Prompts and Examples

Prompts and examples to support the application of the standards of practice.

Principle 1: Accuracy and Completeness

Standard 1.1: Maintain fidelity to the meaning of the original message without adding, omitting, distorting or substituting ideas.

Prompts

• Did I accurately capture and pass on all the speaker’s ideas?

Examples

• Interpreters convey all that is said in the encounter, even if it seems irrelevant, redundant, or rude, including side comments, pleasantries, seemingly irrelevant comments, even if they seem to lack factual medical content, because they build rapport^[1] to the extent possible given the modality and context.
• Interpreters interpret all utterances by all participants, including any accompanying family or friends, as well as clinical staff not involved in the patient’s care.

Standard 1.2: Identify and honor the communicative intent^[2] of the speaker, that may be expressed in the level of terminology and style, tone of voice, and any visible non-verbal^[3] expressions of the speaker (that is, affect^[4]), keeping in mind the context, including cultural context. ^[5]

Prompts

• Have I included the meaning expressed in all the nonverbal elements^[6] of the message?
• Are all my language choices guided by the goal of promoting understanding?

Examples

• Interpreters include the speakers’ expression of happiness, sadness, sympathy, uncertainty, humor, irony, and so on.
• Interpreters convey the meaning of culturally-bound gestures, by including the meaning in the interpreted message, or substituting a gesture with the same meaning in the listener’s culture if one exists, or by explaining the meaning of the gesture to the listener.
• Interpreters maintain the speaker’s level of politeness and level of formality.

Standard 1.3: Ask for clarification when encountering unfamiliar words, or when the meaning of a word in context is unclear.

Prompts

• Am I fully confident I understand what was said?
• Would a quick clarification help maintain accuracy?

Examples

• Interpreters ask speakers to explain the meaning of words or phrases that are unclear or mean different things in different contexts.
• Interpreters may ask medical providers to spell the name of medications with which they are not familiar.
• Interpreters ask for repetition of words they did not hear clearly.

Supplemental Material

Scenario: Asking for clarification in an emotionally charged situation

During a family meeting about a patient’s end-of-life care, the provider uses the phrase “comfort measures only” without further explanation. The interpreter, aware of the emotional and cultural weight of this term, asks the provider for clarification to ensure they understand the full intent, whether it refers to stopping curative treatment, initiating hospice care, or focusing solely on pain management, so they can accurately convey the meaning in a way that is understandable within the patient’s cultural and emotional context.

Standard 1.4: Monitor the interpretation for errors, and assess when and how to correct any errors that influence the meaning of the message or the participants’ goals for the encounter.

Prompts

• Did I make any errors?
• If so, how important is my error in light of the goals of the encounter?
• Is now the right time to transparently correct the error?
• Am I guided by the goals of maintaining accuracy and promoting understanding between participants?
• As the encounter progresses and I learn more context, am I noticing that an earlier word choice I made was not what the speaker meant in context?

Examples

• Interpreters monitor their interpretations to ensure faithful representation of ideas and messages.
• Interpreters correct the errors they make at the best time to support the goals of the encounter.
• Interpreters may say, “The interpreter made a mistake. The speaker’s meaning is better expressed this way: “_______”

Standard 1.5: Take actions to be able to hear and see as much as the modality allows to ensure accuracy and completeness.

Prompts

• Do I have access to as much audio and visual information as the mode of interpretation allows?
• If not, can I increase access?

Examples

• On site interpreters move as necessary so as to be able to see and hear all speakers adequately.
• Remote interpreters request participants to adjust the placement of the technology in use to maximize their ability to hear and see as much as possible to ensure accuracy and completeness.

Standard 1.6: Monitor our emotions, biases, and opinions to avoid letting them influence our interpretation.

Prompts

• Is the interpreted message faithful to the original even if I, the interpreter, don’t agree with it?

Examples

• Interpreters interpret what participants say even if they, personally, do not agree with the speaker.
• Interpreters prioritize the participants’ communication needs, regardless of conflicting beliefs, difficult personalities, or any other circumstances.
• Interpreters maintain a neutral expression regardless of their personal feelings or reactions to the situation.
• Interpreters maintain objectivity and do not add their personal opinion when interpreting opinions that conflict with their own values and belief systems; people may have different perspectives on religious practices, reproductive health care, vaccines, etc.

Principle 2: Effective Communication

Standard 2.1: Maintain transparency in all aspects of our professional practice.

Prompts

• Do all participants clearly understand who I am speaking for, including when I speak for myself, the interpreter?
• Do participants feel they can trust me to keep them informed?

Examples

• Interpreters assess when it is necessary to transparently communicate what interpreting techniques they use to make meaning clear (e.g., metaphors, scaffolding), in order to build and maintain trust.
• Interpreters ensure that all participants are informed of what is said during “side bar” conversations.
• Interpreters make clear that they are speaking on their own behalf when intervening.^[7] Some interpreter interventions include asking for clarification, mediating between cultural perspectives, and sharing relevant information.

Standard 2.2: Monitor communication for understanding and take thoughtful action when probable misunderstandings arise and are not addressed.

Prompts

• How could a misunderstanding affect the patient’s care, safety, or emotional comfort, or the relationship between participants?
• Is this the best time to intervene?
• What action might help restore understanding?

Examples

• Interpreters monitor for nonverbal and verbal signs suggesting that the listener may not understand and intervene to support understanding if participants appear confused.

Standard 2.3: Create conversational space for participants to work through misunderstandings directly, rather than resolving them on their behalf.

Prompts

• Is there a cultural aspect to the message that is not being understood or is there something else that is getting in the way of understanding?
• Are the participants addressing this directly or do I need to alert them to the misunderstanding and create a conversational space for them to arrive at a shared understanding?
• Is cultural context or background information needed to relay the message completely and accurately?

Examples

• Interpreters request an explanation or clarification of “untranslatable”^[8] words used by a speaker and create a conversational space between the speaker and the listeners to arrive at a shared understanding.
• Interpreters assess the situation to choose the intervention(s) that would best resolve any misunderstandings of which they become aware, if the participants are not making progress toward improved understanding. Possible interventions include:

• Asking questions to elicit the key relevant information that will lead to understanding.
• Asking patients to explain the meaning of words that have different meanings in different geographical areas, although the general language is the same.
• Asking doctors to describe medical terms that have no equivalent term in the patient’s language.
• Asking patients to explain the meaning of culturally specific symptoms in their own words so they can preserve the patient’s communicative autonomy^[9] and interpret the patient’s meaning accurately to the provider.

Standard 2.4: Promote direct communication among the participants in the encounter.

Prompts

• Am I supporting the conversation without becoming part of it?
• Is my body language or positioning encouraging the participants to speak to each other rather than to me?

Examples

• Interpreters use first-person interpretation whenever possible and effective.
• Interpreters may use a variety of strategies that support direct communication including positioning and gaze.
• Interpreters may ask that the video pad be positioned to facilitate and encourage direct communication between the participants, rather than placing the interpreter in the center of the interaction.
• Interpreters interpret questions, such as requests for clarification or information, to the other party, rather than answering questions directly.

Standard 2.5: Manage the pace and flow of communication to avoid omissions and ensure that information is shared in a timely manner with all participants.

Prompts

• Am I managing the flow of information so that I can convey everything accurately and completely?
• Do the participants have equal opportunity to speak and be heard?
• Are participants hearing information in their own language often enough to remain engaged?
• Do participants understand when it’s their turn to speak?
• Am I recognizing how my interventions influence the flow of speech?

