COMMUNICATION STRATEGIES EMPLOYED BY HEALTH PROFESSIONALS WITH HEARING IMPAIRED PEOPLE: AN INTEGRATIVE REVIEW

an integrative review carried out in February 2021 in 14 databases and with manual search, without time frame, in Portuguese, English, Spanish and through the Hearing Impaired People and Health Professionals descriptors and their variations, without context delimitation. The results were analyzed by organizing them into thematic groups according to their frequency.

Results:

a total of 16 studies were selected, with the following results standing out: use of writing and mimicry as main communication strategies; non-qualification of the professionals for effective communication, with the use of LIBRAS as the least used means; and feelings of insecurity, blockage and disability experienced by the professionals in communicating with hearing impaired people.

Conclusion:

it is necessary to invest in health professionals’ qualification in LIBRAS, making communication more effective and contributing to improvements in the care practice.

DESCRIPTORS:
Hearing Loss; Communication Barriers; Sign Language; Health Personnel

PICo	Identified terms
Participant	“Perda Auditiva” OR “Deficiência Auditiva” OR Hipoacusia OR “Perda da Audição” OR “Pessoas com Deficiência Auditiva” OR “Pessoas com Audição Deficiente” OR “Pessoas com Dificuldade Auditiva” OR “Pessoas com Insuficiência Auditiva” OR “Pessoas com Surdez” OR “Personas con Deficiência Auditiva” OR “Pérdida Auditiva” OR “Pérdida de la Audición” OR “Pérdida de la Capacidade Auditiva” OR “Personas con Dificultad Auditiva” OR “Personas con Insuficiencia Auditiva” OR “Personas Portadoras de Sordera” OR “Personas Sordas” OR “Portadores de Sordera” OR Surdez OR Surdo* OR Auditivo* OR Auditiva* OR Audição OR Surdez OR Sordera
Participant	“Hearing Loss” OR “Loss, Hearing” OR Hypoacusis OR Hypoacuses OR “Hearing Impairment” OR “Hearing Impaired” OR “Persons With Hearing Impairments” OR “Hearing Disabled Persons” OR “Disabled Persons, Hearing” OR “Hearing Disabled Person” OR “Person, Hearing Disabled” OR “Persons, Hearing Disabled” OR “Deaf Persons” OR “Deaf Person” OR “Person, Deaf” OR “Persons, Deaf” OR “Hard of Hearing Persons” OR Hearing OR Deafness OR Deafnesses OR Deaf
Phenomenon of Interest	(“Pessoal de Saúde” OR “Prestadores de Cuidados de Saúde” OR “Profissionais da Saúde” OR “Profissionais de Saúde” OR “Profissional da Saúde” OR “Profissional de Saúde” OR “Trabalhador da Saúde” OR “Trabalhador de Saúde” OR “Trabalhadores da Saúde” OR “Trabalhadores de Saúde” OR “Personal de Salud” OR “Proveedores de Atención de Salud” OR “Trabajadores de la Salud” OR Medico* OR Enfermagem OR enfermeir* OR Enfermería* OR Enfermer* OR Fisioterapeuta* OR “Terapia Ocupacional” OR fonoaudiologia OR Fonoaudiolo* OR Psicologo* OR Psicologia OR “Assistente social” OR “Assistentes sociais” OR “Equipe de Assistência ao Paciente” OR “Grupo de Atención al Paciente” OR “Equipe