Challenges in nursing care for deaf women during the pregnancy and postpartum period: integrative review

INTRODUCTION

The World Health Organization (WHO) estimates that 466 million people worldwide have moderate to profound bilateral hearing loss, with two-thirds of them living in developing countries.¹ In Brazil, data from the Brazilian Institute of Geography and Statistics (IBGE) in 2015 indicated that approximately 28 million people have hearing impairments, representing 14% of the Brazilian population.^2,3 Most deaf individuals in Brazil use Brazilian Sign Language (LIBRAS) for communication and identify themselves as part of a linguistic and cultural community, where hearing loss is seen as an identity rather than a disability.^2-4

A person is considered deaf if they have bilateral hearing loss of 41 decibels (dB) or more, whether partial or total, and interact with the world primarily through visual experiences and the use of LIBRAS.^2-3 The Statute of the Person with Disabilities guarantees this group the right to access health services and information through technological resources and various forms of communication, including LIBRAS, as stipulated in Article 3, Section V.^2-3

Decree No. 5.626, dated December 22, 2005, officially recognizes LIBRAS and mandates the implementation of health care services for this population in both public and private networks, provided by professionals trained in the use or interpretation of LIBRAS.^2-3 However, this population continues to face challenges in accessing health services, particularly due to communication barriers and difficulties in obtaining information from standard care sources, leading to inequalities and marginalization in health promotion resources.^2,4-6

Studies reveal that, despite being a right, individualized and quality care for deaf patients faces challenges in being both humane and comprehensive due to restricted communication. Strategies such as writing, lip reading, gestures, and the presence of family members are employed, but the lack of LIBRAS usage by health care workers, particularly nursing staff, weakens communication and interaction with patients, hindering access to health services at all levels of care.^5-8

The communication challenges faced by the deaf population limit health care, resulting in lower problem resolution rates and a lack of strong bonds between nurses and patients. Communication is one of the most valuable tools in nursing care, enabling the understanding of the patient's social context, beliefs, anxieties, and needs, with the goal of minimizing discomfort during the care process. Nurses have an ethical and legal responsibility to provide equivalent health care to deaf patients as they do to others, through effective communication, autonomy, and confidentiality.^9-10

Health care for deaf individuals does not align with what current laws guarantee, with deaf women often being perceived as incapable by society, facing prejudice and inequality.^9-10 In the context of care for pregnant and postpartum women, this reality is even more pronounced, as these women require specific and individualized care. Today, they are consciously choosing to experience motherhood, making it essential that care during pregnancy, childbirth, and the postpartum period be intensified to help them overcome the obstacles imposed by hearing limitations and pregnancy itself.^10-11

In practice, disparities exist in health services when comparing care provided to deaf and non-deaf women. Nurses, who are in direct and daily contact with patients, play a crucial role, but many nursing professionals are not adequately prepared to care for this population due to a lack of basic knowledge or previous contact with LIBRAS, which compromises the quality of care.^11-12

Therefore, there is an urgent need to deepen discussions on this topic as there is a significant gap in the care of pregnant, birthing and postpartum deaf women. The development of studies in this area is critical to building knowledge that can be incorporated into practice and serve as a basis for the creation of targeted public policies.^11-12

OBJECTIVE

This study aims to identify in the literature the challenges of nursing care during the pregnancy and postpartum period for deaf women and the impacts on maternal health.

METHOD

This study is an integrative literature review, a method that allows for the presentation of various perspectives on a given phenomenon while adhering to rigorous methodology.¹³

The research focused primarily on variables related to the type of care provided and patients’ perceptions of the care they received during pregnancy and the postpartum period through qualitative analysis.

This review was conducted in six methodological stages: 1) identification of the review question; 2) literature search; 3) establishment of inclusion and exclusion criteria; 4) categorization of the studies; 5) evaluation of the studies included in the integrative review; and 6) interpretation of results and presentation of the review/synthesis of knowledge.^13-14

In the first stage, the PCC acronym (Population: “women”; Concept: “pregnancy”; Context: “deafness”) was used to formulate the research question. The resulting review question was: “What are the challenges of nursing care during the pregnancy and postpartum period for deaf women, and what are the impacts on maternal health?”

