Sensory Disabilities in Learner and Nursing Education
Whats Are Types of Disabilities
Disabilities can be classified into two major categories: mental and physical. Physical disabilities typically are those that involve orthopedic, neuromuscular, cardiovascular, or pulmonary problems but may also include sensory conditions such as blindness or deafness. A disability is not an illness or disease but rather the consequence of illness, injury, congenital anomaly, or genetics.
Therefore, a physical problem such as a brain injury may result in a physical disability such as impaired ability to ambulate. Physical problems also may result in a mental disability. For example, the mental disability of dementia that is associated with Alzheimer's disease is a result of physical changes in the brain. Mental disabilities include psychological, behavioral, emotional, or cognitive impairments.
Six categories of physical and mental disabilities have been chosen for discussion in this chapter because they represent common conditions that the nurse is likely to encounter in practice:
(1) sensory disabilities
(2) learning disabilities
(3) developmental disabilities
(4) mental illness
(5) physical disabilities
(6) communication disorders.
The multiple specific disabilities (subcategories) that fall under each of these major categories are described as follows, along with the teaching strategies that should be used to meet the needs of learners.
What are Sensory Disabilities
Sensory disabilities include the spectrum of disorders that affect a person's ability to use one or more of the five senses auditory, visual, tactile, olfactory, and gustatory. The most common of these involve the ability to hear or see. Sensory disabilities can be complex, with multidimensional consequences that the nurse must address when in the role of educator.
Nurses should be prepared to attend to the physical and emotional issues that may be related to the sensory loss. For example, vision impairment in older adults is associated with subsequent depression (Qian, Glaser, Esterberg, & Acharya, 2012). Children with impaired hearing have been found to have an injury rate twice that of children without hearing impairments (Mann, Zhou, McKee, & McDermott, 2007).
Hearing Impairments Its Types and Nursing Education
Hearing impairment is a common disability that affects people of all ages who have either a total or partial auditory loss. It is estimated that approximately 30-48 million Americans have hearing loss in one or both cars (Lin, Niparko , & Ferrucci, 2011). Of every 1,000 children born in the United States, approximately two or three are diagnosed as deaf or hard of hearing (National Institute on Deafness and Other Communication Disorders (NIDCD], 2014). Nine out of every 10 children who are born deaf are born to parents who can hear (NIDCD, 2014).
The incidence of hearing loss increases with age. Approximately 18% of all American adults aged 45-64 years have a hearing impairment. This share increases to 47% by age 75, with men. being more likely to develop a hearing impairment than women (NIDCD, 2014). Adult-onset hearing loss is often associated with exposure to loud sounds or noises (CDC, 2017c).
Types of Hearing Loss
People with impaired hearing both the deaf and the hard of hearing-have a complete loss or a reduction in their sensitivity to sounds. Hearing loss is generally described according to three attributes: type of hearing loss, degree of hearing loss, and configuration of the hearing loss (American Speech Language-Hearing Association [ASHA), 2017b). The three basic types of hearing loss are as follows:
1. Conductive hearing loss: A type of hearing loss that is usually correctable and causes reduction in the ability to hear faint noises. Conductive hearing loss occurs when the ear loses its ability to conduct sound for example, when the ear is plugged with ear wax, a foreign body, a tumor, or fluid.
2. Sensorineural hearing loss: A type of hearing loss that is permanent and caused by damage to the cochlea or nerve pathways that transmit sound. Sensorineural hearing loss is sometimes referred to as nerve deafness.
It not only results in a reduction in sound level but also leads to difficulty: in hearing certain sounds. Although they do not “cure” the hearing impairment, cochlear implants and hearing aids can improve hearing in persons with this type of disability.
3. Mixed hearing loss: A type of hearing loss that is a combination of conductive and sensoryneural losses.
People with hearing loss may have a problem with one or both ears. The degree of hearing loss experienced by people with a hearing impairment is classified on a scale ranging from slight to profound. Although health professionals may use the scale to differentiate people who are classified as being deaf or hard of hearing, clients themselves do not always agree with this classification.
According to the National Association of the Deaf, how people label themselves is very personal and depends on many variables, including how closely the individual identifies with the Deaf community. Therefore, the nurse must determine if the patient with profound hearing loss prefers to be referred to as deaf or hard of hearing (National Association of the Deaf. 2010).
