Nurse Education in Practice 28 (2018) 144–149

Contents lists available at ScienceDirect

Nurse Education in Practice

journal homepage: www.elsevier.com/locate/nepr

Original research

Exploring an educational assessment tool to measure registered nurses' MARK

knowledge of hearing impairment and effective communication strategies: A
USA study
Amy L. Ruesch DNP, CRNP∗
Doylestown Hospital, 595 West State Street, Doylestown, PA, 18901, USA

A R T I C L E I N F O A B S T R A C T

Keywords: Poor communication between the Registered Nurse and a hearing impaired patient can affect quality of care and
Communication health outcomes. Communication skills training programs for healthcare providers are needed to improve pa-
Hearing impairment tient centered care. A descriptive research study, using a knowledge assessment tool developed and validated by
Registered nurse the researcher, was conducted on 339 Registered Nurses to identify knowledge deficits to be addressed in a
Assessment tool
communication skills training program being designed. The educational tool measured the Registered Nurses'
knowledge across four areas - hearing impairment, hearing aids, communication strategies, and regulations
regarding access to care for a person with a hearing disability. Knowledge deficits were detected in all four areas.
Using this educational assessment tool may enable nurse educators to tailor communication skills training
programs to specifically address the gaps identified regarding hearing impairment and how to effectively
communicate with the hearing impaired patient. Post training program, nurse educators can use the tool to
evaluate effectiveness.

1. Introduction
Hearing loss is the third most common chronic health condition in
the United States (U. S.) (Barnett et al., 2014; Chaseng et al., 2010;
Hardin, 2012). Approximately 48 million adult persons in the U.S. have
some degree of hearing loss (Hardin, 2012; Lin et al., 2011; Shuler
et al., 2013). Approximately three million children in the U.S. have
hearing loss (National Institution on Deafness and Other
Communication Disorders, 2015).
Hearing impairment is often described as an invisible condition, as
there are no visual indications that the person has any impairment, and
the only thing seen are its effects, such as confusion and being seen as
unfriendly (Jaccarino, 2009). Halpin et al. (2009) reported that patients
do not inform the health care provider (HCP) that they have a hearing
loss and HCPs may not document this condition in the medical record.
Effective communication between the HCP and the patient is vital to
providing safe, high quality care to the patient. Healthcare providers
may lack knowledge and awareness of the effect that impaired com-
munication with the hospitalized patient has on that patient's “ability to
communicate, learn and care for oneself” (Scheier, 2009, p. 9). Regis-
tered Nurses (RNs) on the inpatient nursing units provide important
components of direct patient care that includes admission assessment,
ongoing nursing assessment, patient teaching, and discharge care. Poor
communication between the HCP and the patient could lead to mis-
diagnoses, medication errors, unnecessary transfers, poor assessments,
noncompliance with care, missed appointments, increased testing,
higher hospital admission rates, and inadvertent patient harm
(Matthews et al., 2011).
2. Background/literature
Several studies indicated that hearing impairment and deafness af-
fected the individual's speech perception, communication, social in-
teraction, and satisfaction with care (Barnett et al., 2014; Hallam and
Corney, 2014; Wie et al., 2010). Other studies found that the hearing
impaired or deaf patient experiences communication difficulties when:
(a) interacting with health care providers in poor acoustic surround-
ings, (b) background noise is present, and (c) there is limited visual
access to lip reading or facial cues (Hallam & Corney, 2014; O'Halloran
et al., 2011; Pope et al., 2013; Wie et al., 2010). Background noise, a
noisy hospital environment, and the physical environment or acoustics
of the facility impairs communication by affecting speech intelligibility,
key word recall and identification (O'Halloran et al., 2011; Pope et al.,
2013; Wie et al., 2010). To compensate when background noise is

∗
5992 Schlentz Hill Road, Pipersville, PA 18947, USA.
E-mail addresses: aruesch@dh.org, wanderingfrog2@msn.com.

