Running Head: BREAKING DOWN LANGUAGE BARRIERS 1

An Innovative use of Technology for Education of Anesthesia Providers to Address

Language Barriers

Steven C. Cortes, SRNA

Rutgers University
BREAKING DOWN LANGUAGE BARRIERS 2

An Innovative use of Technology for Education of Anesthesia Providers to Address

Language Barriers

History

United States national policies have struggled to address issues related to individuals

whom are non-English speaking in the healthcare setting. In 1964, a law was enacted as part of

the Civil Right Act, requiring federally funded programs to develop means to improve access to

care for non-English speaking individuals.1 However, a deficiency in knowing how to enforce

this law coupled with a lack of awareness regarding compliance, has led to continued problems

related to language barriers.1 Multiple public policies have been written, revoked, and revised; a

pattern which continues today.1 As the population of limited English proficiency (LEP)

individuals grows in the United States, policies surrounding the issue remain a pivotal political

topic to be debated.

Introduction

Language barriers in healthcare have long been a source of struggle between healthcare

workers and patients who are limited in their ability to speak the native language. Healthcare

workers today, on average, have received extensive training and are generally more educated

about the worth attributed to evidence-based practices. However, ineffective communication

with patients impedes their ability to extract developed skills and knowledge from their training

and then apply them to practice. The language barrier that most commonly presents itself in the

United States is with individuals that are predominately Spanish-speaking. As the prevalence of

the Spanish speaking population continues to grow, the impact of language barriers in the

healthcare setting will continue to amplify. Because of the inability to communicate, there is a
BREAKING DOWN LANGUAGE BARRIERS 3

decrease in the quality of care provided, increased clinician stress, lost staff time, and decreased

safety generating increased healthcare costs.1,4

LEP patients are more likely to be admitted to the hospital, remain in the hospital longer,

and possibly receive insufficient anesthesia.1 Moreover, LEP patients have an increased chance

of being intubated, undergo unnecessary testing, and suffer from medical errors.1 Additionally,

LEP who are intubated further exacerbate the communication barrier. Intubated patients can

only listen to and follow the directions of the clinician. Important assessment terms such as

“squeeze my hand” to assess that the patient is able to follow commands, “lift your head off of

the pillow” to assure that respiratory muscles can function adequately, “take a deep breath in” to

assure that the patient could breathe efficiently after extubation would not be possible, secondary

to the language barrier. This situation presents itself often and is unsafe, offering the potential

for patients to remain intubated unnecessarily for a longer period of time or extubated too soon

and in an unsafe manner.

Current Methods

Interpreters, either professional or ad hoc, such as family members, are currently used for

translation, yet the use of professional interpretive services has been underutilized. Van Rosse et

al. found in 30% of cases where the patient was language deficient, no language barrier was

documented in the patient record, and relatives (even young children) served as interpreters,

despite the availability of professional interpreters.2 Realistically, the availability of professional

interpreters, ad hoc family member interpreters, or matching a LEP with a provider who also

speaks the patient’s native language is difficult, especially in certain settings such as in the

operating room (OR) or intensive care unit (ICU). Due to the underutilization and
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ineffectiveness of currently used interpretative techniques, further assessment of interventional

techniques should be investigated.

Interventions

Language barrier research has traditionally been descriptive in nature, meaning the

research revolves around identifying that a language barrier problem exists rather than exploring

interventions to alleviate the obstacles presented from a barrier in communication.3

“Don’t find fault, find a remedy”

-Henry Ford
What are possible remedies and/or interventions that would alleviate the negative

consequences of language barriers? There are language learning tools, as well as classes

available to healthcare providers to mitigate communication barriers. However, communication

barriers in healthcare continue to persist. Notwithstanding the availability of these learning

tools, it is not a requirement that healthcare professionals learn even basic words in other

languages during their training. Thus, it can be concluded that these language learning tools are

not being utilized and/or applied effectively.

Why is it that learning a new language is a requirement in primary and secondary

education but ceases to transfer to professional practice? Keep in mind, the difference between

commonplace Spanish and medical Spanish are quite different. Learning a new language is

challenging, and to become fluent, one must fully immerse themselves in the culture and

continually reinforce the learning process. Inevitably, the time commitment is substantial and

healthcare providers may find it difficult to overcome this barrier. As such, medical Spanish,

rather than learning commonplace Spanish, is more concise and conducive to be integrated into
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rigorous curriculums, such as nurse anesthesia, and should be considered as an elective or

required course.

