Nursing Management of Hearing Impairment in Nursing Facility Residents.

Hearing impairment (also known as hearing loss) is highly prevalent in residents of nursing facilities and its impacts are far-reaching. Hearing impairment has negative consequences for an individual's quality of life, psychosocial health, physical health, and mortality; these impacts are also exacerbated when hearing impairment cooccurs with other conditions, such as visual or cognitive impairment. These guidelines summarize the extensive evidence about the impacts of hearing impairment, the factors that are associated with increased risk of hearing impairment, assessment criteria for measuring impairment, and the management of residents' hearing impairment. Nursing interventions should focus on (a) cerumen management to reduce hearing impairment and allow for the use of hearing devices; (b) hearing device support so that residents can use hearing aids and/or other assistive listening devices; and (c) communication strategies so that conversations with residents can be facilitated. [Journal of Gerontological Nursing, 46(7), 15-25.].

Hear-Communicate-Remember: Feasibility of delivering an integrated intervention for family caregivers of people with dementia and hearing impairment via telehealth.

PURPOSE: To evaluate the feasibility of Hear-Communicate-Remember, a training programme developed for family caregivers of people with dementia and hearing impairment that integrated hearing, communication and memory strategies, which was intended to be delivered via telehealth. MATERIALS AND METHODS: Participants included six dyads consisting of adults with dementia and hearing impairment and their family caregivers. Data collection involved a combination of semi-structured interviews, self-report questionnaires and field notes. RESULTS: Analysis of the qualitative interviews revealed four themes: appropriateness of intervention resources, considerations for the delivery of intervention via telehealth, knowledge and application of intervention strategies, and impact of the intervention on day-to-day life. Results from the satisfaction survey indicated that caregiver participants were mostly satisfied with all aspects of the intervention except the use of some technological components. The field notes described challenges with implementation via telehealth. CONCLUSIONS: Future research involving a cohort comparison study with a larger cohort of dyads is needed to establish treatment efficacy.

The nurse's role in ear care: undertaking hearing assessment and ear cleaning.

Noreen Kilkenny, Senior Lecturer, Adult Nursing, Northumbria University, noreen.kilkenny@northumbria.ac.uk , describes the physiology and anatomy of the ear, common abnormalities and the procedures that nurses should follow in assessing and diagnosing ear conditions and hearing problems in adults.

Exploring the sensory screening experiences of nurses working in long-term care homes with residents who have dementia: a qualitative study.

BACKGROUND: The prevalence of vision and hearing loss is higher amongst older individuals with dementia, as well as higher in long-term care settings than in the wider community. However, the incidence of sensory impairment is underreported and often goes untreated. In this study, we aimed to understand nurses' current experiences of screening and caring for long-term care residents who have dementia and sensory impairment. METHODS: As part of a larger study on the sensory screening of long-term care residents with dementia, an environmental scan was conducted with front-line healthcare providers. We report here on the findings from the content analysis of individual, semi-structured interviews with nurses working in two long-term care homes in Southern Ontario, Canada. Twenty regulated nurses, including designated resident assessment coordinators, working full- or part-time with individuals who have dementia, participated across the two sites. All interviews were transcribed, and their contents reviewed and coded for themes by means of inductive thematic analysis. RESULTS: Following a systematic and recursive approach, three analysts identified several themes relating to: 1) the sensory screening process, 2) communication strategies, and 3) quality of life, sensory loss, and dementia. Participants reported on the strengths and limitations of screening procedures, what improvements should be made, which informal strategies are effective, and the continued professional development that is needed. CONCLUSIONS: Nurses demonstrated insight into the facilitators and barriers to effective screening and care of residents with dementia and sensory impairments, and expressed the need for further education, more suitable screening tools, and formalised accountability within the screening process for vision and hearing loss in these long-term care residents.

Raising awareness of sensory impairment among community nurses: a brief intervention in a remote island setting.

