English Language Learners Needs

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Purpose of this Educational Project:To advocate that hospitalized Hispanic, limited English proficiency (LEP) patients are provided a language assessment upon admission with referral for language assistance resources, as needed, to be able to fully understand and participate in their own healthcare.

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Upon Completion of this Section the Learner will be able to:
  • State 2 reasons why limited ability to speak and understand English is a barrier to being fully able to participate in ones own healthcare and health care decisions
  • State 2 Hispanic/Latino cultural beliefs or practices regarding healthcare practices
  • State 3 questions to initiate a language assessment
  • Describe resources available to provide language assistance

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Overview and Description of the Problem:

There is an increasing Hispanic population in the United States, it is currently the largest minority group in the US. Many of these people come from Mexico or other central or South American countries. Their ability to speak English is limited at times and when they are hospitalized this impacts their ability to fully participate. Sometimes these patients are men who are far from family, especially female family members who traditionally provide and manage healthcare needs. Additionally, studies have shown that healthcare providers, at times, lack an awareness of cultural issues and overestimate these patient's ability to speak and understand English. Finally, there are financial restrictions which impact the provision of translation and other language assistance services.

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Key points
Background Information:
  1. The Hispanic population in the United States is the largest minority in the US; it numbers nearly 47 million. It is the fastest growing US minority group as well.
  2. More than one in twelve US residents speak Spanish at home, and approximately half of these people report not speaking English "very well".
  3. Limited English proficiency or an inability to fully speak and understand English has been identified as a barrier to health and access to healthcare.
  4. Cultural Hispanic themes of respect, importance of family, patriarchial respect for medical practioners and folk remedies affect response to caregiving and compliance with instructions.
  5. US Department of Health and Human Services, Healthy People 2010 Project's second overarching goal is to eliminate health disparities among different segments of the population.
  6. The Health Insurance Portability and Accountability Act (HIPAA) limits family members from serving as interpreters due to confidentiality issues.
  7. The Americans with Disabilities Act states that patients will have language accomodations in the health care setting.
  8. In order to assure full and equitable access to healthcare services for Hispanic hospitalized patients and as part of the admission assessment, a language assessment should be performed followed by referral, as needed, for language assistance, i.e interpreter, phone based interpreter service or other appropriate resource.
  9. The assessment must be documented in the medical record and the results communicated to healthcare providers.

  • Albert Bandura, Social Learning Theory
    • This theory addresses the impact of social factors and the social context in which learning occurs. Included are concepts of role modeling and reinforcement. This theory can be used to support educational efforts to nursing and other healthcare personel where new knowledge is provided and a heightened awareness develops whereby the full understanding of the need for a language assessment occurs.

http://www.youtube.com/watch?v=byhLPxT_FJQ Bandura video

  • Madeleine Leininger, Culture Care Theory
    • The goal of this theory is to improve and to provide culturally congruent care that is useful to people and culturally appropriate. This theory also supports a recognition and respect of cultural diversity and the need incorporate these attitudes into the delivery of healthcare.

http://www.nipissingu.ca/faculty/arohap/aphome/NURS3036/Resources/Leiniger.ppt#256,1,Madeleine Leininger’s

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Self Assessment

Learner Self Assessment:Three Questions
  1. Have you ever tried to speak with a patient who seemed to not fully understand English but then thought you could "get by" with simple words and gestures?
  2. Have you ever used a family member to translate for a patient who spoke no English, maybe this was a minor child?
  3. Do you ever experience difficulty obtaining interpreter assistance for your patients?

Consider your answers to the above questions and reflect on how an increased awareness of the issues related to language barriers for the hospitalized patient on the part of the nurse and other health care providers can lead to a decision to first assess the patient and then appropriately provide language assistance and to advocate for more language assistance resources when the current resources are not adequate

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Patient Assessment Resources
  • In order to fully address the language needs of Hispanic, limited English speaking hospitalized patients a language assessment should be conducted as early in the hospitalized stay as possible. Without an assessment, there is much variability and no certainty that these patients needs are being addressed. An accurate, comprehensive and documented assessment of language and communication needs is crucial at the initial point of contact in a healthcare setting. Additionally, determining limited English profiency (LEP) and the need for an interpreter or language assistance is important in coordinating an appropriate and safe plan of care.
  • To initiate a valid language assessment, patient self-reporting is an important first step. Three questions can form the basis of an initial language assessment:
      1. What language does patient speak at home?
      2. What language is patient most comfortable speaking when recieving healthcare?
      3. Does the patient need an interpreter for health care?
  • It is imperative that these results be documented and communicated to all other healthcare staff.

