Working with Patients

‘The greatest benefit for the largest number of Deaf patients is the routine provision of sign language interpreter support for all who desire it’ (Reeves and Kokoruwe 2005, 95)[1].

Effective communication is essential to quality health care. By using qualified Sign Language interpreters, health care professionals can provide the same standard of care to individuals who are deaf as to those who are not.

Irish Sign Language is the first and/or preferred language of around 5,000 Deaf people in Ireland.  

Some important things to remember when providing care to Deaf patients:

• ISL is a visual-gestural language, with its own grammar and principles. These differ from the grammatical structure of English
• You should not assume a Deaf person’s knowledge or fluency in ISL
• Many Deaf people use ISL as their primary means of communication, and therefore consider English to be their second language, meaning there may be some difficulty with English/written English
• Always use plain English where possible, using simple and concrete terms
• Visual aids can be useful

[1] https://www.researchgate.net/publication/232054448_Communication_and_Communication_Support_in_Primary_Care_A_Survey_of_Deaf_Patients

A Sign Language interpreter provides a vital and confidential service in facilitating effective communication between hearing and Deaf people.

Most ISL interpreters have been formally accredited or have attended an interpreter-training programme and are awaiting independent accreditation. A national register of accredited Sign Language interpreters has been established (Sign Language Interpreter Services (SLIS), www.slis.ie).

To become an accredited ISL interpreter, one must have a high standard of fluency in ISL (Level 4) and undergo stringent training via a recognised course, such as that provided by the Centre for Deaf Studies in Trinity College, Dublin (http://www.tcd.ie/slscs/cds).

Accredited interpreters are members of the professional interpreting bodies IASLI (Irish Association of Sign Language Interpreters) and/or ITIA (Irish Translators and Interpreters Association: http://translatorsassociation.ie) and are bound by their Code of Ethics.

The responsibility for the booking of, and payment for, the interpretation is usually borne by the service providers. This should be clarified when booking.

As there is a shortage of interpreters, especially outside the Dublin area, book as far in advance as possible to ensure availability.

Before booking a Sign Language interpreter, the following information should be available.

• Date, time and venue.
• The nature of the meeting/consultation, as sometimes two or more interpreters will be required to maintain efficient continuity.
• Duration and content: an interpreter will need regular breaks, as interpreting is a highly demanding task.
• As a general rule, an interpreter should never work alone if the assignment is more than two hours long; if this is the case, two interpreters should be booked.
• Interpreters may need to be made aware of the content of health-related consultations/meetings, especially if these are of a difficult/sensitive nature or there is unfamiliar or technical vocabulary. Providing information beforehand, papers or online resources will allow the interpreters to prepare properly and to familiarize themselves with the vocabulary being used. Any papers provided will be kept confidential and will be returned/destroyed as soon as the assignment ends.

• An interpreter can only interpret one speaker at a time.
• Speak directly to and look at the Deaf person when addressing them. Do not look towards the interpreter.
• The interpreter should be clearly seen by Deaf participants, therefore lights need to remain switched on and there should be no obstruction between the interpreter and the participants.
• Ideally, the interpreter should sit alongside the healthcare professional, so that the Deaf person can see both the interpreter, and the speaker easily.
• If it is a long consultation/meeting, take regular breaks (every 30 minutes), as the Deaf person and the interpreter will require an eye break.

Face-to-face interpreting is the method most appropriate for Deaf patients. There are a number of agencies that provide ISL interpreters in Ireland. A list of agencies providing ISL interpreters is available here.

The Irish Remote Interpreting Service (IRIS) uses a web-based programme to connect to a central Internet server where an interpreter acts on behalf of the practitioner and the Deaf person.

This is on-screen video interpretation over an internet connection.

The web-based programme does not replace face-to-face interpretation and should only be used for basic interactions, for example booking an appointment, checking times or details with the Deaf person.

If an appointment becomes more serious or requires more in-depth discussions, a face-to-face meeting should be booked if possible

A service provider or service user will need access to broadband, a microphone, speakers and a camera/video facility on their PC or laptop.

The IRIS service is available five days a week. The hours are 10.00am–4.00pm (lunch 1.00pm–2.00pm). Contact www.slis.ie

When dealing with a group of people who are Deaf or have significant hearing loss, there is a separate service that can be used—Live Speech to Text Transcription. Using this service means that while you are speaking a trained person is simultaneously typing, and your speech (even the ‘ums’ and ‘ahs’) appear on a screen for everyone to read. Afterwards everyone receives a printout. For Deaf people it is especially helpful when technical terms, medical terms, precise numbers or jargon are being employed or arrangements are being made, while for the hard of hearing it is great for general clarification.

The term ‘hard of hearing’ is generally used to denote a person with mild to moderate hearing loss. It is important to recognise, however, that the term can also be used to indicate a person with a more profound hearing loss who does not identify with the deaf community.

