Is it possible to practise with compassion and empathy?

Paul Peryman, MA, Dipl Aud (Melb), MNZAS-CCC, Audiologist

Van Asch Deaf Education Centre 

Christchurch, New Zealand

I work as a paediatric audiologist at van Asch Deaf Education Centre in Christchurch, New Zealand. I have worked there for 30 years. During that time I have practised within a family-centred care model, in conjunction with the teams with whom I work in the Centre.

Part of my work includes meeting families with preschool and primary school aged children who are deaf/hard of hearing (DHH). These families are referred to our centre from around central and southern New Zealand and stay in residence for four days. During that time, they meet and work with a team which includes myself, a speech language therapist, a specialist literacy teacher, a specialist early intervention teacher, and a New Zealand Sign Language tutor. The families also meet other parents who bring their DHH children to our early intervention centre.

The objectives of our residential courses are to provide assessments of the children and guidance to the families. Immediate post-course ratings of each specialist area of assessment and support are received from families before their departure. In common with the approach of the Colorado Home Intervention Programme, evidence for modifying and continuing professional practice within the residential course teams has been based on both family and professional feedback (both internal and external), as well as international research within each team member’s professional speciality.

Some reasons why our residential courses work well

  • An intense focus is provided on early language, hearing, signing, speech, visual communication, social behaviour, and literacy.
  • Consistency exists for each family from across the team members.
  • Family and child-centred focus – parents find this refreshing.
  • Generous time frames and flexibility in courses, allowing the tailoring of courses to family needs and referrer priorities.
  • Opportunities to meet other families and share experiences – especially beneficial for isolated families.
  • Unique and relaxed environment – helps families focus on themselves and their DHH child’s needs.
  • Presence of other deaf adults and children on the site is perceived as a positive characteristic.
  • Family travel, accommodation and meal costs are supported.

Hearing family stories and experiences

Working with these parents and families involves hearing stories. The stories are invited and prove highly informative for the team. Hearing the stories and reflecting back to parents requires the display of empathy and compassion, as parents are often at the same time quite emotional. Some have not previously had the opportunity to tell their story, and it comes as a relief to do so and to be heard.  Some parents have also had experiences of rushed audiological appointments, leaving them with little time to share observations and to ask the questions they want of the professionals. Those parents were feeling removed from the audiological management of their child; not understanding what was happening and what to expect. In some cases, parents didn’t believe the diagnosis, which they admitted had affected their willingness to persevere with the battle of keeping hearing aids on an infant who appears to hear.

How to balance limited time?

It seems to me that this state of affairs comes about due to my hospital colleagues being so pressed for time that they have to reduce their service to one of meeting the required evidence-based clinical protocols, against which they are audited. While some try to resist this pressure, it is ever present. They are concerned that too much valuable clinical time might be used up once a conversation is entered, leaving them unable to complete the protocols. Colleagues have also said anecdotally that they feel ill prepared to engage in conversations that might become emotional or difficult. There is a feeling that stopping and allowing time for conversation will affect their appointment schedules and therefore cause them stress (Severn et al, 2012).

 

 

TWO QUESTIONS FOR THE PROFESSION:

1. Is altruism in clinical practice being lost?

The dominating effects of the need to conform to evidence based practice has been raised as an issue in nursing (Straughair, 2012): “…as the profession of nursing advanced to develop evidence-based practice, some of the ethos of the compassionate nursing character was seemingly lost in favour of technical skills. This is supported by evidence suggesting that nurses have a decreased affinity with the ethos of altruism. Recent reports have highlighted negative patient experiences which reflect a clear lack of compassionate nursing care. This has led to a variety of documents re-endorsing the concept of compassion as a core and fundamental nursing value.”

We need more research in this area amongst paediatric audiologists.

2. Can EBP, the desire to help, and having the space to show empathy and compassion co-exist in audiology?

Audiology is a helping profession“A helping profession is one that nurtures the growth of or addresses the problems of a person’s physical, psychological, intellectual, emotional or spiritual well-being, including medicine, nursing, psychotherapy, psychological counseling, social work, education, life coaching and ministry.”

