After our meeting with John from DeafBlind Scotland and reading two studies about patient experience (Deafblind Scotland Report in Health Service to Deafblind people in Scotland) and (Report on NHS BSL/English interpreting provision within health settings in Scotland – https://www.bda.org.uk/wp-content/uploads/2017/03/NHS_interpreter_Website.pdf), I think it’s important to note what we can take from these to help patients with sensory impairements as medical students and as doctors in the future. I also want to talk more generally about what I’ve learned from the project as a whole and how it will help us in the future. I will be using Gibb’s Reflective Cycle to help me.
What have we been doing?
From what we’ve heard, the healthcare service provided by the NHS, opticians, pharmacies and dentists is varied for the sensory impaired population. Whilst some are providing a great accessible service, others could definitely improve theirs. There were stories from patients about not realising that their doctor had gone away, that the doctor talked more to the interpreter than to them and lack of understanding of the medications they were taking. There was also a lack of consideration of other conditions that patients might have, with under diagnosis of raised blood pressure, and under treatment of hypertension, diabetes, hyperlipidaemia and cardiovascular disease in the hearing impaired population (https://bjgp.org/content/65/631/95.full). There was also a lack of awareness of healthcare staff in hospitals of how to communicate with sensory impaired patients which often resulted in lack of meal choices or patients knocking over drinks as they did not realise it had been put in front of them!
More generally, this project has involved a lot of self-motivated learning, as we have been progressing through online BSL videos in Level 1 and Level 2 courses. 2 people have also taught sign language each week specifically about History-Taking which has required preparation and research. We have needed to schedule our own meetings amongst tutorials and lectures and book rooms for these. We have also emailed lots of different charities and contacts around Scotland to seek help or patient opinions for our project.
What are my feelings?
I was really quite shocked when I first heard these stories from John and I read more in the studies. I felt that patients were really not receiving the best healthcare they could and this made me upset because they were quite simple things going wrong. However looking at it from healthcare staff’s perspective I could quite easily see how this could happen, if the staff had not had awareness training. I realised that I could quite easily have done the same thing!
In terms of the project as a whole, I have remained excited about it throughout because I could see the value that this might bring us and our colleagues if we managed to raise awareness. Nevertheless, I have been a bit worried that we have taken on many different things (learning BSL level1 and Level 2, teaching medical sign language, talking to patients, analysing questionnaires sent to patients, making a blog and making resources to help raise awareness and teach sign language to other medical students). However, as we are reaching the end of the project, I think that between us all, the workload has been split up and been quite manageable. I am very happy with all that we have achieved so far.
What’s been good and bad about the experience and how does it apply to the future?
I think that it’s been great to get such an insight into patients’ experiences who have sensory impairments because it is quite hard to understand which parts of the service are working well or could be improved otherwise. I think as a general point, we have gained much more expertise in communicating effectively with all patients, not just those with sensory impairments, as the advised methods make communication with everyone much easier: for example looking directly at patients not at computer screens, talking clearly, telling the patient what topic the conversation is moving onto e.g. “We’re now going to talk about your operation”, telling the patient what will be happening to them that day, or saying goodbye to them and checking they have any concerns. It’s given me an insight into how much progress there still is to be made however, as even though we now have the technology and the tools to make communication easier, for example hearing loops, these are not often switched on or known how to be used.
As for the sign language we have learnt, I am glad we have learned it but I am unsure exactly how much we will remember as we have not probably practiced it enough to build a sure foundation. I am happy that we have learned the most relevant parts of the sign language course to us and how we want to use it in the future as doctors.
In terms of the other skills I have learned, I am very happy with the way we have worked as a team and organised our learning. I can see this will be really important in the future for studying for exams and also for organising anything involving teams and assigning work to others in the group. After this project, I feel that I would be quite happy organising a group to raise awareness of any issue, and know how to conduct our preliminary research, interviews, resource making etc.
Action plan and how we would change the project in the future:
As a group we would like to make a poster to put up to raise awareness of sensory impairments and simple actions healthcare students and staff can take to make patients’ experience better.
We would also like to contact the medical school to see if deafblind awareness training could be given to our year, and possibly other years if it is successful.
Once we learn all the topics of sign language that we have assigned to ourselves, we will hope to make videos to cover the medical history-taking aspect so that other medical students may benefit and as we go onto wards we can rewatch them to help us to remember. However, if we were to do this project again, I would hope to find an experienced signer that might help us practice more and correct us if we are wrong with how we are signing as this was an element that was lacking for me.
In terms of improving communication from healthcare staff perspective for patients who are deaf and/or blind, these are the key points:
- Telling the patient that you are there, who you are, what will be happening to them and that you have to leave now.
- Making sure the room is set up with lighting shining onto your face, there is enough light in the room or corridor where they are walking
- Make sure you always face the patient and that there is nothing obstructing your mouth e.g. computer screen
- Make sure you speak clearly, but do not shout (as it makes you look angry and alters your lip patterns)
- You should always talk to the patient themselves (not to the interpreter)
- Should never get a family member to interpret (for confidentiality reasons)
- Even if you have limited knowledge, finger spelling or tactile spelling goes a long way in basic communications.
- Make sure if a hearing loop is available, that you use it
- Signpost during the conversation e.g. “We’re now going to talk about your operation.” as this helps patients who are lip reading or signing to know the context.
- If patients do not understand, repeat what you said or say it in a different way – ( NEVER say “It doesn’t matter.” )
- Be aware that online interpreting e.g. Sign Live are a good alternative if no interpreters are available
- Don’t forget to give patients information about their general health e.g.:
- Cholesterol
- Healthy eating
- Mental health
- Depression
- Information on getting more help to give family a short term break
- Transport
- Diabetes
- When patients are booking appointments, make sure you book:
- A double appointment with them (double the appointment time)
- A guide/communicator and check that they have the appropriate skills e.g. Hands On Signing or Deafblind Manual for deafblind patients
- Let people know that they have placed food or drink in front of them and describe what is on it and where it is
- Use as much basic sign language to communicate with patients until specific communicator arrives
- Give patients consent forms, or information leaflets in braille, moon, large print text etc.
- Refer patients to accessible complaints procedure (not just phone options or online in case they have no laptop)
- Care about their autonomy eg ask inpatients what they want to have for lunch (not just presume and choose for them)
- Ask if patients need help on getting out of the hospital
- Make sure that patients’ notes state their sensory impairment to make staff aware of their needs
- Use other alternatives in the waiting room to alert patients that you are ready to see them
- e.g. vibration alert systems, ticket systems or visual information boards
Sign Of The Times 