医疗机构服务盲人的标准
2016/10/15 16:11:17 诸任之谈医学人文

     今天是世界盲人日。对于这样一个特殊的人群，各家医疗机构有没有一些提供帮助的服务呢？我相信有，但有没有相应的服务标准呢？我估计没有。以下内容来自美国AFB(American Foundation for the blind)，关于医疗服务提供者在关注这些人时要注意和可以做的17项指导，希望对国内的医疗机构有所启发。

     [1]Identifying personnel.

     Staff should initiate an introduction to a patient who is blind, deaf-blind, or visually impaired by addressing the patient by name. They should always identify themselves by name and function and the reason they are there. ("Good morning, Mrs. Green. I'm Mr. Upshaw from the Physical Therapy Department. I'm here to show you some exercises your doctor ordered for you.") Name badges or uniforms may not be seen by a patient who is visually impaired.

     [2]Reviewing documents.

     Staff should read fully, upon request, and provide assistance, if necessary, in completing consent forms, financial responsibility forms, advance directive forms, bills, menus, and other documents. You may find it more helpful to your patient to provide frequently used or important documents such as advance directive forms, consent forms, and financial responsibility forms in braille, large print, or on tape. The ADA requires that the contents of written material must be effectively communicated to a person who cannot read printed material. In many situations, this requirement can be satisfied by providing a staff person to read the document while maintaining the patient's right to privacy (e.g., assistance in completing medical histories or financial forms should not be provided in the waiting room or other public area). The ADA requires that any mode of communication chosen be effective, which is determined on a case by case basis. Thus, for example, unless a tactile interpreter is present, braille may be the only effective form of communicating written material to a person who is deaf-blind.

     [3] Counting and identifying currency; credit cards; signatures.

     When handing currency to a patient, bills should be individually identified and counted. A person who is blind or visually impaired usually identifies currency by folding it in different ways and-or by placing different denominations in separate locations in a wallet or purse. Identifying coins is usually not a problem because of their varying sizes and milled edges. Credit cards should be handed to patients after imprint, not simply laid on a counter or table. A piece of cardboard or a plastic or metal signature template can be used to indicate where a signature is required. Place the cardboard edge horizontally below a signature line or orient the opening of signature template where signature is required.

     [4] Sighted guide technique and mobility aids.

     Staff should not touch or remove mobility canes (such as the long white cane) unless requested to do so and should not interfere with dog guides. Identify yourself and offer guide assistance if it appears to be needed. If assistance is accepted, offer your arm to the patient. The patient will lightly hold your arm directly above the elbow. Don't pull or push the patient or hold his or her arm. Relax and walk at a comfortable, normal pace. Allow the patient to walk a step or two behind you, and indicate changes in terrain, such as stairs, narrow spaces, and escalators, by hesitating briefly as you approach them and explaining what you are about to do. This standard form of sighted guide technique should be modified, however, if the patient's other disabilities require him or her to be supported by the guide. When seating the patient, ask if you may show him or her the back of the chair. If the response is yes, simply place the patient's hand on the chair back. When it is time for you to leave, indicate that you are leaving his or her presence. If it is necessary to take an individual's cane, tell the person you are removing it and where it can be retrieved.

     [5] Verbalizing directions.

     Be specific. Be sure to use right and left as they apply to the person who is blind. What is on your right is on the left of a person facing you. Indicate number of blocks to the bus stop and whether one proceeds right or left when exiting the hospital. Provide the name of the street corner at which the stop can be found. Simply saying, "The bus stop is about six blocks down in that direction" is ineffective. Similarly, be specific about directions to rooms within your facility, e.g., "To find the cardiac rehabilitation unit, go to the end of this corridor, turn left, and it is the fifth room on your right." In addition, the layout of a patient's room can be verbalized, or if the patient is not otherwise incapacitated, a walk-around orientation can be offered. Other solutions include the provision of tactile maps, large-print maps, or recorded materials as aids to wayfinding.

     [6]Using disability-sensitive language and etiquette.

