Guide for Effective Communication in Health CareAs part of HLAA’s program for Communication Access in Health Care Settings, The Guide for Effective Communication in Health Care was created for patients, families, caregivers, all members of the health care team, administrators, and support staff. It provides information, resources, and tools to help improve communication in medical settings. This health care guide can help hospitals, facilities, and private offices follow federal, state and local laws, regulations, and health care standards, and allow patients to ask for and get the services they need. Show
Technology for Patients VideoSee more videos on Hearing Assistive Technology. What is Effective Communication?When information between two or more people is shared or exchanged and each person is able to fully understand and make decisions based on that information, effective communication has been accomplished. This process often requires going back and forth with questions and answers until everyone has a clear understanding. Patients must be able to communicate with their doctors, nurses, and other members of their health care team. Providers must communicate clearly with their patients so they can diagnose, care for, and treat them in the best and safest way possible. However, communication between patients and providers is not always effective. To help remedy the situation, it is strongly recommended that patients and providers use the Communication Access Plan (CAP) and include it in the patient’s medical record. We want your feedback
Introduction for PatientsIt is important for your health and well-being that you communicate clearly with your doctors and staff. Asking questions can avoid mistakes and misunderstandings and help you to get the safest and best care possible. The more you understand about your own health, the better decisions you and your health care team can make. This is known as effective communication. Effective communication is when information between two or more people is shared or exchanged and each person is able to fully understand and make decisions based on that information. This is often a process that requires going back and forth with questions and answers until everyone has a clear understanding. This Guide will help you to understand:
Communication Access Plan (CAP) Instructions for Patients and ProvidersPatient InstructionsWhat Is a Communication Access Plan?A Communication Access Plan (CAP) is a one-page form to let your doctors and health care team know about your hearing status and the communication aids and services needed. Why Is the CAP Important?Communicating clearly with your health care team helps you get the best and safest care possible. When you are part of and understand all discussions about your health, you will make better decisions. How Do I Use the CAP?
Provider InstructionsWhat Is a Communication Access Plan?A Communication Access Plan (CAP) is a one-page form that will document your patient’s hearing status and communication needs. A completed CAP can help ensure that you and your patient communicate effectively using the appropriate aids and services. Why Is the CAP important?Delivering the best and safest care is only possible when patients can fully participate in and understand all discussions about their health and well-being and make informed decisions. How Do I Use the CAP?
Communication Aids and Services - PatientsMaking sure you have the aids and services you need for effective communication is the responsibility of the hospital, institution, facility, or practice. You and your family cannot be asked to pay for aids or services. Effective communication is when information between two or more people is shared or exchanged and each person is able to fully understand and make decisions based on that information. This is often a process that requires going back and forth with questions and answers until everyone has a clear understanding. Assistive Listening Devices (ALDs)An ALD will make the voice of the people you are speaking with louder when they speak into a small microphone. If you have a pocket talker, FM system or other ALD, bring it with you to your appointment. If you do not have an ALD, ask staff if a pocket talker is available. (See Pocket Talker below) Amplified PhonesAn amplified phone will make the voice of the person you are speaking with louder. Captioned PhonesIf you are using a captioned phone, you can read what the person you are speaking with is saying on the phone screen. Captioning services are also available on some smartphones. CART (Communication Access Realtime Translation)A CART captionist will type the discussion you have with your doctor or staff so you can read it on a laptop, tablet, or smartphone. CART can also be used remotely, meaning that the captionist is at another location using the internet to connect. Dry Erase Board (or Whiteboard)A small board that can be written on with an erasable marker. Hearing LoopIf your hearing aid or cochlear implant has a telecoil, and the room you are in has a special wire called a loop, you will be able hear and understand more clearly. Pen and PaperPen and paper may be helpful for very short communications or as a back-up if there are no devices or equipment that can be used. Pocket TalkerA pocket talker is a small assistive device with a microphone, amplifier, earbuds or headset and a neckloop for hearing aids that have telecoils. It makes the speaker’s voice louder to help you hear better. Many hospitals have pocket talkers for you to use. Relay CallsYou can call a specially trained relay operator who will type what a person is saying while you read it on the phone screen. Tablet, Computer, SmartphoneAsk your doctor’s office or hospital staff if they have an iPad or other tablet that can be used for typing discussions. If not, you might want to bring your own. You may also be able to use the voice activation option on a smartphone. UbiDuoUsing two separate screens with keyboards, you and the doctor or staff member can face each other while they type and you read what they are saying on the screen. Interpreting Services