Demand for techniques to obviate language barrier is exemplified by the results of a 2015

study by Bernard et al. in which clinicians used focused translation cards to facilitate

communication. The results of a survey were a significant reduction of clinician stress,

attestation that the focused translation cards met the clinician’s bedside needs to communicate,

and attestation that they would use the translational cards in the future.4 A crucial limitation to

the study was that the clinicians were bound to the availability of translational cards which may

not always be readily accessible in certain settings or situations.4

The method and delivery from which lessons are taught is of great importance for the

transfer of learning into practice. For this reason, an interactive language learning program, such

as the well-known Rosetta Stone, would provide one of the best innovative uses of technology

for educational purposes. The interactive technique of learning is unique in its effectiveness

because the learners are more engaged in their learning process.5 Furthermore, interactive

learning is uniquely effective when learning a language because positive reinforcement from

real-life simulation replicates how a child first learns to speak. To address issues regarding

legality and litigation, perfunctory terminology should be the content focus for learning, with

informed consent or information of high importance being allocated to professional

interpretation utilization in practice.

Anesthetists and Associated Providers

In the hospital, LEP patients who are intubated predominate in the OR surgical setting

and the ICU setting. As stated previously, the availability of professional and/or ad hoc
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interpreters, or matching a LEP with a provider who also fluently speaks their native language is

difficult in these settings. Therefore, all practitioners working in such settings can benefit from

increasing their communication skills. Since care surrounding intubated patients is unique and

specialized, efforts provided by a language learning program should be tailored to the commonly

used terminology needed. Routine phrases used by providers in these settings such as “squeeze

my hand,” “open your eyes,” or “do you have any pain?” are a few examples of commonly used

phrases in these settings that are necessary and would be the focus for learning.

Conclusion

Language learning educational efforts utilizing the most technologically effective

methods can help to mollify a plethora of negative sequalae associated with language barriers in

the healthcare setting. Additionally, focused learning would allow for an attractive return on the

learner’s investment of time and effort by affording them the ability to communicate.

Ultimately, the usefulness of an interactive medical language learning program will be realized

by decreasing healthcare costs, improving the quality of care as well as the safety of care

provided, and a decrease in healthcare provider stress by empowering them with the skills

needed to care for their patients of limited English proficiency.

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References

1. Jacobs, E., Chen, A., Karliner, L., Agger-Gupta, N., Mutha, S. (2006, March). The Need for

More Research on Language Barriers in Health Care: A Proposed Research Agenda. Milbank

quarterly; 84(1):111-133. Available from: Academic Search Premier, Ipswich, MA.

Accessed February 16, 2018.

2. Van Rosse, F., de Bruijne, M., Suurmond, J., Essink-Bot, M., Wagner C. (2016, February).

Language barriers and patient safety risks in hospital care. A mixed methods study. Int J

Nurs Studies. 54 (Language and Communication Issues in Health Care):45-53. Available

from: ScienceDirect, Ipswich, MA. Accessed March 3, 2018.

3. Schwei R., Del Pozo S., Agger-Gupta, N, Alvarado-Little, W., Bagchi, A.,…Jacobs E. (2016,

February). Changes in research on language barriers in health care since 2003: A cross-

sectional review study. Int J Nurs Studies. February 16, 2016; 54 (Language and

Communication Issues in Health Care): 36-44. Available from: ScienceDirect, Ipswich, MA.

Accessed April 3, 2018.

4. Bernard, A., Summers, A., Thomas, J., Ray, M., Rockich, A.,…Kearnery, P. (2005,

November). Novel Spanish translators for acute care nurses and physicians: Usefulness and

effect on practitioners' stress. Am J Crit Care; 14 (6):545-550. Available from: Science

Citation Index, Ipswich, MA. Accessed June 15, 2017.

5. Hung, I., Kinshuk, Chen, N., (2018). Embodied interactive video lectures for improving

learning comprehension and retention. Comp & Edu; 117:116-131. Available from:

ScienceDirect, Ipswich, MA. Accessed April 14, 2018.