What is a proper way for a nursing assistant to respond if a resident does not hear well or does not understand?

Your hearing device will help you hear better in some situations, but for better results using a range of communication skills will help you make the most of your hearing and your hearing device. There are other things you can do to give yourself the best chance of hearing and understanding well. These are commonly known as “communication tactics”. The best thing about these tactics is that they are useful for everyone, whether or not they have a hearing loss or use a hearing device.

Table of Contents Show

Tips to help you hear better
Be assertive
Using visual cues
Using context
Reduce background noise
Asking for clarification
Asking for repeats
Importance of concentration and keeping calm
Tips for communicating with a person with hearing loss
Speak clearly and don’t shout
Face the person
Reduce the distance between you and the person
Reduce background noise
Rephrase the sentence

Tips to help you hear better

Be assertive

Inform people you have a hearing loss and tell them how they can help you. Most people will be happy to oblige if they understand what they need to do.

Explain you don’t need them to shout at you, but to face you when they are talking and speak normally. You might need to remind people of this at times.

Using visual cues

We all “lip-read” to some degree, as we understand how different sounds look on people’s lips when they are talking. We use this naturally to help us figure out what a word might be if we missed it.

Keep a clear view of a person’s face by looking at them when they talk and making sure the room is well-lit.

Using context

When chatting with somebody try not to worry about hearing every single word but focus instead on the theme of the conversation. You can piece in missed words if you understand the general context of the conversation.

Reduce background noise

Try to reduce the noise around you when people are speaking, for example, turn off the television or radio, or sit away from the kitchen or entrance-way in a café.

Asking for clarification

If you miss what somebody has said and you can’t figure it out, try to avoid saying simply “I can’t hear you” or “what did you say?” as this will eventually lead to frustration for yourself and those talking with you.

Instead, ask them to repeat specifically what you missed. For example, “I’m sorry; I missed where you said you were going on Sunday afternoon?”

Asking for repeats

If you keep missing the same word or group of words, ask the speaker to rephrase what they are saying. You might say “I keep missing that last part about your new car, could you please try saying it a different way for me?”

Importance of concentration and keeping calm

Try to keep calm if you can’t hear well in certain situations. When you miss words you might find yourself getting tense, but this will make it even harder for you to catch up with what has been said. There will be times when you don’t hear so well, when you find it almost impossible to figure out the conversation. This is an expected part of having a hearing loss, even if you are wearing a hearing device.

It can help to think about what you can do to help yourself in these situations. For example, can you ask the speaker to write down what they have said?

Remember that if you are tired, or unwell, you will likely find it more difficult to concentrate on following a conversation and you might not hear as well.

Tips for communicating with a person with hearing loss

A person with a hearing loss will struggle to hear at times, even with a hearing device. This is normal and to be expected – a hearing device can help a person, but it cannot cure the underlying hearing loss. Your understanding and consideration of this will help them a great deal.

Try not to get frustrated if somebody can’t hear you – they are asking you to repeat yourself because they value what you have to say.

Speak clearly and don’t shout

Shouting will make your voice distorted and hard to understand. Instead, speak clearly and if necessary, slightly slower than normal. If you do need to raise your voice, project your voice the way you would if you were speaking to a person on the other side of the room. This usually sounds clearer than shouting.

Face the person

When talking to a person who has a hearing loss, make sure you face them. This is helpful because they can watch your face for extra clues about what you are saying, and the volume of your voice will be louder when you are looking at them.

Try not to cover or hold objects in front of your mouth, as this will make it hard for a person with a hearing loss to see and read your lips.

Reduce the distance between you and the person

The ideal listening distance for a hearing impaired person is less than two meters from the speaker. Avoid talking to a person with a hearing loss from a different room.

Reduce background noise

Reduce background noise if you can – turn off the radio or television, close the door leading onto a busy street, pick a quieter restaurant to dine in.

Rephrase the sentence

Rephrase what you are saying if you need to. If a person with a hearing loss asks you to repeat something you said, repeat it once – if they still cannot understand you, think of a different way to say the same thing. This is something most people will naturally do, even for those with normal hearing.