Bearing in mind this definition while sharing my approach to paediatric practice with my colleagues, I believe that it is possible for us to listen to parents and have the conversations that they request and that I know are necessary to support their understanding. I know that this can be done in a compassionate and empathetic manner, while still completing clinical procedures. Being empathetic and compassionate, and talking about what is going on, does not add time to the appointment, nor prevent the professional requirements of an appointment from taking place. Rather, it can just be present in the manner of speaking during the conversations that occur. As Brill and Nahmani have said, the presence of compassion (and presumably showing empathy) is simply a means of taking a stance towards clients, and toward the clinical relationship with them (Brill & Nahmani, 2017).

In some cases, conversation with parents does become sensitive, for which some counselling skills are required. This is especially the case if it is noted that progress in managing a child’s or parent’s needs will not occur without helping parents to move forward, and if one knows that this is the best opportunity to begin these conversations for the benefit of the family.

Diana Harbor recently cited research in her article on this site showing that compassion and listening skills can be taught and measured in audiology students. It is time for audiologists in training to have a practical counselling component within the curriculum; and for them to be introduced to the concepts of mindfulness, compassion and empathy, and how they are woven into professional practice. One could go even further and state that training needs to embed compassion and empathy as core values of audiological practice. Effective role modelling in practice that demonstrates high-quality compassionate audiological care is also essential for newly trained audiologists.

In conclusion…

Families need a balance between audiologists getting the assessment and technical aspects right, and understanding what their child can and can’t hear and what audiologists are trying to achieve. They need this provided within a climate of compassionate and empathetic care. Families are the ones who live every day with their child with hearing loss. No family can be expected to run with our recommendations unless they trust their professionals, they feel listened to, they understand what is going on, and they are given appropriate emotional and practical support.


References

American Speech-Language-Hearing Association. (2005). Position Statement.

Brill, M. & N. Nahmani (2017). “The presence of compassion in therapy.” Clinical Social Work Journal 45(1): 10-21.

Severn M. et al. (2011). “Occupational stress amongst audiologists: compassion satisfaction, compassion fatigue, and burnout.” Int J Audiol 51(1): 3-9.

Straughair, C. (2012). “Exploring compassion: implications for contemporary nursing. Part 1.” Br J Nurs 21(3): 160-164.

Kindness Begins at Home

Diana Harbor, BA

Audiological Scientist & Speech and Language Therapist

The Ear Foundation Nottingham England

This week yet again I have been reminded of the very powerful force of kindness and its power source…the listening ear. Yesterday I had the privilege of being with a group of teenagers all living with hearing loss, using different technology from cochlear implants to bone implanted devices with different personalities and experiences of the world, some who had never met each other before. We all took part in an exciting improv, drama workshop at the Ear Foundation. Much of the afternoon was spent in small groups creating wonderful stories and weaving a single idea into a feast of creativity that JK Rowlings would have drooled at. And the real magic happened as Loydie, a DJ from Capital radio, revealed to us very simple techniques for keeping ideas going, for turning problems into new ideas and for getting the best out of each other. The power of using the phrase “…yes and” and how to do this while listening and maintaining eye contact.

The reason I’m sharing it here is I will be using it in practice and it was a light bulb moment for me. Well maybe that’s a bit dramatic but definitely some sparks and embers that I’m going to ruminate over and feed with other new ideas on the subject. So if you are partial to a camp fire…feel free to bring along your marshmallow on a stick and sit with me for a bit as I share with you what I’ve learnt.