     Using words such as blind, visually impaired, seeing, looking, and watching television is acceptable in conversation. Similarly, using descriptive language, including references to color, patterns, and the like is appropriate. When referring to patients with disabilities, refer to the person first, then the disability, e.g., refer to the patient in 439 who is blind rather than the blind man in 439. Talk directly to the person you are addressing, not through a companion. Speak in normal conversational tones. It is not necessary to raise your voice.

     [7]Communicating with persons who are deaf-blind.

     Most persons who are deaf-blind communicate using finger spelling, printing letters in the palm, or tactile American Sign Language. The patient who is deaf-blind may also use braille or large print if he or she has some residual vision. Remember to ask how your patient prefers to receive information from you and how you can recognize that your message has been understood by your patient. Subject to the undue burden defense, the ADA requires the provision of interpreters only if the communication is particularly complicated. Interpreters should be present in situations to provide effective communication for lengthy or complex information, such as discussing a patient's medical history; obtaining informed consent; obtaining permission for treatment; discussing the diagnosis, course of treatment, or outcome; counseling; or discussing cost of treatment. If a tactile interpreter is required, you may be able to find one through the Registry of Interpreters for the Deaf listed in the Yellow Pages or through a local sign language or deaf service agency. For more routine communication, printing in the patient's palm may be all that is necessary. If this does not effectively communicate the procedure to be performed and if an interpreter is unavailable, allow your deaf-blind patient to touch the equipment involved, such as a blood pressure cuff or empty syringe, by gently placing his or her hand on it. Never perform a procedure without some advance warning (see Note [11]). In addition, staff should be aware of the universal sign for an emergency situation, i.e., drawing the letter X on the back of the person who is deaf-blind with the fingertips. Aids such as the Brailtalk tactile communicator can also facilitate communication. This is an inexpensive plastic device that contains braille and raised character alphabet and numerals. For many people who are deaf-blind, communication can be accomplished using this device by simply pointing the finger to the appropriate braille or raised letters or numerals. In addition, some persons who are deaf-blind may use combination braille and print "help cards" containing basic messages.

     [8]Dog guides.

     The ADA requires admission of service animals to hospitals, offices of health care providers, and similar facilities unless a fundamental alteration would result or safe operation would be jeopardized. The presence of a "direct threat" to health or safety must be determined by competent personnel, based upon medical or other evidence. The exclusion of the animal cannot be based on stereotype or conjecture as to the health or safety threat involved. The dog guide should always remain under control by its owner. In addition, care and supervision of the animal is the responsibility of the patient or visitor. Staff should not pet, feed, or otherwise distract dog guides from their work. Although the ADA does not require you to provide a dog guide relief area, it would be helpful to your patients or visitors who use dog guides if you can provide some suggestions in this regard.

     [9] Identifying visual acuity.

     With rotation of hospital staff, it is sometimes necessary to alert staff concerning a patient's visual disability. This should be done in a dignified manner and in such a way as to communicate the patient's functional ability. A note in a chart such as "Patient is blind" does not communicate that the patient is actually visually impaired, reads printed materials with a monocular lens, has no difficulty in getting around the hospital room, but usually cannot visually recognize staff. Thus, the usual chart note that the patient is "blind" is really quite meaningless. A simple note that staff should inquire about the patient's visual disability, as circumstances require, is all that is usually necessary. If the patient's eye condition involves symptoms that could be confused with other signs or symptoms indicative of trauma or disease, this information should be noted.

     [10] TDDs for patients who are deaf-blind.

     Subject to the undue burden defense, a hospital that permits its patients to make outgoing calls on "more than an incidental, convenience basis" must, upon request, provide a TDD (telecommunications device for the deaf) for the patient's use. Accordingly, a hospital may be required to provide a braille-output TDD to a patient who is deaf-blind. Such equipment may be purchased, or perhaps rented or borrowed from the manufacturer or from a state or local service agency for blind or deaf persons. In addition, a personal alert system which convert sounds from sources such as a smoke alarm or telephone into vibrations which can be felt by a person who is deaf-blind is another example of an accommodation for such a patient. This equipment can be obtained from the sources just mentioned.

     [11]Verbalizing or demonstrating procedures before they are performed.

