A Healthcare Interpreter's Best Friend

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Information about A Healthcare Interpreter's Best Friend
Health & Medicine

Published on September 30, 2013

Author: NCIHC

Source: slideshare.net

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An overview of the NCIHC National Code of Ethics for Interpreters in Health Care

Shiva Bidar-Sielaff, M.A. Karin Ruschke, M.A. Presented by: Jorge U. Ungo American Translators Association 49th Annual Conference A Health CareA Health Care Interpreter’s BestInterpreter’s Best Friend: The NationalFriend: The National Code of Ethics forCode of Ethics for Interpreters in HealthInterpreters in Health CareCare

Creating the National Code ofCreating the National Code of Ethics for Interpreters in HealthEthics for Interpreters in Health CareCare  Overview of the NCIHC  Review of the process used to develop the Code of Ethics for Interpreters in Health Care  Review the principles of Code of Ethics  Case Studies

The National Council on InterpretingThe National Council on Interpreting in Health Care (NCIHC)in Health Care (NCIHC)  1994 - informal working group  1998 - formally established  Multidisciplinary membership:  medical interpreters  interpreter service coordinators and trainers  clinicians  policymakers  advocates  researchers  Mission: to promote culturally competent professional health care interpreting as a means to support equal access to health services for individuals with limited English proficiency  Website: www.ncihc.org

Building a ProfessionBuilding a Profession  Create and build support for a single Code of Ethics that will guide the practice of interpreters working in health care venues  Develop a nationally accepted, unified set of Standards of Practice based on the Code of Ethics that will define competent practice in the field  Develop standards for health care interpreter training  Contribute to the development of a national certification for health care interpreters as part of the National Coalition on Healthcare Interpreter Certification

Challenges in Creating theChallenges in Creating the National Code of EthicsNational Code of Ethics To design a code that built on and solidified existing work To expand upon this existing work to ensure its relevance to all health care interpreters, irrespective of the languages or particular venue in which interpreters work

Designing the National Code ofDesigning the National Code of Ethics for Interpreters in HealthEthics for Interpreters in Health Care: The ProcessCare: The Process

Step 1:Step 1: Reviewed Existing Codes of EthicsReviewed Existing Codes of Ethics  Identified and collected existing codes of ethics in health care and other related areas such as legal and sign language interpreting  Focused on ten codes that were considered most relevant to our work  Compared and identified the elements that were held in common and analyzed how each approached those issues that were most difficult and controversial in the field

Step 2: Created a Draft CodeStep 2: Created a Draft Code  Drafted a code that included the elements shared across these existing codes as well as a few that were controversial but relevant  Included a short commentary after each principle that further explained and illustrated that principle

Example of Draft PrincipleExample of Draft Principle Principle #2. Accuracy and Completeness        The interpreter strives to render the message faithfully, conveying the content and spirit of the original message, while taking into consideration its cultural context. It is the interpreter’s responsibility to interpret everything the speaker says  without changing the meaning. The interpreter should attempt to convey what is  said and how it is said without additions, deletions or alterations, but with due  consideration of the cultural context of both the sender and the receiver of the  message.    Whenever possible, the interpreter should convey the meaning of gestures, body  language, and tone of voice that add significantly to the content of the message.    Additionally, when the interpreter becomes aware of a mistake they have made,  the interpreter must reveal and correct the error.  

First Draft Code of EthicsFirst Draft Code of Ethics  Confidentiality  Accuracy and Completeness  Impartiality  Professional Boundaries  Professional Development  Cultural Competence  Respect for all Parties  Professional Integrity

Step 3:Step 3: Conducted National FocusConducted National Focus Groups to Review the Draft (Fall 2002)Groups to Review the Draft (Fall 2002)  17 focus groups across the country   Broad representation of language groups and  modes of service delivery (e.g. face to face and  telephone interpreting)  Groups confirmed the need for a unified national  code of ethics and affirmed its development as a  positive step for the profession   Feedback also concluded that the draft code was  fundamentally complete and appropriate although  some principles were seen as more or less  controversial 

Step 4: 2Step 4: 2ndnd Draft Code of EthicsDraft Code of Ethics Included focus group commentaries and incorporated  recommended changes:  Confidentiality  Accuracy and Completeness  Impartiality  Professional Boundaries  Professional Development  Cultural Competence →  Cultural Intervention  Respect for all Parties  Professional Integrity   →Advocacy

Step 5: National SurveyStep 5: National Survey    2nd  draft introduced to a larger cross-section  of working interpreters through a survey   survey disseminated through the NCIHC  website and state associations of health  care interpreters  approximately 2,500 surveys were  distributed, with a return rate of 20%     

Sample Survey QuestionsSample Survey Questions Principle #9. Advocacy Advocacy is an action that is taken on behalf of an  individual that goes beyond facilitating communication  with the intention of supporting good health outcomes. In  some special circumstances, the interpreter may advocate  for the interests of any individual patient, provider, or  community. Advocacy must be undertaken carefully, if at all, only if  other mechanisms for addressing a problem do not work.

