An Exploration of Ethical Decision Making and Boundaries in Health Care Interpreting

1. An Exploration of Ethical Decision Making and Boundaries in Health Care Interpreting Richard Laurion, MA, CI, CT, NIC: Advanced Paula Gajewski Mickelson, MA, CI, CT, NIC: Advanced UMTIA Presentation Saturday, January 26, 2013, 9 – 12 noon

2. Our Plan for our Day • Welcome! • Wide-Angle Lens: studies on medical interpreting – spoken and sign language interpreters. • Zooming in on “boundaries” • “boundaries” in these studies. • “boundaries” in codes of ethics/conduct: • International Medical Interpreters Association • National Council on Interpreting in Health Care • National Association of the Deaf / Registry of Interpreters for the Deaf • Developing mutual understanding regarding “boundaries” in our work. • Discussion of case study. • Wrap-Up

4. Ways medical interpreting may differ from other settings (Roat, 2004) • Often triadic, with doctor or therapist, patient and interpreter in a small space. • The perception of the interpreter’s role is heavily constrained by the setting (Angelelli, 2004) . Supported by the National Consortium of Interpreter Education Centers

5. Questions have a different function in medical settings than other settings such as the courtrooms or classroom • Dr. - patient interview • Intimate & consultative • Complex interpersonal relationships and roles Supported by the National Consortium of Interpreter Education Centers

6. Poor Health Literacy • Health Literacy: ability to obtain, process and understand health information that is necessary to make suitable health care decisions (HHS, 2001; Nutbeam, 2000; Zarcadoolas, et al., 2002) • >33% of English-speaking patients and >50% of primarily Spanish-speaking patients at U.S. public hospitals have low health literacy (Marcus, 2006) • Deaf ASL users???

7. Prevention • Deaf and hard of hearing were less likely to learn preventive information from their doctor or the media (Tamaskar, et al., 2000) • Preventive health counseling and screening procedures were thought to be less important (Tamaskar, et al., 2000) • Children with hearing loss had twice the injury rate as hearing peers (Mann, Zhou, McKee, & McDermott, 2007).

8. Cardiovascular Health • Cardiovascular disease (Margellos-Anast et al., 2006) • 40% of deaf were unable to list a single symptom of heart attack (<10% for hearing) • 60% of deaf unable to do the same for stroke (30% for hearing) • Only 61% reported that they would call 911 if they had any acute cardiovascular symptoms • Knowledge of risk factors for heart disease: • Hypertension (59% of deaf respondents reporting this as a risk factor versus 97% of hearing respondents reporting the same); • High cholesterol (52% versus 92%) • Diabetes (40% versus 75%)

9. National Center for Deaf Health Research Major Implications (McKee, 2010) • Lack of interpreters or if available unqualified • Medical staff not aware of ASL or Deaf Culture • Consumers unaware or poorly informed about their legal rights • NCIEC Deaf Self-Advocacy Initiative

10. How can we prepare interpreters towork effectively in healthcare settings? Supported by the National Consortium of Interpreter Education Centers

11. Defining Domains & Competencies Separate Efforts finding common ground Supported by the National Consortium of Interpreter Education Centers

12. Domains for Effective Practice • Health Care Systems • Mental Healthcare Context • Therapeutic Dynamics • Multiculturalism and Diversity • Self-Care • Boundaries • Preparation to Interpret • Ethical and Professional Decision Making • Language and Interpreting • Interpreting Therapeutic Discourse • Technology • Research • Legislation • Leadership • The Interpreter as Professional • Communication Advocacy • Professional Development Supported by the National Consortium of Interpreter Education Centers

13. Domains NCIEC Study Refki, Avery & Dalton Healthcare Systems Legislation & Advocacy Interpreting Skills Medical Terminology & Anatomy Culture (& Diversity) Language • Health care systems • Legislation & Advocacy • Medical Terminology • Interpreting skills & Development • Role and boundaries • Ethics and decision-making • Culture and Diversity • Language (ASL & English) • Preparation • Technology & Research Supported by the National Consortium of Interpreter Education Centers

14. Zooming in on “boundaries” “Professional Boundaries in Health Care.” (2012). VEA Australia – New Zealand • http://www.youtube.com/watch?v=gOHhCUWc0hw

15. Professional Boundaries A nurse’s guide to the importance of appropriate professional boundaries. (p 4). (2009).

16. “Boundaries” in the studies

17. Themes regarding boundaries in Codes of Ethics/Conduct - IMIA

18. Themes regarding boundaries in Codes of Ethics/Conduct - NCIHC

19. Themes regarding boundaries in Codes of Ethics/Conduct - RID

20. Developing mutual understanding regarding boundaries in our work. • Richard – are we using the case study of the power of attorney question? Or do you have a clip from Anita’s film we should use?

21. Circle Discussion • I’ll add instructions for the discussion here.

22. Questions to explore.

23. Wrap Up • Share insights from conversations (as time allows) • What’s next? • How will you use this information in your coming work? • What further study will you do? • Conversations with colleagues? • Other?

24. Resources • Professional Boundaries A nurse’s guide to the importance of appropriate professional boundaries. (brochure). (2009). National Council of State Boards of Nursing. Chicago, IL. (retrieved on January 20, 2013 from: https://www.ncsbn.org/ProfessionalBoundariesbrochure.pdf) • Code of Ethics. International Medical Interpreters Association. (2006) (retrieved on January 20, 2013 from: http://www.imiaweb.org/code/default.asp) • IMIA Guide on Medical Interpreter Ethical Conduct. (2010). International Medical Interpreters Association. (retrieved on January 20, 2013 from: http://www.imiaweb.org/uploads/pages/376_2.pdf) • National Standards of Practice for Interpreters in Health Care. (2005). National Council on Interpreting in Health Care. (retrieved on January 20, 2013 from: http://www.ncihc.org/assets/documents/NCIHC%20National%20Standards%20of%20Practice.pdf) • A National Code of Ethics for Interpreters in Health Care. (2004). The National Council on Interpreting in Health Care. (retrieved on January 20, 2013 from: http://www.ncihc.org/assets/documents/NCIHC%20National%20Code%20of%20Ethics.pdf) • NAD-RID Code of Professional Conduct. (2005). Registry of Interpreters for the Deaf. (retrieved on January 20, 2013 from: http://rid.org/UserFiles/File/NAD_RID_ETHICS.pdf) • Professional Boundaries in Health Care (video). (2012). VEA Australia – New Zealand. (retrieved January 20, 2013 from: http://www.youtube.com/watch?v=gOHhCUWc0hw)