Patients with special needs can present unique circumstances that influence how you deliver treatment.
However, communicating with them is really no different than interacting with any other patient under your care. Whether you are new to the nursing profession or have years of experience, you know that your bedside manner must always be infused with empathy, courtesy, and respect. This holds true when assisting a patient with special needs. Nevertheless, if you still find the prospect daunting and are concerned your approach might come off as offensive or unprofessional, here are some helpful tips to make you and your patients feel more comfortable.
Distinguish your patient from their physical accommodations.
Greeting a patient with special needs straight-forwardly communicates a genuine respect for who they are regardless of their limitations. Don’t let a wheelchair, crutches, cane and dark glasses, oxygen tank, service dog, or artificial limb stop you from shaking hands or making eye contact with a special needs patient. People with limited hand use or an artificial limb can usually shake hands in some capacity.
Do not patronize or praise a patient with special needs.
Most patients with disabilities do not want to be pitied or treated like troopers for enduring their limitations. For the most part, individuals with special needs try to shake attitudinal barriers that relegate them to a different set of standards than the so-called “norm.”
- Talk to them as you would any other patient. Be thoughtful, friendly, and even-keel.
- Avoid patting a patient in a wheelchair on the back or shoulder as you greet them and especially refrain from using a tone of voice that is overly endearing or too charged with exuberance.
- Never lean against or hang on a patient’s wheelchair— bear in mind that chairs are extensions of their bodies.
- It’s okay to place yourself at eye level when speaking with a wheelchair patient—sitting or kneeling across from them is courteous, not offensive.
- If a patient in a wheelchair or using crutches is having a problem opening a door or negotiating through a crowded passage, offer to assist, but ask first.
Do not “talk-down” to patients with special needs.
To do so implies that you regard them as inferior. Under no circumstances should you use a voice that is louder than usual (unless you know a patient is hearing-impaired) or includes an overly-simplified or child-like vocabulary. Pet names, such as “dear” should never be used in place of a patient’s proper name, since expressing this type of informality can come across as deprecating.
Do not stereotype or generalize about patients with special needs.
False generalizations about patients with special needs include the notion that the visually impaired have keener hearing than sighted people, wheelchair-confined people are docile, people with developmental disabilities are naive and good-natured, or all people with disabilities are sad and bitter. These over-simplifications are biased and untrue, so approach your patient’s bedside with an objective mindset. Chances are, after a few introductory greetings followed by a minute or two of conversation, you will form your own accurate assessment of your patient’s character and capabilities and leave your pre-conceived notions at the door—for good.
Etiquette for Assisting the Visually Impaired
- When greeting a visually impaired patient, speak to them when you approach and tell them who you are. Above all, do not raise your voice—they might be blind, but do not assume they are deaf as well.
- If the patient is accompanied by an aid or a family member, remember to direct your greeting to the patient first; thereafter, you can converse with the group.
- Do not play with or pet a service animal or distract it unless you ask the owner’s permission beforehand.
- Before leading a patient, ask for their consent; if it’s okay, let them hold your arm and move at their own pace.
- Be descriptive when explaining the treatment process. For example, if you are using a step approach, mention how many steps are involved before explaining each one. Then describe each step using imagery that would be visually obvious to a seeing patient.
- When the exam, treatment, or consultation is over, let the patient know and inform them when you are leaving the room.
What to do when a patient’s disability or impairment is not readily apparent
Unlike mobility disabilities, patients with hearing, speech, or cognitive impairments are more difficult to read. Communicating well under these circumstances requires the same degree of respect you show to every other patient, however, there are a few special things to consider.
Tips for communicating with the hearing impaired
- If a hearing-impaired patient appears distracted, gently tap them on the shoulder to get their attention before you speak.
- While interacting, always look directly at the patient and try to keep your face in the light to visually accentuate your presence.
- Speak clearly in a normal tone of voice.
- Avoid chewing gum while you speak as this can garble your speech or interfere with mouth movements should a hearing-impaired patient try to read your lips.
- When a patient is accompanied by a sign language interpreter, speak directly to the patient not the interpreter.
Tips for communicating with the speech impaired
- If you do not understand a patient’s speech, do not pretend that you do. Ask them to repeat what they said and then you repeat it back for clarification. Concentrate on what they are trying to say.
- Take as much time as necessary to get your point across and ensure that you and the patient understand each other.
- Try to ask questions requiring short answers or a nod of the head.
- Do not attempt to finish the patient’s sentences.
- It’s acceptable to pull out a note pad and communicate through writing when attempts to communicate via speech are unsuccessful.
Tips for communicating with patients with cognitive impairments
Cognitive disabilities encompass a broad range and wide spectrum of disorders from mild to severe. If you are uncertain about your patient’s impairment but sense something is “different” about them, take your time communicating. In a non-patronizing way ask your patient if they need a few minutes to think about your instructions—they might feel overwhelmed or anxious, or have memory processing issues stemming from autism, ADHD, dementia, or a traumatic brain injury. Any of these conditions might require your help filling out forms, make it necessary to verbally repeat what you are saying or put your explanations in writing. Whatever the case, be respectful and courteous and ask before offering help.
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