Chapter 12: Experiential Learning Project: Implementation

Working with Translated Materials and Interpreters

Translation and interpretation are two different processes used to exchange information from one language to another. For both, a thorough knowledge of cultural and linguistic differences is necessary to effectively communicate meaning. Translation involves written communication, in which written text in one language is converted into written text in another language. Interpretation, on the other hand, involves oral communication, in which the words spoken in one language are rendered into another language in real time. Because of the difficulties presented by the live setting, interpretation can be more challenging than translation, such as when the speakers use the wrong words, correct themselves, or use local dialects. Furthermore, unlike the translation process, interpreters lack the ability to review the text or go back and listen again. These disadvantages can make it more difficult for interpreters to accurately convey the meaning of the message.

In any clinical setting, it is critical to use certified medical interpreters, professionals trained in the use of medical terminology, cultural awareness, and ethical conduct. The interpreter should be treated as a respected professional, and extra time should be allotted for messages to be conveyed and understood. The environment should be free of distractions, and the interpreter should be provided with a summary of the client’s background, goals, and needs for the session. The name of the interpreter should be clearly documented.

When working with a client who needs an interpreter, the nurse should speak directly to the client rather than addressing the interpreter, even if the client makes eye contact with the interpreter. The nurse should observe and monitor nonverbal communication. Sentence-by-sentence interpretation and clear, simple language without medical jargon will ensure that the nurse and interpreter convey all important information to the client. The interpreter may ask open-ended questions to establish rapport or clarify client statements; during these times, the nurse should avoid interrupting the interpreter. Finally, near the end of a visit, the nurse should use the “teach-back” method to confirm that the client understands the directions and recommendations.

As a student or professional nurse, you may find yourself in a situation where a certified medical interpreter is not present. In these situations, it is critical to follow organizational policy and consult with leadership to locate or access remote interpretation services. Family members or friends should never be used as interpreters under any circumstances. The reasons for this are many, including a potential lack of accuracy, violation of privacy, potential conflicts of interest, and ethical and legal concerns.

Developing Culturally Tailored Materials

Nurse scientists have made significant contributions to the development and implementation of culturally tailored materials and interventions to address the specific needs of different cultural groups and to improve their engagement and outcomes. According to nurse researcher Miyong Kim, adapting materials and interventions to respond to a client’s or population’s cultural needs should consider eight domains: 1) audience, 2) language, 3) contents, 4) context, 5) concepts, 6) metaphors, 7) methods, and 8) goals (Kim et al., 2022). For example, culturally tailored materials use language, content, and ideas that reflect the values and traditions of the targeted cultural group; align with belief systems; and frame outcomes within the customs and traditions of the targeted group.

When a professional nurse designs a culturally tailored intervention, they first identify the cultural group on which the intervention will focus. This may be a specific ethnic or racial group, a religious group, a linguistic group, or any group that has unique customs, experiences, or perspectives. So that the intervention is appropriate, acceptable, and effective, research is needed to understand the beliefs, values, and practices related to the issue being addressed (Im & Chee, 2021). This research may involve adapting an existing intervention or creating new ones, using culturally appropriate materials such as visuals, activities, and language that are respectful of the culture. Members of the targeted cultural group are often involved to ensure that the intervention is tailored to their needs (Kim et al., 2022). Involving multiple community members in the review process can help create buy-in and awareness.

The U.S. Department of Health and Human Services has developed a strategy to create culturally tailored interventions using the mnemonic CAPABLE, in which each letter represents a consideration related to the best ways to meet a community’s needs when developing educational materials (Kelly et al., 2007):

• Colors: Do the colors used have special significance for the target population?
• Art: Are the images appropriate for and reflective of the target population?
• Paper: If the materials are printed, is the paper easy to handle and read, and is its size appropriate for the target population?
• Access: Will the materials be placed in physically accessible locations? Should the information be provided electronically?
• Buy-in: Were members of the target population involved in developing or reviewing the materials? If so, do they endorse them?
• Language: Are the words in a type size most people will be able to read? Is the content easy to comprehend, appropriate for the community being served, and written at a level most readers will understand?
• Evaluation: What changes are needed to meet the needs of the target population?

After the intervention, the nurse should survey community members for feedback or observe health behaviors and outcomes to evaluate the impact of any changes made as a result of the materials. The findings would then be used to inform any revisions or additions to the materials.

12.4 Developing Partnerships to Support Organizational Cultural and Linguistic Competence

Cultural and linguistic competence within health care organizations is essential for delivering effective and equitable care to diverse populations. Community health nurses play a pivotal role in this endeavor by developing partnerships with various concerned parties (Handtke et al., 2019) and can use the following strategies:

1. Assessing Community Needs
   • Engaging with the community: understand the unique cultural and linguistic needs of the community through direct engagement.
   • Using existing research: analyze data and existing studies that identify cultural and linguistic gaps in care.
2. Collaboration with Key Community Partners
   • Identifying partners: engage with community leaders, cultural organizations, educational institutions, and other health care providers.
   • Defining shared goals: develop common objectives aligned to the community’s cultural and linguistic needs.
3. Implementing Cultural and Linguistic Training:
   • Developing curricula: create training programs that enhance cultural awareness and linguistic skills.
   • Promoting ongoing education: encourage continuous learning through workshops, seminars, literature, and online resources.
4. Leveraging Technology:
   • Using language assistance tools: implement technology that facilitates effective language translation and interpretation.
   • Promoting telehealth services: ensure that virtual health care platforms accommodate individuals with diverse linguistic needs.
5. Policy Advocacy:
   • Supporting legislative initiatives: advocate for policies that promote cultural and linguistic competence at local, state, and national levels.
   • Aligning with accreditation standards: ensure that practices align with standards set by accrediting bodies.
6. Evaluating and Adapting Strategies:
   • Monitoring outcomes: regularly assess partnership initiative effectiveness via feedback and data analysis.
   • Iterating strategies: continuously refine and adapt strategies to meet evolving community needs.

Developing partnerships to support organizational cultural and linguistic competence is a dynamic and multifaceted process. Community health nurses, in collaboration with various community partners, can spearhead efforts to ensure that health care delivery aligns with the diverse needs of the communities they serve. Through thoughtful engagement, education, advocacy, technology utilization, and continuous evaluation, health care organizations can create an environment that truly resonates with all members of the community.