Examples

• Interpreters make adjustments to how frequently they interpret when the flow of communication is hindering the participants’ ability to fully engage in the conversation.
• Remote interpreters usually rely on verbal interventions to manage the flow of information.
• Interpreters on site may use whispered simultaneous (chuchotage) to an elderly patient if the adult child is discussing their treatment in English with the clinician.
• Interpreters assess the best action(s) to take when two people speak at the same time.

Standard 2.6: Support participants who speak some of the other participant’s language to speak as much as they can as long as the listener understands them.

Prompts

• If the patient speaks English moderately well, or understands English well but does not feel comfortable speaking in English, what strategies can I use to support them speaking for themselves?
• If the clinician speaks a little of the patient’s language, how can I support the clinician’s efforts to build rapport while ensuring understanding?^[10]

Examples

• Interpreters allow patients who speak English moderately well to speak for themselves, while being ready to interpret at any point.
• Interpreters let clinicians who speak only a little of the patient’s language build rapport by greeting and exchanging pleasantries with the patient in the patient’s language
• Interpreters who believe that a speaker may have not said what they actually meant in their second language feel confident back-interpreting to the speaker so they can confirm their intended meaning.

Standard 2.7: Conduct a pre-session^[11] with patients and clinicians based on the context and situation to introduce the interpreter and set clear expectations about the interpreter’s responsibilities, prioritizing information relevant to the participants in that encounter.

Prompts

• Does everyone understand what I will and won’t be doing during this encounter?
• Are the languages I interpret the ones needed for this encounter?
• Would the patient benefit if we called a different interpreter or a relay interpreter?

Examples

• Interpreters introduce themselves and explain their responsibilities.
• Interpreters adjust their introduction and pre-session to the needs of the situation.
• Interpreters hired by workman’s compensation insurance companies inform all participants who their employer is.
• Interpreters manage the participants’ expectations about interpreter availability by sharing any organizational guidelines about interpreter time limitations.

Standard 2.8: Engage in pre-encounter huddles and post encounter debriefs with clinicians, when possible, to create goal alignment, understand the context and purpose of the encounter, as well as any specific communication needs of participants.

Prompts

• Do I understand enough of the context of the encounter to align with the goals of the participants, and any of their specific communications needs?

Examples

• Interpreters may ask clinicians for additional information before the encounter begins, such as a brief summary of the patient’s situation, the goals of the encounter and the participants involved.

Principle 3: Confidentiality

Standard 3.1: Share patients’ healthcare information that we learn during our professional practice only with members of the patient’s health care team who have a need to know.

Prompts

• If I am asked to share information, is the person asking part of the patient’s health care team, and do they have a legitimate need to know?

Examples

• Interpreters honor patient privacy by not sharing information across separate medical systems.
• Interpreters may share information with members of the patient’s treating team on a need-to-know basis.
• Interpreters who are asked by a patient’s neighbors, friends, or family about the patient’s health suggest that they ask the patient directly.
• Interpreters do not gossip about their patients.

Standard 3.2: Refrain from sharing patients’ healthcare information learned outside the interpreted encounter; however, encourage the patients to share medically relevant information with their treating team. Disclosure may be necessary to prevent a risk of serious harm to the patient or others.^[12]

Prompts

• Have I made every effort to encourage the patient to share the information themselves?
• Is sharing this information without the patient’s permission legally required or necessary to prevent serious harm?

Examples

• Interpreters who know information relevant to the patient’s health care that they learned in the community encourage the patient to share the information with the clinician by explaining why it is important for the patient’s well-being and/or safety.
• Interpreters encourage patients to share with clinicians if they are planning to hurt themselves or someone else. If the patient refuses to share this information with the provider the interpreter shall share this information with the provider.

Standard 3.3: Learn about the current legal and institutional requirements related to confidentiality.

Prompts

• Have I researched the legal and institutional requirements in the country and state where I interpret?
• Am I considered a mandated reporter in the state(s) where I interpret?
• Can I tell the clinician if they are mandated reporters?

Examples

• Interpreters read about statutes that address confidentiality in health care, including The Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Americans with Disabilities Act (ADA).^[13]
• Interpreters learn whether they are considered mandated reporters in the state(s) in which they interpret.^[14]
• Interpreters ask their supervisors about the institutional rules, regulations and requirements regarding confidentiality in the facilities in which they interpret.
• Interpreters attend lectures and workshops about legal requirements related to confidentiality.

Standard 3.4: Seek legal guidance if receiving a legal request to share information, such as a subpoena, to understand interpreters’ ethical responsibility and to ensure legal protection for everyone involved.

Prompts

• What guidance is available to me through my employer to understand what is legally required of me before sharing patient information?
• Do I need a lawyer?

Examples

• If subpoenaed to give evidence about a prior interpretation, interpreters ask their manager to connect them with the employer’s legal team for guidance regarding confidentiality and more.

Standard 3.5: Take all actions available to secure patient confidentiality in the work setting.

Prompts

• Are the audio and visual portions of the interpreted encounter protected?
• Can written or computerised notes, or any other records of the interpreted encounter, be completely erased at the end of the encounter?^[15]

Examples

• Remote interpreters create a private home-office/ workspace, so the interpreted encounter is not overheard or observed.
• On-site interpreters, in the exam room, may pull the curtain or close the door if no one else has.
• Interpreters use only note-taking tools, including AI tools, that are HIPAA compliant.
• Interpreters make sure their notes are secure and can be disposed of after the session in accordance with HIPAA “safe harbor”^[16] guidance.

Standard 3.6: Omit all identifying information when speaking about cases we interpreted.

Prompts

• What information could identify the participants in an encounter?
• How can I share the case with colleagues for ethics discussions, or present at a conference, without including identifying information?

Examples

• When debriefing with colleagues, interpreters remove all information that could identify the patient, medical provider, or institution.

Principle 4: Equitable Practice^[17]

Standard 4.1: Pay attention to the communication and interpersonal needs of the participants, and adjust your interpreting strategies to support clear communication.

Prompts

• Am I aware of anything that might be impeding communication?
• How can I adjust to the unique communication needs of the participants?

Examples

• Interpreters adjust to the patient’s needs, finding additional communication support that allows the patient to more fully understand, such as, asking the provider to show a picture of the organs being discussed, switching to the patient’s preferred term, adjusting volume of speech to be heard.

Standard 4.2: Share relevant information^[18] that may help participants address their needs and achieve their goals, if we know it and no one else is sharing it.

Prompts

• Is the information relevant to the goals of the participants in the current encounter?
• Is the information accurate, objective and verifiable (not just my own opinion)?
• What is the best way to ensure that the participants are aware of the information?
• Can I ask one of them to share the information with the other?
• Is it clear no one else is going to share it?
• If no one else is going to share the information should I politely and succinctly share the information with all participants?
• Can I maintain the confidentiality of any medical information of relevant parties?

Examples

• Interpreters share relevant institutional information (such as, information about health insurance coverage, transportation programs, how to request a prescription refill, the availability of culturally and linguistically appropriate community resources, and more)^[19][20] if it supports the participants in meeting their needs and solving problems.
• Interpreters who are aware of a program that might benefit the patient, may share the information with the provider, to see if they wish to refer the patient.
• Interpreters may share relevant medical information^[21] within the patient’s treating team to support good health care for the patient, being careful not to diminish patient autonomy.

Standard 4.3: Respond to indications that the language of interpretation is not the patient’s preferred language.

Prompts

• Are there aspects of the patient’s speech that suggest that the language of interpretation is not the patient’s primary language?
• Has the patient been asked what their preferred language for healthcare is?
• What language is the patient most comfortable speaking?