The use of people-first language is something controversial in the Deaf community. A recognized Deaf culture exists with a shared identity, language, and other cultural components (Clason, 2014; Johnson & McIntosh, 2009; McLaughlin, Brown, & Young, 2004). Because of this shared culture of which they are proud, many Deaf people want to be recognized as deaf because it reflects who they are as people.
Regarding the spelling of the term deaf, it is suggested that the word deaf with a lowercase D be used when referring to the physical condition of not being able to hear, and the word Deaf with an uppercase D be used when referring to people affiliated with the Deaf community or Deaf culture (Berke, 2017; Strong, 1996).
Communication is a primary concern for health professionals working with people who are deaf or hard of hearing. Regardless of the degree of hearing loss, any person with a hearing impairment faces communication barriers that interfere with efforts at patient teaching (Stock, 2002).
Hearing loss poses a very real communication problem because some individuals who are deaf or hearing impaired also may be unable to speak or have limited verbal abilities and vocabularies (Lederberg, Schick, & Spenser, 2012), This is especially true for adults who are prelingually deaf that is, they have been deaf since birth or early childhood. They and speakers of other languages share many of the same problems in learning English.
Problems with clients understanding health- and illness-related vocabulary also may be exacerbated with people who are deaf. Numerous research studies have found that although health education is critical for the deaf, they often are faced with significant barriers in accessing and understanding health information (Pollard & Barnett, 2009; Smith, Massey-Stokes, & Lieberth, 2012).
For example, a study about high levels of cardiovascular risk among Deaf adolescents found they encounter significant barriers in communicating about health information with parents and health education teachers (Smith, Kushalnagar , & Hauser, 2015). The study also found that even those with strong reading skills had difficulty understanding medical terminology commonly found on websites and in health information brochures.
Clearly, individuals who are deaf will have different skills and needs depending on the type of deafness and the amount of time they have been without a sense of hearing. Those who have been deaf since birth will not have the benefit of language acquisition. As a result, they may not possess understandable speech and may have limited reading and vocabulary skills.
Most likely, their primary modes of communication will be signing language and lipreading.In recent years, research has inspired new hope for children with severe hearing loss to develop language skills.
In 1984, the Food and Drug Administration (FDA) approved marketing of the first cochlear implant, a device that restores partial hearing by sending signals directly to the auditory nerve fibers, bypassing damaged hair cells in the inner ear (American Academy of Otolaryngology Head and Neck Surgery, 2015).
Cochlear implants are used with adults and children when hearing aids are in effective in restoring hearing in the presence of severe hearing loss (Food and Drug Administration, 2016). Research has shown that cochlear implants have a positive effect on language development when inserted in very young children (Ertmer, Young, & Nathani, 2007; Nicholas & Geers, 2007).
If deafness has occurred after language has been acquired, Deaf people may speak quite understandably and have facility with reading and writing and some lipreading abilities. If deafness has occurred in later life, often caused by the process of aging, affected individuals will probably have poor lipreading ability, but their reading and writing skills should be within average range, depending on their educational and experiential background.
If aging is the cause of hearing loss, visual impairments also may be a compounding factor. Because vision and hearing impairments are two common sensory losses in the older adult, these deficits pose major communication problems when teaching older clients,People with hearing impairments, like other individuals, require health care and health education information at various periods during their lives. B
ecause of the diversity within this population, assessment is a critical first step in patient education to determine the extent of the hearing loss and the use of hearing aids, cochlear implants, or other types of assistive equipment. Also, individuals with hearing loss often experience social isolation and feelings of inadequacy ( Fusick , 2008).
These feelings may contribute to a lack of confidence when faced with health challenges. Nurses should assess the patient's prior knowledge of the issue being addressed, recognizing that people who have hearing impairments may not have been exposed to the same kinds of health information as people who can hear (Pollard, Dean, O'Hearn, & Haynes, 2009 ).
Finally, it is important to remember that Deaf individuals will always rely on their other senses for information input, especially their sense of sight. For patient education to be effective, then, communication must be visible.
Because there are several different ways to communicate with a person who is deaf, one of the first things nurses need to do is ask patients to identify their communication preferences, sign language, written information, lip reading, and visual aids are some of the common choices .
Although one of the simplest ways to transfer information is through visible communication signals such as hand gestures and facial expressions, this method will not be adequate for any lengthy teaching sessions.
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