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.
This is of more than passing interest to me personally, because ever since contracting a good whopping Mycoplasma pneumoniae pneumonia my ears have never been right. Who knew M.pneumoniae had a predilection for ears? My grandchildren thought it hilarious that I got tubes– “Silly! Kids get tubes, not G’annys!” Now, a year and a half later, I have one fairly decent ear and one that has almost no hearing at all with about a 50% defect in the tympanic membrane. I’m also looking at possible surgery to clean out a chronic mastoid infection, cartilage grafting to repair the TM, and stenting of the Eustachian tube. Great good fun, eh? Won’t know until after the CT scan…
Since I never did ENT nursing, I needed a lot of explaining about all this, and it was irritating as hell to have to keep saying, “What?” — and in an ENT office, no less. All of this makes me understandably anxious and apprehensive, and not being able to understand it clearly doesn’t help at all.
Being intermittently dizzy is annoying as hell. I checked cold calorics on organ donors for years, and now have firsthand knowledge of how weird nystagmus is from ear drops. Not knowing where a sound is coming from is disorienting– you need two functioning ears for decent echolocation. On the bright side, I no longer crank at my husband for having the TV too loud; we sit companionably while the ballgame rattles the windows.
But I now find myself increasingly unwilling to bother the people who are talking to me with my constant need to have them speak up or face me, and that means I’m starting to lose active connections in conversation. I can’t hear the house phone or the doorbell ring if I’m in my office with my headphone earbud in my functioning ear. I find myself being grumpier than usual to people who don’t deserve it.
Deafness is the most isolating sensory handicap there is. Helen Keller always said that if she had a choice she’d want her hearing back over her sight. A deaf child can’t hear you calling, “I’m coming, sweetie!” in the night when she cries. I too remember describing hearing in an admission assessment– quiet voice at two paces, ticking watch at 2 feet (who carries a ticking watch anymore?). Why would we stop assessing that when the population is getting older and 50% of elders have significant losses? If one of our prime responsibilities is teaching, how do we do that if we ignore such a basic conduit for information? Hopelessness is not often diagnosed but is certainly underassessed; feeling like “It’s always going to be this way and nobody cares” is the first step down the hopelessness path. No wonder people with decreased hearing are, well, grumpy.
Can anybody hear me?