spanish for healthcare · the terms “hispanic” and “latino” are not the same. hispanic...

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SPANISH FOR

HEALTHCARE

DANA BARTLETT, BSN, MSN, MA, CSPI

Dana Bartlett is a professional nurse and author. His clinical experience includes 16 years of ICU and ER experience and over 20 years of as a poison control center information specialist. Dana has published numerous CE and journal articles, written NCLEX material, written textbook chapters, and done editing and reviewing for publishers such as Elsevire, Lippincott, and Thieme. He has written widely on the subject of toxicology and was recently named a contributing editor, toxicology section, for Critical Care Nurse journal. He is currently employed at the Connecticut Poison

Control Center and is actively involved in lecturing and mentoring nurses, emergency medical residents and pharmacy students.

Abstract

Communicating with patients and families in their native language in a

health setting is important for the delivery of safe and appropriate health

care. Increasingly, health organizations provide resources for non-English

speaking patients and their families. These resources are discussed,

including use of common words or phrases, a telephone interpretation

service, a medical interpreter on site, and family members. All of these

resources are helpful for non-English speaking individuals needing to explain

health symptoms or to understand a medical condition and treatment.


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Policy Statement

This activity has been planned and implemented in accordance with the

policies of NurseCe4Less.com and the continuing nursing education

requirements of the American Nurses Credentialing Center's Commission on

Accreditation for registered nurses. It is the policy of NurseCe4Less.com to

ensure objectivity, transparency, and best practice in clinical education for

all continuing nursing education (CNE) activities.

Continuing Education Credit Designation

This educational activity is credited for 2 hours. Nurses may only claim credit

commensurate with the credit awarded for completion of this course activity.

Statement of Learning Need

As the Hispanic population continues to grow in the United States so does

the need for health clinicians who speak Spanish. Organizations such as the

NAHN (National Association of Hispanic Nurses) identify the need for more

nursing participation at all levels of health care to improve the quality of

health prevention and treatment in Hispanic communities and, hence, reduce

health disparity that may exist for non-English speaking people.

Course Purpose

To increase nursing knowledge and skills related to Medical Spanish and

common words or phrases that can be used when individuals require an

interpreter.


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Target Audience

Advanced Practice Registered Nurses and Registered Nurses

(Interdisciplinary Health Team Members, including Vocational Nurses and

Medical Assistants may obtain a Certificate of Completion)

Course Author & Planning Team Conflict of Interest Disclosures

Dana Bartlett, BSN, MSN, MA, CSPI, William S. Cook, PhD, Douglas

Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no

disclosures.

Acknowledgement of Commercial Support

There is no commercial support for this course.

Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article.

Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course.


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1. True or False: The terms “Hispanic” and “Latino” are the same, and may be used interchangeably. a. True b. False

2. Approximately ________ of the U.S., population consists of

racial and ethnic minorities. a. one-third b. one-fourth c. two-thirds d. one-tenth

3. True or False: It is NOT appropriate to routinely rely on family

members as interpreters. a. True b. False

4. “Necesitas un intérprete?” means in Spanish:

a. Is your niece the interpreter? b. Do you have an interpreter? c. Do you need an interpreter? d. None of the above

5. According to the Joint Commission, in order for the communication process to be truly effective, it requires a. an interpreter. b. a two-way process: expressive and receptive. c. that the patient be a good listener. d. a two-way process: proclamation and comprehension.


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Introduction

Audible speech is an important method of communication. Speaking English

increases one’s ability to identify and access health care services in most

parts of the United States. Yet, for many non-English speaking persons the

national goal of access to quality health care is unachieved and health

disparities prevail. A large number of these individuals speak Spanish as a

primary language, and the Hispanic or Latino population is the largest

minority group in the United States. This course will focus on communication

with Spanish-speaking patients and families, give some commonly used

words or phrases that may be helpful, and discuss some broad guidelines

when interacting with patients and families from a culture different than

one’s own.

Spanish-Speaking Population In The United States

The ability to communicate clearly and accurately is an imperative aspect of

quality healthcare. The Joint Commission defines effective communication

as:

“the successful joint establishment of meaning wherein patients and

health care providers exchange information, enabling patients to

participate actively in their care from admission through discharge,

and ensuring that the responsibilities of both patients and providers

are understood. To be truly effective, communication requires a two-

way process (expressive and receptive) in which messages are

negotiated until both parties correctly understand the information.