http://dx.doi.org/10.1016/j.nepr.2017.10.017
Received 10 June 2016; Received in revised form 15 January 2017; Accepted 16 October 2017
1471-5953/ © 2017 Elsevier Ltd. All rights reserved.
A.L. Ruesch
present, the hearing impaired person utilizes lip reading, avoidance,
and disengagement tactics when interacting with the HCP
(Hallam & Corney, 2014).
A small number of studies focused on determining the patient pre-
ferences in communicating with their HCPs (Middleton et al., 2010;
Diamond et al., 2009). Several supported the need for provider
awareness of communication tactics to use in interacting with the
hearing impaired patient, including the use of interpreters (Diamond
et al., 2009; O'Halloran et al., 2011; Middleton et al., 2010; Trotter
et al., 2014).
The literature search and review reflect a lack of research specifi-
cally focused on determining the RNs' knowledge and awareness about
hearing impairment and deafness, as well as effective communication
strategies in the care of the hearing impaired patient. There was also a
lack of studies that specifically investigated the effectiveness of an
educational program to improve the RNs' knowledge of hearing im-
pairment and effective communication tactics in caring for hearing
impaired patients. There were no comparative assessment tools found
that measured the RNs’ knowledge of hearing impairment and effective
communication strategies when caring for and interacting with the
hearing impaired hospitalized patient.
3. Objectives of the study
The overall objective of the study was to develop, validate, and test
a knowledge assessment tool to measure the RNs’ knowledge of (a)
hearing impairment, (b) hearing aids and other assistive listening de-
vices, (c) effective communication strategies in interacting with the
hearing impaired patient, and (d) laws and policies regarding inter-
acting and caring for persons with a hearing disability. The assessment
test tool identified knowledge deficits regarding hearing impairment
and effective communication strategies when interacting with the pa-
tient. The baseline assessment will provide the foundation for future
educational programming.
4. Research design
4.1. Ethical considerations
Academic Institutional Review Board (IRB) approval and IRB ex-
emption from the hospital where this study took place were obtained.
There were no anticipated risks to the RNs participating in this study.
Potential benefit for RNs participating in the study was increased
knowledge about hearing impairment and effective strategies to be used
in communicating with the hearing impaired patient.
The RN's participation in this study was voluntary with no com-
pensation provided. No participant identifiers were attached to the
assessment test tool. The researcher informed the study participants via
a cover letter attached to the assessment test tool that (a) completion of
the test tool signified his/her consent to be part of this study, (b) his/
her identity remained anonymous and, (c) the assessment test answers
were kept confidential. The study results and test question answers
were made available to the RNs via hospital wide email after the
completion of the study.
4.2. Setting and participants
The descriptive research study was conducted in a 232 bed com-
munity hospital in Pennsylvania. The minimum sample size of 128
participants needed for the study was determined through the use of a
power analysis (Cohen, 1992). The minimum sample size was also es-
timated using a confidence interval calculation (Bluman, 2009). The
final sample size needed (n = 251) was based on the confidence in-
terval calculation since it was the more conservative approach. A target
convenience sample of a minimum of 251 RNs was recruited from 15
nursing units in this community hospital to complete the knowledge
145
Nurse Education in Practice 28 (2018) 144–149
assessment test.
4.3. Instrument development and data collection
The researcher developed the assessment test tool to obtain the
data. The test consisted of six demographic questions (Appendix A) and
22 knowledge questions (Appendix B). The six demographic questions
included the participant's (a) age, (b) highest level of academic nursing
education, (c) number of years worked in patient care as a RN, (d)
assigned nursing unit, (e) having a hearing impairment or knowing a
hearing impaired person, and (f) if the participant has had a prior
course on hearing impairment and effective communication strategies
when interacting with the hearing impaired patient.
The knowledge questions, adapted from the literature review, were
divided into four categories of knowledge: general knowledge of
hearing impairment, hearing aids and assistive listening devices, com-
munication strategies in interacting with the hospitalized patient, and
laws and policies regarding interacting and caring for persons with a
hearing disability. Multiple choice and true/false questions were uti-
lized in the assessment tool.
The 22 question knowledge assessment test was reviewed and va-
lidated by an expert panel consisting of (a) three Master's prepared
Speech-Language Pathologists, (b) two Master's prepared board certi-
fied Audiologists, and (c) a hearing impaired RN. The item content
validity index was 1.00 for each test question calculated. The scale
content validity index, using the averaging approach, was 1.00 in-
dicating excellent content validity (Polit and Beck, 2012).
There were no other directly comparable tools available to guide the
research. Prior studies in analogous research found the average test
score ranging from 50% to 83% (Dimitrov and Rumrill, 2003; Kelly and
Bishop, 2013; Rosneck et al., 2014). An average test score of less than
75% in the pilot test group was utilized as a “cut off” to determine the
need for an educational intervention.
A pilot test study of 20 RNs was completed to determine usability of
the assessment test tool. The pilot test study assessment test tool was
distributed between September 11, 2015 and September 30, 2015.
These 20 RNs’ test results were not included in the main study sample
population. Cognitive questioning of the pilot test study participants
was conducted with findings suggesting no need for any further mod-
ifications to the assessment test tool.
A total of 425 knowledge assessment test tools were distributed to
the RNs at departmental staff meetings, the hospital's health fair, and
nursing workshops between October 10, 2015 and January 27, 2016. Of
the 425 assessment test tools distributed, 339 participants completed
the test for a return rate of 80%.
4.4. Data analysis
The data was entered into an Excel spreadsheet and analyzed using
statistical analysis software SAS version 9.4 (SAS Institute Inc., Cary,
NC). The 15 nursing units were aggregated to five categories in order to
support effective analyses: critical care, medical/surgical, emergency
department, labor and delivery/postpartum, and surgical services. De-
scriptive statistics were used to (a) describe the study participants in the
pilot and main studies who had completed the knowledge assessment
test questions, and (b) assess the RNs’ knowledge of hearing impairment
and effective communication strategies when caring for a hearing im-
paired patient. The focus of the data analysis and results are on the
main study population except where significant differences are note-
worthy.
5. Results
5.1. Demographic summary of main study population
The six demographic questions of the knowledge assessment test
A.L. Ruesch Nurse Education in Practice 28 (2018) 144–149

