Nursing perspectives on advancing language access in the emergency department: A qualitative study

Abstract

Objective Failure to provide language services in health care settings negatively impacts patients with non-English language preferences (NELPs), yet underuse of language assistance remains rampant. Nurses in the Emergency Department (ED) handle critical communication in a fast-paced environment, posing a communication challenge. The aim of this study is to describe ED nursing perspectives on barriers and facilitators to accessing language services to construct interventions that increase the uptake of language services when interacting with ED patients with NELPs. Methods This is a qualitative study of ED nursing staff at two sites using the Behavior Change Wheel (BCW). Participants included registered nurses, nurse practitioners, and nursing assistants. The BCW was used to identify barriers and facilitators to accessing formal language services (professional interpreters, remote or in-person) which were mapped to intervention functions to construct proposed interventions. Results A total of 36 interviews were conducted with registered nurses (n = 29), nurse assistants (n = 3), and nurse practitioners (n = 4). Barriers and facilitators to calling an interpreter were identified in all three of the BCW categories of capability, opportunity and motivation. These were mapped to intervention functions on the BCW to construct tangible interventions including restructuring the environment to have designated parking spaces for video remote interpreter machines in private areas, standardized training on language access services, equipment and policies, and training senior nursing language access champions to model the behavior of calling interpreters and to discourage ad hoc interpretation. Conclusion We identified nursing perspectives on barriers and facilitators to language access and used the BCW to construct interventions. ED administrators can use these interventions as part of efforts to eliminate the underuse of language services and the potential negative impact outcomes for patients with a NELP.