In my early years in nursing, attention to patients’ hearing deficits was a big deal. It was assumed that we couldn’t properly care for someone if that person couldn’t hear us. Every admission assessment included an appraisal of the patient’s hearing: “Hears ticking watch eight inches from each ear,” or “hears quiet conversation at three feet without difficulty,” or “patient states deaf in right ear,” or some other specific description.

When hearing difficulties were evident, a sign was prominently posted over the head of the bed, a note in red ink was written in the Kardex (those quick-reference summaries of key points on all patients that were updated daily), and a special label was affixed to the front of the (paper) chart.

A communication impediment, often ignored.

Why don’t we do these things anymore? I see little indication that the needs of a hearing-impaired patient are a clinical priority. The deficit is not noted on the whiteboards that seem to be standard issue in patients’ rooms today. As a hospital visitor, I watch with dismay as staff fail to acknowledge acutely obvious hearing impairments.

A family member has tumor-induced hearing loss in one ear, and I explain on every admission that people need to speak up when addressing him. I ask them to make use of his intact hearing on the right. Over multiple hospitalizations, there has been no evidence that anyone ever made note of his hearing problem. There have been no posted signs or attempts to speak clearly. When it’s clear to me that he doesn’t hear what staff members are saying and I remind them about his hearing loss, I often receive bland why-are-you-telling-me-this looks.

Is this impediment to communication too ordinary or technologically simple to warrant attention?

Patient experiences, in their own words.

In this month’s issue, Amy Funk and colleagues share the findings of their qualitative study “Understanding the Hospital Experience of Older Adults with Hearing Impairment” (5 CE credits available).

Comments gathered from patient interviews reveal how this disability increases a patient’s vulnerability and stress during a hospitalization:

“I can’t hear over [the call system speaker] when I call the nurse. I can’t hear what she says back to me.”

“I usually don’t [tell staff that I have hearing loss] unless they ask me about it. Sometimes I do, and other times I just figure—why bother? They don’t really care.”

Sadly, these interviews revealed that “the participants neither expected nor demanded accommodations.” In this study, at least, most patients seemed to passively accept their disadvantaged situation without insisting that their basic communication needs be met, and they then tended to withdraw from involvement in their care.

The authors encourage nurses to advocate for hearing-impaired patients, promote staff education about the communication problems that can occur, and educate patients and families about the level of care (including full accommodation of their hearing deficits) that they should expect.

This month’s issue also includes a 1944 article from AJN’s archives, “The Hard of Hearing Patient” (free until June 20), in which author Louise Neuschutz offers communication tips that are just as relevant today as they were more than 70 years ago.