Successful communication takes place only when providers understand

and integrate the information gleaned from patients, and when

patients comprehend accurate, timely, complete, and unambiguous


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messages from providers in a way that enables them to participate

responsibly in their care.”1

Approximately 60.6 million people speak a language other than English while

at home. Approximately 25 million of those people are identified as limited

English proficiency (LEP), speaking English not at all or not well.2,3 The

Hispanic or Latino population is the largest minority group in the U.S. and

represented 17.6% of the population in 2015.4 The majority of LEP people

speak Spanish.5

Although often used interchangeably, including by the U.S. Census Bureau,

the terms “Hispanic” and “Latino” are not the same. Hispanic refers to

people born in a country conquered by Spaniards and for whom Spanish is

the primary language, whereas Latino is more inclusive, referring to people

born in a country whose language evolved from Latin (the Romance

languages).6

According to the 2010 U.S. Census,7 approximately one-third of the

population in the U.S., consists of racial and ethnic minorities, with Latinos

encompassing the largest minority group. Between the years 2000 and

2010, Latinos represented more than half of the nation’s overall population

growth, which has been attributed primarily to immigration and birth rates.7

The Hispanic population in the U.S., has increased exponentially in the last

10 years and is expected to continue to grow throughout all regions of the

United States. Projections reveal the U.S., population will be 30.2% Hispanic

by 2050.8,9


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The largest influx of Latino immigrants has occurred over the last few

decades with Latinos arriving to new areas of the country, bringing an array

of challenges to both the healthcare system and healthcare clinicians in

those areas. Historically, Latinos resided in a few select states, with nearly

two-thirds living in California, Texas, Florida, and New York. However, with

increased employment opportunities in the Southern region of the country,

approximately one-third of Latinos nationwide currently live in the

southeastern United States. The 2010 U.S. Census indicated that the Latino

population in Alabama grew 145%, which represents the second largest

percentage growth between 2000 and 2010 in the U.S., after South

Carolina.7 The migration of populations to areas of the country not prepared

to accommodate the healthcare needs of the new inhabitants presents

challenges, ranging from not knowing where to get care to language barriers

and cultural competence among health clinicians.

Language And Healthcare

As previously described, Hispanics and Latinos are now the largest ethnic or

racial minority group in the United States. Like the overall U.S., population,

the most prominent causes of death among Hispanics and Latinos are heart

disease and cancer; however, they are also subject to some significant

health disparities than non-Hispanic Caucasians, including higher rates of

some chronic diseases, such as diabetes, some cancers, high cholesterol and

asthma. They are also less likely to receive recommended cancer screenings

and other preventative healthcare. Other disparities exist in dental care,

prenatal care, health insurance coverage, and ease of accessing needed or

desired healthcare. In addition, Hispanics are more likely to be overweight or

obese and engage in less physical activity compared with non-Hispanic

Caucasians.


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For the majority of the individuals in the U.S., audible speech is an

important method of communication. Speaking English increases one’s

ability to identify and access healthcare services in most parts of the United

States. For many non-English speaking persons, the national goal of access

to quality healthcare is unachieved and health disparities prevail. Language

barriers play a large part in this. Patients with LEP have limited health

literacy and are more likely to experience adverse outcomes.10-14

Evidence suggests that quality patient-clinician communication is associated

with increased adherence to treatment, patient satisfaction, and overall

enhanced health outcomes.2,15 Given the number of Spanish speakers who

have LEP this is clearly a large public health issue.

Language barriers in the Hispanic population have been associated with less

access to healthcare, preventive healthcare, and emergency services,

decreased adherence to treatment recommendations, decreased quality of

care, fewer interventions performed, fewer admissions, an increased number

of medical errors, a greater number of poor outcomes; and, decreased

patient satisfaction.2,16-19 Other studies have shown that patients’ with an

inability to communicate with clinicians and other healthcare professionals

can greatly affect overall health and healthcare seeking behaviors,

particularly when the clinician and the patient do not speak the same

language.20-22

Betancourt, et al., (2014), reviewed the literature and concluded that

patients who had limited English proficiency were more likely to have

intravenous line infections, falls, and pressure ulcers. Additionally, these

patients were more likely to have a delay in surgery and had a greater

chance for readmission for certain chronic conditions for a variety of


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reasons, all of which were related to an inability to understand English.23 As

early as 1964, the U.S. Congress tried to address problems such as these

when it enacted Title VI of the Civil Rights Act declaring that “no person in

the United States shall, on the grounds of race, color, or national origin, be

excluded from the participation in, be denied the benefits of, or be subjected

to discrimination under any program or activity receiving federal

assistance.”24

In the year 2000, Executive Order No. 13,166 was issued by President Bill

Clinton, which reaffirmed Title VI and mandated equal access for individuals

with limited English proficiency to healthcare at no cost to the patient. As a

result, currently there are language access laws in forty-three states, but the

problem persists and the implications are quite serious.

