The healing power of language: caring for patients with limited english proficiency and COVID-19.
The healing power of language: caring for patients with limited english proficiency and COVID-19.
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DOI：
10.1038/s41390-021-01487-6
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发表时间：
2022-03
影响因子：
3.6
通讯作者：
Matute JD
中科院分区：
文献类型：
--
作者：
Herzberg EM;Barrero-Castillero A;Matute JD
在过去的40年里，美国至少5岁的儿童在家不说英语的人数从20世纪80年代的11%（2300万）增加到2018年的21.5%（7100万）。1在这7100万人中，近40%（2570万，约占美国人口的8.5%）的英语水平“有限”（LEP）， 1定义为自我评估的英语能力“不太好”。LEP患者面临许多医疗不公平和较差的健康结果，因为LEP对医疗保健的多个方面产生不利影响，包括获取和利用、医患沟通和信任、满意度、质量和安全以及住院时间。3,4在美国，大多数LEP患者说西班牙语（66%），拉丁裔人口继续增长。除了墨西哥、哥伦比亚和阿根廷，现在在美国说西班牙语的人比拉丁美洲任何一个国家都多。尽管如此，只有5.8%的美国医生是拉丁裔，这给医疗保健领域的代表性带来了重大挑战。1964年的《民权法案》和卫生与公众服务部（HHS）规定，接受卫生与公众服务部联邦财政援助的机构在需要时为LEP患者提供语言服务。7 .近年来，卫生保健机构作出了重大努力，确保为LEP患者提供语言服务，利用各种战略，包括在医疗记录中识别和记录患者喜欢的语言，并利用技术增加口译人员的可用性。然而，许多医疗保健系统仍然难以提供适当的语言服务，10-13以及COVID-19大流行加剧了为LEP患者提供公平医疗服务的重大挑战。在我们自己的机构，在最初的COVID-19激增期间，现有的口译服务无法满足绝大多数LEP患者，特别是讲西班牙语的患者的面对面语言需求，并且在配备全套个人防护设备时，使用电话语言服务证明具有挑战性。这些挑战为我们提供了一个机会，作为通常照顾新生儿的讲西班牙语的新生儿科医生，我们可以照顾讲西班牙语的LEP成年患者。在2020年春季波士顿大流行的高峰期，马萨诸塞州总医院约有60%的住院患者患有LEP，约40%的住院患者说西班牙语。这是一个显著的增长，在基线时，9%的住院患者患有LEP， 6%的住院患者说西班牙语患有LEP。作为合格的双语工作人员（QBS），我们与来自14个国家和13个专业的51名讲西班牙语的临床医生一起，成为新的西班牙语护理小组（SLCG）的一部分。SLCG是一项倡议，旨在为在现场口译人员短缺、个人防护装备配给以及最初COVID-19激增期间需求增加的情况下，为患有LEP和COVID-19的西班牙语患者提供富有同情心和文化能力的护理。作为COVID-19应急小组的一部分，我们用西班牙语对患者进行了评估，并协助进行了有关预后、决策、症状管理、护理目标和出院计划的对话。抛开我们通常的医疗武器库，我们进入了一个新的角色，作为治疗师，用语言的力量武装起来。我们协助照顾一位刚拔管的ICU新妈妈。几天前，她要求紧急剖宫产，因为…
Over the last 40 years, the number of individuals at least 5 years old in the US who speak a language other than English at home has increased from 11%(23 million) in the 1980s to 21.5%(71 million) in 2018. 1 Of those 71 million, almost 40%(25.7 million,~ 8.5% of the US population) have “Limited English Proficiency”(LEP), 1 defined as a self-rated English-speaking ability of “less than very well.” 2 Patients with LEP face numerous healthcare inequities and poorer health outcomes, as LEP adversely impacts multiple aspects of healthcare including access and utilization, patient–physician communication and trust, satisfaction, quality and safety, and duration of hospitalization. 3, 4 The majority of individuals in the US with LEP speak Spanish (66%), and the Latinx population continues to grow. There are now more people who speak Spanish at home in the US than in any country in Latin America, with the exception of Mexico, Colombia, and Argentina. 5 Despite this, only 5.8% of US physicians identify as Latinx, 6 creating a major challenge for representation in healthcare. The Civil Rights Act of 1964 and the Department of Health and Human Services (HHS) regulations mandate that institutions that receive federal financial assistance from HHS provide language services to individuals with LEP where required. 7 In recent years, healthcare institutions have made significant efforts to ensure the provision of language services for patients with LEP, utilizing strategies including identification and documentation of patient preferred language in the medical record and harnessing technology to increase the availability of interpreters. 8, 9 However, many healthcare systems continue to struggle to provide appropriate language services, 10–13 and the COVID-19 pandemic has magnified significant challenges in providing equitable healthcare to patients with LEP. In our own institution, during the initial COVID-19 surge, existing interpreter services were unable to meet the in-person language needs of the overwhelming number of patients with LEP, in particular Spanishspeaking patients, and the use of telephone language services proved challenging in full personal protective equipment. 14 These challenges created an opportunity for us, as Spanish-speaking neonatologists, who normally care for newborns, to care for Spanish-speaking adult patients with LEP. At the height of the pandemic in Boston during spring 2020, approximately 60% of the inpatients at Massachusetts General Hospital had LEP, and around 40% of the inpatients were Spanishspeaking with LEP. This was a significant increase given, at baseline, 9% of our inpatients have LEP and 6% of our inpatients are Spanish-speaking with LEP. 14 As Qualified Bilingual Staff (QBS), alongside 51 other Spanish-speaking clinicians from 14 countries and 13 specialties, we were part of the new Spanish Language Care Group (SLCG). 14 The SLCG was an initiative developed to provide compassionate and culturally competent care for Spanishspeaking patients with LEP and COVID-19 in the setting of a shortage of in-person interpreters, rationing of personal protective equipment, and increased demand during the initial COVID-19 surge. We evaluated patients in Spanish as part of the COVID-19 surge teams and assisted with conversations about prognosis, decision-making, symptom management, goals of care, and discharge planning. Putting aside our usual medical arsenal, we stepped into a new role as healers, armed with the power of language.We assisted with the care of a new mother in the ICU who had recently extubated. A few days earlier, she had required an emergency cesarean delivery due to …
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DOI：
10.15585/mmwr.mm6942e1
发表时间：
2020-10-23
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Gold JAW;Rossen LM;Ahmad FB;Sutton P;Li Z;Salvatore PP;Coyle JP;DeCuir J;Baack BN;Durant TM;Dominguez KL;Henley SJ;Annor FB;Fuld J;Dee DL;Bhattarai A;Jackson BR
通讯作者：
Jackson BR
DOI：
10.1177/0046958017739981
发表时间：
2017-11-16
影响因子：
1.7
作者：
Ryan, Jennifer;Abbato, Samantha;Good, Phillip
通讯作者：
Good, Phillip
DOI：
10.1089/tmj.2009.0186
发表时间：
2010-07-01
期刊：
TELEMEDICINE JOURNAL AND E-HEALTH
影响因子：
--
作者：
Masland, Mary C.;Lou, Christine;Snowden, Lonnie
通讯作者：
Snowden, Lonnie
影响因子：
1.9
作者：
Ginde, Adit A.;Clark, Sunday;Camargo, Carlos A., Jr.
通讯作者：
Camargo, Carlos A., Jr.
影响因子：
120.7
作者：
Webb Hooper, Monica;Napoles, Anna Maria;Perez-Stable, Eliseo J.
通讯作者：
Perez-Stable, Eliseo J.