Examples

• Interpreters ask patients what their preferred language is, and inform the medical provider so that an interpreter for that language can be contacted. If an interpreter for the preferred language is not immediately available, the interpreter offers to do their best to assist until another interpreter is available.
• Interpreters know, or find out, who to notify when a relay interpreter is needed to ensure adequate understanding.
• Interpreters who are asked to interpret for a language that is perceived as “close enough” to the language in which they normally interpret, state that a qualified interpreter who speaks the patient’s language should be called. Examples include: Portuguese/Spanish, Russian/Polish, Cape Verdean Creole/Haitian Creole, Spanish /Quechua, Spanish/Mayan languages, and the various Chinese languages.
• Interpreters who lack familiarity with a patient’s regional language variant, assess their level of understanding and ask whether an interpreter who is more skilled in the language variant is available. If no such interpreter is available, they transparently alert the participants that they may need to ask for clarification more often, to support effective communication.

Standard 4.4: Strive to become aware of our unconscious biases and countertransference and consciously work to keep personal beliefs, values and emotions from influencing our interpretations and behavior.

Prompts

• Am I feeling some negative or positive emotional response to a person I have just met?
• How can I identify whether I may be acting on an unconscious bias?
• How can I put that bias or emotional response aside, and treat them fairly?
• Am I respecting the autonomy of the speaker to speak for themself?

Examples

• Interpreters work to avoid letting negative feelings about the identity^[22] of the parties influence their demeanor, behavior, or accuracy.
• Interpreters remind themselves to respect the patient’s right to the interpreter’s best self, particularly when the patient belongs to a group which they dislike or with which they disagree.
• Interpreters focus on fidelity to the message while interpreting, even when they disagree with what is being said.

Standard 4.5: Disclose potential conflicts of interest^[23] to participants and withdraw, calling for another interpreter to take over. Follow organizational guidelines when withdrawing from assignments to ensure interpreter coverage is maintained.

Prompts

• Could my continuing as the interpreter restrict the patient’s comfort and freedom to disclose information to the provider?
• Will the conflict of interest make it difficult for the participants in the encounter to trust my objectivity?
• Is this conflict of interest^[23:1] going to prevent me from being objective and accurate?
• Could the medical organization call a backup remote interpreting service so the interpreter would not be acquainted with this patient?

Examples

• Interpreters who cannot remain objective have an ethical obligation to withdraw from the assignment. If no other interpreter is available to take over, the interpreter has an ethical obligation to continue in the encounter and provide the most unbiased services possible, until another becomes available to take over.
• An interpreter whose family member is suing the patient’s family offers to call in another interpreter.
• Interpreters who belong to a language group that includes warring factions may offer to withdraw if another interpreter is available. If an interpreter from the patient’s faction is not immediately available, the interpreter offers to assist until another interpreter is available.

Principle 5: Respect

Standard 5.1: Respect the communicative autonomy ^[24] of those for whom we interpret.

Prompts

• Am I consistently aware that each person has the right to express themselves freely, in their own words and style?

Examples

• Interpreters allow individuals to express themselves at their own pace, respecting pauses, hesitations, and the speaker’s natural rhythm to preserve the authenticity and intent of the message.
• Interpreters convey the full meaning of the message accurately and without omission, even if the content is offensive or causes discomfort.

Standard 5.2: Respect the decision-making autonomy of those for whom we interpret.^[25]

Prompts

• Am I keeping in mind that each person has the right to make decisions for themselves?

Examples

• Interpreters maintain a respectful demeanor even when they do not agree with the person’s choices.
• Interpreters avoid manipulating the message to convince a participant to make the choice they think is best.
• Interpreters do not offer personal recommendations, even when asked for advice. Instead, they respectfully redirect the question to the appropriate party, supporting the patient’s right to make their own decisions.
• Interpreters strive to find at least one aspect of each person that they can respect, in order to treat them with respect, even if some of their behaviour elicits disrespect and distaste in the interpreter.

Standard 5.3: Use professional and culturally appropriate ways of showing respect.

Prompts

• What information do I need to ask for in order to use polite forms of address.

Examples

• Interpreters address patients and providers politely, using culturally appropriate forms of address.
• Interpreters show respect for the identity of the persons they interpret for by using the correct pronouns.
• Interpreters use knowledge of the cultural norms of the participants to adjust their behaviour so participants feel respected and heard.

Principle 6: Cultural Competence

Standard 6.1: Continually work to expand our knowledge of the cultural groups we interpret for, taking into account changes over time. (Cultural Awareness)

Prompts

• Am I aware of how culture affects behaviors, beliefs and values?
• Am I aware of the variety of cultures I encounter in the performance of my interpreting duties?
• How can I learn more about the cultures of the people I interpret for?
• Am I aware that individuals often belong to different types of cultural groupings simultaneously?
• How do people assimilate to other cultures?
• Am I aware that each person follows their culture in their own way?

Examples

• Interpreters should understand that culture affects all of us and our perceptions of the physical, social, and spiritual world, and of our place in that world.
• Interpreters understand that culture provides us with ready-made answers to what we should expect and how we should behave in different situations.
• Interpreters develop an understanding of what culture^[26] is and of how a person’s cultural affiliations shape how they assign meaning to what happens to them and choose to act.
• Interpreters develop an understanding and awareness of how cultural practices and world views influence communication, meaning, and behavior.
• Interpreters learn about cultural assimilation and how it varies from person to person.
• Interpreters learn beliefs about health, illness, common practices in medicine of the cultural/linguistic groups they work with, and how they vary across cultures, so that they can recognize references to those beliefs and practices when they emerge in an interpreted session.
• Interpreters respect the fact that no matter how much they have read or know about a culture, what they know is only a hypothesis about how any one individual lives their culture.
• Interpreters confirm everything they think they know about an individual’s culture with that individual before acting on what they think they know.

Standard 6.2: Engage in ongoing self-reflection,^[27],^[28] to discover our own cultural values and beliefs, without using it as the standard for judging another culture’s worldview, (Cultural humility^[29])

Prompts

• Am I recognizing and challenging my own cultural assumptions and biases during this interaction?
• Do I keep an open mind when I am faced with different cultural world views and refrain from making any judgments?

Examples

• Interpreters engage in ongoing self-reflection to recognize and critically examine their own cultural assumptions, biases, and power as an interpreter.
• Interpreters connect with participants based on the participants’ current reality, accepting their perspective, emotional state, and situation without judgment or trying to impose their own expectations or agenda.
• Interpreters approach every encounter with respect for participants and a commitment to learning from the cultural perspectives of others.
• Interpreters recognize that no culture is better than another.
• Interpreters cultivate awareness of their own biases in order to recognize and accurately reflect the meaning of diverse speakers (e.g., LGBTQIA+), which may or may not conflict with their own belief system.
• Interpreters choose their words carefully to avoid creating stereotypes. For example, rather than saying, “people who speak this language believe ______,” interpreters might say “many people who speak this language have probably heard of the belief _______ . . . ”

Standard 6.3: Facilitate effective cross-cultural communication and interactions.

Prompts

• Am I ensuring that the speaker’s message is accurately conveyed in a way that the listener from a different culture can understand?
• Should I ask the speaker to explain their cultural perspective?
• Am I identifying and informing all parties about cultural differences if they seem to be affecting how messages are understood or received?

Examples

• Interpreters apply knowledge of cultural practices, worldviews, and language to accurately and meaningfully interpret messages between participants.
• Interpreters pay attention to both the speaker’s cultural context and the listener’s cultural context to ensure clarity and understanding.
• Interpreters invite the speaker to explain culturally specific ideas or concepts when needed.
• Interpreters may share relevant cultural information to support cross-cultural understanding.

