Chapter 2

One of the first major findings that is relevant in this case is the fact that this patient does not speak English. Proper communication is key to establish rapport with patients and provide a thorough nursing assessment. Patients who do not speak English as their preferred language should be provided with a trained medical interpreter or interpreting service to ensure that communication is clear. It is not appropriate for a family member, particularly a young child, to interpret for a patient due to the mature and complicated medical content, medical terminology, and risk for inaccurate interpretation. Although nonverbal communication, such as hand gestures and body language, can be used during the assessment, an experienced healthcare interpreter will ensure that a thorough nursing assessment can be conducted. The patient is also grabbing at her ear, which is an example of nonverbal communication.

More information should be obtained about the patient’s reported ear pain. The nurse should perform a focused pain assessment, determining if the pain is constant, what it feels like, and whether anything makes it better or worse. Additionally, the nurse should inquire about the cough. Specifically, the nurse should ask how long the patient has had the cough, if anything makes it better, and if she has ever had a similar symptom, such as during the two occasions when she had COVID-19. The nurse should also ask the patient about any history of hypertension diagnosis or treatment, as her blood pressure reading is slightly elevated at this visit.

The main factor that makes communication between the nurse and patient difficult is the language barrier. Additionally, while the son is attempting to help interpret, it is hard to know if the interpretation is accurately reflected to both parties, which could further complicate the situation. The nurse utilized a picture board for communication, which is a great option. The nurse may also consider using electronic translation services and communication until the trained interpreter arrives.

The foundation of the transactional model is that it allows for two-way communication between the nurse and patient as opposed to one-way communication from just the patient or just the nurse. Specifically, the nurse must be able to interpret the patient’s communication in the context of their culture and language. Using the transactional model in this situation, it would be helpful for the nurse to use nonverbal feedback from the patient because of the existing language barrier. An example would be assessing the patient’s facial expressions to interpret their pain level and then reassessing for nonverbal feedback after administration of pain medication to determine whether it was effective. Ideally, the patient exhibits less grimacing or crying, which would indicate improvement and positive feedback that the nurse can use as a guide for providing further intervention.

There are many ways the nurse can use therapeutic communication to address the patient’s concerns. First, the nurse should allow the patient to express and share their feelings. Specifically, the patient has reported feeling anxious about leaving her older mother at home alone, so the nurse should allow the patient to express their anxiety. The nurse should remain empathetic, telling the patient they hear and understand the patient’s concerns and that they are valid. If appropriate, the nurse may use gentle touch to convey understanding and empathy. The nurse could also ask the patient relevant questions about her concerns, such as, “Do you have any neighbors or family that could go check on her?” or “Would you like to call your mom to check on her? I can help you call her.” Above all, the nurse should practice active listening throughout all interactions with the patient, which is the foundation of therapeutic communication.

Because the patient does not speak English, the nurse will have to rely on the interpreter to ensure understanding of provided information. Health literacy, an individual’s ability to obtain, understand, and apply basic health information and services to make informed health decisions, is important, especially for patients with language or other barriers. The nurse should collaborate with the interpreter to have the patient “teach back” the information to ensure understanding.