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

¡TODO ESTÁ BIEN!

An Evidence-Informed Toolkit to Enhance Communication and Comfort with Spanish-Speaking Patients

Developed by:
Elizabeth Malfaro, RRNA, BSN, RN
Daniel Negrón Guzmán, RRNA, BSN, RN

© 2026 Elizabeth Malfaro, Daniel Negrón Guzmán · For educational use only

¡Todo está bien! — Toolkit Guide
This toolkit supplements professional interpreters. It never replaces them.
✓ 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 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
Important: This toolkit is for orientation, reassurance, and reorientation only. It does not replace professional medical interpreters, who remain the gold standard for all complex, high-stakes, and consent-required communication.
¡Todo está bien! Toolkit · Malfaro & Negrón Guzmán · 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 interpreterDo not proceed without oneSimple includes:Orientation / reassuranceProcedural cueingPain scale (1–10)PACU reorientationToolkit phraseavailable?NoCall interpreterDo not proceed without oneYesUse toolkit phraseAccess via QR codeUse phonetic pronunciation guidePatient confirmsunderstanding?NoCall interpreterimmediatelyYesContinue careWhen in doubt → call the interpreter. Always.The toolkit supplements interpreters.It never replaces them.
¡Todo está bien! Toolkit · Malfaro & Negrón Guzmán · 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 interpreterimmediatelyYesContext is clearExample: patient awakening from anesthesia→ use reorientation phraseUse ONE phase-appropriate phraseAccess via QR codeUse phonetic pronunciation guidePatient settlesor confirms?NoCall interpreterimmediatelyYesContinue careWhen in doubt → call the interpreter. Always.The toolkit supplements interpreters.It never replaces them.
¡Todo está bien! Toolkit · Malfaro & Negrón Guzmán · University of Puerto Rico Medical Sciences Campus
Pre-Operative Phrases
Greetings · Introductions · Orientation · Reassurance · Pre-operative Prep
EnglishSpanish — hover/tap for pronunciation
Greetings · Orientation · Reassurance
Gender note: words marked /o/a change ending based on gender — Use -o for male patients · Use -a for female patients · Match your own gender when referring to yourself
Phonetic key: CAPITALIZED syllables = primary stress · 'y' = English 'y' in 'yes' · 'h' is silent · 'v' sounds like 'b' · 'j' sounds like 'h'
If the patient asks questions or initiates complex communication — stop and call the interpreter. These phrases are for simple communication only.
¡Todo está bien! Toolkit · Malfaro & Negrón Guzmán · University of Puerto Rico Medical Sciences Campus
Transfer & Arrival Phrases
Moving to the OR · Positioning · Comfort · Safety
EnglishSpanish — hover/tap for pronunciation
Gender note: words marked /o/a change ending based on gender — Use -o for male patients · Use -a for female patients · Match your own gender when referring to yourself
Phonetic key: CAPITALIZED syllables = primary stress · 'y' = English 'y' in 'yes' · 'h' is silent · 'v' sounds like 'b' · 'j' sounds like 'h'
If the patient asks questions or initiates complex communication — stop and call the interpreter. These phrases are for simple communication only.
¡Todo está bien! Toolkit · Malfaro & Negrón Guzmán · University of Puerto Rico Medical Sciences Campus
Intraoperative Phrases
Placing Monitors · Induction
EnglishSpanish — hover/tap for pronunciation
Gender note: words marked /o/a change ending based on gender — Use -o for male patients · Use -a for female patients · Match your own gender when referring to yourself
Phonetic key: CAPITALIZED syllables = primary stress · 'y' = English 'y' in 'yes' · 'h' is silent · 'v' sounds like 'b' · 'j' sounds like 'h'
If the patient asks questions or initiates complex communication — stop and call the interpreter. These phrases are for simple communication only.
¡Todo está bien! Toolkit · Malfaro & Negrón Guzmán · University of Puerto Rico Medical Sciences Campus
Emergence & PACU Phrases
Awakening · Reorientation · Pain Assessment · Transfer
EnglishSpanish — hover/tap for pronunciation
Gender note: words marked /o/a change ending based on gender — Use -o for male patients · Use -a for female patients · Match your own gender when referring to yourself
Phonetic key: CAPITALIZED syllables = primary stress · 'y' = English 'y' in 'yes' · 'h' is silent · 'v' sounds like 'b' · 'j' sounds like 'h'
If the patient asks questions or initiates complex communication — stop and call the interpreter. These phrases are for simple communication only.
¡Todo está bien! Toolkit · Malfaro & Negrón Guzmán · University of Puerto Rico Medical Sciences Campus
MAC Cases Phrases
Monitored Anesthesia Care · Sedation Phrases
EnglishSpanish — hover/tap for pronunciation
Phrases for this section are pending native-speaker review and will be added here.
Gender note: words marked /o/a change ending based on gender — Use -o for male patients · Use -a for female patients · Match your own gender when referring to yourself
Phonetic key: CAPITALIZED syllables = primary stress · 'y' = English 'y' in 'yes' · 'h' is silent · 'v' sounds like 'b' · 'j' sounds like 'h'
If the patient asks questions or initiates complex communication — stop and call the interpreter. These phrases are for simple communication only.
¡Todo está bien! Toolkit · Malfaro & Negrón Guzmán · University of Puerto Rico Medical Sciences Campus
Regional Phrases
Regional Anesthesia · Block Phrases
EnglishSpanish — hover/tap for pronunciation
Phrases for this section are pending native-speaker review and will be added here.
Gender note: words marked /o/a change ending based on gender — Use -o for male patients · Use -a for female patients · Match your own gender when referring to yourself
Phonetic key: CAPITALIZED syllables = primary stress · 'y' = English 'y' in 'yes' · 'h' is silent · 'v' sounds like 'b' · 'j' sounds like 'h'
If the patient asks questions or initiates complex communication — stop and call the interpreter. These phrases are for simple communication only.
¡Todo está bien! Toolkit · Malfaro & Negrón Guzmán · University of Puerto Rico Medical Sciences Campus
About This Toolkit
An Evidence-Informed Toolkit · University of Puerto Rico Medical Sciences Campus

This perioperative Spanish communication toolkit helps CRNAs and SRNAs provide orientation, reassurance, and reorientation to Spanish-speaking patients with limited English proficiency (LEP). It is designed for point-of-care use via QR code 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.

Developers

Native Spanish-Speaking CRNA Reviewers

Phrases were written in neutral, regionally unmarked Spanish and reviewed by native Spanish-speaking CRNAs representing Caribbean, Central American, and South American dialect 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 — not substitutes — that obligation.

© 2026 Elizabeth Malfaro & Daniel Negrón Guzmán · For educational use only

¡Todo está bien! Toolkit · Malfaro & Negrón Guzmán · University of Puerto Rico Medical Sciences Campus
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