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Communicating with Hard of Hearing Patients

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Having spent a lifetime as a hearing aid wearer, I know what helps me communicate in unfamiliar environments and with new voices. As a nurse, I have been able to expand these strategies and transfer my experience into better patient care. With these few tips, you can too.

Specializes in Peds Hem/Onc & Ortho/Neuro; Postpartum Mother/Baby. Has 2 years experience.

What are some ways you've used to communicate with hard of hearing patients?

Communicating with Hard of Hearing Patients

Let’s set the scene

It’s vitals time- morning medications time- one patient just puked and another fell out of bed time- and you can see down the hall that the surgeons just left Mr. A’s room. You make a mental note to grab the procedure consents when you go in his room for your assessment.

You’ve finally handled enough urgencies to get to Mr. A’s room. You show him the consent and repeat for the millionth time in your career, “I know the surgeons discussed the procedure for tomorrow with you. If you don’t have any questions and feel comfortable signing the consent, I have it here for you.” And, then, like clockwork, the patient says “Actually, do you know..” or “I meant to ask..”.

It’s a scene that is played out countless times a day in every hospital. However, what we may not always consider is why the patient didn’t get all the information they needed. It is both possible and easy to say that in the moment, yes, these things slip our minds. But the reality may be something else entirely: maybe your patient didn’t hear the surgeon.

Why is it important to identify hard of hearing patients?

I was born hard of hearing and have the benefit never living in a world I could hear clearly. You might be wondering why I consider that a benefit. I learned from a young age to speak up for myself when someone is mumbling or the TV is too quiet. I learned that in order to be included in the hearing world, I had to advocate for myself constantly. That didn’t come naturally to me, it’s a skill that has taken a lifetime to master, and I still struggle with from time to time.

While some patients will advocate for themselves, I’ve found that most of mine do not. They are still firmly in that, “I hear just fine”, phase when in fact, they do not. Why they are in that phase is not for me to determine, however what is up to me, as their nurse, is to make sure they are hearing and comprehending the information everyone on the healthcare team is communicating to them.

Just as a translator is used for someone who speaks another language, there are steps we as nurses can take to ensure we are “speaking a language” our hard of hearing patients can understand.

How can we help?

1- Reduce surrounding noises

Hospitals are not quiet places. The hallways are filled with people talking, machines beeping, computers rolling down hallways, even the patient’s room itself can be noisy (TVs on, family members in person or on speaker phones). All of these can be distracting when someone is trying to concentrate on hearing. Assess the background noises, close the door, turn down the TV, ask people on the phone or in the room to be quiet while you talk to the patient.

2- If your patient wears hearing aids, make sure they are in and turned on

I’ll never forget in nursing school at a long term care facility helping a patient put on her hearing aids. Having experience with hearing aids, I knew to check that batteries were in and working. When I checked, the batteries were clearly dead. The patient did not have any batteries and I asked the facility for new ones and they didn’t have any either. I have no idea how long this patient had been wearing these hearing aids (which were essentially ear plugs since the batteries were dead). Moral of the story: make sure that if the patient wears hearing aids that they are in fact wearing them when you are speaking with them (with functioning batteries). If you don’t know how to check batteries and the patient is unable to explain or do it for themselves, ask.

3- Communicate clearly

I’m not sure what it is about being told someone is hard of hearing that instantly makes people start screaming but I’m here to tell you: it helps no-one. Additionally, from my experience, over-enunciation, which changes the sounds of the words you are saying, helps no-one. Speak at a solid average, mid-level volume and cadence.

Furthermore, communicating is more than the spoken word. While masks are an unfortunate obstacle for the hard of hearing, most of whom use lip reading to communicate, you can still make every effort to make sure they are able to understand you. Facing the patient, getting at eye level, and making eye contact are steps that can help to mitigate the mask issue.

4- Including healthcare team on communication plan

We are not always present when doctors, care management, physical/occupational/speech therapy, or others are in our patient’s room so how can we include them in our communication plan? Some kind of signage is a good idea, although it could be considered a patient rights violation to include a “hard of hearing” sign on the door. I once worked on a unit where they used picture codes for different conditions. For example, a cut out of an ear on their door could mean hard of hearing. This would communicate to everyone entering the room to adjust their communication techniques accordingly.

Finally

Living as a hard of hearing person can be challenging in many ways. Our patients are already going through a difficult time being in the hospital; we can lessen their burden by making sure the entire healthcare team makes every effort to communicate with them effectively. Does anyone have any other tricks or tips they use to communicate with their hard of hearing patients? Or, to notify other members of the healthcare team?

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4 Comment(s)

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

 

kdstarwrites, BSN, RN

Specializes in Nurse healthcare content writer and editor. Has 15 years experience.

Great article Kelly!

heron, ASN, RN

Specializes in Hospice. Has 40 years experience.

Pitch your voice low. Many hearing impairments aquired later in life hit the higher registers more than the lower. Women, especially, tend to have higher-pitched voices and it tends to go higher when we attempt to speak more loudly. I find that I can communicate better when I pitch low at the same time as I increase volume a bit. I also try to speak into the “good ear” since such impairments are often asymmetrical. Saves a LOT of shouting.

KellyM RN, BSN, RN

Specializes in Peds Hem/Onc & Ortho/Neuro; Postpartum Mother/Baby. Has 2 years experience.

On 4/27/2021 at 11:52 AM, kdstarwrites said:

Great article Kelly!

Thank you!