Utilizing Interpreters For Spanish-Speaking People

Due to all the reasons discussed

above, communicating with patients

and families in their native language

in the healthcare setting is important

and it can help improve care.25,26

Some organizations have resources

for non-English speaking patients

and families. This may include the

use of a telephone interpretation service or having a medical interpreter on

site. The use of a medical interpreter is ideal; however, not all organizations

have such resources available at all times. Sometimes family members may

want to serve as an interpreter and they may even offer the service. Using a

family member as an interpreter may be necessary in an emergency


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situation, but should not be routine practice for the reasons referred to

below.

Medical Understanding

There is no substitute for a properly trained and qualified medical

interpreter. Professionals that have completed a credible medical

interpreting program have knowledge of healthcare terminology and

comprehension of medical issues that the average person does not.

Correctly interpreting medical information is imperative for the health and

wellbeing of a patient, and mistakes could be time-consuming at best or

injurious in a worst-case scenario.

Lack of Impartiality

There is a reason clinicians are generally discouraged from treating or

performing procedures on their own family members. While they may be

qualified, it is virtually impossible for most people to detach themselves

emotionally from someone they love. Family members may become

emotionally distressed at receiving upsetting medical news and may

incorrectly interpret information or become unable to continue interpreting.

A qualified medical interpreter can relate sensitive information more

impartially, often with better judgment and better bedside manner.

Impropriety or Discomfort with Personal Issues

Imagine a child having to explain sensitive personal information about a

parent or relative of the opposite sex. Honesty between the patient and

clinician is critical in achieving accurate treatment, but it can be

uncomfortable or inappropriate for certain family members to discuss


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personal medical conditions. Certain cultural beliefs may complicate these

issues.

Stress on Relationships

Many parents or relatives rely on children or other family members as

interpreters for them. This can place a strain on relationships if taken to

extremes. Many children feel undue responsibility when interpreting for their

parents, and medical interpreting adds one more level of stress to the

relationship. Consulting with a medical interpreting agency and finding a

professional medical interpreter can ease the burden on family members and

improve relationships. Family members can be helpful as interpreters but it

should be remembered that they are not medical professionals and their

emotional involvement in the situation could affect a translation. Children

should not be used as interpreters;22,27-28 in some states this is illegal.29

Interpreters can be invaluable but they are not an infallible resource.

Inaccurate interpretation is not uncommon,29 and a poor level of

interpretation can cause misunderstanding of information needed to provide

self-care or care for a family member. It may also lead to unnecessary

testing, emotional distress, and an inability of patients to follow a treatment

plan.22,31-32 Tips to keep in mind when working with an interpreter are

outlined below.

• Sit facing the person

• Look at the person and maintain awareness of body language

• Avoid looking at the interpreter unless directly addressing him/her

• Speak directly to the person as might be done with an English speaker


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• Always use the first person, i.e., “how are you feeling?” Do not

address the interpreter with “ask her how she is feeling.”

• Don’t try to save time by asking the interpreter to summarize

• Be aware that it may take more words than that being spoken to

convey the message

• Do not let the interpreter’s presence change the clinician’s role in the

conversation

• It is not the interpreter’s role to lead the discussion.

Commonly Used Spanish Words Or Phrases

Commonly used Spanish words or phrases may be learned by health

professionals to use in situations with Spanish-speaking patients and families

when an interpreter is not available. If an interpreter is not available, the

health professional will have to do the best she or he can and use the

resources available to communicate with the Spanish-speaking patient

and/or family. The next section of this course will give health professionals

some common Spanish phrases that may be useful in these situations.

Greetings and Farewells

Good morning Buenos días

Good afternoon Buenas tardes

Good night Buenas noches

Hi Hola

Goodbye Hasta luego

Sir Señor

Ma'am Señora

Miss Señorita


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Social Pleasantries and Courtesy

Please Por favor

Thank you Gracias

You're welcome De nada

I'm sorry Lo siento

How are you feeling today? ¿Cómo te sientes hoy?

Are you feeling better? ¿Te sientes mejor?

