Featured Article| Volume 32, P20-26, July 2019

Integrating Health Care Interpreters Into Simulation Education


      • Language barriers increase patient vulnerability for adverse outcomes.
      • Health care interpreters are required in the United States.
      • Nursing students can benefit by practicing with health care interpreters.
      • Literature is limited surrounding use of health care interpreters in simulation.
      • Different types of health care interpreters are easily integrated into simulations.


      Patients with limited English proficiency skills are accessing health care services more frequently around the world. Language barriers increase patient vulnerability for adverse events, and health care interpreters may mitigate this risk. Nursing education regarding the effective and appropriate use of health care interpreters has been limited. Interpreters are natural partners for nurses as a strategy to bridge language barriers with patients and could be integrated more regularly into nursing education using clinical simulation strategies. This article offers an overview of the different types of interpreters in health care, proposes recommendations for integrating them into simulation education, and provides a case example to illustrate implementation.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Simulation In Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Agency for Healthcare Research and Quality
        CAHPS Health Literacy Item Sets | Agency for Healthcare Research & Quality.
        (Retrieved from)
        • Bailey S.C.
        • Sarkar U.
        • Chen A.H.
        • Schillinger D.
        • Wolf M.S.
        Evaluation of language concordant, patient-centered drug label instructions.
        Journal of General Internal Medicine. 2012; 27: 1707-1713
        • Beck A.
        • Corak M.
        • Tienda M.
        Age at immigration and the adult attainments of child migrants to the United States.
        The Annals of the American Academy of Political and Social Science. 2012; 643: 134-159
        • Cyracom
        The new law on language access: How will section 1557 of the ACA impact care for LEP patients?.
        (Tucson, AZ. Retrieved from)
        Date: 2016
        • Diamond L.C.
        • Tuot D.S.
        • Karliner L.S.
        The use of Spanish language skills by physicians and nurses: Policy implications for teaching and testing.
        Journal of General Internal Medicine. 2012; 27: 117-123
        • Hsieh E.
        Provider-interpreter collaboration in bilingual health care: Competitions of control over interpreter-mediated interactions.
        Patient Education and Counseling. 2010; 78: 154-159
        • Hsieh E.
        • Kramer E.M.
        Medical interpreters as tools: Dangers and challenges in the utilitarian approach to interpreters’ roles and functions.
        Patient Education and Counseling. 2012; 89: 158-162
        • Hull M.
        Medical language proficiency: A discussion of interprofessional language competencies and potential for patient risk.
        International Journal of Nursing Studies. 2016; 54: 158-172
        • Hyun K.K.
        • Redfern J.
        • Woodward M.
        • Briffa T.
        • Chew D.P.
        • Ellis C.
        • Brieger D.
        Is there inequity in hospital care among patients with acute coronary syndrome who are proficient and not proficient in English language?: Analysis of the SNAPSHOT ACS study.
        The Journal of Cardiovascular Nursing. 2017; 32: 288-295
        • INACSL Standards Committee
        INACSL standards of best practice: SimulationSM: Simulation Design.
        Clinical Simulation in Nursing. 2016; 12: S5-S12
        • INACSL Standards Committee
        INACSL standards of best practice: SimulationSM: Simulation-enhanced interprofessional education (Sim-IPE).
        Clinical Simulation in Nursing. 2016; 12: S34-S38
        • Ju M.
        • Luna N.
        • Park K.T.
        The effect of limited English proficiency on pediatric hospital readmissions.
        Hospital Pediatrics. 2017; 7: 1-8
        • Karliner L.S.
        • Pérez-Stable E.J.
        • Gregorich S.E.
        Convenient access to professional interpreters in the hospital decreases readmission rates and estimated hospital expenditures for patients with limited English proficiency.
        Medical Care. 2017; 55: 199-206
        • Ku L.
        • Flores G.
        Pay now or pay later: Providing interpreter services in health care.
        Health Affairs (Project Hope). 2005; 24: 435-444
        • Leanza Y.
        • Boivin I.
        • Rosenberg E.
        Interruptions and resistance: A comparison of medical consultations with family and trained interpreters.
        Social Science & Medicine (1982). 2010; 70: 1888-1895
      1. - Limited English Proficiency (LEP): A federal Interagency Website.
        (Retrieved from)
        • Lindholm M.
