Deaf/HOH Community

llg, PhD, RN · Sep 13, 2009

As a person with a hearing impairment, I just wanted to point out that not all deaf people are fluent in sign language! Not all deaf people are Deaf. And not all deaf/Deaf people want strangers (or interpreters who might be within their circle of acquaintences) to know their private business. The first rule of communicating with people who have special communication needs is to use what works best for the patient -- even if that is NOT the method that is the most convenient and cheapest for the hospital.

You seem to think that your patient who refused the interpreter was being unreasonable -- and seem to resent that he required a form of communication that was inconvenient for you. I find that offensive and unprofessional. We all need to learn about the needs of our patients before we conclude that they are being unreasonable. Maybe he had good reasons for not wanting a sign language interpreter -- like, maybe he was not fluent in sign. Did you ask him to explain why he didn't want an interpreter? If you did, what explanation did he give?

I'm sorry if I sound harsh -- but your OP suggests that you "blame" the patient for being unreasonable when if fact, he may have had very good reasons for not wanting an interpreter. One of the problems deaf/Deaf/HOH people have is that people "blame" us for our handicap. Those same people would never blame a blind person or a person in a wheel chair like that. Ours is an "invisible" handicap that gets little sympathy or understanding. We are considered "unreasonable" or "a nusiance" more than anything else.

It's really quite complicated. Start by asking the patient what works best for HIM. Then provide that.

lisa41rn · Sep 13, 2009

After reading your reply I reread my inital post. "My patient" was someone I spent little time with so having to write my interaction down on paper wasn't a big deal for me specifically. For the floor nurses it was. He preferred ASL and was not open to video communication which was offered. He then signed a form saying he was refusing this offer and was quite demanding no matter how much the staff tried to help him.

When I was young I was found to be nearly deaf in both ears, but regained some of my hearing. Articles I read that some hospitals treated deaf and HOH patients who did not fully understand their treatment plan was upsetting to me. I chose this topic to better help the deaf community and frankly am sorry I did. The lack of trust seems to be common in this community from what I've found and from numerous articles I've read. When I've made it 100% clear that I am doing this to help the situation and not offend them, it has broken some ice, but trust takes time to build.

I went to hospital staff to seek their opinions and yes some have said they believe some of these people come off as being deserving of services they may need and try to get anything and everything they want. If a hosptial, for example offers a video interpreter and they want a live interpreter that is unfair. The world needs to be flexible. We all have a disability of some sort, some more obvious than others, so for you to be so insulted seems unclear to me. I have a disability and when people comment about my disability that could offend me, but I am intelligent enough to know that some people with the same disability are easy going while others are quite difficult. If you believe what you have written than take this opportunity to teach others, not dump on them!! I believe in helping others learn!

llg, PhD, RN · Sep 14, 2009

I WAS trying to help you learn. Your OP left out a lot of important information and suggested a lot of negativity towards the deaf/Deaf/HOH community. I think that if you want to help the relationship between the deaf/Deaf/HOH communities (note that they are very different communities), you should learn to talk about them in ways that don't sound so negative.

As I no longer work in a direct patient care role, I can't answer most of your questions, but maybe some current staff nurses will respond to those.

lisa41rn · Sep 14, 2009

I guess when I mentioned in the beginning I was hoping to help the deaf community, that would have meant something. If I mentioned all the details, the OP would have been quite long. I tend to take someone's statement and give them the benefit of the doubt. Thanks for your thoughts anyway!

NeoNurseTX, RN · Sep 21, 2009

Questionnaire for Health Care Workers

1. How often do you work with deaf or HOH patients? I actually never have

2. Do you dread having to work with the deaf/HOH community? No, I was once fluent in sign language so I retained quite a bit of that.

3. How much harder/easier is your job relating to this community? N/A

4. Is it required you obtain an interpreter for these patients? I don't think it's required but I would because I don't know a lot of medical signs.

5. Who pays the fee for an interpreter? The patient or the healthcare facility? Us

6. What is your view of this community? Quite fond of it

7. Do you believe this community is flexible in accepting whatever communication interpreter you obtain? I don't see why not if they actually know sign language and also if the interpreter uses the form of sign language that they're familiar with.

8. If your facility has equipment for this community, where is it kept? Don't know

9. What is the procedure if a deaf patient is being treated? My patients are infants so N/A. Parents could be Deaf though.

