Patient Speaking Disability In Nursing Education and Communication
What Is Sign language In Nursing Education
Many people who are deaf consider American Sign Language (ASL) to be their primary language and preferred mode of communication. In many families with children who are deaf, ASL is used in the home and is the first language children learn. For other children who are raised in an environment where Deaf culture predominates, ASL is the medium of social communication among peers, which reinforces English as a second language.
Children who primarily use ASL have difficulty achieving fluency in English and may struggle with written English as well (Disabilities, Opportunities, Inter networking, and Technology [DO-IT], 2017). Some evidence, though, suggests that a high level of ASL proficiency is related to higher English literacy skills (Vicars, 2003).
ASL differs from simple finger spelling. which is a method of using different hand positions to represent letters of the alphabet. In contrast, ASL is a complex language made up of signs as well as finger spelling combined with facial expressions and body position. Eye gaze and head and body shift are also incorporated into the language (NIDCD, 2017).
In recent years, much debate has taken place within the Deaf community regarding the development of a written form of ASL and it remains somewhat controversial, particularly among the Deaf community (Grushkin, 2017). The nurse who does not know ASL is advised to obtain the services of a professional interpreter. Sometimes a family member or friend of the patient skilled in signing is willing and available to act as an interpreter during teaching sessions.
However, just as it is preferable to use a professional interpreter when dealing with an individual who speaks a different language, so it also is preferable to use a professional interpreter for a person who uses sign language (Scheier, 2009). Family members and friends may have difficulty translating medical words and phrases and may be hesitant to convey information that may be upsetting to the patient.
Prior to enlisting the assistance of an interpreter, whether family member or professional, the nurse should always be certain to obtain the patient's permission to do so. Information communicated regarding health issues may be considered personal and private. If the information to be taught is sensitive or confidential, it is advised that family or friends should not be enlisted as interpreters.
Hiring a certified language interpreter is often the best strategy.Federal law (Section 504 of the Rehabilitation Act of 1973, PL 93-112) requires that health facilities receiving federal funds secure the services of a professional interpreter upon request of a patient. If the patient cannot provide the names of interpreters, the nurse should contact the state Registry of Interpreters of the Deaf (RID).
This registry can provide an up-to-date list of qualified sign language interpreters.During a teaching session, the nurse should stand or sit next to the interpreter. He or she should talk at a normal pace and look at and talk directly to the Deaf person when speaking. The interpreter will convey information to the patient as well as share patient responses with the nurse.
It is important to remember that ASL does not provide a word-for-word translation of the spoken or written word and that misunderstandings can occur. Patient education involves the exchange of what is often very detailed and important information.
To determine whether the information given is understood, the nurse should ask questions of the patient, request verbal teach back or demonstrations, allow the patient to ask questions, and use other appropriate assessment strategies (Scheier, 2009). Providing supplemental text, diagrams, and other forms of media will help to increase understanding (Palmer et al., 2017).
What Is Lip Reading In Nursing Education
Lipreading is the process of interpreting speech by observing movements of the face, mouth, and tongue (Feld & Sommers, 2009). One common misconception among hearing persons is that all people who are deaf can read lips. This is a potentially dangerous assumption for the nurse to make. Not all people who are deaf reading lips, and even among those who do, lipreading may not be appropriate for health education or other forms of patient communication.
Among Deaf persons in general, word comprehension while lipreading is only about 30-45%. Therefore, even the most skilled lip readers also use facial cues, body language, and context to get the full message. However, the technique of lipreading taxes the brain in several different ways, so a lipreader can become exhausted over an extended period of time (Callis, 2016).
Consequently, only a skilled lip reader will obtain any real benefit from this form of communication ( Roger et al., 2007). When working with a client who is lipreading, nurses should:
Speak normally. It is not necessary to exaggerate lip movements, because this action will distort the movements of the lips and interfere with interpretation of the words. Make sure clients are wearing their eye glasses. Lip reading requires good vision. Provide sufficient lighting on their faces and remove all barriers from around the face, such as gum, pencils, hands, and surgical masks.
Beards, mustaches, and protruding teeth also present a challenge to the lip reader. Supplement teaching using other forms of communication as it is not possible for clients to lipread every word. Conduct teaching sessions in a quiet environment. It is easier to lipread when distractions are kept to a minimum (Lipreading.org, 2017)
Consider using an interpreter if English is the client's second language. Clients can lipread more accurately when the speaker is using the client's primary language (Lipreading.org, 2017).
Written Materials and Speaking Disabilities In Nursing Education
Written information is probably the most reliable way to communicate, especially when understanding is critical. In fact, nurse educators should always write down the important information as a supplement to the spoken word even when the Deaf person is versed in lipreading or an interpreter is involved. Written communication is always the safest approach, even though it is time consuming.
Printed client educational materials must always match the reading level of the audience. When preparing written materials for learners who are deaf, it is prudent to keep the message simple. Although recent studies suggest that students who are deaf are making strides in their reading performance, the data at this point are inconclusive and many people with deafness still struggle with the written word (Easterbrook & Beal Alvarez, 2012).
