Developing a course to teach Spanish for health care professionals

To make the baccalaureate nursing curriculum more responsive to changing U.S. demographics, the School of Nursing at The University of Texas at Austin instituted a required course, titled Spanish for Health Care Professionals. This course, developed in collaboration with the University's Department of Spanish and Portuguese, focuses on conversational Spanish using the communicative language teaching approach, rather than grammar and medical terminology instruction. Class activities, along with course materials, are linked to nursing practice. Course assignments are designed to develop authentic communication in reading, writing, listening, speaking, and understanding culture, and students demonstrated oral and written linguistic gains in relation to their Spanish fluency and accuracy. Because the Hispanic population is now the largest minority group in the United States, this course will help nurses communicate with Spanish-speaking patients.     

Spanish adaptation of the Collett-Lester Fear of Death Scale

The Collett-Lester Fear of Death Scale (CL-FODS) consists of 4 subscales: Death of Self, Dying of Self, Death of Others, and Dying of Others. The aim of this study was to develop a Spanish version of the CL-FODS and to explore its psychometric properties. The revised version of the scale was translated into Spanish from English. Then, the back translation technique was carried out. A sample of 281 Spanish nursing students and professionals responded to the Spanish CL-FODS, along with 2 instruments assessing death anxiety and general anxiety. Good internal consistency and satisfactory test-retest reliability of the 4 subscales of the Spanish CL-FODS were achieved. Its correlations with death anxiety were higher than that with general anxiety, supporting its discriminant validity. The principal component analysis forced to 4 components provided a distribution of loadings that is more coherent with the theoretical formulation of the 4 components than those obtained in previous studies. These results justify the use of the CL-FODS in Spanish-speaking health care professionals for the purpose of assessing attitudes toward death and dying in self and others.     

Registered Nurses'' Perceptions of Their Communication with Spanish-Speaking Migrant Farmworkers in North Carolina: An Exploratory Study

Communication forms the foundation for all that nurses do. Recently, nurses working with migrant farmworkers have become challenged as the language of this population has become predominantly Spanish. To explore how nurses in North Carolina are managing communication issues, 55 nurses at 12 state health care agencies that serve migrant farmworkers was surveyed. Data were collected to determine what nurses believed about various communication issues involving these Spanish-speaking clients, including how they were presently communicating with them, in what areas of nursing functions they believed communication barriers were problematic, what they were doing to improve their communication, and what they envisioned the potential solutions were concerning communication barriers. Language differences proved to be substantial barriers to adequate nursing care for these individuals. Nurses cited many problems and said that they were receiving little assistance from their agencies to improve direct communication with the clients. Responses indicated a need for and a willingness by nurses to focus on improving communication with Spanish-speaking clients. Classes held at their agencies were seen as the most effective way of learning Spanish.     

Instrucciones de Alta por Video: Effectiveness of Video Discharge Instructions for Spanish-Speaking Caregivers in the Pediatric Emergency Department

IntroductionAlthough evidence supports the addition of video discharge instructions to improve caregiver knowledge among English-speaking caregivers of children in the pediatric emergency department, there is no evidence about the effectiveness of videos for Spanish-speaking caregivers. The purpose of this study was to test whether Spanish video discharge instructions added to standard written and oral discharge instructions would result in improved knowledge and satisfaction among caregivers compared with written and oral instructions alone.MethodsSpanish videos were created for fever, gastroenteritis, and bronchiolitis. A quasi-experimental, consecutive-sample, pre–post-test design was used with an audio computer-assisted survey platform to provide surveys in Spanish. The intervention group received written and oral instructions + video, whereas the comparison group received written and oral instructions alone.ResultsData were collected from 150 caregivers. Caregivers who were given written and oral instructions + video showed significant knowledge improvement regarding their child’s diagnosis and treatment (+19.3% and +23.6%, respectively, among standard participants; P < 0.001). Moreover, videos did not significantly improve caregivers’ knowledge regarding illness duration and when to seek further care. Regardless of the discharge instruction format, no significant difference was observed in the helpfulness of the instructions (-1%; pre vs post, 84% vs 80%; χ² = 0.35; P = 0.58).DiscussionStudy results demonstrate that when tailored to reflect diagnosis-specific education, video discharge instructions can improve Spanish-speaking caregiver knowledge about discharge education compared with written and oral instructions alone. Videos can be integrated to standardize the ED discharge process as an adjunct to nurse-provided written and oral instructions with an interpreter for Spanish-speaking families.     