American Sign Language InterpreterIf you or a family member communicate in American Sign Language, you can ask for an ASL/English interpreter. An ASL interpreter can help you and your health care team communicate. If you need interpreting services, ask for nationally certified interpreters. Certified Deaf InterpreterA CDI is a deaf person who has been nationally certified to provide interpreting services to deaf people who may not be able to communicate well in American Sign Language. If you or a family member use sign language from another country, or have difficulties communicating in sign language, you may ask for a CDI. A CDI typically works with a hearing ASL interpreter. Low-Vision InterpretingIf you or a family member have low vision, you may need the sign language interpreter to stand or sit very close to you so you can see the signs. Oral InterpreterIf you or a family member are very good speechreaders, you may want to request an oral interpreter. An oral interpreter repeats what the speaker is saying, using different words that are easier to speechread. Oral interpreters and sign language interpreters do not provide the same service. Be sure to let the hospital or facility staff know which service you need. Tactile InterpretingIf you or a family member use sign language and are DeafBlind, you can request a tactile interpreter. A tactile interpreter has a DeafBlind person put their hands lightly over theirs so signs and fingerspelling can be felt. Video Remote Interpreting (VRI)VRI is an interpreting service with the interpreter, in a different location. However, you may still need an on-site interpreter in medical and mental health settings. See National Association for the Deaf and VRI. There are strict guidelines for the use of VRI services which hospitals and institutions must follow. Note: The Americans with Disabilities Act (ADA) refers to communication aids and services as Auxiliary Aids and Services.
Communication in the Emergency Department - PatientsEmergency Department (ED) visits can be scary. The ED can also be noisy and busy, making communication even more difficult than usual. It is very important that you and your nurses and doctors understand each other. A Communication Access Plan (CAP) will help you get the services you need so you can understand what is being said. By law, the hospital must give services to you, your family, and your caregivers to help with communication so you can understand your treatment options, make good decisions, and receive the best and safest care possible. You cannot be asked to pay for aids or services used during your Emergency Department visit. Triage/Registration
Treatment Area/Bedside
Tests, Procedures, Surgery
Leaving the Emergency Department (Discharge and Follow-up)
Communication in Inpatient Settings - PatientsIf you are a person with hearing loss, your inpatient stay in a hospital or other facility can be especially stressful. Planning ahead by filling out a Communication Access Plan (CAP) can help you to get the aids and services you need. Hospitals or other health care facilities cannot ask you to pay for aids and services you use during your stay. Hospitals and health care facilities must follow laws that protect your rights to receive all information in a way you can understand. Clear communication helps avoid misunder-standings, keeps you safe, and helps you make better decisions. Pre-Admission: Planning Your Stay at a Hospital or Facility
A Planned Hospital Stay
Admission from the Emergency Department
During Your Stay in the Hospital/Facility
Some options are:
Leaving the Hospital (Discharge)
Communication in Outpatient Settings - PatientsWhen scheduling outpatient appointments, let staff know what aids and services you will need so you, your doctor, and your health care team can communicate clearly. Services and aids you use for your visit, will be at no cost to you, your family, or your caregiver. A Communication Access Plan (CAP) should be filled out and become part of your medical record. This will save time and help you feel less stressed and frustrated. It should make communication easier and make your visits go more smoothly. Scheduling AppointmentsOnline Scheduling
Phone Scheduling
Managing AppointmentsWhen You Arrive
Your Visit with Your Doctor or Other Health Care Staff
Communication During Tests and Procedures - Patients
Communicating in RadiologyX-ray / CT Scan / MRI
Some options are:
