Communication between hearing-impaired patients in radiologic technology
Abstract
Hearing-impaired patients form a significant percentage of the United States population. Some seek health care while other cases remain undiagnosed and endure the hard times with their conditions in society. The radiologic technology department is among the healthcare departments that provide care and services to hearing-impaired patients when they seek diagnostic procedures to aid their diagnoses and treatments. While in these departments, the front line healthcare provider that hearing-impaired patient will interact with is the radiologist who will provide consultations services, conduct a physical examination, and finally take the patient through the diagnostic procedure. During these interactions, the radiologist enters in a therapeutic relationship with the hearing impaired patients, which require effective management to promote outcome.
The radiologist must explain to the patient the procedures after acknowledgment and introduction, meaning the two must objectively converse. Some hearing-impaired patients may communicate but cannot hear. Others may have more problems and only hears when or respond with the help of hearing aid or assistive devices. Some cannot completely talk or hear, thus use primarily text messaging to communicate as others use lip-reading and other forms to communicate. The radiologist must understand hearing patients’ needs to avail of all the necessary resources, including the translators, hearing aids, and any support required to promote effective communication with hearing-impaired patients. Similarly, they must be skilled, knowledgeable, and empathetic throughout communication with hearing-impaired patients. The research below shows how radiologic
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technologists can ensure effective communication with the hearing impaired patients to promote empathetic, equitable, and equal care and services to these patients.
DIFFICULTIES THAT HEARING IMPAIRED PATIENTS EXPERIENCE
Hearing-impaired patients exploit numerous ways to communicate[1]. Some use hearing aids, others rely on sign language interpreters, written messages, assisting listening devices, among others. There are good numbers of hearing-impaired patients who speak but cannot hear. Often radiologic technology facility per American with Disability Act will provide a method of communication, services, or aid based on the hearing impaired patient’s ability, complexity, and the nature of the assistive communication that such patients require.
Effective communication in every clinical setting is vital in radiologic technology because misunderstanding or miscommunication may lead to misdiagnosis, improper, and delayed initiation of treatment. Usually, the communication involves the exchange of information between the hearing impaired persons and their healthcare provider who, in this case, is the radiology technologist and also the caregivers. The impact of a minor communication gap may lead to robust consequences in the radiology technology organization, necessitating effective communication. What is effective communication? Effective communication requires efforts from both parties involved regardless of their hearing status, mode of communication, and setting. Usually, people with hearing problems used hearing aids and active listening strategies to improve their communication. However, that should not be an excuse for the other party involved in the communication processes to assume the use of excellent communication strategies to ensure successful communication.
HOW TO IMPROVE COMMUNICATION WITH HEARING-IMPAIRED PATIENTS
Knowledge and skills to communicate with hearing-impaired patients are crucial for all radiological technologists[2]. They must be aware that people are suffering from hearing impairment and need empathy and compassion when communicating or attending to them. The radiologists must know that every aspect of their communication will impact communication with the hearing impaired patient, including accent, verbal, and non-verbal cues. They also need to learn how to operate and fix hearing aids and other assistive hearing devices whenever required. Few studies have been conducted regarding the communication of hearing-impaired patients in radiographic technology[3]. Among the researches on this topic, most found out that hearing-impaired patients face a lot of difficulties and barriers in communication in the radiologic technology environment. Most healthcare providers, including the radiologists, overestimate the number of spoken words that lip-read hearing impaired patients understand[4]. Studies estimate that only about thirty percent of the spoken words are read by lip-reading. This makes lip reading appear as if it can substitute spoken communication; however, writing is unacceptable in most cases, particularly patient who uses ASL as their language. Hence, most hearing-impaired patients in the radiologic technology department remain with the empathetic radiology technologist as their only key to improve communication and understanding of the same.
