The experiences of telepractice nurses undertaking a vocational audiological rehabilitation program.

OBJECTIVE: In response to modest outcomes in the field of vocational audiological rehabilitation, we examined the mechanism by which a group of workers with hearing challenges engaged with such a program. DESIGN: Telepractice nurses with hearing challenges participated in a four-session, online course teaching evidence-based communication strategies. Using multiple case study methodology, we collected ethnographic interviews, surveys, and discussion-forum comments before, during, and after the program. We applied grounded theory to these data sources to develop an across-case model of nurses' engagement with the strategies presented. STUDY SAMPLE: Twelve female nurses made up the study's twelve cases. RESULTS: Nurses undertook a problem-solving process in response to the presented strategies. They evaluated strategies based on perceived benefits and obstacles to implementation. Nurses took steps to incorporate promising strategies into their unique work contexts', but not all completed the problem-solving process required to do so. CONCLUSIONS: Participants needed to problem solve to implement course strategies in the workplace. This process was effortful and not always successful. We conclude that future interventions in the field of vocational audiological rehabilitation may benefit workers by actively supporting their problem-solving processes.

The clinical use of personal hearing amplifiers in facilitating accessible patient-provider communication: A scoping review.

BACKGROUND: Older adults with hearing loss struggle to communicate with care providers and experience higher mortality rates when hospitalized (Genther et al., 2015), even after controlling for age and comorbidities. Personal hearing amplifiers (PHAs), (e.g., Pocketalkers™), can improve communication with older patients. METHODS: We conducted a scoping review to identify research gaps and summarize findings on the clinical use of PHAs with patients with hearing loss. After refining search terms relating to hearing loss and PHAs, we searched MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL Complete, Web of Science Core Collection, ERIC (Proquest), PubMed, ClinicalTrials.gov, International Clinical Trials Registry Platform, and the International Standard Randomised Controlled Trial Number Registry. We identified articles published in English between 1980 and 2022 that reported empirical outcomes relating to PHA use in clinical settings. Two reviewers independently extracted data from articles. We then organized data into an evidence map, and a narrative review summarizing outcomes. RESULTS: From 4234 initially identified titles and abstracts, 12 met our criteria as full texts. These included three surveys on clinicians' awareness and use of PHAs, one evaluation of the acoustic output of a PHA, and eight interventions wherein PHAs were provided to patients with hearing loss. These papers used 10 different terms for PHAs and largely did not cite one another. Results showed high levels of satisfaction with PHAs, and consistently improved speech understanding. Despite this, care providers used devices inconsistently, with challenges around provider awareness, and device maintenance and location tracking. CONCLUSIONS: PHAs have a consistent positive effect on patients' ability to understand their care providers despite hearing loss. Barriers and facilitators to their use in clinical settings should be further explored.

The Intelligibility of the Reversed-Stethoscope Technique in Age-Related Hearing Loss.

Background: This study evaluated the effectiveness of the reverse stethoscope technique in improving speech intelligibility. In this technique, a clinician places the earpieces of their stethoscope into the ears of a hearing-impaired patient and speaks into the chest piece. Methods: The International Speech Test Signal was presented to four Littman® stethoscope models and a Pocketalker® personal voice amplifier using an Audioscan® hearing instrument test box. The acoustic outputs of the stethoscopes and voice amplifier were measured across the frequency spectrum of speech. The Speech Intelligibility Index of the resulting speech was calculated for natural speech and for each device in relation to 10 standardized hearing losses representing the population of older adults. Results: For each of the 10 hearing losses, the speech signal emitted by the stethoscopes was quieter and yielded lower speech intelligibility scores than regular speech. In contrast, the voice amplifier provided mid- and high-frequency amplification and improved speech intelligibility scores for all but the mildest hearing losses. Conclusions: The reverse stethoscope technique worsens the clarity of speech and should not be used with older, hearing-impaired patients. Instead, clinicians should use regular speech or, preferably, personal voice amplifiers.