Working with patients who are cognitively impaired presents an ongoing communication challenge. For instance, they likely will have trouble following any instructions about their care, including how and when to take prescriptions. Make sure someone can closely monitor care management, and try to involve a care partner whenever possible.

Here are 15 tips for effectively working with and communicating with cognitively impaired patients.

Try to address the patient directly, even if his or her cognitive capacity is diminished.
Gain the person's attention. Sit in front of and at the same level as him or her and maintain eye contact.
Speak distinctly and at a natural rate of speed. Resist the temptation to speak loudly.
Help orient the patient. Explain (or re-explain) who you are and what you will be doing.
If possible, meet in surroundings familiar to the patient. Consider having a family member or other familiar person present at first.
Support and reassure the patient. Acknowledge when responses are correct.
If the patient gropes for a word, gently provide assistance.
Make it clear that the encounter is not a "test" but rather a search for information to help the patient.
Use simple, direct wording. Present one question, instruction, or statement at a time.
If the patient hears you but does not understand you, rephrase your statement.
Although open-ended questions are advisable in most interview situations, patients with cognitive impairments often have difficulty coping with them. Consider using a yes-or-no or multiple-choice format.
Remember that many older people have hearing or vision problems, which can add to their confusion.
Consider having someone call the patient to follow up on instructions after outpatient visits.
If the patient can read, provide written instructions and other background information about the problem and options for solutions.
Address potential issues of driving, getting lost, and home safety each time you see the patient. And, encourage regular physical activity, social activity, hobbies, and intellectual stimulation, as well as a healthy diet. Some studies link these approaches to the maintenance of cognitive function.

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed: May 17, 2017

Successful communication requires the efforts of all people involved in a conversation. Even when the person with hearing loss utilizes hearing aids and active listening strategies, it is crucial that others involved in the communication process consistently use good communication strategies, including the following:

Face the hearing-impaired person directly, on the same level and in good light whenever possible. Position yourself so that the light is shining on the speaker's face, not in the eyes of the listener.
Do not talk from another room. Not being able to see each other when talking is a common reason people have difficulty understanding what is said.
Speak clearly, slowly, distinctly, but naturally, without shouting or exaggerating mouth movements. Shouting distorts the sound of speech and may make speech reading more difficult.
Say the person's name before beginning a conversation. This gives the listener a chance to focus attention and reduces the chance of missing words at the beginning of the conversation.
Avoid talking too rapidly or using sentences that are too complex. Slow down a little, pause between sentences or phrases, and wait to make sure you have been understood before going on.
Keep your hands away from your face while talking. If you are eating, chewing, smoking, etc. while talking, your speech will be more difficult to understand. Beards and moustaches can also interfere with the ability of the hearing impaired to speech read.
If the hearing-impaired listener hears better in one ear than the other, try to make a point of remembering which ear is better so that you will know where to position yourself.
Be aware of possible distortion of sounds for the hearing-impaired person. They may hear your voice, but still may have difficulty understanding some words.
Most hearing-impaired people have greater difficulty understanding speech when there is background noise. Try to minimize extraneous noise when talking.
Some people with hearing loss are very sensitive to loud sounds. This reduced tolerance for loud sounds is not uncommon. Avoid situations where there will be loud sounds when possible.
If the hearing-impaired person has difficulty understanding a particular phrase or word, try to find a different way of saying the same thing, rather than repeating the original words over and over.
Acquaint the listener with the general topic of the conversation. Avoid sudden changes of topic. If the subject is changed, tell the hearing impaired person what you are talking about now. In a group setting, repeat questions or key facts before continuing with the discussion.
If you are giving specific information – such as time, place or phone numbers – to someone who is hearing impaired, have them repeat the specifics back to you. Many numbers and words sound alike.
Whenever possible, provide pertinent information in writing, such as directions, schedules, work assignments, etc.
Recognize that everyone, especially the hard-of-hearing, has a harder time hearing and understanding when ill or tired.
Pay attention to the listener. A puzzled look may indicate misunderstanding. Tactfully ask the hearing-impaired person if they understood you, or ask leading questions so you know your message got across.
Take turns speaking and avoid interrupting other speakers.
Enroll in aural rehabilitation classes with your hearing-impaired spouse or friend.

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.

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