Sensory Disabilities in Learner and Nursing Education Types of Disabilities
Disabilities are typically classified into two broad categories: mental and physical. Physical disabilities are often associated with orthopedic, neuromuscular, cardiovascular, or pulmonary issues, but can also include sensory disabilities like blindness or deafness. Importantly, a disability is not the same as an illness or disease but is a consequence of an illness, injury, congenital anomaly, or genetic condition.
For example, a brain injury might result in a physical disability such as impaired mobility. Additionally, physical problems may also lead to mental disabilities. An example is dementia, a mental disability associated with physical changes in the brain, as seen in Alzheimer’s disease. Mental disabilities encompass a range of psychological, behavioral, emotional, or cognitive impairments.
In nursing education, six primary categories of disabilities are commonly addressed due to their prevalence in healthcare settings:
- Sensory disabilities
- Learning disabilities
- Developmental disabilities
- Mental illness
- Physical disabilities
- Communication disorders
Each of these categories includes numerous specific subcategories, each with its own set of challenges and teaching strategies that nurses must understand to meet the unique needs of learners effectively.
What Are Sensory Disabilities?
Sensory disabilities refer to impairments that affect a person’s ability to use one or more of their five senses: auditory (hearing), visual (sight), tactile (touch), olfactory (smell), and gustatory (taste). The most common sensory disabilities are related to hearing and vision. These impairments can be complex and often have far-reaching consequences that the nurse must address in both physical and emotional contexts.
For example, vision impairments, particularly in older adults, can be associated with mental health challenges such as depression (Qian, Glaser, Esterberg, & Acharya, 2012). Similarly, children with hearing impairments have been found to have an injury rate twice that of children without such impairments (Mann, Zhou, McKee, & McDermott, 2007). Nurses, acting as educators, must be prepared to address both the physical limitations and emotional needs that arise from sensory disabilities.
Hearing Impairments: Types and Nursing Education
Hearing impairments are one of the most prevalent sensory disabilities and affect individuals across all age groups. These impairments range from partial to total loss of hearing and can be classified in different ways depending on the degree and type of hearing loss. According to estimates, between 30 to 48 million Americans experience hearing loss in one or both ears (Lin, Niparko, & Ferrucci, 2011). Additionally, around two to three of every 1,000 children born in the United States are diagnosed as deaf or hard of hearing (National Institute on Deafness and Other Communication Disorders, 2014).
Hearing loss is more common with age, affecting approximately 18% of adults between the ages of 45-64, and this figure rises to 47% in adults aged 75 and older. Hearing impairment tends to affect men more than women (NIDCD, 2014). In older adults, hearing loss is often associated with prolonged exposure to loud noises (CDC, 2017).
Types of Hearing Loss
Hearing loss can be categorized into three main types, each of which presents different challenges for both the individual and the nurse educator:
- Conductive Hearing Loss: This type of hearing loss occurs when sound waves are not properly conducted through the outer or middle ear, often due to blockages or malfunctions like earwax build-up, fluid, foreign objects, or tumors. Conductive hearing loss is typically correctable and results in difficulty hearing faint sounds.
- Sensorineural Hearing Loss: Often referred to as nerve deafness, sensorineural hearing loss is caused by damage to the cochlea or auditory nerve pathways. This type of hearing loss is permanent and affects both the loudness and clarity of sounds. While hearing aids or cochlear implants can help improve hearing, they do not cure the condition.
- Mixed Hearing Loss: This type of hearing loss is a combination of both conductive and sensorineural impairments, involving both sound transmission and nerve damage issues.
Hearing loss can affect one or both ears and is classified along a continuum from slight to profound. Importantly, individuals with hearing impairments may self-identify differently. The National Association of the Deaf emphasizes that labeling someone as “deaf” or “hard of hearing” is a deeply personal decision influenced by factors like connection to the Deaf community. For nurses, it is crucial to understand and respect the patient’s preference.