Patient Rights and ResponsibilitiesYour RightsEvery patient has rights. federal, state, local laws, and guidelines protect you if you are hard of hearing or deaf to make sure you receive information in a way you can understand. This is called effective communication. Effective communication is when information between two or more people is shared or exchanged and each person is able to fully understand and make decisions based on that information. This is often a process that requires going back and forth with questions and answers until everyone has a clear understanding. Although medical staff will make the final decisions as to what services they will provide, they need to include you in the discussion. You should work together to make sure your communication needs are met. Your family and caregivers also have the same rights to aids and services so that they can be included in your care and treatment (Department of Justice, 2005). Americans with Disabilities Act (ADA)Title III, says that all health care providers (including private doctor and dentist offices) must provide aids and services to hard of hearing, deaf, and DeafBlind patients so they can communicate clearly. For more information, see ADA. Section 1557 of the Affordable Care ActSection 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). The law prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities. The Joint Commission (TJC)TJC is a nonprofit organization that makes sure hospitals have high standards of care for patients, their families, and caregivers. Hospitals are expected to follow TJC guidelines. This link will show you what hospitals need to do to provide access to effective communication: A Roadmap for Hospitals. TJC “Roadmap”. Centers for Medicare and Medicaid (CMS)CMS is part of the Department of Health and Human Services. As a federal agency, CMS has many programs that help people get low-cost health care services. Your ResponsibilitiesHave a PlanIf you have a plan before you see your doctor, you will feel more comfortable and less anxious. Review this Guide to make sure you know what to bring to your appointments and how to get the services you need. Be Willing to ShareIt is important to tell your doctors and staff that you are hard of hearing or deaf. You may not always feel comfortable doing this, but it can help you get the best possible care and keep you safe. Try to be PatientIt will take time for your health care team to understand your communication needs. You may feel frustrated and even angry at times. Take a deep breath and continue to educate them until you get what you need. Be Sure to ParticipateYou are the expert in what it is like to be hard of hearing or deaf and what you need to communicate. Your health care team members are the experts in medicine and treatment. By working together, you can get the communication aids and services you need. Filing a complaintWhile hospitals, facilities, and practices have the responsibility, by law, to provide aids and services to hard of hearing and deaf patients, families, and caregivers, it is your responsibility to take action when your needs are not being met. If your rights are being violated (you are not provided the services you are legally allowed), you have the right to file a complaint. ADA Complaint The Joint Commission Complaint You may also file a complaint with CMS and your state’s Department of Health.
Introduction for Health Care ProvidersThis Guide will help health care providers establish and maintain best practices in ensuring effective communication for hard of hearing and deaf patients, families, and caregivers. Hospital administrators, risk managers, and chief regulatory officers of hospitals, health care facilities, and private practices, and all members of the health care team, should read this Guide to ensure compliance with laws, regulations, and guidelines related to the provision of services for effective communication. Effective communication is the process of exchanging information between two or more people and asking for clarification until all parties are able to fully understand. Effective communication results in the patient being able to make informed decisions and the health care team providing safe and responsible care. This Guide includes information on:
Research supports that effective communication between patients, families, and their health care providers can have a significant impact on a patient’s health and well-being. Costs associated with the provision of aids and services to ensure access to communication can be mitigated by reducing:
Effective communication improves the quality of treatment, resulting in:
The majority of people in the United States with hearing loss do not use American Sign Language (ASL) as their primary or preferred language, and yet sign language interpreting services are typically what are offered by hospitals and other health care facilities. These services do not meet the communication needs and rights of non-signing people who are hard of hearing or deaf. Institutions and practices increase their liability by being non-compliant with federal, state, and local laws as well as standards and guidelines set forth by accrediting agencies such as The Joint Commission (TJC), Centers for Medicare and Medicaid Services (CMS), the U.S. Department of Health and Human Services (HHS), and the Office of Minority Health (OMH). ReferencesInstitute for Healthcare Communication. (July 2011). Impact of Communication in Healthcare National Association of the Deaf. Position Statement of Health Care Access for Deaf Patients The Joint Commission. (2010). Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals
