Successful Communication with Hearing-Impaired Patients
by Rynae Golke
There are a few nursing skills that are hard to master even for the best nurses out there and communicating with hearing impaired patients in a respectful, dignified, and effective way is one of them. Everybody knows what not to do—don’t yell and don’t talk to them as if they’re children. But how many nurses know what they can do to communicate effectively and respectfully with hearing-impaired patients? This course aims to provide practical, applicable advice to make communication a breeze.
Understand Your Audience
Walter Brown, PhD, discusses the generic nature of the term hearing impaired in his medical journal article, Communicating with Hearing-Impaired Patients. The term hearing impaired describes a wide variety of people, including:
- Those who have some level of hearing loss but can still hear most tones
- Those who need hearing aids to hear clearly
- Those who can’t hear at all, with or without hearing aids
In addition, every patient is unique. Some can read lips and some can’t, while some can speak and others can’t. Some know sign language but many don’t. Most are over 65 but the young are not immune; as a matter of fact, almost 15% of children in school have at least some degree of hearing loss, according to the Hearing Loss Association of America.
The first step in effectively communicating with your hearing-impaired patients is never putting them into a box, stereotyping their ability or communication style, or assuming you know what they need from you. Take time to read their chart and plan for effective communication in advance.
Tips for Successful Communication
Successful communication requires preparation and effort on the nurse’s part. These guidelines can promote respectful and effective communication with patients who are able to hear some or read lips.
- Directly face the patient. Ensure lighting is adequate and the listener can clearly see your face when you speak.
- Avoid talking while working (facing a different direction, coming into and out of the room, or bending and reaching for things). Instead, focus entirely on communication when talking and listening.
- Position yourself on the side of the “strong” ear if there is one. Some patients are only deaf in one ear or have more hearing loss in one ear than the other.
- Speak naturally. Avoid exaggerated mouth movements and yelling. Instead, speak clearly and slowly while maintaining a natural tone.
- Eliminate background noise. Shut off quiet music, fans, and other equipment that makes noise whenever possible. For many hearing-impaired patients, hearing is much harder with background noise.
- Address the patient by name before you begin speaking. This can gain their attention and help them avoid missing parts of the conversation because they weren’t looking or working hard to hear.
- Don’t touch or cover your face while talking. Many hearing-impaired patients rely heavily on lip-reading and facial expressions, so covering your mouth can disrupt the message.
- Observe the patient’s reaction to your words by watching their body language and listening carefully. Patients may indicate confusion or frustration through their facial expressions.
- When you have specific instructions for patients regarding appointment times, medication dosages or schedules, directions, or a diagnosis, provide as much information in writing as possible.
- To confirm the patient has understood, ask them to repeat what they have heard. This gives you the opportunity to identify and correct miscommunications early.
When an Interpreter is Present
A nurse might be street smart, but that doesn’t mean they have sign language interpreter etiquette memorized. Nurses can show respect to the patient by looking directly at the patient rather than the interpreter when speaking. When the interpreter is interpreting their message back to the nurse, he or she should look at the patient, not the interpreter. This often feels uncomfortable but eye contact is an important aspect of communication.
It’s also important to address the patient in second person. For example, “How long have you been experiencing these symptoms?” is appropriate, while, “Ask him how long he has been experiencing these symptoms,” is not.
Nurses must keep in mind that the interpreter interprets all information, not select information. No comments should ever be made that the nurse does not want the patient to hear, as the interpreter will likely interpret them. It’s also important to only give messages to the interpreter when the patient is present.
Finally, speaking naturally at a moderate pace ensures the interpreter has time to interpret the message. Nurses should feel prepared to be asked to slow down or repeat themselves if something is missed.
When a hearing-impaired individual is misunderstood in the grocery store, the result is frustration and perhaps leaving without the item he or she came for. When a patient misunderstands or is misunderstood, the result can have a much greater impact. The U.S. Department of Justice reinforces the importance of effective communication in the healthcare setting, where errors can lead to misdiagnosis and delay in treatment.
Every nurse wants to provide the broad hearing-impaired population with the best assessments, treatments, and outcomes possible, but they first need education and training that is reinforced and refreshed from time to time. The foundational aspects and key takeaways here include:
- Understand your patient, never making assumptions.
- Communicate with the patient in a way that is customized to their communication needs and style.
- Never allow an interpreter to replace eye contact and facial communication with a patient.
Establishing a connection with the patient is critical despite barriers to successful communication, and listening is as critical a component as speaking.