One of the significances of effective communication in radiographic technology setting is that it aids in diagnosing and treating patients. The code of ethics tool, acknowledge, introduce, duration, explain, and thanks abbreviate as AIDET is implemented in numerous radiographic technology facilities to encourage effective communication between hearing-impaired patients and radiographic technologists at all times[5]. The radiologist should conduct acknowledgment of the patients during the first encounter through greetings using their title, first name, and requesting to know how they are doing. Radiologic technologists must ensure patient-centered care, and the simple acknowledgment which should display respect for the patient, make them feel at home in the radiologist’s hands, and creating a rapport is crucial to ensure this. The hearing-impaired patient should then be led to a private room as a means of ensuring privacy and confidentiality. The radiographer should introduce himself or herself. The introduction and the continued creation and maintenance of rapport help receive the anxiety since most hearing-impaired patients tend to be anxious as they wait for their diagnosis in the waiting room. It also helps develop some sense of trust in the just established radiographer-patient therapeutic relationship and urging the patient to cooperate throughout the process and feel at home to voice their concern as necessary. The radiographer then requests for patient history, and here is where they will learn more about the patients, including the hearing impairment.
Completion of history taking is followed with an explanation of the procedure and assurance of taking good care of the patient throughout the procedure. It is appropriate at this time for the radiographer to discuss with the patient the mode of communication that they will use during the physical loss of their lovedand procedure to alert the patient whenever the radiographer wants to make contact. This will ease stress and improve patient relaxation and feeling of empathy, which is the goal of patient-centered care. The significance of explaining the procedure to the patient is that it may aid in management, relieve stress, diagnosis, and treatment of the patient if they turn positive for the test or procedure. Depending on the patient’s hearing impairment, communication preference, and other vital aspects, the radiologist arranges the team to ensure holistic care of the patient before, during, and after the procedure.
It is so unfortunate that most people in the radiology technology workplace do not communicate, and this is the most significant problem with communication. Most people keep communicating with themselves, thus impacting the hearing impaired patient in radiology technology[6]. A lot of radiology technologists and workers either do not communicate or communicate poorly. Communication remains a vital thing for all radiology technologies and the hearing impaired persons to improve care provision and understanding. Radiology technologists often have front line interaction with patients and also responsible for explaining some of the most complex procedures to types of patients, including those with hearing-impairments while taking an accurate patient history. Communicating with hearing-impaired persons requires excellent care, and it is better to short, sweet, and direct to the point instead of rambling, which will not get you anywhere.
Luckily, radiology technologists and therapists, just like other healthcare providers, already have the key to most of the hearing impaired awareness matters, which is empathy[7]. The radiologist should think about how the day would be if they had to spend a day with hearing impairment. Thus, they often strive to improve communication with hearing-impaired patients without grand gestures. Often hearing-impaired patients deal with continuous harsh reactions from people, stereotyping, and impatience. They struggle to listen to what people say, but some cannot hear and will often be embarrassed to request the speaker to repeat what they had said. The secret to promoting and warranting effective communication with people with hearing impairment is to be observant, conscious, adapt favorable communication environment, take adequate time, repeat or rephrase as necessary the conversation and expect what might be helpful to the patient.
Consider the environment: Background noise will affect communication making it difficult for hearing impaired patients to follow through a conversation[8]. If the radiology technologist cannot control or minimize the noise, it is advisable to move to a different consultation room or a quiet corner to continue with the conversation. Also, closing the doors and windows to minimize the noise may be helpful. While hearing aids that most hearing-impaired patient uses help them understanding and following through communication, some make it difficult for these patients to know where the sound is coming from. Most hearing-impaired patients using hearing aids will hear one speaking but will find it hard to determine the speaker. It can be embarrassing for such patients when they respond to the wrong person. This is why a quiet environment free from background noise is necessary for the radiologic technology workplaces to promote effective communication between the radiologist and the hearing-impaired patients.
Moreover, radiology technologists must talk to patients while in the same room. Hearing-impaired patients failing to the speaker or the listener is a common reason for numerous misunderstandings of the message that present in the radiology technology department. Hearing-impaired persons have not the only difficulty in hearing but also to some extent information processing. Thus it is vital to speak clearly and distinctly but naturally. Never shout or exaggerate mouth movement as these may confuse and lead to misunderstanding of what is said. It also distorts the sound of the speech and makes it difficult for the hearing-impaired persons to read the speech.
