Janice Davidson, DNP Student

Doctor of Nursing Practice Program

Chamberlain College of Nursing

Cultural Competence in Using and Assessing for an

Interpreter: A Best Practice Implementation Project

This program has been developed solely for the purposes of

describing nurse practitioner (NP) provider knowledge, skills,

and practice compliance specific to cultural competence in

using and assessing for an interpreter, before and after

participation in an online multi-modal quality improvement

project. The program is posted as a part of this project’s

educational intervention and is intended only for such use.

The study has been approved for this purpose by the

Chamberlain College of Nursing Institutional Review Board.

You may download copies of the interventions contained

within or contact the author jdavidson@chamberlain.edu to

obtain a hard-copy of the interventional resources.

Project Background

• Best practice evidence indicates that using and

assessing for an interpreter to improve patient

outcomes is recommended across all healthcare

settings (Gray, Hilder, & Donaldson, 2011; Giese,

Uyar, Uslucan, Becker, & Henning, 2013). However,

evidence reveals that many providers lack the

necessary cultural competence skills and resources

necessary to support using and assessing for an

interpreter (Okrainec, Miller, Holcroft, Boivin, &

Greenaway, 2014; Lie, Bereknyei, Braddock, Encinas,

Ahearn, & Boker, 2009).

Project Objectives

• To determine current compliance with evidence-

based Joanna Briggs Institute (JBI) audit criteria

specific to using and assessing for an interpreter.

• To improve knowledge regarding best practices

specific to cultural competence in using and

assessing for an interpreter.

• To improve compliance with evidence-based JBI

audit criteria specific to using and assessing for an

interpreter.

• To improve practice outcomes regarding cultural

competence in using and assessing for an

interpreter.

JBI Audit Criteria for Using and

Assessing for an Interpreter

1. Accredited interpreters are utilised to obtain informed

consent for treatment (medical, surgical, pharmaceutical,

therapy, etc.).

2. Individuals are assessed for communication or cultural

barriers.

3. Interpreters are utilised for persons with limited English

proficiency in accordance with local organisational policy

(i.e. interpreter protocols).

4. Standardized methods for identifying individuals with

limited English proficiency exist.

5. Verbal or written consent is obtained and documented in

the medical record when using an interpreter.

Need for Cultural Competence

to Inform Using and Assessing

for an Interpreter

• Attributes for cultural competence

• Family assessment skills

• Cultural heritage assessment skills

• Cultural diversity awareness

• Cultural diversity knowledge

• Cultural sensitivity

• Transcultural caring integrative abilities

Understanding Acculturation

• Gradual changes produced in one culture

through influence of another

Understanding Assimilation

• Absorption of one culture by another, leading

to extinct behaviors

The next slide is provided as an interventional resource for

those providers interested in downloading a brochure that

organizational representatives and providers can use to

establish interpreter protocols and methods to access and

establish interpreters using verbal or written consent. You

may download copies of the interventions contained within

or contact the author jdavidson@chamberlain.edu to obtain

further evidence in support of the interventional resources.

• Protocol for using

and assessing for

an interpreter

(Towers & Harfield,

2013; Jayasekara,

2014).

• The brochure at

right can be

downloaded so

organizational

representatives

and providers can

establish the

protocol in situ.

Family assessment instruments

in advanced practice nursing

• Overview of FAMTOOL – A Family Health

Assessment Tool

• Overview of FAMCHAT – A Family Cultural

Heritage Assessment Tool

• History and Development

• Design

• Psychometrics

The next slide is provided as an interventional resource for

those providers interested in downloading a copy of two

assessment tools – one to assess culturally-diverse families

(FAMTOOL) and the other to assess cultural heritage of

individuals within the family (FAMCHAT). You may download

copies of the interventions contained within or contact the

author jdavidson@chamberlain.edu to obtain further

psychometric data and/or a hard-copy of the interventional

resources.

Companion Tool Development

History of FAMCHAT Validation

and Psychometrics

• Tertiary validation with elderly Mennonite

immigrants from the Ukraine (Davidson,

1994)

• Secondary validation with Mennonite family

members (ages 8-80) from Kansas

(Davidson, Regier, & Boos, 2001)

• Primary validation in village-based nurse

practitioner practice in Haiti

indicating tool and knowledgebase

convergence of international

FNP cultural competence (Davidson &

DeJong, 2002)

• Secondary validation with hospitalized

patients in Canada (Higginbottom et al., 2012;

Higginbottom et al., 2011)

• Further model explication (Davidson, 2012-

2015)

An additional resource that will be made available to

participants upon request at the end of the project is a

“Getting Research into Practice” (GRiP) report. The GRiP

report will offer the results of the clinical audit, selected

strategies for improving compliance, and documentation of

barriers and required resources to encourage sustainable

engagement of stakeholders. If interested, please contact

the author jdavidson@chamberlain.edu to obtain a hard-

copy of the results of the project and GRiP report.

