Robin Dawson Estrada

The Work of Language Interpretation in Health Care: Complex, Challenging, Exhausting, and Often Invisible

The value of qualified language interpretation services for limited-English-proficient patients is gaining increasing recognition by policy makers and researchers in the United States. Yet the actual work experiences of health care interpreters have not been adequately studied. The purpose of this qualitative research was to explore the work experiences of formal and informal interpreters (n = 27). The core narrative finding from the interview data was the complex, challenging, exhausting, and often invisible work of language interpretation. Critical examination of health care interpreters’ complex work and interactions with patients, providers, and administrators is needed to provide more effective and integrated services for limited-English-proficient patients.

A conversation analysis of verbal interactions and social processes in interpreter-mediated primary care encounters.

Language asymmetry between patients with limited English proficiency and health care providers increases the complexity of patient-provider communication. In this research, we used conversation analysis to examine the content and processes of five triadic clinical communication encounters between Spanish-speaking adult patients, English-speaking nurse practitioners, and clinic-based interpreters. Data collection included audio-recordings of the triadic clinical encounters and self-administered post-encounter surveys of the nurse practitioners and interpreters. Our findings revealed communication trouble spots that, when directly addressed by the interactants, facilitated processes of negotiating relationships, and coming to a mutual understanding. Exemplars labeled Making Assumptions; Colloquialisms as Signaling Potential for Trouble; Repairing a Mis-Statement; and Turn-Taking, Silences, and Laughter illustrated how the parties identified and navigated such trouble spots. The final exemplar, Attaining Intersubjectivity, represented a successful multi-lingual triadic communication. While the role of the interpreter often is seen as a conduit of information from one language to another, in practice they also enacted roles of communication collaborators and coconstructors. Future interdisciplinary research can include closer examination of occurrences of communication trouble spots and further exploration of how interpretermediated communication is conceptualized and problematized in diverse clinical settings, to promote language interpretation policies and practices that contribute to reducing health disparities among limited-English-proficient populations.

Urban-Rural Differences in School Nurses' Asthma Training Needs and Access to Asthma Resources

Purpose Few studies have examined school nurses preferences’ for asthma training. Our purpose was to: 1) assess school nurses’ perceived asthma training needs, 2) describe nurses’ access to asthma educational resources, and 3) identify urban‐rural differences in training needs and access to resources in southern states. Design and Methods A convenience sample of school nurses (n = 162) from seven counties (two urban and five rural) in North Carolina and South Carolina completed an online, anonymous survey. Chi‐square tests were used to examine urban‐rural differences. Results Although most nurses (64%) had received asthma training within the last five years, urban nurses were more likely to have had asthma training than rural nurses (χ2 = 10.84, p = 0.001). A majority of nurses (87%) indicated they would like to receive additional asthma training. Approximately half (45%) of nurses reported access to age‐appropriate asthma education materials, but only 16% reported that their schools implemented asthma education programs. Urban nurses were more likely than rural nurses to have access to asthma education programs (χ2 = 4.10, p = 0.04) and age‐appropriate asthma education materials (χ2 = 8.86, p = 0.003). Conclusions Few schools are implementing asthma education programs. Rural nurses may be disadvantaged in terms of receiving asthma training and having access to asthma education programs and materials. Practice Implications Schools are an ideal setting for delivering age‐appropriate asthma education. By providing school nurses with access to age‐appropriate asthma education resources and additional asthma training, we can help them overcome several of the barriers that impede their ability to deliver asthma care to their students. HighlightsOnly 45% of school nurses had access to age‐appropriate asthma education.Only 16% of school nurses were implementing asthma education programs.Rural school nurses had less access to asthma training and materials.