The Power of “Yes and…”

“Yes and…” Ideas start to fly; we feel accepted and heard

In the improv workshop we all put the idea of “yes and…” into practice as we started a story with “let’s go to…”. As one teenager started with a single idea (“Let’s go to the beach”), his team mates were asked to reply with “yes and…”

Wow!! This simple phrase encouraged a wave of ideas from “yes and we could build a sand castle”, “yes and we could build it so high it reached into space”, “yes and we could eat our picnic on the moon”, “yes and we could discover a new specifies of plant life that ends world hunger” or “yes and we can ride in a Lamborghini with the top down.”

At the heart of “yes and …” lay the principles of listening first, starting from what was shared, then accepting and acknowledging the value of the idea offered and then moving it forward by sharing ourselves. We were all amazed how quickly our ideas flowed, how quickly we got to exciting places in our minds because the people around us were listening and affirming our ideas. When it worked well, we bonded quickly with our groups and we were sad to leave them as we moved into different groups. It feels so good to be looked at, heard and our ideas enjoyed.

Compare to the Impact of “Yes, but …”

“Yes but…” usually means “we can’t”

Loydie then asked us to try the exact same activity, but this time when ideas were shared around the group instead of saying “yes and…. ” we had to say “yes but…” Not to overuse the campfire metaphor but this equally succinct phrase was like pouring cold water on the fire, as ideas fizzled into soggy piles of embarrassment and stray sparks leapt up in defensiveness. Now all our energies were going into planning our negative responses, usually judgmental.  “Let’s go to the beach…” “yes but it looks like it might rain”, “yes but we could take umbrellas”, “yes but it’s windy too they won’t work”….You get the idea now …. Whereas before our conversations and ideas flowed in a safe circle of sharing and equal power, now we found ourselves feeling dismissed, having to force our ideas into the circle — and the quieter members of the group withdrew completely.

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How To Create Moral Distress: Compromise Values and Professional Ethics by Not Practicing Patient-Centred Care

Jeanine Doherty, Au.D., M.Phil., M.B.S, B.Soc.Sci.(Hons.), 

Hearing Excellence 

Christchurch, New Zealand

Trying to live up to a philosophical ideal of increasing the social, psychological, cultural and ethical sensitivity of our human encounters requires our personal, deliberate effort in an ongoing process. The action requires reflection, experience, introspection and the development of emotional quotient (EQ). It is not possible to complete a course about Patient-Centered Care (PCC) and think “Hey I can write on ‘Linked in’ now that I am a PCC clinician,” nor is it something that clinic owners should believe is ‘ticked off’ by sending their staff to a course.

While PCC is not yet fully conceptualised within audiology (although some essays on the topic are available), as Stewart (2001) wrote, we do know that PCC is not technology centred, not practitioner centred, not clinic centred and not disease centred. I believe PCC has to be lived in like it is your 2nd skin – our “thermals” as we would wear in a chilly southern New Zealand winter. PCC has to be infused, like ethics awareness, into all aspects of student training, as well as within the modus operandi of any practice arena.

Ethics, Legality, Morality

As we know, ethics, legality and morality are each different, though related, constructs. Something can be legal, yet immoral to an individual, as our values lead to our personal morals. Moral distress arises when clinicians are unable to act according to their moral judgement and their Profession’s Ethical Code (Rodney, 2017). This distress is located not only within individuals when their actions mismatch their values, but also from within the broader healthcare structures of the clinician’s workplace. The socio-political structures that can create moral/ethical distress have been studied mostly within nursing, but the relevance of the concept to audiology should not be ignored. Moral distress also emerges from situations that are against all the principles of PCC.

Harris and Griffin (2015) write that some organisational policies can lead to diminished care quality and cynicism with lack of teamwork and lower morale amongst clinical staff. In such a work-place, increased competition and mistrust develops between staff, while middle management level finds itself stuck between demands from higher-up levels (e.g. profit/cost outcomes) and the lack of teamwork and lower morale of the clinicians who are in moral distress. The physiological and psychological effects caused by the existence of moral distress can lead to burn-out, and then the staff member becomes ill, finds another better workplace, or just gives in, morally disengages, and carries on in a manner that is opposed to their values/morals (Musto, Rodney & Vanderheide, 2015). Lachman’s (2016) list of symptoms of burnout includes fatigue, general illness, headaches, insomnia, disillusionment, anger, negative self-concept and a loss of concern for others.

