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Nurses who serve non-native English speakers know that speaking a foreign language is only half of medical translation. To better serve such patients, the nurse also must cross a cultural divide and recognize different notions of medicine and the nature of illness.

As a child, Dorah Sanchez de Jeudy, RN, traveled from cotton fields in Texas to beet fields in Colorado and on to Oklahoma and Ohio, moving with her family and other migrant workers who spoke little or no English.

“I would end up going to the clinics with some of the women,” said Sanchez de Jeudy, who recently retired as the tuberculosis elimination nurse at the South Texas Health Care System in Harlingen. There, she would interpret the physicians’ questions and the women’s answers. “A lot of things I didn’t comprehend. I was just a child.”

What she did comprehend was both English and Spanish and the differences between American and Hispanic cultures. She interpreted for the workers during visits to clinics. She changed their dressings and translated the directions for their medications.

“I think that’s what encouraged me to go into nursing,” Sanchez de Jeudy said, adding that her parents’ emphasis on getting a good education helped, too.

According to the U.S. Census, the foreign-born population grew from 10 million in 1970 to 28 million in 2000. Previously, most immigrants came from Europe, but since 1970, the percentage of immigrants from Asia and Latin America has steadily grown. In 2000, the bureau estimated that Asians accounted for one-quarter of foreign-born residents and Latin America accounted for nearly half.

Since civil rights legislation in the 1960s, the American medical system has tried to accommodate patients who don’t speak English, but Sanchez de Jeudy and other nurses who serve non-native English speakers know that speaking a foreign language is only half of medical translation. To better serve such patients, the nurse also must cross a cultural divide and recognize different notions of medicine and the nature of illness.

At the same time, the nurse represents a medical establishment that has its own language, said Faye Gary, RN, PhD, FAAN, executive consultant to the minority fellowship program at the American Nurses Association.

“You talk about IV and bed rest. All of these terms might seem simple, but have no meaning outside of health care,” she said. “That language has to be translated into a language the patient understands within their culture.”

Nurses are usually the first point of significant contact for patients, and they may subsequently oversee that person’s health care team, said Gayle Tang, director of Kaiser Permanente’s National Linguistic and Cultural Programs. “We need to be the role model and be more knowledgeable to facilitate understanding,” she said.

Tang helps Kaiser deliver “culturally and linguistically appropriate care” to its 8 million members. She trains key regional leaders to develop systems and materials for patients who don’t speak English fluently, helping them make appointments, find interpreters, receive written instructions in the appropriate language, and get referrals to other providers.

Twenty years ago when Tang started at Kaiser, the organization had no such system in place. She was sometimes pulled aside as an impromptu interpreter. Although she didn’t mind the demand on her time, she did fret over seeing patients in the late stages of diseases that could have been prevented had they had more adequate access to health care.

“It was so evident as soon as I set foot into nursing that our diverse population is not able to access the system, and when they do, they don’t always get care and services that are meaningful,” she said. “When you have those barriers, patients cannot adhere to treatment.”

Too often, she saw patients labeled as noncompliant or indecisive when the real problem was in translation and a lack of understanding about cultural differences.

Workplace programs like Kaiser’s are mirrored in the academic world in places like the University of San Diego, which offers a family nurse practitioner track with a specialization in Hispanic health care. The track trains nurses to work specifically with vulnerable Hispanic populations like migrant workers and their families.

Cultural classes

Trang Kay, RN, MSN, became a family nurse practitioner through the program.