7 Communications with Clients of Differing Abilities

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Introduction

This chapter will provide how to communicate with clients who have differing limitations or needs effectively. As you can see from Devante’s story, many people can develop changes in their abilities through trauma, disease, age or can be born with the differing ability. While this chapter will explore general communication principles with persons with diverse needs, it will cover verbal, vision, and hearing impairments; this is not to suggest these are the only limitations requiring clear communication exchanges or interactions.

Assessing What You Already Know

Governing Principles for Communicating with Clients with Limitations

An impairment may be new or temporary, such as an injury, surgery or drug impairment. When the impairment is new, try different methods to address the clients’ needs. For example, if the person requires assistance in communication, treat them as you would any other person requiring assistance. The first principle is to ask the client how to best communicate with them. Then listen to their response. The client is the expert on their needs and what works for them. Do not insist that your way is the correct way; they have lived with their limitations daily (Harrington, 2020).

If a person asks for assistance, clarify how to help and what to do. For example, do they want you to take their arm? Ensure that you speak clearly and wait for responses and cues as to how they wish to proceed. Do not touch anything without asking first. For example, service animals or wheelchairs. A person’s assistive device (e.g. wheelchair, cane, walker) is considered a part of their personal space. Acknowledge the presence of an interpreter, attendant, or companion, but remember to address the person with a disability directly.

Communications with Clients with Verbal Impairments

There are a variety of reasons that a client may be non-verbal so one should never assume the reason. Whether their verbal impairment is permanent or temporary, exploring alternate modes to communicate effectively with the client is essential. Once again, ask the client how to proceed. For example, they may be verbally impaired, but their hearing may be intact and they can provide you with an answer it just might be in a different format than you are expecting.

If the client is presenting to the health care setting alone, do not assume they speak another language or cannot hear. Use hand motions or actions to attempt to decipher the clients’ needs. Nodding and pointing may assist with the initial assessment. The use of signage in different languages may assist with determining if the client is not verbalizing due to a language barrier. However, if a support person accompanies the client, speak and face the client and if the support person intervenes, acknowledge their presence; however, continue to speak and face the client.

The verbal impairment may be new or temporary, such as a facial injury, dental surgery, drug impairment or trauma. When the impairment is new, try different methods to address the clients’ needs (Harrington, 2020). These communication modes may include writing if the client understands and can read English. Consider pointing to, or having the client point to pictures or maps to engage in the Interaction Model of Communication. If the client has had the verbal impairment longer term, they may have a preferred way of managing communication; please ask them how to best communicate with you.

Communications with Clients with Visual Impairments

Visual impairments reduce one’s ability to see clearly. Very few people are completely blind. The majority have some vision. Some have tunnel vision and can only see straight ahead. Others have no central vision but can see around the edges. People with cataracts often have an unclear vision and see things through a ‘foggy window’.

How to Recognizing a Visual Impairment

A person with a visual impairment may wear dark glasses, use a white cane, have a guide dog, be accompanied by someone who will act as a guide. They may exhibit squinting, read at close range, or they move to get close to people. They may also be asking someone to read a sign or document out loud.

How to Enhance Communication with Clients with Visual Impairments

You may ask if the person would like assistance and ask how you can help them and listen for their instructions. As the person has problems with visualization, address the person by name and identify yourself and your role. Speak directly to the person in a normal tone of voice. When the HCA provides verbal directions, be precise and clear.

It is important to inform the person if and when you are leaving the area, as they can not see if you have left the room. The HCA could explain to the client how they could be contacted, i.e. call bell, the position of the phone and extension. The HCA should verbally tell the person when you are giving them materials or returning their health or hospital card or any other documents across a counter or table.

When in a health care setting, orient the patient to their surroundings, such as the furniture, closets, call bell, washroom, curtains, the shape of the room, roommate. It is an excellent time to assess the area to identify any potential hazards (furniture, equipment) in the person’s travel path (Harrington, 2020).

Communication with Clients with Hearing Impairments

There are several different types of hearing loss, including hard-of-hearing, deafened, and oral deaf (unable to speak or hear). The awareness and knowledge of the hearing loss type are essential in communication, particularly ensuring messages are received, acknowledged, and understood.

Media 7.1. Canada VRS – Don’t hang up! [Video]. From SRV Canada VRS/ASL, 2018.

How to Enhance Communications with Clients with Hearing Impairments

People who are hearing impaired may require assistive devices or utilize an American Sign Language (ASL) interpreter when communicating. Most people who are hard-of-hearing can understand some speech with or without hearing aids. The client may choose to write their messages. They often also read lips to assist with communication (Naseribooriabadi, 2017).