Have a good day Que tengas un buen día

Excuse me Perdón

Introductions

I'm the nurse Soy la enfermera

I’ll be taking care of you today Yo voy a cuidar de ti hoy

My name is _______. Mi nombre es_______.

What's your name? ¿Cuál es tu nombre?

Nice to meet you Mucho gusto.

Please sit down Por favor, siéntese

This is the nurse's aide Este es el auxiliar de enfermería

This is the doctor Este es el doctor

Do you need an interpreter? ¿Necesitas un intérprete?

Strategies for Better Communications

Do you speak English? ¿Hablas Inglés?

I don't speak Spanish Yo no hablo español

I only speak a little Spanish Yo sólo hablo un poco de español

Do you understand? ¿Me entiendes?


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I don't understand No entiendo

Repeat that, please Repita eso, por favor

Please, only answer "yes" or "no" Por favor, sólo responda sí o no

Speak very slowly, please Por favor, hable despacio

Talking About Family

Do you have children? ¿Tienes hijos?

What's your relation to Mr.

Gomez?

¿Cuál es su relación con el Sr.

Gómez?

Is he your son? ¿Él es su hijo?

Is she your daughter? ¿Ella es su hija?

Are you her husband? ¿Es usted el esposo de ella?

Are you his wife? ¿Es usted la esposa de él?

Is he your brother? ¿Él es tu hermano?

Is she your sister? ¿Ella es tu hermana?

Patient Orientation

This is your room Este es tu cuarto

This is your bed Esta es tu cama

This button will raise and lower the

bed

Este botón sube y baja la cama

Please keep the side rails up Por favor, tenga las barandas arriba

Push this button if you need help Pulse este botón si necesitas ayuda

The telephone is here El teléfono está aquí

Here's the control for the television Aquí está el control de la televisión

The bathroom is here El baño está aquí


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Numbers

Zero Cero

One Uno

Two Dos

Three Tres

Four Cuatro

Five Cinco

Six Seis

Seven Siete

Eight Ocho

Nine Nueve

Ten Dez

Twenty Veinte

Thirty Treinta

Forty Cuarenta

Fifty Cincuenta

Sixty Sesenta

Seventy Setenta

Eighty Ochenta

Ninety Noventa

Hundred Cien

Taking Vitals

I'm going to take your blood

pressure

Voy a tomar la presión arterial

I'm going to take your temperature Voy a tomar la temperatura

I'm going to take your pulse Voy a tomar el pulso


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I'm going to listen to your lungs Voy a escuchar a los pulmones

Breathe deeply, please Respire profundamente, por favor

I'm going to listen to your heart Voy a escuchar a tu corazón

Everything is normal Todo es normal

Ambulation

I'm going to help you get into the

chair

Voy a ayudarte a sentarse en la silla

Hold on to me Aférrate a mí

I want you to stand up Quiero que tú te levantes

Hold the walker Sostenga el andador

Let's walk down the hallway Vamos a caminar por el pasillo

I won't let you fall Yo no te voy a dejar caer

Don't get out of bed without help No salga de la cama sin ayuda

You can't walk by yourself No se puede caminar por sí mismo

Basic Commands

Breathe in Inhale

Breathe out Exhale

Cough, please Tosa, por favor

Take this medicine Tome este medicamento

Listen to me Escúchame

Wake up Despiértese

Lie down Acuéstese

Be careful. Ten cuidado

Swallow, please Trague, por favor


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Open your mouth Abre la boca

Please, don't move No te muevas, por favor

Pay attention Preste atención

Positioning

Turn on your right side Gire a tu derecha

Turn on your left side Gire a tu izquierda

Turn onto your back Gire en tu espalda

Sit up Siéntese

Sit on the side of the bed Siéntese al lado de la cama

Stand up, please Levántese, por favor

Medications

Are you allergic to anything? ¿Es usted alérgico a algo?

Are you currently taking any

medications?

¿Toma alguna medicación?

Take this pill Tome esta pastilla

Take one pill at a time Tome una pastilla a la vez

This is for the pain Esto es para el dolor

You need an antibiotic Usted necesita un antibiótico

I'm going to give you a shot Voy a darle un inyección

There will be a little stick Esto va a doler un poco


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Patient Comfort

Are you having trouble breathing? ¿Estás teniendo problemas para

respirar?

Did you sleep okay? ¿Has dormido bien?

Are you cold? ¿Tienes frío?

Are you hot? ¿Tienes calor?