Table 1 Table 2
Demographic summary of the study population. Descriptive summary of total and subscales scores.

Demographic Pilot Study Main Study (n = 339) Subscale Pilot (n = 20) % Main (n = 339) % Main (n = 339)
(n = 20) correct correct Cronbach's
alphaa
Age, years % (n) % (n)
20-25 0 (0) 2 (7) Overall Mean (SD) = 63.0% Mean (SD) = 60.3% N/A
26-30 10 (2) 8 (27) (8.8) (10.8)
31-35 0 (0) 9 (29) Median = 64% Median = 59%
36-40 0 (0) 9 (32) Mode = 55% Mode = 63%
41-45 0 (0) 11 (38)
GK Mean (SD) = 39.2% Mean (SD) = 39.5% 0.256
46-50 20 (4) 18 (61)
(20.4) (21.7)
51-55 20 (4) 21 (72)
Median = 33% Median = 33%
56-60 15 (3) 15 (45)
Mode = 17% Mode = 33%
61-65 20 (4) 6 (22)
66+ 15 (3) 2 (6) HA/LD Mean (SD) = 73.8% Mean (SD) = 74.9% 0.136
(12.1) (13.2)
Years of Nursing Experience % (n) % (n)
Median = 75% Median = 75%
0-5 10 (2) 15 (50)
Mode = 63% Mode = 75%
6-10 5 (1) 15 (50)
11-15 0 (0) 7 (23) CS Mean (SD) = 76.0% Mean (SD) = 72.5% 0.046
16-20 5 (1) 11 (37) (12.3) (16.8)
21-25 5 (1) 12 (41) Median = 80% Median = 80%
26-30 20 (4) 19 (65) Mode = 80% Mode = 80%
31+ 55 (11) 22 (73)
LP Mean (SD) = 60.0% Mean (SD) = 42.3% 0.357
Highest Nursing Degree % (n) % (n) (23.2) (29.8)
Diploma 25 (5) 12 (39) Median = 67% Median = 33%
Associate 20 (4) 21 (72) Mode = 67% Mode = 67%
Bachelor 45 (9) 58 (198)
a
Master 5 (1) 8 (28) Equivalent to Kruger-Richardson correlation with dichotomous responses. Subscales
Doctor of Nursing Practice 5 (1) 1 (2) abbreviations: GK, general knowledge of hearing; HA/LD, hearing aids/listening devices;
Know Hearing Impaired Person % (n) % (n) CS, communication strategies used interacting with a hearing impaired person; LP, laws
Yes 85 (17) 59 (200) and policies regarding interacting and caring for persons with a hearing disability in the
No 15 (3) 41 (139) hospital.

