Long-Term Care

Tip of the week: Overcoming language barriers with ESL staff members

Contemporary Long-Term Care Weekly, October 2, 2008

It is common for nurses and nursing assistants to come from various backgrounds. Therefore, dealing with staff members who speak English as a second language (ESL) is very common. ESL staff members may cause communication barriers in your facility, so you need to know how to recognize and overcome these barriers to continue to provide the highest quality of care for your residents.

“[ESL staff members] are not able to understand what residents are trying to say, or they might have different interpretations,” says Nemcy Cavite Duran, RN, BSN, CRNAC, director of MDS at Dr. William O’Benenson Rehabilitation Pavilion in Flushing, NY.

This can cause problems if a resident is trying to communicate that he or she has to use the bathroom or is in pain, says Duran.

“The needs might be neglected or ignored until someone comes along to do the interpretation, and there can be delay in the care provided,” she says.

In addition, residents can get frustrated when they don’t understand what the caregiver is saying.

“Though workers may speak English very well, they may have strong accents that can be a barrier,” says Duran.

Tips for ESL intervention

Overcoming communication barriers is an essential task to conquer when you have ESL staff members. “We have a language bank. There is a pool of workers that speak different languages, and when we need different interpreters, we call on those caregivers,” says Duran.

A communication board can also be useful, Duran adds.

This is a place to post pictures of common symptoms for residents to point to. “If the resident says, ‘I have pain in my stomach,’ they can point to a picture of a person with a grimacing face, touching their stomach,” Duran says.

It is important to make sure ESL staff members have a general knowledge of common ideas that residents may try to portray.

“We provide inservice education with the common words that residents use—that way staff can understand,” says Duran.

You should also ensure that your ESL staff members know what behaviors are appropriate and the necessary code of conduct to follow so that residents are given the highest quality of care.

“For example, if there are two caregivers caring for a resident at the same time who have the same native language, we discourage speaking in their dialect in front of the resident,” says Duran. “It’s unethical and not good for the patient.”

Language diversity has come to be one of the greatest challenges in nursing homes, Duran says.

Consider sharing the following tips with your ESL staff members:

  • Caregivers should speak in a moderate volume
  • Keep the message short and simple
  • Use nonverbal communication techniques
  • Use cognates, or words with the same roots in two different languages (e.g., use the word complicated, which, in Spanish, is complicado)
  • Be precise in word choice, and avoid medical terminology when dealing with patients
  • Decide what you’re going to say before you say it
  • Allow pauses in conversation to allow time for questions
  • Avoid slang
  • Use positive phrasing
  • Note an absence of questions 

ESL staff members should assess whether the message has been understood by waiting for nonverbal signs. For example, the avoidance of eye contact may indicate the person is not following what you’re saying; however, some cultures view eye contact as a sign of disrespect.

Keeping ESL staff members on board

Having access to healthcare workers who speak languages other than English is an important asset to an organization when caring for an increasingly diverse patient population, says Duran.

“If they are good workers, there is always a way for them to get their message across and be understood,” she says. “If there is a language barrier, it is important to continue to give inservices on how to deal with residents.”


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