Profit vs Patient Outcomes

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From Person-Centered Moments to Person-Centered Culture

Laya Poost-Foroosh, PhD., MClSc.
AMS Phoenix Fellow & Research Associate
St. Michael’s Hospital, Toronto, Canada
Audiologist
Sound Advice Hearing Clinic, Toronto, Canada

Many organizations and healthcare professionals have person-centered aspirations and perceive their model of care to be person-centered. However, the complexities and constraints of actual practice may lead to person-centered moments, occurring in spite of health systems that actually impede person-centered care. As more organizations declare person-centered care as their preferred model of practice, challenges to effectively deploy person-centered care start to emerge. These challenges include both organizational challenges that are embedded in the organizational practice culture and individual challenges associated with lack of adequate training. These challenges could impact how person-centered care is perceived and enacted in different organizations. The following are two examples of encounters that have elements or degrees of person-centered care; however, they result in different outcomes and different care experience by patient.

A Person-Centered Moment

Emily is an 8-year old girl whose teacher suggested her hearing to be tested. Her parents took Emily to see an audiologist. The hearing assessment showed a permanent moderate hearing loss in both ears. When Emily’s parents heard the test results and learned that she needed hearing aids, they were shocked. They were also shocked to hear how much the instruments cost and how much commitment and follow-up it would take to manage Emily’s hearing needs. They felt the audiologist was kind and thorough with testing; she spent one full hour with them and explained the test results and hearing aid options and why it was important for Emily to use hearing aids. She also provided different hearing aid options. However, all of the options were beyond their budget, so they told the audiologist they needed to think about it. They left the clinic without any immediate treatment plans.

seeking “an emotional engagement with the patient that goes beyond sharing information” (Stewart et al., 2014, p. 10)

A Person-Centered Culture

This scenario has played out differently in another setting. In the second setting, Emily’s audiologist recommended hearing aids and Emily’s parents showed some hesitation to follow up with the recommendation. However, in this scenario the audiologist did not want them to leave without knowing what the source of their hesitation was. The audiologist did not know what the issue was; were the parents shocked with the news and needing more time to process it? Was the issue the stigma associated with wearing hearing aids? Or were there concerns with the cost of the intervention? So, she spent more time to get to know Emily and her family. She learned that there were some concerns with Emily’s hearing when she was younger but her parents did not take it seriously because Emily started talking, reading, and writing in line with typical developmental expectations.

They also thought the reason that Emily did not socialize in school like other kids her age was because she was shy. They did not attribute Emily’s poor academic performance to her hearing because they were never academically strong themselves. Emily’s dad works in a bakery and her mom has a part time job with minimum wage. Emily has three siblings ranging in age from 3 to 11.

After taking the time to get to know the family better, the audiologist realized the reason for Emily’s parents’ hesitation was a complex mix of guilt, regret, and frustration. While their most tangible concern was the cost associated with getting hearing aids, they also felt regret for not having noticed or acted sooner, and could not help but wonder if Emily had missed out on academic and social development over the years as a result of their own failings.

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Like the Emperor’s New Clothes … Invisible! Or at Least Tiny or Discreet?

Hearing Excellence Low Resolution-9533Jeanine Doherty, Au.D., M.Phil., M.B.S, B.Soc.Sci.(Hons.)

Hearing Excellence, Christchurch, New Zealand

In Hans Christian Andersen’s (1837) tale, an Emperor’s weavers said they made him some new clothes that would be visible to all but the stupid or incompetent, when in fact they had made no clothes at all. So he walked around naked, yet believed he was attractively well dressed and adequately demonstrating his position of achievement and power.