When providing handwritten or typewritten instructions or using commercially prepared printed educational materials, remember to keep in mind that a person with limited reading ability often interprets words literally. Therefore, instructions should be clear, with minimal use of words or phrases that could be misinterpreted or confusing. For example, instead of writing. “When running a fever, take two aspirin,” write “For a fever of 100.5°F or higher, take two aspirin.”
The second message is clearer in that it avoids misinterpretation of the word “running” and provides clarification of the word “fever.” In addition, visual aids such as simple pictures, drawings, diagrams, and models are also very useful media as a supplement to increase understanding of written materials.
Verbalization by the Client In Nursing Education
Sometimes clients who are deaf will choose to communicate through speaking, especially if they have established a rapport and a trusting relationship with the nurse. The tone and inflection of the voice of a client who is deaf may be different from normal speech, so nurses must listen carefully, remembering that time may be needed to become accustomed to the patient's voice sounds (pitch) and speech rhythms.
A quiet, private place should be selected for teaching so that the patient's words can be heard. If the patient's words are difficult to understand, it may help to write down what is heard, which may help those listening to get the gist of the message.
Sound Augmentation In Nursing Education
For those patients who have a hearing loss but are not completely deaf, hearing aids are often a useful device. A patient who has already been fitted for a hearing aid should be encouraged to use it, and it should be readily accessible, fitted properly, turned on, and with the batteries in working order.
If the client does not have a hearing aid, with permission from the patient and family, the nurse should make a referral to an auditory specialist, who can determine whether such a device is appropriate for the patient.Only one out of five people who could benefit from a hearing aid in actual wear one (NIDCD, 2014). Cost contributes to this problem. Although Medicare policies vary from state to state, as a rule Medicare does not pay for routine hearing examinations or hearing aids.
Under some circumstances, Medicare will pay for diagnostic hearing tests when hearing loss is suspected to result from illness or treatment (Medicare, 2012). Therefore, it is important to seek permission from the client before initiating the referral for a hearing examination or hearing aid.
Another means by which sounds can be augmented is by cupping one's hands around the client's ear or using a stethoscope in reverse. That is, the patient puts the stethoscope in his or her ears, and the nurse talks into the bell of the instrument (Babcock & Miller, 1994).
If the patient can hear better out of one ear than the other, speakers should always stand or sit closer to the good ear, use slow speech, and provide adequate time for the patient to process the message and to respond. Shouting, which distorts sounds, should be avoided. That is because it is not necessarily an increase in decibels that makes a difference but rather the tone, rhythm, articulation, and pace of the words.
Telecommunications In Nursing Education
Technology can be used effectively to teach a person who is deaf. The Deaf also can be taught to use technology to enhance life skills. Some examples of telecommunication devices that accomplish both goals include television decoders for closed captioned programs, captioned telephones that transcribe everything a person says into writing on a screen, and alerting devices that warn of a crying baby, ringing doorbell, or ringing phone.
Captioned films for patient education are available free of charge through Modern Talking Pictures and Services. Text telephones (TTY or Teletype), sometimes referred to as TDD (telecommunication devices for the deaf), are type writer like devices that allow for text messages between two parties. These devices use a relay station to translate messages if only one party has the TTY device.
Under federal law, these technology-based devices are considered reasonable accommodations for persons with deafness and hearing impairments. However, nurses should note that translation of the spoken word on health related videos created for the hearing population, without the tone of voice, voice level, and other strategies speakers use to emphasize a point, may alter the message that is conveyed to patients who are deaf (Pollard et al., 2009; Wallhagen , Pettengill, & Whiteside, 2006).
What are Responsibilities of Nursing Educator
In summary, the following guidelines can be applied when using any of the already mentioned modes of communication (McConnell, 2002; Navarro & Lacour , 1980).
Nurse educators should:
Be natural, not rigid or stiff, and do not attempt to over articulate speech.
Use short, simple sentences.
Speak at a moderate pace, pausing occasionally to allow for questions. Be sure to get the Deaf person's attention by a light touch on the arm before beginning to talk. Face the patient and stand no more than 6 feet away when trying to communicate.
Ask the patient's permission to eliminate environmental noise by lowering the television, closing the door, and so forth.
Make sure the patient's hearing aid is turned on, the batteries are working, and his or her glasses are clean and in place.
Nurse educators must avoid:
Talking and walking at the same time. Moving their head excessively. Speaking while in another room or turning away from the person with hearing loss while communicating.
Standing directly in front of a bright light, which may cast a shadow across their face or glare directly into the patient's eyes. Joking and using slang or vocabulary the patient might misinterpret or not understand. Placing an intravenous line in the hand the patient will need for sign language.
No matter which methods and materials of communication for teaching are chosen, it is important to confirm that health messages have been received and correctly understood. It is essential to validate patient comprehension in a nonthreatening manner, such as using the teach-back approach.
However, in attempts to avoid embarrassing or offending one another, patients as well as healthcare providers will often acknowledge with a smile or a nod in response to what either party is trying to communicate when.in fact, the message is not well understood.
To be sure that the health education requirements of patients who are deaf and hearing impaired are being met, the nurse educator must find effective strategies to communicate the intended message clearly and precisely while at the same time demonstrating acceptance of individuals by making accommodations to suit them needs (Harrison, 1990). People who have lived with a hearing impairment for a while usually can indicate which modes of communication work best for them.
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