One-Dimensional Scales for Pain Evaluation Adopted in Italian Nursing Practice: Giving Preference to Deaf Patients

Abstract

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.

Communication difficulties experienced by deaf male patients during their in‐hospital stay: findings from a qualitative descriptive study

“…The limited time available to healthcare professionals due to higher workloads and limited resources at the bedside also seems to further threaten the chance to explain the individual needs of deaf persons and develop effective communication. In addition, some instruments adopted in daily practice, such as checklists and assessment tools, which often are not validated in the context of deafness failed to support healthcare workers in their effective communication. These new instruments may be assimilated to a healthcare bureaucracy that has already acknowledged them as a barrier to effective communication .…”

“…The focus group was stimulated by a semistructured interview (Table ) and conducted using the Italian sign language (LIS) by two researchers (both female, experts in the field of LIS and deaf culture, with previous research experience) . The first researcher (LS) assumed the moderator role given her expertise in LIS and her capability in understanding the meaning of emerging issues, due to her specific personal and research competence both with deaf people and in‐hospital nursing care.…”

“…The internal board of the local university authorised the research project. In addition, aiming at ensuring a comfortable experience, and to protect participants from stress, a nurse able to perform LIS and to conduct focus groups, with previous experience in this research field and already confident with the Deaf Community, was involved. Confidentiality was ensured at each stage of the research process by attributing to each participant a progressive causal number before eliminating personal data (e.g., P2).…”

“…The process of nursing care, which is the basis of an individualised nursing approach, may also be threatened by lack of accuracy in assessments, the lack of tools validated in the deaf population for assessing specific issues (e.g. the risk of falls, pain) and the failure of nursing surveillance .…”

Anesthesia for the deaf and mute

“…While patients and their relatives in the United States are often well versed in the use of American Sign Language, this is unusual in many other countries. A language specialist can help to elicit an optimum history, assist with the preoperative evaluation, explain the importance of and techniques associated with postoperative interventions (e.g., the use of deep breathing exercises and lung expansion maneuvers by incentive spirometry), and train the patient to quantify postoperative pain by explaining simple pain scoring systems like the visual analog scale [ 2 ].…”