There are many possible explanations for why Mr. Cruz might not respond. They include:
- He may speak a language other than English
- He could be deaf or hard of hearing, perhaps with a hearing aid that is not working or lost
- He may use a communication device that was not sent with him from his mother’s house
- He could be having difficulty understanding the FNP if she is using medical jargon or complex language
- He may have difficulty with communicating with people he is meeting for the first time
- His intellectual disability may limit his ability to understand even simple language and he may require pictures
Skillful communication, taking the client’s needs into account, is an important aspect of providing full access to services for people with ID. Helpful resources are available in Module 2 of this training in Communication Skills Scenario 1- Communication skills for working with people with ID in the context of health care and wellness encounters (https://iddhealthtraining.org/module-2/scenario-1/).
If the provider and the client speak different languages and are from different cultural backgrounds, the provider must also be skilled in working cross culturally and in working with interpreters. Resources are available in Module 2 of this training in Communication Skills Scenario 2- Cultural and linguistic competency in communication; working with interpreters (https://iddhealthtraining.org/module-2/scenario-2/).
Communication with people with ID who also have sensory challenges such as hearing loss and visual impairment involves careful consideration of specific client needs and modes of communication, including the use of technology. Resources on this are found in two scenarios in Module 2 of this training: Scenario 6–Use of technology to enable effective communication by and with people with ID (https://iddhealthtraining.org/module-2/scenario-6/) and Scenario 6- Communication with people with sensory challenges such as hearing loss and visual impairment (https://iddhealthtraining.org/module-2/scenario-7/).
The Disability Rights and Education Defense Fund (DREDF) has produced a helpful learning module on effective communication with people who have sensory disabilities (https://dredf.org/wp-content/uploads/2014/11/Module-3-Effective-Communication-10-14.pdf).
Case Continuation
Ms. Scott tells the FNP that Mr. Cruz has left his hearing aid in the car. She also states that Mr. Cruz speaks and understands Spanish but not English; his mother spoke Spanish in the home. She offers that she is bilingual and would be happy to translate for the FNP. The FNP thanks her, explains that it is preferable to use a trained medical translator and leaves the room to get the phone number for the translation service that the practice uses. The aide goes to the car to get the hearing aid.
With his hearing aid in place and the Spanish translator on the line, Mr. Cruz is able to participate to a certain extent in the conversation. When the FNP asks him a few questions about his diabetes, he tells her he has had diabetes for “a long time” and that he checks his glucose and takes insulin once per day “by a shot.” He states that his mother used to help him set an alarm on his wristwatch so he would know when it was time for his insulin each day. His sister volunteers that he requires assistance with drawing up and administering the insulin and has never given himself the injection. The aide states that since being at the group home, Mr. Scott has injected his own insulin but does need assistance in drawing up the correct dose into the syringe. He produces a booklet in which his mother recorded blood glucose levels for him. The FNP notes that only one to two blood glucose levels are recorded per week and that they were frequently above acceptable values.
After completing the medical history, the FNP asks Ms. Scott and the aide to leave the room, but keeps the translator on the phone for the next part of the visit. She explains to Mr. Cruz that she would like to examine him and asks him if he needs help from the staff nurse to change into an examination gown.
She steps out of the room to review what is already in his medical record. She notes that his weight is 280 lb and his Body Mass Index is 40.2, in the obese range.
Question 1.4
Mr. Cruz has obesity and diabetes. How do obesity and diabetes figure in the health of people with intellectual disabilities?