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Salt Lake County Jail and a Spanish Translation Tool

Dixie State University

Amelia R. Jenkins

Salt Lake County Jail and a Spanish Translation Tool

Ludwig Wittgenstein a philosopher and someone who devoted a lot of time to the study

of logic, math, and language said, The limits of my language means the limits of my world.

(Brainy quote, 2016, Language quote section). For those of us who have never traveled to

another country or place where they have spoken an other language, it is hard for us to

understand what it feels like to have a medical need and not be able to express it nor get the help

needed for it. The expectation to understand any patient who speaks another language that might

come through our door would not be reasonable, but to know what resources are available and

the tools we might use to help those who at the time cannot help themselves is essential. We are

truly limited to what we know as Ludwig points out. So how can a process be improved? What

role do we as nurse play in this? And how can this improve the outcomes of our patients?

Relationship-Based Project

When specifically referring to relationship-based care it has been said, The activities of

care are organized around the needs and priorities of patients and their families. All care

practices visibly demonstrate the mission and values of the organization, including those of

clinicians and staff members from all disciplines, departments, and services (Koloroutis, 2004,

15). While keeping this in mind, part of the mission statement of the Salt Lake County Jail states,

Salt Lake Countys Protective Services Division prides itself on meeting the diverse challenges

of effective crime prevention by transitioning between law enforcement authority, prisoner

management, government security and public service (Salt lake county sheriffs office, 2015). I

want to focus on the part where it talks about meeting the diverse challenges, how can that be

applied to our specific unit? What modifications do we need to make so that we are are prepared

to meet those various challenges?

Target Population
In the Salt Lake County Jail about a couple years ago, in 2014, there were approximately

2,150 inmates being reported at any one given time, and during that same year more than 32,703

were admitted into the jail (Justice Center The Council of State Government, 2016, para. 4). Of

this population, roughly 30% of them are Spanish speaking, as reported by a Chris Cater of U.S.

Immigration and Customs Enforcement department (ICE). He states this can obviously

fluctuate, but it is usually around this percent of immigrants in the Utah correctional system at

any one given time (Chris Cater, November 29, 2016, personal communication).

Problem Identification

Over the past year of working at the Salt lake County Jail, it has come to our attention

that when we got people in our intake who spoke little to no English that fellow co-workers

would simply ask Tiene problemas? Which means do you have any problems? If they said

no, then they would call it good, and not inquire any further, because they knew that they could

not understand even if they got more information. It was then noticed that when they got to the

post screen area that other nurses would then basically repeat the same thing, and call it good.

Obviously this is not an accurate or thorough assessment or history. Seeing that I could speak

Spanish, when I would get some of these patients I would find out that we were missing things

like medications they were taking, diagnoses, or mental health problems. In a study about

language barriers and patients with diabetes they state, Language barriers contribute to health

disparities among Latinos with diabetes (Fernandez, Schillinger, Warton, Alder & Moffet, 2011,

p. 170). They then go onto explain how because they have poor English proficiency skills that it

results in them having poorly controlled blood glucose levels. Though this is just one example of

how language can affect this population, inability to communicate is likely to also interfere with

other health issue when things cannot be communicated clearly.

I also found when working in our mental health area that some of them ended up on

suicide watch because they could not answer the questions about their mental status, resulting in

them being put on suicide watch not because they were suicidal, but because they could not

understand the questions. After talking to some of them they could not understand why they were

being treated so poorly. Being able to see both sides, I understand that if the nursing staff was

unsure of these patients mental health status then they had to error on the side of caution, but

this unwanted and needed treatment does not need to occur if the time is taken to make sure that

these patients are provided a translator or language tools are used.

Goal and Objectives

My goal is to help improve the care provided and outcomes to those patients who come

into the jail whos primary language is Spanish. By providing a translation tool at the initial intake,

my hope is that when it is used that pertinent and vital patient information will be able to be gathered to

help keep the continuity in patient care and avoid miscommunications and errors.


One of the best options for this situation is to always use the phone translation line that is

free and available for us to use to get language assistance for any language need we may have.

