Impact of language barrier on acute care medical professionals is dependent upon role.

Communication with patients is essential to providing quality medical care. The study was conducted to evaluate the effects of language barriers on health care professionals. It is hypothesized that these language barriers are commonly perceived by health care professionals and they are a source of workplace stress in acute care environments. We designed and distributed a survey tool of staff experiences and attitudes regarding the English-Spanish language barrier among patients in an acute care surgical environment of a tertiary medical center. Responses were anonymous, stratified by professional role and comparisons made using paired t tests. Sixty-one nurses and 36 physicians responded to the survey. Overall, 95% of nurses reported that the language barrier was an impediment to quality care, whereas 88% of physicians responded similarly (P = .0004). More nurses than physicians report experiencing stress (97% vs. 78%) and the degree of stress appears to be greater for nurses (P < .0001). The basis of stress was unique between the two groups. This study demonstrates that acute care hospital medical professionals perceive language barriers as an impediment to quality care delivery and as a source of workplace stress. Nurse and physician perceptions differ; therefore, strategies to address these language barriers should be specific to those professional roles. These barriers create a void in health care quality and safety that has effects on health care professionals.

Novel spanish translators for acute care nurses and physicians: usefulness and effect on practitioners' stress.

BACKGROUND: Language barriers are significant impediments to providing quality health care, and increased stress levels among nurses and physicians are associated with these barriers. However, little evidence supports the usefulness of a translation tool specific to health care. OBJECTIVES: To evaluate the effectiveness of a novel English-Spanish translator designed specifically for nurses and physicians. The hypothesis was that the translator would be useful and that use of the translator would decrease stress levels among nurses and physicians caring for Spanish-speaking patients. METHODS: Novel English-Spanish translators were developed entirely on the basis of input from critical care nurses and physicians. After 7 months of use, users completed surveys. Usefulness of the translator and stress levels among users were reported. RESULTS: A total of 60% of nurses (n=32) and 71% (n=25) of physicians responded to the survey. A total of 96% of physicians and 97% of nurses considered the language barrier an impediment to delivering quality care. Nurses reported significantly more stress reduction than did physicians (P=.01). Most nurses and physicians had used the translator during the survey period. Overall, 91% of nurses and 72% of physicians found that the translator met their needs at the bedside some, most, or all of the time. All nurses thought that they most likely would use the translator in the future. CONCLUSIONS: The translator was useful for most critical care nurses and physicians surveyed. Health care providers, especially nurses, experienced decreased stress levels when they used the translator.

Supplemental enteral arginine is metabolized to ornithine in injured patients.

BACKGROUND: Arginine has been added to immune enhancing diets that may improve patient outcomes, but little is known about the metabolic fate of supplemental arginine. We hypothesize that supplemental enteral arginine in injured patients is metabolized to ornithine by increased activity of the enzyme arginase. MATERIALS AND METHODS: Twenty-five adult patients with injury severity scores > or =20 received up to 14 days of enteral nutrition supplemented with arginine (30 g/day) or placebo in a prospective, randomized, blinded study. Plasma arginine, citrulline, and ornithine concentrations and peripheral blood mononuclear cell (PBMC) arginase activity were measured at baseline and on days 1, 3, 5, 7, 10, and 14. Clinical data collected included demographics, injury patterns, lengths of stay, and infectious complications. Data were analyzed using ANOVA and t test. RESULTS: PBMC arginase activity was elevated in all patients. In the supplemented group, plasma arginine concentrations increased at days 7, 10, and 14 when compared to baseline (P < 0.05) and were higher at day 14 when compared to those of controls (P < 0.05). Citrulline concentrations in both groups were unchanged over time. Ornithine concentration increased within 24 h of arginine supplementation and remained elevated when compared to baseline (P < 0.01). Ornithine concentration in the supplemented group was higher at days 1, 3, 5, and 7 when compared to that of controls (P < 0.05). There were no differences in clinical outcomes. CONCLUSIONS: Supplemental enteral arginine is absorbed in injured patients and increases arginine levels. Supplemental arginine appears to be metabolized to ornithine. Increased arginase enzyme activity in peripheral blood mononuclear cells may be a contributor.