Attended a Course on Hearing % (n) % (n)

Impairment alpha of > 0.70 indicates acceptable internal consistency and relia-
Yes 0 (0) 8 (28) bility. For each of the categories or subscales listed in Table 2, the
No 100 (20) 92 (311) Cronbach's alpha was < 0.70.
Nursing Unit % (n) % (n) Table 2 also provides a descriptive summary of the total and sub-
Critical Care 0 (0) 27 (92) scales scores for the pilot (n = 20) and main study (n = 339) popu-
Medical/Surgical 50 (10) 33 (112) lation. The mean total score of correct answers for the pilot study cohort
Emergency Department 0 (0) 10 (33)
Labor, Delivery, Postpartum 0 (0) 14 (49)
was 63.0% (SD = 8.8, range = [50.0, 77.3]). The mean score for the
Surgical Services 50 (10) 15 (53) category of general knowledge was 39.2% (SD = 20.4). The mean score
for the hearing aids category was 73.8% (SD = 12.1). The mean score
for category of communication strategies was 76.0% (SD = 12.3). The
tool were used to describe the study participants in the pilot and main laws and policies category mean score was 60.0% (SD = 23.2).
studies who had completed the knowledge assessment test. The data on The mean total score of correct answers for the main study cohort
the pilot study population is included as a reference. The demographic was 60.3% (SD = 10.8, range = [27.3, 86.4]). The mean score for the
summary of the study population is listed in Table 1. The years of age category of general knowledge was 39.5% (SD = 21.7). The mean score
category ranged from 20 to 66 + with the most nurses being in the for the hearing aids category was 74.9% (SD = 13.2). The mean score
51–60 year old category (21%, n = 71). The years of nursing experi- for the communication strategies category was 72.5% (SD = 16.8). The
ence ranged from zero to 31 + with the most nurses being in the mean score for the laws and policies category was 42.3% (SD = 29.8).
31 + years of experience category (22%, n = 73). The highest nursing Table 3 lists the percent correct for each test Q number. Four Q had
degree category was the bachelor of nursing (58%, n = 198). The a low percentage (under 30%) of correct responses by the participants
majority of the respondents knew a hearing impaired person (59%, (Q4, 6, 8, and 18 as noted with * in Table 3). There were eight Q that
n = 200). The medical/surgical nursing unit had the largest number of had a high percentage (at or over 75%) of correct responses by the
participants out of the five nursing unit categories (33%, n = 112). participants (Q1, 2, 3, 7, 13, 14, 15, and 21 as noted with ** in Table 3).
Only 28 respondents attended a course on hearing impairment (8%). Table 4 shows the association between total score and respondent
Data analysis was performed on a 22 question knowledge assess- demographic characteristics for the main study participants. There
ment test tool that was used to measure the pilot and main study par- were no statistically significant differences in test scores for age, years
ticipants’ knowledge of hearing impairment and effective communica- of experience, academic degree, knowing a hearing impaired person, or
tion strategies when interacting with a hearing impaired patient. The association with a specific nursing unit. The only characteristic asso-
22 knowledge questions (Q) were divided into four categories based on ciated with a higher total score was whether the participant indicated
the content relevancy of the stem question: general knowledge of they had attended a course or workshop on hearing impairment and/or
hearing impairment (Q4, 10, 11, 12, 16, 19) hearing aids and other communication strategies when interacting with a hearing impaired
assistive listening devices (Q2, 3, 7, 13, 15, 17, 18, 22) communication patient (t = −2.65, p = 0.0084).
strategies in interacting with the hospitalized patient (Q1, 5, 8, 14, 21), Further analysis was conducted on this main study subpopulation of
and regulations regarding interacting and caring for persons with a those who attended a course or workshop (n = 28). Table 5 provides
hearing disability (Q6, 9, 20). the comparison of those participants that attended a course on hearing
The knowledge assessment test tool was evaluated for internal impairment with those participants who did not. Those who attended a
consistency and reliability by the use of Cronbach's alpha. A Cronbach's

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 A.L. Ruesch

Table 3
Percent Correct for each Test Question.

