# Situation: A 29-year-old man with schizophrenia was admitted voluntarily to the psychiatric ward of a provincial hospital 3 days ago. He hears voices, stays in his room most of the day, and speaks a regional language at home; he is also fluent in Filipino and English. A nursing student is assigned to him and writes a process recording of each interaction. In a later talk he becomes tearful when he speaks of his late mother and switches to his regional language. He says, "I cannot say this in Filipino." The nurse does not speak his language, and per hospital policy a trained interpreter for it can be called from the social service office. What should the nurse do?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630048  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 29-year-old man with schizophrenia was admitted voluntarily to the psychiatric ward of a provincial hospital 3 days ago. He hears voices, stays in his room most of the day, and speaks a regional language at home; he is also fluent in Filipino and English. A nursing student is assigned to him and writes a process recording of each interaction.

In a later talk he becomes tearful when he speaks of his late mother and switches to his regional language. He says, "I cannot say this in Filipino." The nurse does not speak his language, and per hospital policy a trained interpreter for it can be called from the social service office. What should the nurse do?

## 보기

1. Ask a utility worker who speaks his language to interpret
2. Ask him to try again in Filipino, which he speaks fluently
3. Ask his older brother, who visits daily, to interpret
4. Arrange a trained interpreter to help in his own language **✔ 정답**

**정답: 4**

## 해설

Clients often prefer their first language for emotional topics, and multilingual Filipino clients should be allowed to use the language they choose for such topics. When the nurse does not speak it and a trained interpreter is available, the interpreter is used; family members and untrained staff risk errors, filtering of the message, and breaches of confidentiality.

## 심화 해설

Core issue

A multilingual client with schizophrenia becomes emotionally distressed while discussing his late mother and spontaneously switches to his regional language, stating he cannot express this content in Filipino. The nurse must decide how to support communication when a trained interpreter is available through hospital policy.

Why the correct answer is to arrange a trained interpreter

Emotional topics such as grief, trauma, or loss are often most accurately expressed in a person’s first language. Even when a client is fluent in other languages, the cognitive and emotional load of discussing painful memories can make the first language the only channel through which the full meaning and affect can emerge. In psychiatric nursing, this is not simply a preference; it is a clinical necessity for accurate assessment of mood, thought content, and risk. The client’s statement, “I cannot say this in Filipino,” signals that forcing a switch would distort or suppress the very material the nurse needs to understand.

The presence of a trained interpreter changes the decision entirely. Trained interpreters are bound by confidentiality, are skilled in accurate message transfer without omission or editorializing, and understand the need to preserve the client’s emotional tone. They can also serve as cultural mediators, helping the nurse interpret not only words but context. This is especially important in mental health, where nuanced communication—hesitation, word choice, and emotional inflection—carries diagnostic weight.

Why the other options are unsafe or inadequate

Using a utility worker who speaks the language introduces an untrained individual into a therapeutic interaction. Utility staff are not bound by the same confidentiality expectations as clinical interpreters, have no training in mental health terminology, and may inadvertently filter, summarize, or alter the client’s words. The same applies to family members. An older brother, despite daily visits and good intentions, has an emotional stake in the client’s care and may filter the message to protect the family or avoid painful content. Family members may also breach confidentiality, either intentionally or through casual disclosure. Asking the client to “try again in Filipino” disregards his explicit statement that he cannot express this material in that language and risks shutting down the therapeutic conversation at a critical moment.

What the evidence adds

Research on language barriers in mental healthcare consistently shows that professional interpreter use remains low despite official recommendations, and that this compromises care quality for patients with limited proficiency in the dominant language [1]. The role of the interpreter extends beyond word-for-word translation to include cultural mediation, which is particularly relevant when a client’s emotional expression is tied to language-specific meanings [1]. A scoping review of nurse–patient language barriers found that nurses are often the first point of contact and that how they manage language barriers directly affects patient safety and satisfaction [2]. Qualitative findings from nurses in tertiary care settings identified “communicating via interpreters” as a distinct theme, highlighting both the value and the challenges of interpreter-mediated care [3].

