Hearing loss is a common medical condition affecting people of all ages with numerous causes.
In this article:
- Overview
- Nursing Process
- Nursing Care Plans
- Deficient Knowledge
- Disturbed Sensory Perception (Auditory)
- Impaired Verbal Communication
- Social Isolation
Overview
There are three types of hearing loss:
- Sensorineural: This is the most common type of hearing loss and occurs when there is damage to the inner ear or the hearing nerve. Aging, injury, disease, medications, and loud noise exposure are potential causes. This type cannot be treated medically or surgically, but patients can benefit from using hearing aids.
- Conductive: This type of hearing loss occurs in the middle or outer ear, affecting how the sound waves are carried toward the inner ear. This may be caused by an obstruction in the ear canal, impacted middle ear, infection, bone abnormality, or injury to the eardrum and may be corrected medically or surgically.
- Mixed: Some patients with hearing loss may be affected by sensorineural and conductive hearing loss.
Clinical manifestations of hearing loss include the following:
- Difficulty understanding words
- Muffling of speech
- Trouble hearing consonants
- Frequently asking others to repeat themselves
- Needing to increase the television volume
- Withdrawal from conversations
- Social isolation
Hearing loss is diagnosed through a physical examination, general hearing screening test, tuning fork tests, and audiometer tests.
Nursing Process
Nursing care for patients with hearing loss focuses more on cerumen management to reduce hearing impairment and the use of hearing aids and patient education to help prevent complications, promote recovery, and enable effective communication.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for hearing loss, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for hearing loss.
Chronic Low Self-Esteem
Patients with hearing loss may have significantly low self-esteem due to their impaired ability to communicate with others.
Nursing Diagnosis: Chronic Low Self-Esteem
Related to:
- Disturbed body image
- Fear of rejection
- Vulnerability
- Inadequate sense of belonging
- Inadequate social support
- Ineffective communication skills
- Insufficient approval from others
As evidenced by:
- Depressive symptoms
- Excessive seeking of reassurance
- Expresses loneliness
- Hopelessness
- Reduced eye contact
- Self-negating verbalizations
- Shame
- Underestimates their ability to deal with the situation
- Isolates self
- Nonassertive/passive
Expected outcomes:
- Patient will show an improved ability to interact with other people.
- Patient will demonstrate self-acceptance and attempt to communicate with others.
Assessment:
1. Assess stressors causing low self-esteem.
Psychological and physical stressors like hearing loss can cause the patient to feel insecure about themselves and communicating with others.
2. Assess existing strengths and coping abilities.
Hearing loss can significantly decrease the patient’s self-esteem causing anxiety and depression. Assess the patient’s coping abilities to their perceived limitation.
3. Assess the patient’s self-esteem.
Low self-esteem can manifest as insecurity, self-care deficits, inadequacy, nonadherence to the treatment regimen, isolation, and withdrawal from social relationships.
Interventions:
1. Use therapeutic communication.
Therapeutic communication techniques such as maintaining eye contact, listening, offering time, and validating the patient’s experiences promote trust and ongoing communication.
2. Help the patient recognize their strengths.
Acknowledging positive strengths and coping abilities to manage hearing loss can help boost the patient’s self-esteem.
3. Refer the patient to group therapies and support groups.
Support and community groups for hearing impairments provide the patient with emotional and social support enabling acceptance and promoting confidence.
4. Encourage socialization.
Once the patient becomes comfortable, encourage activities that promote ongoing socialization where talking isn’t the primary goal, such as quiet craft events or outdoor activities.
Deficient Knowledge
Lack of accurate information about hearing loss and its management can cause psychosocial and physiological complications.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Misinformation
- Inadequate commitment to learning
- Inadequate information about hearing loss
- Lack of available sources of information
- Inadequate knowledge of resources
- Inadequate participation in care planning
As evidenced by:
- Inaccurate follow-through of instructions
- Inaccurate statements about hearing loss
- Lack of motivation to change
- Development of poor social or language skills in children
- Nonadherence with hearing devices
Expected outcomes:
- Patient will actively participate in the care plan to manage hearing loss.
- Patient will utilize devices and tools to increase hearing ability.
Assessment:
1. Inquire about the patient’s attempts to correct their hearing loss.
It is helpful to assess what the patient has tried to correct their hearing loss, such as technological devices, surgery, or specialist care, so the nurse does not duplicate interventions.
