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

Knowing the Deaf Community's Rights

Although members of the Deaf community reject the notion of a disability or the label disabled, they receive their legal protection under the ADA. According to the ADA, health care providers are responsible for ensuring that their deaf patients are given reasonable accommodation. The law's objective is to ensure that all patients can access available health services (Phillips, 1996). Health care professionals should ask their deaf patients, in advance of the health care visit, about their perception of need and preference for these accommodations. It is then the provider's responsibility to make these accommodations, such as providing a qualified sign language interpreter or comparable alternative services. It is also the provider's responsibility to arrange and pay for the interpretive services, should these be required. However, even in those instances when the provider deems that an interpreter is not required to provide reasonable accommodation, the patient's expressed preference for an interpreter should take precedence. For example, while the provider may anticipate a routine blood pressure screening, the patient may anticipate the visit as an opportunity to ask about a health concern that previously was not addressed adequately. Follow ing provisions of the ADA will aid in more successful communication between members of the Deaf and health care communities and also may contribute to better health outcomes for deaf patients, reducing the risk of legal consequences secondary to ineffective communication (Barnett, 1999; Cole, 1990; Meador & Zazove, 2005).

Despite the ADA, many hospital staff members fail to provide interpreters for their deaf patients due largely to costs, inconveniences, or ignorance of their legal obligation (Barnett, 1999; Iezzoni et al., 2004; Steinberg et al., 2006). The authors' discussions with participants in a variety of health care competency training programs in their respective institutions re vealed that only a small minority of them knew the use of a professional ASL interpreter (or a reasonable alternative) was required by law. For example, the hospital in which one of the training sessions took place had defined policies and procedures regarding language interpretation services, but the trainees did not know the policies existed and/or did not know how to access them (Deyo Stohlmann, personal communication, August 24, 2006). In actuality, both the patient and the provider require professional interpretive services for effective and safe communication (Stein berg et al., 2006).

The ADA's provisions of a reasonable alternate accommodation should not be misinterpreted to mean that the health care provider can tell the deaf patient to bring along a member of the family or friend as an interpreter. This practice would not comply with the intent of the law (National Association of the Deaf, n.d.). The law recognizes that while family members or friends may be able to communicate with a deaf loved one and deaf patients often ask them to do so, the health care provider must remember that family members would be unlikely to possess the breadth of signing skills needed to convey complex medical concepts that might need to be explained. Even if they are skilled enough in sign language to communicate the complex medical information, family members and friends may be too emotionally or personally involved to interpret effectively, accurately, and impartially. Using family members and friends as interpreters can cause problems in maintaining patient confidentiality (56 Fed. Reg. at 35553). Further, professional medically experienced ASL interpretation provides simultaneous ("on-the-fly") speech-to-sign interpretation, a qualification few untrained family members or friends will have (McAleer, 2006). Even more importantly, few family members or friends possess the professional training that enables the interpreter to communicate impartially and without interpreting the content or the context being conveyed between patient and provider (Steinberg, Wiggins, Barmada, & Sullivan, 2002).

Family members or friends also may alter the patient's remarks unintentionally, or they may give biased information to protect the patient from dispiriting information (Barnett, 2002a; Ebert & Heckerling, 1995; Stein berg et al., 2006). Finally, family members' or friends' action as interpreters can lead to a loss of privacy for the deaf patient and may result in the patient's reluctance to convey vital information of a personal or sensitive nature (Ebert & Heckerling, 1995; Stein berg et al., 2006). Thus, the nurse should not depend on untrained interpreters to act as liaisons (McAleer, 2006).

Along with the ADA mandates, the Joint Commission on Accre ditation of Healthcare Organi zations (JCAHO) maintains that culturally and linguistically appropriate health care services are not only fundamental to individual care but also are important quality and safety issues (JCAHO, 2006). JCAHO standards indicate that care, treatment, and services are provided in a manner appropriate to the cultural, language, literacy, and learning requirements of the individual patient. In accordance with standards RI.2.100, RI.2.30., and RI.2.20, patients have the right to be involved in their care and have appropriate communication, which includes professional interpreters and translation services (JCAHO, 2006).

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