Alternative Text Option: Client Who is Hard of Hearing

Introduction

Welcome to the simulation learning experience. During this experience, you will be interacting with a scenario between the client, the Health Care Administrator (HCA) and a nurse. The experience is presented in the following format:

• Scenario description
• Video scenes
• Questions for points
• Prompt to move to the next level
• Opportunity to play again

Scenario Details

According to the Canadian Hard of Hearing Association, 1 in 10 Canadians have a hearing loss. Four out of 1000 babies are born with some type of hearing deficit (CHHA, 2021).

In this experience, you will meet a client who has a hearing impairment. The client is new to the facility and has arrived for their appointment and approaches the desk for check-in. Let’s see how it goes!

Learning Objectives

• Recognize the impact of poor therapeutic communication in health care settings.
• Identify the benefits of therapeutic communication techniques in health care settings.
• Adjust communication to meet the client’s health care needs in health care settings.

Please be advised that some viewers may find the following scenes upsetting or triggering.

Hard of Hearing Patient Scene 1

Congratulations, you have reached level 1! To reach level 2, choose your next move.

Do you want to answer a question for 2 points?

Question: Consider the video you just watched. What HCA behaviours did you observe that led to ineffective therapeutic communication? Choose all that apply.

1. The HCA stands up and greets the client
2. Blocked mouth with a pen
3. HCA raised their voice

Solution: Answers two and three are correct as they are ineffective therapeutic communication behaviours. The client had already let the HCA know they needed the HCA to look at them so that they could read their lips. The HCA blocks her mouth with the pen so the client can not read the HCA’s lips. The client needs to be able to read lips, so yelling does not help. The client will read the body language of yelling, disregarding the client’s preferred communication method and making assumptions.

Answer one is incorrect because standing up and greeting the client is an effective behaviour. This interaction could be improved if the HCA maintained eye contact. It is important to look at the client so that the HCA picks up the client’s cues. In this scene, the client was signing and needed an adjustment to communication.

Watch the video again?

Let’s see what happens next.

Hard of Hearing Patient Scene 2

Congratulations you have reached level 2.

To earn more points choose your next move.

Do you want to answer a question for 2 points?

Question: Consider the video you just watched. What behaviours did the HCA miss in this scene? Select all that apply.

1. Client rolls eyes
2. Abrupt turn away from the desk
3. Agitated signing
4. Tone of voice

Solution: All the answers are correct, the HCA should be able to identify visual cues and adjust their communication in a way that de-escalates the situation. For example, observing the client is upset and responding accordingly.

Re-watch the video for 1 point?

Will this get better? Stay tuned!

Hard of Hearing Patient Scene 3

Congratulations, you have made it to level 3!

To continue to earn points choose from the following.

Answer a question for 2 points

What assumptions is the HCA making in this scene? Choose all that apply.

1. That everyone in the waiting room has the ability to hear the HCA.
2. That everyone has the ability to respond verbally.
3. That the client reading a book was not the client that was being called.
4. That people in the waiting room can respond quickly.

Solution: The correct response includes all of the options. While the HCA stood up and scanned the waiting room, which is good, the HCA assumed there would be a verbal response. The HCA assumed that when someone does not look up from their device or a book (in this case), they do not want to engage. The HCA assumed there would be a response quickly, as indicated in her sudden call for the next client. Considering that all people respond in different ways based on their abilities, no standard way should be expected.

Re-watch the video

What will happen next? Stay tuned!

Hard of Hearing Patient Scene 4

Congratulations! You have reached level 4.

To earn more points choose your next move!

Answer a question for 2 points

Consider the video you just watched. Since a communication breakdown has occurred, what blocks to communication between team members did you observe that exacerbated the situation? Choose all that apply.

1. The HCA (who returns from lunch), implies the HCA (who is covering) is not doing their job properly. Which causes a defensive response and breaks down communication between the team members.
2. The HCA who returns from lunch, implies the HCA (who is covering) is not doing their job properly, and walks swiftly over to the client.  Which blocks any opportunity for the HCA covering to resolve the situation or explain further.
3. The emotionally charged conversation is being witnessed by other clients in the waiting room. The HCA (who was covering lunch) is likely feeling embarrassed as clients in the waiting room are watching.

Solution: All the answers are correct. Implying that a team member is not working properly can be perceived as a personal attack and blocks further communication. The action of walking away by the HCA prevents a further opportunity for a resolution between team members. This is disingenuous as it blocks further communication. As well, the emotionally charged conversation is being witnessed by other clients in the waiting room and make them feel uncomfortable and concerned about the HCAs communication.

Re-watch the video

Let’s see how this could be done differently

Reflection

Reflecting on the video consider the following for communication adjustments:

• What biases did you recognize in yourself as you played the game?
• How can your biases create barriers for clients who are hard of hearing?
• How can you and your team support each other in overcoming identified biases?
• What considerations will you make for clients with differing abilities beyond hard of hearing?
• What considerations will you make when working with team members based on your experience with this game?

Summary

Therapeutic communication with clients is essential. HCAs should actively engage in self-reflection to identify personal biases and learn about the different needs that people who are hard of hearing may require. HCAs should continue to develop their therapeutic communication competencies by recognizing and adjusting their behaviours to meet the client’s health care needs.

Therapeutic communication is complex and requires a lifetime commitment of reflection, practice, making mistakes, and learning from those mistakes.

Game Over Congratulations, you have completed the game!