Sample Survey QuestionsSample Survey Questions Principle #9. Advocacy 1. This final principle is being considered for inclusion in the Code of Ethics. Do you think the code should include a principle regarding advocacy? ___ Yes ___ No 2. Do  you agree with this principle? ____ Yes ____ No Please explain. 3. When do you think it is appropriate for a health care interpreter to act as an advocate for the patient? (Check one or more) a. When the interpreter has tried all other avenues to resolve the problem.  b. When the health, well-being or dignity of the patient is at risk. c. Never. A nurse in the pre-operative area of a hospital tells a patient that her left leg is being amputated. The patient becomes increasingly agitated, insisting that her right leg was to be amputated. The interpreter interprets what the patient is saying, and the nurse in charge ignores the patient’s protests. The interpreter is aware from a previous appointment that the patient is correct and the doctor had been planning on amputating the right leg. The patient continues to protest, even as the anesthesia is being prepared. The interpreter continues to interpret for the patient, attempting to convey his frustration and fear, but when the situation is not resolved, the interpreter leaves the room and calls the nurse’s supervisor. Do you agree with this application of the advocacy principle? ____ Yes ____ No

Survey ResultsSurvey Results Strong agreement on the principles as stated  in the draft. Most controversial principle was  “Advocacy” Commentaries generated most controversy Commentaries generated unresolved  questions about implementation 

Step 6: The National Code of Ethics forStep 6: The National Code of Ethics for Interpreters in Health CareInterpreters in Health Care  Code of ethics highlights the consensus there was on the principles themselves - published without commentary  Final draft was also reviewed by a select number of health care providers and medical ethicists  Companion document is created that offers a more thorough discussion of the issues raised  places the code in the context of ethical behavior in general  provides an elaboration and discussion of each principle and the interrelationships among them, acknowledging that controversies still exist while offering the working interpreter a way to think about these controversies

National Code of Ethics forNational Code of Ethics for Interpreters in Health CareInterpreters in Health Care “The role of interpreter is a‘tightrope’ balancing act: A code of ethics is a good guide for the ‘bar’ carried on such a walk on the tightrope. It offers balance, some security and especially is a comfortable way to face the unknown risks faced on the interpreter’s path.” Anonymous Respondent to Code of Ethics Survey

Core ValuesCore Values Support health and well-being of patient and do no harm Remain faithful to original message Take into consideration culture and cultural differences to ensure understanding

The interpreter treats as confidential, within theThe interpreter treats as confidential, within the treating team, all information learned in thetreating team, all information learned in the performance of their professional duties, whileperformance of their professional duties, while observing relevant requirements regardingobserving relevant requirements regarding disclosure.disclosure.  Shared with other health care professionals  Sharing information with the treating team does not violate confidentiality  Avoid situations that expose you to confidential information  Explain your role  Avoid being alone with the patient  If information is shared in confidence,  encourage patient to disclose information to provider  decide, based on core values and legal obligations, whether or not to share

The interpreter strives to render the messageThe interpreter strives to render the message accurately, conveying the content and spiritaccurately, conveying the content and spirit of the original message, taking intoof the original message, taking into consideration its cultural context.consideration its cultural context.  Essence of interpreter role  Remain unbiased  Do not omit, add or distort message  Offensive language, derogatory remarks  Possible exception: if not intentional, warn speaker  Interpret meaning, not words  Correct all mistakes

The interpreter strives to maintainThe interpreter strives to maintain impartiality and refrains from counseling,impartiality and refrains from counseling, advising or projecting personal biases oradvising or projecting personal biases or beliefs.beliefs.  Provider-patient relationship is key  Refrain from judging  No personal biases and beliefs  Last resort:  Withdraw from assignment  Disclose limitations  Impartial ≠ Uncaring

The interpreter maintains the boundaries ofThe interpreter maintains the boundaries of the professional role, refrainingthe professional role, refraining fromfrom personal involvement.personal involvement.  DO NOT mix roles  Know your limitations  Accept assignments you can manage  Withdraw from assignment  Disclose limitations  Maintain professional relationship  Do not provide personal information  Avoid personal involvement

The interpreter continuously strives toThe interpreter continuously strives to develop awareness of his/her own and otherdevelop awareness of his/her own and other (including biomedical cultures) encountered(including biomedical cultures) encountered in the performance of their professionalin the performance of their professional duties.duties.  Culture is a central factor in health care and necessary to interpret meaning  Be aware of your own culture  Possess enough understanding of patient and biomedical culture to facilitate communication across cultures  Cultural competence should be a value shared by the whole medical team

The interpreter treats all parties withThe interpreter treats all parties with respect.respect.  Treat everyone with courtesy and dignity  Respect autonomy and expertise of all parties

When the patient’s health, well-being, or dignity areWhen the patient’s health, well-being, or dignity are at risk, the interpreter may be justified in acting asat risk, the interpreter may be justified in acting as an advocate. Advocacy is understood as an actionan advocate. Advocacy is understood as an action taken on behalf of an individual that goes beyondtaken on behalf of an individual that goes beyond facilitating communication, with the intention offacilitating communication, with the intention of supporting good health outcomes. Advocacy mustsupporting good health outcomes. Advocacy must only be undertaken after careful and thoughtfulonly be undertaken after careful and thoughtful analysis of the situation and if other less intrusiveanalysis of the situation and if other less intrusive actions have not resolved the problem.actions have not resolved the problem. Most controversial principles Advocacy ≠ taking sides, judging, personal opinions Only after careful and thoughtful analysis Seek supervisor advice whenever possible Only when clear and/or consistent observation that something is not right and action needs to be taken to protect patient’s health and well-being

The interpreter strives to continuallyThe interpreter strives to continually further his/her knowledge and skills.further his/her knowledge and skills.  Continue to sharpen your skills  Language is dynamic  Keep abreast of developments in your profession  Attend trainings/workshops/conferences

The interpreter must at all times act in aThe interpreter must at all times act in a professional and ethical manner.professional and ethical manner.  Monitor own performance and behavior  Do not use knowledge to your personal advantage  Do not exploit the vulnerability of the patient  Ethical business practices  Compensation  Punctuality  Keeping appointments

Case StudiesCase Studies Which ethical principles apply to each case study? What would you do?

The National Council on InterpretingThe National Council on Interpreting in Health Care (NCIHC)in Health Care (NCIHC) www.ncihc.orgwww.ncihc.org

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