We must hope that hearing aid manufacturers are not looking at hearing aid visibility with the same deceptive reasoning, for in their push for invisibility as desirable, audiologists and aid wearers could be treated as if a bit stupid. Completely in-the-ear hearing aids were introduced by the manufacturers, in part, as a solution for stigma or the “hearing aid effect” (Johnson et al, 2005) and yet it can be argued that making the devices discreet actually contributes to self-stigma, a belief that hearing loss is a problem that should be hidden (Kelly & Wensveen 2014; Wallhagen, 2009).

Invisible hearing aids have also been shown to produce the highest mark-up factor for both manufacturer and audiologist (De Silva, Thakur & Xie, 2013). It could be suggested that our promotion of invisible aids is a social construction suiting our own benefit.  Or is invisibility also, or solely, an end-user concern? What is a patient’s desire for invisibility driven by? Vanity, stigma, gender, significant-other input? How do we counsel that size really does not matter?

Vanity and Stigma

Most human interactions involve an appreciable chance of being slightly embarrassed, or a slight chance of being deeply humiliated (Goffman, 1959). We spend a lot of energy managing the impressions we make in appearance and lifestyle to avoid embarrassment to the best we can (Scheff, 2013), Cooley (1922) wrote that our perception of ourselves has 3 principal elements:

  1. Our imagination of our appearance to others
  2. Our imagination of their judgement of our appearance
  3. Self-judgement about these imaginings, such as pride or mortification

The four traits of vanity common within sociology, psychology and philosophy literature are consistent with Cooley: (1) appearance concern, (2) concern about appearance perception, (3) achievement concern and (4) concern about achievement perception. Appearance concern and achievement concern are related to personal values, while the two perception components relate to self-concept (Wang & Waller, 2006).

Wang and Waller (ibid.) state that advertising messages use this knowledge to appeal to our need for physical beauty and achievement status. We see the symbolically positive appeal, for example in an expensive handbag or car advert, where customers are told their beauty and/or status will improve with ownership. In hearing aid adverts, we see a negative spin on product visibility; consumers, then, are led to prefer invisibility to protect their self-image. Continue reading

Taking Audiology Practice in Ghana to the Next Level

UnknownGeorgina Aidoo

Occupational Audiologist

Ghana, West Africa

I have always strived to search for the unique dynamics and realities in Audiology and ultimately discover what makes our patients incomplete without our services and our personal care. I have to face many encumbrances right from the onset of this journey, as being in Africa, and even in West Africa, my developing and third world country has made the trends very challenging, with diverse milestones which all bring learning experiences that are priceless. Pursuing a Doctor of Audiology degree will give me a wide range of opportunities and experiences to develop knowledge, skills and attitudes which will enable me to grow the field and advocate for change.

Challenges

Audiology practice and management of hearing loss and balancing disorders usually does not command much attention in third world countries, even though various studies and estimates indicate that two-thirds of the world’s populations of hearing impaired people live in the developing countries. In many African countries, the general awareness of Audiology and hearing loss management is low, and lack of resources, ignorance, illiteracy, cultural diversity and national priorities among many other factors relating to technology enhancement and sense of focus has caused a lack of strong advocacy in this area. The Africa continent has a predominantly young population and many are at risk of getting diseases causing hearing loss (McPherson & Holboro, 1985). Overall, it is estimated that in the countries below Sahara, more than 1.2 million children aged between 5 and 14 years suffer from moderate to severe hearing loss in both ears. General prevalence studies show higher rates of severe to profound hearing loss in this part of Africa than in other developing countries.

Hearing problems are a severe handicap, particularly in developing countries where the ability to take part in normal conversations is vital for economic and social survival. However, many are illiterate as well as hearing impaired, and thus unable to communicate by writing and reading. It is difficult to get an exact overview of the prevalence and causes of hearing loss in Africa. Several studies have been conducted but they use different methods and not all are up to date. However, they do serve as indicators and together they provide a general picture of the situation.

Unknown-1The case of Ghana is no different. In spite of the fact that hearing and balancing disorders are common among persons in communities in Ghana, very few studies have been carried out. The pace of development is very slow despite how critical the need is.

