Which action by the medical assistant Ma is appropriate when teaching a patient with a hearing loss?

Hearing aids are beneficial in many situations. However, there are some listening events where hearing aids alone cannot provide enough benefit. In those situations, communication partners can help the person with hearing loss be more successful in hearing. Remember, communication involves at least two individuals: a talker who sends the message, and a listener who receives the message. You, as a member of this communication pair, can improve the conversation by following a few simple strategies.

Gain attention

Gain the listener's attention before you begin talking, for example, by saying his or her name. If the person with hearing loss hears better from one ear, move to that side of the person. Also consider touching the listener's hand, arm or shoulder lightly to gain attention. These simple gestures will prepare the individual with hearing loss to listen and not miss the first part of the conversation.

Maintain eye contact

Face the person who has the hearing loss. Make eye contact. Your facial expressions and body language add vital information to the message being conveyed. For example, you can "see" a person's excitement, joy, confusion or frustration by watching the facial expressions or body language.

Keep hands away from face

When talking, try to keep your hands away from your face. You will produce clearer speech and allow the listener to make use of those visual cues by keeping your mouth and face visible.

In addition, most listeners can improve their perception by watching the talker’s face – also known as speechreading. Speechreading helps to improve speech perception. Many sounds can been seen that are hard to hear. For example, the sound /s/ is very difficult to hear but easily speechread. It is important to not over exaggerate your talking, talk with food in your mouth or chew gum when talking to a person with hearing loss. Keep in mind that heavy beards and moustaches can also hide your mouth.

Speak naturally

Speak distinctly, but without exaggeration. You do not need to shout. Shouting actually distorts the words. Try not to mumble, as this is very hard to understand, even for people with normal hearing. Speak at a normal rate, not too fast or too slow. Use pauses rather than slow speech to give the person time to process speech. Give clues when changing subjects or say “new topic."

Rephrase rather than repeat

If the listener has difficulty understanding something you said, repeat it once. If they are still having difficulty find a different way of saying it. Use different words with the same meaning. For example: “I am going to the grocery store." Repeat once and then rephrase. “I am going to the supermarket," If he or she did not understand the words the first time, it's likely he or she will not understand them a second time. So, try to rephrase it. Another option is to ask what the person did not understand and just repeat that phrase or word. For example, "grocery store" is what was not understood, so just repeat those words "grocery store."

Talk away from background noise

Try to reduce background noises when talking. Turn off the radio or television. Move to a quiet space away from the noise source. When going to a restaurant or making dinner reservations, ask for a table away from the kitchen, server stations or large parties.

Good lighting is important

A person with hearing loss can speechread to assist in hearing so lighting on your face is important. When in a restaurant or other social gathering, sit where there is good lighting so that your face can be more easily seen. Poor lighting may cause shadows on the face of the talker. Conversely avoid sitting with strong lighting coming from behind, such as through a window, as that will cause difficulty looking into the bright light.

Use an app to translate from spoken word to written word, or use texting

There are numerous apps that can be downloaded that can allow you to speak into a smart phone and have your words show up on the screen for the person with hearing loss to read. One such app is called Dragon. The use of texting is also an efficient use to supplement communication.

1. The consultation room

   • Give the patient privacy: they should be able to ask you to raise your voice without fear that others will hear about their medical history.

   • Minimise distractions. This is even more important if your patient is a child.

   • Reduce background noise.

   • Ensure the room is well lit, so that the patient can see your face or any written information they may be given.

   • Ask the patient to wear their hearing aids (if they have them and find them helpful) and sit closer to them than you would to another patient.

   • If possible, have a helper of the same gender as the patient in the room.

   • When adult patients are accompanied, always ask them before you start if they would prefer to be alone with health personnel in the consultation room. Do not wait until the questions become uncomfortable for the patient.

2. Remember that your face is an essential communication tool

   • Face the patient, not their interpreter or carer.

   • Remove any masks or face shields.

   • Do not have anything between your lips (cigarette, pen, etc.) or in your mouth (chewing gum, sweets, etc.) as this can distort lip movement when you are speaking. Avoid placing your hand or an object in front of your mouth when talking.

   • Have the light on your face rather than on the person you are talking to. This makes it easier for them to read facial expressions and to lip-read.

   • Support your speech with facial expression where you can, e.g. look happy if you are giving good news and sad if you are giving bad news.

   • When signing, hold your hands up at chest level to enable both your face and hands to be clearly seen.

   • Understand and use the local culture of gestures, expressions and accepted physical contact (or absence of it).

3. Ensure that you speak effectively

   • Speak normally, not too fast or too slowly. Certain sounds can be distorted or lost if speech is rushed or slowed down too much.

   • Use short, simple sentences.

   • Do not exaggerate your speech or lip movements.

   • Ask questions if you are not sure you understand what the patient is saying.

   • Patients tend to agree with their health are workers, sometimes without understanding what has been said to them. After every important point or message, ask the patient if he/she has understood you and, if necessary, ask him/her to repeat the message or instructions back to you (especially important if the patient is unaccompanied).

4. Use other means of communication, e.g. writing and signing

   • If the patient can sign, use an interpreter. If at all possible, learn the local sign language yourself. This can be fun and can be done with other colleagues.

   • Be prepared to write down any questions or answers, and give the person with a hearing impairment the opportunity to do the same if necessary.

   • Write down important information, e.g. instructions for taking medicines, to give to the patient. Have this information available in alternative formats (e.g. large print) for people with impaired vision or give the information to the person assisting them.

   • Use pictures and drawings to help the patient to understand you.

PARTICIPATION

Deputy Director, Advocacy and Alliances for Inclusive Development, CBM.

‘Nothing about us without us’ has been a slogan of the disability rights movement for decades. Participation is fundamentally about people with disabilities participating in decisions that relate to them so that actions affecting people with disabilities are not planned or performed without their input. This guiding principle highlights the need for people with disabilities to be brought into the process in such a way that they can directly influence decisions. This results in greater inclusion of people with disabilities and also brings with it lasting change.

Extensive involvement of people with disabilities will build skills and capacity. At the same time, people with and without disabilities working alongside each other can often foster changes in attitudes and understanding about the abilities, contributions, and aspirations of people with disabilities.

People with disabilities are often empowered and enabled by the confidence and skills that result from the fostering of genuine partnerships. These partnerships can include partnering with families, wider support networks, service providers, and community leaders, where appropriate. Working in partnership with disabled people's organisations (DPOs) is a very effective strategy (page 12).