Abstract
This chapter describes situations of distress and the working climate of healthcare interpreters in Sweden. A questionnaire focused on distressful situations was administered to interpreters with experience in healthcare interpreting. The results indicated that distress in healthcare interpreting could be traced back to ethically and emotionally challenging interpreting situations and working conditions, and a lack of respect for the interpreters' work. An interview study using Grounded Theory showed that interpreters' main concern was the threat to professional and private integrity. Despite the fact that in general the interpreting profession in Sweden may seem professionalized, interpreters struggle with dilemmas connected to less professionalized activities. Our study was conducted in Sweden, but we argue that the results can be generalized to other countries. Although differently organized in different countries, health care interpreters experience similar dilemmas. Equal access to equitable care can be effectively hindered by language barriers.
TopIntroduction
Healthcare interpreters face many distressing situations. These may include anything from delivering a difficult message or dealing with sorrow and anger, to handling challenging terminology. Research has shown that interpreters often find it difficult to convey certain messages, such as those related to a serious illness. Interpreters may experience difficulty balancing their own feelings of compassion, while being neutral at the same time (e.g. Jungner et al., 2015; Lor, 2012; Butow et al., 2010; Splevins et al., 2010; Hsieh 2008). Previous research also points to the lack of support structures or debriefing for interpreters, which in turn leads to vicarious trauma and burn-out (Lai & Mulayim, 2015; Bontempo & Malcolm, 2012; Splevins et al., 2010).
For the study reported in this chapter we assumed that healthcare interpreters handle emotional distress in the interpreter mediated event. Such distress may differ depending on the specific healthcare sector and from country to country, as working conditions for interpreters and their organizations vary. Research on emotional distress and the role of the healthcare interpreter has been conducted on a larger scale in Australia, South Africa and the United States (Penn & Watermeyer, 2018; Hsieh, 2016). These countries differ in terms of conditions for interpreters and interpreted languages. They also differ from Sweden (our country of study) in that respect. There are differences in terms of users of the interpreting services, for example. In South Africa, the users of interpreting services are often indigenous speakers of official languages, but not the language of the institution in question. In the US, Spanish is the most common language and South America the most common geographical background of users of interpreting services. Australia has large geographical distances. Two groups, immigrants and indigenous language speakers, require interpreting services. The interpreters’ task can sometimes be more challenging in countries with large immigrant groups. There are newly arrived refugees who may have experienced trauma. Interpreters in countries with indigenous populations face difficulties related to heritage, culture or accessibility. Other differences may stem from the interpreters’ working conditions, how the interpreting services are organized, whether interpreters are staff or independent and whether or not they have been trained.
Healthcare interpreters in any country may come face to face with emotionally challenging situations. Situations can be challenging in different ways. Stress, conflict, cultural background, difficult stories or difficult messages may all contribute to challenging work. Distress can originate in the interpreter, the participants, or even the surrounding system.
The research project on healthcare interpreting in Sweden relies on two different studies with two different methodological approaches, one questionnaire study and one interview study. The overall aim of the two studies presented in this chapter was to explore Swedish healthcare interpreters’ experiences of distressing situations in interpreter-mediated encounters in the healthcare context in Sweden: how common these situations are; how the interpreters deal with them, and; what type of support they felt they needed.
The first study, which also laid the ground for the second study, was a questionnaire-based survey of healthcare interpreters’ perception of moral distress and handling of difficult situations in healthcare interpreting. Study one was explorative and was based on the following three initial research questions:
- 1.
How distressing (intensity) are different situations that may occur for healthcare interpreters?
- 2.
How frequent are these situations?
- 3.
How ethically supportive are healthcare interpreters’ working environments?
The second study was based on interviews with interpreters who expressed their interest in participating in interviews in the first study. The study was performed using Grounded Theory as theory and tools for analysis. The two research questions were:
Key Terms in this Chapter
Questionnaire: The questionnaire is the actual instrument, preferably developed and tested for validity and reliability, consisting of several questions or items and distributed to a population which one would like to investigate for some reasons. The questionnaire in this project measures attitudes rather than exact instances of a specific phenomenon.
Discretionary Power: Term coined by legal philosopher Ronald Dworking, further developed for decision making in professional work by Social Scientist Anders Molander, and introduced in interpreting by Hanne Skaaden (see reference list). Discretionary power is the professional autonomy that an individual who is practicing a profession governed by rules and guidelines such as interpreting has in order to exercise their own professional judgment.
Moral Distress: Term used in healthcare and nursing, introduced by Andrew Jameton, which describes the emotional state that arises from situations when someone feels that the ethically correct action is hindered by institutional constrains or provisions. The situation may create a moral and ethical dilemma where the person feels powerless.
Survey: The survey is a more comprehensive approach to a field, a survey can comprise several instruments for data collection such as questionnaires, register-studies and/or interviews.
Healthcare Interpreting: This text uses healthcare interpreting rather than medical interpreting as interpreters in Sweden interpret for all types of healthcare professions, rather than being limited to the medical encounter with a physician or a nurse.
Allophone: Canadian term for a person who does not speak either English (anglophone) of French (francophone), used in this text for a person speaking a non-indigenous minority language, a language other than the majority language of the institution in question.
Ethically Supportive Work Climate: A work climate which is defined by both a high social capital (i.e. mutual understanding, shared aims, and unifying members of social networks and communities) as well as support for the individual to feel confident and supported in making ethically or morally difficult decisions.