Standard 6.4: Support participants in negotiating cultural differences. (Cultural responsiveness)

Prompts

• How can I, within my scope of practice, help each participant recognize and navigate cultural differences in order to facilitate mutual understanding during communication and decision-making?

Examples

• Interpreters may alert participants to cultural expectations and behaviors that might not be shared or understood, and if necessary, assist them in constructing shared understanding.
• Interpreters alert the provider to cultural norms that may be important to address to increase rapport, understanding, and/or acceptance of the treatment plan.
• Interpreters assess whether and when to ask providers to explain the reasons for medical recommendations that are foreign to the patient’s culture, such as, recommending to parents from cultures in which sleeping with babies is common that the babies should sleep in separate beds for safety reasons.
• Interpreters provide participants with relevant cultural insights to enhance communication if the participants are not explaining it themselves and it is causing a misunderstanding, such as, cultural norms related to decision-making, concepts of time and punctuality, expressions of pain, gender roles in communication, religious or spiritual practices, and non-verbal cues.
• Interpreters mediate^[30] between two word views when needed, so each participant understands the other’s point of view.

Supplemental Material

Interpreters may raise awareness among participants that cultural norms or expectations may shape how messages are understood, inviting curiosity and dialogue.

Awareness statements may include:

• Silence during conversation may be a sign of respect or contemplation; it is not always disengagement or confusion.
• Some patients might avoid saying “no” directly, which could lead to an assumption of their agreement or consent.
• Expressions of pain may be minimized due to social norms in a culture that values stoicism, affecting how providers assess patient discomfort.
• Concepts of time and punctuality vary, and a late arrival might not reflect disrespect but a different cultural approach to schedules.
• Physical touch during communication (e.g., a reassuring hand on the shoulder) may be appropriate in some cultures but uncomfortable or inappropriate in others.
• In some cultures, people “talk” to their departed loved ones as part of their grieving process.

Interpreters may share observations relevant to the encounter about how different cultural behaviors or communication styles might be understood by participants, encouraging mutual exploration rather than assumptions.

Observations may include:

• A patient avoiding direct eye contact might be demonstrating respect or deference, rather than evasiveness.
• Direct questioning style may feel confrontational or rude to a patient from a culture that values indirectness.
• A patient’s tendency to use storytelling or metaphors to describe symptoms may require more time listening in order to understand the intended meaning clearly.
• Expressions of disagreement or discomfort may be subtle in some cultures, and some patients may need gentle encouragement to voice concerns openly.
• In some cultures, a patient’s reliance on family decision-making can be understood as a cultural value rather than a lack of autonomy or engagement.

Principle 7: Professionalism

Standard 7.1: Hold ourselves accountable for our professional performance.

Prompts

• Do I regularly reflect on the quality of my interpreting?
• Am I open to feedback on my performance?
• Am I listening to learn?
• What steps am I taking to improve my interpreting practice?

Examples

• Interpreters regularly think about how well they interpreted during a particular encounter or day, identifying areas they could improve.
• Interpreters actively seek more technical or content training when necessary.

Standard 7.2: Be honest and ethical in all professional practices.

Prompts

• What do I need to consider to be sure I remain honest and transparent?
• Have I provided an accurate depiction of my skills, credentials, and experience?

Examples

• Interpreters have the moral fortitude to behave ethically even when it is challenging to do so.
• Interpreters accurately represent their level of expertise and know the difference between a certificate of completion and certification.
• Interpreters accurately record their hours worked, and submit requests for payment in a timely fashion.
• Interpreters are mentally, emotionally, and physically available and engaged during scheduled work hours.
• Interpreters may graciously accept token^[31] gifts of appreciation if their institutional guidelines permit, at the same time explaining to the patient that their commitment to providing the best possible interpretation does not depend on receiving gifts
• Interpreters do not take bribes and decline any gift offerings that could be perceived as bribes.

Standard 7.3: Disclose any barriers to our ability to interpret.

Prompts

• Am I being honest with myself and the participants about my ability to interpret accurately and completely in a given encounter?

Examples

• Interpreters recognize when they are fatigued and work with the participants to ensure they can maintain accuracy.
• Remote interpreters may ask that the door into the hall be closed if noise in the corridor prevents hearing clearly; on-site interpreters may close it themselves.
• Interpreters who do not speak the language they have been called to interpret for, work to ensure that an interpreter for the correct language is requested.

Standard 7.4: Respect all the professionals with whom we work, including our interpreter colleagues in all fields and modalities.

Prompts

• How can I create a collaborative environment that supports my colleagues?

Examples

• Interpreters are considerate of healthcare providers, patients, and interpreters they work with.
• Interpreters acknowledge that providers and patients who have not worked with interpreters before may find it challenging.
• Interpreters collaborate to create a smooth transition from one modality to another.
• Interpreters recognize the unique challenges facing colleagues who work in different sub-fields or modalities.
• Interpreters assume the best about other people’s intentions.^[32]
• Interpreters do not spread rumors that could discredit others.

Standard 7.5: Act in a manner that is befitting the dignity of the profession and appropriate to the setting.

Prompts

• How should I behave so that others trust me and the interpreting profession as a whole?
• How does acting appropriately in different settings help maintain respect for both the people I serve as well as for the interpreting profession?

Examples

• Interpreters remain calm and serene under pressure and control their feelings.
• Interpreters do not take advantage of their professional relationship with any of the participants in the encounter for personal benefit.
• Interpreters do not blame others for their interpreting errors.

Standard 7.6: Evaluate which documents are appropriate for sight translation and within our level of competence.^[33][34]

Prompts

• Am I considering the patient’s need to understand the written content before accepting or declining a sight translation request?
• Am I assessing whether the document is appropriate for sight translation?
• Am I recognizing my personal limits in sight translation and conveying my concern about protecting the message’s integrity in a way that builds trust with patients and providers?

Examples

• Interpreters carefully consider whether the document is appropriate for sight translation and whether they have the skills and the time needed to sight translate it accurately .
• Interpreters who work in modalities that do not allow them to see the document may ask someone to read it to them.
• Interpreters who are asked to sight translate a document that is not appropriate for sight translation may suggest other methods of communicating the information in the document, such as asking whether the medical facility has the document available in written translation, or asking staff to explain relevant parts of the document to the patient orally.

Standard 7.7: Be reliable, punctual, and prepared.

Prompts

• How do I manage my time and technical setup to ensure reliability and professionalism in every assignment, regardless of location?

Examples

• Interpreters test remote equipment ahead of time or arrive early for onsite appointments and communicate promptly if delays occur.
• Interpreters recognize that their punctuality or tardiness may affect other interpreters’ break times or providers’ wait time for an interpreter.
• Interpreters dress appropriately for the context and in line with their employer’s guidelines.

Principle 8: Continuing Professional Development

Standard 8.1: Regularly evaluate our own performance, identifying strengths and areas for improvement to guide ongoing development.

Prompts

• How do I use critical thinking and reflective practice to uncover areas for additional learning and improvement?

Examples

• Interpreters review challenging sessions and plan targeted growth activities.
• Interpreters seek learning opportunities that will educate them on different world views that are not representative of their own beliefs.

Standard 8.2: Continue to develop interpreting skills, including skills in different modalities.

Prompts

• How can I assess and improve my interpretation skills?