        • Hargraves J.L.
        • Ferguson W.J.
        • Reed G.
        Professional language interpretation and inpatient length of stay and readmission rates.
        Journal of General Internal Medicine. 2012; 27: 1294-1299
        • López L.
        • Rodriguez F.
        • Huerta D.
        • Soukup J.
        • Hicks L.
        Use of interpreters by physicians for hospitalized limited English proficient patients and its impact on patient outcomes.
        Journal of General Internal Medicine. 2015; 30: 783-789
        • Marion G.S.
        • Hildebrandt C. a
        • Davis S.W.
        • Marín A.J.
        • Crandall S.J.
        Working effectively with interpreters: A model curriculum for physician assistant students.
        Medical Teacher. 2008; 30: 612-617
        • McFarland D.C.
        • Johnson Shen M.
        • Holcombe R.F.
        Predictors of satisfaction with doctor and nurse communication: A national study.
        Health Communication. 2017; 32: 1217-1224
        • Moreno G.
        • Walker K.O.
        • Morales L.S.
        • Grumbach K.
        Do physicians with self-reported non-English fluency practice in linguistically disadvantaged communities?.
        Journal of General Internal Medicine. 2011; 26: 512-517
        • Nailon R.E.
        Nurses’ concerns and practices with using interpreters in the care of Latino patients in the emergency department.
        Journal of Transcultural Nursing : Official Journal of the Transcultural Nursing Society/Transcultural Nursing Society. 2006; 17: 119-128
        • National Council on Interpreting in Health Care
        Ethics and standards of practice.
        (Retrieved from)
        • NCIHC
        National standards for healthcare interpreter training programs.
        2011 (Washington, DC. Retrieved from)
        • Omoruyi E.A.
        • Dunkle J.
        • Dendy C.
        • McHugh E.
        • Barratt M.S.
        Cross talk: Evaluation of a curriculum to teach medical students how to use telephone interpreter services.
        Academic Pediatrics. 2018; 18: 214-219
        • Parker W.-A.
        • Steyn N.P.
        • Levitt N.S.
        • Lombard C.J.
        They think they know but do they? Misalignment of perceptions of lifestyle modification knowledge among health professionals.
        Public Health Nutrition. 2011; 14: 1429-1438
        • Patil S.
        • Davies P.
        Use of google translate in medical communication: evaluation of accuracy..
        BMJ. 2014; 349: g7392
        • Pendergrass K.M.
        • Nemeth L.
        • Newman S.D.
        • Jenkins C.M.
        • Jones E.G.
        Nurse practitioner perceptions of barriers and facilitators in providing health care for deaf American sign language users: A qualitative socio-ecological approach.
        Journal of the American Association of Nurse Practitioners. 2017; 29: 316-323
        • Propp K.M.
        • Apker J.
        • Zabava Ford W.S.
        • Wallace N.
        • Serbenski M.
        • Hofmeister N.
        Meeting the complex needs of the health care team: Identification of nurse-team communication practices perceived to enhance patient outcomes.
        Qualitative Health Research. 2010; 20: 15-28
        • Radwin L.E.
        • Cabral H.J.
        • Woodworth T.S.
        Effects of race and language on patient-centered cancer nursing care and patient outcomes.
        Journal of Health Care for the Poor and Underserved. 2013; 24: 619-632
        • Rodriguez F.
        • Cohen A.
        • Betancourt J.R.
        • Green A.R.
        Evaluation of medical student self-rated preparedness to care for limited English proficiency patients.
        BMC Medical Education. 2011; 11: 26
        • Ryan C.
        Language use in the United States : 2011.
        US Census Bureau, Washington, DC2013
        • Sleptsova M.
        • Hofer G.
        • Morina N.
        • Langewitz W.
        The role of the health care interpreter in a clinical setting—a narrative review.
        Journal of Community Health Nursing. 2014; 31: 167-184
        • Squires A.
        • Peng T.R.
        • Barrón-Vaya Y.
        • Feldman P.
        An Exploratory Analysis of Patient-Provider Language-Concordant Home Health Care Visit Patterns..
        Home Health Care Management & Practice. 2017; 29: 161-167
        • Vargas Pelaez A.F.
        • Ramirez S.I.
        • Valdes Sanchez C.
        • Piedra Abusharar S.
        • Romeu J.C.
        • Carmichael C.
        • Silveyra P.
        Implementing a medical student interpreter training program as a strategy to developing humanism.
        BMC Medical Education. 2018; 18: 141
        • Wu M.S.
        • Rawal S.
        “It’s the difference between life and death”: The views of professional medical interpreters on their role in the delivery of safe care to patients with limited English proficiency.
        PLoS One. 2017; 12: e0185659