Bilingual nurses improve patient safety and understanding of their care By Heather Stringer


n 2013, nearly 62 million U.S. residents — 21% of the population — spoke a language other than English in the home, according to the U.S. Census Bureau. Statistics

like these are raising questions in the healthcare arena about patient safety for millions of residents nationwide, who have limited English proficiency, when they seek care.

According to an article published in 2014 in the International Journal of Healthcare Quality, unaddressed language barriers can

lead to low quality, unsafe and costly healthcare. When compared to English-speaking counterparts, LEP patients have a greater risk of line infections, surgical infections, falls, pressure ulcers and surgical delays, according to studies referenced in the article. They also have a greater chance of readmissions for certain chronic conditions due to difficulties with understanding how to manage their condition and take their medications.

From passion to purpose Nurses like Lauren Micale, BSN, RN, CPHON, a bone marrow transplant

coordinator at Nemours/Alfred I. DuPont Hospital for Children in Del- aware, can attest to the importance of speaking a patient’s language. A few months ago, Micale was talking to a mother about her son, who had recently had a bone marrow transplant. During their conversation, the mother mentioned she had seen some blood in the child’s stool. She had not told anyone else because of the language barrier — and she did not realize it was important. Micale knew this could be a sign of skin breakdown and infections can be life threatening for these patients. She alerted the team and they addressed the problem. Micale had started taking Spanish in grade school and fell in

love with the language. In high school, she volunteered at a school with Spanish-speaking children and became aware of the signifi- cant need for accurate, in-person translation. Micale sought out a nursing school where she could minor in Spanish, and after much searching she finally found one. Most schools told her she would need to take summer classes or would be in school for an extra year in order to minor in Spanish, but the University of Delaware allowed her to finish on time and participate in a study abroad program in Ecuador. “As a nurse who speaks Spanish, I can explain to patients and

families what I am doing,” Micale said. “I’m also able to build trust and advocate for them with the team.”

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An unexpected path Unlike Micale, Ida Bradley, BSN, RN, a member of the Navajo Tribe,

had not planned to use her bilingual skills in nursing, but once she realized the value to patients, she dedicated her career to serving fellow Native Americans. Bradley had worked as a nurse for more than 11 years before she took her first job at the Northern Navajo Medical Center in Shiprock, N.M. “I grew up in a traditional Native American home, and although

I never met my grandmother, I was told she was a medicine woman,” Bradley said. “I knew about the values and teaching of our culture, and I could understand where my patients were coming from.” Te Northern Navajo Medical Center is one of eight facilities that

serves patients who live in the Navajo Nation, which has a population of about 200,000 people and covers the corners of Arizona, New Mexico and Utah. Te majority of patients who are fluent in Navajo — and not in English — are elderly, Bradley said. The Navajo language is very descriptive, and she often uses

visual pictures and analogies to explain health conditions to elderly patients. For instance, she sees patients who are suffer- ing from pulmonary fibrosis after years of working in uranium mines and uses the image of a tree to help them understand the condition. The main tree trunk is the trachea, the branches are the bronchi, and the leaves are the alveoli. “In their mind’s eye, this

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