Examples

• Interpreters analyze, and consider how to navigate the challenges of working remotely to better support ethical practices.
• Interpreters record themselves interpreting a practice text, listen for areas of improvement, and create a study plan to improve.
• Interpreters learn various notetaking methods and adapt them to their needs.

Standard 8.3: Actively pursue continuing development of linguistic and sociocultural knowledge including the culture of medicine.

Prompts

• How do I identify gaps in my knowledge about the languages, cultures, or specialized topics relevant to my work?
• What resources can I explore to fill those gaps?
• How can I stay curious about language, culture, and topics that might affect my interpreting work?

Examples

• Interpreters stay up to date on changes in regional variations, and changes to the languages over time.
• Interpreters expand their knowledge of medical terminology, bodily systems, and medical tests and treatments.
• Interpreters familiarize themselves with respectful terminology related to diverse identities, such as LGBTQIA+ terminology.
• Interpreters engage in professional development about topics or viewpoints that they may not necessarily agree with in order to be prepared to interpret effectively (for example: gender-neutral language).
• Interpreters learn terms that describe languages, such as the differences between “dialect” and “language,” “creole” and "pidgin,” and use them correctly.
• Interpreters consult trusted community members to expand their understanding when encountering new cultural references.
• Interpreters attend continuing education sessions for clinicians, if feasible.

Standard 8.4: Participate in activities that develop ethical judgment and reasoning skills.

Prompts

• How do I transform what I’ve learned about ethics into effective action?
• How can I strengthen my ability to make sound ethical decisions during interpreting assignments?
• Do I use reflective practice to learn from my experiences and improve my practice/skills?

Examples

• Interpreters use reflective practice to learn from their experiences, asking themselves which ethical choices worked, which didn’t work, why, and what to do differently next time for a better result.
• Interpreters reflect on their experiences^[35] to polish their professional practice.

Standard 8.5: Recognize that constructive feedback is fundamental for professional growth.

Prompts

• How can I thoughtfully consider new perspectives about my work to grow professionally?

Examples

• Interpreters seek and welcome feedback from trustworthy colleagues, providers, patients, and their families.
• Interpreters welcome input from people they encounter in their work.
• Interpreters ask family members and caregivers for input if the interpreter needs help understanding the patient’s language variations.
• Interpreters consult with colleagues about challenging assignments.

Standard 8.6: Support the professional development of fellow interpreters.

Prompts

• What opportunities can I create to exchange knowledge and experience with colleagues?

Examples

• Interpreters engage in mentorship programs, both as mentors and mentees.
• Interpreters may choose to meet over lunch to share new vocabulary words they encounter with colleagues.
• Interpreters attend learning opportunities arranged by their employer.
• Interpreters research and share best practices in the profession.
• Interpreters participate in research to evaluate which practices are best.

Standard 8.7: Participate in professional organizations and contribute to the growth and development of our profession.

Prompts

• How can I use my skills and experiences to support initiatives within professional organizations that strengthen the interpreting community?

Examples

• Interpreters regularly attend events and conferences to stay connected with their professional community.

Standard 8.8: Stay informed about advancements in technology and assess how these developments may influence our work, tools, and professional practices.^[36]

Prompts

• How might technology change the way I approach my work in the near future?

Examples

• Interpreters actively engage in learning about the technology they use when interpreting to maintain confidentiality and to help patients, providers, or colleagues adapt to current technologies.
• Interpreters learn about the AI technologies providers employ, including documentation tools.

Standard 8.9: Engage in effective collaboration with all the professionals with whom we interact.

Prompts

• How do I build collaborative relationships that enhance communication and service quality?
• How can I interact with others to collaborate optimally?

Examples

• Interpreters participate in interdisciplinary trainings to deepen their understanding of medical contexts and communication goals.
• Interpreters explain what is not working to the IT specialist calmly, even when they are frustrated by the technical issues.
• Interpreters listen to feedback about their performance without getting defensive.

Principle 9: Advocacy^{[37][38][39][40]}

Standard 9.1: Healthcare Interpreters may engage in an act of advocacy during an interpreted encounter in order to protect an individual when there is objective and verifiable evidence of risk for serious, imminent, avoidable, physical or emotional harm that remains unaddressed, even after it has been brought to the attention of the person who could correct the problem. ^[41]

Prompts

“Questions to Consider When Deciding Whether Advocacy is Needed “ ^[42]

• Is the information that alerted me to the potential for serious imminent harm to the patient objective and verifiable?
• Is my assessment unbiased by my own feelings and opinions?
• Am I reasonably certain no one else will recognize and correct the potential for serious harm before harm occurs?
• Have I confirmed the information with the patient as well as the patient’s understanding of the implications for their health and well-being? Does the patient want me to advocate for them?
• Have I exhausted all the interventions I have at my disposal to transparently alert the parties to the potential for imminent harm without having to advocate?
• Is the potential for serious harm still there?
• Can I advocate professionally, framing the issue in terms of shared goals and respecting each participant and their sphere of expertise?^[43]
• If I work remotely, is there a reporting system to contact a designated on-site person who can prevent “never events”^[44] if I get disconnected?

Examples

• Interpreters, who perceive imminent harm that could be resolved by cultural mediation advocate for the importance of listening to the patient’s concerns if the provider is refusing to listen.
• Interpreters use non-advocacy interventions available to them, including sharing relevant information, to support communication, and resolve potential issues so the need for advocacy does not arise.
• Interpreters assess how serious and imminent a potential harm is and, when to best address it if needed.
• Interpreters recognize that in some cases the potential harm would occur after the interpreted encounter, but the only window of time when the interpreter can address it is during the encounter.

Supplemental Material

Scenario: Advocating for conversational space to resolve misunderstanding

A patient was upset by some pre-procedure questions and began to speak in a very loud, emphatic voice; the medical provider became concerned and annoyed and was about to cancel. The patient became furious at being refused treatment. When the interpreter realized they would not be able to resolve the issue on their own, and intervened.

The interpreter advocated to the provider to wait before concluding the session. The interpreter suspected the patient was afraid and reacted by yelling, so they advocated to the patient to calm down and listen.

After the advocacy, there was conversational space for the interpreter to do some cultural mediating. Once both participants understood each other’s perspective, they agreed to do the procedure.

Reflecting on the encounter afterward, the interpreter realized it would have been better to intervene a little earlier to begin cultural meditation before advocacy was needed.

Scenario: Interpreter checks with patient before advocating to respect patient autonomy

A surgeon was brusque to the point of severe rudeness. The interpreter conveyed the surgeon’s tone. The interpreter asked the patient if they felt distressed and if they would like the interpreter to advocate for more politeness when the surgeon addressed the patient. The patient said, “No, it doesn’t matter, I want excellent surgical skill from a surgeon, I don’t care if he’s rude.” The interpreter did not advocate because the patient did not want them to, however, the interpreter felt better knowing the rudeness did not bother the patient. (This example happened on site, face-to-face, but it could just as well have happened remotely.)

Scenario: Advocating for consideration of the possibility of abuse

The patient had included a person in the appointment by phone, so that person was hearing everything said in the room. The interpreter suspected the patient was possibly in an abusive relationship with that person. The interpreter found a reason for the clinician to move the video-interpreter screen out of the room so they could share their concern with the clinician in confidence. The clinician said this patient always had the other person on the phone so it was apparently normal for them and was going to let it drop. The interpreter advocated for finding a safe way to double check with the patient.

The provider agreed. They learned the patient was being abused. The patient was given information about resources for leaving the abuser safely.

During the debrief, the clinician explained that they can only give information because the abused person has to be the one who chooses to leave the abuser.

