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Cultural Competence: Non-English-Speaking Home Health Patients Benefit from Same-Language Nurses-Part 1

Analysis  |  By Jasmyne Ray  
   August 25, 2023

Beyond interpreters, bilingual or nurses that speak the same language as patients can foster better health outcomes.

Part one of a two-part story.

Having a nurse who speaks the same language can help prevent hospital readmissions among home health patients who don't speak or know very little English, says a new study out of New York University Rory Meyers College of Nursing.

For that reason, home health agencies should try to hire and retain nurses who speak the same languages as their patients, according to Allison Squires, PhD, RN, FAAN, an associate professor with the college and lead author of the study.

Unfortunately,  there aren't enough nurses to meet this specific demand, Squires said

HealthLeaders spoke to Squires about her intentions for the study, her experience as a bilingual nurse, and how healthcare should support non-English speakers and their treatment.

The following transcript has been edited for clarity and brevity.

HealthLeaders: What information were you hoping to find with the study?

Allison Squires: We were looking at the idea of using the nursing role as an intervention in home health care.

If you are working with patients with limited English proficiency, would having the same nurse be as effective as having a nurse who speaks your same language? We looked at this in terms of language concordance: if you had a nurse with the same ethnic background and spoke the same language, or if you had several nurses who knew how to speak your language, because there's a lot of interest in this notion of concordant care in healthcare and languages.

The trouble with languages is we don't have enough people in the U.S. who speak other languages to meet the demand, especially among Spanish speakers, and so we needed an alternative intervention to look at in terms of what might make a difference in terms of home health outcomes.

I'm not Latina, but I've worked in Mexico, so I have an above-average understanding, certainly of Mexican culture, but also of Latin American culture, in addition to being fluent. There have been moments in my time working clinically as a nurse for a decade that having a nurse who spoke the same language made a difference.

As I developed into a health services researcher and understood workforce interplays, I also know that having language-concordant providers is not necessarily realistic for a lot of organizations.

When I began working with the Visiting Nurse Service of New York around 2011, they had the data that we could use to do this analysis and determine these types of effects. They had a large enough data set because of the size of the organization and the clientele that they serve to be able to study this.

The last couple of years and the pandemic has certainly sensitized the broader healthcare community to the needs of non-English speakers when seeking healthcare.

And it goes beyond just using an interpreter; if just using an interpreter worked, then there shouldn't be any disparities in health outcomes when controlling for all other types of things.

HL: Being bilingual, is Spanish something you picked up specifically to help you as a nurse?

Squires: No, I started studying Spanish in junior high school and found that I was good with languages, so I continued it while I was in university studying to be a nurse, and just happened to have the opportunity to study abroad in Mexico.

Since I graduated university in 1995, it happened to be a very good time to graduate and be a bilingual nurse speaking Spanish.

It's always a good time to be a bilingual or speaking Spanish, but back then there were even fewer of us who spoke Spanish.

HL: How do you think Hispanic patients perceive you when speaking to them one-on-one?

Squires: When I was working as a staff nurse, and even now when I volunteer, and I'm able to speak Spanish, usually what happens is people work with interpreters and they tend to sort of curtail the information that they share because it is the best option for communication.

It also makes everything take longer, given time constraints in healthcare delivery.

When I would work with patients who had been working with interpreters or didn't have a family member around or whatever reason, oftentimes you'd start speaking and they'd be like, "Oh my God. Do you speak Spanish?" And then suddenly, all this other stuff would come out and it would give answers as to a lot of the issues that we're coming up around specific patient in terms of what their health needs were.

Jasmyne Ray is the revenue cycle editor at HealthLeaders. 

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