Tummy Time for Latinos With Limited English Proficiency: Evaluating the Feasibility of a Cultural and Linguistically Adapted Parent Education Intervention

Purpose Tummy Time is preventive positioning designed to strengthen an infants neck and upper body muscles and minimize musculoskeletal disorders, including positional plagiocephaly. Latino parents with limited English proficiency (LEP) may experience barriers to receiving instruction on this important health‐promotion strategy. Study aims included 1) adaptation and implementation of a Spanish‐language version of Tummy Time; 2) evaluation of participant Tummy Time knowledge; and 3) assessment of efficacy and acceptability of the Spanish language intervention. Design and Methods This feasibility study involved translation of educational materials into Spanish, creation of Spanish‐language print materials, and training of bilingual research assistants to deliver the educational intervention. Participants were 21 Latino expectant and current parents with self‐identified LEP. Participants completed brief pre‐ and post‐tests and performed a return demonstration. Results Participant knowledge of Tummy Time increased post‐intervention. Program evaluation and on‐site observations supported feasibility and acceptability. Conclusions The cultural and linguistic tailoring of targeted educational interventions is a feasible and potentially effective strategy to overcome barriers experienced by parents with limited English proficiency and may contribute to improved infant health outcomes. Practice Implications To be effective, health education programs must be tailored to the target population. Pediatric nurses and nurse practitioners should be aware that populations with LEP face many barriers that may inhibit their ability to participate in and understand health promotion educational activities. While translating interventions can mitigate language barriers, providers should also evaluate and address other barriers such as time constraints, transportation issues, and trust. HighlightsRegularly and properly performed Tummy Time is beneficial to newborns.Populations with limited English proficiency are at risk of health disparities.Latino caregivers significantly improved their knowledge of Tummy Time after this program.A culturally and linguistically appropriate Tummy Time program is feasible and acceptable.

Rural Asthma: Current Understanding of Prevalence, Patterns, and Interventions for Children and Adolescents

Purpose of ReviewAsthma is the most common chronic illness of children and adolescents in the USA. While asthma has been understood to disproportionately affect urban dwellers, recent investigations have revealed rural pediatric asthma prevalence to be very similar to urban and to be more closely correlated with socioeconomic and environmental factors than geographic location or population density.Recent FindingsRural children experience factors unique to location that impact asthma development and outcomes, including housing quality, cigarette smoke exposure, and small/large-scale farming. Additionally, there are challenging barriers to appropriate asthma care that frequently are more severe for those living in rural areas, including insurance status, lack of primary care providers and pulmonary specialists, knowledge deficits (both patient and provider), and a lack of culturally tailored asthma interventions.SummaryInterventions designed to address rural pediatric asthma disparities are more likely to be successful when targeted to specific challenges, such as the use of school-based services or telemedicine to mitigate asthma care access issues. Continued research on understanding the complex interaction of specific rural environmental factors with host factors can inform future interventions designed to mitigate asthma disparities.

Teachers' Experiences With and Perceptions of Students With Attention Deficit/hyperactivity Disorder

Purpose The purpose of this research was to examine teacher experiences with and perceptions of students with attention deficit/hyperactivity disorder (ADHD). Teachers are integral in helping these children learn effectively and foster healthy relationships, yet little is known about their interactions with these children. Design and Method Semi structured interviews were conducted with a purposive sample of fourteen currently practicing or retired elementary and middle schools teachers in North Carolina and South Carolina. All interviews were audio‐recorded then analyzed for common themes. Results Participants obtained ADHD information from in‐services or peer interaction, rather than formal education. Culture and gender influenced teacher perceptions, and ADHD classroom strategies were based on anecdotal experience. Teachers experienced guilt and worry while negotiating student needs, school system constraints, and family issues. Conclusions While teachers have developed effective coping mechanisms through informal means, formal education and support will help teachers better serve students with ADHD. Practice Implications Pediatric nurses in many settings can benefit from better understanding how teachers perceive and interact with students who have attentional issues. HighlightsTeachers report learning about ADHD from sources such as peers, in‐service education offerings, and personal experience.Teachers need to balance multiple complex demands to help students with ADHD.Teachers often experience feelings of guilt related to interactions with students with ADHD.Teachers develop ways of coping with students with ADHD through informal means or by trial and error.