Q# Category Question Correct Answer Main Study (n = 339)

Q1 CS Mode(s) of communication used by Deaf Persons include? d. All of the above. 98% (n = 332)**
Q2 HA/LD The basic function of a hearing aid is to? b. Amplify sounds. 87% (n = 294)**
Q3 HA/LD The source of power for a hearing aid is? b. Battery. 99% (n = 336)**
Q4 GK Which illnesses can cause hearing loss? b. Diabetes, meningitis, rubella. 13% (n = 45)*
Q5 CS The hearing impaired person who lip reads is generally able to understand? b. 30–40% of the words being spoken. 40% (n = 137)
Q6 LP Which Federal law(s) prohibits discrimination against hearing impaired persons and mandates effective communication with d. Section 504 of Rehabilitation Act of 1973, American with 15% (n = 50)*
hospitalized persons who are hearing impaired? Disability Act of 1990.
Q7 HA/LD A single type of hearing aid is a universal fit and is appropriate for all patients with a hearing loss? b. False. 99% (n = 335)**
Q8 CS When speaking to a hearing impaired patient, obstacles to successful lip reading include? c. Shouting into a person's ear, standing in front of light source. 17% (n = 56)*
Q9 LP Coworker, family, and/or friends can be used to translate for the Deaf patient? b. False. 49% (n = 166)
Q10 GK Sensorineural hearing loss is most often the result of? c. Medication, genetics, prolonged noise exposure. 45% (n = 154)

147
Q11 GK American Sign Language is not the universal language of all Deaf persons across the globe? a. True. 49% (n = 167)
Q12 GK The medical term for the hearing loss that accompanies aging is? c. Presbycusis. 35% (n = 120)
Q13 HA/LD A hearing impaired person learns how to use and care for the hearing aid by? d. All of the above. 80% (n = 271)**
Q14 CS Which one of these aids to communicating with the hearing impaired person are most important? b. Facing the person, speaking clearly in a normal tone. 91% (n = 307)**
Q15 HA/LD A hearing aid will restore normal hearing? b. False. 98% (n = 332)**
Q16 GK Conductive hearing loss is most often the result of? c. Ruptured ear drum, ear wax, fused bones of the middle ear. 40% (n = 136)
Q17 HA/LD A behind the ear (BTE) hearing aid has an ear mold attached to it. To clean this ear mold that is dirty with ear wax, one uses? a. Soap and warm water. 57% (n = 193)
Q18 HA/LD A hearing aid that whistles or squeals is most often the result of? a. A loosely fitted ear mold. 24% (n = 80)*
Q19 GK American Sign Language includes? d. All of the above. 54% (n = 182)
Q20 LP According to the hospital's Language Barrier or Impairment Services policy, an interpreter for the hearing impaired/deaf c. Calling the hospital operator. 63% (n = 214)
patient is obtained by?
Q21 CS Strategies to best optimize communication with a hearing impaired person include? a. Asking the person's communication preferences. 91% (n = 308)**
Q22 HA/LD A cochlear implant restores normal hearing in a person who is profoundly deaf or severely hard of hearing? b. False 56% (n = 191)

Note. Category abbreviations: Q #, question number; GK, general knowledge of hearing; HA/LD, hearing aids/listening devices; CS, communication strategies used interacting with a hearing impaired person; LP, laws and policies regarding
interacting and caring for persons with a hearing disability in the hospital. Additional legend marks: * indicates under 30% correct responses; ** indicates at or over 80% correct responses.
Nurse Education in Practice 28 (2018) 144–149
A.L. Ruesch Nurse Education in Practice 28 (2018) 144–149

