Developing Trust in the Nurse-Patient Relationship when a Language Barrier is Present

Trust is an important component in the nurse-patient relationship with hospitalized patients and a key cultural value in the Hispanic culture. In my previous study of the development of trust with English-speaking Mexican American patients, trust was found to develop from positive interactions with the nurse and negative interactions led to the patient not wanting further contact with the nurse which led to patient safety concerns. A limitation of my previous study was not including Spanish-speaking patients. In this current study I explored how interpersonal trust develops between the nurse and the Spanish-speaking Mexican American hospitalized patient in the United States. From a global perspective, nurses worldwide interact with patients who does not speak the same language as the nurse.

Purpose: To explore how trust develops between the nurse and the hospitalized Spanish-speaking Mexican American patient in the United States

Methods: In this study I used the classic grounded theory method. Face-to face interviews were conducted in the hospital setting with Spanish-speaking patients hospitalized at least two days on a medical or obstetric unit in the Midwestern United States. Data collection was done in Spanish using an interview guide with semi-structured questions. Sixteen participants were interviewed in an urban setting and findings indicated nearly all the nurses spoke at least some Spanish. Theoretical sampling led to an extension of data collection to a rural setting where the nurses did not speak Spanish. Data analysis in this classic grounded theory study using constant comparison included first and second level coding.

Results:

A model of the development of trust with the hospitalized Spanish-speaking patient in the United States was developed and includes a core category.  The preliminary data analysis indicated the language was the key factor. If the nurse spoke the patient’s language (Spanish), the patient could express himself or herself related to care concerns but also to simply chat with the nurse, which could lead to the development of trust. In situations where the nurse did not speak Spanish, the patient placed the responsibility of the language barrier on the patient rather than the nurse, and the patient expressed frustration and vulnerability at the lack of English-language skills. In addition, the patient found ways to communicate with the nurse to overcome the language barrier and participate more fully in care decisions. Another important factor in the development of trust was the nurse’s attitude; participants noted some nurses were able to transmit trust even with a language barrier present. Finally, time spent with the nurse was important, the participants noted the need for time and/or an opportunity to develop trust with the nurse.

Conclusion: Findings from this study are useful in the practice setting. Implications for practice include the importance of the nurse at least attempting to speak the patient’s language, even basic words or phrases for social interactions while patients relied on interpreters for detailed explanations of care. In addition,  the nurse’s attitude toward the patient who has a languare barrier is an important factor on whether trust will develop.