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Introduction   

The presence of a medical interpreter can make a significant difference in the care of a patient with limited knowledge of the English language. Their presence is essential for numerous reasons. Along with addressing language barriers and improving communication, they assist in bridging cultural gaps. With the number of those in need of these services increasing, their presence is more important than ever.  

Definition 

The role of the medical interpreter is a very specialized one. It requires a very distinct set of skills, which includes the ability to speak fluently in several languages and to have an extensive understanding of medical terminology (1). They aim to help non-English speaking people communicate with their healthcare providers and other medical professionals.  

The National Council on Interpreting in Health Care (NCIHC) defines a qualified interpreter. "An individual who has been assessed for professional skills demonstrates a high level of proficiency in at least two languages and has the appropriate training and experience to interpret with skill and accuracy while adhering to the National Code of Ethics and Standards of Practice published by the National Council on Interpreting in Health Care" (2).  

The terms healthcare interpreter and medical interpreter may be used interchangeably, as they both handle communication in the medical setting (9).  

Medical Interpreters 

Medical interpreters play a vital role in bridging gaps in healthcare. They promote effective communication between healthcare providers and the individuals who speak different languages, in their care. Most importantly, they address and eliminate language barriers that could result in serious medical errors. 

It is common knowledge that language barriers present significant challenges for healthcare providers and medical professionals. Miscommunication between them and their patients can reduce provider and patient satisfaction, decrease the quality of care, and impact patient safety (3).  

Medical interpreters promote effective communication by giving the patient a voice. They ensure patients receive the care they are entitled to and assist in avoiding medical errors that could harm the patient. They are essential in advocating for patients experiencing communication barriers (4).  

The Importance of Medical Interpreters 

As the role of a medical interpreter is to facilitate communication, they are needed in a variety of different situations, which could include (5). 

• When a patient needs to provide consent. 
• When a healthcare provider is gathering medical history. 
• During physical exams. 
• When a patient is describing pain or other symptoms. 
• When the patient has questions or concerns. 
• For treatment discussions and decisions. 
• To understand discharge instructions. 

These situations can occur in different sites that provide care to patients with language barriers and involve various settings such as (6):  

• Hospitals 
• Clinics 
• Private medical offices 
• Rehabilitation centers 
• Nursing homes 
• Long-term care facilities 
• Assisted living facilities 
• Mental health facilities 
• Forensic services 
• Substance abuse clinics 
• Domestic violence centers or programs 

Differences between the Medical Interpreter and the Medical Translator 

It is essential to differentiate between a medical interpreter and a medical translator. While some may use these terms interchangeably, there are significant differences. While a medical interpreter assists in communication between people, a medical translator focuses on written text and content (1).  

The interpreter will use spoken words, while the translator will use written words. Therefore, the significant difference is in the way they communicate. Medical interpreters are needed to explain and clarify important events related to healthcare.  

Some examples include (1): 

• Medical procedures 
• Surgical procedures 
• Aftercare instructions 
• Discharge planning 
• Doctor’s explanations and recommendations  

Medical translators play an important role in translating written content from one language to another in (1): 

• Medical records 
• Patient charts 
• Patient history 
• Family history 
• Health issues 

Qualifications and Training 

The role of the medical interpreter is a very specialized one. They are a crucial healthcare team member, and their services are vital to those they are working with. Therefore, they must possess specific skills, qualifications, training, and credentials.  

To start becoming a medical interpreter, the following prerequisites must be met (6): 

• Must be 18 years of age. 
• General education: Must have proof of a United States high school diploma/GED or equivalent from another country.  
• Oral proficiency in the English language. 
• Oral proficiency in the target language. 
• Medical Interpreter education. 

Medical Interpreter education includes training obtained at a college or university and must be at least three credit hours. It may also be obtained through a training course which consists of at least 40 hours (6).  

Certification 

The next step is to become a certified medical interpreter. If the above requirements have been met, then certification can be pursued. The benefits of becoming a certified medical interpreter include being on the national registry and the respect that accompanies certification.  

In addition, certification identifies the recipient as a competent professional, who understands and follows the standards of practice (9). Certification is becoming important as more employers prefer certified medical interpreters (9).  

Two organizations provide professional certification for medical interpreters.  

• Certification Commission for Healthcare Interpreters (CCHI) (7). 

• National Board of Certification for Medical Interpreters (NBCMI) (8). 