Lighting: Since some of the hearing impaired patients may not hear the sounds correctly, they tend to read the lips and body language. This may be very difficult when lighting is not adequate. The phase of the radiologic technologist conversing with the hearing impaired patients must be in a great light to enable patients to lip-read and learn from body language. Radiologists should face the hearing-impaired patient directly in the eye, be on the same level as with the patients, and ensure that there is good light when possible[9]. The light should be shining on the speaker’s face meaning that whenever a hearing-impaired person speaks, the light should be directed to shine on his or her face and not in the face of the listener. The radiologist must not stand in front of a light source or speak from another room as this may hinder the hearing impaired patients from lip-reading. Saying the hearing-impaired person’s name before beginning to converse with them makes them focus their attention and will often reduce the possibility of missing words when conversation commences. Sentences that are too complex or rapid talking will likely confuse thus, encourage and practice pausing; slowing down between sentences to warrant that the hearing-impaired person understands the previous words then proceeds.
Radiology technologists should aim to ensure that the hearing-impaired person maximally understands their words through the conversation[10]. Hence, they must keep away anything that may distract, confuse, or make understanding difficult—these including keeping hands away from the face while conversing, ceasing chewing, eating, or smoking. Similarly, hearing-impaired patients will take any mouth movement and will want to analyses to get that information out. Studies show that beards and mustaches may interfere with the hearing-impaired persons’ ability to read. With that said, they should be shaved to promote maximum understanding. Background noise interferes with hearing; thus, hearing-impaired persons will often have difficulty in understanding speech in a place with background noise. The radiology technologist must strive to minimize background noise.
Booking appointment: Most of the hearing impaired patients exploit devices such as the amplifiers, text relay, and operator-assisted service, and some use smartphones. The amplifiers are used to increase the volume of the speaker to ensure they hear what others are saying over the phone—often hearing impaired patients will type a message in their phone and have the opera-tor read it for them after every line. The receptionists, radiologic technologist, and the therapist in the radiologic technology setting should be familiar with making and receiving calls in information ways. Radiologic technology settings should accept text messaging through the hospital line, email, or online messaging to accommodate the hearing impaired patients. Besides, the receptionist desks should clearly show that hearing help is available and that the radiologic technology center is ready and willing to care for hearing impaired patients compassionately and with empathy.
Waiting room: Radiologic technology facilities should have a waiting room with a loop system to accommodate and help hearing-impaired patients. Often, hearing impaired patients find it stressful and tiring to wait in the consultancy room. The radiologic technologist must not disregard the emotional energy by the hearing impaired patients who are concerned that they might not hear their name. The chairs in the waiting of a radiologic technology facility should face the reception desk to ensure hearing impaired patients can lip read to know whether their names have been called or not. Also, the radiologic technology may use a notice board to ensure that the patient quickly sees their names on the board, indicating their turn to be served. Though that may not be ideal due to confidentiality matters, it is still a helpful method to keep off the worry of hearing-impaired patients not hearing their names. The radiologic technologist may as well give every patient a pager on arrival that will vibrate to indicate that it is their turn to be served.
Consider cultural diversity: Moreover, hearing impaired patients from across the world visits the radiology technology workplace. Sometimes radiology technologists will have cases where the patients that they are dealing with, the peer physician, are not typical Americans, and they will have to learn to work through an interpreter. There are numerous interpreters or communication support workers who help in such situation s with communication with the hearing impaired patients. Those hearing-impaired patients who use only lip reader will necessitate a professional lip reader. The lip-reader should sit next to the radiologic technologist and will mouth the spoken words exploit g the clear lip patterns as well as fingerspelling[11]. Similarly, the radiologic technologist may be assisted by a speech to text reporter or the note-taker who may turn the conversed words into written form to promote hearing impaired patient’s understanding. Lengthy consultations will require such options. However, the radiologic technologists and must be keen since the hearing impaired patient may not lip-read the whole conversation without some support since even experts in lip reader may only follow about thirty percent of the conversation. Some hearing-impaired patients use sign language, which will force the radiologic technologist to use a BSL interpreter.
