Guidelines for health staff

Minimising the risk.

If you assess that there is a risk for miscommunication you should:

Engage a registered interpreter from the appropriate language group (interpreters are available in many Aboriginal languages through the Aboriginal Interpreter Service which provides access to interpreters throughout the NT - ring 89998353 anytime. To book an interpreter at RDH ring the RDH switchboard).

If you do not share the patient's language or cultural background then you need an interpreter to achieve effective communication with your patient and their family. You have a professional responsibility to ensure effective communication - and it is important that you are able to recognise when the help of an interpreter is necessary. The decision about whether or not an interpreter is required should therefore not be left entirely to the patient /family.

Make sure the patient/ family have the opportunity to make an informed choice about whether or not an interpreter is needed.

Simply asking the patient / family if they want an interpreter can be ineffective for a number of reasons:

• the patient / family may not be aware of the risk for miscommunication (many staff and patients assume that proficiency in conversational English is adequate for medical interactions - this is a dangerous assumption)
  
• the patient / family may feel ashamed of admitting to limited English proficiency
  
• the patient / family may have no idea of what an interpreter is, or they may have concerns about the interpreter's role, impartiality and / or confidentiality

The patient / family need to understand the role of the interpreter to make an informed decision about their involvement - this may need to be explained in the patient's preferred language (by the interpreter, another appropriate language speaker, or by using a video or tape about interpreters).

Avoid using untrained family members (or patient escorts) as 'interpreters' - this is unethical and unsafe

If a family member or escort is a registered interpreter then they may be employed if this is appropriate based on their relationship to the patient - a registered interpreter should be formally engaged (and paid) for their work, even if their involvement is opportunistic - this is a simple process - fill in the appropriate form and return it to the AIS.

Do not assume the patient / family shares your understanding of common Western cultural concepts - even if they seem to be fluent in conversational English.

Many concepts you take for granted may be understood very differently by people from other cultures e.g. causality, function of the heart or other organs, action of medication or other treatments and other important concepts related to time, quantity, frequency etc.

Learn about the extent to which your communication (in style and content) is culturally specific - and therefore not necessarily shared by people from other cultures.

Learn about how to work effectively with an interpreter. Click here for suggestions or see below.

Develop your cultural competence. Click here for more information

Identify and address systemic barriers to effective communication Click here for more information

Locate (or develop) resources in Indigenous languages to assist your discussions with patients and their families (videos, tapes, translated texts e.t.c)

Practice good communication strategies. For example:

• talk to the patient, not the interpreter, and encourage the patient to talk directly to you (arrange seating to facilitate this)
• do not speak too quickly (or too slowly)
• keep your sentences short: one idea or question at a time
• pause frequently and allow sufficient time for translation and/ or questions
• avoid complex grammar but do use standard English (not 'broken English')
• repeat the same information in different ways
• avoid over-simplification of information: detailed explanations are important if the patient / family are to make genuinely informed choices about their health care (with the assistance of an interpreter this can be achieved)
• avoid metaphors which are culturally specific e.g. clock and calendar references to time, quantification in terms of percentages, grams or litres e.t.c
• fully explain terms and processes in plain English
• encourage the interpreter to interrupt when clarification or repetition of information is needed
• provide opportunities for the patient / family to use their preferred communication style e.g. ask them to tell their story rather than using question and answer routines which are can be uncomfortable/ unfamiliar / ineffective
• avoid questions that require a yes/no response
• learn about different linguistic and politeness conventions which could cause confusion e.g. in some cultures it is polite to give the answer you think the person wants to hear: a patient may say 'yes' to a request for consent to a procedure even though this is not what they want, then does not attend for the procedure as this is their culturally appropriate way to communicate refusal.
• WAIT: pause times are very different across cultures; some people might need a few minutes before they are ready to respond to a request or question or to continue a story.. just be patient - you'll get used to it..
• check frequently to check the message has been understood - both the patient's understanding of your message and your understanding of the patient's message (asking 'do you understand is notan effective way to do this).
  

Click on the links below for other guidelines on working with interpreters:

http://www.ethnomed.org/ethnomed/clin_topics/intrprt.html

http://www.health.qld.gov.au/multicultural/pdf/guideto.pdf