Dealing With The Deaf Patient in The Sleep Center
Best practices for dealing with the deaf patient in the sleep center
Throughout your time working as a sleep technologist you will run into many different types of patients, each with their own special needs. Sometimes those needs are challenging; but with a little direction and a few tips you can successfully navigate any issue and provide quality patient care for all of your patients.
One type of special need you may see in the sleep center is a patient who is either deaf or so significantly hard of hearing they are classified as deaf. Your ability to communicate effectively with these patients is vitally important; as the sleep technologist caring for the deaf patient you need to be able to explain what they should expect during their sleep study and what you will need them to do to assure they receivean excellent study and appropriate care.
First and foremost, did you know that by law you are required to provide an interpreter for a deaf patient? It is not the patient’s responsibility to bring someone along to interpret. Even if they do bring a family member or friend, unless the patient refuses in writing, a professional interpreter must be available, either in person or via technological means.
Having family in the sleep center with the patient has the potential to be either a boon or a bane with every patient. It is great when family is there to provide support and help the patient to remember things afterwards, or even to ask for some additional clarification when the patient may be hesitant to ask. However, when a patient has special needs such as deafness, you need a professional who can sign the complicated words and medical terminology that we use and assure that the patient understands. There is also always the delicate issue of asking the patient questions that the family may not wish to ask, or the patient may not wish to answer, due to embarrassment. Privacy is always a concern, and is a key reason that we have laws that require that we offer an interpreter.
I have had the good fortune to be able to work frequently with an actual on-site interpreter. This is always preferable but is not always practical. The alternative is a video remote interpreter (VRI) but there are many technical issues your information technology (IT) department will have to resolve before you plan to use one. They are also a bit bulky and when you are hooking a patient up, frequently in a small space where you are moving around and blocking the patient’s view of the device, it is not nearly as convenient or quick as a human being who can also move around and keep within the patient’s view. I have found that working with an on-site interpreter caused little disruption and involved nearly no extra time for setting the patient up. However, using a VRI as an interpreter requires significantly more time for hook up, so be sure to plan for the additional time needed when using this technology.
A VRI is a viable alternative for remote areas where you may not have available an onsite interpreter. They do provide real time interpretation. However, it is important that you take into account that the screen needs to be large enough for the patient to see well and consider placement of the device carefully; it must be located where the patient can see it at all times. The screen needs to be large enough and of sufficient quality to clearly display the interpreter’s face, arms, hands and fingers. You will also need to make sure that there is no lag or delay in the communication, which requires adequate bandwidth. The sound microphone needs to be of high quality as well so that the interpreter can hear what you, the caregiver, are saying.
So as mentioned previously, your IT department will have to make sure that your system is set up properly and meets all the standards for such a device. Staff using this device will also need training in order to quickly and properly set up and use the device.
Again, it is of utmost importance that the patient can see it all times; and that requires remembering not to block the patient’s view or place the equipment where they have to constantly turn to be able to see the device. This may mean you having to move the device periodically to keep it in the patient’s view and adjust how you do your hook up as well, to not block that view. Hence the reason more time should be set aside if you are going to use this device.
You may be wondering if you are going to need that interpreter for the entire night. I have not generally found that to be necessary. Normally, after the patient has been hooked up, we have completed bio-calibrations, and the patient is ready to sleep the interpreter can be sent home to return in the morning for the unhook process and to provide follow-up instructions.
During the night pen and paper will usually be sufficient communication tools. Make sure you have completed any and all desensitization, fitting, and explaining of the mask and positive airway pressure (PAP) devices well before the patient goes to bed and while your interpreter is still present in case you need to perform a split- night study.
The patient should be comfortable with a communication plan prior to the interpreter leaving; I never allow the interpreter to leave if the patient feels uncomfortable and thinks they may need them during the night. To date I have not had any patient that felt they needed someone there while they slept when they knew the interpreter would be back first thing in the morning, shortly before they would be awakened. Pen and paper has always been sufficient for the middle of the night run to the bathroom or other communication needs during the night.
There are a few protocols that should be observed when you are working with an interpreter. First and foremost, talk to the patient! It is our natural instinct to look at the person talking, however when you are dealing with an interpreter you must always look at the patient and talk to the patient, not the interpreter. Just as when you are working with any other patient, you want to make sure you maintain eye contact with your patient while you are working, talking, and demonstrating. Do not talk to the patient with your head down or turned away and do not mumble.
Here are some helpful tips for patient hook up. There are times during the hook up that you will need to move around behind the patient. Make sure you tell the patient what you are going to do and make sure that the interpreter is keeping up and informing the patient of what you will be doing. With a deaf patient it is more important than ever to let them know what you are going to be doing before you move out of their sight. I have developed a system that works well for me. I explain what I will be doing, and that I will tap their shoulder before proceeding to the next step. For example, I tell the patient about the electroencephalogram (EEG) placement and show him the leads while standing in front of him, and explain that before each lead placement I will be tapping his shoulder. This way, though I was behind him, the interpreter in front of him could sign that I was going to put another electrode on the scalp. I tap the patient’s shoulder before actually placing each lead. I have found that using this method my patients quickly begin to relax and to trust me. The extra moment taken to tap the patient’s shoulder before I start touching his head is well worth the effort in assuring patient comfort.
Keep in mind when working with the deaf patient that there is no need to speak loudly, or exaggerate your mouth or lip movements. For those that read lips, you will only make it more difficult for them to understand you, not less so. It is also important to make sure that the room is well lit so that the patient is able to clearly see the interpreter and what is going on around them.
An important thing to discuss with your patient while an interpreter is available is how they wish to be approached if you need to enter their room during the study. It is vital that you talk about this. Whereas with another patient you might slip into a room and fix something quietly without waking the patient and simply slip back out, that is not going to happen with a deaf patient. The deaf patient is much more attuned to their surroundings with their other senses. Sneaking into the room of a deaf patient is likely to be a frightening experience. My patients have all stated that if I would simply tap or jostle the foot of the bed and briefly wake them that would be satisfactory.
Trust me if you have discussed this with the patient ahead of time, they are going to relax and go to sleep easier as they will trust that you are aware of and sensitive to this need. I also tell the patient that if I need to fix something during the night that once I woke them I would give them a thumbs down to indicate something was not working correctly and then point on myself to what area I needed to access to correct the issue. For example a thumbs down and then pointing to my own left leg would let them know that was the lead I needed to fix. I also always offer a night light for the patient; and I have found that most patients prefer that it is left on for them. Keep a pen and paper near the patient and handy if communication during the night if necessary.
It is important to assure that the patient knows how to contact the technologist during the night. I inform my patient that at any point if they need me they should call out or simply clap their hands. When I have more than one patient I make a point of letting the deaf patient know that if I do not respond immediately I may be in the other patient’s room. The patient is instructed to wait a moment and then repeat the process. In addition, I instruct that if they need to go to the bathroom it is a good idea to sit up. Then, when I come out of the other patient’s room and see they are sitting on the side of the bed I would immediately know to come in and get them up to the bathroom. I explain this will reduce the wait time and the need for them to call out again or clap. Remember, the deaf patient is not able to hear you say “just a moment” over an intercom, so it is vital that you explain and work out how delays on your entering the room will be handled.
Every person having a sleep study feels vulnerable. The patient who has a hearing loss feels even more vulnerable. It is your job to make sure you do everything you can to make the deaf patient as comfortable as possible, and alleviate any fears they may have before lights out. Communicating with the deaf is much easier than you may think with the application of just a bit of forethought.