CPNRE® Comprehensive Review Series: Part 10






Picking up from yesterday’s post about the role of the environment in nursing, today’s post looks at language barriers and ways we can overcome them. Today’s the 10th instalment of the CPNRE® Comprehensive Review eBook. To see the previous posts – click here: part 1, part 2, part 3, part 4, part 5, part 6, part 7, part 8 and part 9.


Nurse-client interactions: Language barriers

Clear language is needed for clients or their substitute decision-makers (SDMs) to make informed decisions about their health and their care. But what happens when clients or their SDMs speak different languages than us? Or when clients speak English as a second language? Is clear language still necessary? The short answer: yes.

Situations involving language barriers deserve special attention, especially for the CPNRE®. When it comes to language, there are things we need to do in order to develop a mutual understanding of what a person wants or needs.

Here’s what you need to know about language barriers for the CPNRE®:

  1. Ninety-nine percent of the time when clients or their SDMs have difficulty communicating or understanding us because of a language barrier, it’s best to use trained interpreters. Trained interpreters have specialized knowledge and skills in language and culture, and can be trusted to be more objective, to maintain confidentiality and understand health care terminology better than a client’s family and friends.


  1. If a capable client cannot communicate or understand information because of a language barrier, and they cannot provide informed consent for routine, non-urgent interventions, the proposed interventions should be postponed until someone is available to assist in communicating with the client. What this means is, if a client requires routine blood work or diagnostic testing and we cannot communicate information they need to know to make informed consent, it’s best for us to wait until someone can facilitate communication. Imagine yourself in a walk-in-clinic in another country and you don’t speak the language used by health care providers. How would you feel if they didn’t find an interpreter to explain the plan of care and insisted on providing care they thought was necessary? If it were me, I’d lose my mind.


  1. If a client is capable of making decisions, but cannot communicate and efforts to overcome a language barrier are unsuccessful, treatments or procedures may be provided without their consent if it is clear the client would not refuse treatment and delaying treatment will increase their risk for harm.


  1. If a capable client turns away, shakes their head, pushes back, yells or says ‘no’ when offered care or treatment, these actions imply the client is refusing treatment – regardless of whether a language barrier exists.


We can help overcome language barriers by:

  • Speaking slowly and clearly
  • Avoiding slang and complex medical terminology
  • Avoiding assumptions about what clients are saying
  • Clarifying what we’re hearing or seeing, especially when things are unclear
  • Understanding client preferences, opinions, beliefs, and values
  • Orienting clients who are unfamiliar with a particular health care situation or setting


Exam tactic

You may see questions on the CPNRE® testing your understanding of how practical nurses should handle language barriers.

It’s a sign you’re being tested about language barriers when you see a question referring to a client who is an immigrant, or a client who speaks English as a second language. As you read the answer options to questions like this, keep in mind clients’ rights to informed decision-making and the various ways to overcome communication challenges listed above.

Generally speaking, if there’s a non-urgent clinical situation and a language barrier exists, it’s best to use a trained interpreter to explain the nature of a proposed treatment or procedure in order to obtain informed consent.