have to be open to the continuum of life and aware of the cultural influences through the life process. If dealing with the birthing process, we need to be sensitive to the cultural aspects of birth. If someone is dying, we need to be sensitive to the aspects of death and dying for that culture," says Friesen.