Accommodating the Communication Needs of Deaf-Blind Employees

Accommodating the Communication Needs of Deaf-Blind Employees

by Teresa Goddard and Elisabeth Simpson, Job Accommodation Network, Volume 10, Issue 2, Second Quarter, 2012

When you think of an individual who is deaf-blind (also known as deaf-blindness, blind-deaf, dual sensory impaired, or combined vision and hearing loss), do you think of someone who is fully deaf and fully blind? Helen Keller might be an important historical figure that comes to mind. In reality, while there are individuals who are fully deaf and fully blind, many people who are deaf-blind have some usable vision and hearing. For example, some individuals may have grown up with some degree of vision loss and experienced a change in their hearing later in life, or vice versa. Other individuals may have been born with mild to moderate deficits in both vision and hearing. Others may have experienced trauma or illness at some point in their lives that resulted in both vision and hearing loss while older adults are likely to experience age-related vision and hearing impairments.

Workplace accommodation needs for deaf-blind employees will depend on the setting in which individuals will be working, their specific job tasks, and their unique hearing and vision needs. Typical concerns may include: equal access to information presented in meetings and trainings, effective workplace communication, access to printed materials, computer access, and emergency preparedness. For instance, the following accommodation scenarios involving workers who are deaf-blind show how reasonable accommodations can support effective communication in the workplace and allow equal access to employment opportunities.

  • Providing Equal Access to an Interview: A federal employer provided an interpreter who specialized in interpreting for individuals who are deaf-blind to accommodate a candidate who needed an interpreter to participate in a job interview.
  • Accommodating a Presenter who is Deaf-Blind: A research scientist had profound deafness and low vision. He needed to present research findings at a meeting. The employee created slides using a large font size and a high contrast theme. The employer provided an interpreter who used techniques for interpreting for Deaf-Blind individuals including standing within four feet of the individual to communicate questions and comments from the audience. A second interpreter voiced the employee’s signs for the hearing attendees.
  • Communicating with Coworkers: A student employee at a federal agency needed to interact with her team to plan and implement projects, but face-to-face communication was difficult for her and she had difficulty hearing on the telephone. Her most reliable method of communication was instant messaging (IM). The employer set up a secure IM client so that all team members could discuss projects via chat. The intern successfully exchanged ideas about team projects with team members who also found the chat logs useful.
  • Communicating with Clients: A consultant usually used email and IM to interact with clients remotely, but used a Deaf-Blind Communicator (DBC), a device which allows a Braille user to exchange messages with a sighted communication partner, to facilitate communication during face to face meetings when an appropriate interpreter was not available. He also used the device to interact with staff at restaurants when entertaining clients at lunch meetings.
  • Communicating with Public: An employee at a doctor’s office needed to ask intake questions at a check in counter. The employee had progressive hearing loss and was a Braille user. A JAN consultant suggested exploring use of devices that would allow the employee to type her responses on a keyboard or Braille keyboard and receive replies via Braille. Some examples of such products include the DBC, an Interpretype with a Braille display, or other interactive communication system.

Job seekers and employees who are deaf-blind are likely to be very knowledgeable about their accommodation needs, especially equipment and techniques that have served them well in other settings. Employers should be prepared to work with the individual, and likewise, individuals should be open to discussing their own ideas as well as effective alternatives. Remember that accommodations may be needed to allow effective communication during this process. Many helpful resources are available to assist in determining effective accommodation including: medical providers, vocational rehabilitation and other state agencies, assistive technology projects, and of course JAN.

For more JAN resources, visit JAN’s A to Z for:

You can also contact a JAN consultant to discuss accommodation ideas and get targeted suggestions. Additional resources include:

– Teresa Goddard, MS, Senior Consultant, Motor / Sensory Team

– Elisabeth Simpson, MS, Senior Consultant, Motor / Sensory Team

Can I Use a Calculator in Clinical Practice

I Have Dyscalculia: Can I Use a Calculator in School and in Clinical Practice?
by Robin Jones, Director, Great Lakes ADA Center

I think that you have to go back to the analysis of what is being asked: Use of a calculator
What is the question:  Does the use of a calculator create a fundamental alteration in the program or service.  

It gets down to what is being taught in the course and whether or not the use of the calculator fundamentally alters that. Is it essential to that program that a student NOT use a calculator. What is being tested? The faculty need to be able to defend that the use of a calculator would create a fundamental alteration. Just because they require all of the students to not use a calculator does not mean that it would be a fundamental alteration for a student with a disability that needs to use one as an accommodation to do so. I do not know what course this is in relation to. For example, if it’s a fundamental math class that every student has to take, etc. to learn the fundamentals of algebra or something else then they need to look at how the student can demonstrate mastery of the information. This may require a different analysis than what is used with other students without this type of disability. The fact that the various tests, etc. that they student will take for nursing boards, on the job, etc. don’t require use of a calculator is a different matter. First you need to look at the course that is at question and what is it fundamentally teaching/intended to teach.  From there you look at alternative in terms of accommodations that do not alter what is being taught.    