Descriptors in Health Sciences (DeCS) were used for national databases, and Medical Subject Headings (MeSH) were used for international databases. The controlled descriptors used were: “surdez/ deafness/ sordera,” “mulheres/ women/ mujeres,” “gravidez/ pregnancy/ embarazo,” “parto/ delivery,” and “período pós-parto/ postpartum period/ período posparto.”

Search for relevant articles was conducted in November and December 2022. The databases consulted included PubMed, CINAHL, LILACS, Embase, and the Cochrane Library. Boolean operators OR and AND were used to combine the descriptors.

In the third stage, the inclusion criteria defined were: full-text articles available electronically and for free, in Portuguese, English, and/or Spanish. Editorials, letters to the editor, dissertations, theses, experience reports, and reflective studies were excluded. No publication date limit was set to include as many relevant publications as possible.

For categorizing the studies that met the criteria, the recommendations from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed. Information from the studies was extracted through a four-stage process: identification, screening, eligibility, and inclusion (Figure 1).

Figure 1. Flowchart of the article selection stages. Bandeirantes (PR), Brazil, 2022.

From the combination of descriptors, 383 articles were initially selected for review. Of these, 35 were duplicates, identified using the State of the Art through Systematic Review software. The titles and abstracts of 348 articles were then reviewed, and 32 were selected for full-text reading. In the end, 7 articles were included.

In the fifth stage of this research, the selected studies for the integrative review were read in pairs. In cases of disagreement between the authors, the articles were referred to a third reviewer. Subsequently, a full reading of the studies that met the inclusion criteria and aligned with the research objective was conducted.

In the sixth stage, the data were analyzed and presented in tables, summarizing the selected articles as follows: 1) characterization of the included studies (ID, title, journal, year, country, design, and sample); 2) characteristics associated with nursing care (pregnancy-postpartum period, nursing care, patient perception); and main results (study objective, key findings, and conclusions).

For interpreting the results and presenting the review, the findings were discussed based on the converging themes identified in the articles. The content extracted from the articles that comprised the sample was integrated into the results and discussion sections of this study. Ethical principles were strictly followed, with proper citation of authors and verification that studies involving human subjects had received approval from an ethics review board.

RESULTS

The results of this research are presented in tables that detail the characterization of the studies mentioned in the article, the characteristics of nursing care during the pregnancy and postpartum period, and the main findings obtained from this review.

Regarding the characterization of the studies, the American Journal of Preventive Medicine was the journal with the most publications. Sample sizes ranged from 1 to 6,745,201 participants, with most of the publications (85.7%) being international, and only one being a national publication (Chart 1).

Chart 1. Characterization of the studies. Bandeirantes (PR), Brazil, 2022.

ID	Title	Journal	Year	Country	Design	Sample
65	Pregnancy Outcomes Among Deaf Women in Washington State, 1987–201213	The American College of Obstetricians and Gynecologists	2017	United States of America	Retrospective cohort	645
1815	Acolher e escutar o silêncio: o cuidado de enfermagem sob a ótica da mulher surda durante a gestação, parto e puerpério14	Revista de pesquisa Cuidado é Fundamental Online	2018	Brazil	Exploratory descriptive	9
ID	Title	Journal	Year	Country	Design	Sample
1925	Differences in Prenatal Care by Presence and Type of Maternal Disability15	American Journal of Preventive Medicine	2019	United States of America	Retrospective cohort	6.745.201
1945	Promoting Best Practice for Perinatal Care of Deaf Women16	Nursing for Women's Health	2018	United States of America	Descriptive	5
1961	"They must understand we are people": Pregnancy and maternity service use among signing Deaf women in Cape Town17	Disability and Health Journal	2017	South Africa	Cross-sectional	42
1973	Birth Outcomes Among U.S. Women With Hearing Loss18	American Journal of Preventive Medicine	2016	United States of America	Cross-sectional	10.462
2087	Family-centered maternity care for deaf refugees: the patient-centered medical home in action19	Families, Systems, & Health	2009	United States of America	Case report	1

The analysis of the articles revealed that two of them (28.6%) focused on pregnancy and the postpartum period, two addressed only pregnancy (28.6%), and three focused on pregnancy and childbirth (42.8%). Five studies (71.4%) identified the absence of interpreter services and communication barriers as the main obstacles in providing care to deaf women. In contrast, two other studies (28.6%) reported favorable outcomes due to the presence of interpreters during consultations (Chart 2).

