Helping a patient who's visually impaired

Caring for the Deaf, Hard-of-Hearing, Blind, and Low-Vision Patients in the Breast Center

Two heterogeneous populations with widely varying needs are being increasingly encountered in breast care facilities: blind or low vision patients and deaf or hard of hearing patients. The Americans with Disabilities Act and the Rehabilitation Act mandate that all governments, businesses, and not-for-profit organizations provide effective communication to those facing hearing, vision, or speech communication disabilities and that the provided communication is equally effective as that provided to those lacking communication disabilities. It is vitally important that breast center providers understand the requirements put forth by these acts in the provision of patient care, which includes interactions with the patient as well as their family members and partner. Breast center providers must identify each patient's individual needs and preferred method of communication. Options to assist in communication for the deaf or hard of hearing include the use of text conversations, preprinted or accessible video health care education material, and dedicated American Sign Language or video interpreters. Attention to breast imaging facility design, access to large print or braille documents, and the use of qualified readers can aid in improving access and communication for the blind or low-vision individual. All members of the breast health team, from scheduling staff to front office personnel, technologists, and breast imaging radiologists, should understand how to respectfully communicate with and identify the needs of patients facing these challenges.

Caring for Visually Impaired Patients in the Hospital: A Multidisciplinary Quality Improvement Project

BACKGROUND

People with low vision or blindness may experience anxiety, fear, and depression-sometimes severe-as a result of the challenges encountered when they seek medical care. Such patients deserve, and health care professionals must provide, equal opportunities to participate in and benefit from their health care in a safe environment. A search of the literature yielded information on the needs of visually impaired people but failed to find a comprehensive program that health care facilities could use to meet the needs of this vulnerable population. This gap in the literature on visually impaired patients (VIPs) and implications for their care led us to conduct focused meetings with this population.

OBJECTIVE

The specific aims of this quality improvement (QI) project were to determine the needs of hospitalized VIPs, develop educational and other resources that would help clinicians and ancillary hospital staff in their interactions with VIPs, and assemble a toolbox of useful materials for VIPs themselves.

METHODS

A VIP care team identified the needs of VIPs as reported in the literature and in personal meetings with visually impaired people in the community. The team also surveyed interdisciplinary hospital staff members to determine their experience in caring for VIPs as well as their educational needs, and then developed strategies and educational modules to help clinicians and ancillary staff members accommodate the unique needs of VIPs in accordance with the Americans with Disabilities Act of 1990. The team also assembled a VIP toolbox that contained several items useful to VIPs themselves. Supplementary information tailored to the function of each hospital department (such as nursing, admissions, environmental services, dietary, and radiology) was also provided to help staff members improve VIPs' hospital experience.

RESULTS

The hospital's interdisciplinary staff members participated in an education program to improve their care of VIPs. Before the program, only 23.6% of 161 staff members reported having received education on caring for VIPs. After the program, however, 56.4% of 140 staff members reported having received such education. Former patients requested bracelets and room identifiers that would alert staff members to VIPs' needs, and the team provided these. The team also introduced a braille version of the hospital menu and provided VIP toolboxes at each nursing station that contained many useful daily care items.

CONCLUSIONS

VIPs have specific needs when hospitalized. Patients' and staff members' responses to this QI project were overwhelmingly positive; both groups were appreciative of the newly implemented initiatives to meet the special needs of the visually impaired.

The consultative process used in outreach: a narrative account

AIM

The aim of this paper was to provide a narrative account of the communication skills used in an effective outreach consultation utilizing Neighbour's consultative model. Other consultation models were considered; however, because of their overly comprehensive approach or emphasis on behaviour modification, these were deemed inappropriate.

BACKGROUND

The nursing profession has endured significant changes of late and as a result is developing more autonomous roles in both the community and the acute health care settings. In the past, the term consultancy was used within the medical context; nowadays, there are advance nurse practitioners for whom consultancy is an integral part of their role. Although every nursing interaction is in essence a consultation, the fact that nurses are taking up on new advanced roles highlights the necessity for nurses to develop their consultation skills even further. Therefore, it makes sense to explore what aspects of that consultancy role needs special consideration in order to ensure that positive outcomes are achieved.

CONCLUSIONS

This paper has used a narrative account to uncover those salient skills needed to enhance the therapeutic relationship with a patient requiring the services of outreach. Furthermore, the application of a recognized consultation model was used to elucidate the underpinning knowledge of systematic history taking and assessment as well as demonstrating the communication skills and strategies needed to increase the patient's participation and empowerment throughout the consultation.

RELEVANCE TO CLINICAL PRACTICE

Effective communication skills encompassed in a consultative model are integral to the success in safeguarding the well-being of patients requiring advanced levels of care. Prejudging or pre-empting information being conveyed can be detrimental to patient safety and may prolong or complicate treatment plans.