SENSORY DEFICITS

Hearing Impairments

People with impaired hearing—both the deaf and the hard of hearing—have a complete loss or a reduction in their sensitivity to sounds. Strong (1996) explains that “[the word] ‘deaf ’with a lowercase ‘d’ is used to refer to the physical condition of hearing loss, whereas‘ Deaf’, with an uppercase ‘D’ is used to refer to special collectives and attitudes arising out of interaction among people with hearing losses.

Hearing impairmentHearing impairment is a term used to describe any is a term used to describe any type of hearing loss, the etiology of which may be type of hearing loss, the etiology of which may be related to either related to either conductiveconductive or or sensorineuralsensorineural problems problems resulting from congenital defect, trauma, or disease.resulting from congenital defect, trauma, or disease.

For those who are deaf, “being a recipient of health For those who are deaf, “being a recipient of health care services is similar to being in a foreign country care services is similar to being in a foreign country without fluency in the native language” (Harrison.without fluency in the native language” (Harrison.

Hearing lossHearing loss poses a very real communication poses a very real communication problem because deaf and hearing-impaired problem because deaf and hearing-impaired individuals may also be unable to speak or have individuals may also be unable to speak or have limited verbal abilities and often have poor limited verbal abilities and often have poor vocabularies.vocabularies.

Prelingually deaf –adult who have been deaf since early childhood.

In many families with deaf children, American Sign Language (ASL) is used in the home and is the children’s first language.

Nurse as educator will encounter many differences among people who are deaf, there is one common denominator they will always rely on their other senses for information input, especially their sense of sight.

Different ways to communicate with a deaf person one of the first things you need to do is ask your client to identify communication preferences .Sign language, written information, lipreading, and visual aids are some of the common choices.

If aging is the cause of hearing loss, visual impairments may also be a compounding factor.

Vision and hearing are two common sensory losses in the older adult.

Sign Language

One of the simplest ways to transfer information is through visible communication signals such as hand gestures and facial expressions; however, this method will not be adequate for any lengthy teaching sessions.

For most deaf people whose native language is ASL, sign language is often the preferred mode of communication.

Registry of Interpreters of the Deaf (RID)-This registry can provide an up-to-date list of qualified sign language interpreters.

Lipreading

Lipreading- one common misconception among hearing persons is that all people who are deaf can read lips. This assumption is potentially dangerous (DiPietro, 1979). Only about 40% of English sounds are visible on the lips.

If lipreading is preferred, you must be sure to provide sufficient lighting on your face and remove all barriers from around your face such as gum, pencils, hands, and surgical masks.

Beards, mustaches, and protruding teeth also present a challenge to the lip-reader. supplement this form of communication with signing or written materials

Written Materials Written information is probably the most reliable way to

communicate, especially when understanding is critical. Written communication is the safest approach, even

though it is time-consuming and sometimes stressful. When putting information in writing for your client who

is deaf, keep the message as simple as possible. Visual aids such as simple pictures, drawings, diagrams,

models, and the like are also very useful media as a supplement to increase understanding of written materials.

A tactile alphabet is a system for writing material that

the blind can read by touch.

Verbalization by the Client

Sometimes clients who are deaf will choose to communicate through speaking.

Often the tone and inflection of the patient’s voice will be different than normal speech, so you must give yourself time for listening carefully. Listen without interruptions until you become accustomed to the person’s particular voice intonations and speech rhythms.

If you still have trouble understanding what try writing down what you hear, which may help you to get the gist of the message.

Sound Augmentation

For those patients who have a hearing loss but are not completely deaf, hearing aids are often a useful device.

Another means by which sounds can be augmented is by cupping your hands around the client’s ear or using a stethoscope in reverse; that is, the patient puts the stethoscope in his or her ears, and you talk into the bell of the instrument.

Be sure to slow your speech, provide adequate time for the patient to process your message and to respond, and avoid shouting.

A hearing aid is an electroacoustic device which typically fits in or behind the wearer's ear, and is designed to amplify

and modulate sound for the wearer

Telecommunications

Telecommunication devices for the deaf (TDD) are an important resource for patient education.

Television decoders for closed-caption programs are an important tool for further enhancing communication.