Interpreter: It is crucial to ask the hearing impaired patient if they may need additional communication support and make them feel free to say if they feel they want one in the course of the consultation or intervention. The aim is to improve communication and promote understanding to achieve a common goal. While using an interpreter or communication n support worker may be helpful, it may as well worsen the situation, and relevant adjustments are necessary to make sure the patients understand the communication. Having the interpreter does not completely help the situation. The radiology technologist must learn how to communicate with the interpreter while still being keen on the hearing impaired patients. The radiology technologist must learn to speak with the patient with the interpreter in the background. This means that the eye contact should be with the patients like it would be while taking a healthy person without hearing impairment.
Physical Examination: Radiologic technologists will do a physical examination before doing the procedure or after consultation. It is crucial to ensure adequate eye contact with the hearing impaired patients as much as possible to ensure that the patient knows when the radiologic technologist wants to make contact or converse something. Sometimes one may want to speak to the patient as the examination continues. Such cases necessitate the radiologic technologist to ensure that they are visible when speaking. The healthcare giver must agree with the hearing impaired patient the mode of communication before the examination starts. This is to help the patient know that you are addressing them when you do as you had agreed.
Radiologic technology facility sees patients from all corners of the world; thus, the need to be culturally sensitive to ensure effective and productive communication with the hearing impaired and culturally diverse patient. Since the language barrier may prevent communication between the hearing-impaired patient and the radiology technologist, family members who may be able to translate may help in such situations if there are no alternatives.
Additionally, since hearing impairment may affect anyone any age, radiologic technologists attend to patients of all ages. This presents different layers of communication, such as the age communication layers that come with another challenge. How the radiology technologist communicates with older patients with hearing impairment is not often the same as how they will communicate with an adolescent with the same problem. The radiology technologist must be skilled in age communication techniques to grab information and still achieve the needed cooperation from the patients. Speaking with a child with hearing impairment will necessitate the radiologist to be at eye-level with the child. The child does not have to maintain eye contact or look up to the radiologic technologist as long as the radiology technologist is looking at her or him. Periodically, the healthcare giver can look at the parent as they speak with the child to satisfy both age groups. The vital key to communication is to make sure you do not come across threatening.
CONCLUSION
Empathetic, skilled, and knowledgeable radiologic technologists can save hearing impaired patients the distress that they endure in the radiologic technology facilities whenever they seek care. These patients need healthcare providers who understand the much agony that they endure and at least empathize with them. A radiologic technologist who will provide equitable and equal care and services to them through improve communication to promote their understanding of the vital health messages and spoken words.
References
1Cohen, Jamie M., Jan Blustein, Barbara E. Weinstein, Hannah Dischinger, Scott Sherman, Corita Grudzen, and Joshua Chodosh. “Studies of physician‐patient communication with older patients: How often is hearing loss considered? A systematic literature review.” Journal of the American Geriatrics Society 65, no. 8 (2017): 1642-1649.
2Erlichman, David B., Marjorie W. Stein, Amanda Weiss, and Fernanda Mazzariol. “Radiologist, obstetric patient, and emergency department provider survey: radiologist-patient interaction in the emergency department setting.” Emergency radiology 23, no. 3 (2016): 245-249.
3Fukuzaki, Izumi, Noriko Ishigami, Terumasa Sata, and Shinichiro Nakaishi. “Initiative for Improving Medical Instruction Communication with Elderly Hearing Impaired Patients at an Outpatient Pharmacy Counter.” In International Conference on Applied Human Factors and Ergonomics, pp. 139-147. Springer, Cham, 2017.
4Hayre, C. M., S. Blackman, and A. Eyden. “Do general radiographic examinations resemble a person-centred environment?.” Radiography 22, no. 4 (2016): e245-e251.
5Hinberg, Brenda. “Caring for Older Patients.” Radiologic technology 90, no. 3 (2019): 278-278.
