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UNIVERSITY OF PUERTO RICO MEDICAL SCIENCES CAMPUS
SCHOOL OF NURSING · NURSE ANESTHESIA PROGRAM

¡TODO ESTÁ BIEN!

A Fixed-Phrase Spanish Communication Toolkit for Perioperative Nurse Anesthesia Practice

Developed by:
Elizabeth Malfaro, RRNA, BSN, RN

© 2026 Elizabeth Malfaro · For educational use only

¡Todo Está Bien! — Toolkit Guide
This toolkit supplements professional interpreters. It never replaces them.

This perioperative Spanish communication toolkit helps CRNAs and SRNAs provide simple directions, simple yes-or-no questions, orientation, and reassurance to Spanish-speaking patients with limited English proficiency (LEP). It is designed for point-of-care use via QR code or as an installable app on a mobile device in the operating room. It supplements — and never replaces — professional medical interpreters, who remain the gold standard for all complex, high-stakes, and consent-required communication.

✓ Use the toolkit for these situations
✕ Call a professional interpreter instead
Preoperative orientation"You are going to the operating room." / "I am here with you."
Informed consentAnesthesia risks, benefits, and alternatives must be interpreter-supported
Induction cueing"Take a deep breath." / "Count back from 10."
Risk disclosureComplications, medication reactions, and adverse event discussions
Intraoperative reassurance"Everything is going well." / "You are safe."
Medical history and anesthesia assessmentAllergies, medications, past anesthesia history, preoperative screening
Emergence cueing"Open your eyes." / "Take a deep breath. Surgery is over."
Treatment decisionsAnesthesia plan changes, regional vs. general, or plan modifications
PACU reorientation"You are in the recovery room." / "Rate your pain 1–10. Do you feel nauseous?"
Patient-initiated unclear communicationIf a patient says something you cannot independently interpret from context
Basic comfort phrasesWarmth, reassurance, presence
Any complex or high-stakes exchangeWhen in doubt — always call the interpreter
Select your patient
Spanish is a gendered language — many words and phrases take a masculine or feminine form. Please select which form fits best for your patient.
No patient selected yet.
A note on language: Spanish grammar assigns a masculine or feminine form to many words, so this toolkit offers both to help you communicate clearly. These are grammatical categories, not assumptions about identity. Choose the form that fits your patient — you can switch anytime using the toggle in the corner — and when in doubt, or when a patient shares a preference, follow their lead or ask your interpreter.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
Provider-Initiated
Clinical Judgment Flow
Scenario ACRNA initiates communicationCRNA needs to communicatewith a Spanish-speaking LEP patientWhat type of communicationis needed?ComplexSimpleComplex includes:Consent / risk disclosureMedical history / allergiesTreatment decisionsPatient questionsCall interpreterSimple includes:Orientation / reassuranceProcedural cueingPain scale (1–10)PACU reorientationToolkit phraseavailable?NoCall interpreterYesUse toolkit phraseUse phonetic pronunciation guide or tap the audio iconPatient confirmsunderstanding?NoCall interpreterYesContinue careWhen in doubt → call the interpreter. Always.The toolkit supplements interpreters.It never replaces them.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
Patient-Initiated
Clinical Judgment Flow
Scenario BPatient initiates communicationPatient says something in SpanishCRNA does not understandCRNA observes clinical context:Visible distress, pain, or agitation?Gesturing to body, IV, or monitor?Repeated attempts to communicate?Can CRNA determine needfrom context alone?No / unclearCall interpreterYesContext is clearExample: patient awakening from anesthesia→ use reorientation phraseUse toolkit phraseUse phonetic pronunciation guide or tap the audio iconPatient confirmsunderstanding?NoCall interpreterYesContinue careWhen in doubt → call the interpreter. Always.The toolkit supplements interpreters.It never replaces them.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
Introductions
Greetings & Introduction · General Phrases
EnglishSpanish — hover/tap for pronunciation
If it's complex or unclear — call the interpreter.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
Airway Assessment Phrases
Starting the Exam · Mallampati & Mouth Opening · Thyromental Distance · Jaw Protrusion · Neck Mobility · Dental · Finishing
EnglishSpanish — hover/tap for pronunciation
If it's complex or unclear — call the interpreter.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
Preoperative Phrases
Placing an IV · Pre-op Sedation
EnglishSpanish — hover/tap for pronunciation
If it's complex or unclear — call the interpreter.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
Transfer to OR
Leaving Pre-Op · Transfer to OR · Arrival to OR
EnglishSpanish — hover/tap for pronunciation
If it's complex or unclear — call the interpreter.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
Positioning Phrases
Positioning · Supine · Sitting Position · Lateral Position · Prone Position
EnglishSpanish — hover/tap for pronunciation
If it's complex or unclear — call the interpreter.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
Monitors Phrases
Placing Monitors
EnglishSpanish — hover/tap for pronunciation
If it's complex or unclear — call the interpreter.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
Induction Phrases
Induction
EnglishSpanish — hover/tap for pronunciation
If it's complex or unclear — call the interpreter.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
Emergence Phrases
Emergence & Awakening
EnglishSpanish — hover/tap for pronunciation
If it's complex or unclear — call the interpreter.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
Transfer to PACU Phrases
Transfer to PACU · Arrival to PACU
EnglishSpanish — hover/tap for pronunciation
If it's complex or unclear — call the interpreter.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
Sedation Cases
During the Procedure · Reassurance
EnglishSpanish — hover/tap for pronunciation
If it's complex or unclear — call the interpreter.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
C-Sections
Positioning · During the Surgery · Nausea · Encouragement · Birth & After
EnglishSpanish — hover/tap for pronunciation
If it's complex or unclear — call the interpreter.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
GI Cases
Before the Procedure · Starting Sedation · During the Procedure · If the Patient Starts Waking Up · Waking Up
EnglishSpanish — hover/tap for pronunciation
If it's complex or unclear — call the interpreter.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
Spinal Phrases
Reassurance · During the Block · After the Block
EnglishSpanish — hover/tap for pronunciation
If it's complex or unclear — call the interpreter.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
Epidural Phrases
Reassurance · Positioning · During the Block · Threading the Catheter · If You Feel a Zing · Test Dose · After the Block · Follow-Up
EnglishSpanish — hover/tap for pronunciation
If it's complex or unclear — call the interpreter.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
Suggestions
Help Us Improve This Toolkit

Have a phrase you use often that isn't here? Notice a translation that could be better, or something that isn't working right? Tell us — your feedback shapes the next version.

