Speaking Disability In Nursing Education What Is Sign Language in Nursing Education?

For many individuals who are deaf, American Sign Language (ASL) serves as their primary language and preferred mode of communication. In families with children who are deaf, ASL is often used in the home and becomes the first language children learn. For those raised within Deaf culture, ASL remains the dominant form of social communication, while English is learned as a second language. Children whose primary language is ASL can struggle with achieving fluency in written English, although research indicates that a high level of ASL proficiency may be linked to better English literacy skills (Vicars, 2003).

ASL is distinct from finger spelling, a technique that uses hand positions to represent letters of the alphabet. Instead, ASL is a fully developed language comprising signs, finger spelling, facial expressions, body movements, eye gaze, and head shifts to convey meaning (NIDCD, 2017). The complexity of ASL means that simply translating word-for-word from English to ASL can result in misunderstandings, so it is vital that patient education sessions account for this.

When communicating with a patient who uses ASL, nurses who are not proficient in ASL should ideally seek the services of a professional interpreter. Family members or friends may assist with translation, but using a certified interpreter is often preferable, especially when dealing with medical terminology that could be misinterpreted or when discussing sensitive health matters (Scheier, 2009). Federal law mandates that health facilities receiving federal funds provide professional interpreters upon request under Section 504 of the Rehabilitation Act of 1973.

During teaching sessions with Deaf patients, nurses should position themselves near the interpreter, maintain eye contact with the patient, and speak directly to the patient, allowing the interpreter to relay the message. To ensure comprehension, nurses should use the “teach-back” method or ask the patient to demonstrate understanding.

What Is Lip Reading in Nursing Education?

Lip reading involves interpreting speech by observing mouth movements, facial expressions, and body language (Feld & Sommers, 2009). A common misconception is that all people who are deaf can lip-read proficiently. In fact, only about 30-45% of words can be accurately interpreted through lip reading alone, and even skilled lip readers must rely on additional cues like facial expressions and context. Moreover, lip reading can be mentally exhausting over time (Callis, 2016).

For nurses, it is essential to avoid assuming that patients can rely on lip reading. When working with patients who lip-read, certain practices should be followed to facilitate communication:

1. Speak normally without exaggerating lip movements, as this can distort the message.
2. Ensure clear vision by making sure the patient is wearing glasses if needed, and providing adequate lighting without shadows.
3. Minimize distractions by eliminating background noise and avoiding objects like gum or pens that could obstruct lip reading.

Lip reading may not be appropriate for extended teaching sessions, so nurses should supplement it with written materials or visual aids.

Written Materials and Speaking Disabilities in Nursing Education

Written materials are often the most reliable method of communication for patients with speaking or hearing disabilities, especially in critical health situations. Nurses should always provide written instructions as a supplement to spoken communication.

When creating written materials for Deaf patients, it is important to use clear, simple language. Although literacy among Deaf individuals has improved, many still face challenges with reading comprehension, particularly when it comes to complex or technical medical terms (Easterbrook & Beal Alvarez, 2012). The use of clear, direct language helps prevent misinterpretation. For example, instead of writing “When running a fever, take two aspirin,” a more straightforward message would be “If your temperature reaches 100.5°F or higher, take two aspirin.”

Visual aids, diagrams, and models can further enhance understanding and should be used alongside written instructions whenever possible.

Verbalization by the Client in Nursing Education

Some clients with speaking disabilities, particularly those who are deaf, may still choose to communicate verbally. Deaf individuals who have developed speech skills may have distinct speech patterns due to their inability to hear their own voice, which may result in different tones, pitches, or inflections. Nurses should allow time to get accustomed to the patient’s voice and ensure they provide a quiet and private environment for effective communication.

If the patient’s speech is difficult to understand, it can help to repeat back what was heard or ask the patient to write down key points to ensure accurate comprehension.

Sound Augmentation in Nursing Education

For patients with partial hearing loss, hearing aids are valuable tools to enhance communication. Nurses should ensure that patients have their hearing aids available and that they are functioning properly. Hearing aids should be turned on, fitted correctly, and have working batteries. If a patient does not have a hearing aid, nurses can seek the patient’s permission to refer them to an audiologist for an assessment.

In situations where hearing aids are not used or are ineffective, sound augmentation techniques like cupping one’s hands around the patient’s ear or using a stethoscope in reverse can help amplify sound (Babcock & Miller, 1994). Nurses should also consider the patient’s preferred ear and ensure they are speaking slowly, clearly, and at a pace that allows the patient to process the information without distortion.

Telecommunications in Nursing Education

Telecommunication devices can be powerful tools for improving the communication and education of patients with speaking disabilities. Examples include:

1. Television decoders for closed-captioned programming.
2. Captioned telephones, which display conversations as text on a screen.
3. Alerting devices that visually or vibrationally signal sounds like a ringing doorbell, phone, or crying baby.

Text telephones (TTY) and telecommunication devices for the deaf (TDD) allow written communication between two parties, often facilitated by a relay operator. These devices ensure that patients with speaking or hearing disabilities can engage in remote communication and access health information.

Federal law requires healthcare providers to offer reasonable accommodations such as these devices to patients with disabilities. However, nurses should be mindful that some health education videos or resources made for hearing audiences may lose important meaning when translated into text without the inflection or emphasis of spoken words.

Responsibilities of Nursing Educators

Nursing educators have a critical role in ensuring that communication with patients who have speaking or hearing disabilities is effective. The following best practices can help educators facilitate clear and compassionate communication:

1. Use natural, unexaggerated speech and maintain a moderate pace, pausing for questions.
2. Ensure visual clarity by facing the patient directly and avoiding obstructions or bright lights that could interfere with lip reading or visual cues.
3. Reduce environmental noise by turning off televisions, closing doors, and eliminating distractions.
4. Incorporate visual aids such as diagrams, models, and written materials to support verbal communication.
5. Confirm comprehension through methods like teach-back, where patients demonstrate understanding by explaining the information in their own words.

Nurse educators must avoid behaviors that could hinder communication, such as turning away from the patient while speaking, standing in poor lighting, or using jargon and slang that could confuse the patient. Additionally, nurses should not assume that a patient will understand simply because they nod or smile; it is crucial to validate understanding in a respectful and non-threatening way.

By making necessary accommodations and seeking to understand each patient’s preferred communication methods, nurses can ensure that health education is accessible and effective for patients with speaking disabilities.