Standard 9.2: Interpreters may advocate outside interpreted encounters on behalf of a party or group to correct a pattern of mistreatment or abuse.^[45]

Prompts

• Did something happen during the encounter that I could not address in the moment but still needs to be addressed as a systemic issue?
• Am I seeing a pattern of exclusion/diminished service for a particular group of patients that should be corrected?
• Is a particular clinic or provider consistently making choices that do not seem to support the patients’ best interests?

Examples

• Interpreters who work remotely persuade someone with the authority to act to arrange a contact person at the medical site in case a “never event”^[46] is about to happen and the interpreter has been disconnected.
• Interpreters promote an environment of respect by reporting when a patient’s rights are violated.
• Interpreters may alert their supervisor to patterns of disrespect or implicit bias towards patients.
• Interpreters follow organizational guidelines for reporting systemic issues such as patterns of implicit bias.
• Interpreters tactfully persuade clinicians who speak a little bit of the patient’s language to continue working with interpreters because the healthcare setting is not the place to practice their language skills without backup. Acknowledge that it is helpful to greet the patient in their language to establish rapport.
• Interpreters who observe a barrier to accessing healthcare may present a persuasive argument to their supervisor to take action to correct the issue.
• Interpreters may write to their legislative representatives (national, state and local) in support of good language access policies.

Standard 9.3: Advocate for working conditions that support quality professional interpreting.

Prompts

• How can I tactfully and effectively speak up about systemic changes to working conditions that will help interpreters do our best interpreting?

Examples

• Interpreters advocate for policies that support the ethical practices of the profession.
• Interpreters may persuade managers to invest in quality equipment that protects interpreters’ hearing.
• Interpreters bring evidence to persuade managers that time spent on activities that rejuvenate interpreters and prevent burn-out and vicarious trauma (such as discussions of challenging cases, ethics rounds, ‘supervision’,^[47],^[48]) benefit the employer in the long run.
• Interpreters choose the optimal method, time and setting to respectfully advocate for system improvements to the appropriate manager or supervisor.
• Interpreters may choose to advocate for short breaks to support accurate interpretation.
• Interpreters may advocate for professional development opportunities, such as case conferences led by a skilled facilitator.

Principle 10: Health and Wellness

Standard 10.1: Recognize the importance of self-care and take proactive steps to maintain our physical, psychological and emotional well-being.

Prompts

• Do I regularly participate in activities that help me reduce the effects of compassion fatigue, emotional distress, and burnout, which are intrinsic^[49] to my work setting?
• What steps can I take to protect my health at work?
• Am I taking care of my physical and emotional health?

Examples

• Interpreters seek and participate in opportunities that help them examine their feelings and learn how to manage emotionally charged situations so they can interpret for them.
• Interpreters engage in debriefing sessions, reflective practice,^[50][51] case conferences, reframing, peer support meetings, counseling and any other activities that restore their health and wellness.
• Interpreters recognize early signs of fatigue or emotional distress, and implement strategies to restore balance and prevent harm.
• Interpreters reflect on their work and process emotional responses after difficult encounters to build resilience.
• Interpreters learn to recognize transference and countertransference in their reaction to specific situations and/or people and develop strategies to manage them.
• Interpreters maintain a healthy diet and get adequate sleep.
• Interpreters use personal protective equipment (PPE) when appropriate for on-site encounters.
• Interpreters may take mini-breaks to close their eyes and take one or two deep relaxing breaths.
• Interpreters may stand up and take a few steps between encounters.
• Interpreters may learn from clinicians who work in emotionally charged settings (such as social workers and forensic interviewers) about what training they received to remain emotionally balanced, and what they find useful.

Standard 10.2: Collaborate with employers and colleagues to develop programs and activities that support our health and well-being and that help mitigate various types of trauma.

Prompts

• Do I proactively suggest activities that support my well-being?
• How can I learn about countertransference and recognise when it is affecting me?^[52]
• Am I taking steps to restore my emotional balance before my performance is affected?

Examples

• Interpreters ask for periodic case conferences to discuss with colleagues how to handle challenging situations.
• Interpreters ensure language access is uninterrupted by seeking appropriate coverage, or for a support interpreter, when they are unable to continue interpreting.

Standard 10.3: Recognize and develop effective coping strategies for our triggers, which may include exposure to distressing medical procedures, patient histories, or ethically challenging situations.

Prompts

• What situations might trigger a strong emotional response based on my lived experiences?
• How can I prepare myself beforehand and manage my emotions during an encounter to stay calm and focused?

Examples

• Interpreters use healthy coping techniques to stay grounded and maintain focus.
• Interpreters assess whether to pause or continue interpreting effectively when emotionally triggered.
• Interpreters learn how to create emotional distance while remaining kind and caring, so they can be aware of participants’ emotions and convey them, without vicariously experiencing them.^[53]

Principle 11: Scope of Practice^[54]

Standard 11.1: Interpreters understand the range of behaviors and actions that can and should be expected of them in their practice of the profession, as well as which actions are outside the scope of practice of an interpreter.

Prompts

• Am I aware of the continuum of ethical possibilities available to me to choose to use in my professional practice?
• Am I choosing the one that best serves the goals and well‑being of participants in this situation?

Examples

• Interpreters reflect on the wide range of ethical principles and standards that may apply to any particular situation, consider which options will produce the most beneficent result, and implement them.
• Interpreters connect patients who need transportation with the person who organizes it, rather than giving the patient a ride.
• Interpreters ask patients to direct questions about health to a clinician, or ask the clinician the question, rather than answering the question themselves.

Standard 11.2: Interpreters respect the expertise, autonomy, rights, and responsibilities of each participant in the encounter.^[55], ^[56]

Prompts

• Am I the best person to address the challenge I am facing?
• When providing my opinion, is it within my realm of expertise (communication)?

Examples

• Interpreters fulfill the responsibilities within their scope of practice, without taking over anyone else’s responsibilities.
• Interpreters refrain from providing medical advice even if they possess relevant medical knowledge. They may ask the patient to ask the clinician, or if necessary, they may ask the clinician to explain.
• Interpreters refrain from speculating in answer to questions about the thoughts and feelings of the patient. They may ask the clinician to ask the patient.
• Interpreters refrain from any activity that is clearly beyond their professional scope of practice.

Standard 11.3: Interpreters practice professional discretion^[57] and consider the potential consequences of their decisions.

Prompts

• How can I evaluate whether my actions align with my responsibilities, and uphold ethical standards?
• How are my actions influencing the probable outcome of the encounter?

Examples

• Interpreters prioritize the values and principles that are most important in a given encounter in order to best meet the needs of the participants.
• Interpreters use critical thinking to consider a range of possible actions, (including inaction), evaluate them based on their expected outcomes, and then choose which action to take in the moment.

Standard 11.4: Interpreters make clear for participants what to expect of interpreters working within their scope of practice.

Prompts

• How should I adjust what I say in the pre-session or huddle to let participants know what to expect from me as an interpreter?
• If I am a dual-role interpreter with two sets of responsibilities, how can I ensure that participants know which set of responsibilities I am fulfilling at any given moment?^[58]

Examples

• Interpreters who are hired to do two different jobs make clear which role they are performing at any given time.
• Interpreters who are hired to work as medical assistants and as interpreters, assess, in consultation with clinicians and patients as needed, whether they can perform both functions effectively at the same time. If they cannot do both effectively, they make clear which role they are fulfilling.
• Interpreters who are asked to push an empty wheel chair or an IV pole evaluate whether they can do so safely. If they decide that they can, they set reasonable expectations for future interpreters by explaining that it is not part of the interpreter’s scope of practice and that other interpreters may or may not agree to do it.