Do you need another blanket? ¿Necesitas otra cobija?

Would you like another pillow? ¿Quieres otra almohada?

Are you in pain? ¿Tienes dolor?

Where does it hurt? ¿Dónde te duele?

Touch the spot where it hurts. Toque donde tienes dolor.

Cleansing

Did you have a bowel movement? ¿Has tenido un movimiento de

intestino?

I'm going to clean you. Yo te voy a limpiar.

I'm going to change your diaper. Voy a cambiar el pañal.

I'm going to change the sheets. Voy a cambiar las sábanas.

I'm going to bathe you. Voy a bañarte.

Can you raise your arms? ¿Puedes levantar los brazos?

Food and Drink

Are you hungry? ¿Tienes hambre?

Are you thirsty? ¿Tienes sed?

Do you have problems chewing? ¿Tienes problemas para masticar?

Do you have problems swallowing? ¿Tienes problemas para tragar?


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I'm going to help you eat. Voy a ayudarte a comer.

Here's your breakfast. Aquí está tu desayuno.

Here's your lunch. Aquí está tu almuerzo.

Here's your dinner. Aquí está tu cena.

Good Cheer

You'll be going home soon! Usted se va para su casa pronto!

You have a wonderful family! Usted tiene una familia maravillosa!

You're doing great! Que está haciendo muy bien!

Sleep tight! Duerma bien!

You're looking much better! Se le ve mucho mejor!

Assessing Patient Orientation

Do you know where you are? ¿Sabe usted dónde se encuentra?

Do you know why you are here? ¿Sabe usted por qué está aquí?

What day is it? ¿Qué día es hoy?

What month is it? ¿Qué mes es?

Do you know who I am? ¿Sabe usted quién soy yo?

Assessing Patient Comfort

Are you hot? ¿Tienes calor?

Are you cold? ¿Tienes frío?

Do you feel OK? ¿Te sientes bien?

Do you feel sick? ¿Te sientes enfermo/a?

Are you feeling better? ¿Te sientes mejor?


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Are you feeling worse? ¿Te sientes peor?

Bathroom

Do you need to use the bathroom? ¿Necesitas usar el baño?

Here's the bathroom. Aquí está el baño.

I'll help you bathe. Te voy a ayudar a bañarse.

Try to urinate. Trate de orinar.

Eating

Pick up your fork. Recoja tu tenedor.

Put down your spoon. Deje tu cuchara.

Scoop up some food. Recoja algo de comida.

Chew well and then swallow. Mastique bien antes de tragar.

Pick up your cup. Recoge tu taza.

Take a drink. Tome una copa.

Not too much. No mucho.

Wipe your mouth. Limpie la boca.

Dressing

Put on your shirt. Ponga la camisa.

Put on your socks. Ponga las medias.

Put on your pants. Ponga los pantalones.

Remove your shirt. Quite la camisa.

Remove your socks. Quite las medias.

Remove your pants. Quite los pantalones.


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Summary

Recognizing and understanding how language barriers influence healthcare

access is a necessary starting point. Health clinicians can consider their

potential role in eliminating this barrier and decreasing health disparities.

With an appreciation of the role language barriers play in disparities in

access, health clinicians can address the degree of cultural relevance in the

design and delivery of healthcare services to ethnic minority populations

whose primary language is not English.

This course has explained how the demographics of the U.S., are changing,

which relates to why the Spanish language is becoming increasingly

important in healthcare. Additionally, some of the disparities in healthcare

and those the Hispanic community may face were described. Lastly, some

commonly used Spanish phrases have been provided that may be used in

situations with Spanish-speaking patients and families when an interpreter is

not available. Given the current healthcare environment and population

changes in the U.S., the information shared in this course will only become

more important in the future.

Please take time to help NurseCe4Less.com course planners evaluate the nursing knowledge needs met by completing the self-assessment of Knowledge Questions after reading the article, and providing feedback in the online course evaluation. Completing the study questions is optional and is NOT a course requirement.


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1. True or False: The terms “Hispanic” and “Latino” are the same, and may be used interchangeably. a. True b. *False


racial and ethnic minorities. a. *one-third b. one-fourth c. two-thirds d. one-tenth

3. True or False: It is NOT appropriate to routinely rely on family

members as interpreters.

a. *True b. False


a. Is your niece the interpreter? b. Do you have an interpreter? c. *Do you need an interpreter? d. None of the above

5. According to the Joint Commission, in order for the

communication process to be truly effective, it requires

a. an interpreter. b. *a two-way process: expressive and receptive. c. that the patient be a good listener. d. a two-way process: proclamation and comprehension.