Overarching questions to be asked:

  • Does the use of the calculator as a reasonable accommodation provide the students with an unfair advantage or undermines academic standards?
  • Is the ability to add, subtract, multiply, or divide accurately considered an essential part of what an exam/quiz is designed to test?

Additional Points for Consideration:
NOND Board Member Responds: There are calculators on the NCLEX. And yes, most NCLEX prep courses allow use of calculators. There are calculators all over the clinical setting as well. The Pyxis unit and infusion pumps have calculator features on them as well. The nurse can also bring and use her own calculator. I am a faculty member in a community college based nursing program, so I do understand why this student has meet resistance with calculator use during her exams. Many nurses loose their license or require remediation as a result of medication errors. It is so very important that students know how to perform the process of calculating drugs. Final thoughts: If a student can put the information in a calculator and get the correct answer, she/he knows how to perform the calculation. I think this is a ” reasonable accommodation.”

NOND Board Member Responds: The NCLEX does have a calculator function (via drop down feature) that can be used on the screen for questions that require calculations.  Also, preparation courses like Kaplan have similar set ups that  allow for the use of an online calculator. In the field, calculators definitely can be used. In fact, I  used my calculator several times on the post-surgical unit to check IV calculations. My nurse preceptor used a dictionary consistently when documenting because she was a terrible speller.  These are just resources that make our jobs easier. The important piece is knowing “how to calculate” not the “tool used to calculate.” For this student, it would actually be a reasonable accommodation. 

NOND Board Member Responds: Once nurses graduate, they can use a calculator in their clinical setting if they so choose. Even with a calculator, the student/nurse still needs to know how to set up the equation. It seems that letting the student use a calculator for math questions on an exams would certainly be a reasonable accommodation given this disability. This can also be conceptualized as creative access. Isn’t it important that the student get the answer right, regardless of whether a calculator is used?  If using a calculator helps a student or nurse get the correct answer, then the end result is the same.

Additional Resources
My Eternal Struggle with Numbers
By Kirstin Bell, 2010 Anne Ford & Allegra Ford Scholarship Finalist
Published: April 4 2012

Disclaimer: The National Organization of Nurses with Disabilities (NOND) does not offer legal advice but NOND does offer resources to help you understand your rights, protections, and responsibilities within various Disability Rights Laws.

To Disclose or Not to Disclose?

To Disclose or Not to Disclose?
by Karen McCulloh and Beth Marks

411 on Disability Disclosure
Do you homework before deciding to disclose. The decision of whether to disclose is entirely up to you.

If you need an accommodation you must disclose. This is true for both higher education and employment. So the choice to disclose or not is contingent upon the need for accommodations. 

The issue then becomes at what point does a person disclose? Although disclosing a disability is a choice protected under the Americans with Disabilities Act (ADA), the choice of not disclosing a disability where accommodations are needed and cannot be provided, may set up a student or employee to fail. The fear of rejection or stigma directed to a student or employee that has a disability does not have the same impact as denying oneself the accommodations by choosing not to disclose and setting up an environment that is potentially less successful in academic or career advancement.

Also, an important point that might be made is that before choosing a school, ensure that the university, college or technical program has a disability services department. It would also be helpful to research if the school has or has had other students with disabilities enrolled in their nursing or allied healthcare programs. You may also want to speak with the disability services coordinator to see what his or her experiences has been with students enrolled in their nursing or allied healthcare programs and the types of disabilities students have had.

Below are some additional resources for you to consider:

McCulloh, K.J & Marks, B. (2012). To disclose or not to disclose? NOND Website FAQ Resources. NOND, Chicago, IL.

Disclaimer: The National Organization of Nurses with Disabilities (NOND) does not offer legal advice but NOND does offer resources to help you understand your rights, protections, and responsibilities within various Disability Rights Laws.

Technical Standards Versus Essential Functions: Developing Disability-Friendly Policies for Nursing Programs

Technical Standards Versus Essential Functions: Developing Disability-Friendly Policies for Nursing Programs
by Martha Smith

What do technical standards mean for nursing?