Facts about Hearing LossCommunication barriers compromise patients’ safety and ability to make informed decisions effecting their overall health and well-being. Communication needs and preferences vary greatly among people who are hard of hearing or deaf. These are general guidelines; however, case-by-case assessments are required for providing patient-centered care. Note: “Hearing loss” is a general term and often includes people who were born deaf or hard of hearing as well as those individuals who experienced hearing loss any time after birth. Many deaf and hard of hearing people who communicate primarily in a signed language, identify as being members of a community or linguistic minority, not as having a disability. This Guide focuses mainly on the communication needs and services of non-signing hard of hearing or deaf patients, family members, or caregivers. However, the legal rights to effective communication and considerations are consistent for all. Hearing loss is a major public health issue; it is the third most common physical condition after arthritis and heart disease. It is not only a medical condition or diagnosis; more importantly, it is a communication and psychosocial issue. Demographics
Recognizing Patients Who Are Hard of Hearing or DeafPatients may not always disclose they have hearing loss. This may be due to denial, stigma, or fear of being treated differently. Rather than focus on the hearing loss, it is imperative to address the communication needs of the patient. Here are some common indications a patient may be hard of hearing or deaf: The patient:
Being Hard of Hearing or Deaf May:
Rights and Responsibilities of Health Care ProvidersFederal, state, and local laws address the communication rights of hard of hearing and deaf patients, families, and caregivers. Despite the Americans with Disabilities Act (ADA) of 1990, regulations and guidelines established by regulatory and accreditation bodies such as The Joint Commission and the Centers for Medicare and Medicaid, access to effective communication continues to be a challenge for hard of hearing and deaf patients, resulting in health care disparities. In March 1998, the Advisory Commission on Consumer Protection and Quality in the Health Care Industry issued its final report, which included the Consumer Bill of Rights and Responsibilities.[1] You have the right to receive accurate information you can understand about your health, treatments, health plan, providers, and health care facilities. If you speak another language, have a physical or mental disability, or just do not understand something, you will be helped so you can make informed health care decisions. For more information on laws, regulations, and guidelines see: U.S. Department of Health and Human Services Americans with Disabilities Act Section 1557 Affordable Care Act Culturally and Linguistically Appropriate Services The Joint Commission “Roadmap” National Association for the Deaf [1] Internet Citation: About AHRQ. October 2015. Agency for Health care Research and Quality, Rockville, MD. Consumer Bill of Rights and Responsibilities
Communicating with Hard of Hearing and Deaf Patients - Providers
*If services and/or devices are provided, and patient and provider are still unable to communicate, ask the patient if a family member, caregiver, or friend may assist. Without permission from the patient, speaking with family members, caregivers, or friends, may be a violation of HIPAA and ADA regulations. To Facilitate Effective Communication
Communication Aids and Services - ProvidersIf aids and services are provided, and patient and provider are still unable to manage effective communication, ask patient if a family member, caregiver, or friend may assist. Without permission from the patient, speaking with or asking for communication services from family members, caregivers or friends, may be a violation of HIPAA and ADA regulations. Determine who will be the designated person and document in the electronic medical record (EMR) or paper chart. Effective Communication is when information between two or more people is shared or exchanged and each person is able to fully understand and make decisions based on that information. This is often a process that requires going back and forth with questions and answers until everyone has a clear understanding. Assistive Listening Devices (ALDs)An ALD will make the voice of the people you are speaking with louder when they speak into a small microphone. If you have a pocket talker, FM system or other ALD, bring it with you to your appointment. If you do not have an ALD, ask staff if a pocket talker is available. (See Pocket Talker below) Amplified PhonesAn amplified phone will make the voice of the person you are speaking with louder. Captioned PhonesIf you are using a captioned phone, you can read what the person you are speaking with is saying on the phone screen. Captioning services are also available on some smartphones. CART (Communication Access Realtime Translation)A CART captionist will type the discussion you have with your doctor or staff so you can read it on a laptop, tablet, or smartphone. CART can also be used remotely, meaning that the captionist is at another location using the internet to connect. Dry Erase Board (or Whiteboard)A small board that can be written on with an erasable marker. Hearing LoopIf your hearing aid or cochlear implant has a telecoil, and the room you are in has a special wire called a loop, you will be able hear and understand more clearly. Pen and PaperPen and paper may be helpful for very short communications or as a back-up if there are no devices or equipment that can be used. Pocket TalkerA pocket talker is a small assistive device with a microphone, amplifier, earbuds or headset and a neckloop for hearing aids that have telecoils. It makes the speaker’s voice louder to help you hear better. Many hospitals have pocket talkers for you to use. Relay CallsYou can call a specially trained relay operator who will type what a person is saying while you read it on the phone screen. Tablet, Computer, SmartphoneAsk your doctor’s office or hospital staff if they have an iPad or other tablet that can be used for typing discussions. If not, you might want to bring your own. You may also be able to use the voice activation option on a smartphone. UbiDuoUsing two separate screens with keyboards, you and the doctor or staff member can face each other while they type and you read what they are saying on the screen. Interpreting Services