6. If you wanted to tell a patient that the medication you are

giving to him or her is for his or her pain, in Spanish, you would say, “Esto es para el

a. *dolor.” b. enfermo.” c. cuchara.” d. despacio.”


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7. In Spanish, how would you ask a patient if he or she is having problems swallowing?

a. Mastique bien antes de tragar? b. Tienes problemas para comer? c. Tienes problemas para cuchara? d. *Tienes problemas para tragar?

8. Hispanics and Latinos suffer from ___________ at the same

rate as non-Hispanic Whites?

a. asthma b. obesity c. diabetes d. *None of the above

9. According to Betancourt, et al., patients with limited English

proficiency were more likely to

a. have stomach ulcers. b. accelerate surgeries. c. *have IV line infections. d. not be readmitted for chronic conditions.

10. When working with an interpreter, a healthcare provider

should

a. ask the interpreter to summarize what is being said. b. always look at the interpreter when talking. c. *sit facing the patient. d. be aware of the interpreter’s body language.

11. When may an interpreter lead the discussion with the patient

and the healthcare provider?

a. If the interpreter is a properly trained, qualified medical interpreter b. *Never c. On a case-by-case basis d. If a family member is also present


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12. Projections reveal that the U.S., population will be _____ Hispanic by 2050.

a. *30.2% b. 24.7% c. 35% d. 20%

13. True or False: Like the overall U.S., population, the most

prominent causes of death among Hispanics and Latinos are heart disease and cancer.

a. *True b. False

14. Language barriers in the Hispanic population have been

associated with

a. fewer poor outcomes for Hispanic patients. b. less patient dissatisfaction by Hispanic patients. c. less medical errors for Hispanic patients. d. *less preventative healthcare for Hispanic patients.

15. Language barriers in the Hispanic population have been

associated with greater

a. emergency room services. b. patient satisfaction. c. *numbers of poor medical outcomes. d. adherence to treatment recommendations.


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Correct Answers:

1. True or False: The terms “Hispanic” and “Latino” are the same and may be used interchangeably.

b. False p. 6: the terms “Hispanic” and “Latino” are not the same. Hispanic refers to people born in a country conquered by Spaniards and for whom Spanish is the primary language, whereas Latino is more inclusive, referring to people born in a country whose language evolved from Latin (the Romance languages).


racial and ethnic minorities.

a. one-third p. 6: “…, approximately one-third of the population in the U.S., consists of racial and ethnic minorities, ….”

3. True or False: It is NOT appropriate to routinely rely on family members as interpreters.

a. True p. 9: “Sometimes family members may want to or offer to serve as interpreters. This may be necessary in an emergency situation, but should not be routine practice for the reasons referred to below.”


c. Do you need an interpreter? p. 13: Do you need an interpreter? Necesitas un intérprete?

5. According to the Joint Commission, in order for the communication process to be truly effective, it requires

b. a two-way process: expressive and receptive. p. 5: “To be truly effective, communication requires a two-way process (expressive and receptive) in which messages are negotiated until both parties correctly understand the information.”


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6. If you wanted to tell a patient that the medication you are giving to him or her is for his or her pain, in Spanish, you would say, “Esto es para el

a. *dolor.” p. 16: “This is for the pain: Esto es para el dolor.”

7. In Spanish, how would you ask a patient if he or she is having

problems swallowing?

d. Tienes problemas para tragar? p. 13: “Do you have problems swallowing?: Tienes problemas para tragar?”

8. Hispanics and Latinos have the same rates as non-Hispanic Whites when it comes to

d. None of the above p. 7: “Like the overall U.S., population, the most prominent causes of death among Hispanics and Latinos are heart disease and cancer; however, they are also subject to some significant health disparities than non-Hispanic Whites, including higher rates of some chronic diseases, such as diabetes, some cancers, high cholesterol and asthma…. In addition, Hispanics are more likely to be overweight or obese and engage in less physical activity compared with non-Hispanic Whites.”

9. According to Betancourt, et al., patients with limited English proficiency were more likely to

c. have IV line infections. p. 8: “Betancourt, et al., (2014), reviewed the literature and concluded that patients who had limited English proficiency were more likely to have IV line infections, falls, and pressure ulcers; were more likely to have a delay in surgery; and, had a greater chance for re-admission for certain chronic conditions for a variety of reasons, all of which were related to an inability to understand English.”


