Tips to Best Cope with Interpreter Fatigue for Hospitals
By Kat Jackson, VP of Language Operations
Medical interpreters provide a bridge of meaningful understanding between a limited English proficient (LEP) patient and his or her provider. This includes responsibility for the accuracy and completeness of the message, a message often containing complex healthcare information that may differ in meaning from one culture to another. The stakes are high, as the quality of the medical interpreter’s work is directly correlated with patient experience and outcome.
In addition to a high level of responsibility, the nature of the work is complex. Medical interpreters navigate complicated, interpersonal dynamics stemming from differences in culture, belief systems, health programs and religion. The work conditions can be distracting, e.g, interruptions from healthcare staff and background noise of machines and hospital operations. Highly emotional situations invoke higher levels of stress in interpreters. Examples include patients and family members receiving a terminal prognosis or life changing news, new and life altering diagnoses, adverse effects during hospital encounters, and discussions between unsatisfied patients and staff.
Medical interpreters witness traumatic situations with some frequency, particularly those who work in urgent care, mental health or other high stress environments. Studies have found that the intensity level of the session has a larger impact on the interpreter than the length of the session.
The quantity and speed of interpretation sessions, particularly for onsite interpreters who must physically get from one part of the hospital to another in a limited amount of time, add to the stress factor. Due to the demanding nature of medical interpretation, it is common for even the most dedicated professionals to experience interpreter fatigue.
Interpreter fatigue has been shown to compromise the quality of the medical interpretation, resulting in less effective communication between patient and provider. By offering support and encouraging healthy habits, hospitals and health systems can help medical interpreters take steps to reduce interpreter fatigue.
Children’s Healthcare of Atlanta has performed extensive research on the subject. The healthcare system recommends establishing “a measurement system used for identifying and stratifying encounters according to their complexity and the corresponding mental resources used by the interpreter”, also known as acuity in healthcare interpreting. The principal was adopted from the concept of acuity in nursing, which evaluates the intensity of the care needed by the patient. By looking at what is required to fulfill the needs of each patient, nurse managers can staff more appropriately. This helps ensure patient needs are met while simultaneously reducing stress in the workplace. The same applies to medical interpreting. Hospitals can more effectively schedule interpreters by factoring the complexity of the sessions versus the number of sessions alone.
A compelling study on the effects of interpreting mental health therapy sessions for LEP refugees found it essential that “interpreters have an adequate support system and…receive consistent support from experienced staff within their agency”. Interpreters who participated in the study reported a moderate increase in stress over the first few weeks to months of their work due to the intensity of the information shared during the interpretation sessions. The medical interpreters, some of them refugees themselves, were internalizing the trauma of the LEP patients, as if it were their own. Also known as vicarious trauma, this is a common phenomenon among first responders and other healthcare professionals. Interpreters who received ongoing support for the trauma reported a significant decrease of stress over the length of the study. Ongoing support included debriefing with therapists to discuss and develop coping strategies for processing distressing clinical material. The study concluded that an increase in institutional support could minimize the difficulties that interpreters experience in their daily work.
A recent article published by the American Translators Association (ATA) on interpreter fatigue recommends the following strategies for language services managers:
- Implement improvements in work conditions and changes in departmental policies.
- Encourage healthy work habits: take breaks, hydrate and eat throughout the day.
- Provide team interpreting upon request in the case of excessive fatigue.
Team interpreting allows interpreters to share the workload. This can be a great tool to use for particularly long or difficult interpreting scenarios. Team interpreting has been shown to ensure consistent quality and reduce the overall occurrence of errors. If team interpreting is not possible, interpreters need to be able to request breaks.
- Break up time spent interpreting for full time employees with administrative tasks or translation assignments.
- Provide training resources for interpreters to more easily complete ongoing education requirements.
- Implement a support system to better cope with difficult scenarios.
ATA also recommends tips to help interpreters better self-manage stress:
- Identify where the stress originates.
- Pinpoint the physical signs of stress.
- Practice healthy habits outside of work.
Interpreter fatigue is widespread in healthcare due to the high stress environment and nature of conversations that take place as well as the complexity of the work itself. Language services managers can take steps to reduce interpreter fatigue by staffing according to a healthcare acuity model when possible, offering a support system and encouraging healthy habits.