The Deaf Community and Communication
Within the Deaf community, there is a recognized culture that includes a shared language (American Sign Language), identity, and traditions. For many, being “Deaf” is a source of pride and an essential part of who they are. Because of this, many individuals prefer to be referred to as “Deaf” with an uppercase ‘D’ to indicate affiliation with the Deaf community, rather than just being deaf as a medical condition (Berke, 2017; Strong, 1996).
Effective communication is one of the most significant challenges nurses face when working with individuals who are deaf or hard of hearing. Regardless of the degree of hearing loss, communication barriers can interfere with patient education and care delivery (Stock, 2002). For individuals who are prelingually deaf (deaf since birth or early childhood), there may also be additional challenges, such as limited verbal skills or difficulty learning English.
Studies have shown that individuals who are deaf or hard of hearing often face significant barriers to accessing health information. Pollard and Barnett (2009) highlighted the critical need for accessible health education, while Smith, Kushalnagar, and Hauser (2015) found that Deaf adolescents face communication challenges when trying to understand cardiovascular risk factors. Even individuals with strong reading skills often struggle with medical terminology, highlighting the need for clear, accessible communication from healthcare providers.
Nursing Education Strategies for Hearing Impairments
As nurses, it is essential to assess each patient’s hearing capabilities and communication preferences. This involves understanding the degree of hearing loss and whether the patient uses hearing aids, cochlear implants, or other assistive technologies. Recognizing the potential for social isolation and low confidence due to hearing loss, nurses should approach patient education with sensitivity and a focus on inclusion (Fusick, 2008).
Deaf individuals often rely on other senses, particularly sight, to receive information. Therefore, visual communication methods—such as sign language, written information, lip reading, and visual aids—are essential for effective education. Nurses should ask patients about their preferred communication method and ensure that teaching sessions are adapted accordingly. While simple hand gestures and facial expressions can be useful, more complex teaching requires visual aids and clear written instructions.
For patients with profound hearing loss or those in the Deaf community, healthcare education must be designed with cultural competence in mind. Nurses should be aware of the cultural significance of Deaf identity and work to ensure that communication methods are accessible and respectful.
Cochlear Implants and Technological Advances
In recent years, technological advancements such as cochlear implants have provided new hope for individuals with severe hearing impairments. Approved by the FDA in 1984, cochlear implants restore partial hearing by bypassing damaged hair cells in the inner ear and sending signals directly to the auditory nerve (American Academy of Otolaryngology-Head and Neck Surgery, 2015). These implants are often used when traditional hearing aids are ineffective.
Research has shown that cochlear implants, when provided to children at a young age, can have a positive impact on language development (Ertmer, Young, & Nathani, 2007). However, individuals who receive cochlear implants later in life, or those who experience hearing loss as a result of aging, may have different educational and support needs.
Nursing Considerations for Older Adults with Hearing Impairments
Hearing impairments in older adults often occur alongside other sensory disabilities, such as vision loss, making communication particularly challenging. These combined impairments necessitate a tailored approach to patient education, where both hearing and sight are accommodated. Nurses should assess the extent of the hearing loss, whether hearing aids or other assistive devices are being used, and whether visual impairments further complicate communication.
For older adults, feelings of social isolation and frustration are common as hearing impairments can lead to difficulties in participating in conversations and accessing health information. Nurses should provide patient education that is both visually accessible and supportive of the emotional challenges that often accompany hearing loss in later life.
Conclusion
Sensory disabilities, particularly hearing impairments, present unique challenges in nursing education. Nurses must be equipped to assess each patient’s specific needs and preferences, respecting their identity and communication style. Whether through assistive technologies, such as cochlear implants, or adaptive teaching strategies that utilize visual communication, nurses play a critical role in ensuring that patients with hearing impairments receive the care and education they need to maintain their health and independence. With a focus on inclusion, cultural sensitivity, and accessible communication, nurses can bridge the gap for individuals with hearing disabilities in the healthcare setting.