D/deaf人群的沟通可及性与急诊护理：患者体验的反思性主题分析

文献信息

中文摘要

目的： 探讨D/deaf人群在急诊科就诊期间如何体验沟通可及性，并确定他们认为对可及且安全的急诊护理最重要的改变。
设计： 采用反思性主题分析的解释性定性调查研究。
方法： 在一项可及的双语澳大利亚手语-英语调查中，对开放式问题的书面回答在批判性、系统导向的框架内进行分析。解释受到聋人长者及D/deaf咨询视角的启发。
结果： 叙述描述了广泛的沟通障碍，包括手语翻译缺席或延迟、视频远程口译的局限性以及被期望唇读、书写或依赖家庭成员。这些反映了以听力为中心的急诊护理，将沟通责任转移给患者。在紧急或疼痛就诊期间，恐惧、困惑和沮丧尤为明显。积极体验与早期手语翻译参与、视觉沟通策略以及工作人员对手语的熟悉程度相关。参与者确定了系统层面的改变，包括随叫随到手语翻译路径、聋人意识培训以及改进的视觉和非听觉沟通系统。
结论： D/deaf患者的沟通可及性不确定且支持不一致。改善护理需要组织层面的方法，将手语翻译可及性、视觉沟通系统和聋人知情培训嵌入常规实践。
对专业和/或患者护理的启示： 沟通可及性应通过可靠的手语翻译路径、视觉沟通系统和聋人知情的工作人员教育嵌入常规急诊护理中。
影响： 本研究确定了可能影响D/deaf患者在急诊护理中的安全、理解和参与的沟通障碍，并强调需要组织层面的沟通可及性方法。
报告方法： 报告遵循基于共识的调查研究报告清单（CROSS）。
患者或公众贡献： D/deaf人群参与了研究设计、招募、分析和解释。调查项目与聋人长者和D/deaf咨询团队共同完善。一位聋人长者共同作者参与了招募和手稿撰写，而咨询意见影响了主题完善并挑战了以听力为中心的解释。

英文摘要

AIM: To examine how D/deaf people experience communication access during emergency department visits and identify changes they consider most important for accessible and safe emergency care.
DESIGN: Interpretive qualitative survey study using reflexive thematic analysis.
METHODS: Written responses to open-ended questions in an accessible bilingual Auslan-English survey were analysed within a critical, system-oriented framework. Interpretation was informed by Deaf Elder and D/deaf advisory perspectives.
RESULTS: Accounts described widespread communication barriers, including absent or delayed interpreters, limitations of video remote interpreting and expectations to lip-read, write or rely on family members. These reflected hearing-centred emergency care that shifted communicative responsibility onto patients. Fear, confusion and frustration were particularly evident during urgent or painful presentations. Positive experiences were associated with early interpreter engagement, visual communication strategies and staff familiarity with sign language. Participants identified system-level changes, including on-call interpreter pathways, Deaf awareness training and improved visual and non-auditory communication systems.
CONCLUSION: Communication access was uncertain and inconsistently supported for D/deaf patients. Improving care requires organisational approaches that embed interpreter access, visual communication systems and Deaf-informed training within routine practice.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Communication access should be embedded within routine emergency care through reliable interpreter pathways, visual communication systems and Deaf-informed staff education.
IMPACT: This study identifies communication barriers that can affect safety, understanding and participation for D/deaf patients in emergency care and highlights the need for organisational approaches to communication access.
REPORTING METHOD: Reporting was guided by the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).
PATIENT OR PUBLIC CONTRIBUTION: D/deaf people contributed to study design, recruitment, analysis and interpretation. Survey items were refined with Deaf Elders and a D/deaf advisory team. A Deaf Elder co-author contributed to recruitment and manuscript development, while advisory input informed theme refinement and challenged hearing-centred interpretations.