American Sign Language InterpreterIf you or a family member communicate in American Sign Language, you can ask for an ASL/English interpreter. An ASL interpreter can help you and your health care team communicate. If you need interpreting services, ask for nationally certified interpreters. Certified Deaf InterpreterA CDI is a deaf person who has been nationally certified to provide interpreting services to deaf people who may not be able to communicate well in American Sign Language. If you or a family member use sign language from another country, or have difficulties communicating in sign language, you may ask for a CDI. A CDI typically works with a hearing ASL interpreter. Low-Vision InterpretingIf you or a family member have low vision, you may need the sign language interpreter to stand or sit very close to you so you can see the signs. Oral InterpreterIf you or a family member are very good speechreaders, you may want to request an oral interpreter. An oral interpreter repeats what the speaker is saying, using different words that are easier to speechread. Oral interpreters and sign language interpreters do not provide the same service. Be sure to let the hospital or facility staff know which service you need. Tactile InterpretingA DeafBlind person feels the interpreter’s hands while the interpreter signs or fingerspells to receive information. Video Remote Interpreting (VRI)VRI is an interpreting service with the interpreter, in a different location. However, you may still need an on-site interpreter in medical and mental health settings. See National Association for the Deaf and VRI. There are strict guidelines for the use of VRI services which hospitals and institutions must follow. Note: The Americans with Disabilities Act (ADA) refers to communication aids and services as Auxiliary Aids and Services.
Communication in the Emergency Department - ProvidersBelow are general guidelines that can be applied to most Emergency Department visits from hard of hearing and deaf patients. Due to the varying nature of emergencies and individual patient needs, these guidelines may not be representative of all scenarios. Effective and accurate communication can be a matter of life and death. It is important to establish communication with the patient, if possible, before the patient is evaluated, diagnosed, or treated. However, if the patient is unable to communicate, medical treatment should be administered without delay. Triage/RegistrationBe sure communication devices and equipment are available and ready for use at all times. These may include but are not limited to:
Be sure all appropriate staff know how to arrange for:
Refer to Communication Aids and Services in this guide for more information. Be sure appropriate staff know they must:
Note: Speaking to the patient while simultaneously providing care results in confusion and misunderstandings increasing anxiety.
Transport or EscortBe sure patient escorts or transporters are aware of patient’s hearing status and know how best to communicate. DischargeBe sure patient understands diagnoses, treatment plan, medication, and follow-up instructions and has all information in writing. This should include any documents or information regarding an inpatient admission or transfer to another facility.
Communication in Inpatient Settings - ProvidersEstablishing and maintaining best practices to support effective communication is essential for the delivery of safe and exemplary care. Creating and sustaining an environment that promotes equal access to communication for hard of hearing and deaf patients, families, and caregivers is also the legal responsibility of hospitals, institutions, practices, and facilities. Patients must clearly and completely understand all aspects of their treatment to fully participate in their health care and make informed decisions. When the patient arrives:
To ensure effective communication at bedside:
Refer to Communicating with Hard of Hearing and Deaf Patients section in this Guide for more information. Transporting patient for tests or procedures:
Preparing patient for discharge:
Communication in Outpatient Settings - ProvidersEstablishing a plan for effective communication with your patient is critical in delivering safe and competent care. A plan should be developed at the first point of contact with the patient. Including a Communication Access Plan (CAP) in the patient’s EMR or paper chart will ensure accurate and consistent information for all staff and health care providers. Scheduling AppointmentsOnline SchedulingOnline patient portals should be utilized for hard of hearing and deaf patients, whenever possible. Make the CAP available through the portal and ask the patient to complete it. Phone SchedulingScheduling appointments may require additional time if the patient is using a captioned phone or calling through a relay operator.