Regarding the patients’ perceptions of the care received, four studies (57.1%) did not mention this aspect. Among the three studies (42.9%) that did, the absence of interpreters, lack of knowledge of LIBRAS by professionals, and additional difficulties such as rapid speech, which complicates lip reading, impatience and rudeness from the healthcare team, and the use of masks, which limit communication, were highlighted (Chart 2).

Chart 2. Characteristics Related to Nursing Care During the Pregnancy and Postpartum Period. Bandeirantes (PR), Brazil, 2022.

ID	Pregnancy-postpartum period	Nursing care	Patient perception
65	Pregnancy and postpartum 13	Interpreter services are not consistently available in some hospitals, which may be related to increased postpartum vaginal hospitalization days.	Not mentioned.
ID	Pregnancy-postpartum period	Nursing care	Patient perception
1815	Pregnancy and postpartum 14	Participants unanimously reported minimal contact with the nursing team during pregnancy. This issue also occurred during childbirth, postpartum, and breastfeeding guidance, directly related to communication barriers between these patients and professionals.	Interviewees pointed out the lack of interpreters, reliance on a companion, lack of professional knowledge of LIBRAS, the speed of speech by professionals, and the use of masks, which hindered lip reading.
1925	Pregnancy 15	Women with limited hearing experienced delays in starting prenatal care and had a low number of consultations, directly linked to difficulties in obtaining interpreters, indicating poor care.	Not mentioned.
1945	Pregnancy and childbirth16	Participants reported both positive experiences, such as the presence of interpreters during care, and negative ones, such as the use of masks by health care workers and a lack of patience.	There were reports of impatience from professionals. Participants also expressed dissatisfaction with the way newborn hearing exams were conducted and the communication with parents. The delay in obtaining interpreters was also a noted issue.
ID	Pregnancy-postpartum period	Nursing care	Patient perception
1961	Pregnancy and childbirth17	About 38% of participants mentioned linguistic barriers, and 15% mentioned mistreatment.	Communication problems were evident due to limited interpretation services and the use of complex terminologies. Additionally, 15% of participants reported rudeness, shouting, and negligence.
1973	Pregnancy and childbirth18	Deaf women were more likely to have preterm births and newborns with low birth weight, highlighting the need for more studies and programs aimed at comprehensive care for this population.	Not mentioned.
2087	Pregnancy 19	The study indicated higher quality care due to the presence of interpreters and individualized attention from the workers involved in the care.	Not mentioned.

The results also indicated an increase in preterm birth rates among deaf women (28.6%). One of the studies demonstrated that deaf pregnant women are at higher risk of not receiving the minimum number of prenatal consultations. The studies highlighted the importance of understanding deaf culture, implementing interpretation services, and professional training as essential factors in overcoming communication barriers (42.8%) (Chart 3).

Quadro 3. Principais resultados dos artigos analisados. Bandeirantes (PR), Brazil, 2022.

