Find ways to support verbal education for patients who don’t speak English

Language barriers encourage educators to be creative

Addressing the educational needs of non-English-speaking patients is becoming increasingly difficult, given the influx of immigrants and foreign visitors to the United States.

"It gets harder and harder to maintain [support for] every language for every situation that comes around," says Eileen Troutman, RN, BSN, OCN, senior oncology nurse for community cancer education at OhioHealth in Columbus.

Interpreters can provide verbal translations via telephone, but reinforcing verbal education isn’t always easy. Non-English-speaking patients are no different from those who speak English in at least one way: Patients taught verbally retain about 20% of what they hear, says Kathy Ordelt, RN, patient and family education coordinator at Children’s Healthcare of Atlanta.

Patients verbally taught at the bedside and then given a handout or video retain 50% of the information. When verbal teaching is accompanied by hands-on instruction, retention jumps to 90%, says Ordelt.

Patient education managers are developing new ways to help non-English-speaking patients increase retention of the information they’re taught. One method is collecting an inventory of materials in languages most frequently spoken by the non-English-speaking patients who visit a health care facility. Managers also are acquiring teaching tools to foster communication when language is a barrier and discovering ways to reinforce teaching when written materials and videos are not available.

Children’s Healthcare of Atlanta is a pediatric facility, so dolls with central lines, tracheotomy sites, and other models of medical interventions are common teaching tools. The dolls allow non-English-speaking parents to learn about self-care on the doll first and then translate this information to their child at the bedside, just as English-speaking parents would do, says Ordelt. Staff members are comfortable with this teaching technique because they already use the dolls successfully with English-speaking patients and families.

"Having the parents work with the doll and then with their child gives us the biggest bang for our buck as far as them learning what to do. So a lot of the teaching is hands-on reinforcement," says Ordelt.

The time needed to teach non-English-speaking patients is a drawback. When interpreters are added to the teaching team, the time required for teaching doubles or triples, says Ordelt.

Pictures often are used to teach people with low literacy skills, and these tools also are a good method for teaching non-English-speaking patients, says Teresa Towne, MSN, RN, inpatient educator at Bayhealth Medical Center in Dover, DE.

Bayhealth uses a handbook titled "Do You Understand?" that is published by the Literacy Volunteers of America in Syracuse, NY. "The book has great picture resources that are ideal as an assessment tool, particularly when the nurse is admitting the patient," says Towne.

Sometimes educational efforts can be tailored specifically to the culture. For example, people from Somalia enjoy storytelling, and most do not learn from the printed word. Therefore, a good way of disseminating information to this patient population might be through an audiotape having a native speaker teach the patient by telling a little story, says Sandra Cornett, PhD, RN, director of The Ohio State University AHEC Health Literacy Program in Columbus.

When the written word is necessary

No matter how education takes place, written materials often are necessary to give patients a resource to which they can refer if they forget certain steps to a procedure or other important information.

Maintaining teaching sheets in every language for patients admitted to a health care institution is difficult. Fairview-University Medical Center in Minneapolis uses staff from Interpreter Services to provide both verbal information and written material.

To ensure patients receive the written information they need to reinforce teaching, staff in the Patient Learning Center at Fairview-University Medical Center developed simple instruction sheets in English that contain the most essential information for each of the units or classes taught.

"We ask that the interpreter make notes in the person’s language on those cards. That way, we are sure the patient is getting the most up-to-date information in his or her language," says Nancy Goldstein, MPH, patient education program manager at Fairview-University.

OhioHealth looks for materials in the languages needed to teach on certain topics rather than translating materials, because the cost is $100 per page. "If there is something that has already been written that meets our standards, we would purchase that rather than paying to convert all of our materials," says Troutman.

When purchasing materials from outside sources, it is important to establish criteria, adds Troutman. The material must have an English version so medical staff know what information is being given to patients. Also, the information cannot conflict with anything the physicians at OhioHealth teach.

To make sure materials from outside sources are reputable, staff members at OhioHealth first look to medical educational resource publishers that have a good reputation.

Networking with colleagues is another way to find reliable education resources, says Jennifer Robinson, RN, MHS, South Carolina Hospital Association patient education liaison. By interacting with others in the field, she has discovered reputable resources on the Internet and in other places. (To learn about some of the resources Robinson has uncovered, see the resources section at the end of this article.)