2. Assess the patient’s developmental needs.
Hearing loss can affect people of all ages, and patient education must be developed according to the patient’s developmental needs. Children may require more intense support and resources.
3. Assess the patient’s motivation to learn.
Assess if the patient is interested in advanced technology or working with a specialist to improve their hearing.
Interventions:
1. Educate on tips to improve hearing abilities:
- Remove background noise
- Remind people not to yell but to speak clearly
- Be upfront about your hearing loss and explain how you hear best
- In a loud setting, such as a restaurant, ask to be seated in a quieter area
- Ask a friend to relay important information
- Focus on one person at a time instead of a group
- Turn on closed-captioning on the television
2. Refer the patient to a speech therapist or audiologist.
A speech therapist can help children develop their speech and language around hearing loss. An audiologist is integral in assessing hearing loss and recommending devices such as hearing aids or cochlear implants.
3. Teach the patient alternative communication techniques.
Children can be taught sign language at a young age. Amplifiers can increase sound volume while eliminating background noise. Text telephones can allow typing of messages instead of voice calls.
4. Recommend organizations and resources.
Schools for the deaf, the Hearing Loss Association of America, and community resources help adults and children learn about hearing loss and available technologies.
Disturbed Sensory Perception (Auditory)
Disturbed auditory functioning may impair a patient’s ability to communicate, interact with others, and perform daily tasks.
Nursing Diagnosis: Disturbed Sensory Perception (Auditory)
Related to:
- Aging process
- Damage to the inner structures of the ear
- Long-term noise exposure
- Ear obstruction
As evidenced by:
- Vertigo or dizziness
- Ringing in the ears (tinnitus)
- Impaired communication
- Change in behavior
Expected outcomes:
- Patient will demonstrate improved communication and interaction with others.
- Patient will utilize resources available to cope with hearing loss.
Assessment:
1. Monitor for changes in balance.
Changes in the inner ear can lead to vestibular dysfunction, which may cause dizziness, vertigo, and balance issues. Consider this as a potential cause if the patient has experienced new neurological symptoms or falls.
2. Monifor for changes in behavior.
Auditory disturbances may cause the patient to become withdrawn, appear confused, or no longer participate in activities or conversations.
3. Review the patient’s medications.
Ototoxic medications may cause hearing loss, tinnitus, and dizziness. Examples include loop diuretics, chemotherapy agents such as cisplatin or carboplatin, and certain antibiotics.
Interventions:
1. Encourage the use of hearing and listening devices.
Hearing aids, assistive listening devices, closed-caption TV, and captioned telephones are devices that can support patients with hearing impairments.
2. Encourage the use of touch and eye contact.
Auditory perception is disrupted in patients with hearing loss, but other senses can compensate for this deficit, such as touch and visualization. Use touch, eye contact, and gestures to convey emotions and communicate.
3. Limit extraneous noise.
Alarms, music, competing conversations, and other background noise can make communication even more difficult for patients with hearing loss.
4. Prepare for procedures or surgery.
Simple procedures, like earwax removal, may make a difference in the patient’s hearing ability. Patients with more severe hearing loss may benefit from implants, such as a cochlear implant or a bone-anchored hearing device. Surgical interventions, like tympanoplasty, can help restore a ruptured eardrum.
Impaired Verbal Communication
Hearing loss can affect a patient’s verbal communication as they have difficulty understanding spoken words, especially when there is background noise. Hearing loss affects mainly speech perception rather than speech production in adults. In children, it can affect the child’s speech development and language skills.
Nursing Diagnosis: Impaired Verbal Communication
Related to:
- Hearing loss
- Inability to hear audibly
- Disease process
- Low self-esteem
- Impacted cerumen
- Inner ear abnormality
- Fluid in the ear
- Frequent ear infections
- Perceived vulnerability
- Psychological barriers
As evidenced by:
- Alternative communication
- Difficulty comprehending communication
- Difficulty establishing social interaction
- Difficulty maintaining communication
- Difficulty using facial expressions
- Inappropriate verbalization
- Withdrawal from conversations
- Absence of eye contact
- Difficulty expressing thoughts
- Frustration
Expected outcomes:
- Patient will demonstrate the use of effective communication techniques.
- Patient will communicate verbally and nonverbally congruently.
Assessment:
1. Assess the patient’s extent of hearing loss and ability to interpret spoken words.
Different conditions can cause hearing loss, including dysfunction in the central nervous system and damage to the inner ear and associated nerves. Central hearing loss causes difficulty perceiving speech and processing complex information.
