Patients with special needs (blind patients, deaf blind patients)

Doctor – patient communicationBlind patient:

Jurášek is blind since he was born. He has only small remnant of sight, compensated by glasses with twenty-five dioptres. His handicap (disability) is combined – it is result of infantile paralysis (malformation of organs and bones), he suffers from dermatitis, doctors must watch epilepsy as well. Social adaptability is very difficult, he is unable to care for himself, but he was lucky because he was born into a cultivated and devoted family. With mother's careful and consistent leadership he has learned how to use the remnants of sight so he is able to communicate with the whole world using magnifying glass, special optics and the Internet connection. He uses a special mobile phone with display 5x10 cm and keyboard in a size of typewriter. Jurášek can also play the piano – he plays e.g. Prelude C-dur by J. S. Bach or world jazz cancan which he plays without any mistakes although his hands are partly paralysed after postpartum paralysis. Jurášek has been learning mainly by touch and hearing. Spoken word means a lot to him although he has difficulty with speech.

Doctor – patient communicationNational Disability Council established Ten Commandments for dealing with patients with visual impairments:

1. Treat the patient so they don´t feel humiliated.2. Treat directly with blind patient, not through his/her accompany.3. A person communicating with blind person gives a hand first.4. Giving a hand replaces a greeting.5. During an examination it is necessary to explain what is going to happen.6. Door to the doctor´s office should be fully open or fully closed.7. Blind person things should stay on the same place.8. During the communication with the blind patient you can use words „see,

look, blink, watch“ with no worries.9. On the guide dog is not appropriate „be smacking, whistle, stroke, feed“10. Blind should be ordered for a certain hour.

Doctor – patient communication

It is appropriate if the doctor knows thepatients handicap in advance:• practically blind;• totally blind;• partial impotence;• overwhelming helplessness;• entirely dependent on foreign help.

Doctor – patient communication

• Some patients with degenerative eye disease variously rotate with head. They look for a point which they can see. They „are“ as a mentally handicapped.

• Missing sight is replaced by smell, touch and hearing.

• They can hear whence the voice comes, recognize head bowed over papers and face turned away.

Doctor – patient communication

• If the patient is accompanied by a guide dog, pay attention only to the patient.

• If we want the patient to sit, grab his/her arm gently, bring him/her to a chair, put his/her hand on the back of the chair (patient can feel the back of the chair) and encourage him/her to sit.

• Let the patient (in a case he/she is being examined instrumentally) touch every tool or machine (if it´s possible).

Doctor – patient communication

• Give me your hand. I´m going to take blood for the laboratory right from this place. I´m tieing a tourniquet – it is elastic gum which tightens your hand to get swollen your vein.

Doctor – patient communicationDeaf blind patient:• According to WHO deaf blind is the heaviest

disability.• In the Czech Republic – 4000 people (2005).• It is caused by different combinations of auditory

and visual impairment. It causes big problems in communication, in social interaction and it defends from participation in society.

• Deaf blind are the most people older 60, but children can be handicapped as well.

Doctor – patient communication

• Deaf blindness is usually attended by impairment of balance or mild mental retardation.

• Deaf blind people we can know because they have red white cane.

• They are absolutely depend on their guardians (especially when they are in an unfamiliar environment).

Doctor – patient communicationHow to communicate with deaf blind person:• You should order a patient at a certain time.• He/she comes with a guardian, interpreter.• We always talk to the patient, not the accompaniment.• when he/she comes we shake hands with her/him.• We bring him/her to a chair and we say where we lead

him/her.• We lean patient's hand on the back of the chair and we

appeal him/her to sit.

Doctor – patient communication

• The same procedure will be when we will lay patient on bed.

• We verbally comment on all the handling with the patient – the interpreter simultaneously translates.

• We carefully attend to non-verbal communication.

Doctor – patient communication

• More difficult situation arises when it is necessary to hospitalize the deaf blind patient.

• In a unfamiliar environment the deaf blind patient become more anxious, sensitive and mentally vulnerable.

• Gentle, calm and slow voice, fluent speech, not words syllabification (they hate treatment as a child).

• In unfamiliar room it is necessary to establish a fixed point (legs of bed, door or sink).

Doctor – patient communicationDeafblind people communication techniques:• Blind and deaf patients: the Lorm Deafblind

manual alphabet.• Blind with residual hearing: inductive loop (hearing air) and

they can speak.• Virtually blind and deaf: the Lorm Deaf blind

manual alphabet and sign language.• Heavily visually impaired and deaf at the same time:

the Lorm Deafblind manual alphabet, sign language and lip-reading.

• Heavily visually impaired and hearing impaired: inductive loop (hearing air), lip-reading and they can speak.

Doctor – patient communication

How the people communicate:• They communicate mainly by touch.• They can perceive the verbal speech by fingers

put on larynx, music by vibrations of musical instrument.

• Means of communication is LORM alphabet.• It is possible to write capital letters in the

palm.

Doctor – patient communication

LORM alphabet:• Hieronymus Lorm (1820 – 1902) – born in Moravia.• He suddenly lost his hearing ability at the age of 15.• In 1882 he lost the remains of his sight.• His daughter made this alphabet public six years

after his death – 1908.• It had quickly spread through the whole Europe.• The touch for the Czech alphabet was created by

Anna Sedláčková.

Doctor – patient communication

Doctor – patient communication

Vowels:A – point on the top of thumb.E – point on the top of forefinger.I – point on the top of middle finger.O – point on the top of ring finger.U – point on the top of little finger.

Doctor – patient communication

A) Consonants - in the form of tensile middle finger from tip to root:

T - move on the thumb.B – move on the forefinger.D – move on the middle finger.G – move on the ring finger.H – move on the little finger.L – move on the middle finger extended to the wrist.

Doctor – patients communication

B) Consonants - move to the outer edge of fingers pointing always on the top of finger:

P – move from the thumb bent of side edge forefinger.Q – move on the little finger side.C) Consonants - letters created by pressing of one or

more fingers between thumb and forefinger:J - press the top middle finger by two fingers.F - current edges press of forefinger and middle finger.CH - current edges press of ring finger and little finger.

Doctor – patient communication

D) Consonants – on the palm in point form or point forms:

M – point under the little finger.N – point under the forefinger.V – point under the thumb.W – twice repeated point V (under thumb).C – point on the wrist.K - hand-shaped hint.

Doctor – patient communication

e) Consonants - moves on the palm representing letters:

S – circle on a palm.Z – oblique move from the thumb to the little

finger.X – move on the wrist from the thumb to the little

finger.Y – move across the fingers roots from forefinger to

little finger.

Doctor – patient communication

f) Consonants - letter „r“ is showed specifically:R – „trill“ in the palm – contemporary touch by

middle finger and ring finger and after that by forefinger in the palm (in the form of fast flicking).

g) Numbers:A = 1, B = 2, C = 3, D = 4, E = 5, F = 6, G = 7, H = 8, I =

9, J = 0.h) Point A = ano (yes), point N = ne (no).