MIT S2 Handbook

NCIHC

• National Council on Interpreting in Health Care

  • National Standards of Practice, adopted in 2005

NCIHC Standards / 9 Code of Ethics

1. Accuracy

2. Confidentiality

3. Impartiality

4. Respect

5. Cultural Awareness

6. Role Boundaries

7. Professionalism

8. Professional Development

9. Advocacy

Accuracy Standard

• The interpreter renders all messages accurately and completely, without adding, omitting, or substituting

• The interpreter replicates the register, style, and tone of the speaker

• The interpreter tells everyone present that everything said will be interpreted

• The interpreter manages the flow of communication

• The interpreter corrects errors in interpretation

• The interpreter maintains transparency

Confidentiality Standard

• The interpreter maintains confidentiality and does not disclose information outside the treating team, except with the patient’s consent or if required by law

• The interpreter protects written patient information in his or her possession

Impartiality Standard

• The interpreter does not allow personal judgments or cultural values to influence objectivity

• The interpreter discloses potential conflicts of interest, withdrawing from assignments if necessary

Respect Standard

• The interpreter uses professional, culturally appropriate ways of showing respect

• The interpreter promotes direct communication among all parties in the encounter

• The interpreter promotes patient autonomy

Cultural Awareness Standard

• The interpreter strives to understand the cultures associated with the language he or she interprets, including biomedical culture

• The interpreter alerts all parties to any significant cultural misunderstanding that arises

Role Boundaries Standard

• The interpreter limits personal involvement with all parties during the interpreting assignment

• The interpreter limits his or her professional activity to interpreting within an encounter

• The interpreter with an additional role adheres to all standards of practice while interpreting

Professionalism Standard

• The interpreter is honest and ethical in all business practices

• The interpreter is prepared for all assignments

• The interpreter discloses limitations with respect to particular assignments

• The interpreter avoids sight translation, especially of complex or critical documents, if he or she lacks sight translation skills

• The interpreter is accountable for professional performance

• The interpreter advocates for working conditions that support quality interpreting

• The interpreter shows respect for professionals with whom he or she works

• The interpreter acts in a manner befitting the dignity of the profession and appropriate to the setting

Professional Development Standard

• The interpreter continues to develop language and cultural knowledge and interpreting skills

• The interpreter seeks feedback to improve his or her performance

• The interpreter supports the professional development of fellow interpreters

• The interpreter participates in organizations and activities that contribute to the development of the profession

Advocacy Standard

• The interpreter may speak out to protect an individual from serious harm

• The interpreter may advocate on behalf of a party or a group to correct mistreatment or abuse

IMIA

• “International Medical Interpreters Association”

• Standards of Practice (originally MMIA) are oldest in country and great assessment tool

• SOP is divided into three duties: Interpretation, cultural interface, ethical behavior

• Code of Ethics is a code of conduct

• CoE guidelines are to “protect the rights of the patient and protect the rights of the interpreter.”

IMIA Code of Ethics (11)

1. Interpreters will maintain confidentiality in all assignment-related information.

2. Interpreters will select the language and mode of interpretation that most accurately conveys the content and spirit of the messages of their clients

3. Interpreters will refrain from accepting an assignment when professional skills, family, or close personal relationships affect impartiality

4. Interpreters will not interject personal opinions or counsel patients (impartiality)

5. Interpreters will not engage in interpretations that relate to issues outside the provision of health care services unless qualified to do so. (role boundary)

6. Interpreters will explain their roles and cultural differences or practices to health care providers and patients when appropriate. (cultural awareness / transparency)

7. Interpreters will use skillful unobtrusive interventions so as not to interfere with the flow of communication in a triadic setting. (professionalism)

8. Interpreters will keep abreast of their evolving languages and medical terminology. (professional development)

9. Interpreters will participate in continuing education programs as available. (professional development)

10. Interpreters will seek to maintain ties with relevant professional organizations in order to be up-to-date with the latest professional standards and protocols. (professional development)

