Communication Strategies for Nurses Interacting With Patients Who Are Deaf

Christine Chong-hee Lieu, BA; Georgia Robins Sadler, PhD, MBA, BSN; Judith T. Fullerton, PhD, CNM, FACNM; Paulette Deyo Stohlmann, MSN, RN, OCN

Disclosures

Dermatology Nursing. 2007;19(6):541-544; 549-55. 

In This Article

Abstract and Introduction

Nurses play a pivotal role in promoting access to culturally competent health care services for those who experience linguistic and cultural barriers. Nursing strategies to facilitate and enhance the Deaf community's access to health care services are provided.

An estimated 28 million Americans are deaf and hard-of-hearing (Lucas, Schiller, & Benson, 2004). Within this population, hearing impairment varies from those whose hearing loss predated their acquisition of speech (pre-lingually deafened) to those whose hearing loss followed the acquisition of speech (post-lingually deafened). The focus of this article is on members of the Deaf community who rely upon American Sign Language (ASL) and who self-identify as members of the Deaf community. This community also is characterized by diverse types and levels of language proficiency, varying among ASL, lip reading, and English. For instance, some deaf persons may be fluent in ASL, know little or no English, and scarcely lip read, while others may know little ASL, but be proficient lip readers. Similarly, varying levels of oral communication skills exist within the community. As a result of this variability, health care providers face particular challenges to become culturally and linguistically competent practitioners.

The nursing scope of practice encompasses patient advocacy, education, and the promotion of health (American Nurses Association [ANA], 2001; Hyland, 2002). The patient's participation in health care decisions is a legal right, as well as a source of accurate assessment and treatment information (ANA, 2001; Pozgar, 2004). Additionally, deaf patients have specific rights authorized under the Americans with Disabilities Act (ADA) (DuBow, 2000; U.S. Department of Justice, 2003). As the patient's first point of contact with the health care system, the nurse can impact both the delivery of health care and the patient's perceptions about that care.

Unfortunately, the ability to use ASL or telecommunication equipment (TTY) and services for the deaf is not prevalent among health care providers (Barnett, 2002a). They recognize the value of second-language proficiency but few acquire ASL skills as that second language. In fact, until recently, ASL did not qualify to fulfill foreign language requirements in most academic institutions. The Edu cation Reform and Funding Act (H.B. 1017) of 2004 endorsed ASL as a foreign language and stated that the language may be offered to fulfill any requirements associated with foreign language acquisition (Na tional Council of State Super visors for Languages, 2004). The absence of ASL skills has made it difficult for providers to become familiar with Deaf culture, including preferred styles of communication. This leads to awkward, abbreviated, and often aborted communication by one or both parties. Deaf people frequently abandon efforts to try to explain themselves to their health care providers and are less likely to press their providers for additional information (Jeffrey & Austen, 2005; Sadler et al., 2001; Steinberg, Barnett, Meador, Wiggins, & Zazove, 2006). Health care for the Deaf community may be improved if providers have a fundamental, current knowledge of the sociocultural and linguistic aspects of deafness; barriers to care for the Deaf community are removed; and appropriate resources and services for deaf patients are improved (Tamaskar et al., 2000).

Transcultural nursing theory, including Leininger's theory of culture care diversity and universality, is relevant particularly to care of patients who are deaf or hard of hearing (Gustafson, 2005; Leinin ger & McFarland, 2002). Focusing on the processes with which nursing care is provided, transcultural theory includes within its definition of cultural competence the individual attitudes, skills, and practices that frame the ways in which communication is patterned between nurses and their patients. These processes need to be examined specifically and adapted (Hartrick Doane & Varcoe, 2005) to ensure that the particular needs of individual deaf patients are respected, in accord with their self-perceptions of identity and their membership in the Deaf community (McLeod & Bently, 1996; Stebnicki & Coeling, 1999). The purpose of this article is to explain the culture of the Deaf community, identify barriers to communication and health care, and discuss the transcultural competence nurses must attain to provide optimal care for individuals who are deaf.

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