Interdisciplinar de Saúde” OR “Equipe Multiprofissional” OR “Equipe de Assistência Médica” OR “Equipe de Cuidados de Saúde” OR “Equipe de Saúde” OR “Equipes de Saúde” OR “Assistentes Sociais” OR “Trabajadores Sociales”) AND (Comunicação OR “Canal Interpessoal” OR “Comunicação Educacional” OR “Comunicação Educativa” OR “Curso de Comunicação” OR “Educação Comunicacional” OR “Educação Comunicativa” OR Comunicación OR “Comunicación Educacional” OR “Comunicación Educativa” OR “Educación Comunicativa” OR “Barreiras de Comunicação” OR “Entraves à Comunicação” OR “Obstáculos à Comunicação”)
Phenomenon of Interest	(“Health Personnel” OR “Personnel, Health” OR “Health Care Providers” OR “Health Care Provider” OR “Provider, Health Care” OR “Healthcare Providers” OR “Healthcare Provider” OR “Provider, Healthcare” OR “Healthcare Workers” OR “Healthcare Worker” OR “Health Care Professionals” OR “Health Care Professional” OR “Professional, Health Care” OR Physicians OR Nurses OR Nurse OR Nursing OR Nursings OR “Physical Therapists” OR “Physical Therapist” OR Physiotherapist OR Physiotherapists OR “Therapist, Physical” OR “Therapists, Physical” OR “Occupational Therapy” OR “Speech, Language and Hearing Sciences” OR “Speech and Hearing” OR “Speech-Language Pathology and Audiology” OR “Speech-Language-Hearing Pathology” OR “Social Workers” OR “Social Worker” OR “Worker, Social” OR “Workers, Social” OR “Patient Care Team” OR “Care Team, Patient” OR “Care Teams, Patient” OR “Patient Care Teams” OR “Team, Patient Care” OR “Teams, Patient Care” OR “Medical Care Team” OR “Care Team, Medical” OR “Care Teams, Medical” OR “Medical Care Teams” OR “Team, Medical Care” OR “Teams, Medical Care” OR “Interdisciplinary Health Team” OR “Health Team, Interdisciplinary” OR “Health Teams, Interdisciplinary” OR “Interdisciplinary Health Teams” OR “Team, Interdisciplinary Health” OR “Teams, Interdisciplinary Health” OR “Healthcare Team” OR “Healthcare Teams” OR “Team, Healthcare” OR “Teams, Healthcare” OR “Health Care Team” OR “Care Team, Health” OR “Care Teams, Health” OR “Health Care Teams” OR “Team, Health Care” OR “Teams, Health Care”) AND (Communication OR “Communications Personnel” OR “Personnel, Communications” OR “Communication Barriers” OR “Barrier, Communication” OR “Barriers, Communication” OR “Communication Barrier”)
Context	- Different Health Care Scenarios - The context (Co) terms were not considered in the search strategy, as the context represents the care types and levels (from primary care such as Basic Health Units to Family Health Teams, specialized care such as specialized outpatient services, and in-hospital care such as general hospitals and university hospitals, among others). With this strategy, it was possible to expand the search and retrieval to any of the care levels; the most important point was to identify how health professionals communicate with hearing impaired people during care provision at any health care level.