Caption films for patient education are also available free of charge through Modern Talking Pictures and Services. Under federal law, these devices are considered to be “reasonable accommodations” for deaf and hearing-impaired persons.

A Telecommunications Device for the Deaf (TDD) is a teleprinter, an electronic device for text communication over a telephone line, that is designed for use by persons

with hearing or speech difficulties

The following guidelines suggested by (Navarro and Lacour) should be applied when using any of modes of communication

Don’t be rigid and stiff or attempt to over articulate your speech. Use simple sentences. Be sure to get the person’s attention by a light touch on the arm

before you start to talk. Face the patient and stand no more than six feet from the patient. Be considerate and refrain from talking and walking at the same

time. Bobbing your head excessively. Talking with your mouth full, while chewing gum, etc. Turning your face away from the deaf person while. Standing directly in front of a bright light. Placing an IV in the hand the patient will need for sign language

•Visual Impairments

Visual Impairments

In the United States, a person is determined to be legally blind if vision is 20/200 or less in the better eye with correction or if visual field limits in both eyes are within 20 degrees diameter.

People lose their vision and may be rendered legally blind for a variety of reasons infections, accidents, poisoning, or congenital degeneration such as retinitis pigmentosa.

blindness in AIDS patients as a result of infection has been associated with the end stages of this disease.

The four leading eye diseases associated with the aging process are macular degeneration, cataracts, glaucoma, and diabetic retinopathy

Severe visual impairment after correction with glasses is defined- as the inability to read newspaper print.

Age-related macular degeneration (AMD) is a medical condition which usually affects older adults and results in a loss of vision in the center of the visual field (the macula) because of damage to the retina. It occurs in "dry"

and wet" forms. .

A cataract is a clouding of the lens inside the eye which leads to a decrease in vision. It is the most common cause of blindness

and is conventionally treated with surgery.

Glaucoma- is an eye disease in which the optic nerve is damaged in a characteristic pattern. It is normally associated with

increased fluid pressure in the eye (aqueous humour)

Diabetic retinopathy-is retinopathy (damage to the retina) caused by complications of diabetes, which can eventually lead to blindness. It is an ocular manifestation of diabetes, a systemic disease.

Tips which is helpful in caring for a blind or visually impaired patient:

Secure the services of a low-vision specialist, who can prescribe optical devices such as a magnifying lens, a telescope, a closed-circuit TV, or a pair of sun shields, any of which will enable you to adapt your teaching material to meet the needs of your particular client.

• Persons who have long-standing blindness have learned to develop a heightened acuity of their other senses of hearing, taste, touch, and smell.

When explaining procedures, be as descriptive as possible.

Because blind persons are unable to see shapes, sizes, and the placement of objects, tactile learning is an important technique to use when teaching.

When using printed or handwritten materials, enlarging the print (font size) or handwriting is typically an important first step for those who have diminished sight.

Color is a key factor in whether a visually impaired person can distinguish objects.

Proper lighting is of utmost importance in assisting the legally blind person to read the printed word.

Providing contrast is a very helpful technique. Providing a template (writing guide) for signing their

name or writing checks and addressing envelopes is a way to encourage independence.

Large-print watches and clocks with either black or white

Audiotapes and cassette recorders are very useful tools.

The computer is a popular and useful tool for this population of learners. Although they are costly, some computers have synthetic speech as well as Braille keyboards.

Most blind associations either have a Braille library or can direct you to appropriate resources for information written in Braille.

If you are assisting the person who is blind to ambulate, always use the “sighted guide” technique; that is, allow the person to grasp your forearm while you walk about one-half step ahead of them.

Braille Technology is capable of revolutionizing the lives of thousands of people because it allows them to engage in the virtual world that can not be perceived through their eyes. Braille technology allows blind or visually impaired people to do common tasks such as writing, browsing the Internet, typing in Braille and printing in text, engaging in chat, downloading files, music, using electronic mail, burning music, and reading documents. It also allows blind or visually impaired students to complete all assignments in school as the rest of sighted classmates and allows them take courses online.

Diabetic retinopathy is a major cause of blindness. Adaptive Diabetes Education for Visually Impaired

Persons (ADEVIP) provides consistent practice guidelines for the care of diabetics who are visually handicapped.