INTRODUCTION: The prevalence of sensory impairment that includes sight and/or hearing impairment is projected to rise worldwide given the strong correlation between sensory impairment, older age and the demographic structure of the global population. Sensory impairment and associated disability is thus a significant global health concern. The prevalence rates for sensory impairment in Scotland are significant: as more people live into older age and as the age distribution in rural areas is markedly different with a higher proportion of older people, the extent of sensory impairment in the rural population will increase proportionally. In rural areas community nurses have a key role in recognising sensory impairment and directing people to sensory services to reduce the debilitating impact of sensory impairment. However, there is limited evidence about the utility of educational interventions to enhance healthcare professionals' knowledge, skills and attitudes about sensory impairment and subsequent impact on referral practices. The aim of this study was to evaluate the impact of a brief educational intervention with community nurses. The educational intervention was a training workshop that included simulation practice, information on assessment and referral pathways. The study was conducted in a remote island community health setting in the Western Isles of Scotland. The study evaluated nurses' perceptions of the training on their knowledge, attitudes and practice. METHODS: Mixed method, longitudinal design was implemented in three phases. Phase 1 was a pre- and post-workshop questionnaire, phase 2 a postal questionnaire 3 months post-workshop and phase 3 a qualitative focus group interview 6 months post-workshop. Kirkpatrick's model of training evaluation provided a framework for data evaluation. RESULTS: A total of 41 community based healthcare professionals who were mostly nurses participated in the study. Participants described increased awareness of the potential for their patients to have a sensory impairment, greater understanding and empathy with patients who experience sensory impairment, more robust patient assessment to identify impairment, and increased likelihood to inform of, and refer to, sensory services. CONCLUSIONS: Community nurses are often well placed to identity disabilities and patients at risk of injury because of sensory impairment. Participation in simulation training can help to develop greater awareness of the impact of that sensory impairment. Knowledge of specialist services will increase the opportunities for referral to services and impact positively on the lives of older people living in rural settings. Provision of accessible education on sensory impairment for health and social care professionals can enhance care delivery to older people.

Implications of Hearing Care Policy for Nurses.

Hearing loss (HL) becomes increasingly common with age and can lead to multiple negative outcomes, including isolation, falls, depression, altered social relationships, and altered cognitive functioning. HL also can affect patient-provider communication and lead to misunderstandings. Despite the negative effects that HL has on multiple domains, less than 20% to 25% of individuals who might benefit from amplification devices and/or hearing aids own them. Barriers to use include stigma, cost, and access. Nurses can play a critical role in promoting appropriate care for individuals with HL and providing access for those who need hearing aids. The current article (a) briefly reviews how history and policies, especially Medicare and Medicaid, but also those defining the practice of audiology and dispensing of hearing aids, affect insurance coverage for hearing care; (b) reviews how a combination of forces brought the need for accessible and affordable hearing care to national attention and resulted in the Over-the-Counter (OTC) Hearing Aid Act; and (c) discusses the implications of the OTC Act for nurses and nursing practice. [Journal of Gerontological Nursing, 44(9), 9-14.].

CE: Original Research: Understanding the Hospital Experience of Older Adults with Hearing Impairment.

: Background: Older hospitalized adults with hearing impairment are vulnerable to adverse outcomes. These patients are at risk for being labeled confused, experiencing a loss of control, experiencing heightened fear and anxiety, and misunderstanding the plan of care. OBJECTIVE: This qualitative study sought to assess the hospital experience of older adults with hearing impairment in order to formulate suggestions for improving nursing care. METHODS: Open-ended interviews were conducted with eight participants, ages 70 to 95 years, who were identified as having a hearing impairment and were admitted as inpatients to a midwestern medical center. RESULTS: Through data analysis, three common themes emerged: health care communication difficulties, passivity and vulnerability, and frustration with family. CONCLUSIONS: Nurses will benefit from having a deeper understanding of the hospital experience of this vulnerable population. Efforts to address their needs can be accomplished through the following nursing actions: assess, accommodate, educate, empower, and advocate.

In hospital with a hearing impaired child - How parents experience communication between nurses and their child / Das Kind mit einer Hörbeeinträchtigung im Spital - Wie Eltern die Kommunikation zwischen Pflegenden und ihrem Kind erleben.

Background: In daily communication, children with hearing impairment are restricted and dependent on their parents' help. In case of a hospitalisation, the risk of insufficient information and resulting traumatisation for those children is high. The aim of this study is the investigation of the communicative needs of the children concerned in order to avoid negative consequences of a hospitalisation and of inappropriate communication by nursing staff. Aim: This study explores how parents of a child with hearing impairment experience the communication between the nursing staff and their hospitalised child. Method: The study was conducted together with an advisory centre for hearing-impaired children, where most of the parents could be recruited. Narrative, semi-structured interviews were conducted. The transcribed interviews were analysed according to the method of interpretative phenomenology. Results: The parents expressed their wish for affectionate verbal and nonverbal love and care for their child. They often experienced the nursing staff having little time, that there was no continuity and that the communicative needs of the child were not recognised. Since the parents did not think the nursing staff were capable of communicating with the child and because they wanted to protect him or her, they adopted a mediating role. Conclusions: Besides the sensitisation of the nursing staff, time resources, continuity, professional knowledge and benevolence in the nursing care of a child with hearing impairment play a fundamental role.

Evaluation of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study.