Universidade Federal do Paraná Av. Prefeito Lothário Meissner, 632, Cep: 80210-170, Brasil - Paraná / Curitiba, Tel: +55 (41) 3361-3755 - Curitiba - PR - Brazil
E-mail: cogitare@ufpr.br

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[1] Corresponding author: Domisy de Araújo Vieira Universidade Federal Fluminense Rua Maria Das Dores nº 141, conjunto Esperança 1.Q02,C03 CEP:69915-126 E-mail: domisyvieira@id.uff.br

S	Title/Year/Country	Objective	Design/Level of Evidence	Main results
S1¹⁰10 Britto FR, Samperiz MMF. Dificuldades de comunicação e estratégias utilizadas pelos enfermeiros e sua equipe na assistência ao deficiente auditivo. Einstein [Internet]. 2010 [cited on 2022 apr 28];8(1 Pt1):80-5. Available in: https://doi.org/10.1590/S1679-45082010AO1339. https://doi.org/10.1590/S1679-45082010AO...	Dificuldades e estratégias de comunicação utilizadas pelo enfermeiro e sua equipe no cuidado ao deficiente auditivo. 2010 Brazil	To identify the communication difficulties of the Nursing team with the hearing impaired and to know the strategies developed in non-verbal communication	Descriptive, exploratory study with a quantitative approach Level 5	Mimicry and lip reading were used my almost all the professionals, whereas the aid of a companion and writing were resorted to by the minority. Communication through LIBRAS rarely occurred.
S2¹¹11 Chaveiro N, Barbosa MA, Porto CC, Munari DB, Medeiros M, Duarte SBR. Atendimento à pessoa surda que utiliza a língua de sinais, na perspectiva do profissional da saúde. Cogitare Enferm. [Internet]. 2010 [cited on 2022 apr 28];15(4):639-45. Available in: http://dx.doi.org/10.5380/ce.v15i4.20359. http://dx.doi.org/10.5380/ce.v15i4.20359...	Atendimento à pessoa surda que utiliza a língua de sinais, na perspectiva do profissional da saúde 2010 Brazil	To characterize the communication between health professionals and deaf people who use SL and to describe the relationship resources used by the professionals.	Descriptive-analytical research study with a qualitative approach Level 5	The interpreter promotes improvement in communication, although this is not decisive for food quality care. The professionals are not sufficiently prepared to care for deaf people.
S3¹²12 Ferreira DRC, Alves FAP, Silva EMA, Linhares FMP, Araújo GKNA. Assistência à gestante surda: barreiras de comunicação encontradas pela equipe de saúde. Saúde Redes. [Internet]. 2019 [cited on 2022 apr 28];5(3):3142. Available in: https://doi.org/10.18310/2446-4813.2019v5n3p31-42. https://doi.org/10.18310/2446-4813.2019v...	Assistência à gestante surda: barreiras de comunicação encontradas pela equipe de saúde 2019 Brazil	To identify the main communication barriers and mean between the health team and deaf pregnant women.	Descriptive and exploratory study of a quantitative nature Level 5	90% of the professionals had no knowledge of LIBRAS. The companion was referred to as the interpreter by 100% of the participants; 75.0% asserted that there were communication barriers between them and the deaf pregnant women. The professionals associate lack of knowledge in LIBRAS with inadequacy of the assistance provided.
S4¹³13 Ljubicic M, Zubcic S, Sare S. Communication between nurses and deaf people in health institutions. In: CBU International Conference Proceedings, Research Institute; 2017. v. 5. p. 958-65; Praga (CZ). Available in: http://dx.doi.org/10.12955/cbup.v5.1052. http://dx.doi.org/10.12955/cbup.v5.1052...	Communication between Nurses and Deaf People in Health Institutions 2017 Croatia	To examine the communication difficulties experienced by deaf people with a health institution.	Cross-sectional study Level 5	Communication takes place by showing (95.1%), writing (62.5%) and speaking (50%). The manual alphabet (20%) and sign language (12.5%) are less used.
S5¹⁴14 Lyall FC, Clamp PJ, Hajioff D. Smartphone speech-to-text applications for communication with profoundly deaf patients. J. Laryngol. Otol. [Internet]. 2016 [cited on 2022 apr 28];130(1):104-106. Available in:https://doi.org/10.1017/S0022215115003308. https://doi.org/10.1017/S002221511500330...	Smartphone speech-to-text applications for communication with profoundly deaf patients 2016 United Kingdom	To establish the feasibility of communication through voice recognition software for smartphones, when compared to writing or typing.	Prospective study Level 3	The mean time for smartphone dictation was significantly lower than writing or typing. Speech recognition was slightly less precise, but accuracy increased with time spent dictating.