ID	Objective	Main findings	Conclusion
65	To evaluate the gestational and neonatal outcomes of deaf women using population-based vital records in Washington State from 1987 to 2012.13	A modestly increased risk of cesarean delivery was identified for deaf women, along with a higher risk of preterm birth and low birth weight.	Deaf women have an increased risk of preterm birth and low birth weight.
1815	To identify the perception of deaf women regarding nursing care during pregnancy, childbirth, and the postpartum period.14	Unprepared nursing staff, lack of interpreters, rapid speech by professionals, and the use of masks hindered communication.	Communication barriers are a clear issue in the interaction between deaf women and health care workers.
1925	To examine and describe the timing and frequency of prenatal care among women with physical, sensory, or intellectual disabilities compared to women without disabilities.15	Women with hearing, visual, or intellectual disabilities had less prenatal care than recommended.	Specific interventions for deaf women are necessary to improve the acceptance of prenatal care.
1945	To evaluate perinatal nursing care for deaf women using the Quality and Safety Education for Nurses (QSEN) framework to analyze women’s responses and explore implications for practice.16	The QSEN framework was deemed most suitable for analyzing responses and translating them into nursing practice.	Greater understanding of deaf culture and the use of accessible technologies are essential for best practices in care.
ID	Objective	Main findings	Conclusion
1961	To describe and compare pregnancy outcomes and the use of maternity services among signing deaf women of childbearing age in Cape Town with the population of Western Cape, South Africa.17	Limited interpretation services and reports of mistreatment in the hospital.	Improving care requires the implementation of interpretation services.
1973	To estimate the national occurrence of births among women with hearing loss and compare birth outcomes with those of women without hearing loss.18	Women with hearing loss were more likely to have preterm births.	The study reveals significant disparities in birth outcomes between women with and without hearing loss.
2087	To present the experience of applying the principles of the Patient-Centered Medical Home (PCMH) in the care of a newly immigrated Vietnamese refugee couple with no formal language skills.19	The presence of interpreters throughout labor, delivery, and postpartum repair was crucial.	The presence of interpreters, patient-centered care, and a multidisciplinary team are essential to overcoming communication barriers.

DISCUSSION

The results of this study indicate that the primary challenge in providing healthcare to deaf women during the pregnancy and postpartum period is ineffective communication between patients and nursing professionals, primarily due to the absence of interpreters during care.¹⁵ This communication gap often necessitates that deaf women are always accompanied, which can hinder the development of a strong professional-patient relationship, leading to omissions, impatience, and less effective and resolutive care.^15-16

One of the studies included in the review (ID: 1815) provided testimonies from deaf women that illustrate this reality: “The nurses don’t know LIBRAS and have no patience,” and “It’s hard to always have to bring my mother with me wherever I go. The professionals should know LIBRAS”.^15-19

Another study (ID: 65) highlighted a significant effect of this communication breakdown: an increase in postpartum vaginal hospitalization days and the overall length of stay for deaf women: “Deaf women had a moderately increased risk of hospitalization for 4 or more days after vaginal delivery.” Other negative outcomes include difficulties with breastfeeding due to inadequate guidance, delays in prenatal care, low adherence to prenatal consultations, and an increased risk of premature birth.^17-18

Low adherence to prenatal care is another negative factor impacting care for deaf pregnant and postpartum women. One study (ID: 1925) found that deaf women tend to start prenatal care later and receive less care during pregnancy, ranking just behind women with intellectual and developmental disabilities in terms of the quality of care received.^17-20

Despite the absence of interpreters and health care workers trained to communicate with deaf patients, alternative strategies such as lip-reading, the presence of a companion, and manual writing are used. However, studies (ID: 1815, 1961, 1945) have shown that these techniques are often ineffective, as the presence of a companion can limit privacy, and lip-reading is hindered by the use of masks and specialized terminology.¹⁹

The experience of pregnancy is unique, evoking a range of emotions that can impact the pregnancy and postpartum period. Therefore, effective communication is essential to understanding these emotions and contributing positively to the health of deaf women.^15-19

One study (ID: 1961) reported instances of mistreatment by healthcare professionals during obstetric care, including verbal aggression, rudeness, disregard, and prolonged wait times.^20-22 Other authors also highlighted the inefficacy of care practices in Primary Care, emphasizing the lack of understanding by health care teams regarding effective communication with deaf women.^23-25

In contrast, a review published in Disability and Rehabilitation: Assistive Technology demonstrated that the use of assistive technologies can facilitate the learning of students with hearing impairments in educational environments. This approach could be explored within the health care system.^26-27

Articles (ID: 1945, 2087) in this review highlighted positive experiences in perinatal care for deaf women, thanks to the use of alternative methods such as the Quality and Safety Education for Nurses (QSEN) framework. These studies confirm that understanding deaf culture and using accessible technologies are essential for effective care practices.^26-28

Nurses, due to their training, work in various capacities, including education, management, coordination, implementation, and direct care, engaging with the patient-family-community triad across different levels of care. It is necessary for these professionals to uphold ethical principles and seek new ways to include deaf patients in the care process, ensuring their active participation. Therefore, incorporating LIBRAS training into the education of future healthcare professionals is essential.^28-29