11. Interpreters will refrain from using their position to gain favors from clients. (professionalism / role boundary)

Only exceptions to maintaining confidentiality for an interpreter are:

• When there is knowledge of suicidal or homicidal plan

• When there is knowledge or suspected abuse of a child

• When there is knowledge or suspected abuse of an elder

• When there is knowledge or suspected abuse of an incapacitated/disabled adult

5 Guiding principles of both NCIHC and IMIA

1. Maintain Confidentiality

2. Interpret accurately and completely

3. Maintain Impartiality

4. Respect Patient Privacy

5. Maintain a Professional Attitude

1. Maintain Confidentiality

Guard the patient’s right to confidentiality at all times, including with family and friends

2. Interpret accurately and completely

• Provide an accurate rendition of the original meaning in the target language without editing, changing, or deleting anything that is said. Remain aware of educational, cultural, and regional variations.

• Interpret for meaning, not words.

• Reflect the spirit of what is said (i.e., anger, fear, self-doubt).

• Interpret everything that is said, including repetitions, circular speech, or swears.

3. Maintain Impartiality

• Identify your personal biases and beliefs that may interfere with your ability to be impartial.

• Withdraw from interpreting if you are unable to be impartial.

• Conduct the session in a non-judgmental way. Avoid conveying any personal bias or attitude.

• You do not have to agree with or believe in what you interpret.

4. Respect Patient Privacy

• Don’t ask probing questions outside of the scope of the interpretation.

• Don’t become personally involved in the life of the patient.

• Refrain from expressing personal comments or opinions.

5. Maintain a Professional Attitude

• Keep a professional distance

• Instill trust and have empathy without crossing the boundaries of the interpreter’s role

• Maintain professional integrity

• Do not have contact for your personal benefit

  • Avoid conflicts of interest (e.g., do not interpret for family members or friends).

CONDUIT

Most basic of the roles of an interpreter

• “Rendering in one language exactly what has been said in the other without adjusting register”

• No additions, omissions, or polishing

• Default role of the interpreter - the interpreter adopts unless she/he perceives a clear potential for misunderstanding

Register Defintion

• Differences in levels of language difficulty and formality

• The linguistic style in which a person chooses to express him/herself

• Different registers or linguistic styles are used depending on the degree of familiarity the speaker wants to establish with the listener

Register Examples:

Formality:

• Formal: Mrs. Ramos, may I check your glucose level today?

• Informal: Maria, I’m going to check your blood sugar

• Intimate: Sweetie, give me your finger to check your blood sugar today

Difficulty:

• High: Myocardial infarction

• Medium: Cardiac arrest

• Low: Heart attack

CLARIFIER

• The interpreter adjusts the register (e.g., complex language about health care procedures and concepts).

• Makes pictures of terms that have no linguistic equivalent (or whose linguistic equivalent will not be understood by the patient) and checks for understanding.

• Adopted when the interpreter believes it is necessary for understanding.

CULTURE BROKER

• Interpreter provides necessary cultural framework for understanding verbal communication and patient’s affect.

• Adopted when cultural differences are leading to misunderstanding on the part of either the provider or patient

ADVOCATE

• Any action an interpreter takes on behalf of the patient outside the bounds of an interpreted interview

• Concerned with quality of care (direct and follow- up), in addition to quality of communication, and familiarity of system’s complexity.

• Adopted when needs of the patient are not being met due to a systemic barrier, such as the complexity of the health care system or racism

In the role of the Conduit, the interpreter…

is simply relaying to the listener what the speaker has said. It is fairly unobtrusive.

As the Clarifier, the interpreter…

might need to intervene to ask for clarification, break into his/her own voice, and ask questions to help the interpreting process along As

As Culture Broker, the interpreter…

becomes more and more involved, offering an explanation of a cultural framework. This diverts the attention of the provider from the patient to the interpreter. Additionally, the interpreter can explain provider culture to the patient, diverting the patient’s attention from the provider to the interpreter. Th

The Advocate role is the

most biased role, as the interpreter acts and speaks on behalf of the patient, becoming the focus of the interaction.