     This is absolutely essential and will help to put your patient at ease. Talk to your patient. Describe the procedure before you perform it and-or permit the patient to inspect the equipment being used. "Mr. Jones, I'm Pete Walters, an EKG technician. Have you ever had this procedure done before? No? Well, I'll first be placing an EKG lead on your chest. Would you like to see what the instrument looks like?"

     [12] Customizing treatment and discharge plans.

     It is important that treatment and discharge plans be tailored to meet the life-style of a patient who is blind, deaf-blind, or visually impaired. For example, a cane or dog guide user may not be able to use crutches effectively but could remain ambulatory if outfitted with a mechanical or walking cast instead of a rigid cast. Assuming that both casts are equally therapeutic, the more elaborate and expensive mechanical cast will afford a much greater degree of independence and manageability for your patient who is blind, deaf-blind, or visually impaired and thus is a much more appropriate treatment option. Similarly, discharge planners and other staff should be aware of the range of abilities of persons with vision loss and the availability of equipment and devices that can make self-care possible, e.g., talking thermometers, talking blood pressure and glucose monitoring equipment, and dosage measuring devices. Dieticians and other staff should also be aware of cooking and other independent living skills possessed by many blind persons and should be willing to alter meal plans to include low fat and low sodium microwave easy-to-prepare dishes if a patient does not have cooking skills. Today, blindness or visual impairment alone does not always require convalescence in a nursing home for patients who otherwise lead independent lives. For the newly blinded patient, whether vision loss is caused by accident, illness, or is incidental to the hospital admission, staff should consult with state or local blindness service delivery agencies to ensure immediate services and continuity of care after discharge.

     [13]Identifying medication.

     While the patient is hospitalized, this is usually not a problem since all patients are not permitted to self-medicate. Names of medications and their dosages can be recorded on audiocassette tape for the patient. In addition, advice can be given to the patient about labeling of prescription bottles or containers. Some methods of labeling include: the use of an inexpensive device that produces self-adhesive Dymo-type labels for affixing to bottles or containers; use of different size bottles or containers with notes kept about the contents of each size package; use of rubber bands and paper flag-type labels that can be brailled or printed in large print using a wide point felt tip pen, or brailled and raised character pill sorters.

     [14]Food service assistance.

     Such assistance could include reading and completing menus, identifying items on a patient's tray, or cutting meat on request. For buffet or cafeteria service, assistance may include identifying and-or serving food from the buffet table or cafeteria line and assisting a visitor or patient to locate an available table in the dining area. For table service, the waiter should explain arrangement of the tableware and announce the placement of food and beverage items as they are served. Assistance in feeding is not required by the ADA unless this service is provided to all patients when necessary, regardless of disability.

     [15] Accessible signage and other ADAAG requirements.

     The ADA Accessibility Guidelines (ADAAG), which is available as an appendix to the Justice Department's Title III regulations, contains several provisions concerning accessible signage: braille, raised characters, contrast, Serif, and character height. In addition, the ADAAG contains provision regarding braille and raised character elevator controls, audible direction and floor indicators for elevators, and floor designations on elevator hoistways. The ADAAG also contains provisions regarding protruding objects, stairs, and handrails. These ADAAG requirements generally must be incorporated into new construction and must be incorporated when facilities are being altered. Items such as raised character and braille elevator controls are usually required to be installed in existing facilities, because they involve little difficulty or expense and are generally considered to be readily achievable.

     [16] These items are not reflected in the ADAAG but are listed here because awareness of the barrier that they represent to persons who are blind or visually impaired will aid architects and designers in the development of appropriate standards. For example, although inadequate lighting, glare, and interference from masking sounds present significant barriers to access for many persons who are visually impaired, the ADAAG currently do not contain standards relative to ambient lighting, glare control, or white noise.

     [17]Identifying community-based programs.

     The organizations listed in the resource section of this pamphlet can provide you with information concerning state and local service agencies for the blind, deaf-blind, or visually impaired or self-help consumer advocacy groups. A national directory of services for persons who are blind, deaf-blind, or visually impaired is also available for purchase from the American Foundation for the Blind. To ensure continuity of care for the newly blinded child, parents should also be advised of their child's right to a free appropriate public education provided by the local school district.

    http://weixin.100md.com
返回 诸任之谈医学人文 返回首页 返回百拇医药