Though often times it is difficult to stop and use that option unless there appears to be some

obvious need to understand what the patient is trying to tell us. The use of interpreters can

inform the assessment process, but there are challenges in accessing and utilizing these services,

which we have found to also be the case (McCarthy, Cassidy, Graham, & Tuohy, 2013, p.335).

Another great option is there are a few people in the jail, which include nurses and officers who

speak Spanish as a primary or secondary language who can be called on the radio system to

come help. Again because of time constrains, people often do not want to wait to have someone

come translate or the people who can help are in a situation where they are not available to come
help at the time it is needed. This leads us to need some as a good quick reference that allows us

to find out basics until we are able to sit down with them at the post screen time and get further

information on a more in-depth level.


Some of the problems that face this language tool is that often the population of people

who come in do not have the education level where they are able to read. This would pose a

problem seeing as the tool would require the patient to be able to read it, to then be able to in turn

point out the questions where they my need to provide further information.

Also one of the main reasons people are brought in are for drug and alcohol use. When

they come in under the influence of these substances it often makes it hard to even communicate

basic things let alone any thing like a medical history or medications. The intoxicated state also

makes it hard for them to then focus, which again would amen it hard for the to read the

language tool.

Language Tool Implementation

At the beginning of September I made a sheet that kept tract of those who were brought

into the jail who spoke little to no English. This was done for a little over 2 months, and during

that time there were approximately 47 people admitted to the jail who met this criteria. These

patients charts were then reviewed to see how much information was written down at the initial

intake, and then if there was more information obtained at the post screen that should have been

obtained initially. Then a few of the patients were interviewed who were still in the facility to

see if there were things that were missed that should have been included in their care. Many of

the patients had been released making it hard to follow up, but of the 47, 13 were able to be
interviewed. Of those 13 all of them but 2 had more information that should have been gather at

the initial intake.

The translation tool was then made and implemented for the past week. Only 3 patients

have come in during that time frame and the tool was used for all of them and none stated that

after using this tool they needed further translation needs. Obviously, this is something we are

going to see through for a little longer before drawing any conclusions, but from the information

we do have, we see that this tool seems to help gather needed information in a situation where

language was a barrier. But This tools allows us to break down that barrier to some extent and

help provide better care for these patients.


If we allow the language barrier to affect the care we give to our patients, we are running

the risk of bad if not potentially fatal outcomes. When we nurses we took an oath to do no

harm, how can we know that we are following that if we dont know what our patients needs.

Greater treatment access is of little consequence if, whether for language-related or other

reasons, ineffective or otherwise inadequate treatment is a result. We must seek a comprehensive,

deeper understanding of treatment programs and care provided to the large limited English

proficiency Spanish-speaking population (Snowden, L.R. & McClellan, 2013, p. 1632). Then

like Ludwig said, lets not limit our world because we are unwilling to take the time to provide

patients with the basic need of understanding care in their own language.

Brainy quote. (2016). Language quotes. Retrieved November 30, 2016, from

Fernandez, A., Schillinger, D., Warton, M.E., Alder, N., & Moffet, H.H. (2011). Language

Barriers, Physician-Patient Language Concordance, and Glycemic Control Among

Insured Latinos with Diabetes: The Diabetes Study of Northern California (DISTANCE).

Journal of General Internal Medicine, 26(2), 170-176.

Justice Center The Council of State Government. (2014, August 13). Salt Lake County Launches

Sweeping Study of Jail Population. Retrieved November 30, 2016, from https://


Koloroutis, M. (2004). Relationship-Based Care: A Model for Transforming Practice.

Minneapolis, MN: Creative Health Care Management, Inc.

McCarthy, J., Cassidy, I., Graham, M.M., and Tuohy, D. (2013). Conversations through barriers

of language and interpretation. British Journal of Nursing, 22(6), 335-339.

Salt lake county sheriffs office. (2015). Salt lake county sheriff's office. Retrieved November 15,

2016, from

Snowden, L.R. & McClellan, S.R. (2013). Spanish-Language Community-Based Mental Health
Treatment Programs, Policy-Required Language- Assistance Programming, and Mental
Health Treatment Access Among Spanish-Speaking Clients. American Journal of Public
Health, 103(9), 1628-1633.