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10. When working with an interpreter, a healthcare provider should

c. sit facing the patient. p. 11: “Tips to keep in mind when working with an interpreter include: Sit facing the person (“patient”) … Look at the person and maintain awareness of body language … Avoid looking at the interpreter unless you are directly addressing him/her … Don’t try to save time by asking the interpreter to summarize … It is not the interpreter’s role to lead the discussion.”

11. When may an interpreter lead the discussion with the patient

and the healthcare provider?

b. Never p. 11: “It is not the interpreter’s role to lead the discussion.”

12. Projections reveal that the U.S., population will be _____ Hispanic by 2050.

a. *30.2% p. 6: “Projections reveal the U.S., population will be 30.2% Hispanic by 2050.”

13. True or False: Like the overall U.S., population, the most prominent causes of death among Hispanics and Latinos are heart disease and cancer.

a. True p. 6: “Like the overall U.S., population, the most prominent causes of death among Hispanics and Latinos are heart disease and cancer.”


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14. Language barriers in the Hispanic population have been associated with

d. less preventative healthcare for Hispanic patients. p. 8: “Language barriers in the Hispanic population have been associated with less access to healthcare, preventive healthcare, and emergency services; decreased adherence to treatment recommendations; decreased quality of care; fewer interventions performed; fewer admissions; an increased number of medical errors; a greater number of poor outcomes, and; decreased patient satisfaction.”

15. Language barriers in the Hispanic population have been associated with greater

c. numbers of poor medical outcomes. p. 8: “Language barriers in the Hispanic population have been associated with less access to healthcare, preventive healthcare, and emergency services; decreased adherence to treatment recommendations; decreased quality of care; fewer interventions performed; fewer admissions; an increased number of medical errors; a greater number of poor outcomes, and; decreased patient satisfaction.”


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References Section

The reference section of in-text citations includes published works intended

as helpful material for further reading. Unpublished works and personal

communications are not included in this section, although may appear within

the study text.

1. The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. Oakbrook Terrace, IL: The Joint Commission, 2010. https://www.jointcommission.org/assets/1/6/ARoadmapforHospitalsfinalversion727.pdf. Accessed September 30, 2016.

2. Jaramarillo J, Snyder E, Dunlap JL, Wright R, Mendoza F, Bruzoni M. The

Hispanic Clinic for Pediatric Surgery: A model to improve parent-provider communication for Hispanic pediatric surgery patients. J Pediatr Surg. 2016;51(4):670-674.

3. American Community Survey Reports: Language Use in the United

States. August, 2013. http://www.census.gov/prod/2013pubs/acs-22.pdf. Accessed September 30, 2016.

4. United States Census Bureau. Quick Facts, United States. https://www.census.gov/quickfacts/table/PST045215/00. Accessed September 30, 2016.

5. Montie M, Galinato JG, Patak L, Titler M. Spanish-speaking limited English proficiency patients and call light use. Hisp Health Care Int. 2016;14(2):65-72.

6. Clayman, M.L., Manganella, J.A., Viswanath, K., Hesse, B.W. & Arora, B.N. (2010.) Providing Health Messages to Hispanics/Latinos: Understanding the Importance of Language, Trust in Health Information Sources, and Media Use, Journal of Health Communication: International Perspectives, 15(S3), 252-263.

7. McGuire, A.A., Garces-Palacio, I.C. & Scarinci, I.C. (2012.) A Successful Guide in Understanding Latino Immigrant Patients: An Aid for Health Care Professionals. Family & Community Health, 35(1), 76-84.


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8. Ortman JM, Guraneri CE, US Census Bureau. United States Population Projections: 2000 to 2050. http://www.census.gov/population/projections/files/analytical-document09.pdf. Accessed September 30, 2016.

9. United States Census Bureau. Overview of Race and Hispanic Origin: 2010. 2010 Census Briefs. http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf. Accessed September 30, 2016.

10. Becerra BJ, Arias D, Becerra MB. Low health literacy among immigrant

Hispanics. J Racial Ethn Health Disparities. 2016 Jun 20. [Epub ahead of print]

11. Morse E, Mitchell S. Language-appropriate appointment reminders: assessing the communication preferences of women with limited English proficiency. J Midwifery Womens Health. 2016 Aug 10. doi: 10.1111/jmwh.12494. [Epub ahead of print]

12. Calo WA, Cubillos L, Breen J, et al. Experiences of Latinos with limited English proficiency with patient registration systems and their interactions with clinic front office staff: an exploratory study to inform community-based translational research in North Carolina. BMC Health Serv Res. 2015 Dec 23;15:570. doi: 10.1186/s12913-015-1235-z.