Under Section 504 of the Rehabilitation Act, schools can, in fact, have technical standards. Technical Standards are all the non-academic requirements a students must have/meet to enter a program. For most health sciences programs, there are usually a list of skills or experiences students must have prior to entry. Technical Standards cannot be written to exclude a class of people, including students with disabilities, and must have the “tag-line” “able to meet these requirements with or without a reasonable accommodation.” Most schools have difficulty writing good technical standards. They often use physical attributes as a skill, e.g, “must be able to talk to patients directly” versus “must be able to communicate effectively”. Also, technical standards should be written as the “what” of a skill, not the “how”, e.g., “must be able to gather vitals using variety of means” versus “must be able to hear a heart murmur through a stethoscope” (actually specifying how the task will be accomplished). Many technical standards are written based on skills that students will actually learn how to do in the program (e.g., “must be able to hear/detect a heart murmur through a stethoscope”). Because students will learn this skill in school, it is not a requirement for entering the program.

How are technical standards used in nursing programs?

Most institutions write technical standards on a page or two. Once students are admitted, they are asked to read and sign the technical standards page saying they can meet these requirements. Some schools ask all their students to have the page signed by their physician. If a school is a asking a particular student to “prove” they can, in fact, meet the technical standards, then they should be asking all the students to prove they can also meet the technical standards.

Do they write them for students already in a nursing program?

Yes. They should write them and give them to students up front so they know what to expect and what they will encounter but they are not used as admissions requirements.

What are some of the issues related to technical standards?

One of the big problems with technical standards is if you use them purely as admissions requirements how do you “test” folks (all folks) to make sure they can do all those things?

Where are some examples of technical standards for nursing?

What does the term “essential functions” mean for nursing?

“Essential functions” is a term used in employment, not education. The essential functions of a nurse are not the same, nor should they be, as the technical standards for a nursing student.

Smith, M. (2012).
Technical standards versus essential functions: Developing Disability-Friendly Policies for Nursing Programs, NOND FAQ Resources. NOND, Chicago, IL.

Disclaimer: The National Organization of Nurses with Disabilities (NOND) does not offer legal advice but NOND does offer resources to help you understand your rights, protections, and responsibilities within various Disability Rights Laws.

Open the Door, Get ‘Em a Locker: Educating Nursing Students with Disabilities

This documentary film produced by Bronwynne Evans, RN, PhD and Beth Marks, RN, PhD chronicles the experience of a nursing student who entered a baccalaureate program using a wheelchair. The 23 minute film provides a forum for the voices of nursing students, faculty, administrators, and agency nursing staff to discuss trials and triumphs encountered during this experience. It is a real life example of the exploration of roles and responsibilities in nursing education, experiential learning, shifting perspectives, and being a part of old ways turning into new ways in the world of nursing.

Watch on YouTube.

Off to College: Tips for Students with Visual Impairments

Off to College: Tips for Students with Visual Impairments
By Laura Magnuson

College is full of new experiences. You will meet new people, learn new things, and perhaps be away from home for the first time. As a person who has a visual impairment, you may be wondering how you’re going to do it all. How will you pick a good school? How will you find all your books and do all your homework? How are you going to find your way to class? Will you be able to make friends with other students? This article will answer these and other questions.
First Steps
The first step in transitioning to college is finding the best school for you. Don’t worry; you don’t have to do it alone. Your parents, school counselors, and teacher for the visually impaired will all help you choose a school that meets your needs and goals and best fits with what you want to learn in college.
If you and your parents are able to take a college’s campus tour, you can begin to develop a good feel for the school’s atmosphere. You also can stop by the office for students with disabilities, which will be an important resource for you in college. This office provides supports to students with disabilities so they will have the same opportunities to complete their education as students without disabilities. Talking with department staff and finding out what kinds of services they provide can help you decide about attending that school. (The name of this office is different for every college, but the title is similar enough that you should be able to find it.)
Download article

The Americans with Disabilities Act and Afterwards: Disabilities in Medical Education and Practice


Disabilities: Looking Back and Looking Ahead
Sue Sun Yom, MA, University of Pennsylvania School of Medicine

Neither numbers nor definitions come easily when considering disabilities. Although 35 to 49 million Americans are formally classified as disabled,1 many more disabilities may be unreported or undiagnosed. Disabilities differ in kind and degree of functional impairment and in the role they play in shaping a person’s identity.

In this issue we explore how the Americans With Disabilities Act (ADA) has affected medical education and medical practice, since the ADA’s major provisions were implemented 5 years ago.2 Additionally, we were curious to learn about the experiences of individuals living with a disability. In our authors’ candid accounts we saw their focus on adaptation and success rather than failure, and their development of insights and compensations that may bring a special compassion to the profession.

1 9 10 11