Teaching Spanish to Emergency Medicine Residents

Objective: To determine the effects of teaching medical Spanish to eight PGY1 emergency medicine residents on their subsequent interactions with Spanish-speaking patients.
Methods: Eight PGY1 residents completed a 45-hour medical Spanish course administered during their first residency month. Thirty-four subsequent physician-patient interactions by these residents were audiotaped over a six-month period at a suburban teaching ED. The tapes were transcribed and analyzed for errors by a professional medical Spanish interpreter and a native Spanish speaker.
Results: Minor errors (e.g., technically incorrect grammar or vocabulary with generally appropriate patient understanding) were found in more than half of the interactions and major errors (e.g., misunderstanding duration of symptoms, misunderstanding of vocabulary) were found in 14% of the interactions. In addition, although the course was designed to supplement, not replace, professional interpreters, the residents called for an interpreter only 46% of the time.
Conclusion: Although medical language courses may be a useful adjunct to interpreters, they are not designed to replace them. Significant errors may occur when participants in such courses assume their knowledge is sufficient to obtain a good history, give patient release instructions, and provide medical care in general without an interpreter present.     

Spanish health information resources for nurses

According to the U.S. Census Bureau, Spanish-speakers currently constitute 1 in 10 U.S. households, and the number is expected to rise. To provide responsible and responsive care, many nurses will need to develop communication skills for working with Spanish speakers and be able to find quality, reliable health information in Spanish for their patients and patients' families. A number of efforts have been described in the literature. This article augments prior efforts by providing nurses with resources for learning key words and phrases, sources to increase awareness of and sensitivity to cultural nuances, reliable consumer Web resources for Spanish-speaking patients, and tips for evaluating Spanish language health information on other Web sites.     

An English and Spanish Pediatric Asthma Symptom Scale

BACKGROUND: Pediatric asthma survey measures have not been adequately tested in non-English-speaking populations. OBJECTIVES: To test the reliability and validity of an English and Spanish symptom scale to measure asthma control in children. SUBJECTS: Parents (54% Spanish-speaking; 61% not high school graduates) of 234 children seen in the emergency department for an asthma exacerbation. MEASURES: Parent report of frequency and perceived severity of child asthma symptoms during the beginning and after resolution of the exacerbation. RESULTS: An 8-item scale composed of reports of cough, wheezing, shortness of breath, asthma attacks, chest pain, night symptoms, and overall perceived severity had very good psychometric properties in both English and Spanish. The reliability (Cronbach's alpha) of the scale ranged from 0.81 to 0.87 for both languages and time frames. In both languages, the validity of the scale was supported by responsiveness to changes in clinical status (lower symptom score after resolution of the exacerbation, P < 0.001) and by moderate to strong correlations (P < 0.001) with other asthma morbidity measures (parent report of child bother: r = 0.59-0.65; school days lost: r = 0.38-0.67; and activity days lost: r = 0.41-0.59). There were no statistically significant differences in the reliability or construct validity of the summary symptom scale by language, although Spanish speakers reported a lower frequency of some symptoms than did English speakers. CONCLUSIONS: A reliable and valid 8-item scale can be used to measure control of asthma symptoms in Spanish-speaking populations of low literacy. Additional research to evaluate language equivalency of asthma measures is necessary.     

Assessing frequency effects on verb inflection use by Spanish-speaking individuals with agrammatism: Theoretical and clinical implications

The resistance of high-frequency linguistic elements to aphasic impairment suggests that frequency of occurrence may be implicated in verb use differences in agrammatic aphasia. The highly-inflected Spanish verb system allows for the examination of frequency of occurrence along two main metrics, daily usage frequency and paradigmatic frequency. In this study, we explored the role of those two frequency dimensions in verb repetition by Spanish speakers with agrammatism. Six native Spanish-speaking individuals with agrammatic oral expression were matched for age, education and Spanish dialect with six speakers with typical language. The speakers participated in a sentence repetition task involving simple verb tenses. Results revealed that high frequency in daily usage can have a stronger facilitating effect on verb repetition than paradigmatic frequency. Theoretical and clinical implications of the findings are discussed to highlight some plausible repercussions of typical discourse patterns in providing a socio-cognitive dimension to agrammatism theory and in supporting the use of frequency-based linguistic features in agrammatism therapy.     