A study conducted in Iran, which analyzed the performance of nursing students in caring for simulated deaf patients, revealed that 61.5% of the students had low levels of knowledge, and 87.3% performed poorly in communicating with these patients.²⁹ These findings highlight the inadequacy and delay in the training of future nurses in providing care to the deaf population.^29-30

In Brazil, Law 10.436, enacted on April 24, 2002, mandates that the educational system ensure the inclusion of LIBRAS instruction in Special Education, Speech-Language Pathology, and Teacher Training courses, as part of the National Curriculum Guidelines (PCNs).³¹ Decree 5.626 of 2005 further regulated this law, making the inclusion of LIBRAS mandatory in the curricula of Speech-Language Pathology programs and various teacher training courses.³²

Despite these laws, many public and private educational institutions have not fulfilled the requirement to include LIBRAS in their health-related programs, with many not offering it as a mandatory subject or even including it in their curricula. A study comparing sign language laws in Brazil and Sweden showed that in Sweden, the right to acquire and use Swedish Sign Language as a mother tongue is guaranteed by law, and the country effectively creates the conditions for its acquisition, viewing deaf individuals primarily as Swedes.^33-34

In this context, the care of deaf women during pregnancy and postpartum needs to be restructured to be more inclusive and humane. This includes the inclusion of LIBRAS teaching in schools and universities, the use of new technologies and, most importantly, the training of health care workers to adequately address the needs of this population.

CONCLUSION

This review identified the available evidence in the literature regarding nursing care provided to deaf women during pregnancy, childbirth, and the postpartum period. It was found that the lack of inclusion of LIBRAS and inadequate awareness among nursing professionals in caring for deaf individuals reveal a significant gap that needs to be addressed and transformed.

The initial hypothesis, which suggested a substantial communication barrier between deaf patients and nursing professionals, was confirmed through the analysis of scientific studies. These results underscore the need for further research on this topic. This study is considered a valuable contribution to the scientific community, as it addresses a target population that has been relatively underexplored.

CONTRIBUTIONS

All authors contributed equally to all phases of the study, including the conception of the research project, data collection, analysis, interpretation, and discussion, as well as the writing and critical review of the content, with intellectual contributions and approval of the final version of the scientific article.

CONFLICT OF INTEREST

Nothing to declare.

FUNDING

Fundação Araucária (Call 001/2020).

REFERENCES

1. Zaien SZ, El-Houfey AA, Alqahtani H, El Sayed HAE, Elgzar WT, Essa RM, et al. Predictors of premarital screening and genetic counseling knowledge and attitude among deaf and hard hearing females in Tabuk, Saudi Arabia. Journal of medicine and life. 2022;15. DOI: https://doi.10.25122/jml-2021-0165

2. Brasil. Decreto n° 5.626, de 22 dezembro de 2005. Regulamenta a Lei nº10.436, de 24 de abril de 2002, que dispõe sobre Língua Brasileira de Sinais -Libras, e o art. 18 da Lei nº 10.098, de 19 de dezembro de 2000. Ministério da Saúde [Internet]. [cited 2022 mar]. Available from: http://www.planalto.gov.br/ccivil_03/_ato2004-2006/2005/decreto/d5626.htm

3. Conselho Federal de Enfermagem. Resolução COFEN nº 358/2009, de 15 de outubro de 2009. COFEN [Internet]. [cited 2022 mar]. Available from: http://www.cofen.gov.br/resoluo-cofen-3582009_4384.html

4. Grazioli VS, Graells M, Schmutz E, Cantero O, Sebai T, Favre V, et al.Developing a capacity-building intervention for healthcare Workers to improve communication skills and awareness of hard of hearing and D/deaf patients:results from a participatory action research study. BMC Health Serv Res. 2024;24(301). DOI: https://doi.org/10.1186/s12913-024-10574-3

5. Condessa AM, Giordani JMA, Neves M, Hugo FN, Hilgert JB. Barreiras e facilitadores à comunicação no atendimento de pessoas com deficiência sensorial na atenção primária à saúde: estudo multinível. Revista Brasileira de Epidemiologia. 2020;(23):e200074. DOI: https://doi.org/10.1590/1980-549720200074

