The patient is alone, critically ill and doesn't appear to understand me.

In evaluating negative outcomes including medical mistakes, misunderstanding of consents or procedures, non-compliance or dissatisfaction with care, patient and family education is scrutinized as to what the patient and family were taught and how their understanding was evaluated.

The medical and nursing teams take into consideration that there is always an enormous amount of information to impart on a patient and family for medical care.

The conversation topic list can contain one, multiple or all possible items about the situation, medical tests, treatments, diagnoses, medications, expectations, possible outcomes, possible home needs and life and death decisions.

And an emergency medical situation is never the best place to have complicated conversations.

Engagement and understanding can be affected by emotion, fear, education barrier, language barrier, interest, intoxication, medical problems and medications, to name only a few.

How do you know the patient understood what you said? With a language barrier, a patient may not understand most of what is happening to them.

The medical record can and should include documentation on any and all patient and family education... and resources needed to engage in education.

Physician education can be documented in consultation, progress notes and consultation forms.

Nursing education can be documented in daily nursing notes, or separate situational patient and education notes.

Patient and family education strategies and products can include videos, pamphlets, verbal instruction and demonstration.

Educational products can be found in multiple languages... BUT THEY ARE PRIMARILY IN ENGLISH AND SECONDARILY ONLY IN SPANISH. Check your institution's IT capabilities for printing instructions in various languages.

But what about the patient and family that doesn't speak English or Spanish? What if my patient speaks... Burmese?

There are a few ways medical and nursing staff can get past the limitations of products in only two languages.

Medical translators and translator phones and digital technologies.

Medical translator technologies are services provided by medical language companies that specialize in providing specialized conversations such as medical issues. These systems can translate over 50 languages and specific dialects.

It is not encouraged to allow family members to translate complicated medical information to the patient.

So, a nurse has a patient with a hemorrhagic brain bleed who speaks only Burmese and just lays there and stares at her and sometimes fights against her and sometimes is compliant... how does the nurse know if he understands her non-verbal messages, one-word instructions, is too sick or medicated, or has neurological or cognitive deficits?

Until now, no one had taken the time to figure out a solution to the patient's language barrier. They were being kind and sympathetic in their use of simple sentences and non-verbal gestures.

But how do you do a complete neurological assessment if you have a language barrier?

Finally, this nurse used a Translator phone. And, discovered that the patient had severe cognitive deficits... he didn't understand the questions or follow commands, even in his own language and dialect.

The problem was severe neurological damage from his brain injury and not... non-compliance.

A thousand questions began after her one intervention and assessment!

What would a finding like that mean to the patient outcome and plan of care?

And it means a lot to evaluating a medical-legal case.

Helping You Find The Answers,

Audrey Friedman, RN

Friedman Medical Legal Consulting, LLC