A Scoping Review of the Literature: Content, Focus, Conceptualization and Application of the National Standards for Culturally and Linguistically Appropriate Services in Health Care

With the aim of addressing inequalities and disparities in health care access and outcomes, in 2001 the United States Department of Health and Human Services Office of Minority Health (OMH) established National Standards for Culturally and Linguistically Appropriate Services (CLAS). In 2010 the OMH solicited public, private and government input which was incorporated into the Enhanced National CLAS Standards. To date there have been no formal reviews of the published literature on the CLAS Standards. The aim of this scoping review was to identify the scientific and professional literature related to the CLAS standards and describe the content, focus, conceptualization and application of these publications, with the goal of providing insights and directions for further research and application of the CLAS standards.

Exploring app features with outcomes in mHealth studies involving chronic respiratory diseases, diabetes, and hypertension: a targeted exploration of the literature

Objectives Limited data are available on the correlation of mHealth features and statistically significant outcomes. We sought to identify and analyze: types and categories of features; frequency and number of features; and relationship of statistically significant outcomes by type, frequency, and number of features. Materials and Methods This search included primary articles focused on app-based interventions in managing chronic respiratory diseases, diabetes, and hypertension. The initial search yielded 3622 studies with 70 studies meeting the inclusion criteria. We used thematic analysis to identify 9 features within the studies. Results Employing existing terminology, we classified the 9 features as passive or interactive. Passive features included: 1) one-way communication; 2) mobile diary; 3) Bluetooth technology; and 4) reminders. Interactive features included: 1) interactive prompts; 2) upload of biometric measurements; 3) action treatment plan/personalized health goals; 4) 2-way communication; and 5) clinical decision support system. Discussion Each feature was included in only one-third of the studies with a mean of 2.6 mHealth features per study. Studies with statistically significant outcomes used a higher combination of passive and interactive features (69%). In contrast, studies without statistically significant outcomes exclusively used a higher frequency of passive features (46%). Inclusion of behavior change features (ie, plan/goals and mobile diary) were correlated with a higher incident of statistically significant outcomes (100%, 77%). Conclusion This exploration is the first step in identifying how types and categories of features impact outcomes. While the findings are inconclusive due to lack of homogeneity, this provides a foundation for future feature analysis.

Language Co-Construction and Collaboration in Interpreter-Mediated Primary Care Encounters With Hispanic Adults

Purpose: Language asymmetry between patients and providers may influence the context, content, and quality of health care communication, affecting patient outcomes and contributing to health disparities. This research examined interpreter-mediated, primary care encounters between English-speaking nurse practitioners and Spanish-speaking adult patients. Method: Situational analysis guided the collection, analysis, and interpretation of audio-recorded clinical encounter data. Results: Interpreter-mediated communication was situated within intersecting social, economic, political, and health systems contexts. Three modes of collaborative knowledge generations were Constructing Connections, Constructing Mutual Understanding, and Constructing Effective Systems Navigation Strategies. Discussion: These findings illustrate how interactants contributed individual and collective knowledge across multiple systems to address patient concerns. Conclusion: The analysis revealed ways in which communication processes may influence both providers’ diagnostic and interventional decision-making and patients’ understanding and potential compliance. Ongoing preparation and support for intraprofessional collaboration is needed to ensure effective communication and mitigate untoward effects of language asymmetries in clinical encounters.

School nurse experiences with prescription opioids in urban and rural schools: A cross-sectional survey

ABSTRACT Few studies have examined the use of prescription opioids in schools. The current study aimed to: (1) describe the context within which school nurses encounter student opioid prescriptions; (2) assess school nurses’ preferences for training and student education; and (3) explore urban–rural differences in school nurses’ experiences and training preferences. A convenience sample of school nurses (n = 633) from North Carolina and South Carolina participated in a brief, anonymous, online survey. Qualitative data were analyzed thematically and statistical tests (t-tests and Chi-square tests) were performed to investigate urban–rural differences. Many school nurses (40.3%) had encountered a student with an opioid prescription, but only 3.6% had naloxone available in case of an overdose. Most school nurses (69.9%), especially rural school nurses, believed students would benefit from opioid education (74.9 versus 66.6%, p = 0.03). The majority of school nurses (83.9%) were interested in opioid-related training. Many school nurses encounter students with prescription opioids and would like additional opioid-related training. The potential benefits of providing naloxone access to prevent opioid-related deaths at schools should be explored.