Despite the increasing attention given to pain, little is known about how deaf patients communicate their pain and which pain scales they prefer to use. Studies of the validity of various scales often specify conditions that exclude them. With the aim to explore the preferred pain evaluation scale and the method of administration when evaluating deaf patients, a descriptive phenomenology of qualitative research study was undertaken and articulated in two phases. In the first phase, a purposeful sample of 10 nurses with experience in the care of deaf clients was studied using focus groups to collect data regarding which pain scale they used and the methods they used to administer the scales in clinical settings during care to deaf patients. In the second phase, a purposeful sample of 16 deaf people was engaged in multiple focus groups to analyze a set of one-dimension scales that emerged from the first phase of the study with nurses and to discuss their preferences for pain scales. Nurses who participated in the focus group reported using the numerical rating scale, visual analogue scale, Faces Pain Scale, and the Iowa Pain Thermometer (IPT) scale when caring for deaf people. Deaf patients involved in the second phase of this study preferred the IPT scale. Participants also noted the interference of environmental factors such as dimly lit rooms or glaring lights in situations that required lipreading for communication of pain such as in operating rooms. It was concluded that decisions regarding how to administer pain scales to deaf persons need to consider the preferences and the values of the patients. To avoid the risk of misunderstanding the pain of deaf patients, practice guidelines and strategies related to measuring pain in deaf persons should be specified by deaf associations at international, national, and local levels. Utilization of a simple sign language even at an international level could guarantee security in the communication of the pain between patients and health care workers and may help in the assessment of acute pain even in emergency conditions.

Studies available have described several specific issues affecting healthcare accessibility by deaf people, but to date, no research has reported the experience of deaf patients with in-hospital communication. The aim of the study was to explore the communication experience of deaf patients with regard to their in-hospital stay. A purposeful sample of participants was selected. The data collection process was based on a focus group. The focus groups were conducted in Italian sign language and videorecorded; subsequently, the entire conversation was faithfully transcribed. A qualitative content analysis of the transcription was performed and the findings are reported using the Consolidated Criteria for Reporting Qualitative Research approach. Four themes have emerged: (a) experiencing a common vulnerability: the need for reciprocal understanding and sensitivity, (b) being outside the comfort zone: feeling discriminated against once again, (c) perceiving a lack of consonance between care and needs and (d) developing a sense of progressively disempowerment. The experience of deaf individuals during their in-hospital stay may be critical: they are exposed to protracted communication and interaction with healthcare providers and an environment that is not prepared and designed for these vulnerable patients. Two levels of strategies should be identified, implemented and developed to increase the quality of communication with deaf people during hospitalisation, both at the hospital/health system level and at the healthcare professional/clinical level.