Date of Award
Projects: SPU Access Only
Doctor of Nursing Practice (DNP)
Dr. Chanam Shin
Background and Significance
Compared to individuals who speak English fluently, the patients with limited English proficiency (LEP) typically reports lower satisfaction, experience poorer quality of care, and have worse health outcomes across all interactions with the U.S. healthcare system (Barwise et al., 2021; Silva et al., 2021). Interpreter services are not as fully utilized as they should be due to clinician time constraints and perceived burden to the clinician workload (Silva et al., 2021). The low use of medical interpreters among healthcare providers is associated with a lack of skills needed for optimal use of interpreter services, which could be improved by training and/or pre-encounter huddles with clear guidelines (Silva et al., 2021). Cumulative literature supports pre-encounter huddles between healthcare providers and interpreters as they lead to positive health outcomes and satisfaction for patients and promote health equity (Barwise et al., 2021; Silva et al., 2021). However, there is a lack of initiatives in translating this evidence into practice (Barwise et al., 2021).
Problem and Purpose Statement
The current process of a line-by-line translation between healthcare providers, interpreters, and patients adds barriers to clear and culturally appropriate communication in exchange of clinical and key information (Barwise et al., 2021). Consequently, the current interpreting process may result in poor health outcomes of patients as well as low satisfaction of patients and healthcare providers, which is associated with suboptimal use of interpreter services. The use of the pre-encounter huddles may increase the competent use of interpreter services by healthcare providers, improve patient outcomes, and satisfaction of both healthcare providers and patients. The pre-encounter huddle provides context, background, cultural considerations, and role expectations for the healthcare provider and the interpreter. The purpose of this DNP project was to increase nurses’ competence and satisfaction in using interpreter services by implementing the pre-encounter huddle.
This project was a pre-post intervention design consisting of one group of staff nurses. The intervention was the implementation of the pre-encounter huddle between the nurse and the interpreter prior to meeting the patient with LEP. Prior to the intervention, participants took a pre-intervention survey via Swedish Microsoft Forms and then attended an in-service about the pre-encounter huddle. After completing these two tasks, the participants were then able to fill out the post-intervention survey.
The pre-intervention data (n=24) demonstrated appropriate use of interpreter services when caring for patients with LEP. Nearly 21% of staff nurses were not satisfied with the current interpreting process. Reasons for dissatisfaction included difficulty in finding specific languages (25%), contributing patient factors like confusion and hearing acuity (16.7%), and need for context, background information, and conversation planning (12.5%). Post-intervention data from participants (n=12) revealed increased nursing knowledge and competency with using the pre-encounter huddle (83.3%). The majority (83.4%) of respondents were satisfied with the pre-encounter huddle process with interpreter services. Most respondents (91.7%) felt that the pre-encounter huddle helped improve the care they provided for their patients and saved time (58.3%). Of the post-intervention survey respondents, 75% would recommend the pre-encounter huddle to other nurses, and 91.6% felt that a standardized tool for the pre-encounter huddle would be useful.
To sustain the pre-encounter huddle with medical interpreters in the hospital, additional education about the pre-encounter huddle is required. This could be added to the existing annual training module that all nurses at the organization must complete. Financially, the implementation of the pre-encounter huddle poses little to no additional cost to the organization as interpreter services are already incorporated in patient care. For the implementation of the pre-encounter huddle to keep momentum, the hospital would need to consider examining the implementation of a similar project on a larger multi-unit scale.
Implications for Nursing Practice
The current practice of insufficient and lack of competent utilization of interpreter services in the unit can be changed as positive outcomes were revealed in this DNP project. The project provided access to a costless intervention that aids in decreasing the accrued costs of inequitable healthcare and the associated poor health outcomes for patients with LEP. This project revealed the need for a validated and standardized pre-encounter huddle tool. Further projects may ultimately impact the way that nursing and other clinicians utilize interpreter services.
Barwise, A., Yeow, M., & Partain, D.K. (2021). The premise and development of CHECK IN – check-in for exchange of clinical and key information to enhance palliative care discussions for patients with limited English proficiency. American Journal of Hospice and Palliative Medicine, 38(6), 533-538. https://doi.org/10.1177/1049909120979982
Silva, M.D., Adelman, R.D., Singh, V., Gupta, R., Moxley, J. Sobota, R.M., Tsai, S., Abel, B.T., & Reid, M.C. (2021). Healthcare provider perspectives regarding use of medical interpreters during end-of-life conversations with limited English proficient patients. American Journal of Hospice and Palliative Medicine, 1-8. https://doi.org/10.1177/10499091211015916
Ma, Grace, “Implementation of the Pre-Encounter Huddles with Medical Interpreters: A Process Improvement Project” (2023). Doctor of Nursing Practice (DNP) Scholarly Projects.
Ma, Grace E., "Implementation of the Pre-Encounter Huddles with Medical Interpreters: A Process Improvement Project" (2023). Doctor of Nursing Practice (DNP) Scholarly Projects. 58.