Clinical reasoning for the nursing licensure examinee

In a psychiatric setting, the nurse’s first obligation is to obtain an accurate assessment. When a client initiates disclosure of emotionally charged content in his first language, the nurse must honor that choice. Key point! The availability of a trained interpreter, per hospital policy, makes this the only defensible option. Watch out! Family members and untrained staff are never substitutes for professional interpreters, because they introduce risks of filtering, role conflict, and confidentiality breach. The correct nursing action is to pause the conversation, explain that an interpreter will be called, and arrange for the trained interpreter from social service before continuing the emotionally sensitive discussion.

| Option | Interpreter type | Confidentiality | Accuracy risk | Appropriate for emotional psychiatric content |
| --- | --- | --- | --- | --- |
| 1. Utility worker | Untrained staff | Not assured | High (filtering, omission) | No |
| 2. Ask client to use Filipino | None | N/A | High (suppression of affect and content) | No |
| 3. Older brother | Family member | Not assured | High (emotional filtering, role conflict) | No |
| 4. Trained interpreter | Professional | Assured | Low (trained in accurate transfer and cultural mediation) | Yes |

Pathophysiological and communication rationale

Schizophrenia is characterized by disturbances in thought, perception, and emotional regulation. Auditory hallucinations and social withdrawal, as described in this client, already place him at risk for fragmented communication. Adding a language barrier during an emotionally charged disclosure compounds that fragmentation. The client’s tearfulness and language switch are not manipulative behaviors; they reflect the affective and cognitive load of grief. In first-language processing, emotional memories are often encoded with greater sensory and contextual detail, so retrieval in that language yields richer, more accurate clinical data. Forcing a second-language retelling can flatten affect, omit key details, and increase distress—all of which undermine the nurse’s ability to assess suicide risk, depression, or psychotic content related to the loss.

Key point! A trained interpreter preserves both the content and the emotional tone of the client’s disclosure, which is essential for psychiatric assessment. Watch out! The fact that the client is fluent in Filipino and English does not mean he can or should discuss his mother’s death in those languages. Language choice during emotional disclosure is a clinical signal, not a test of fluency.References (research sources)

- [1]Language barriers in mental healthcare: A critical analysis.Research articleRichly P (2025) · DOI: 10.1177/10398562251316102

- [2]Language barriers between nurses and patients: A scoping review.Research articleGerchow L, Burka LR, Miner S, Squires A (2021) · DOI: 10.1016/j.pec.2020.09.017

- [3]Language barriers and their impact on provision of care to patients with limited English proficiency: Nurses' perspectives.Research articleAli PA, Watson R (2018) · DOI: 10.1111/jocn.14204

## 임상 시나리오

Interpreter Use in Psychiatric NursingSupporting emotional expression in the client's first language
When a client becomes tearful discussing grief or loss, switching to their first language signals that emotional content is most accessible in that language. Even if the client is fluent in other languages, forcing a switch may distort or suppress critical clinical material.

Per hospital policy, a trained interpreter should be called from social service. Trained interpreters maintain confidentiality, transfer messages without omission or editorializing, and preserve the client's emotional tone.

CautionDo not use family members or untrained staff as interpreters. They risk filtering the message, introducing bias, and breaching confidentiality, especially during emotionally charged discussions.

## 핵심 개념

- **Trained Interpreter** — A professional bound by confidentiality and skilled in accurate, unbiased message transfer, essential for emotional or complex clinical communication.
- **First Language** — The language a person learned earliest and often uses for emotional expression, even when fluent in other languages.
- **Process Recording** — A written verbatim account of a nurse-client interaction used for analysis and improvement of therapeutic communication skills.
- **Therapeutic Communication** — Techniques that support the client's expression of feelings and thoughts in a safe, nonjudgmental environment.
- **Confidentiality** — The ethical and legal duty to protect client information from unauthorized disclosure, upheld by trained interpreters but not guaranteed by family or untrained staff.

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