Adaptation of the Amsterdam Inventory for Auditory Disability and Handicap into Spanish

Purpose: Self-report questionnaires have been suggested as valuable assessment tools in audiology, especially when investigating the effect of hearing impairment on the everyday lives of adults. Many self-report questionnaires have been developed for English-speaking populations; however, there is a lack of this type of questionnaire for Spanish-speaking patients. The aim of the present research was to adapt the Amsterdam Inventory for Auditory Disability and Handicap (AIADH) into Spanish. Methods: The AIADH consists of 30 questions that deal with real-life listening situations. Each question is accompanied by a picture representing the situation being addressed. Six Spanish-English bilingual speakers and one Spanish-English bilingual speaker participated in the translations and back translations of the English version of the AIADH. Once the adaptation was finalized, 189 normal-hearing and hearing-impaired Spanish-speaking participants completed the Spanish version of the AIADH (S-AIADH). Results: Statistical analysis showed a high Cronbach’s alpha coefficient, indicating good internal reliability. Test-retest scores were highly correlated. Also, the S-AIADH showed good criterion validity. Statistically significant differences for all questionnaire item responses were observed between normal-hearing and hearing-impaired respondents. Conclusions: The AIADH has been adapted into Spanish. Normative data in percentiles have been obtained for clinical use with Spanish-speaking populations, to explore self-reported performance for the hearing functions proposed by the ICF.

Implications for Rehabilitation

• The clinical setting represents an artificial situation and it is not possible to directly assess the patient’s hearing performance in real life situations. For this reason, the use of self-report questionnaires is recommended.

• Self-report questionnaires are especially useful when investigating hearing disability in a range of listening activities. Thus, hearing rehabilitation can be tailored according to the specific needs of the patient.

• Self-report questionnaires such as the AIADH may assist to determine the benefits of hearing rehabilitation for the patient throughout a range of activities, for which hearing in essential.

     

Community-based violence awareness

Violence against women is a major influence on women's mental health. We used popular education techniques to train 14 Spanish-speaking women as promotoras (community health workers) to increase awareness about violence against women in low income Texas communities. These women then conducted over 80 presentations in Spanish in local community settings. The impact of the program on the promotoras and on women attending the presentations was evaluated using qualitative methods. This research lends support to the idea that nurses working in community mental health settings must use innovative primary prevention strategies and evaluation mechanisms to change awareness about violence against women.     

Validation of the Spanish Life Support Preference Questionnaire (LSPQ)

Purpose: To translate and validate the Life Support Preference Questionnaire (LSPQ) for use with Spanish-speaking adults, and to further validate the English version of the LSPQ.
Methods: Two samples were included: community-dwelling Hispanic and non-Hispanic adults who were monolingual or bilingual Spanish speakers, and an English-speaking sample, all living in south-central United States. Validation included calculation of internal consistency, stability, and alternate forms reliability estimates for two language versions of the LSPQ. Factorial validity was studied for both language versions and regression and t test analyses were done to explore ethnic differences in selection of the life support choices in the scale.
Findings: Both language versions of the LSPQ showed strongly supportive measurement properties. Differences were found between ethnic groups on four of the item choices, indicating that Hispanics in this sample preferred interventions to actively support life more than did the non-Hispanic adults.
Conclusions: Both the English and Spanish versions of the LSPQ have been validated for use in research and practice. Additional validation will be necessary in other samples.     

Measuring satisfaction with nursing care among hospitalized patients: refinement of a Spanish version

This study was designed to improve the psychometrics of English and Spanish measures of hospitalized patients' satisfaction with nursing care. One hundred Spanish-speaking participants in the northeastern and southwestern United States completed a new 20-item Spanish version; 64 of the same participants also completed the English version. Correlations between item pairs (p < .001, r = .56-.96) and total scores of both versions (r = .92, p < .01), and similar factor structures support equivalence of the two versions. Evidence for construct validity is also presented. Results surpass standards for new instruments and support the utility of this much needed, bilingual measure of inpatient satisfaction with nursing care.     

Complementary and alternative medicine in cancer — A qualitative study on the Internet offer in Spanish-speaking South America

BackgroundThe number of people with cancer using complementary and alternative medicine (CAM) is increasing. However, CAM may have interactions with conventional cancer therapies. In addition, alternative medicine procedures may result in significant health risks. Because of the Internet, regional CAM methods easily spread globally. This study aims at evaluating CAM procedures offered on Spanish-speaking South American websites and assessing the quality of these websites.MethodsAn Internet search was carried out in nine Spanish-speaking countries in South America. Websites were analysed using a standardized tool.ResultsIn total, 85 websites, with a wide range of 158 different CAM procedures were evaluated. The vast majority of websites had poor content and formal quality. Overall, no website was rated as very good and only two websites could be rated as good. Among the most commonly mentioned South American methods were an Aloe- mixture called “Fray Romano”, graviola, uncaria tomentosa (Cat’s claw), the "Método HANSI" and components of the lapacho tree.ConclusionsThere is an urgent need for quality-assured, easy-to-find sites with high quality for Spanish speaking persons in South America. Several of the methods have already spread to Europe as graviola or uncaria.     

