Mini Case Study - Culture & Ethnicity

A 67-year-old patient is brought to the emergency room at 0230 for injuries received in a motor vehicle accident. Her husband died in the accident. She is alert, oriented, and only speaks Russian. No one at the hospital speaks Russian. Several diagnostic tests are needed immediately to determine the extent of her injuries. Internal bleeding and other potential life-threatening injuries are suspected (BP 98/60, P120).

• Discuss whether informed consent can be waived.
• What options are available to assist the patient?
• What should be your initial actions?

The patient is alert and oriented; thus, informed consent is needed for invasive diagnostic tests. The inability to speak the patient’s language (Russian) does not override the need to obtain informed consent. The nurse and providers must determine how best to explain the procedure, reasons for the procedure, pre- and post-procedure care, alternatives, and possible complications.

Thinking: Explore the various options that are available to communicate with the patient in her language, focusing, in order, on those that will be most effective to ensure safe effective nursing care. The best is to have a bilingual  healthcare provider. Because this is not an option, an interpreter should be obtained for the patient. Several computer-based translation tools and software available. In addition, many companies offer 24 hours, 7 days per week telephone translators.

Doing: Given the situation, immediate actions are needed. Explore interventions that will promote patient safety, while addressing the immediate concerns. Students may provide medical/nursing interventions (e.g., intravenous fluids, comfort measures). Focus students back to the need to establish communication as a safety measure. The nurse’s initial action should be to review the hospital policies and procedures on translation services/language interpreters or contact the on-call social services representative to determine the available resources. The nurse can delegate this task if needed. The Joint Commission (2010) views the communication as an essential component of patient care; thus, accredited healthcare facilities must have policies and procedures for communicating with clients who require translation services. Pictures and other methods of non-verbal communication can be used until an interpreter is obtained. The nurse can use computer software to translate basic words, such as pain, intravenous fluids, etc.