2. Assess the patient’s medical history leading to hearing loss.
Early age hearing loss can affect the patient’s communication skills. Other factors may include long-term noise exposure, medications like chemotherapy, and illnesses such as meningitis.
3. Assess the patient’s reaction to their hearing impairment.
Patients respond differently to hearing loss, and evaluating the patient’s emotional and social status can help determine an appropriate plan of care to help promote coping and recovery.
Interventions:
1. Make sure you have the patient’s attention.
Before speaking or asking the patient questions, ensure you have their attention and make eye contact to prevent misunderstandings.
2. Place signage in the room.
It is reasonable to place a sign in the patient’s room to alert other healthcare providers to the patient’s hearing loss and how they best communicate.
3. Use simple and easy-to-understand instructions.
Simple and easy-to-understand instructions allow the patient time to process information correctly or follow instructions. Speak clearly, face the patient, and enunciate your words.
4. Encourage the use of alternative communication techniques.
Using gestures, writing, and sign language are effective strategies for communicating with patients with hearing loss.
5. Help utilize hearing aids.
Hearing aids are a common device used to overcome hearing loss. The nurse can assist the patient in charging, cleaning, and inserting hearing aids.
Social Isolation
Hearing loss may contribute to social isolation, as patients may withdraw from activities and avoid engaging in conversations.
Nursing Diagnosis: Social Isolation
Related to:
- Difficulty communicating
- Impaired hearing
- Low self-esteem
As evidenced by:
- Expresses dissatisfaction with social connections
- Reports difficulty participating in conversations
- Expresses loneliness
- Flat affect
- Poor eye contact
- Minimal interaction with others
- Reports feeling insecure in public
- Social withdrawal
- Rejection from others
Expected outcomes:
- Patient will practice communicating with others.
- Patient will initiate interactions and participate in social engagements.
Assessment:
1. Assess the patient’s feelings and perceptions about social interaction capabilities.
Patients with hearing loss may feel embarrassed by their difficulty hearing others and participating in conversations. They may find it easier to listen, sit on the sidelines, or disengage rather than face isolation. Assess the patient’s feelings surrounding social situations to understand their perception and develop potential solutions.
2. Identify the patient’s support system.
Assess family members, friends, colleagues, and religious members who are part of the patient’s social circle. The nurse may include support persons in care planning or, if there is a lack of social support, seek other resources and programs to enhance socialization.
Interventions:
1. Establish a trusting relationship with the patient.
Establishing a trusting relationship with the patient will help them feel less isolated and allow them to open up and discuss their feelings and emotions about hearing loss and social isolation.
2. Assist the patient in practicing social skills.
Help the patient practice and develop social skills in settings that make them uncomfortable. The nurse can roleplay situations that allow the patient to learn how to respond if they are having difficulty hearing or communicating.
3. Encourage creative methods to reduce isolation.
The patient may find interest in activities that don’t require talking, but allow them to be in the company of others, such as exercise, crafts, journaling, or dancing. The patient may connect with people online where they can type instead of talking.
4. Teach the patient alternative communication methods.
Sign language and gestures can help patients with hearing loss communicate effectively with others, addressing social isolation issues.
5. Refer the patient to community support groups.
Community support groups for patients with hearing loss facilitate social interaction with individuals who share the same disability and interests.
References
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Deafness and hearing loss. World Health Organization. Reviewed: April 1, 2021. From: https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss
- Hearing loss. Mayo Clinic. Reviewed: April 16, 2021. From: https://www.mayoclinic.org/diseases-conditions/hearing-loss/symptoms-causes/syc-20373072
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
- Meyer C, Hickson L. Nursing Management of Hearing Impairment in Nursing Facility Residents. J Gerontol Nurs. 2020 Jul 1;46(7):15-25. DOI: 10.3928/00989134-20200605-04. PMID: 32597997.
- Types of Hearing Loss. Centers for Disease Control and Prevention. Reviewed: July 18, 2022. From: https://www.cdc.gov/ncbddd/hearingloss/types.html
- Types of Hearing Loss. Johns Hopkins Medicine. 2023. From: https://www.hopkinsmedicine.org/health/conditions-and-diseases/hearing-loss/types-of-hearing-loss
- Wyatt, C. (2012, September 25). Socializing with hearing loss, learn strategies to improve participation. SayWhatClub. Retrieved February 21, 2023, from https://www.saywhatclub.org/socializing-with-hearing-loss/