Outpatient VisitsPrior to Patient’s Arrival
Patient’s Arrival
Refer to the Communicating with Hard of Hearing and Deaf Patients section of this Guide for more information. Visit with Provider
Communication During Tests and Procedures - Providers
RadiologyX-ray / CT Scan / MRICommunication can be particularly challenging since the technician typically does not remain in the room when X-rays, scans, or MRIs are in progress.
Surgical ProceduresDue to anxiety, fatigue, and effects of pre-surgical medication, the ability to understand and retain information may be further compromised for hard of hearing and deaf patients.
Discharge and Follow-upIt is essential to allow sufficient time for discussion, questions, and clarification. It is also important to:
The AuthorsHLAA Members Toni Iacolucci and Jody Prysock developed the Guide for Effective Communication in Health Care. Toni Iacolucci is an advocate for people with hearing loss, a former member of the HLAA Board of Trustees, and ex officio member of the HLAA New York City Board of Directors. Her previous career as a social work administrator in New York City has made her aware of the challenges for people whose needs have been marginalized. Since becoming profoundly deaf in 2006, Toni’s own experience as a patient, caregiver, and advocate has resulted in her strong commitment to improving the culture and practice of providing access to communication in health care. She believes this will only be achieved by educating health care providers and empowering patients so that they can achieve effective communication. Jody Prysock is a certified sign language interpreter with more than 30 years experience interpreting in a variety of settings, specializing in mental health interpreting. It is through her former role as director of Language, Cultural & Disability Services at a large, urban, academic medical center that Jody first became aware of the significant challenges faced people with hearing loss who do not communicate in sign language. As she listened to the stories of patients and their families, she recognized the great inequity in receiving quality health care. This is where her commitment to education, training, and advocacy began. Jody’s mission is to help change practice by first changing the culture. Currently, people with hearing loss are seen only through a medical lens, therefore minimizing or denying their rights to effective communication. Acknowledgments from Toni Iacolucci and Jody PrysockThank you to the Hearing Loss Association of America (HLAA) for their leadership and support: Margaret Wallhagen, RN, Ph.D., FAAN, UCSF School of Nursing, former chair, HLAA Board of Trustees; Barbara Kelley, HLAA executive director; and Lise Hamlin, HLAA director of public policy. We appreciate the HLAA New York City Chapter Members Ruth Bernstein, Holly Cohen, Anne Pope, and Gail Weiss, for their guidance, feedback, edits, and support. Thank you to our colleagues who contributed their insight and expertise to this project: Steven R. Weiner, RN, MS, MPA, senior director, Patient Access, NYU Langone Medical Center; Jodi Herbsman, PT, DPT, program manager, Acute Care Rehabilitation Therapies, Rusk Rehabilitation; Joseph Montano, Ed.D., associate professor of audiology in clinical otolaryngology, Weill Cornell Medical Center. Preparing for Appointments with Hearing Care ProfessionalsThe Ida Institute, a nonprofit organization based in Denmark working to advance a person-centered approach to hearing care, has developed a set of Telecare Tools aimed at helping people with hearing loss. The online Telecare Tools help people with hearing loss to articulate their unique needs and circumstances to their hearing care professional. The tools are designed to involve people with hearing loss in their own care, making them partners with their hearing care professional. How should the nurse communicate with a patient who has impaired hearing?To facilitate communication with a hearing-impaired person, face the patient when speaking, speak slower and in a normal tone, talk toward the patient's best or normal ear, articulate clearly, and demonstrate ideas you wish to convey. You should also position yourself so the light is on your face when you speak.
How can you effectively communicate with a client with hearing loss name 5 strategies?Communication strategies for people affected by hearing loss. Be assertive. ... . Using visual cues. ... . Using context. ... . Reduce background noise. ... . Asking for clarification. ... . Asking for repeats. ... . Importance of concentration and keeping calm. ... . Speak clearly and don't shout.. How would you communicate with a person with a vision or hearing impairment?Speak directly to the person not through a companion, guide, or other individual. Speak to the person using a natural conversational tone and speed. Do not speak loudly and slowly unless the person also has a hearing impairment. Address the person by name when possible.
What is the communication system for the hearingThe hearing-impaired person calls using a text telephone (TTY), which the CA then verbally relays to the other caller. The CA then types the person's response back to the TTY caller. There are two types of telecommunication relay services: voice carry-over (VCO) and hearing carry-over (HCO).
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