Although clients may have a preferred manner to communicate the HCA can try some of the following suggestions for clear communication. Attract the person’s attention before speaking. The best way is a gentle touch on the shoulder or gently waving your hand. And look at and speak directly to the person. Make sure you are in a well-lit area where your patient can see your face. Avoid standing in front of a window as this will create a shadow on the face.

The HCA should be aware to keep hands and other objects away from their face so the person can see you and your lips. If wearing a mask and if possible for you to remove it, please do so before giving instructions. Alternatively, utilize masks with a clear, transparent window.

When able, use illustrations, drawings or critical words/phrases to explain information. Often, lip reading is easier when you know the subject.

The HCA should always use professional, qualified sign language interpreters; again, American Sign Language is the most common.

Technological devices such as cochlear implants or external hearing aids assist the client with sound. If the person uses a hearing aid, try to speak in an area with few competing sounds. Keep the person’s hearing aids handy when removing them. If you remove a person’s hearing aids, make sure they are placed in a secure location. A personal hearing aid or cochlear implant battery should be the last thing removed or turned off before surgery (or other procedure) and the first thing made available in recovery.

When trying to call into a client’s room, do not use the intercom. Make a personal visit to the client’s room. Alternatively, if communicating via video meeting, use captioning on video screens for health teaching tools (Kumar, 2017).

Check Your Understanding

Alternative Text Option

Summary

In this chapter you have:

• Communicated clearly as part of a team while providing exemplary customer service to clients with differing limitations or needs.
• Explored strategies to support communication channels with clients of differing abilities.
• Developed an understanding of addressing persons with communication limitations such as verbal, visual, or hearing impairment.
• Demonstrated empathy and understanding of differing needs

Key Terms

Barrier: Something that could be mental or physical that prevents you from progressing.

Cochlear implants: Electronic prostheses are used to aid in hearing. Has an external microphone and one or more electrodes placed into the cochlea. (Merriam-Webster, n.d.)

Decipher: Interpret or decode a message sent to the receiver. (Merriam-Webste, n.d.)

Device: Equipment that serves a specific function. (Merriam-Webster, n.d.)

Expert: Someone who has obtained mastery or experience through education or life experience.

Gentle touch: Used to console a person, placing one hand softly onto another’s shoulder.

Hazards: Are potential risks of danger. (Merriam-Webster, n.d.)

Impairment: Regression or loss of mobility. (Merriam-Webster, n.d.)

Interaction Model of Communication: Process in which participants alternate roles of sender and receiver and incorporate feedback.

Limitations: Due to varying impeding factors one person may not be able to do the same things as someone else.

Methods: Process or steps taken to achieve an objective. (Merriam-Webster, n.d.)

Squinting: Straining one’s eyes in order to try and see something clearly.

Temporary: For short periods of time. (Merriam-Webster, n.d.)

References

Canadian Radio-television and Telecommunications Commission. (2021, September 15). Video relay service (VRS). Government of Canada. https://crtc.gc.ca/eng/phone/acces/rela.htm

Harrington, C. N., Koon, L. M., & Rogers, W. A. (2020). Design of health information and communication technologies for older adults. In A. Sethumadhavan & F. Sasangohar (Eds.), Design for Health: Applications for Human Factors (pp. 341-363). Academic Press. https://doi.org/10.1016/C2018-0-00043-2

Kumar, N. (2017, May). Sign language recognition for hearing impaired people based on hands symbols classification. In 2017 International Conference on Computing, Communication and Automation (ICCCA) (pp. 244-249). IEEE. https://doi.org/10.1109/CCAA.2017.8229808

Naseribooriabadi, T., Sadoughi, F., & Sheikhtaheri, A. (2017). Barriers and facilitators of health literacy among D/deaf individuals: A review article. Iranian Journal of Public Health, 46(11): 1465-1474. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5696685/

SRV Canada VRS/ASL. (2018, September 19). Canada VRS-Don’t hang up! [Video]. YouTube. https://www.youtube.com/watch?v=gcP23Y5q89c

Check your Understanding (Text-based Activity)

Question 1

When a person requires assistance in communication, the first principle is:

1.  Ask the client how to best communicate with them.
2. Assume all hearing impaired persons use American Sign Language.
3.  All persons requiring assistance will give you a memo for communications.

Solution. The correct response is option one. When a person requires assistance in communication the first principle is to ask the client how to best communicate with them. The client knows what techniques assist with their ability to understand others. The health care professional will adapt their communication to mee the needs of the client. Return to Activity