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JCAHO Video : Improving Patient-Provider Communication

This video discusses the importance of communication in patient and healthcare provider encounters. It discusses the issues of safety, language accomodation and culturally appropriate care. http://www.jointcommission.org/PatientSafety/HLC/video_improving_pt_provider_comm.htm

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Overview of this Educational Module

This educational module has discussed the ongoing situation where Hispanic limited English proficiency (LEP) patients are hospitalized and their language assistance needs may not be fully noted. A self assessment portion was included to assist learners in reflecting on this issue and their past experiences. This module has also addressed the need for an initial language assessment to determine if there is a need for language assistance. Lastly this module, has provided a brief, simple, but untested tool for use in an initial language assessment. There are also a number of online resources which may be helpful as well.

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Web Resources

Resources for Language Assistance:


  • Coffman, M. J., Shellman, J., & Bernal, H. (2004). An integrative review of american nurses percieved cultural self-efficacy. Journal of Nursing Scholarship, 36(2), 180-185. Retrieved from Retrieved November 14,2009 from CINAHL Plus with Full Text database.
  • Collins, A. S., Gullette, D., & Schnepf, M. (2004). Break through. Nursing Management, 35(8), 34-38. Retrieved November 14, 2009 from
  • Dubard, C., & Gizlice, Z. (2008). Languages spoken and differences in health status, access to care, and reciept of preventive services among US Hispanics. American Journal of Public Health, 98(11), 2021-2028. Retrieved from Retrieved November 1, 2009 from CINAHL Plus with Full Text database.
  • Gordon, S. M. (1994). Hispanic cultural health beliefs and folk remedies. Journal of Holistic Nursing, 12(3), 307-322. Retrieved from http://jhn.sagepub.com/cgl/content/abstract/12/3/307
  • Jacobs, E. A., Shepard, D. S., Suaya, J. A., & Stone, E. (2004). Overcoming language barriers in health care:costs and benefits of interpreter services. American Journal of Public Health, 94(5), 866-869. Retrieved from Retrieved November 25, 2009 from CINAHL Plus with Full Text database
  • Mayo, R. M., Sherrill, W. W., Sundareswaran, P., & Crew, L. (2007). Attitudes and perceptions of hispanic patients and health care providers in treatment of hispanic patients:a review of the literature. Hispanic Health Care International, 5(2), 64-72. Retrieved September 20, 2009 from CINAHL Plus with Full Text database.
  • McFarland, M. (2006). Madeleine Leininger:Culture care theory of diversity and universality. In A. M. Tomey & M. R. Alligood (Eds.), Nursing theorists and their work (pp. 472-496). St.Louis, Missouri: Mosby Elsevier.
  • Morales, L. S., Lara, M., Kingston, R. S., Valdez, R. O., & Escarce, J. J. (2002). Socioeconomic,cultural and behavioral factors affecting Hispanic health outcomes. Journal of Health Care for the Poor and Underserved, 13(4), 477-503. Retrieved from Retrieved November 21,2009 from Research Library. (Document ID:1429518511).
  • Nailon, R. E. (2007). The assessment and documentation of language and communication needs in healthcare systems:current practices and future directions for coordinating safe,patient-centered care. Nursing Outlook, 55(6), 311-317. Retrieved from Retrieved November 24,2009 from CINAHL Plus with Full Text database.
  • Zun, L. S., Sadoun, T., & Downey, L. (2006). English-language competancy of self-declared english speaking hispanic patients using written tests of health literacy. Journal of the National Medical Association, 98, ( 6), 912-917.