As hearing starts to deteriorate, high-frequency sounds, such as female or children’s voices, may become difficult to hear. It may also be harder to hear consonants such as ‘s’, ‘f’ and ‘th’. This can make understanding speech in background noise very difficult.

Hearing loss relates to a reduced level of hearing. It can vary in degrees of severity and can occur in all age groups, but age is the biggest cause. Most people begin to lose a small amount of their hearing from around 40 years of age. This hearing loss increases with age. By the age of 80, most people have significant hearing problems.

There are steps that can be taken to help mitigate the difficulties experienced by people who are deaf or have significant hearing loss:

Physical environment:

• A lack of awareness of the difficulties experienced by people who are Deaf or have SHL can result in some avoidable problems. For example, it is easy to miss being called for an appointment in a clinic or health care setting unless some visual aid is provided.
• Receptionists play a key role and need to be trained to be aware of how best to provide services for people with hearing loss and deaf people.
• Glass screens between visitors and staff e.g. in reception areas can cause difficulties.
• Include visual displays in waiting rooms and consultation rooms.
• Provide colour markings on floors as directional aids.
• Subtitles should be available for TVs used in health care settings.
• A Loop system, for amplification, can be installed (at low cost) in most auditoriums, lecture halls and other public buildings.
• Smoke and fire alarms in any public building (and in homes) need to have flashing lights and not just sound. This is particularly important in nursing homes, as many older people may take out a hearing aid at night.

Communicating with people who have significant hearing loss:

• Face the person to whom you are speaking.
• Attract the attention of the person before you speak.
• Speak a little slower but not too slowly.
• Speak a little louder but don’t shout.
• Make the subject of the conversation clear at the beginning.
• Be as succinct as possible
• Ensure that your face is clearly visible.
• Maintain good eye contact.
• Don’t cover your mouth with hands or pen.
• Reduce background noise where possible.
• A room with soft furnishings, such as carpets, curtains and cushions, is best. These absorb sound and reduce the echo effect.
• When engaged in conversation, the TV/radio should be switched off or you should move your conversation to another room.
• Close windows and doors if traffic intrudes.
• Make sure the lighting is good and that you are not sitting in front of a window, as light will get in the person’s eyes and they will be unable to read your face.
• Have a pen and paper to hand and write legibly.
• Make sure you speak slowly and clearly, and open and move your mouth adequately. Use gestures.
• If a person with SHL does not understand what you are saying, repeat/use different language—never say ‘Oh, it doesn’t matter’.
• Most hard-of-hearing (SHL) people do not sign, so an interpreter is not needed, but it is worth checking as you go along that people are following okay, and clarify as necessary—it is not always possible to distinguish many words when relying on lip-reading and it’s very easy to make mistakes.

The term ‘deafblindness’ tends to be thought of as a total inability to see and hear. In reality, however, the term covers a spectrum of combinations of varying degrees of vision and hearing loss—individuals with a total absence of vision and hearing at one end, and others who have retained residual vision or hearing, or some residual facility in both senses, at the other. When someone is deafblind they cannot compensate for the impairment in the other sense—these individuals cannot function as either a deaf person or a blind person.

There are many causes of deafblindness. It is estimated that 90% are affected by acquired deafblindness, while about 10% are congenitally deafblind. Those who are congenitally deafblind are generally vision- and hearing-impaired from birth or become so by the age of two, with limited opportunity to develop communication skills.

A common cause of deafblindness is a genetic condition called Usher Syndrome, which involves hearing impairment from birth with gradual sight loss from late childhood. Deafblindness can also be acquired through illness or accident. Older people are the largest group with acquired deafblindness[1].

There are approximately 1,700 deafblind people in Ireland. Deafblind Ireland is an organisation set up by deafblind people, their families and professionals working in this specialist field. It seeks to raise awareness of the disabling consequences of the combined loss of sight and hearing, and to provide a source of support for people who are deafblind and their families and information and guidance for professionals.

[1] Kathleen Deasy & Fiona Lyddy, ‘Challenges in the acquisition of language for congenitally deafblind’, The Irish Psychologist Vol. 30, 7 (2004), 150–4.)

When communicating with a person who is deafblind, there are some things to keep in mind:

• A white cane with a red band signifies that someone is deafblind.
• A person who is deafblind needs a specialised interpreter. This person works in tandem with the deafblind peer advocate to ensure that the person is understood and understands what is being said.
• A peer advocate is a person whose touch and communication style is known to the person who is deafblind and who can relay information to the healthcare worker.
• How to communicate with a person who is deafblind is an individual matter. The practitioner adjusts their strategy to the person’s need for support.
• The deafblind alphabet is a system to fingerspell words onto the hand of a person who is deafblind.

Contact Deafblind Ireland for further information and advice.

E: info@deafblindireland.ie    W: www.deafblindireland.ie