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Know ways to combat implicit bias
Recognize that we all have implicit bias that can negatively impact our clinical
interactions and outcomes
Accept responsibility to ID and understand your own implicit biases
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Appropriate interactions with patients who have disabilities.
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Be able to identify people first language
Emphasize abilities, not limitations
Emphasize the need for accessibility, not disability
Avoid language the implies stereotypes
Do not use offensive language
Do not portray people with disabilities as inspirational only because of their disability
Do not use language the suggests a lack of something
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Know different communication styles/preferences for various cultures (per lecture
slides)
Tone, Volume, and Speed
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Loud and expressive speech
• African American, Caribbean, Latino, an Arab cultures.
Softer tones of voice, less expressive speech
• Some American Indian cultures, Alaskan native, and Latin American
indigenous
Direct eye contact
• While speaking and listening is valued by white Americans
Direct eye contact
• Rude in some Asian cultures
Pauses and silence
• Often considered uncomfortable for people with dominant U.S. cultural
norms
• Some American Indian cultures value silences and pauses to process
information and collect thoughts.
Usually cultures that value high verbal expressiveness also appreciate facial
expressiveness
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Neutral face
• Some American Indian and Asian cultures
Western European, white Americans are comfortable with expressing emotions
such as feeling sad
East Asian cultures
• Strong emotions may be considered inappropriate
East Asian cultures
• Tend to have low self-disclosure especially related to mental illness, SUD
• Trust and rapport can facilitate disclosure
Latin American, Asian cultures
• Negative or embarrassing things should be stated subtlety
Dominant US norm More direct than other cultures
Formality (warmth, respect, formality)
Many Latinx, African American, and white Americans like a warm and personal
style
East Asian cultures- more formal
 Know acceptable practice for working with an interpreter-- from assigned readings.
Allow extra time (twice)
Eliminate distractions
Document the name of the interpreter*
Introduce yourself to the patient/family/friends, do not direct intro to the interpreter
Use first person language
Face and speck directly to the patient, not the interpreter
Use sentence by sentence*
Use “teach back” to ensure patient understands
Patient may waive their right to an interpreter, this should be properly documented
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Know law on “families of choice”- from assigned readings.
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Nursing communication techniques for patients with hearing or vision loss.
VISION LOSS:
Introduce/identify yourself and anyone with you to the person with vision loss
If the person uses glasses, ensure that they are readily available
Touch the person's arm lightly when you speak so that he or she knows to whom you
are speaking before you begin
Face the person and speak directly to him or her
Use a normal tone of voice
Explain when you are leaving the environment
When offering directions, be as specific
When assisting, allow the person to take your arm
Never pet or otherwise distract a canine companion or service animal without
permission
HEARING:
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Ask the person how he or she prefers to communicate
Eliminate or minimize background noise and distractions
If the person uses an assistive hearing device (hearing aid), ensure that it is readily
available to the person
If you are speaking through a sign language interpreter, pause occasionally to allow the
interpreter time to translate completely and accurately
Talk directly to the person who is assisted by a sign interpreter, not to the interpreter
Visual (wave) or tactile signals (light touch) can be used to get the person's attention.
Speak without exaggerating your words
Do not raise your voice, unless you are specifically requested to do so.
If the person lip reads (speech reads), face the person and keep your hands and other
objects away from your mouth.
Maintain eye contact.
Do not turn away or walk around while talking.
Anticipate that only 30% of lip reading (speech reading) will be understood
The avg Deaf ASL user reads at </= 6th grade level, lower health literacy
If you do not understand something that is said, ask the person to repeat it or to write it
down. Do not pretend to understand if you do not
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Nursing communication techniques for patients with intellectual or mental health
disabilities.
INTELLECTUAL:
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Treat adults as adults.
Adjust your method of communication as necessary depending on the individual's
responses to you.
Use simple, direct sentences or supplementary visual forms of communication, such as
gestures, diagrams, or demonstrations as needed
Use concrete, specific language.
Be prepared to repeat the same information more than once in different ways.
When asking questions, phrase them without suggesting desired or preferred
responses
He or she may also benefit from watching a task demonstrated.
Do not pretend to understand if you do not.
Ask the person to repeat what was said.
Be patient, flexible, and supportive.
Do not assume that the person will be able to read well; some may not read at all.
Avoid giving too many directions at one time
Eliminate distractions and minimize background noise if possible.
Avoid sensory overload
MENTAL HEALTH:
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Speak directly to the person, using clear, simple communication.
Treat persons who are adults as adults.
• Do not patronize, condescend, or threaten when communicating with the
person.
Do not make decisions for the person or assume that you know the person's
preferences.
Offer to shake hands when introduced.
Use the same good manners in interacting with a person who has a psychiatric/mental
health disability that you would with anyone else
Encouraging people with IDD to have similar roles as their peers who do not have IDD through
policy and practice
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Abuse - what is the nursing role?
 Routine screening
 Realize an increased risk of abuse
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Recognize signs of abuse- physical and behavioral
Report- KY state law requires reporting of child abuse, neglect and
dependency and the abuse, neglect or financial exploitation of adults
with disabilities
Report to the Cabinet for Health and Family Services .They will then
perform an investigation
Know the 7 types of Elder Abuse -readings.
physical abuse, neglect, emotional abuse, financial abuse, sexual abuse,
self-neglect, and abandonment.