At Ullevål Hospital, nurse anesthetists are using Care to Translate to improve patient communication and safety, particularly when interpreters aren't available. The app enables anesthetists to address important pre-surgery questions, enhance patient understanding, and streamline processes during high-risk procedures.
Ullevål Hospital is the largest of the four main campuses of Oslo University Hospital (OUS). It dates back to 1887 and became part of Oslo University Hospital in 2009.
Victoria Margrethe Causevic Bernt is Lead Specialist Nurse in anesthesia and splits her time between the gynecology, eye and dental care units. Being responsible for 30 employees, she ensures they receive training and stay up to date on research. She herself works both clinically and administratively at the department.
“There are a total of 130 nurses employed at Ullevål, and there are three others like me, managing them. We work closely together, but I have taken responsibility for implementing Care to Translate for all 130 employees. We work in all surgery departments here at Ullevål, from orthopedics and neurosurgery to the emergency room or the trauma unit.”
At Ullevål, the doctors and surgeons use interpreters for booked appointments, but oftentimes the nurse anesthetists do not have access to these interpreters.
"We use interpreters when we can.” Victoria says. “But there is mostly a focus on the patients talking to the surgeons who will operate on them. And we've realized in recent years that anesthesia also wants to speak with the patient before they go into surgery."
They can access the information from the meetings with the interpreters, but they themselves often have additional or follow-up questions that arise when the interpreter is not present.
"Typically, an anesthesiologist speaks with them beforehand, but it's us - the nurse anesthetists - who meet them in the operating room and administer anesthesia without having had the chance to ask our own questions."
"So then we end up using body language, make attempts with English, and use Google Translate." Victoria explains.
Sometimes information from the interpreter’s conversation with the doctor reaches the nurses, but it’s often hectic, and the surgeon may not know exactly what details the nurses need before the operation, making it hard to pass on the right information.
"It's very dependent on the individual."
Most of the time, Care to Translate is used to gather important background information in order to administer anesthesia in the safest way possible.
"For the most part, we can read up on medical history. But we also want to know things like whether the patient has eaten anything, when they last ate or drank, whether they have taken their medication today. We can see in the records if the patient is on medication, but we don't know if they have taken it today.”
With factors like loose teeth, smoking, allergies, problems with movement in the neck or the ability to open the mouth wide being of interest, the app serves several purposes.
“These are all things we have to consider during surgery.” Victoria explains.
The app also helps to explain to the patient what is going to happen to them.
"We want to be able to tell the patient that we are going to insert a needle in their arm or back to administer anesthesia. And that they should breathe into the mask that will be placed over their mouth and nose. We also explain positioning and why we are doing what we are doing."
If there are parents present when a child is being put under anesthesia, the parents should also be thoroughly informed.
“It's very important for the parents to know that the child will fall asleep very quickly and that this is completely normal.” Victoria emphasizes. “We also explain that they will be asked to leave when the child has fallen asleep. These are things that are not covered in the interpreter conversation that happens two hours in advance."
Victoria has seen that using Care to Translate to communicate about these things has great value.
"It gives a sense of control to the patients,” Victoria explains “in the few minutes they are awake with us. We’ve noticed that this can make a big difference."
The nurse anesthetists are with the patient from when they come into the operating theater, throughout surgery, until they wake up.
"Waking up is another situation where we need to communicate with the patient. We aim to have the shortest possible anesthesia time, because there is always a risk. So, we can't keep a patient under anesthesia while waiting for an interpreter."
Through the admin portal, Victoria can see that the app has been used in over 500 sessions in the past year. But introducing the app hasn’t just been smooth sailing.
"People say that they have managed without it for ages. But then I usually reply that maybe it has worked in the past for you, but you don't know if it has worked for the patient. So, a lot of it is about informing and educating everyone. That this is how we should communicate and that it's about the patient's integrity and safety. And when I put it like that, I feel like people really listen and understand ."
"There has been a lot of fine-tuning with the playlists to make the conversation as smooth as possible.” Victoria says. “Because you don't want to be standing there with the patient searching for phrases. And there is a huge selection of phrases. So, the more I fine-tune the playlists and get feedback from my colleagues on what works and what doesn't, the better it works."
Some patients still prefer to use Google Translate. And even though you can never be sure of the accuracy of the translations, the need for efficiency often trumps an educational address.
"Sometimes it has happened that I'm standing there with Care to Translate, and they respond using Google Translate. And we communicate that way."
But Victoria has also had patients with whom she’s communicated well using English before anesthesia. But when they’ve woken up, she’s gotten no response when trying to communicate in English.
"I stood there for a few minutes trying to communicate in English and saying that we are done, you can breathe on your own now. But I got no response."
"Then I took out the Care to Translate app and played the phrase 'Breathe in' in the patient's own language. And that’s when they reacted. When you communicate in their native language you get a response that is quite unconscious because it penetrates in a completely different way."
This experience from Victoria shows how vital proper communication is in health care. And how important it is to be prepared, for example by having Care to Translate downloaded and ready, when meeting patients.
Get in touch to explore how you can trial our medical translator in your department. Request a demo here.
Want to learn more about how Care to Translate is being implemented across Norway? Request the Norwegian procurement and implementation report here.
You can also read more about the study in this article from Sykepleien.
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