Introduction
This assignment will reflect on the problem encountered with obtaining informed consent and promoting autonomy with a deaf patient who required an Electrocardiograph (ECG). According to Somerville and Keeling (2004) reflection can be categorised as reflecting in practice, which is a dynamic activity, you reflect as you do it, and reflecting on practice means looking back at an event and reflecting on it. For the purpose of this assignment I will be using Gibbs (1998) reflective cycle. In line with the Data Protection Act (1998) and the care of duty all personal information will be kept confidential. Informed consent is the process by which a fully informed patient can participate in choices about their health care. It originates from the legal and ethical right the patient has to direct what happens to their body and from the ethical duty of the clinician to involve the patient in their health care. Autonomy according to (Gillon 1994) is best described as deliberated self rule whereby individuals make their own decisions based on thoughts and information. The need for good communication skills are an obvious implication for practice that respects autonomy. Polit and Hungler (1995) claim that respect for the principles of beneficence encompasses the maxim: ‘above all, do not harm’. In effect they are combining the principles of beneficence (doing good for others) and non-maleficence (not harming others). However as Beauchamp and Childress (1994) point out, the principle of beneficence is not just about preventing harm or making risk assessments about the potential benefits and harms. It is firstly about promoting welfare and removing and preventing harm.
Description
A profoundly deaf lady was booked in with my self for an ECG who had been complaining of palpitations. She had consulted with the Doctor the preceding day, with her daughter who had translated for her mother. Unfortunately there was nobody able to attend surgery with her for the procedure to be carried out and consequently the patient came to the surgery alone. Under the Disability Discrimination Act (1995) it is unlawful for a service provider (including health services) to discriminate by offering a lower standard of service or providing a service in a worse manner to deaf people. According to The Royal National Institute for The Deaf there are around 8.7 million people in the United Kingdom who are deaf or hard of hearing.
Feelings
When this patient entered my room I felt ignorant of her disability as I knew I would not be able to communicate as efficiently as I would have liked. If I could have communicated using basic finger signing, British Sign Language (BSL) this would have ensured a better understanding for the patient, although on promoting autonomy I asked the patient her preferred method of communication, which was pen, paper and lip-reading which ensured the procedure was fully understood. How would I have communicated if the patient had been unable to read or write?
Evaluation
On evaluating the situation the positive outcome was that the patient did understand the procedure that was going to be performed by lip-reading, pen and paper, and by giving her time to read the information that I had written down for her. Informed Consent and autonomy for the patient was obtained by taking time to explain fully the procedure, enacting the procedure on my self and eye to eye contact throughout. The negative aspect of the procedure was my lack of knowledge in BSL.
Analysis
On analysing the situation I feel that the procedure went well. I communicated with the patient by using open body language, making sure the seating and lighting was arranged to best meet the needs of the patient and also by pronouncing my words slowly and precisely thus enabling the patient to lip-read. My understanding of her spoken word was not very good therefore pen and paper was used in these instances. By not being able to use BSL with the patient made the experience awkward at times for the patient and myself. The patient thanked me for my time and understanding of her impairment, writing that she had understood all that we had discussed during the consultation. I apologised for my lack of knowledge and the inability to use sign language, stating that the next time we had a chance to meet I would greet her with simple finger spelling.
Conclusion
This patient’s needs were not met in the way they should have been. Emotionally and psychologically the experience of not being able to communicate with a hearing person in a natural and open manner may have caused this patient undue anxiety. Although the procedure was carried out to the best of my ability and in line with the Conduct Guidance for Assistant Practitioners I feel I should have been better equipped to care for this patient by knowing basic sign language. Health care should be available to all irrespective of the disability. (Corker 1993, British Deaf Association, 2002) sees deafness as a cultural and linguistic minority rather than a disability. Harmer (1999) suggests that unlike other cultural and linguistic minorities like Asians for example, deaf people are unlikely to be able to find a deaf health professional that they can relate to in their own language and who has an understanding of their culture. An ethic of caring is not something clearcut, like some theory might be. On the contrary, it is something which disturbs patterns, asks awkward questions, and puts emphasis on aspects which are not easily dealt with. Tschudin, V (1992)
Action plan
This encounter with a deaf patient has highlighted the need for both front line staff and clinical staff to have basic deaf awareness training to enable us to communicate efficiently and respectfully with deaf patients. Health information in the form of signed videos or picture based leaflets should be available for deaf patients who are experiencing difficulty understanding a health professional about any procedure that needs to be carried out. Clinicians should be made aware of when a deaf person is attending surgery so that the best possible form of communication can be used.
References
British Deaf Association (2002) DEAFinitions, British Deaf Association Factsheet. (Internet) Available at: . Last accessed on 20/11/07
Tschudin, V (1992) Ethics in Nursing: The Caring Relationship
Butterworth:Heinemann
Somerville, D. Keeling, J. (2004) A practical approach to promote reflective practice within nursing. Nursing Times 100 (12) 42-45.
Corker, M., (1993) integration and deaf people: the policy and power of enabling environments.
Harmer, L.M., (1999) Health Care Delivery and Hearing-Impaired People: Practice, Problems and Recommendations for Change. Journal of Hearing Impaired Studies and Hearing Impaired Education 4:2 pp73-110
Beauchamp, T. L., Childress, C.F (1994) Principles of Biomedical Ethics, (4th edition), Oxford University Press, Oxford.
last accessed 20/11/07
Polit, D.F., Hungler, B.P. (1995) Nursing Research: Principles and Methods, (5th edition), J.B. Lippincott, Philadelphia.
Royal National Institute for Deaf People. Statistics on Deafness. Factsheet. London: RNID, (1997)