6Jama, Guled M., Shayan Shahidi, Julian Danino, and John Murphy. “Assistive communication devices for patients with hearing loss: a cross-sectional survey of availability and staff awareness in outpatient clinics in England.” Disability and Rehabilitation: Assistive Technology (2019): 1-4.
7Koth, Jana. “Diagnosis and Treatment of Oncologic Emergencies.” Radiologic technology 91, no. 2 (2019): 161-172.
8Mazer, Susan E. “Radiology, Noise, and the Patient Experience.” Journal of Radiology Nursing 37, no. 4 (2018): 243-246.
9Nakagawa, Kei, Shinichiro Nakaishi, Takeshi Imura, Yumi Kawahara, Akira Hashizume, Kaoru Kurisu, and Louis Yuge. “Neuromagnetic evaluation of a communication support system for hearing-impaired patients.” NeuroReport 28, no. 12 (2017): 712-719.
10Odle, Teresa G. “Patient-Centered Care in Breast Imaging.” Radiologic technology 90, no. 3 (2019): 259M-277M.
11Otoni, Jessyca Couto, Marcela Pecora Cohen, and Almir Galvão Vieira Bitencourt. “Physician-patient communication in diagnostic examinations: what is the role of the radiologist?.” Radiologia brasileira 51, no. 2 (2018): 109-111.
[1] Cohen, Jamie M., Jan Blustein, Barbara E. Weinstein, Hannah Dischinger, Scott Sherman, Corita Grudzen, and Joshua Chodosh. “Studies of physician‐patient communication with older patients: How often is hearing loss considered? A systematic literature review.” Journal of the American Geriatrics Society 65, no. 8 (2017): 1642-1649.
[2] Erlichman, David B., Marjorie W. Stein, Amanda Weiss, and Fernanda Mazzariol. “Radiologist, obstetric patient, and emergency department provider survey: radiologist-patient interaction in the emergency department setting.” Emergency radiology 23, no. 3 (2016): 245-249.
[3] Hayre, C. M., S. Blackman, and A. Eyden. “Do general radiographic examinations resemble a person-centred environment?.” Radiography 22, no. 4 (2016): e245-e251.
[4] Fukuzaki, Izumi, Noriko Ishigami, Terumasa Sata, and Shinichiro Nakaishi. “Initiative for Improving Medical Instruction Communication with Elderly Hearing Impaired Patients at an Outpatient Pharmacy Counter.” In International Conference on Applied Human Factors and Ergonomics, pp. 139-147. Springer, Cham, 2017.
[5] Hinberg, Brenda. “Caring for Older Patients.” Radiologic technology 90, no. 3 (2019): 278-278.
[6] Jama, Guled M., Shayan Shahidi, Julian Danino, and John Murphy. “Assistive communication devices for patients with hearing loss: a cross-sectional survey of availability and staff awareness in outpatient clinics in England.” Disability and Rehabilitation: Assistive Technology (2019): 1-4.
[7] Koth, Jana. “Diagnosis and Treatment of Oncologic Emergencies.” Radiologic technology 91, no. 2 (2019): 161-172.
[8] Mazer, Susan E. “Radiology, Noise, and the Patient Experience.” Journal of Radiology Nursing 37, no. 4 (2018): 243-246.
[9] Nakagawa, Kei, Shinichiro Nakaishi, Takeshi Imura, Yumi Kawahara, Akira Hashizume, Kaoru Kurisu, and Louis Yuge. “Neuromagnetic evaluation of a communication support system for hearing-impaired patients.” NeuroReport 28, no. 12 (2017): 712-719.
[10] Odle, Teresa G. “Patient-Centered Care in Breast Imaging.” Radiologic technology 90, no. 3 (2019): 259M-277M.
[11] Otoni, Jessyca Couto, Marcela Pecora Cohen, and Almir Galvão Vieira Bitencourt. “Physician-patient communication in diagnostic examinations: what is the role of the radiologist?.” Radiologia brasileira 51, no. 2 (2018): 109-111.