Facemasks in the NHS setting - challenges for the d/Deaf

While the coronavirus pandemic has already meant that face masks and coverings have become part of daily life, this is proving to be a huge challenge for d/Deaf people, especially within the medical environment. The UK government and the World Health Organisation (WHO) have both advised wearing face coverings in a bid to reduce the infection transmission of Covid-19, and deaf people do understand this reasoning. However, there remains a challenge for both the clinician or medical staff and the deaf patient about how to ensure vital communication measures are in place.

Many people who are deaf or have hearing loss rely, heavily, on visual cues for effective communication, including facial expressions and lip-reading. Being able to see lip patterns and facial expressions is also vital for those who communicate through British Sign Language. However, there is currently a national shortage of deaf-friendly face masks with clear panels which allow users to lip read and to see the facial aspects of British Sign Language. While this is a known challenge, deaf patients will be hoping that in-house patient experience and procurement teams can find some way of working to meet this need. Meanwhile, other measures must be considered and, hopefully for the deaf person, introduced. This could include social or physical distancing, timed appointments, being seen immediately, and not kept in waiting rooms. Deaf patients need patience and, therefore, often, more time.

Meanwhile, effectively understanding and capturing the communication needs of patients with sensory loss is key. While many people hate being labelled, the opposite can be the case with deaf people who, more often, state that there is not enough information on, or in, their patient files, about their deaf needs. It is essential to identify and record this information and the communication needs of patients with sensory loss on both the PAS/MAXIMs system, or equivalent, and their paper files. A deaf sticker rarely causes embarrassment! A stated “hearing impairment” will not, necessarily reflect the true nature of their communication needs. Some deaf people have a mild to moderate hearing loss and maybe coped well enough with their hearing aids, prior to facemask usage. However, a hearing impairment could mean someone who has no hearing and no understanding of British Sign Language (BSL), who could have lost their hearing through illness or accident and never grew up with sign language. For this person, who relies on lipreading, their communication challenge is enormous, especially as lipreading is extremely tiring at the best of times! They will often require an electronic notetaker for their communication support.

All clinicians will know that patients don't take in everything that is said and, that there are many medical conditions which may hinder communication, including neurological conditions, mental health and simply pain or fear. So, while the problematic issue of wearing facemasks isn't peculiar to just those with hearing loss, it's probably worse for these patients to understand and take on board the information if, for example, they are a signer or solely a lipreader.

And, let’s not forget that there are many NHS colleagues, across the services who are living with hearing loss. While 1 in 5 people in Cornwall live with hearing loss, this translates into a large percentage of team members who are also struggling with the current requirement to wear a facemask, not helped by the fact that, if they have to wear glasses along with hearing aids or CI, this creates another uncomfortable physical barrier in communicating. Alongside this, the need for social distancing takes away the capability to get closer to enable hearing with the additional challenge of the patient also wearing a mask! Another reminder of the need for consideration for all those with sensory needs.

Currently, it would seem that facemasks will continue to be part of everyday life and certainly an additional requirement within the NHS teams that have not previously needed to wear them.

Here are some ideas of how communication can be supported:

In advance:

• Ensure that written communications, signage and patient information are very clear
• Be prepared and identify any patient/s with hearing loss, and ensure a plan is put in place for how you are going to communicate with them, (especially if they need an interpreter/communication support worker

In situe:

• Speak clearly, slowly, distinctly, but naturally, without shouting or exaggerating mouth movements. Deaf people often lipread well (without masks!)
• Try to find a quiet environment
• Acknowledge that the person is in “receive” mode.
• Avoid talking too rapidly or using sentences that are too complex. 
• Keep your hands away from your face while talking
• Write things down - use pen and paper, a white board, or text on device screens. “Live Transcribe” is often a preferred app for deaf patients, or actually, anyone who may have difficulty ‘hearing’
• Use descriptive visuals to aid understanding
• Try to find a different way of saying the same thing, rather than repeating the original words over and over
• Point when explaining BUT don’t use exaggerated movements, this can be scary.
• Ensure patient understands what is happening next i.e.: injection, bloods
• Clarify understanding, especially any change of subject
• Never use a family member, unless they specifically request this. (Less relevant during Covid).
• Review future instructions – again write clearly

For Deaf BSL users:

• Face the person directly, speak to the patient (not the interpreter!) 
• Sit or stand beside the interpreter if one is present
• Use a professionally accredited BSL interpreter, details below

It is important to reiterate that there can remain gaps in communication. Deaf people, particularly, will admit to nodding their head because they have become used to not being part of the conversation. It is vital that you continue to reaffirm that the appropriate information has been received. It is not unusual for d/Deaf people to concede that they have only heard about 50% of the information, which is very disquieting in medical/medication scenarios.

On the wards it is always worth checking if patients who use hearing aids, are wearing their aids and that their batteries are working. Maybe they have come from a procedure and not been reunited with their hearing assistance? There are some Assistive Listening Devices which may be of help too, enquire within your department/surgery.

These are challenging times for everyone, clinicians, NHS colleagues and patients. Being “deaf” has so many variances, we hope this has helped. Feel free to contact Hearing Loss Cornwall, as below, for further assistance or signposting.

NB: Most Deaf patients, within Cornwall, have a preferred interpreter who they work with. Hearing Loss Cornwall provide British Sign Language and Communication Support to NHS and other services.
Bookings can be made through: hearingloss.cornwall@nhs.net or info@hearinglosscornwall.org. Phone: 01872 225868 or 24 hour Out of Hours: 01209 823103

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