Managing Complex Situations with Hearing Loss - Advocacy Series #2

Many of us are involved in complex situations on a daily basis, defined as scenarios with fluctuating signal-to-noise ratios, multiple speakers, and predisposition for people to be less mindful of clear articulation. Examples include, but are not limited to: the operating room, emergency codes, agitated patients, and newborn deliveries.

In these situations, not only is there often information overload (a lot of data to intake, withhold, and consider), but there is our dual processing burden—the work to listen more carefully or actively as a person with hearing loss regardless if one is using cochlear implants or lipreading and possibly even the challenge of internally translating information transmitted in sign language to meaningful medical knowledge.

How then do we best position ourselves?

  1. Literally, positioning! Put yourself where you can best get information. Make sure you can see your key people—is this the timekeeper/scribe? Is this the patient itself? Is this your fellow nurse who is helping you with the IV placement? Is being across from the attending surgeon or the surgical tech more important? Additional tricks: use a stool to get at or above eye-level. Work with your interpreters on how to voice over for you with authority if you are running codes or the OR.

  2. Do your best to come prepared! These are not ideal situations to learn your ACLS algorithms or your SOAP frameworks. Develop “thought islands” that allow you two seconds for your language processing to catch up: for example, your standard review of systems or medication reconciliation during a triage intake will allow you to consider your next steps in parallel. If you struggle in particular with remembering data or skipping parts of your pertinent responsibilities in data collection, have a sheet template in your back pocket. Nobody will fault you for being meticulous.

  3. Mock training is important. They improve teamwork cohesion for everyone. They are especially important in introducing interpreters to the challenges of these situations and how to develop an intuitive sense of what may happen next and how to best transmit that information. For example, in a code when the machine is ready to shock, the interpreter may do better physically touching the healthcare provider with hearing loss rather than signing “shock”—it is faster. One facility runs mock codes with the leading physician blindfolded as a way to enhance communication and teamwork building.

  4. It is normal to ask for help. We might even need more of it than our peers, and there is nothing wrong with that. Of course it is easier said than done to feel empowered or that we are in a safe environment to do so. This is the first step—knowing that it is normal and okay. Asking a nurse or an attending to confirm your lung exam is reasonable.

  5. It is also normal to assert yourself. We often fall to playing the victim or passive participant because of the hierarchy of medical or healthcare training and because of systemic oppression regarding disability (as well as gender, and other -isms).

  6. Embrace your unique value. You may never blend in.

  7. Codes do not have to be loud. The best run are quiet—this keeps communication clear and the patient or patient’s family from becoming even more distressed.

  8. You are never alone. Healthcare is run as a team and there should be several trusting collaborative relationships with other providers. If there are not, a hard look at the workplace culture and your own contributions or readiness is warranted.