Professional interpreters must exercise discretion according to the situation. For instance, when the patient and healthcare provider step behind a curtain or drape for a physical examination, matters of privacy are paramount. The patient can be asked their level of comfort with having the interpreter present for certain types of examinations. If the patient prefers the interpreter to step out for a few minutes, the health care provider should provide only limited communication to the patient until the interpreter is present in the room again. More details and explanations need to wait until the interpreter returns. Communication Etiquette In situations when an interpreter is required for a communication event, healthcare professionals might default to speaking directly to the interpreter rather than to the patient. It is more appropriate to speak directly with the patient, maintain eye contact with them, and allow the interpreter to render the interpretation as required. Interpreters are generally the expert when handling communication dynamics between two languages and cultures. Therefore, it is not necessary to say, “please ask the patient” or “tell the patient.” Adhering to best practices for communicating with patients through an interpreter can ensure the quality and integrity
the whole utterance before rendering it into the target language. Alternatively, the interpreter may decide to work in a simultaneous mode, which means the rendition begins a few moments after the speaker has begun speaking. In another circumstance the interpreter may move along this spectrum between the two modes during the interpretation. Here the interpreter is making regular and conscious decisions to wait in order to understand the full utterance or is able to move ahead with a more simultaneous method. Either method is an acceptable strategy to use. Sign language interpreters work in both modes yet may opt for simultaneous mode because there is less auditory interference than two spoken languages. Positioning The physical positioning of participants in the communication event will vary depending upon the type of meeting, consultation or procedure. In addition, the positioning of a sign language interpreter will also differ from that of a spoken language interpreter. Signed languages incorporate movements of the body, hands, torso, and face, so the interpreted message needs to be easily visible to interlocutors. Spoken language interpreting can occur over a telephone line or through a closed loop microphone and headset where the language is not necessarily seen. This is one implication of the modality differences between signed and spoken language interpretation. In person, spoken language interpreters generally position themselves in a manner which forms a triangle, or they stand or sit directly behind the patient. Typically, a sign language interpreter, however, will position themselves close to the provider in order for the Deaf patient to see both the provider and the sign language interpreter with ease- in other words, opposite to and in front of the Deaf person. Re-positioning may be required so that the Deaf patient has a clear and unobstructed view of the visual communication at all times, particularly in settings where equipment and procedures are occurring that can block the Deaf person’s view of the language message. This is not necessarily a requirement of interpreting between spoken languages.
of the patient encounter. Spoken language interpreters seated or standing behind the patient enables consistent provider-patient eye contact. Positioning of the interpreter in the interaction can have significant impact. When a sign language interpreter is present, the healthcare provider should be mindful of maintaining eye contact as much as possible with the Deaf patient. Here, the patient will need to have eye contact with the interpreter but this does not mean the healthcare provider is ignored. It is simply a fact of visual language that the Deaf patient must see the interpreter as well as the provider. A clear communication channel between the provider and the patient is a key factor for communication and effective understanding, diagnosis, and treatment. Professional spoken and signed language interpreters therefore make the healthcare provider’s expertise fully available to their patients. Communication Etiquette with Patients with Other Disabilities So far in this chapter, the focus has been on consulting with patients who have a hearing loss and the effective use of interpreters when consulting with them. In the following brief overview, effective communication strategies with patients who have other types of disabilities will be discussed. Importantly, communication techniques for patients with additional needs are not homogenous. Individual preferences need to be considered. Blindness presents significant communication challenges within the hospital setting, impacting both patients and healthcare providers. For blind patients, the absence of visual cues makes it difficult to perceive nonverbal communication, such as facial expressions or body language, which are crucial for understanding emotions and building rapport. Additionally, accessing written information, such as medical forms or instructions, becomes a barrier without proper accommodations. Healthcare providers face the challenge of effectively conveying medical information to blind patients, requiring alternative methods such as verbal descriptions or tactile models. Moreover,
American Sign Language (ASL) differs from sign languages used in other countries, even those where English is the primary spoken language.
In the United States of America and Canada, American Sign Language, ASL, is the most common sign language that is used. ASL is unique to the US and Canada and regional differences have been reported. ASL differs from the sign languages used in other countries, including other countries whose main spoken language is also English. A sign language is not considered to be “spoken language on the hands”. In addition to their modality, ASL and other sign languages have grammar systems and concepts that widely differ from spoken languages. Due to educational differences, family background, and circumstances of their first language acquisition, Deaf people will have various degrees of written English proficiency. This is important when considering the sole use of printed or written material in a healthcare setting or communication event. Interpreting Dynamics - Spoken language vs Sign Language Interpreting involves control over complex cognitive efforts requiring strategies that take into account social interactional dynamics. A healthcare provider needs to be aware of the time it takes for an interpreter to apply different strategies during a communication event. Interpreters may choose to work in a consecutive mode, which means they will need to hear or see
A deaf patient explaining that he does not understand American Sign Language (ASL).
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WHAT DID YOU SAY?
UNDERSTANDING DIFFERENT DISABILITIES 81
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