S6¹⁵15 Machado WCA, Machado DA, Figueiredo NMA, Tonini T, Miranda RS, Oliveira GMB. Sign language: how the nursing staff interacts to take care of deaf patientsR. Pesq. Cuid. Fundam. Online [Internet]. 2013. [cited on 2022 apr 28];5(3):283-292. Available in: https://doi.org/10.9789/2175-5361.2013v5n3p283. https://doi.org/10.9789/2175-5361.2013v5...	Língua de sinais: como a equipe de enfermagem interage para cuidar de clientes surdos? 2013 Brazil	To identify how professionals from the Nursing team of a university hospital interact to care for their deaf clients.	Descriptive, exploratory, quantitative and qualitative research study Level 6	57% of the professionals reported never having provided care to deaf clients. 43% have provided care to deaf clients. 46.15 used mimicry; 15.38%, lip reading; 30.77%, written language; 3.85% resorted to drawings; and 3.85% had help from an interpreter to communicate with deaf clients.
S7¹⁶16 Magrini AM, Santos TMM. Comunicação entre funcionários de uma unidade de saúde e pacientes surdos: um problema? Distúrb. Comum. [Internet]. 2014 [cited on 2022 apr 28]; 26(3):550-58. Available in: https://revistas.pucsp.br/index.php/dic/article/view/14880/15215. https://revistas.pucsp.br/index.php/dic/...	Comunicação entre funcionários de uma unidade de saúde e pacientes surdos: um problema? 2014 Brazil	To investigate the communication between employees and deaf patients in a health unit, and consequent compliance with Decree No. 5,626.	Cross-sectional study Level 5	80% of the participants assist deaf people but they do not feel prepared for this (97.5%) and do not know LIBRAS (92.5%). 77.5% know about the existence of and need to know LIBRAS, but do not seek preparation due to lack of time, lack of information about the course, financial problems, and because they do not see the importance of learning the language specifically. 97.5% would like the unit to provide a specific LIBRAS course.
S8¹⁷17 Marquete VF, Costa MAR, Teston EF. Comunicação com deficientes auditivos na ótica de profissionais de saúde. Rev. Baiana Enferm. [Internet]. 2018 [cited on 2022 apr 28];32:e24055. Available in: https://doi.org/10.18471/rbe.v32.24055. https://doi.org/10.18471/rbe.v32.24055...	Comunicação com deficientes auditivos na ótica de profissionais de saúde 2018 Brazil	To describe health professionals’ knowledge and training regarding communication with the hearing impaired.	Quantitative and descriptive research study Level 6	92.4% believed they were unprepared to assist the hearing impaired, 83.8% did not know how to communicate with them, and 96.5% did not know how to communicate in LIBRAS. Many used strategies such as gestures and writing (18.7%) or speech and gestures (11.6%), among others.
S9¹⁸18 Miranda RS, Schubert CO, Machado WCA. A comunicação com pessoas com deficiência auditiva: uma revisão integrativa. R. Pesq. Cuid. Fundam. Online [Internet]. 2014. [cited on 2022 apr 28]; 6(4):1695-1706. Available in: https://doi.org/10.9789/2175-5361.2014.v6i4.1695-1706. https://doi.org/10.9789/2175-5361.2014.v...	A comunicação com pessoas com deficiência auditiva: uma revisão integrativa 2014 Brazil	To identify in the literature how communication between health professionals and patients with hearing impairments takes place.	Integrative review Level 6	All 19 articles were grouped into the following categories: communication strategies; professional training; professional relationship with deaf people; and suggestions to improve communication between deaf people and health professionals.
S10¹⁹19 Oyama SMR, Terceiro FABM, Parazzi LC. Comunicação do enfermeiro docente na assistência a pessoas cegas e surdas. Cuid Arte, Enferm. [Internet]. 2017. [cited on 2022 apr 28]; 11(1):78-85. Available in: http://www.webfipa.net/facfipa/ner/sumarios/cuidarte/2017v1/11%20Artigo%20Comunica%C3%A7%C3%A3o%20do_Enfermeiros%20%20docente%20pessoas%20cegas%20e%20ou%20surdas.pdf. http://www.webfipa.net/facfipa/ner/sumar...	Comunicação do enfermeiro docente na assistência a pessoas cegas e surdas 2017 Brazil	To report communication strategies used by teaching nurses in assisting deaf and/or mute individuals.	Descriptive and cross-sectional study Level 5	71% of the interviewees needed help from a companion, 64% used mimicry, 64% resorted to writing, 50% used lip reading and 29% mastered and used LIBRAS communication.
S11²⁰20 Soares IP, Lima EMM, Santos ACM, Ferreira CB. Como eu falo com você? A comunicação do enfermeiro com o usuário surdo. Rev. Baiana Enferm. [Internet]. 2018 [cited on 2022 apr 28];32:e25978. Available in: https://doi.org/10.18471/rbe.v32.25978. https://doi.org/10.18471/rbe.v32.25978...	Como eu falo com você? A comunicação do enfermeiro com o usuário surdo 2018 Brazil	To describe the knowledge and practices of primary care Nursing professionals in assisting deaf users.	Descriptive and exploratory study with a qualitative approach Level 6	Practices used to ease communication: presence of a companion during the consultations; use of writing; use of body language. For the use of writing, it was necessary to ensure that the user knew how to read and write. Body language and use of other senses, such as gestures and lip reading, were also considered communication facilitators.