It took an extraordinary effort for me to enroll in an Au.D program after saving for almost a decade all in relation with finding the true purpose my commitment to the field, and I continue to explore and advocate in quest of gaining deep knowledge to help spread Audiology, especially in Ghana and West Africa where silence has swallowed sufferers’ desire to seek help. Continue reading

New Thoughts on Hearing Loss and Stigma

Hearing Excellence Low Resolution-9533Jeanine Doherty, Au.D., M.Phil., M.B.S, B.Soc.Sci.(Hons.) of Hearing Excellence

Christchurch, New Zealand

Two models of disability, the medical model and the social model, currently represent the opposing ends of the continuum of what defines disability (Berger & Lorenz, 2015).

The medical model sees disability as an individual’s bodily event and so concentrates on aetiology, diagnosis, prevention, and the treatment of the physical, sensory and/or cognitive impairments. Past scholars of disability often took this negative deviance medical approach; bioethicists and eugenicists have spent most of their energy on justifying the morality of preventing or even eliminating people with disabilities by the use of prenatal testing and abortion, or by withdrawal of care (Parens, 2001).

The social model of disability, at the other end of the spectrum, moves away from the impairment itself to consider the socially imposed barriers for the disabled, such as inaccessibility and unequal rights. It also considers the prejudicial attitude (i.e., stigma) that is constructed around any disability and results in sub-ordinate social status and a devalued life (Berger & Lorenz, 2015; Bickenbach et al., 2014). The social model evolved from the disability rights movements in the UK and USA in the 1960’s and 70’s, and carries the notion that a society should embrace all members and address socially imposed barriers.

Regardless of which model is used, stigma seems to be a universally understood experience. Stigma occurs as a process by which people stereotype, label, judge, and then discriminate against others who are different (While & Clark, 2010) and so they spoil any sense of normal identity for the other person.

Goffman (1963) outlined three causes of social stigma:

  • overt, external deformations;
  • personal trait deviations such as mental disorder or addiction;
  • tribal/cultural deviations from a norm in terms of physical appearance like skin colour, dress style, religion, or behaviour.

Goffman added that stigma is the phenomenon whereby an individual with an attribute is deeply discredited by their society and therefore rejected as a result of the attribute.

Understanding Our Reactions

We are drawn to the unanticipated and the inexplicable in an effort to make sense of the experience, a universal part of our cognitive architecture that natural selection has bequeathed us (Garland-Thomson, 2006). We also experience aversion to others who do not fit into Goffman’s (1971) concept of normalcy. This aversion is a primitive response, demonstrated at the minimum with glancing or staring as a sifting mechanism to define safe or “otherness” status among those around us. For example:

I used to travel with a fellow Board member who had one of the first cochlear implants in New Zealand, which is very obvious as he has no hair to hide it. Walking through airports with him was fascinating as I watched others observe, try to decide what it was, understand/comment to their fellows about it and then finally return to their own activities. Before it could be socialised out of them, children had no concern about direct enquiry of David – “What’s that thing on your head, mister?” Being stared at by an adult can mean a lack of understanding, or at worst a social disregard, but children have the “curiosity excuse,” and he loved to take the pieces off his head and explain them to the fascinated child, while the parent often squirmed in embarrassment.

Although on the surface innocuous, staring is actually a strong reaction towards another person and excites the brainstem’s primitive level neural activity (Garland-Thomson, 2006), which is part of our fight or flight system. Stigmatic judgements are made with such fast glances and decisions. The inclination to stigmatize others has long been documented; for instance, in Roman times thieves and slaves were visibly tattoed to identify them as non-equal human beings.

Stigmatising another person can not only make the stigmatised person suffer negative consequences but can, conversely and perversely, enhance positive feelings of membership of the stigmatising tribe by the rise in self-esteem and sense of power that “doing others down” can bring (Falk, 2001). This tribal group-think against the stigmatised person has been used to justify terrible attacks seen worldwide, in which a stigmatised person – often intellectually disabled —  holds little value and so can be beaten or killed as they are considered sub-human.