Summary of Interventional

Resources

1. Educational intervention designed to increase knowledge about the

need for cultural competence to inform using and assessing for an

interpreter.

2. Downloadable tool that stakeholders organizational representatives

and providers can use to assess for communication or cultural

barriers.

3. Downloadable brochure that organizational representatives and

providers can use to establish interpreter protocols and methods to

access and establish interpreters using verbal or written consent.

4. Getting Research into Practice (GRiP) report for dissemination of

audit results, selected strategies for improving compliance, and

documentation of barriers and required resources to encourage

sustainable engagement.

References - continued

• Davidson, J. U. (2012). Patient-centered care using clinically-validated instrumentation. FAANP Forum,

3(1), 12.

• Davidson, J. U. (1994). Portraits of Mennonite health: Selected stories from historical nursing research.

Mennonite Life, 49(1), 19-27.

• Davidson, J. U. (1988). Health embodiment: The relationship between self-care agency and health

promoting behaviors. Dissertation Abstracts International, 49(08B). University of Michigan, MI.

• Davidson, J. U. (1984). Historical perspective of self-care agency among elderly Mennonites at the turn of

the twentieth century. Masters Abstracts International. University of Michigan, MI.

• Davidson, J. U., Regier, T., & Boos, S. (2001). Assessing family cultural heritage in Kansas: Research

and development of the FAMCHAT companion tool for family health assessment. The Kansas Nurse,

76(10), 5-7.

• Giese, A., Uyar, M., Uslucan, H. H., Becker, S., & Henning, B. F. (2013). How do hospitalised patients

with Turkish migration background estimate their language skills and their comprehension of medical

information - a prospective cross-sectional study and comparison to native patients in Germany to assess

the language barrier and the need for translation. BMC Health Services Research, 13196.

• Gray, B., Hilder, J., & Donaldson, H. (2011). Why do we not use trained interpreters for all patients with

limited English proficiency? Is there a place for using family members? Australian Journal of Primary

Health, 17(3), 240-249.

References - continued

• Higginbottom, G. M. A., Richter, M. S., Young, S., Ortiz, L. M., Callender, S. D., Forgeron, J. I., & Boyce,

M. L. (2012). Evaluating the utility of the FamCHAT ethnocultural nursing assessment tool at a Canadian

tertiary care hospital: A pilot study with recommendations for hospital management. Journal of Nursing

Education and Practice, 2(2), 1-17.

• Higginbottom, G. M. A., Richter, M. S., Mogale, R. S., Ortiz, L., Young, S., & Mollel, O. (2011).

Identification of nursing assessment models/tools validated in clinical practice for use with diverse ethno-

cultural groups: An integrative review of the literature. BMC Nursing, 10(1), 16-26.

• Jayasekara, R. (2014). Interpreter services: Clinician information. Adelaide, Australia: Joanna Briggs

Institute.

• Lie, D., Bereknyei, S., Braddock, C., Encinas, J., Ahearn, S., & Boker, J. R. (2009). Assessing medical

students' skills in working with interpreters during patient encounters: A validation study of the Interpreter

Scale. Academic Medicine: Journal of the Association of American Medical Colleges, 84(5), 643-650.

• Okrainec, K., Miller, M., Holcroft, C., Boivin, J., & Greenaway, C. (2014). Assessing the need for a

medical interpreter: Are all questions created equal? Journal of Immigrant & Minority Health, 16(4), 756-

760.

• Towers, K., & Harfield, S. (2013). Interpreter services: Using and assessing for an interpreter. Adelaide,

Australia: Joanna Briggs Institute.

• Weeks, S. K., & O’Connor, P. C. (1997). The FAMTOOL family health assessment tool. Rehabilitation

Nursing, 22(4), 188-191.

• Weeks, S. K., & O’Connor, P. C. (1994). Concept analysis of family + health = a new definition of family

health. Rehabilitation Nursing, 19(4), 207-210.

Acknowledgements

• University of California San Francisco (UCSF) Centre for Evidence-Based

Patient and Family Care: An Affiliate of the Joanna Briggs Institute

• Chamberlain College of Nursing:

• Dr. Valda Upenieks, Advisor

• Dr. Sue Fletcher, Preceptor

• Dr. Pat Fedorka, Mentor

• Dr. Ellen Poole, Coach