S12²¹21 Pagliuca LMF, Fiúza NLG, Rebouças CBA. Aspectos da comunicação da enfermeira com o deficiente auditivo. Rev. Esc. Enferm. USP [Internet]. 2007 [cited on 2022 apr 28];41(3):411-8. Available in: https://doi.org/10.1590/S0080-62342007000300010. https://doi.org/10.1590/S0080-6234200700...	Aspectos da comunicação da enfermeira com o deficiente auditivo 2007 Brazil	To explore the aspects of communication between nurses and the hearing impaired.	Exploratory and descriptive study Level 6	Nurses realize that it is difficult to communicate with the hearing impaired, although some of them do so satisfactorily. In this process, some refer to using both non-verbal communication, through mimicry and lip reading, as well as oral and written verbal communication. Others resort to the companion, breaking secrecy of the consultation.
S13²²22 Vanegas BC, Castro LH, Páez MP, Ramires NS, Salcedo LJ,C. Comunicación del profesional de enfermería con un paciente que presenta dificultad en la expresión verbal por sordera. Rev. Colomb. Enferm. [Internet]. 2008 [cited on 2022 apr 28]; 3(3):13-20. Available in: https://doi.org/10.18270/rce.v3i3.1398. https://doi.org/10.18270/rce.v3i3.1398...	Comunicação do profissional de enfermagem com pacientes que apresentam dificuldade de expressão verbal devido à surdez 2008 Colombia	To verify how Nursing professionals communicate with patients who have difficulty in verbal expression due to deafness.	Qualitative and phenomenological approach Level 6	Among the main communication means they use for this purpose are those described below: interaction through the companion, who is used as an interlocutor, writing, careful gestures, making graphs, signs or demonstrations or giving a child treatment to a patient.
S14²³23 Rosa CG, Barbsa MA, Bachion M.M. Comunicação da equipe de enfermagem com deficiente auditivo com surdez severa: um estudo exploratório. Rev. Eletrônica Enferm. [Internet]. 2000. [cited on 2022 apr 28]; 2(2). Available in: https://revistas.ufg.br/fen/article/view/684. https://revistas.ufg.br/fen/article/view...	A comunicação da equipe de enfermagem com a pessoa com deficiência auditiva com surdos diversos: um estudo exploratório 2,000 Brazil	To survey aspects related to the communication of the Nursing team with a hearing impaired patient with severe deafness.	Exploratory study Level 6	The main ways to communicate with deaf patients were the following: gestures, lip reading, mimicry, body language and writing.
S15²⁴24 Martínez NL, Miranda RM. Intervenciones de comunicación exitosas para el cuidado de la salud en personas con discapacidad auditiva. Enferm. Univ. [Internet]. 2012. [cited on 2022 apr 28]; 9(4):57-68. Available in: http://www.scielo.org.mx/pdf/eu/v9n4/v9n4a6.pdf. http://www.scielo.org.mx/pdf/eu/v9n4/v9n...	Intervenções de comunicação bem-sucedidas para cuidados de saúde em pessoas deficientes auditivas 2012 Brazil	To research which the communication interventions are for the health care of people with hearing impairments existing in the Nursing literature from 2000 to 2012.	Integrative review Level 6	The results of this review confirm that non-verbal communication in its sign language modality, visual materials and use of interpreters are extremely successful in care for establishing the communicative process, as they are part of their own linguistic system and are officially recognized as part of a deaf culture.
S16²⁵25 Dantas TRA, Gomes TM, Costa TF, Azevedo TR, Brito SS, Costa KNFM. Comunicação entre a equipe de enfermagem e pessoas com deficiência auditiva. Rev. Enferm. UERJ. [Internet]. 2014. [cited on 2022 apr 28]; 22(2):169-74. Available in: https://www.e-publicacoes.uerj.br/index.php/enfermagemuerj/article/view/13559. https://www.e-publicacoes.uerj.br/index....	Comunicação entre a equipe de enfermagem e pessoas com deficiência auditiva 2014 Brazil	To analyze the communication between the Nursing team and people with hearing impairments in a teaching hospital from the city of João Pessoa-PB.	Descriptive research study with a qualitative approach Level 6	It was evidenced that the Nursing team has difficulties establishing communication with hearing impaired people, as they do not know LIBRAS, reason why they use strategies such as lip reading, mimicry, writing and intermediation of companions.