Advanced Effective Communication, Cultural Competence, and ...

A Roadmap for Hospitals
Chapter One: Admission
that it is a free service provided for the safety of
the patient.
• Explain the right to accomodation for individuals with
disabilities and the services provided to help patients
with communication needs or mobility issues.
• Explain the right to be free from discrimination,
whether or not anti-discrimination protections are
included in the specific state’s laws and regulations,
because hospital policy ensures the provision of
equitable care to all patients.
• Explain the right to identify a support person, the
purpose of the patient’s support person (to relieve
stress and provide emotional support), and the
limitations if the presence of the support person
infringes on others’ rights, compromises safety, or is
medically or therapeutically contraindicated.
• Explain the right to designate a surrogate decisionmaker
and that a surrogate decision-maker may be a
family member, broadly defined to include friends and
same-sex partners.*
❑ Identify the patient’s preferred language
for discussing health care.
Over 24 million people, or 8.7% of the American
population, speak English less than very well and
should be considered limited English proficient for
health care purposes [1]. For patients that are minors or
incapacitated, the preferred language of the patient’s
parent(s), guardian, or surrogate decision-maker should
also be determined. As these individuals have the legal
authority to make decisions on the patient’s behalf, staff
will need to meet the language needs of patient’s parent(s),
guardian, or surrogate decision-maker as well. †
• Ask the patient, “In what language do you prefer to
discuss your health care?” The hospital should
determine the preferred language of each patient,
regardless of whether the patient speaks English
fluently or uses another language to communicate.
• Use a language identification card or tool to determine
the patient’s preferred language [2].
• Arrange for language services to help identify the
patient’s preferred language. ‡
• Identify the preferred sign language for the patient who
uses sign language to communicate (for example,
American Sign Language, Signed English, or, for patients
who are deaf or hard of hearing and have limited English
proficiency, a sign language from another country).
• Note the patient’s preferred language for health care
discussions in the medical record and communicate
this information to staff.
❑ Identify whether the patient has a
sensory or communication need.
Patients with pre-existing hearing, visual, or speech
impairments may arrive at the hospital with their own
communication aids or devices. For patients that
experience sensory or communication impairment due
to their current medical condition, it may be necessary
for the hospital to provide auxiliary aids and services or
augmentative and alternative communication (AAC)
resources to facilitate communication.
• Ask the patient, “Do you have any hearing aids, glasses,
or other devices that you routinely use in order to communicate?”
If the patient has a personal aid or device,
staff should ensure that the patient can access it at all
times during the hospital stay.
• Contact an audiologist or involve the
Ophthalmology Department, if possible, to
provide the appropriate auxiliary aids and services
needed to help a patient who has a sensory
impairment due to a current medical condition
during admission. §
* This is a critical issue for lesbian, gay, bisexual, and transgender (LGBT) families. In some cases, biological family members may disapprove of
the patient’s same-sex relationship and may try to exclude the patient’s partner from visitation or decision-making. If the couple is legally married in
another state, the hospital should give the spouse the same rights as opposite sex spouses, even if the state in which the hospital is located does
not permit or recognize same-sex marriages. As of March 2010, California, New Hampshire, Massachusetts, Connecticut, Iowa, Vermont, have
permitted same-sex couples to marry. See the April 15, 2010 presidential memorandum respecting the rights of hospital patients to receive visitors
and to designate surrogate decision-makers for medical emergencies regardless of their status of legally recognized immediate family members at
http://www.whitehouse.gov/the-press-office/presidential-memorandum-hospital-visitation.
† See Chapter 6: Organization Readiness: Data Collection and Use (page 36) for more information on the collection of preferred language data.
‡ See Chapter 6: Organization Readiness: Provision of Care, Treatment, and Services (page 40) for additional information on developing a system
to provide language services.
§ See Chapter 6: Organization Readiness: Provision of Care, Treatment, and Services (page 41) for additional information on providing auxiliary
aids and services.
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