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Resources & Education

It takes practice to work effectively with an interpreter, captioner or translator.

Provincial Language Services has developed best practice tips and education that will help create a smooth, seamless appointment.  

Best practice tips

Working effectively with interpreters and captioners

Interpreters and captioners are trained language professionals who help facilitate communication between the patient and the health care provider. Working effectively with an interpreter or captioner takes a bit of know-how and skill. 

 
  • Set up the session by clarifying the roles and responsibilities of the interpreter:
    • Introduce yourself 
    • Brief on the objectives of the session
    • Ask them to introduce themselves to the client and to inform the client that: 
      • Everything said will be interpreted
      • Interpreters are bound by confidentiality
      • Interpreters are impartial
  • Speak in first and second person as you would in normal conversation when speaking with a patient in English, i.e. “Do you have a fever?” rather than “Ask her if she has a fever.”
  • After speaking two to three sentences or finishing a thought, pause to give the interpreter time to interpret. 
  • Ask the patient questions to ensure they understand what was communicated. Avoid missing non-verbal details from the patient by asking questions in different ways. 
  • Articulate clearly and ask others to do the same. Encourage the patient to speak slowly.  
  • Use plain language by avoiding the use of idioms or jargon. These words or phrases may confuse the patient and do not allow an interpreter to convey the message accurately and completely.
 

 

Do

  • Consider your communication style with an English-speaking patient and try to emulate that as much as possible with your patients who communicate in languages other than English, or with Deaf, Deaf-Blind and Hard of Hearing patients.
  • Speak in clear, concise sentences.
  • Speak directly to the patient, not the interpreter or captioners, using  the second person (e.g. ‘what is your address?’ vs. ‘ask them what their address is’)
  • Control the conversation.
  • Provide simple but full explanations.
  • Ask questions if you don’t understand, and allow the client and the interpreter or captioners to do the same.
  • Allow time after each sentence for the interpreter to interpret what you have just said.
  • Be patient – interpreted sessions will take longer than sessions in English.
  • Make sure the client understands.

Don’t

  • Don’t ask questions of the interpreter/captioners about the patient.
  • Don’t use idioms, technical terms or acronyms.
  • Don’t expect the interpreter or captioner to frame questions or explanations.
  • Don’t ask the interpreter or captioner to step outside their role.
  • Don’t ask the interpreter or captioner to summarize or give explanations.
An ideal interpreter and captioner encounter is one in which the interpreter/captioner is unobtrusive and acts only as a conduit of the message between the patient and provider. 

 

Informed consent is a communicative process between a patient and health care provider in which treatment explanations are provided, and risks associated with such treatments are explained.


This process allows an opportunity for a patient to ask questions. It culminates with the patient signing a health authority consent form that states he/she is informed and understands the treatment and risks. Obtaining informed consent is an ethical and legal obligation.   


According to the Health Care Consent Act (HCCA), the four legal requirements for informed consent are that:

  • The patient must be capable
  • Consent must be voluntary  
  • Consent must be informed
  • Consent must be treatment specific

Lack of informed consent in clinical practice can cause:  

  • Health events with adverse effects
  • Extends the length of hospital stay
  • Inappropriate use of testing
  • Unauthorized procedures such as surgeries

Consent documents  

  • Should not state that the interpreter translated the information
    • Translation refers to the written rendering of a language.
  • Should not be sight translated by the interpreter
    •  Sight translation I s the oral rendering of written text from one language into another.
  • It should be interpreted which implies that in addition to the interpreter, the health care provider and patient are involved
    • As stated above, informed consent is completed by a health care provider with the assistance of an interpreter
  • Should not include a section in which the interpreter indicated the patient understood the information given as interpreters canon attest to whether the patient understood
    • An interpreter can only attest that the interpreting was delivered faithfully and that the use of vocabulary, language structure, syntax, etc. when going from source to target language was appropriate.
  • Should include a section that indicates an interpreter was used

 
Informed consent as a communicative process between the patient and the health care provider allows for an opportunity to ask questions. Informed consent is an integral, ethical and legal component of the treatment process therefore, language barriers that negate informed consent must be addressed. For B.C.'s population who communicate in languages other than English, informed consent for procedure or participation in clinical trials can only be achieved by using an interpreter. 

The need for an interpreter is even more pronounced in the clinical trials as, in addition to the information exchange being more substantive (i.e. the study objectives, participant expectations, expected benefits, what is known or unknown about the drug or procedure, etc.), the trials in‐ form future treatment processes and drug utilization. If population groups are excluded due to language barriers, the number of eligible participants is reduced, and the study results are not inclusive of the diversity of the population. 