31970396_sThe Impact of Labels

 When a label or stigma is applied to a person/group, there is a surrounding negativity or taint which engenders feelings of lesser worth in those subjected to the labelling. Being the subject of stigma can adversely affect the behaviour of the stigmatised by changing their emotions and beliefs (Major, 2005). The stigmatised person can become isolated, and then depression and lack of self-esteem can follow (George, 2015). Internalised stigma also leads to decreased hope and self-efficacy, and a poorer general quality of life (Nabors et al., 2014). This impact is not unique to hearing loss – just think about our seniors who have age labels, hearing loss, vision loss, cognition loss and physical disability labels to carry. Continue reading

Audiologist-Centred Patients Are the Outcome Goal of Patient-Centred Audiologists

Jeanine photo 2015

Jeanine Doherty, Au.D., M.Phil., M.B.S, B.Soc.Sci.(Hons.) of Hearing Excellence

Christchurch, New Zealand

Loyalty of patients to their Audiologists is a “win” for all parties. In a business sense, loyalty means repeat business and word of mouth referrals from current patients and both of these are less expensive than attracting new business (Morgan & Hunt, 1994). Thus, a relationship-based strategy builds a firm’s competitive advantage (Morgan & Hunt, 1994; Sumaedi et al, 2015) and patient- centered care can clearly fit this bill.

As a clinician, my experience is that it is the long-term relationship with repeat patient visits that helps make my career so rewarding and keeps me engaged; and for the patient the trust relationship they develop over time with their audiologist must make their interactions much more rewarding emotionally.

Audiology can learn from the general business, especially the service sector, literature and from this customer loyalty has been found to have two main components (Cater & Cater, 2009):

  • Affective (emotional) commitment, which develops from trust and social bonds (liking each other and learning about each other and so includes listening to patients), with trust the more important by far. Health is a “credence category service” and trust is very important in such a context (Chang et al, 2013). Humans also have an additional resistance to change which acts as a loyalty antecedent (Silva, 2015).
  • Relational (rational) benefits such as access, marketing and pricing can lead to perceived satisfaction, but satisfaction ranks second to emotional commitment in establishing loyalty.

hearthead

This Cater and Cater (2009) dual-factor model of motivations of general service industry loyalty includes all the factors in the audiology specific model developed by Grenness et al (2014). The themes from their patients’ data show that they seek individualised care, clinical procedures including information sharing and shared decision making, and the recognition of the importance of the players who make up the therapeutic relationship (i.e., audiologist and patient). These themes would fall into Cater & Cater’s 1st emotional commitment category and show the importance of meeting the emotional need of patients to allow a successful and loyal patient/audiologist relationship. Continue reading

Reflections on Response to Change

CarolyneCarolyn Edwards, M.Cl.Sc., M.B.A.

Auditory Management Services

Toronto, Ontario Canada

Most of us as human beings do not invite change into our lives as a natural part of each day. The reality is that we fall into pattern and that pattern is comfort and security. We do anticipate some natural progression in our work or personal life but when unexpected events change the course of our lives, most of us resist that change at the outset.   The way we resist change takes many forms.   We can stay in denial or surprise, we can blame others or we can fight against the change. Specifically resistance may come in the form of delaying – give me more detail, flooding others with the details, intellectualizing, moralizing, OR impulsive action – everything is suddenly fine, I need a solution fast, blaming others without warning OR sustained confusion or denying the impact (I’m not surprised).   Over time, if we accept the changes that have occurred, we can find a flow, and change becomes an ally rather than the enemy we originally perceived.

Resistance is the outward expression of fear – I am afraid – of being vulnerable, of having to change, of losing control, of not knowing what to do, of being different and being rejected because of the difference. Each of us has our own fears based on our life experiences, and yet the underlying fear of the unknown is understood by all of us.