Standard 11.5: Interpreters engage with others in a polite, caring, and professionally appropriate manner without becoming personally overinvolved.

Prompts

• How can I balance kindness and professional distance?

Examples

• Interpreters keep their personal health care experiences to themselves.
• Interpreters show professional kindness and build professional rapport with patients and providers without asking intrusive personal questions or giving personal advice.

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1. According to Merriam-Webster, rapport is “a friendly, harmonious relationship, especially one characterized by agreement, mutual understanding, or empathy that makes communication possible or easy.” ↩︎

2. Communicative Intent: The underlying purpose or goal that a speaker aims to achieve through an utterance, which is not fully encoded in linguistic form but inferred through a combination of linguistic cues, contextual factors, and multimodal signals such as gesture, prosody, and sequential organization. (Németh, 2020) ↩︎

3. Onsite face-to-face interpreters have access to the most inputs, and can “read the room;” telephonic interpreters have no visual inputs, video remote interpreters can see more than telephonic, but usually less than face-to-face interpreters, depending on the device. ↩︎

4. Affect (meaning in psychology)[pronounced with accent on the first syllable, áffect]: A set of observable manifestations of an experienced emotion, such as facial expressions, gestures, postures, and vocal intonations—that typically accompany an emotional state. (Merriam-Webster, n.d.) ↩︎

5. A speaker’s purpose may include: giving or asking for information, showing respect, establishing a relationship, evaluating a patient’s memory span, and more. ↩︎

6. Paralinguistics refers to the nonverbal elements of communication, the aspects that do not involve words, such as tone of voice, pitch, volume, and speech rate. These features influence meaning and interpretation beyond the literal text. (John E. Reid and Associates, Inc., n.d.) ↩︎

7. Some of the possible ways to say the interpreter is speaking in their own voice include:
   • “This is the interpreter speaking. I think….”
   • “The interpreter wonders …”
   • “The interpreter suspects…”
   • “Speaking as the interpreter, I . . .” ↩︎

8. ‘Untranslatable’ words represent concepts for which a comparable referent does not exist in the society of the target language (Seleskovitch, 1978). ↩︎

9. Garcia-Beyaert, Sofia. (2015). Communicative Autonomy and the Role of the Community Interpreter https://www.researchgate.net/publication/367326583_Communicative_Autonomy_and_the_Role_of_the_Community_Interpreter ↩︎

10. Take into account the employer’s policies. Some hospitals do not allow clinicians to speak to patients in languages other than English until they pass a language assessment exam. ↩︎

11. Also known as a pre-conference, a pre-encounter huddle, an interpreter’s professional introduction. ↩︎

12. While interpreters can try to avoid learning information about individual patients, it is not always possible. Interpreters who live in the community they interpret for, cannot “avoid being alone with a patient.” They may meet the same people in a variety of other settings (grocery store, school, church. etc.) Therefore, interpreters need to develop strategies to manage situations in which confidential information may be shared, as well as when the interpreter knows confidential information that may be key to a patient’s health. ↩︎

13. HIPAA Home | HHS.gov , ADA.gov ↩︎

14. Health Care Interpreters: Are They Mandatory Reporters of Child Abuse? (Updated) ↩︎

15. Now that AI is learning from (“scraping”) everything on line, on-line notes may NOT be confidential. ↩︎

16. Guidance Regarding Methods of De-identification of Protected Health Information in Accordance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule Methods or De-identification of PHI | HHS.gov ↩︎

17. Formerly Impartiality ↩︎

18. “The rationale for the provision of relevant information as an acceptable intervention within the scope of a healthcare interpreter’s practice is based on two key aspects of the National Code of Ethics for interpreters in Health Care (2004): the value of beneficence and the ethical principle of Respect. National Council on Interpreting in Health Care. (2021). … Providing relevant information that enhances a patients’ ability to navigate the healthcare system on their own and to manage their own health concerns and outcomes supports patient autonomy while responding in a caring manner to the needs of the patient. It is a way of acknowledging and respecting the patient’s dignity as a competent individual. Interpreter Advocacy in Healthcare Encounters: A Closer Look Rationale for the Provision of Relevant Information p.19, Relevant Institutional Information P.20 ↩︎

19. Providing relevant institutional information is not an act of advocacy because the healthcare interpreter simply offers objective information that could assist the patient and/or healthcare provider achieve their respective goals in the encounter … .Healthcare interpreters do not … advise or persuade anyone to take any specific action. The interpreter simply offers objective information. It is for the patient and/or the healthcare provider to decide what to do with that information.” National Council on Interpreting in Health Care. (2021) Why Providing Relevant Institutional Information is not Advocacy pp. 23-17 Interpreter Advocacy in Healthcare Encounters: A Closer Look ↩︎

20. “Institutional information refers to information about the availability and location of services and departments within a healthcare facility and how to access such services. It also includes information about resources in the community to support the well-being of the patient and the goals of the medical encounter.” P.21 National Council on Interpreting in Health Care. (2021) Interpreter Advocacy in Healthcare Encounters: A Closer Look ↩︎

21. By medical information, we mean information that the interpreter has learned from having interpreted for the patient in the current or previous encounters, or in similar contexts with other patients. The interpreter may also have learned information that is relevant to the current situation from professional development workshops or their own studies. This information must be directly relevant to the situation at hand and verifiable. We do not mean in any way that healthcare interpreters give medical opinions or advice. P.23 Interpreter Advocacy in Healthcare Encounters: A Closer Look ↩︎

22. “Personal identity is about how you see yourself as “different” from those around you. Hobbies, education, interests, personality traits, and so on. Favorite foods, the roles you hold—“I’m the oldest in my family….
    Social identities…include categories such as social class, race, gender identity, political affinity, and of course, religion and sexual orientation. (Lancer, 2021, para.3). ↩︎

23. A widely used definition is: “A conflict of interest is a set of circumstances that creates a risk that professional judgement or actions regarding a primary interest will be unduly influenced by a secondary interest.” Primary interest refers to the principal goals of the profession or activity, such as the protection of clients, the health of patients, the integrity of research, and the duties of public officers. Secondary interest includes personal benefit and is not limited to only financial gain but also such motives as the desire for professional advancement, or the wish to do favors for family and friends. (Dietrich & Hengstler, 2016) ↩︎ ↩︎

24. Garcia-Beyaert, Sofia. (2015). Communicative Autonomy and the Role of the Community Interpreter https://www.researchgate.net/publication/367326583_Communicative_Autonomy_and_the_Role_of_the_Community_Interpreter ↩︎

25. Guyer, P. (2003). KANT ON THE THEORY AND PRACTICE OF AUTONOMY. Social Philosophy and Policy, 20(2), 70–98. doi:10.1017/S026505250320203X ↩︎

26. CULTURE Definition & Meaning - Merriam-Webster
    a : the customary beliefs, social forms, and material traits of a racial, religious, or social group, also : the characteristic features of everyday existence (such as diversions or a way of life) shared by people in a place or time
    b: the set of shared attitudes, values, goals, and practices that characterizes an institution or organization
    c: the set of values, conventions, or social practices associated with a particular field, activity, or societal characteristic
    d: the integrated pattern of human knowledge, belief, and behavior that depends upon the capacity for learning and transmitting knowledge to succeeding generations ↩︎

27. Self-reflection - Wikipedia Self-reflection is the ability to witness and evaluate one’s own cognitive, emotional, and behavioural processes. ↩︎

28. SELF-REFLECTION definition | Cambridge English Dictionary the activity of thinking about your own feelings and behavior, and the reasons that may lie behind them ↩︎

