Challenges of Communicating with Deaf Patients

Consider yourself alone in a hospital bed, terrified of a new diagnosis. The doctor and nurse have just entered the room to speak with you, but you are unable to hear what they are saying. Regrettably, this is a common occurrence in the community of deaf and hard of hearing (HOH) patients. According to the literature assessment, contact with the HOH community is not just a national but also a global issue. The deaf/HOH culture, like most cultures, has pride and uniqueness that many people do not understand. Laws are in place to protect this culture; however, they are not routinely followed. Within the deaf and hard of hearing (HOH) patients. In the review of literature, communication with the HOH community is not only a country-wide problem but also a global one. Like most cultures, the deaf/HOH culture comes with pride and differences that are not understood by many. There are laws in place to protect this culture; however, they are not routinely followed. Within the deaf and hard of hearing community there is a vast variety of hearing abilities and therefore a variety of different ways in which they communicate. Nurses can improve communication with hearing impaired patients by being knowledgeable about deaf/HOH culture, the laws that protect this group and by understanding the many ways the hearing impaired communicate.

Ways of Improving Communication with Deaf Patients

One way nurses can improve communication with hearing impaired patients is to educate themselves on deaf/HOH culture (Scheier, 2009).

Scheier's article (2009) "Barriers to healthcare for people with hearing loss: A review of the literature" asserts that "healthcare professionals should educate themselves about ways to reduce barriers and to ensure access to health care for all people" (p. 9). The author supports this claim by stating "the articles in this review of the literature concurred that communication is the major barrier to health care for individuals with hearing loss" (p. 9). This article appears in the Journal of the New York State Nurses Association and is intended for nurses. The deaf/HOH culture is vastly different from the hearing community.

Shuler et al.article (2014) "More than signing: Communication with the deaf" argues that "healthcare professionals must increase their efforts to improve communication with patients who are deaf/HOH to make sure they receive quality patient care" (page 6). The authors support this claim by stating "poor communication between a patient who's deaf/HOH and a healthcare professional can have dangerous clinical consequences" (p. 5). This article appears in Nursing Management and the intended audience is for Nurses. If nurses and other healthcare professionals knew the laws to protect the deaf/HOH and followed them, at least some of the communication barrier could be broken down. The two main laws that protect the deaf/HOH are the Americans with Disabilities Act (ADA) and the Title VI of the Civil Rights Act of 1964. The ADA states that "all healthcare providers and facilities are mandated to provide reasonable communication accommodations" (Shuler et al., 2014). The interpreters that are involved must have formal interpreting education. Another way nurses can improve communication with hearing impaired patients is to be knowledgeable and follow the laws that protect the deaf and HOH (Scheier, 2009).

Literature Review

According to the article 'The Relation between Deaf Patients and the Doctor' written by Chaveiro, Porto & Barbosa in 2009, the relationship between health providers and patients with normal hearing levels is established through verbal contact. However, the mechanism is not used by deaf patients who result to sign language to communicate. The main problem is that sign languages are only available on five continents and are not universal. This leads to a challenge in communication as each one of them has its grammatical structure. The article also indicates that the means of communication used by the surrounding milieu is not a facilitating resource for the deaf patients to interact with healthcare providers. The mode of communication is an obstacle to the deaf patients and needs to be overcome to efficiently reach the social world (Chaveiro, Porto & Barbosa, 2009). The article also indicates that communication barriers between deaf patients and healthcare providers compromise the quality of assistance offered to the deaf population.

Another main challenge according to the article is that deaf patients lack trust in the listeners. This means that the healthcare provider can miss valuable information concerning the deaf patient because he or she is not comfortable when speaking with the nurse. The article also indicates that the deaf population believes that they are regarded as having low intelligence as compared to other patients with normal levels of hearing (Chaveiro, Porto & Barbosa, 2009). In most cases, the deaf patients are not willing to communicate without an interpreter as they feel intimidated by the care provider.

Moreover, the article indicates that most of the health professionals lack the basic communication skills for communicating with deaf patients. This leads to frustrations as the deaf patients develop feelings of hopelessness, while the health professionals become impatient with the patient (Chaveiro, Porto & Barbosa in 2009).The result of this is poor communication between the deaf patient and the health professionals which leads to misunderstandings.

Chaveiro, Porto & Barbosa (2009) also indicate that despite the fact that lip reading improves communication between deaf patients and health professionals; it is not responsible for understanding by itself. The reason for this is mainly in the fact that a deaf patient has to be always focused on the care provider. The changes in face position lead to loss of information resulting in problems in the patient-nurse relationship. Additionally, the symbolic function of mimicry which involves the use of gestures is not always understood by the deaf patient (Barnett et al., 2011).This is due to the fact that since the time it has been discovered, it has changed over the centuries which means that people interpret gestures differently based on their ways of thinking. This creates a significant communication problem between a deaf patient and health professionals.