10. If you are unsure how to proceed in the care of a deaf/HOH patient, where can you go for assistance? Charge nurse

lisa41rn · Sep 21, 2009

Thanks NeoNurse; much appreciated!

marjibme · Sep 26, 2009

while i am still a student (first semester actually) i have worked for several years as a disability advocate & ltc ombudsman. i have several friends & clients who are either hoh, deaf or deaf, and have presented workshops and in services on the subject of caring for the deaf or hard-of-hearing patient, so i felt i was at least semi-qualified to answer your questions.

i will say that i have noticed a certain level of mistrust of health care professionals among the deaf community, based in a large part on cultural myths (both founded and unfounded). to be fair, i have encountered a great deal of misconceptions about the deaf community in the health care world as well.

in regard to the deaf community - simply put, the best way to truly combat stereotypes is to not fit into them - and the first step in that is to identify what they are. in regard to the hoh/deaf patients we encounter, with the aging population, this is going to become more and more common, so it's essential we educate ourselves on communication strategies now so we're not scrambling to figure out what to do then. so, let me applaud you for choosing this subject and seeking to educate yourself and others in an effort to improve care for this particular group of people:yeah:

questionnaire for health care workers

1. how often do you work with deaf or hoh patients?

on a weekly, if not daily, basis

2. do you dread having to work with the deaf/hoh community?

not at all. i am conversant in asl (not an interpretor though) and have researched ways to effectively communicate with the hoh or deaf patient who does not know sign language, so i'm actually fairly comfortable.

3. how much harder/easier is your job relating to this community?

i won't lie. communication can be time consuming with those who aren't conversant in asl and time is a precious commodity for anyone who works in health care. however, i'm enough of a bleeding heart/idealist to think that a big part of my job is to relate, regardless of the community or effort required.

4. is it required you obtain an interpreter for these patients?

yes, if the patient uses asl as their primary language, according to the ada, it is. the interpreter must also be licensed, so it is illegal to use family members or friends - or your coworkers who know sign language - to serve in that capacity.

5. who pays the fee for an interpreter? the patient or the healthcare facility?

again, the law requires that the health care provider/facility cover the fee.

6. what is your view of this community?

well, there is only one part of the people being discussed that actually qualify as a "community" - the big d deaf - and even then, there are those who are easy to get along with and those that are more difficult, just as there are in any other group.

7. do you believe this community is flexible in accepting whatever communication interpreter you obtain?

i know some that are way too flexible and wind up having no idea what is happening to them or why. i know others that are going to have it their way (i want this interpreter and no one else!!) or there'll be hell to pay.

8. if your facility has equipment for this community, where is it kept?

i know that one of our local hospitals does have adaptive equipment - but i'm not sure where it is stored.

9. what is the procedure if a deaf patient is being treated?

in theory, in an emergency situation, an interpreter is contacted immediately and communication is accomplished through other means only until the interpreter arrives. if an appointment has been made, the interpreter is contacted beforehand and present when the appointment begins.

in practice - not so much. i've seen notes, gestures or worse - just doing the work without any communication because they had "other patients that needed taken care of too."

10. if you are unsure how to proceed in the care of a deaf/hoh patient, where can you go for assistance?

in most hospitals, the charge nurse should know what the procedure is, as well as have a list of available interpreters. you can also be proactive and find out about policies beforehand, as well research for yourself to discover effective communication strategies so that when the time comes, you do know how to proceed.

flightnurse2b, LPN · Sep 26, 2009

my answers are in red.

good luck on your paper. :)

questionnaire for health care workers
1. how often do you work with deaf or hoh patients? not very often. i think i have had maybe two in my entire nursing career assigned to me, but have interpreted for many more on the floors.
2. do you dread having to work with the deaf/hoh community? not at all. i am fluent in asl.
3. how much harder/easier is your job relating to this community? it doesn't make too much of a difference to me, i am usually assigned these patients because my charges know i am able to sign. i enjoyed working with the deaf in high school and continue to enjoy being able to communicate with them.
4. is it required you obtain an interpreter for these patients? we have the option, yes, but if a staff nurse or cna is fluent in any language (asl included) we are an acceptable interpreter.
5. who pays the fee for an interpreter? the patient or the healthcare facility? the facility. we have a video communication system that is available should we need it.
6. what is your view of this community? not much different then the rest of us. :)
7. do you believe this community is flexible in accepting whatever communication interpreter you obtain? sure! they usually are very grateful that we can accomodate them, and many times if there is a family member present they will stay to make the communication easier.
8. if your facility has equipment for this community, where is it kept? in the director's office.
9. what is the procedure if a deaf patient is being treated? treated for....?
10. if you are unsure how to proceed in the care of a deaf/hoh patient, where can you go for assistance? we have a liason that we can reach that also can help us use the video communication equipment if we need her... but as far as treatment as patient, they are treated the same as any patient... just because they're hoh or deaf doesn't make them unable to make their own choices in care... never have had any questions regarding that.

lisa41rn · Sep 26, 2009

Thanks for all your responses. I really do appreciate it. I have about four more weeks to go before turning in my final paper and your thoughts have been very helpful. What I find so disturbing is that these patients are often assumed to be not-as-intelligent because of their disability. This is so unfair and it obviously isn't fair to assume anything of ANY patient before you fullly assess them. I do believe they often distrust the medical staff, but also believe they may have reason to distrust some of us. Oh well, hopefully a few people will get something out of reading this finished paper. Thanks again!