Certification Commission for Healthcare Interpreters (CCHI) 

The CCHI recognized that certification is fundamental to the medical interpreter's career. The mission of this organization is “to develop and administer a comprehensive national certification program for healthcare interpreters, bringing together representatives from interpreting associations, language companies, community-based organizations, educational institutions, hospitals, health and healthcare providers, and advocates for patients with limited English proficiency (10). 

This organization offers three types of national certification (7): 

• Core Certification Healthcare Interpreter™ (CoreCHI) 

This certification is available to interpreters in all languages and tests the core professional knowledge, critical thinking, ethical decision-making, and cultural responsiveness skills needed to perform duties in healthcare settings (11).  

• CoreCHI-Performance™ (CoreCHI-P™) 

This is considered the second level of certification for interpreters in all languages. The requirements include meeting the CCHIs language proficiency criteria and passing two tests: The knowledge CoreCHI™ exam and the monolingual performance ETOE™ (English-to-English) exam (11). 

• Certified Healthcare Interpreter™ (CHI™) 

This language-specific performance certification for Spanish, Arabic, and Mandarin interpreters focuses on interpreting skills and abilities (11).   

All three certifications are valid for four years from the issue date. The certification must be renewed at that time to ensure that the medical interpreter remains current and updated in their profession (7).  

National Board of Certification for Medical Interpreters (NBCMI) 

The NBCMI recognizes that medical interpreters are vital care team members in assisting people with limited English proficiency. They help medical interpreters advance their careers by providing the following.  

Hub-CMI Credential 

This credential applies to medical interpreters of any language and is a national standard to determine mastery of medical terminology and specialties, cultural competencies, and ethical judgment. This credential is a written exam demonstrating a baseline competency and knowledge level in the medical interpreter profession. This credential must be renewed every four years (14).  

CMI Certification 

This certification is an oral exam and is offered in six languages, including Cantonese, Korean, Mandarin, Russian, Spanish, and Vietnamese. The candidate must have successfully passed the Hub-CMI (8) to take this exam. CMI certification aims to ensure that candidates meet the standards of the medical interpreter’s profession safely and ethically. This certification must be renewed every five years (15).  

Nationwide Impact 

Statistics  

It is estimated that over 25 million Americans have limited English proficiency (LEP), putting them at risk for poor health outcomes due to language barriers (20). Some certain groups and populations have a higher risk for LEP. Those who do not speak English in their homes, immigrants, and those with lower educational levels identify as higher risk (21).  

LEP creates barriers to accessing healthcare, understanding health information, and preventative health care. Also, LEP has been linked to chronic health conditions.  

LEP patients have (21): 

• More extended hospital stays (when interpreters were not used at admission and/or discharge).  
• Greater risk for surgical infections. 
• Greater risk for falls. 
• Greater risk for pressure injuries. 
• Greater risk for surgical delays. 
• Greater risk for readmission for chronic conditions. 

The need for medical interpreters is evident. They are essential for communication between providers and patients with LEP. 

Demand 

Medical interpreters are in high demand in the healthcare system. The employment of interpreters is projected to grow by four percent from 2022 to 2032 (19). While there are approximately 52,000 interpreters and translators in the United States, it is estimated that there will be 7,200 job openings for interpreters and translators each year in the upcoming decade (19).  

Standards of Practice 

Medical and healthcare interpreting is a distinct and specialized area of work. Standards of practice guide interpreters in their practice and improve the quality and consistency of interpreting (12).  

In the past, interpreters lacked guidance for performance requirements, resulting in the quality of interpreting being inconsistent. This inconsistency led to incomplete and inaccurate communication during interpretation. The development of standards resulted from the need for clarity and consistency at a national level in defining the characteristics and competencies of a qualified healthcare interpreter (12).  

Professional organizations such as the National Council on Interpreting in Health Care (NCIHC) and the International Medical Interpreters Association (IMIA) establish these standards. Adherence to these standards is vital for maintaining the integrity of medical interpretation services and promoting positive healthcare outcomes for patients with limited English proficiency. 

The NCIHC Standards of Practice 

The National Council on Interpreting in Health Care (NCIHC) developed the National Code of Standards for Interpreters in Health Care (16). These standards are used as a reference by interpreters, and those who work with and train the interpreters. They also serve as an important guide to the practice of all interpreters (12).  

The standards of practice are used for (12). 

• Training 
• Hiring 
• Performance Monitoring 
• Discussion on Certification of Professional Competence 

The NCIHC Standards of Practice are organized in nine areas consisting of the following (16). 