Without an interpreter, an inequity prevails as one group is allowed access to treatment while another is robbed of the same. Disease and illness are not impeded by languages barrier; opportunities for treatment should not be either.  


When working with an interpreter, health care providers should consider what their role would be if the patient were an English speaking patient and remember that their role does not change in an interpreter‐assisted appointment. It is essential to maintain control of the session and cultivate a relationship with the patient, not the interpreter.  


It is always best practice to meet the interpreter a few minutes ahead of time for four main purposes:


  • Briefly identify who you are and your role with the patient
  • Provide a brief overview of the nature of the study and the types of terminology that might be used
  • Provide general information about the nature of the session.
  • Review your expectations of the process

Tips for during the session:

  1. Have all parties introduce themselves.
  2. Explain the role of the interpreter to the client. Position yourself to maintain eye contact with and talk directly to the client.
  3. Use the first/second person 'I" and "you" rather than "him/her."
  4. Avoid jargon, technical terms and idioms.
  5. Keep statements short.
  6. Keep control of the conversation.
  7. Do not ask the interpreter to speak as a cultural liaison.  
  8. If you and the interpreter need a conversation to explain terms or for clarification, ask the interpreter to explain to the patient the nature of the exchange

 

Using apps, computer programs and other resources to communicate with patients with low English proficiency.

Many apps and programs support communication with patients with low English proficiency. Effective communication with patients is extremely important. However, these electronic and digital tools are not recommended for use within the healthcare setting. While some of these tools may seem helpful for communicating very simple messages, they can be risky.


All available machine translation or interpreting devices that are currently available pose a risk of misinterpretation. While misinterpretation can also occur with human-to-human interpreting, machine interpreting does not include the same opportunities for clarification that human-to-human interpreting provides.


Here are some questions that will also help you think about how a specific tool might be helpful or harmful in your work:

  • Are there positive reviews in the literature from users of this tool? Are any negative impacts of using the tool described?
  • Do you have sufficient information about how/when the tool should be used in order for it to be safe and effective?
  • Was the tool developed in consultation with, or at least tested by, those who would use it in a healthcare setting?
  • Was the tool reviewed by language and communication experts?
  • Does the tool protect patient confidentiality as per the PHSA Privacy and Confidentiality Policy (PDF)?
  • Do the images and functions included in the tool seem culturally appropriate for the patient?
  • Does the tool address any issues for which consent is needed? Professional interpreters should always be used when discussing issues that need consent with patients with low English proficiency.
  • Are you confident that the tool uses the appropriate dialect, tone and language for your patient?
  • Does the tool seem to be sufficiently patient-centred, rather than solely allowing for the care provider to receive some of the information they want?
  • Does the tool transfer any information directly into a patient's chart? This should never occur—all information that is input into a chart should be reviewed by a human for accuracy.
Do
  • Consider your communication style with an English-speaking patient and try to emulate that as much as possible with your limited English proficiency or with Deaf, Deaf-Blind and Hard of Hearing patients.
  • Speak in clear, concise sentences.
  • Speak directly to the patient, not the interpreter or captioners, using  the second person (e.g. ‘what is your address?’ vs. ‘ask them what their address is’)
  • Control the conversation.
  • Provide simple but full explanations.
  • Ask questions if you don’t understand, and allow the client and the interpreter or captioners to do the same.
  • Allow time after each sentence for the interpreter to interpret what you have just said.
  • Be patient – interpreted sessions will take longer than sessions in English.
  • Make sure the client understands.
Don’t
  • Don’t ask questions of the interpreter/captioners about the patient.
  • Don’t use idioms, technical terms or acronyms.
  • Don’t expect the interpreter or captioner to frame questions or explanations.
  • Don’t ask the interpreter or captioner to step outside their role.
  • Don’t ask the interpreter or captioner to summarize or give explanations.

An ideal interpreter and captioner encounter is one in which the interpreter/captioner is unobtrusive and acts only as a conduit of the message between the patient and provider. 
Education & training

On-line training

LearningHub

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Training

Access and Audism: Creating Cultural Appropriate Access to Care

Deaf, Deaf-Blind and Hard of Hearing Cultural Sensitivity Training for health care provider participants address the critical aspect of Deaf, Deaf-Blind and Hard of Hearing Culture and audism. It will strengthen the skills of health care providers who work directly and indirectly with Deaf, Deaf-Blind and Hard of Hearing people ensure they have access to culturally safe care and services.

Provincial Language Services in-service training

Learn about the full suite of Provincial Language Services offerings and which service approach best meets your specific clinic needs. 

Please contact Provincial Language Services to arrange training. 
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