29. Cultural humility begins with a personal examination of our own beliefs and cultural identities to better understand and respect the beliefs and cultural identities of others. Cultural humility helps us uncover our hidden biases and unconscious feelings of superiority. Cultural humility is a lifelong process of self-reflection. From Tervalon & Murray-Garcia, J (1998). ↩︎

30. According to WHO (2020), Intercultural mediators are intermediaries who improve communication and understanding between participants by reducing the interference of linguistic and sociocultural differences.[27] ↩︎

31. Token gifts of appreciation are not expensive. ↩︎

32. Rosenthal, R., & Jacobson, L. (1968). “In 1965 the authors conducted an experiment in a public elementary school, telling teachers that certain children could be expected to be “growth spurters,” based on the students’ results on the Harvard Test of Inflected Acquisition. In point of fact, the test was nonexistent and those children designated as “spurters” were chosen at random.” By the end of the year, however, the students who had been identified as “growth spurters” did significantly better. The Take-a-way: when you assume the best about people, you are more likely to get their best. ↩︎

33. Informed Consent of Subjects Who Do Not Speak English (1995) | HHS.gov ↩︎

34. SIGHT TRANSLATION AND WRITTEN TRANSLATION: Guidelines for Healthcare Interpreters. A. Guidelines for Sight Translation by Healthcare Interpreters p.7 (NCIHC, 2010, Working Paper Series) ↩︎

35. “Reflective practice is the ability to reflect on one’s actions so as to engage in a process of continuous learning.” Schön, D. A. (1983). The reflective practitioner: How professionals think in action. Basic Books. ↩︎

36. Interpreting SAFE AI Task Force Guidance on AI and Interpreting Services Guidance - SAFE AI ↩︎

37. Advocacy is defined as speaking on behalf of another, to plead their cause. (Habersaat et al., 2022) ↩︎

38. The act of pleading or arguing in favor of something, such as a cause, idea, or policy; active support. The American Heritage Dictionary of the English Language. (2022). Advocacy. ↩︎

39. Public support of an idea, plan, or way of doing something. Cambridge Dictionary. (n.d.). Advocacy. In Cambridge Dictionary. ↩︎

40. Advocacy is defined as the act of speaking up or working on behalf of the interests of another person, group, or cause. American Occupational Therapy Association. (n.d.). Everyday advocacy decision guide. ↩︎

41. Interpreter Advocacy in Healthcare Encounters: A Closer Look p.48 ↩︎

42. For a detailed discussion of these prompts see Interpreter Advocacy in Healthcare Encounters: A Closer Look pages 37-40 See also Additional Considerations When the Potential for Harm is Emotional pages 41-42. See also Figure 1 Advocacy Decision Making Process p.43. ↩︎

43. See the discussion of How to Advocate Positively and Professionally pages 43-46 Interpreter Advocacy in Healthcare Encounters: A Closer Look ↩︎

44. The term “Never Event” was first introduced in 2001 by Ken Kizer, MD, former CEO of the National Quality Forum (NQF), in reference to particularly shocking medical errors—such as wrong-site surgery—that should never occur. (Agency for Healthcare Research and Quality [AHRQ], n.d.) ↩︎

45. This standard focuses on observed patterns of mistreatment or abuse best addressed systemically by bringing them to the attention of appropriate personnel within the healthcare system. It allows a healthcare interpreter to alert the healthcare institution to persistent behaviors, policies, or practices that demean the dignity of an individual or a specific group of patients, or that deprive an individual or a group of patients from receiving the same quality and breadth of services as other patients. For Examples, if healthcare providers do not request interpreters because they think that their own rudimentary knowledge of a patient’s language is enough to fully communicate with the patient, an interpreter could bring this to the attention of their supervisor or the institution’s patient safety officer. Interpreter Advocacy in Healthcare Encounters: A Closer Look 2023 p.9 ↩︎

46. The term “Never Event” was first introduced in 2001 by Ken Kizer, MD, former CEO of the National Quality Forum (NQF), in reference to particularly shocking medical errors—such as wrong-site surgery—that should never occur. (Agency for Healthcare Research and Quality [AHRQ], n.d.) ↩︎

47. In the field of mental health, “supervision” for clinicians means discussions with an experienced colleague who helps think through the aspects of a case that make it challenging. This includes the clinician’s emotional responses, counter-transference, and biases (conscious and unconscious). The goal of clinical supervision in a practice profession is to provide insight and to support resilience in the clinician leading to improved ability to effectively help clients. ↩︎

48. Ali Hetherington Manchester University, ​​ Supervision and the Interpreting Profession: Support and Accountability Through Reflective Practice ↩︎

49. belonging to the essential nature or constitution of a thing. https://www.merriam-webster.com/dictionary/intrinsic accessed 9/12/2025 ↩︎

50. “Reflective practice is the ability to reflect on one’s actions so as to engage in a process of continuous learning.” Schön, D. A. (1983). The reflective practitioner: How professionals think in action. Basic Books. ↩︎

51. “Active, persistent, and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusions to which it tends.” Dewey, J. (1933). How we think. D.C. Heath and Company. ↩︎

52. What is Countertransference in Nursing? (Level Up RN, n.d.) ↩︎

53. Different Kinds of Empathy - Daniel Goleman You Tube ↩︎

54. Formerly called “Role Boundaries.” Role boundaries emphasize the limits of what interpreters can do. Scope of practice encourages us to consider all the options available to interpreters when making decisions to support the participants’ shared goal of good communication and good health care for the patients. ↩︎

55. “Patients have the right to decide what is best for them after having received appropriate and relevant information. Providers have the duty to present their knowledge clearly and objectively so that the patient is able to make informed choices. Interpreters have the duty to convey all messages faithfully and completely. By respecting the rights and duties of each party in the encounter and treating all parties equally and with dignity, interpreters can help build mutual respect within the interpreted encounter.” A National Code of Ethics for Interpreters in Health Care • July 2004 • Page 19 of 23 A NATIONAL CODE OF ETHICS FOR INTERPRETERS IN HEALTH CARE ↩︎

56. “Respects and enhances each person’s primary sphere of ‘power’ or expertise (i.e., the patient as an expert on her or his own body with ultimate decision-making power over it; the provider’s medical expertise and power based on knowledge that the patient does not have; the interpreter’s expertise in understanding the two language systems and converting messages from one language to the other)” MEDICAL I NTERPRETING STANDARDS OF PRACTICE p.32 ↩︎

57. Discretion:
    1. The quality of behaving or speaking in such a way as to avoid causing offense or revealing private information. Similar: circumspection, care, carefulness, caution
    2. The freedom to decide what should be done in a particular situation. Similar: choice, option, judgment, preference
    Definitions from Oxford Languages ↩︎

58. “… interpreters fulfill only the duties of a health care interpreter while engaged in the performance of that role and do not assume any duties that are outside that role. Therefore, interpreters, [who] have been engaged to provide interpreting services, should not assume duties that pertain to other roles-- whether they are qualified in those roles or not, unless there is an explicit understanding by all parties that the interpreter will do so. This principle is especially important for those interpreters who are cross-trained in other health care professions such as nursing” or medical assistants. Interpreters who are hired to perform “dual roles have to be very transparent about which role they are engaging in at any particular moment. If there is a need to take on their other roles or responsibilities for the well-being of the patient, they should be transparent by letting the relevant parties know when the shift occurs.” A National Code of Ethics for Interpreters in Health Care • July 2004 • Page 16 of 23 (NCIHC, 2004) ↩︎