WHAT ARE STANDARDS OF PRACTICE?
Standards of practice are a set of guidelines that define what an interpreter does in the perform- ance of his or her role, that is, the tasks and skills the interpreter should be able to perform in the course of fulfilling the duties of the profession. Standards describe what is considered “best practice” by the profession and ensure a consistent quality of performance. For health care inter- preters, the standards define the acceptable ways by which they can meet the core obligations of their profession – the accurate and complete transmission of messages between a patient and provider who do not speak the same language in order to support the patient-provider therapeutic relationship.
As in all professions, the field of interpreting is guided by ethical principles. These standards for health care interpreters show how professional interpreters respond to ethical and other considerations in the performance of their duties. Standards of practice are concerned with the “hows” of performance as compared with codes of ethics that focus on the “shoulds.” A code of ethics provides “a set of principles or values that govern the conduct of members of a profession while they are engaged in the enactment of that profession.”5 In other words, codes of ethics provide “guidelines for making judgments about what is acceptable and desirable behavior in a given context or in a particular relationship”6 while standards focus on the practical concerns of what the interpreter does in the performance of his or her role, offering “best practice” strategies for observing the principles of the code of ethics in day-to-day practice.
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As the profession of health care interpreting in the United States matures and evolves, the importance of creating shared understandings of what is considered high quality and ethically appropriate principles and practices in the field becomes imperative. To this end, the National Council on Interpreting in Health Care identified three steps that needed to take place on a national level in order to standardize the expectations that the health care industry and patients should have of interpreters and to raise the quality of health care interpreting. The first step was to create and build support for a single Code of Ethics that would guide the practice of interpreters working in health care venues. The second step was to develop a nationally accepted, unified set of Standards of Practice based on the Code of Ethics that would define competent practice in the field. The third step was to create a national certification process that would set a standard for qualification as a professional health care interpreter. (NCIHC, 2004)
The Standards, Training and Certification (STC) Committee of the National Council on Interpreting in Health Care (NCIHC) took on the task of bringing the first step to fruition. The goal of the STC Committee was to create a national code of ethics that would provide the growing profession with a set of shared, essential guiding principles expressing what are considered morally appropriate behaviors for its practitioners as they perform their day-to-day duties.
To achieve this goal, the STC Committee engaged in a systematic process of reviewing existing codes of ethics, creating a draft code, conducting national focus groups to review the draft, and eliciting feedback through a national survey. The challenge was to design a code that built on and solidified existing work at the same time that it expanded upon this work to ensure its relevance to all health care interpreters, irrespective of the languages or particular venue in which they were working.
The STC Committee started by identifying and collecting existing codes of ethics in health care and other related areas such as legal and sign language interpreting. This process surfaced a number of codes that were already in use at the local level – by state and national associations of interpreters, institutions of health care, interpreter service organizations, and court programs – in the United States and Canada. The STC Committee then focused on ten codes that were considered most relevant to their work and compared them in order to identify the elements that were held in common and to analyze how each approached those issues that were most difficult and controversial in the field. Based on its analysis, the STC Committee drafted a code that included the elements shared across these existing codes as well as a few that were controversial but relevant. This draft also included a short commentary after each principle that further explained and illustrated that principle.
In the fall of 2002, the STC Committee presented the draft code to working interpreters across the country for review and comment. Focus groups were organized in nine localities across the United States. Attention was paid to the composition of these focus groups to include a broad representation of language groups and modes of service delivery (e.g. face to face and telephone interpreting). The focus groups confirmed the need for a unified national code of ethics and affirmed its development as a positive step for the profession. The feedback from the focus groups also concluded that the draft code was fundamentally complete and appropriate although some principles were seen as more or less controversial.
Based on the focus group feedback, a second draft of the code of ethics, including the commentaries, was developed, incorporating consistently recommended changes. This second draft was then introduced to a larger cross-section of working interpreters through a survey that was disseminated through the NCIHC website and state associations of health care interpreters. Approximately 2500 surveys were distributed, with a return rate of 20%. The STC Committee then analyzed the data from the 500 returned surveys.
In analyzing these data, it became apparent to the Committee that there was strong agreement on the principles as stated in the draft. It was mostly the commentaries that generated controversy in the form of disagreement with the explanations and unresolved questions about implementation. Therefore, in creating the final draft of the code, the STC Committee decided to highlight the consensus there was on the principles themselves by publishing the code as a set of principles without commentary. The STC Committee agreed that further explanation of the principles would be better left to a companion document that could offer a more thorough discussion of the issues raised and to the development of standards-of-practice that would address the practical questions of implementation.
Having considered all the feedback it had received, the STC Committee created a final draft of the code. However, before officially approving the code, the final draft was also sent to a select number of health care providers and medical ethicists for comment.
The National Code of Ethics for Interpreters in Health Care is the result of this systematic, deliberate, and reflective process. The STC Committee is confident that this code represents the principles that working interpreters believe are important to ensure the ethical practice of their profession. These principles are the ones that working interpreters have said merit serious consideration when faced with a dilemma or difficult choice and to which they agree to be held accountable.
This document provides a guide to understanding the National Code of Ethics for Interpreters in Health Care. It was apparent from the responses to the survey that not everyone in the field had the same understanding of the concept of ethics, what a code of ethics represented, what this code meant in the course of professional practice, and what the difference was between a code of ethics and standards of practice. Therefore, this document places the code in the context of ethical behavior in general and then discusses each principle in the context of specific issues and dilemmas often faced by health care interpreters. It provides an elaboration and discussion of each principle and the interrelationships among them, acknowledging that controversies still exist while offering the working interpreter a way to think about these controversies.
This document is organized around three major sections. The first section offers an explanation of ethics and ethical behavior in general as well as in the context of the profession of health care interpreting. The second section describes the core values on which this code of ethics is grounded. Finally, the third section presents a commentary on each of the principles that makes up the National Code of Ethics for Interpreters in Health Care.
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