OBJECTIVES: To gain insights into the process of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors that contributed to these changes in their perceptions. DESIGN: Qualitative study alongside a cluster randomised controlled trial. SETTING: 17 long-term care homes spread across the Netherlands. PARTICIPANTS: 34 licensed practical nurses supporting 54 dual sensory impaired older adults. INTERVENTION: A 5-month training programme designed to enable nurses to support the self-management of dual sensory impaired older adults in long-term care. PRIMARY OUTCOMES: Nurses' perceptions on relevance and feasibility of the self-management programme collected from nurses' semistructured coaching diaries over the 5-month training and intervention period, as well as from trainers' reports. RESULTS: Nurses' initial negative perceptions on relevance and feasibility of the intervention changed to positive as nurses better understood the concept of autonomy. Through interactions with older adults and by self-evaluations of the effect of their behaviour, nurses discovered that their usual care conflicted with client autonomy. From that moment, nurses felt encouraged to adapt their behaviour to the older adults' autonomy needs. However, nurses' initial unfamiliarity with conversation techniques required a longer exploration period than planned. Once client autonomy was understood, nurses recommended expanding the intervention as a generic approach to all their clients, whether dual sensory impaired or not. CONCLUSIONS: Longitudinal data collection enabled exploration of nurses' changes in perceptions when moving towards self-management support. The training programme stimulated nurses to go beyond 'protocol thinking', discovering client autonomy and exploring the need for their own behavioural adaptations. Educational programmes for practical nurses should offer more longitudinal coaching of autonomy supportive conversational skills. Intervention programming should acknowledge that change is a process rather than an event, and should include self-evaluations of professional behaviours over a period of time. TRIAL REGISTRATION NUMBER: NCT01217502, Post-results.

Paid Support Workers for Adults with Intellectual Disabilities; Their Current Knowledge of Hearing Loss and Future Training Needs.

BACKGROUND: People with intellectual disabilities are more likely to have hearing loss than the general population. For those unable to self-advocate, the responsibility of detection and management falls to their caregivers. METHODS: This is the first cycle of a project using action research methodology to improve services. Twenty care workers were interviewed to understand their knowledge of hearing loss and hearing aids. Themes were generated using thematic analysis. FINDINGS: This group was better qualified than their peers but received minimal training in hearing loss. They were unable to accurately estimate expected prevalence and had a negative perception of hearing aids. Only 7% of service users were known to have hearing loss. CONCLUSIONS: Current training is not sufficient to provide the skills for detection and management of hearing problems. This group had clear ideas on methods of learning. Working in collaboration is necessary to achieve long-term change to practice.

Diabetes and Hearing Loss Among Underserved Populations.

Type 2 diabetes (T2DM) disproportionately affects the underserved population, and has been identified as the major risk factor for many microvascular diseases. T2DM also affects the vasculature and neural system of the inner ear, often leading to hearing loss, a major risk factor for falls, depression, and other health problems. This article aims to: increase awareness of the association between T2DM and hearing loss; promote screening for hearing loss; discuss available resources and assistive devices for those with hearing loss; and encourage nurses to take an active role in advocating for assessment and treatment of hearing loss in T2DM patients.

Association of hearing impairment with declines in physical functioning and the risk of disability in older adults.

BACKGROUND: Identifying factors associated with functional declines in older adults is important given the aging of the population. We investigated if hearing impairment is independently associated with objectively measured declines in physical functioning in a community-based sample of older adults. METHODS: Prospective observational study of 2,190 individuals from the Health, Aging, and Body Composition study. Participants were followed annually for up to 11 visits. Hearing was measured with pure-tone audiometry. Physical functioning and gait speed were measured with the Short Physical Performance Battery (SPPB). Incident disability and requirement for nursing care were assessed semiannually through self-report. RESULTS: In a mixed-effects model, greater hearing impairment was associated with poorer physical functioning. At both Visit 1 and Visit 11, SPPB scores were lower in individuals with mild (10.14 [95% CI 10.04-10.25], p < .01; 7.35 [95% CI 7.12-7.58], p < .05) and moderate or greater hearing impairment (10.04 [95% CI 9.90-10.19], p < .01; 7.00 [95% CI 6.69-7.32], p < .01) than scores in normal hearing individuals (10.36 [95% CI 10.26-10.46]; 7.71 [95% CI 7.49-7.92]). We observed that women with moderate or greater hearing impairment had a 31% increased risk of incident disability (Hazard ratio [HR] =1.31 [95% CI 1.08-1.60], p < .01) and a 31% increased risk of incident nursing care requirement (HR = 1.31 [95% CI 1.05-1.62], p = .02) compared to women with normal hearing. CONCLUSIONS: Hearing impairment is independently associated with poorer objective physical functioning in older adults, and a 31% increased risk for incident disability and need for nursing care in women.