13. Eneriz-Wiemer M, Sanders LM, Barr DA, Mendoza FS. Parental limited English proficiency and health outcomes for children with special health care needs: a systematic review. Acad Pediatr. 2014;14(2):128-136.

14. Gallagher RA, Porter S, Monuteaux MC, Stack AM. Unscheduled return visits to the emergency department: the impact of language. Pediatr Emerg Care. 2013;29(5):579-583.

15. Dunlap JL, Jaramillo JD, Koppolu R, Wright R, Mendoza F, Bruzoni M. The effects of language concordant care on patient satisfaction and clinical understanding for Hispanic pediatric surgery patients. J Pediatr Surg. 2015;50(9):1586-1589.

16. Fields A, Abraham M, Gaughan J, Haines C, Hoehn KS. Language matters: race, trust, and outcomes in the pediatric emergency department. Pediatr Emerg Care. 2016;32(4):222-226.


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17. Sasson C, Haukoos JS, Ben-Youssef L, et al. Barriers to calling 911 and learning and performing cardiopulmonary resuscitation for residents of primarily Latino, high-risk neighborhoods in Denver, Colorado. Ann Emerg Med. 2015;65(5):545-552.

18. Stoneking LR, Waterbrook AL, Garst Orozco J, et al. Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations? Adv Med Educ Pract. 2016;7:467-473.

19. Levas MN, Dayan PS, Mittal MK, et al. Effect of Hispanic ethnicity and language barriers on appendiceal perforation rates and imaging in children. J Pediatr. 2014;164(6):1286-1291.

20. Alas AN, Dunivan GC, Wieslander CK, et al. Health care disparities among English-speaking and Spanish-speaking women with pelvic organ prolapse at public and private hospitals: What are the barriers? Female Pelvic Med Reconstr Surg. 2016 Sep 16. [Epub ahead of print]

21. Ngai KM, Grudzen CR, Lee R, Tong VY, Richardson LD, Fernandez A. The association between limited English proficiency and unplanned emergency department revisit within 72 hours. Ann Emerg Med. 2016;68(2):213-221.

22. Juckett G, Unger K. Appropriate use of medical interpreters. Am Fam Phys. 2014;90(7):476-480.

23. Betancourt JR, Tan-McGrory A. Creating a safe, high-quality healthcare

system for all: meeting the needs of limited English proficient populations; Comment on "Patient safety and healthcare quality: the case for language access". Int J Health Policy Manag. 2014;2(2):91-94.

24. Civil Rights Act of 1964, Pub. L. 88-352, Title VI, Sec. 601, July 2, 1964, 78 Stat. 252.

25. Andreae MH, White RS, Chen KY, Nair S, Hall C, Shaparin N. The effect of initiatives to overcome language barriers and improve attendance: A cross-sectional analysis of adherence in an inner city chronic pain clinic. Pain Med. 2016 Jul 14. pii: pnw161. [Epub ahead of print]


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26. Karliner LS, Pérez-Stable EJ, Gregorich SE. Convenient access to professional interpreters in the hospital decreases readmission rates and estimated hospital expenditures for patients with limited English proficiency. Med Care. 2016 Aug 30. [Epub ahead of print]

27. Levine C. Use of children as interpreters. JAMA. 2006; 296(23):2802.

28. Jacobs B, Kroll L, Green J, David TJ. The hazards of using a child as an interpreter. J R Soc Med. 1995;88(8):474P-475P.

29. Code of Massachusetts Regulations. Section 105 - Public Health: Section 130.1105(D).

30. Nápoles AM, Santoyo-Olsson J, Karliner LS, Gregorich SE, Pérez-Stable EJ. Inaccurate language interpretation and its clinical significance in the medical encounters of Spanish-speaking Latinos. Med Care. 2015;53(11):940-947.

31. Lor M, Xiong P, Schwei RJ, Bowers BJ, Jacobs EA. Limited English proficient Hmong- and Spanish-speaking patients' perceptions of the quality of interpreter services. Int J Nurs Stud. 2016;54:75-83.

32. Arthur KC, Mangione-Smith R, Meischke H. Impact of English proficiency on care experiences in a pediatric emergency department. Acad Pediatr. 2015;15(2):218-224.

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