Listening to our clients’ responses is essential to determine where they are in the process of change, because the reality is the diagnosis of hearing loss brings change.

Addressing Resistance5276781_s

When we are resisting change, we cannot hear others and often we cannot hear themselves either. We may be aware or unaware of our resistance; we can feel the fear and don’t know what it is.   Resistance becomes the only way we know how to communicate at the moment. As professionals, when you are observing resistance in your clients, it is often more effective to address the actual behavior at the outset than the fear itself. For example, the behavior may be the inability to attend the scheduled appointments, the lack of questions, a parent’s inability to follow through with agreements to work with their child, a child’s rejection of support, the desire to talk about the same concerns repeatedly, the disinterest in follow-up appointments, or an adult’s consistent use of amplification or assistive listening devices. The underlying fears will often emerge out of those discussions. Continue reading

“Can I Just Give You a Hug?”

Kris English, Ph.D.Kris English, PhD

The University of Akron/NOAC

Anna Hollingdale, MSc, is an Audiologist in West Sussex, England. She recently touched base after an audiologic counseling course at the Ear Foundation in Nottingham with the following patient encounter:

Recently, a 73-year old female came to see me for a fine tune. The patient’s initial complaints were ones, as Audiologists, we hear often: “I cannot hear in noise” or “I am struggling to communicate with others.” It would have been so easy for me to quickly do a fine tune, or respond with the ‘limitations of hearing aids’ script but instead, I listened…

meSoon I learned she has a busy social life and takes part in many activities, but having the hearing loss had started to affect all this. This patient has been coming to our clinic for over a year and had never had the chance to really speak about how the hearing loss was affecting her.

Once she had finished talking, I responded by reflecting what I heard, without adding any solutions: “It seems you are having a really hard time with this, it must be really tough for you.” This “invitation” then enabled the patient to open up even more, and share that she had been avoiding social events and was always looking for ways to cover up her difficulties. The hearing loss was significantly affecting her life and relationships with others. Notably, she did not ask for any answers. All this patient needed was for someone to listen and empathise with her.

At the end of the appointment the patient stood up and said, “Can I just give you a hug?”

I think this says a lot more than any words could!

long road

Another Dimension to Patient Journey: Traveling Together, We Go Farther

The Ida Institute encourages audiologists to consider a “journey” metaphor to better understand the patient experience. A patient’s entry into audiologic care is not an abrupt event, but rather is preceded by several influential experiences. We are charged to sort out those experiences, usually with a question such as “What brings you here today?”

The patient will relay salient facts, an important part of the journey — but not the only part. To date, the journey has also likely been lonely, stressful, confusing. If we fail to inquire about these concerns, the patient may fairly wonder if we even care. Without an indication that the audiologist is personally invested, the prospect of moving forward with no apparent  emotional support may seem daunting and unappealing. Consider, for example, a recent study that found a low degree of adherence to hearing aid recommendations when audiologists dominated the conversation discussing technology (Grenness et al., 2015). Our challenge is to convey with our counseling skills that we are not just watching from the curb as patients travel past, left to their own devices. Rathr, we are committed to travel this journey with them.

The Ultimate Confirmation

It seems safe to say that being asked to give a hug is the ultimate confirmation of patient trust. Patients may initially resist hearing help, and therefore resist us, but if we can mindfully travel with them, help them drop their guard, consider change, and know we care, the subsequent relief can be tremendous! When a patient feels words alone will not convey that relief, and instead asks for permission to enter our personal space, trusting that  our answer will be YES, she has made an important break-though.

Most patients don’t ask for a hug, but they all ask, somehow or other, for our attention and support.

Reference

Grenness, C., Hickson, L., Laplante-Levesque, A., Meyer, C., & Davidson, B. (2015). The nature of communication throughout diagnosis and management planning in initial audiologic rehabilitation consultations.  Journal of American Academy of Audiology, 26, 36-50.