6. Chandanabhumma PP, Ratakonda S, Panko T, Cuculick J, Hauser P, Paasche-Orlow MK, et al. Examining the diferences of perceptions and experience with online health information accessibility between deaf and hearing individuals: A qualitative study. Patient Education and Counseling. 2024;(122). DOI: https://doi.org/10.1016/j.pec.2024.108169

7. Cunha RP, Pereira MC, Oliveira ML. Enfermagem e os cuidados com pacientes surdos no âmbito hospitalar. Revista de Divulgação Científica Sena Aires. 2019;8(3):367-77p. Available from: https://www.researchgate.net/publication/345397955_Enfermagem_e_os_cuidados_com_pacientes_surdos_no_ambito_hospitalar

8. Sousa VS. Cuidados Inclusivos à Mulher Surda na Sala de Partos: Um Desafio à Intervenção do EE ESMO, Escola Superior de Enfermagem de Lisboa [Dissertação]. 2019. Available from: http://hdl.handle.net/10400.26/29475

9. Wetterich CB, Barroso HC, Freitas DAA. Comunicação entre surdos e profissionais da saúde: uma revisão bibliográfica. Educação Profissional e Tecnológica em Revista. 2020;4(1), 130-152p. DOI: https://doi.org/10.36524/profept.v4i1.520

10. Costa AP, Leite KAO, Silva HB, Pereira MAS, Almeida JLS, Crispiano EC, et al. Comunicação entre o enfermeiro e a pessoa surda. Revista Saúde Coletiva. 2023;3(85). DOI: https://doi.org/10.36489/saudecoletiva.2023v13i85p12660-12673

11. Marquete VF, Costa MAR, Teston EF. Comunicação com deficientes auditivos na ótica de profissionais de saúde. Revista Baiana de Enfermagem, 2018;32. DOI: https://doi.org/10.18471/rbe.v32.24055

12. Sá TM, Espósito LC, Pires LA, Ribeiro MT, Kropf RK. A importância do ensino de libras nos cursos de licenciaturas em enfermagem, Universidade Federal Fluminense. Available from: http://nuedisjornadacientifica.weebly.com/

13. Whittemore R, Knafl K. The integrative review: updated methodology. Journal of Advanced Nursing. 2005;52(5):546-553. DOI: https://doi.org/10.1111/j.1365-2648.2005.03621.x

14. Mendes KDS, Silveira RCCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto contexto - enferm, Florianópolis. 2008;17(4):58-764. DOI: https://doi.org/10.1590/S0104-07072008000400018

15. Costa AA, Vogt SE, Ruas EF, Holzmann AP, Silva PL. Welcome and listen to the silence: nursing care from the perspective of deaf woman during pregnancy, childbirth and postpartum. Revista Fundamental Care Online. 2018;10(1):123-129. DOI: https://doi.org/10.9789/2175-5361.2018.v10i1.123-129

16. Schiff MA, Dood DR, Crane DA, Mueller BA. Pregnancy Outcomes Among Deaf Women in Washington State, 1987-2012. Obstet Gynecol. 2017;130(5):953-960. DOI: https://doi.org/10.1097/aog.0000000000002321

17. Horner-Johnson W, Biel FM, Caughey AB, Darney BG. Differences in Prenatal Care by Presence and Type of Maternal Disability. Am J Prev Med. 2019;56(3):376-382. DOI: https://doi.org/10.1016/j.amepre.2018.10.021

18. Hubbard LJ, D’Andrea E, Carmen LA. Promoting Best Practice for Perinatal Care of Deaf Women. Nurs Womens Health. 2018;22(2):126-136. DOI: https://doi.org/10.1016/j.nwh.2018.02.002

19. Gichane MW, Heap M, Fontes M, London L. “They must understand we are people”: Pregnancy and maternity service use among signing Deaf women in Cape Town. Disabil Health J. 2017;10(3):434-439. DOI: https://doi.org/10.1016/j.dhjo.2017.03.016

