Nurses' Perceptions of Technology Used in Language Interpretation for Patients with Limited English Proficiency

Effective Use of Interpreter Services for Diverse Patients in a Safety-Net Hospital: Provider Perceptions of Barriers and Solutions

INTRODUCTION

Culturally and linguistically diverse (CALD) patients should but do not routinely receive professional interpretation. The authors examined provider perceptions of barriers and solutions to interpreter services (IS) in a safety-net hospital to inform quality improvement (QI).

METHODS

A 13-item survey was distributed to 750 clinicians representing 10 services across professional roles, including social workers. Closed- and open-ended questions addressed accessing IS, IS value, and care for CALD patients. Respondents ranked eight barriers to routine IS use and provided ideas for improvement. Descriptive statistics characterized survey results in aggregate and by professional role and care team. Quantitative and qualitative results were triangulated for agreement between survey domains and coded free-text response themes.

RESULTS

A total of 221 responses were analyzed (29.5% response rate). Cost was the lowest-ranked barrier across roles. Leading barriers were efficiency pressures and cumbersome access. Free-text responses agreed with these findings. CALD patients were perceived to have higher complication risk by 87.5% of social workers but by 56.8% of other roles. Recommendations to increase IS varied by team: streamlined access process (46.2% emergency, 37.8% inpatient respondents), expanded in-person interpretation (55.6% inpatient, 45.8% perioperative respondents), and better equipment (44.4% outpatient, 35.9% emergency, 25.0% perioperative respondents).

CONCLUSION

Provider experiences vary by care team and interpretation modality. Interpretation services are cumbersome to access and compete with efficiency pressures, leading to shortcuts that fail to provide adequate language access. Three initial QI efforts resulted: increased video interpretation equipment, a new language access committee, and a new language access leadership role.

Beyond technology acceptance-a focused ethnography on the implementation, acceptance and use of new nursing technology in a German hospital

Introduction

Hospitalised patients could benefit from the emergence of novel technologies for nursing care. There are numerous technical products available, but these rarely find their way into practice. Further knowledge is required about the circumstances under which technology in nursing is accepted and used. In the research project "Centre for Implementing Nursing Care Innovations", technical innovations are implemented on a trauma surgery inpatient ward in Germany. After implementation, it was investigated: Which implemented technologies are accepted/rejected, and which factors influence the acceptance/rejection of technology for nurses?

Material and methods

A focused ethnography was used, containing two approaches: First, participant observation was conducted to examine nurses' and patients' interaction with technologies. Observations were fixed in a field research diary and analysed using evaluative qualitative content analysis. Second, a questionnaire was used by nurses to provide information about the use frequency and technology suitability. The results of the study were consolidated and analysed using the UTAUT model.

Results

Seven studied technologies can be summarised in four result categories: (1) A Mobilising mattress, a Special projector and a Sound pillow are accepted and used by nurses and patients, because they offer a way to provide high quality care with little additional effort. (2) A Fall prevention system is consistently used in patient care as a work obligation, but since nurses consider the system error-prone, acceptance is low. (3) An Interactive therapy ball is accepted but nurses cannot use it due to the high workload. (4) An App for nurse-patient communication and a work-equipment tracking system are not used or accepted because nurses do not see a practical benefit in the systems.

Discussion

Acceptance or rejection of a product does not necessarily equate to use or non-use of the technology. Before implementation, technology acceptance among users occurs as prejudice-when users are given time to experiment with technology, intention-to-use can stabilize into sustained use. Accepted and used technologies can serve to mask problems (such as staff shortages) and encourage problematic developments, such as the reduction of contact time at the bedside. Therefore, technology acceptance should be qualified in asking to what accepted technology contributes.

A Public Health Ethics Framework for Populations with Limited English Proficiency

25.6 Million people in the United States have Limited English Proficiency (LEP), defined as insufficient ability to read, write, or understand English. We will (1) Delineate the merits of approaching language as a social determinant of health, (2) highlight pertinent public health values and guidelines which are most relevant to the plight of populations with LEP and (3) Use the COVID-19 pandemic as an example of how a breakdown in public health ethics values created harm for populations and patients with LEP. We define a framework to tease out public health responsibilities given some populations' limited proficiency in a society's predominant language. The American Public Health Association (APHA) public health ethics core values serve as a framework to interrogate current practices. We use the COVID-19 case to illustrate gaps between health policy and healthcare disparities experienced by populations with LEP.

Perceptions and Use of Telehealth among diverse communities: A Multisite Community Engaged Mixed Methods Study

BACKGROUND

Telehealth has been increasingly adopted by healthcare systems since the start of the COVID-19 pandemic. Although telehealth may provide convenience for patients and clinicians, there are several barriers to accessing it and using it effectively to provide high quality patient care.