Health-Promoting Lifestyles of English-Speaking and Spanish-Speaking Mexican-American Migrant Farm Workers

This study was conducted with 62 Mexican-American migrant farm workers at four different sites in northern Illinois. An established English and a newly developed pilot Spanish version of the health-promoting lifestyle profile was used. The concept of health-promoting lifestyle appeared to be culturally relevant to study participants. English-speaking migrant workers scored significantly lower than Spanish-speaking workers on the dimensions of self-actualization, exercise, and stress management. Patterns of scores among both groups were highest in self-actualization and interpersonal support, and lowest in health responsibility and exercise. Further research in health-promoting behaviors with all cultural groups and socioeconomic levels of society will contribute to achievement of the World Health Organization's goal, health for all by the year 2000.     

Missed Opportunities When Communicating With Limited English-Proficient Patients During End-of-Life Conversations: Insights From Spanish-Speaking and Chinese-Speaking Medical Interpreters

ContextResearch has shown that using medical interpreters in language-discordant patient-provider encounters improves outcomes. There is limited research evaluating the views of medical interpreters on best interpreter practices when they are used to break bad news or participate in end-of-life (EOL) conversations.ObjectivesTo develop insights from medical interpreters about their role when interpreting discussions regarding EOL issues, identify practices interpreters perceive as helping to improve or hinder patient-provider communication, and obtain suggestions on how to improve communication during EOL conversations with Spanish-speaking and Chinese-speaking patients.MethodsSemistructured interviews were conducted with Spanish or Chinese medical interpreters. Participants were recruited until thematic saturation was reached. Twelve interviews were conducted, audiotape recorded, transcribed, and analyzed using standard qualitative methods.ResultsSix major themes were identified: medical interpreters' perceived comfort level during EOL interpretation; perception of interpreter role; communication practices perceived as barriers to effective communication; communication practices felt to facilitate effective communication; concrete recommendations how to best use medical interpreters; and training received/perceived training needs.ConclusionMedical interpreters provide literal interpretation of the spoken word. Because of cultural nuances in Chinese-speaking and Spanish-speaking patients/family members during EOL conversations, medical interpreters can translate the meaning of the message within a specific cultural context. Conducting premeetings and debriefings after the encounter are potentially important strategies to maximize communication during EOL conversations.     

Reported stress of parents of burned children differs on the Spanish and English versions of the parenting stress inventory

The Parenting Stress Inventory (PSI) is a 101-item self-report questionnaire measuring stress in children and their parents. For several years, we have been administering the English and Spanish versions of the PSI to parents of children with >40% total body surface area burn at discharge, 6 months, 1 year, and every year at followup at clinic. The aim of the present study was to evaluate differences between Spanish- and English-speaking families with respect to stress and to further examine potential psychometric differences between the instruments that may contribute to these differences. In the present study, we found the instruments to be equivalent but have significant differences between the two versions, suggesting cultural differences in how coping and stress are manifested in these groups. Spanish-speaking parents noted significantly more distress than the English-speaking parents. Both groups indicated most severe problems on the Child domains of the PSI, suggesting that parents perceived their interactions and relationship as it pertain to their child to be most troubled.     

Test-retest reliability of a complex human immunodeficiency virus research questionnaire administered by an Audio Computer-assisted Self-interviewing system

OBJECTIVES: To evaluate the test-retest reliability of a complex questionnaire administered by Audio Computer-assisted Self-interviewing to recently diagnosed human immunodeficiency virus-positive patients. METHODS: Thirty-seven English-speaking and 32 Spanish-speaking participants completed both test and retest interviews. Pearson correlation coefficients (r) and kappa (kappa) and weighted kappa (kappa) statistics were obtained for individual questions. From these, overall kappa and Pearson correlation coefficients were calculated across all variables and for groups of questions. RESULTS: Overall measures of reliability were kappa = 0.767, r = 0.728. Some variation in reliability existed for different response formats, question content groups, and languages of the participants. Differences in overall reliability by Spanish compared with English participants were small and not statistically significant. CONCLUSIONS: Audio Computer-assisted Self-interviewing provides reliable measures for items assessed in the Antiretroviral Treatment and Access Study baseline questionnaire. Some differences exist as a result of question content, interview language, and response format, requiring assessment in future studies and consideration in designing Audio Computer-assisted Self-interviewing systems and questionnaires.