Although nurses may associate hearing loss with aging, cancer survivors of all ages may have some degree of hearing loss—not just older adults. In a recent study, more than one-half of adult cancer survivors treated with platinum or taxanes had hearing loss. Changes in hearing create communication barriers, so oncology nurses must use best practices for effective communication. To set yourself up for success when working with Deaf and Hard of Hearing (HoH) Survivors, follow the tips below.
1. Get Their Attention
Before you begin speaking, get the Deaf or HoH person’s attention by saying their name or tapping them on the shoulder. Avoid rude behaviors like clapping or snapping, as it is disrespectful. Getting their full attention reduces the chance of missing words at the start of your conversation. Face the person directly, on the same level and with good light. If they listen better in one ear than the other, try to position yourself accordingly.
2. Slow Down
Slow your speech down a little. Give patients more time to process information. Avoid using complex sentences, and instead use shorter sentences with purposeful pausing between phrases. Make the listener aware of the subject. Often, this is done by repeating key factors or their question before continuing the conversation. For instance, nurses can say, “You were having sleep problems. Let’s talk about your sleep now.” If you need to change the subject, consider saying, “Another thing for us to talk about is . . .” to allow them time to transition.
3. Check Understanding
Stop at more frequent intervals to check for comprehension. Use the “teach back” method to check for understanding. Have them repeat times, places, and numbers back to you since this is the easiest information to miss.
4. Use Normal Volume
Although you might be tempted to shout, this does not help and can frighten people. Shouting distorts the sound of speech, making it more difficult to understand. Use your normal speaking volume. If you speak very softly or are wearing a mask, you may need to slightly adjust your volume. Do not overenunciate words as it changes the sound and shape of your mouth.
5. Look at Them While Speaking
Consider using a clear face mask, if allowed. If a patient relies on lipreading to understand speech, it is far more challenging to do if they cannot clearly see your lips. If not, make sure you also include written instructions or encourage patients to record the conversation. Make eye contact during the entire conversation. Many people compensate for hearing loss with visual cues or body language. Although it may be natural for you to continue speaking while you move around the patient or grab something, it makes it difficult for your patient to understand you. Simply face your patient and speak at a normal level at your normal speed. Consider how things like your hand in front of your face, chewing gum, facial hair, masks, and accents may affect lipreading.
6. Remove Distractions
Hearing aids only work if the person is wearing them. Patients may not wear them due to discomfort or embarrassment or they just simply forgot. Hearing aids work by amplifying sound. Unfortunately, this means it amplifies background noise along with the sound of your voice. Consider moving your patient to a quieter area and remove potential distractions like music or the television. Also refrain from moving too much when speaking to your patient—rustling papers, squeaky chairs, and even electronic noises can be distracting. Resist the temptation to talk and type on the keyboard at the same time.
7. Rephrase Instead of Repeat
Reword instead of repeating information. For example, you may substitute “Let me know if you feel any discomfort” with “Tell me if this feels uncomfortable.” Especially for people who lost their hearing later in life, it can be embarrassing to continue to ask for something to be repeated. Some patients may ask you to repeat something once or twice, then give up even if they still do not understand. Reassure your patients that you are there for them and that you have more than enough time to converse with them. Avoid impatient or hurried body language such as turning toward the door or glancing at your watch.
Oncology nurses can improve communication for cancer survivors with hearing loss by using these practical tips. With more than half of cancer survivors having problems with hearing, cancer centers will need robust staff education and processes in place to best serve this ever-growing population.
References
Cancer Survivors and Neurotoxic Chemotherapy: Hearing Loss and Tinnitus
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