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Population Health for Nurses

23.6 Providing Culturally and Linguistically Responsive Care

Population Health for Nurses23.6 Providing Culturally and Linguistically Responsive Care

Learning Outcomes

By the end of this section, you should be able to:

  • 23.6.1 Identify strategies to use when communicating through an interpreter.
  • 23.6.2 Apply principles of culturally responsive care to clients and populations from diverse cultures.
  • 23.6.3 Evaluate translated materials for accuracy and effectiveness.

Nurses use a number of strategies to provide clients with culturally and linguistically competent care. These include evaluating translated materials, using communication strategies, and developing culturally tailored interventions. This section provides an overview of the skills necessary to deliver culturally responsive care and improve the health outcomes of clients from diverse cultures.

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 (Figure 23.4). 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.

A person in a nurse's uniform sits next to a speaking person who wears camouflage and a stethoscope around their neck and holds papers and a pen. A third adult across from them holds a sleeping infant.
Figure 23.4 A medical interpreter communicates information from a nurse to a client at a health clinic in Uganda. (credit: Staff Sgt. Samara Scott/U.S. Army Southern European Task Force, Africa/Flickr, CC BY 2.0)

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. Think back to Cory’s interaction with Faiza. How should he have responded when the man accompanying Faiza offered to translate for her? What if the man accompanying Faiza is not actually her husband but a trafficker who has been forcing Faiza into providing commercial sex?

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.

Cultural Adaptation of Materials

This video from the CDC (2020) discusses best practices for making materials more culturally relevant for clients.

Watch the video, and then respond to the following questions.

  1. Why is it necessary to develop culturally adapted materials and make them available for clients?
  2. What are some potential barriers or challenges nurses and other health care professionals may face when developing culturally adapted materials for clients? How can these be overcome?
  3. In what ways can culturally adapted materials enhance client engagement, health literacy, and adherence to treatment plans?
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