The Hearing Impaired

CRUISING THE CANAL

I am a Family Practice Registered Nurse and have spent my entire career honing my communication skills with people of all ages.  As we age, we are faced with learning how to live with a decrease in our vision, hearing, and even our mobility.  All of these things can affect our ability to communicate and care for ourselves.

Loss of hearing has a major impact on the quality of our lives.  We rely on our hearing to do everything from watching movies to listening to music and from engaging with people at work to spending time with loved ones. When your hearing is impaired it can impact every activity you participate in.

I was recently given the opportunity to go on a two week cruise with my best friend.  Her father had offered up the opportunity for her to bring a friend when her husband had to bow out due to a work conflict.

This two week cruise would take us from Miami through the Panama Canal back home to Los Angeles.  I was very excited to spend time with my best friend, but also nervous about spending a long time with people I have never met.  There would be six of us in total; her father and his wife, son-in-law and daughter-in-law.

We met for the first time in a large mob of people at the ship terminal.  It was very loud and very crowded.  My friend's father was very nice. He smiled a lot, and nodded his head while looking right at you. For all appearances, he was following right along.

My friend mentioned to me that her father had hearing loss from working on a naval ship when he was younger.  Since he is now 86, I’m sure they didn’t have adequate protective equipment at the time.

I enjoyed listening to him tell stories about his past in the navy and his second career as a Special Ed teacher.  Soon, I came to realize that he was more than a little hard of hearing.

ASSESS THE SITUATION

I first noticed that he needed help when we were around a particularly loud area or group of people.  The first night of the cruise, we were in line for a table in the main dining room.  The line snaked past the casino with all of the clicking, clanging and bells ringing that are designed to stimulate a dopamine surge of pleasure.

I happened to be looking at him when his son-in-law asked him a question while standing next to him.  He smiled and nodded, but did not respond verbally.  His son-in-law then made a snarky comment to his wife about being ignored.  I used the technique of looking right at him and getting his attention then repeated his son-in-law's question.  He turned to his son-in-law and answered the question.

The  next day, I noticed that if his wife was nearby, she would repeat what was being said within the group if he didn’t respond.  She would touch his arm and lean over to make eye contact assuring that he was understanding her.  It was interesting that he did not have a problem asking her to repeat herself until he understood.

It is often difficult for the hearing impaired to admit how much they are missing in conversations.  They can be either embarrassed or frustrated and it takes a great deal of trust to show these emotions to those they do not know well.  I have had several patients over the years tell me they would rather not know what was going on around them than admit that they couldn’t hear.  “It makes me feel stupid to have to ask people to repeat themselves”.

If you notice someone in a group that is not participating, it could be they have no interest in their surroundings or the conversations around them.  However, they may actually be hard of hearing.  It is important when speaking with people that you look for clues that they are not really following the conversation.

They may nod and smile without joining the conversation or answering questions.  Active listening skills can give you a good clue as well if the person is not actually “on topic” with everyone else or if they make a statement that doesn't seem to fit the conversation.  So many times, especially in a large group, people are anxiously awaiting their own turn to talk and are not really listening or paying attention to the other people in the group. 

Several times his daughter and I ran into him by the pool while a loud band played.  When she tried to talk to him, he would nod and smile without contributing to the conversation.  She would take him to a quieter area and be sure that she was facing him when conversing with him.

I was able to spend some quiet time with him one-on-one.  I asked him open ended questions about his Naval career and his resultant hearing loss.  He shared his story with me and we were able to connect in a new way.  I believe that showing interest in him and his story allowed him to see me as a trusted person who he could question when he did not hear what was being said.

Three days into the trip, several of us met in the large atrium-like lobby to discuss dinner plans.  His wife was not there and even though we thought he agreed to a meeting time for dinner, he and his wife did not show up.  His daughter had to run up six flights of stairs to knock on his door to get him going before we lost our reservation.  After this we made sure that his wife was aware of all of the plans in advance.

For the first half of the trip, our solution of verifying our plans with his wife worked well.  Unfortunately, the evening we finished traversing the Panama Canal, his wife fell and broke her hip.

At the time, we were past Panama and three days away from Guatemala.  She spent this time in the infirmary on the ship, medicated for pain.  This created a situation where she was cognitively diminished due to pain and medication, while he was not hearing what was being said.  He would not ask for repetition or clarification.  When the rest of us would ask what the doctor said (there were 3 nurses in our group!), we would get conflicting answers from both of them.

When we were finally able to speak with the doctor on their behalf, we were informed that she had a hip fracture.  She needed a hip replacement and would be taken off the ship in Guatemala for transport and treatment.  At this time there were many communication errors in regards to how this would occur.

There is already a great deal of fear and uncertainty in medicine.  It is so important to meet people where they are.  Assessments need to be made about their ability to receive and process information so that they are kept informed and making the best decisions possible.

MINIMIZE CONFUSION

We had a family meeting and instructed the nurses and doctors that my friend’s father was hard of hearing and when they communicated with him about the options and decisions that needed to be made, they needed to:

• Speak slower and louder in person.
• Directly face him when speaking.
• Provide written information.

Another hurdle came as we were getting close to her disembarking in Guatemala.  We were now adding a foreign language barrier to the pain, medication and physical limitations of hearing loss.

Would she have surgery in a foreign country?  Could they trust that the care they received would be adequate?  Should she be flown home to the United States?  How would it be paid for?  They were told that the ambulance meeting them on the dock would only accept cash (foreign currency).  Would they find themselves abandoned in a foreign country?

All of this anxiety added to their already long list of problems: older age, problems with hearing, and lack of medical comprehension. This led to a decision to have the son accompany her on this journey and to have her husband stay on the ship. 

The ensuing 7 days were very hard for her husband, because we could only communicate with his wife when we were in a port (which was every other day or so).  It was very difficult for him to hear in person and even worse over the phone.  He tended to use text and email for all his communication when possible instead of phone calls. 

To help him feel connected and informed, we would gather the current information from his son-in-law, and then make sure that he truly understood what was happening prior to putting him on the phone with his wife.

We wrote up what was happening on a daily basis to give him a record of the events.  During those seven days, we dropped by his cabin often, instead of calling, to check on him and see if he needed anything.  We would leave him written reminders of dinner times and restaurant names.  Unless he was already out and about, we would pick him up at his room. We tried to have him repeat back what was happening as much as possible to be sure that he truly understood. 

His wife had her surgery in Guatemala, and from all reports, they provided excellent care.  She even beat her husband home by a whole day!  He and his daughter-in-law were able to travel together back to their hometown, which was a blessing in that he did not have to spend the day traveling alone.

It is so important when you have family members and friends that are hard of hearing or have other physical limitations to slow down and assess the situation. In this way you can create a plan to minimize confusion and assure understanding.  We were able to assist in a great outcome for this family by using patience, kindness, and advocacy for proper communication.

By: M. Kenne Kennedy, SrRN, BSN, PHN

Kenne was a clinical instructor/preceptor for the last 32 years. In her most recent job, she conducted training and inservice for a staff of 50. Kenne is recently retired.