20. Mitra M, Akobirshev I, Mckee MM, Iezzoni LI. Birth Outcomes Among U.S. Women With Hearing Loss. Am J Prev Med. 2016;51(6):865-873. DOI: https://doi.org/10.1016/j.amepre.2016.08.001

21. Balachandra SK, Carroll JK, Fogarty CT, Finigan EG. Family-centered maternity care for deaf refugees: the patient-centered medical home in action. Fam Syst Health. 2009;27(4):362-367. DOI: https://doi.org/10.1037/a0018214

22. Coelho KR, Aires LC, Schmith JB. Atendimento da equipe de enfermagem ao paciente surdo: percepções e estratégias de comunicação. Revista Interdisciplinar da Faculdade IELUSC. 2020;1(3):39-48. Available from: http://revistaredes.ielusc.br/index.php/revistaredes/article/view/80

23. Gomes ED, Torres RA, Freitas MC, Guedes MV, Veras KC, Maia SR, et al. Reflexões acerca da comunicação na Assistência de enfermagem a pessoa surda. Brazilian Journal of Development. 2020;6(11):93179- 93186. DOI: https://doi.org/10.34117/bjdv6n11-649

24. Ferreira DR, Alves FA, Silva EM, Linhares FM, Araújo GK. Assistência à gestante surda: barreiras de comunicação encontradas pela equipe de saúde. Saúde em Redes. 2019;5(3):31-42. DOI: https://doi.org/10.18310/2446-4813.2019v5n3p31-42

25. Silva AA, Almeida RS, Souza LF, Vasconcelos NJ, Lima MC, Ramos GN, et al. A atenção básica da saúde na vida da pessoa com surdez: reflexões sobre essa política pública. Brazilian Journal of Development [Internet]. 2021;7(3). Available from: https://ojs.brazilianjournals.com.br/ojs/index.php/BRJD/article/view/25819/20498

26. Nunes AL, Macêdo S. Atendimento à Pessoa Surda por Profissionais de Saúde em Hospital Universitário Pernambucano. Revista do NUFEN: Phenomenology and Interdisciplinarity. 2022;14(1):1-12. DOI: https://doi.org/10.26823/nufen.v14i1.21390

27. Barros XM. Atenção em saúde da população surda: uma revisão integrativa. Faculdade de medicina de Porto Alegre, Universidade Federal do Rio Grande do Sul [Dissertação]. 2018. Available from: https://lume.ufrgs.br/handle/10183/184274

28. Bell D, Foiret, J. Uma rápida revisão do efeito da tecnologia assistiva no desempenho educacional de alunos com deficiência auditiva. Deficiência e Reabilitação: Tecnologia Assistiva. 2020;15(7):838–843. 2020. DOI: https://doi.org/10.1080/17483107.2020.1775317

29. Choi GW, Lee K, Chang SJ, Kim HJ. Health education interventions for individuals with hearing impairment: A systematic review. Patient Education and Counseling, 2023. DOI: https://doi.org/10.1016/j.pec.2023.107830

30. Oliveira WS, Sardinha DM, Franco EF, Baia EC, Pereira JP, Gonçalves RC, et al. Desenvolvimento e aplicação de uma tecnologia educacional para auxiliar a comunicação entre o deficiente auditivo e enfermeiro: relato de experiência. Revista Eletrônica Acervo Saúde. 2020;(44):1-6. DOI: https://doi.org/10.25248/reas.e2269.2020

31. Moura RS, Saraiva FJ, Barbosa VM, Gomes GG, Calles AC, Júnior JA. A língua brasileira de sinais como disciplina obrigatória na graduação em enfermagem: opiniões dos discentes. Revista Enfermagem e Atenção à Saúde. 2019;8(1):71-80. DOI: https://doi.org/10.18554/reas.v8i1.3012

32. Hajbaghery AM, Rezaei-Shahsavarloo Z. Nursing students' knowledge of and performance in communicating with patients with hearing impairment. Japan Journal of Nursing Science. 2014;12(2):135-44. DOI: https://doi.org/10.1111/jjns.12057

Correspondence

Geovanna dos Santos Lalier

Email: geovannalalier.enfa@gmail.com

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