The Power of the Spoken Word

Talking is the primary method for health care providers to share information with patients and families-and for so many years I took it for granted.  Over the years I have seen personal growth and maturity develop and strengthen within myself, leading to a deeper respect and appreciation for the struggles and challenges that patients and families face when they are in the ICU and don’t speak english. 

When I examine my behavior when providing care across language barriers over the years I can see the changes that my life experiences have had on me.  When I think back ten years I can see where I started in my beliefs and practice and how much I have grown personally as well as professionally.  When my career changed and I began working as a travel nurse, my world and the way I viewed it turned inside out… nothing was ever the same again.

The beauty of nursing care is that it transcends language barriers.  Personal care, kindness, pain, ice packs, blood pressures, breathing, medication, thirst, and hunger are universal.  The ability to mime through these is easy.  Needing to tell the patient the blue pill they are taking is one part of the treatment for their pulmonary hypertension; the big yellow IV in their neck was floated through their heart and is resting in their pulmonary artery; and the device in their groin has a balloon on the end of it and as it inflates and deflates it is decreasing the afterload of the left side of their heart…. is impossible to mime.(Believe me…I’ve tried).  This conversation has the potential to play out everyday in ICU’s all over this country involving people who speak only Spanish, or Ethiopian, or Mandarin, or Russian, or Tagalog, or Khmer.

When I started as a nurse, the patients that I couldn’t communicate with, because of language barriers, I would try to reassure with nods and smiles.  I would hope that they understood and assumed we were doing everything we could for them.  It was their downfall, their weakness, and their shortcoming that they didn’t speak english.  The language barrier was on their end and the reason that we would have to wait for an interpreter before we could tell them everything that was going on with their health.

My experiences have changed me dramatically and now each night I work and am responsible for the care of a patient and family that do not speak english it is my shortcoming, my weakness, my lack of language that is the reason that we can’t talk to each other.  I feel terrible just nodding and smiling while giving medication and making life-saving interventions.  I feel heartbroken that I can’t talk to them about what they are suffering through and what I’m doing to help.  It is a difficult realization to feel and experience on a near daily basis your own personal inadequacy.

I am a stringent user of medical interpreters and always have been.  They are lifesavers for everyone involved.  There is nothing I could imagine accomplishing without them.

 Having the potential to receive health care at any moment (as any of us do) I couldn’t imagine the fear associated with not knowing what was going on around me.  The anxiety that would be palpable surrounding a lack of information, having no idea what was being said about you, and being forced to trust and hope that all the people standing around your bed are working with your best interest in mind. Medical interpretation is a vital link and a security blanket for patients, families, and staff ensuring everyone has the same information.

When I started traveling I moved from the midwest to San Francisco.  I fell in love with California but became abruptly aware of not being bilingual.  So many of my fantastic coworkers spoke more than one language fluently and had grown up speaking english, as well as spanish, Tagalog, mandarin, or korean.  Being fluent in two languages made them a gift to the unit.  It made me immediately envious.  Being able to talk to their patient and family without the language barrier they were able to build relationships and trust with ease.

Trust is everything in the ICU.  It’s difficult enough to build trust in a nurse/patient relationship sometimes; with the walls of a language barrier present it’s impossible.

As I traveled and worked from coast to coast in the U.S. My experiences with language barriers continued.  Each city and each coast presented new cultures, new languages, and new experiences.  Each patient I took care of, each family I talked to taught me something new.  Something about their lives and so much about mine as well.

As I’m writing this, I’m thinking back to a patient I took care of after he was in a terrible car accident.  He had severe spinal cord injuries, a severe anoxic brain injury and was beginning to herniate his brain stem. Neither he nor his wife spoke english.  I talked to the resident on call and we decided that the piecemeal information that they had been receiving all day left gaping holes in their knowledge about his situation and prognosis as well as many questions to be answered.  I called for an interpreter and the hospital operator asked me to use the phone interpreter service.

The phone line is a fantastic service.  You call a number and can get a medical interpreter for ANY language in minutes.  My situation however called for a personal conversation.  There are somethings that just do not feel right to talk about over the phone and I don’t think they ever will.

It took me multiple urgings for her to page the interpreter to come in.  She told me she was sorry for questioning me but “It would be cheaper for me to use the phone line.”  I understood it was her job to be a part of cost containment and make care as cost-efficient as possible-we are all responsible for that.  I will continue to believe however, as I did then, that this is not where cost saving measures should come from.

With an interpreter present we were able to give his family all the information they needed to feel comfortable with end-of-life care as his body succumbed to the inevitability of his injuries.

There is something bigger that comes along with understanding and working with language barriers on a daily basis.  It’s Respect. Recognizing and working through the language barriers that exist allows us to see the differences and the similarities we share as people during these life changing and sometimes devastating situations.

I feel better about myself, being able to look families in the eye and share in their grief when I know they have all the information available and they trust that I have been upfront and honest with them.  

I have grown and matured a lot and that maturity has brought a deeper respect to my practice. I will always, however, continue to see the barriers of not speaking the same language as my failure each time I wait for an interpreter to provide the vital bridge between my patient and their nurse.

How have you been changed working in this amazing profession?

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