0 / 2000
Suggestions are sent to the toolkit developers. Please don't include any patient information.
¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
About This Toolkit
A Fixed-Phrase Spanish Communication Toolkit for Perioperative Nurse Anesthesia Practice

Developer & Author

Special Contributions

Native Spanish-Speaking CRNA Reviewers

Phrases were written in neutral, regionally unmarked Spanish and reviewed by the following native Spanish-speaking CRNAs, who represent Caribbean, Mexican, Central American, and South American backgrounds:

Theoretical Framework

ACE Star Model of Knowledge Transformation (Stevens, 2004, 2015).

References

  1. Luan-Erfe BM, Erfe JM, Briski D, et al. Limited English proficiency and perioperative patient-centered outcomes: A systematic review. Anesthesia & Analgesia. 2023;136(6):1096–1106.
  2. Joo E, Fernández A, Wick EC, Moreno Lepe G, Manuel SP. Association of language barriers with perioperative and surgical outcomes: A systematic review. JAMA Network Open. 2023;6(7):e2322743.
  3. Dhaliwal J, et al. Communication barriers and perioperative anxiety in patients with limited English proficiency: A narrative review. Journal of Perioperative Practice. 2025;35(10):443–449.
  4. Shebl E, et al. Preoperative anxiety and anesthetic outcomes: A systematic review and meta-analysis. Journal of Clinical and Translational Science. 2025;9(1):e33.
  5. van Lent LGG, et al. Communication strategies for patients with limited language proficiency: A systematic review using GRADE. Patient Education and Counseling. 2025;136:108767.
  6. Heath M, et al. Interpreter services and language-concordant care for migrant populations: A systematic review. Journal of Migration Health. 2023;7:100162.
  7. Pai S, et al. Language discordance in anesthesia care: A scoping review. Patient Education and Counseling. 2026;147:109540.
  8. Rosendahl S, Larsson H. Digital communication tools in transcultural nursing care: A qualitative systematic review. Journal of Transcultural Nursing. 2024.
  9. Silvera-Tawil D, et al. Pre-translated phrase tools and communication parity for patients with limited English proficiency. JMIR Nursing. 2021;4(3):e19709.
  10. Park J, et al. Healthcare anxiety and bilingual provider preference among Spanish-speaking patients: A cross-sectional structural equation model. American Journal of Health Promotion. 2026.
  11. Mano M, et al. A perioperative Spanish communication badge card: A quality improvement report. APSF Newsletter. 2024.
Title VI of the Civil Rights Act of 1964 requires healthcare institutions receiving federal funding to provide meaningful language access to LEP patients. This toolkit supports that obligation.

© 2026 Elizabeth Malfaro · For educational use only · Privacy Policy

¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus
Privacy Policy
What this toolkit collects, and how it is used

Effective date: October 9, 2026

This policy explains what information the ¡Todo Está Bien! toolkit (the website at todoestabientoolkit.com and the Android app) collects, and how it is used. The toolkit is developed by Elizabeth Malfaro, RRNA, BSN, RN, for educational use.

In short: You can use the toolkit without an account, and it doesn't track you. The only information it collects is what you choose to type into the optional Suggestions form.

Information we do not collect

The Suggestions form

If you choose to send a suggestion, the toolkit sends the following to the developer:

Suggestions are delivered by email through Formspree, a form-delivery service, which handles the submission under its own privacy policy. Suggestions are used only to improve the toolkit and to reply to you if you gave an email address. They are never sold, shared for marketing, or used for advertising.

Please do not include any patient information in a suggestion.

Audio pronunciation

The audio button uses your device's built-in text-to-speech voice. The phrase is spoken on your device; the toolkit itself does not send or record any audio.

Offline storage

To work without an internet connection, the toolkit saves a copy of its own pages and images on your device. This copy contains only the toolkit's content, not information about you. You can remove it at any time by uninstalling the app or clearing the site's data in your browser.

Purchases

If you buy the Android app, the purchase is handled entirely by Google Play under Google's Privacy Policy. The developer does not receive or store your payment details.

Hosting

The toolkit is hosted by Netlify. Like most web hosts, Netlify may briefly process standard technical information, such as IP addresses, to deliver the pages and keep the service secure.

Children

The toolkit is intended for nurse anesthesia professionals and students. It is not directed at children, and we do not knowingly collect information from children.

Deleting your information

If you sent a suggestion and would like it deleted, email elizabeth.malfaro@upr.edu and it will be removed.

Changes to this policy

If this policy changes, the updated version will be posted on this page with a new effective date.

Contact

Elizabeth Malfaro, RRNA, BSN, RN
University of Puerto Rico Medical Sciences Campus · School of Nursing · Nurse Anesthesia Program
elizabeth.malfaro@upr.edu

© 2026 Elizabeth Malfaro · For educational use only

¡Todo Está Bien! · Malfaro · University of Puerto Rico Medical Sciences Campus