# A nurse is caring for an elderly client with mixed hearing loss who uses both a hearing aid and relies on lip reading for communication. Which intervention should the nurse prioritize to enhance communication with this client?

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> subject: Adult Health

## 문제

A nurse is caring for an elderly client with mixed hearing loss who uses both a hearing aid and relies on lip reading for communication. Which intervention should the nurse prioritize to enhance communication with this client?

## 보기

1. Speak loudly and slowly while standing behind the client
2. Face the client directly, ensure good lighting, and speak clearly at normal volume **✔ 정답**
3. Use only written communication to avoid confusion
4. Remove the client's hearing aid to prevent feedback during conversation

**정답: 2**

## 해설

Facing the client directly with good lighting and clear speech optimizes both auditory (via hearing aid) and visual (lip reading) cues for effective communication in mixed hearing loss. Other options (speaking loudly from behind, using only written communication, or removing hearing aid) hinder communication by reducing visual access, overloading auditory input, or eliminating auditory support.

## 심화 해설

Understanding Mixed Hearing Loss and Communication

Mixed hearing loss involves a combination of conductive and sensorineural damage. This means the client has deficits in both the mechanical transmission of sound and the neural processing of auditory signals. For an elderly client, this is often compounded by age-related changes affecting speech, language, and sensory functions [2]. The client's reliance on a hearing aid and lip reading indicates they are using multiple compensatory strategies, a common and effective approach in aural rehabilitation . The nurse's priority is to support these strategies by optimizing the environment and communication technique, which is fundamental to person-centered care [1].

Analysis of Correct Intervention (Option 2)

Facing the client directly, ensuring good lighting, and speaking clearly at a normal volume is the most effective intervention. This approach directly supports the client's primary compensatory mechanism: lip reading. Adequate lighting and a direct line of sight provide the essential visual cues for speechreading, while a clear, normal volume prevents sound distortion. Shouting or speaking abnormally loudly can distort the amplified sound from the hearing aid and make lip-reading cues harder to discern. This strategy aligns with the core principle of identifying and adapting to an individual's communication support needs and preferences, a critical component of care identified for older adults [1]. It acknowledges that communication is influenced by an interaction of health conditions and contextual factors, such as the physical environment and the communication partner's behavior [2].

Analysis of Incorrect Interventions

- **Option 1 (Speak loudly and slowly while standing behind the client):** This is contraindicated. Standing behind the client completely negates their ability to lip-read, removing a vital sensory input. Furthermore, speaking loudly into a hearing aid can cause sound distortion and discomfort, a phenomenon related to the device's feedback and gain limits. Effective aural rehabilitation relies on a communication partnership where the speaker actively facilitates the interaction, not hinders it .

- **Option 3 (Use only written communication to avoid confusion):** This is unnecessarily restrictive and dismissive of the client's existing functional abilities. The client uses both a hearing aid and lip reading, indicating a preference for and capability with oral communication. Limiting interaction to writing undermines their autonomy and does not reflect a person-centered approach to identifying and meeting communication preferences [1].

- **Option 4 (Remove the client's hearing aid to prevent feedback during conversation):** This action would actively worsen the client's hearing ability by removing the amplification they depend on. Hearing aid feedback is a technical issue that can be managed by ensuring proper fit, not by removing the device. Removing a sensory aid without a clinical rationale directly contradicts the goal of supporting communication, which is already challenged by barriers like background noise in clinical settings .

Clinical Reasoning and Priority Setting

The nurse's priority is to minimize environmental barriers and maximize the client's residual sensory function. Research on communication in healthcare settings highlights that environmental noise and poor communication partner technique are significant barriers for individuals with hearing loss . By controlling the modifiable factors—lighting, positioning, and speech clarity—the nurse directly applies the principle that contextual factors interact with health conditions to influence communication outcomes [2]. This supportive strategy is a cornerstone of aural rehabilitation that involves the communication partner, where the partner's behavior is a key component of successful dyadic communication .

References (research sources)

- [1]Identifying older adults' communication support needs and preferences: a scoping review of measurement instruments.Research articleManchha AV, Burton B, King M, Tanswell C, Siyambalapitiya S, Wood JM, Hickson L, Fetherstonhaugh D, Shrubsole K, Argus G, Scarinci N, Wallace SJ. (2026) · DOI: 10.1093/geront/gnag033

- [2]Factors Influencing Communication for Older Adults in Residential and Community Aged Care: A Scoping Review.Research articleManchha AV, Burton B, Siyambalapitiya S, Wood JM, Hickson L, Fetherstonhaugh D, King M, Wallace SJ. (2025) · DOI: 10.1093/geront/gnaf140

## 임상 시나리오

Communicating with Hearing Impaired ClientsOptimizing Visual and Auditory Cues
For a client using a hearing aid and lip reading, the priority is to face the client directly with adequate lighting on your face. Speak clearly at a normal volume to avoid distorting amplified sound.

Ensure the hearing aid is functional, clean, and inserted correctly. Minimize background noise by closing doors or turning off televisions. Use simple sentences and rephrase if misunderstood.

CautionNever shout or speak directly into the hearing aid; this can cause distortion and discomfort. Do not stand with a bright light behind you, as it casts your face in shadow and prevents lip reading.

## 핵심 개념

- **Mixed Hearing Loss** — A combination of conductive and sensorineural hearing loss affecting both sound transmission and neural processing.
- **Lip Reading** — A communication technique involving interpreting visual cues from lip movements, facial expressions, and gestures.
- **Aural Rehabilitation** — A patient-centered process to minimize the communication difficulties associated with hearing loss through various compensatory strategies.

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