Interpreters: A Double-Edged Sword in Nursing Practice HENDRIKA J.MALTBY, RN, PhD, FRCNA Edith Cowan University The provision of health services for all Australians is based on equality of access to health care services, regardless of cultural origin or linguistic skill, and on the responsibility of the health system to respond appropriately. Lack of fluency in the English language and lack of bilingual or multilingual nurses are major sources of miscommunication, even with the use of interpreters and translated health information. Many immigrant women find the use of interpreters unacceptable. Nurses are concerned with legal issues. These two viewpoints make the use of interpreters a double-edged sword in prac- tice. The findings of recent research and the literature in rela- tion to language skills and the use of interpreters and transla- tions in the Australian context are explored. Potential resolutions for transcultural nursing practice are provided. Australia is a culturally diverse nation, with more than 6-million people arriving in the past 200 years to join the indigenous people already living here (Armit, Larkins, God- frey, & Benjamins, 1988). People from a non-English- speaking (NES) country made up 13.5% of Australia’s popu- lation (Bureau of Immigration and Population Research, 1993). In the 1996 census, this percentage increased to 16.8% (1996 Census figures show the Australian population to be 17.9 million) (Australian Bureau of Statistics, 1999). Health care services for all people in Australia is based on two princi- ples: “the right of equality of access regardless of cultural ori- gin or linguistic skill; and the responsibility of the health sys- tem to respond appropriately to its target population” (Foster & Stockley, 1988, p. 101). Health and illness care practices are shaped by the values and beliefs of a culture. With immi- grants and refugees coming to Australia from almost any- where in the world, the health care system is finding it increasingly difficult to respond to people who lack fluency in the English language. There is also a dearth of bilingual or multilingual nurses (Nurse Education Review Secretariat, 1994). Even if people do speak English, miscommunication can still occur “due to cultural differences in the rules of com- munication . . . which can lead to dissatisfaction, misdiagno- sis or even death” (Pauwels, 1995, p. 2). Therefore, nurses need to be aware of, and prepared to meet, the needs of people with culturally and linguistically diverse backgrounds (CLDB), so that quality, culturally sensitive care is provided. Unless the nurse is able to speak the language of the client, one way to meet the needs of CLDB people in health care set- tings is the use of health-specific interpreters and translated health information. The use of these interpreters however, can be seen as a double-edged sword. One edge is the need to use interpreters to support legal imperatives (e.g., informed consent); the other is the cultural translation of the message, which can lead to unsatisfactory interpretation for the client. Translated material may be dismissed, if not culturally appro- priate or relevant. The findings of recent research and litera- ture in relation to current communication issues that lead to the need and use of interpreters in the Australian context will be explored. Potential resolutions to cultural miscommunica- tion and enhancing the use of interpreters to provide cultur- ally sensitive nursing care will be proffered. COMMUNICATION ISSUES Communication, which includes spoken language as well as nonverbal features such as facial expressions and gestures, is fundamentally a social process. It occurs between at least two people who cooperate and negotiate meaning. Leininger (1978) sees language and communication as variables in how illness and nursing care are viewed and received by ethnic groups. According to Andrews and Boyle (1995), “One of the greatest challenges in cross-cultural communication occurs 248 Journal of Transcultural Nursing, Vol. 10 No. 3, July 1999 248-254 © 1999 Sage Publications, Inc. CLINICAL PRACTICE DEPARTMENT