School Nurses Advocate, Educate & Nurture Confidence for the Future
Timothy Vander Ploeg, RN, RN-BC, BSN
- ADA – focus on “effective communication” for deaf & hard of hearing (HoH) people.
- In-person American Sign Language (ASL) interpreters are the most appropriate interpreters for school aged deaf children.
- Hospitals often have policies and procedures for deaf adult patients that are not effective with deaf children.
- Not all hospital staff know the use of a professional ASL interpreter (or reasonable alternative) is required by law (ADA).
- Ineffective communication can lead to diagnosis and treatment errors.
- Educate hospitals, students and families.
- Ensure that students get effective communication during their hospital visits.
- Nurture students’ confidence when going to the doctor.
- Encourage full participation in healthcare for students that continues into adulthood.
In-Person Interpreter vs. VRI
- Uses local signs that students will understand.
- Can use whole body to communicate and see patient’s whole body to understand and utilize nuanced communication.
- Trained for medical interpreting & can manipulate models and draw pictures to explain medical concepts.
- Are more appropriate for children.
Video Remote Interpreting (VRI)
- Acceptable in an emergency if no in-person interpreter available yet.
- Can bridge the time from when arrived to when an in-person interpreter is available.
- If an in-person interpreter gives a smaller hospital/clinic an “undue fiscal burden”, VRI may be appropriate.
- If hospital hangs up on VRI and calls back later the student may not get the same interpreter (loss of continuity of care).
Reasons to Nurture Positive Medical Experience
- Everyone needs to be comfortable going to MD with health concerns.
- Lifelong ownership & participation in healthcare is important to good health.
- To give confidence that their MD is giving them proper care.
- If they are confident, they can share confidence and knowledge with others.
Being an Advocate
- Educate students & families of legal rights to effective communication.
- Family members are not obligated to interpret for children, and, even worse, the child may be uncomfortable sharing sensitive information & skew the information given to the doctor.
- Encourage students & families to request an in-person interpreter when setting up appointments.
- Contact Hospitals to see what they will do if you need to send a child to the ED (e.g. call ahead so they can get an in-person interpreter or prepare VRI).
- Find out who needs to be contacted at the medical facility to get the best interpretive services.
- Follow up with students and families to see if the process worked and if an interpreter was present.
Number of Deaf and Hard of Hearing People
- 9-22 out of 1,000 people are deaf or are severely hard of hearing.
- 90% of deaf children are born to adults who are hearing.
- Over 75% of deaf students are mainstreamed in public schools
- ~108 Schools and Programs for Deaf & Hard of Hearing in the US
History of Language
- ASL is a language with 200 years of history in the US & is not a direct translation of English.
- The Americans with Disabilities Act (ADA, 7/26/1990) gives rights for “effective communication” & qualified interpreters.
- Different students may use different sign languages (PSE, SEE, ASL or Cued Speech) & need an interpreter with matching skills.
- English is often a 2nd language for deaf students & they may not have proficiency so writing notes is not effective communication.
- Lip reading is not very accurate (30-45% at best).
- Ineffective communication gives an experience of fear, mistrust and frustration in medical situations and may lead to avoiding medical care even with serious symptoms which can lead to poor outcomes.
- Experience embarrassment when being followed along with a VRI.