According to another article 'Health Care Interaction with Deaf Culture' by Meador & Zazove (2005), deaf patients face different communication problems with physicians regardless of their levels of hearing loss. This leads to misunderstandings concerning their disease as well as treatment recommendations. The main communication challenge according to the article is that deaf patients may prefer a certain language as their means of communication with health care providers but their use of that language is mainly of low standards (Meador & Zazove, 2005).This results in communication problems as the patients can efficiently communicate with nurses.

The article also indicates that most of the deaf patients prefer the use of American Sign Language (ASL) but they normally have very low English reading levels. Moreover, ASL is different from English in many ways which include grammar as well as idioms. The authors cite an example of a physician who wrote to a deaf patient that he may require surgery. The deaf patient realized the statement that he needed surgery in May. This leads to the risk of patient-physician miscommunication which means that the care provider can miss critical information concerning the well being of the patient (Meador & Zazove, 2005).

Challenges for communicating with deaf patients result from the fact that there are not enough interpreters in hospitals and other healthcare institutions. This makes it impossible for deaf patients to communicate with physicians effectively (Meador & Zazove, 2005). Additionally, interpreters may have grammar and syntax different from that of the patient which means that there will be no effective communication between the patient and the professionals.

The authors also maintain that most of the deaf patients experience problems with frequent English words. For instance, some of them do not regognize words like allergic, nausea and even constipation. This means that most of them have poor healthcare information which includes not being in a position to understand current preventive medicine intervention. This results in numerous problems when physicians are communicating with deaf patients (Meador & Zazove, 2005). This communication barrier put deaf patients at risk in many ways which include the patient being unable to interpret written prescriptions.

In addition, in most of the clinical settings, the patient education handouts are unintelligible to the deaf patients who may not be in a position to understand different words. This creates communication problems as the handouts are not tailored to the linguistic needs of the deaf population (Barnett et al., 2011).This means that the deaf patients may lack adequate information related to their diseases which leads to misunderstandings between the patient and the health professional.

Another article 'Health care access among deaf people' by Kuenburg, Fellinger & Fellinger (2016) indicates that deaf patients experience severe communication problems when entering health services. This communication challenge according to the authors is as a result of fear, frustrations as well as mistrust in the side of the patients. This makes it difficult to exchange information between the patient and the physicians which hinder professional treatment for the deaf patients.

Over-protectiveness, lack of independent thoughts as well as a non-questioning attitude leads to communication problems hampering the access to different health care services. The miscommunication leads to misunderstandings when it comes to therapeutic as well as diagnostic aspects (Kuenburg, Fellinger & Fellinger, 2016).Another major challenge of communicating with deaf patients is the risk of marginalization. For example, most of the women with hearing impairment are embarrassed to put various questions in front of an interpreter. This is among the major barriers in accessing effective reproductive health care (Dickson & Magowan, 2014). Due to this communication barrier, deaf women lack information on matters like sex education, childbirth as well as contraception.

Additionally, the article indicates that another challenge of communicating with deaf patients is the lack of effective communication skills on the side of health care providers as well as lack of knowledge related to the deaf culture. Most of the physicians are not able to communicate with the deaf patients as they do not understand their oral language as well as their culture (Kuenburg, Fellinger & Fellinger, 2016).This means that the professionals are not well prepared to meet the needs of the deaf patient.

In conclusion, it is clear from the discussion that physicians and deaf patients face communication challenges which negatively affects the development of a bond that is required in health care which in turn affects treatment and diagnosis. It is, therefore, necessary to understand the specific features of the deaf culture as well as their identity to facilitate communication abilities as well as the relationship between the deaf patients and their physicians. The fundamental rights of the deaf population have to be assured through the provision of adequate training for health professionals to care for this population. Additionally, it is evident that being aware of the different issues concerning health care for the deaf population facilitates the interaction between physicians and patients. This is important as it reduces the discomfort within the clinical setting.

References

Barnett S. Klein J. D. Pollard R. Q , Jr. Samar V. Schlehofer D. Starr M., & Pearson T. A. 2011). Community participatory research with deaf sign language users to identify health inequities American Journal of Public Health, 101 , 2235 - 2238 . doi: 10.2105/AJPH.2011.300247

Chaveiro, N., Porto, C. C., & Barbosa, M. A. (2009). The relation between deaf patients and the doctor. Revista Brasileira de Otorrinolaringologia, 75(1), 147-150.

Dickson, M. & Magowan, R. (2014) Meeting deaf patients' communication needs. Nursing Times, 110(49), 12-15.

Kuenburg, A., Fellinger, P., & Fellinger, J. (2016). Health care access among deaf people. The Journal of Deaf Studies and Deaf Education, 21(1), 1-10.

Meador, H. E., & Zazove, P. (2005). Health care interactions with deaf culture. The Journal of the American Board of Family Practice, 18(3), 218-222.

Scheier, D. (2009). Barriers to health care for people with hearing loss: A review of the literature. Journal of the New York State Nurses Association, 2009, 40(1), 4-10.

Shuler, G.K, Mistler, L.A., Torrey, K. &Depukat, R. (2014). More than signing: Communication with the deaf. Nursing Management, 45(3), 20-27. Doi: 10.1097/01.NUMA.0000444299.04190.94.