When Words Fail: ICU Nurses' Experiences Caring for Patients With Limited English Proficiency in the United States

Keywords

limited English proficiency, LEP, therapeutic communication, medical translator, patient safety, quality of care, intensive care, critical care, critical care nursing, moral distress

Abstract

Aims

To explore the lived experiences of intensive care nurses caring for patients with limited English proficiency.

Design

A hermeneutic, interpretive phenomenological design was used.

Methods

Semi-structured interviews were conducted with intensive care nurses recruited through purposive sampling. Data collection included Qualtrics screening surveys and semi-structured Zoom interviews. The research team, comprising linguistically diverse faculty and undergraduate research assistants, employed reflexivity techniques to minimise bias and enhance interpretive rigour. Data were analysed via inductive analysis using the hermeneutic circle.

Results

Five main themes emerged organically from the data:

  1. Complications of Care Relating to Verbal Communication Challenges.
  2. Benefits and Barriers of Nursing Informatics in Linguistic Care.
  3. The Universal Language: Nursing Effort Builds Trust.
  4. The Ripple Effect: Chronological Considerations for Patient Care.
  5. Moving Forward: Where Do We Go From Here?

Based on these findings, a four-phase model was developed to guide individual and system-level interventions to reduce nurse moral distress and improve language equity in critical care.

Conclusion

Language barriers in the intensive care unit hinder communication, increase stress for patients and nurses, and impact care quality. While nurses' efforts to bridge these gaps are valued, systemic changes (such as expanded interpreter availability and improved cultural safety training) are necessary to support culturally, linguistically, and medically appropriate care.

Implications for the Profession and/or Patient Care

Findings highlight the need for increased institutional support, additional resources for night-shift staff, and the integration of cultural humility education into intensive care training. The Limited English Proficiency Moral Distress Action Cycle for Critical Care Nursing, developed from this study, offers a flexible framework to guide the implementation of these improvements and reduce nurse moral distress. Future research should explore interventions to promote cultural and linguistic competence in multilingual patient populations.

Original Publication Citation

Watson, A. L., Drake, J., Livingston, M., Watson, S. B., Tobe, H., Ruda, P., Anderson, M., Rigby, J., **Holyoak, S., **Cook, R., **Devol, N., **Marquez, G., **Urry, C., & **Detrick, R. (2025). When Words Fail: ICU Nurses’ Experiences Caring for Patients with Limited English Proficiency in the United States. Journal of Advanced Nursing, 0(0), 1-16. https://doi.org/10.1111/jan.70203

Document Type

Peer-Reviewed Article

Publication Date

2025-09-05

Publisher

Journal of Advanced Nursing; Wiley

Language

English

College

Nursing

University Standing at Time of Publication

Assistant Professor

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