• Accuracy 
• Confidentiality 
• Impartiality 
• Respect 
• Cultural Awareness 
• Role Boundaries 
• Professionalism 
• Professional Development 
• Advocacy 

The International Medical Interpreters Association (IMIA) 

The International Medical Interpreters Association (IMIA) has also developed standards that assist in maintaining the integrity of medical interpretation and promoting positive healthcare outcomes for those with limited English (17).  

These standards are used for the following reasons (18). 

• Guidance in the development of educational and training programs. 
• Evaluation tool.  
• Assist healthcare providers in working with interpreters. 
• Foundation for certificate examination. 

The IMIA Standards of Practice are organized in three major areas.  

• Interpretation 
• Cultural Interface 
• Ethical Behavior 

Code of Ethics 

Ethical behavior is essential in all professions, and medical interpreters must follow professional codes. Ethics are principles and values which govern the conduct of members of a profession. The NCIHC, IMIA, and the CHIA provide a Code of Ethics for medical interpreters.  

They are very similar and address the following areas (22): 

• Accuracy 
• Confidentiality 
• Respect 
• Professionalism 
• Professional Development 
• Role Boundaries 
• Impartiality 
• Cultural Awareness 
• Advocacy 
• Communication Flow 
• Accepting Gifts 

Policies  

As a result of the growing number of LEP patients, and the need to provide equal treatment to these individuals, language service policies addressing communication barriers and language gaps have been established. In addition, policies have been developed to mandate the practice of interpreter services (24). By offering access to medical interpreters, healthcare organizations achieve the goals of delivering culturally competent care and maintaining legal and regulatory compliance.  

In the United States, it is a right for all individuals to have access to language services, and no one should be denied care or services because of a language barrier (28).  

These rights originate from two laws (13): 

• The Civil Rights Act of 1964 
• Executive Order 13166 

The Civil Rights Act of 1964 

In 1964, Title VI of the Civil Rights Act was passed. This gave LEP individuals a legal right to language assistance services and prohibited discrimination (27).   

Executive Order 13166 

In 2000, the Executive Order (EO) 13166, Improving Access to Services for Persons with Limited English Proficiency, was issued (27). This order mandated laws requiring professional interpreters to be present in healthcare facilities receiving federal funding (28).   

Both laws ensure that access to language services is a right and that no one can be denied services based on the language they speak (28). 

What Nurses Need to Know 

Effective communication is essential in healthcare. With over 25 million people having LEP, many nurses may encounter a patient with communication barriers. These language barriers can affect nursing practice and the care provided by nurses. There is abundant evidence indicating that language barriers impact patient outcomes. Nurses can make a difference by responding to the communication needs of patients with LEP by using a medical interpreter (26).  

Nurses can improve health outcomes for LEP patients by effectively working with medical interpreters. To achieve this, nurses should know the standards, guidelines, and policies of working with a medical interpreter.  

Some guidance for working effectively with medical interpreters includes these evidence-based interventions (25,26): 

• Identify patients needing an interpreter in advance. 
• Inform the interpreter of the specific language needed. 
• Inform the interpreter how much time the interpretation will take. 
• Introduce yourself to the interpreter and provide a report on the work needed. 
• Provide a brief patient history. 
• Greet the patient and introduce the interpreter. 
• Explain to the patient the reason for the interpretation. 
• Communicate directly to the patient. 
• Have the interpreter sit next to or behind the patient. 
• Speak in short sentences.  
• If the interpreter appears confused, ask them if they need clarification or rephrasing. 
• Do not interrupt the interpreter when they are translating. 
• When the session is finished, ask the patient if they need anything else while the interpreter is present.  
• After leaving the patient’s room, review the session with the interpreter, as they may have cultural insights helpful to care planning.  

Nurses must advocate for their patients by bridging language barriers and providing optimal care. Utilizing medical interpreters and implementing evidence-based strategies can assist nurses in providing quality care by eliminating language barriers (26).  

Resources 

The U.S. Department of Health and Human Services provides an example of a policy and procedure for giving meaningful communication with persons with limited English proficiency (23). 

Conclusion

The role of the medical interpreter is an important one. As the need for professional and certified medical interpreters grows, healthcare organizations must realize this. Medical interpreters are very significant members of the healthcare team. They assist in eliminating one of the most challenging barriers faced by providers: language barriers.  

It is common knowledge that language barriers cause miscommunication, resulting in poor outcomes for all. Medical interpreters improve many aspects of healthcare, by assisting in overcoming cultural and language barriers, encouraging effective communication, and improving overall patient safety and satisfaction. As the need for their services grows, so should recognition of the importance of their work. 

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