OBJECTIVE

This study, was part of a larger multisite community engaged study conducted to understand the impact of COVID-19 on diverse communities. The work described here explored the perceptions of and experience with telehealth use among diverse and underserved community members during COVID-19.

METHODS

We used mixed methods across three regions in the US (Midwest, Arizona, and Florida) from January 2021-November 2021. We promoted our study through social media and community partnerships, disseminating flyers in English and Spanish. We developed a moderator guide and conducted focus groups in English and Spanish mostly using a videoconferencing platform. Participants were placed in focus groups with others who shared similar demographic attributes and geographic location. Focus groups were audio-recorded and transcribed. We analyzed our qualitative data using the framework analytic approach. We developed our broader survey using validated scales and with input from community and scientific leaders and distributed it through social media in English and Spanish. We included a previously published questionnaire which had been used to assess perceptions about telehealth among patients with HIV. We analyzed our quantitative data using SAS software and standard statistical approaches. We examined the effect of region, age, ethnicity/race and education on use and perceptions of telehealth.

RESULTS

We included data from 47 focus groups. Due to our mode of dissemination, we cannot calculate a response rate for the survey. However, we received 3447 English language and 146 Spanish language responses. Over 90% of participants had internet access and 94% had used telehealth. About half of all participants agreed or strongly agreed that telehealth would be beneficial in the future because it better fit their schedules and they would not need to travel. However, about half also agreed or strongly agreed they would not be able to express themselves well and could not be examined when using telehealth. Indigenous participants were especially concerned about these issues when compared to other racial groups.

CONCLUSIONS

This work describes findings from a mixed methods community engaged research study about telehealth including perceived benefits and concerns. Although participants enjoyed the benefits of telehealth (not having to travel and easier scheduling) they also had concerns (not being able to express themselves well and not having a physical exam) about telehealth.. These sentiments were especially notable among the Indigenous population. Our work highlights the importance of fully understanding the impact of these novel health delivery modalities on the patient experience and actual or perceived quality of care received.

CLINICALTRIAL

Prevalent practices amongst healthcare professionals in paediatric settings in using medical interpreters for families with limited national language proficiency: A narrative scoping review

Background

Where language barriers exist, trained medical interpreters provide more accurate and comprehensive communication between clinicians and service users compared to ad hoc interpreters or no interpreter at all. The nature and extent of research evidence about when and how medical interpreters are used by health professionals in paediatric settings to mediate communication with families who do not speak the national language proficiently have not yet been published.

Aim

To examine the potential size and scope of available research literature about the prevalent practices of healthcare professionals in using medical interpreters in paediatric settings for families with limited national spoken language proficiency.

Methods

We used an established framework for scoping reviews, including suggested modifications by JBI. Precise eligibility criteria were identified, and a comprehensive search strategy was applied. Sources of evidence were confined to primary research that spoke specifically to the research question. The process of study selection and results are presented narratively and in tabular form. Two reviewers independently engaged in the screening process, and two reviewers undertook a full paper review of the included articles, with a third consulted where an additional opinion was required.

Results

We included 21 studies published between 2000-2022, most using (quantitative) survey methods. Key results captured in six themes are as follows: medical interpreters tended to be underused by health professionals, especially nurses; time was the greatest impediment to their use, but so too were difficulties with the perceived quality of interpreter services; technology was used for medical interpreting at some study sites with mixed responses; use of unauthorised interpreters was widespread; language barriers impacted on the care provider and family relationship; and cost of interpreter services tended not to be reported as a barrier to their use.

Conclusions

Further scholarship is needed to understand the use of medical interpreter services with reference to the complexity of health work, as well as the social context of inequality for many families with limited national language proficiency accessing paediatric healthcare. Recent developments in video technology offer promise in improving interpreter use but require oversight for quality. We have highlighted the need for better training for and regulation of medical interpreters and clinical guidelines on the use of interpreters by healthcare professionals.

Psychometrics of Nurses' Perceptions of Technology Effectiveness Scale

BACKGROUND

When evaluating new technology designed to improve patient care quality and safety in the clinical setting, researchers need instruments with evidence of reliability and validity. This secondary analysis aimed to examine the reliability and validity of the Positive and Negative Effectiveness of Technology Use (PNET) instrument.

METHOD

A sample of 71 nurses evaluated the current telephone interpretation system in use for persons with limited English proficiency. Internal consistency reliability using Cronbach's alpha and construct validity using factor analysis tests were assessed.

RESULTS

Both positive and negative scales of the PNET instrument had adequate internal consistency reliability coefficients (α > .70) and evidence of construct validity; however, some items on the negative effectiveness scale may need to be revised.

CONCLUSION

The PNET scales may be useful in assessing nurses' views of existing and new technologies for quality improvement in the practice setting. [J Contin Educ Nurs. 2021;52(5):248-252.].