Children’s Healthcare of Atlanta made a commitment a few years ago to translate all teaching materials into Spanish. Whenever new materials are created, whether written copy or a video, they now automatically are produced in Spanish as well as English. This policy also pertains to materials purchased from outside vendors.

"When I order something from the outside in English, I also order the Spanish version if it is available," says Ordelt.

Children’s Healthcare has been able to focus on Spanish because most of its non-English-speaking patients are from Mexico. However, this may change soon because Atlanta’s multicultural community is rapidly growing, says Ordelt. About 10% to 12% of the patients seen at the system’s hospitals are Spanish-speaking. At some satellite clinics, the patient population is about 50% Spanish-speaking.

Whenever a health care facility commits to using materials in foreign languages, these teaching sheets and booklets fall under the same policy for keeping the inventory up to date as the English-language materials. At Children’s Healthcare, this means the education materials inventory is reviewed every three years unless protocols have been changed or new medical information has been introduced.

With 800 teaching sheets in Spanish and English posted on its intranet, Children’s Healthcare of Atlanta relies on its contracted translating services to update the Spanish materials. A template of the sheet in question is sent to the company, and once the changes are made, it is uploaded onto the intranet.

Sources

For more information on teaching non-English-speaking patients, contact:

  • Sandra Cornett, PhD, RN, Director, OSU/AHEC Health Literacy Program, Office of Health Sciences, The Ohio State University, 218 Meiling Hall, 370 West 9th Ave., Columbus, OH 43210-1238. Telephone: (614) 292-0716. E-mail: cornett.3@osu.edu
  • Nancy Goldstein, MPH, Patient Education Program Manager, Fairview-University Medical Center, 420 Delaware St. SE, Minneapolis, MN 55455. Telephone: (612) 273-6356. E-mail: ngoldst1@fairview.org
  • Kathy Ordelt, RN-CPN, CRRN, Patient and Family Education Coordinator, Children’s Healthcare of Atlanta, 1600 Tullie Circle, Atlanta, GA 30329. Telephone: (404) 785-7839. Fax: (404) 785-7017. E-mail: Kathy.ordelt@choa.org
  • Jennifer Robinson, RN, MHS, SCHA Patient Education Liaison, Roper St. Francis Healthcare, 316 Calhoun St., Charleston, SC 29401. Telephone: (843)-747-8665. E-mail: Jenny.Robinson@RoperSaintFrancis.com
  • Teresa Towne, MSN, RN, inpatient educator, Education Department, Bayhealth Medical Center, 640 S. State St., Dover, DE 19901. Telephone: (302) 744-6724. E-mail: Teresa_Towne@Bayhealth.org
  • Eileen Troutman, RN, BSN, OCN, Senior Oncology Nurse for Community Cancer Education, OhioHealth, Columbus, OH. Telephone: (614) 566-9889. E-mail: etroutma@ohiohealth.com

Resources for Non-English Educational Materials

Web Sites

Pictographs

Interactive Therapeutics makes pictorial booklets in English and Spanish to help people communicate without the spoken word. To learn more about the products, contact the company at: P.O. Box 1805, Stow, OH 44224-0805. Telephone: (800) 253-5111. Web site: www.interactivetherapy.com

Books

  • "Speedy Language Phrasebooks" is a pocket reference guide for nurses that provides help in German, Spanish, Italian, Russian, French, and Japanese. Contact: Speedy Language Phrasebooks, P.O. Box 4151, Santa Barbara, CA 93140. Telephone: (800) 962-4028 or (805) 962-4029.
  • Mosby’s "Pocket Guide to Cultural Assessments" by Elaine Geissler provides information on the practices and beliefs of different cultures. The guide is available from Mosby Times Mirror Co., 11830 Westline Industrial Drive, St. Louis, MO 63146.
  • Many other organizations, such as the Dallas-based American Heart Association, have booklets in foreign languages. Also, medical supply and pharmaceutical companies frequently have materials in a variety of languages.

(Editor’s note: These resources were provided by Jennifer Robinson, RN, MHS, patient education liaison for the South Carolina Hospital Association.)