Dónde le duele?”
“Waar kwetst het?”
“Wo verletzt es?”
Sometimes, asking a patient “Where does it hurt?” is part of the problem.Chrissi Bell, RN, holds a picture board designed by Capital Health System while a patient points to the symbol that represents what he is feeling. Bell is a nurse on the surgical trauma unit at Fuld campus.
Faced with an ever-diversified patient population, hospitals — and the nurses who work within them — are finding ways to care for patients of all cultural backgrounds. A growing number of health care systems are adding bilingual staff members. In many places, telephone translation services are used to communicate with non-English-speaking patients.
In New Jersey, nurses and other health care professionals are finding a two-sided card to be a handy tool.
Just ask Robert Cagadoc, RN.
“The picture boards are great. They’re a bridge,” says Cagadoc, who works in the emergency department at University Hospital in Newark, N.J. “Get the problem, get the vital signs and send the patient for an in-depth assessment.”
Statewide programPat Michael, RN, MSN
University Hospital is one of several hospitals across the state participating in a New Jersey Department of Health and Senior Services (NJDHSS)-sponsored program using communication picture boards.
The boards, first developed in 1992 by a Florida-based company called Servision Inc., use a series of pictures to represent health-related complaints. NJDHSS has advocated their use and, with the cooperation of the New Jersey Hospital Association, has distributed more than 2,200 of the boards to facilities across the state as part of its 2007 Strategic Plan to Eliminate Health Disparities. The goal is to make it easier for every patient to receive medical care quickly and efficiently.
On one side of the communication boards, instructions to caregivers are stated simply: The board was designed to bridge communication gaps in emergent situations. The gaps might be because of language, disability, age or trauma. The board’s objective, like the NJDHSS plan, is to help nurses — or EMTs or physicians or shelter workers — communicate with people who need help.
Part of the program
At Capital Health System in Trenton, N.J., the state’s plan is a natural extension of an in-house program that has been evolving for about six years, says Pat Michael, RN, MSN, division director of patient services.
Part of Michael’s responsibility is to oversee the communication efforts between staff and patients. At Capital Health’s Mercer campus, about 11 percent of the patient population is Spanish-speaking. In the past several years, Michael says, the health system has committed many resources to improving communication between health care providers and patients. There is now a full-time interpreter on staff. Language-line use is prevalent. And a videoconferencing program to aid the deaf is in the works.
In addition to the state-issued boards, Capital Health has a homegrown set of situation-specific pictographs, with images ranging from headache and abdominal pain to a request to use the bathroom or have a drink of water. The boards are used primarily on medical-surgical units, where Michael says nurses need them frequently.
On a national level, the use of the boards should grow through a program, “Effective Communication in Hospitals,” sponsored by the U.S. Department of Health and Human Services. New Jersey is one of nine states — Pennsylvania, New York, Rhode Island, Utah, Kentucky, Missouri, Washington and Oklahoma are the others — that have agreed to participate. And whether health care facilities have developed programs like Capital Health’s or are just starting out, the boards will continue to be part of the communication solution for patients and staff alike.
“I think the boards are absolutely great for hospitals that don’t have a program,” Michael says. “If you have the boards available in key access areas — and they should really be available in all areas — then you can utilize them when you have a patient you have difficulty communicating with [who doesn’t] need critical care. “
But Michael cautions that the boards are not all-purpose communication tools.
“I wouldn’t recommend them for trying to tell about a disease or trying to get consent for anything,” she says. “For that, I think you need to get a medical interpreter. But for [questions like] ‘Do you need to go to the bathroom?’ or ‘Do you need a drink of water?’ or ‘Are you having pain?’ — for those simple pieces of information, those boards are very valuable.”