Table 4 6. Discussion
Association between demographics and total score.
The purpose of this study was to develop and validate a knowledge
Demographic Pilot (n = 20) Main (n = 339)
assessment test tool in order to measure the RNs’ knowledge of hearing
N Mean Total p-value N Mean Total p-value impairment and effective communication strategies in interacting with
Score (SD) Score (SD) the hospitalized patient, who may be hearing impaired. Results of this
descriptive research study indicate that knowledge deficits exist sur-
Age, years
20-25 0 – 0.571a 7 64.9 (12.5) 0.905a rounding hearing impairment and effective communication strategies
26-30 2 68.2 (12.9) 27 59.9 (10.6) when caring for a hearing impaired patient. The mean total score of
31-35 0 – 29 59.7 (12.3) correct answers (60.5%) in the main study were well under the pro-
36-40 0 – 32 59.1 (10.5) posed threshold of 75%, indicating a need for an educational inter-
41-45 0 – 38 58.1 (11.7)
46-50 4 60.2 (4.1) 61 60.2 (10.6)
vention.
51-55 4 60.2 (10.1) 72 61.6 (10.5) Subgroup analysis comparing performance by participants with
56-60 3 59.1 (7.9) 45 60.3 (11.7) prior educational course or workshop to those without any educational
61-65 4 61.4 (8.7) 22 60.7 (8.4) interventions affected performance on this knowledge assessment tool.
66+ 3 72.7 (7.9) 6 62.2 (9.8)
The mean total score of those participants who attended a prior course
Years of Nursing Experience on hearing impairment and/or communication strategies when inter-
0-5 2 68.2 (12.9) 0.987a 50 62.2 (12.5) 0.579a acting with a hearing impaired patient was higher for those who at-
6-10 1 59.1 (-) 50 57.8 (11.3)
11-15 0 – 23 61.1 (10.9)
tended (65.4%) versus those who did not (59.8%). This was a statisti-
16-20 1 54.5 (-) 37 56.9 (9.6) cally significant finding (t = −2.65, p = 0.0084). The mean general
21-25 1 63.3 (-) 41 59.1 (8.8) knowledge category score was also higher for those who attended
26-30 4 63.6 (7.4) 65 60.9 (10.2) (46.4%) versus those who did not (38.9%). This finding approached
31+ 11 62.8 (9.9) 73 62.2 (6.4)
statistical significance (t = 1.76, p = 0.079). These findings are sup-
Highest Nursing Degree ported by several studies that found educational programs to be effec-
Diploma 5 64.5 (10.4) 1.497a 39 61.0 (9.3) 0.181a
tive in improving the health care provider's knowledge and perfor-
Associate 4 64.8 (9.4) 72 57.4 (11.0)
Bachelor 9 61.1 (9.1) 198 61.0 (11.1) mance as well as patient health outcomes (Choma and McKeever, 2015;
Master 1 59.1 (-) 28 60.9 (9.4) Edwards and Seibert, 2010; Norgaard et al., 2012; Mansouri and
Practice 1 68.2 (-) 2 72.7 (6.4) Lockyer, 2007).
Know Hearing Impaired Person None of the participants in the pilot phase answered “yes” to having
Yes 17 63.9 (9.0) 0.259b 200 60.8 (10.5) 0.265b attended a prior course on hearing impairment and effective commu-
No 3 57.6 (5.2) 139 59.5 (11.3) nication strategies on the assessment test tool. This lack of response did
Attended a Course on Hearing Impairment not prompt the need for subsequent questions to explore additional
Yes 0 – NA 28 65.4 (11.2) 0.0084b details regarding the type of educational intervention, when the course
No 20 63.0 (8.8) 311 59.8 (10.7)
was taken, and the type of course content. This supplemental in-
Nursing Unit formation may have helped to better explain why these respondents
Critical Care 0 – 0.432b 92 59.3 (11.4) 1.114c scored better on the test.
Medical/Surgical 10 64.5 (9.8) 112 59.6 (11.1)
Emergency 0 – 33 63.5 (10.1)
One of the four categories assessed in the knowledge assessment test
Department was that of communication strategies. This category had the second
LDRP 0 – 49 62.8 (11.7) highest score out of the four categories and yet, it was also below the 75
Surgical Services 10 61.4 (7.8) 5 59.1 (8.3) percentile cut off for adequate knowledge. This finding is consistent
a
with several studies which supported the need for provider awareness
Test for linear trend.
b
Two-sample t-test.
of communication tactics to use in interacting with the hearing im-
c
ANOVA; LDRP, Labor, Delivery, Postpartum. paired patient (Barnett et al., 2014; Diamond et al., 2009; O'Halloran
et al., 2011; Middleton et al., 2010; Trotter et al., 2014).
Table 5 In the main study population (n = 339) the mean score was highest
Comparison of Those that Attended with Those Who did Not Attend a Course on Hearing for the hearing aids and assistive listening devices (HA/LD) category at
Impairment. 74.9%. The higher overall category score and higher percentage of
correct test question responses for the HA/LD category may be due to
Category Attended Course Did not Attend Course p-value
(n = 28) (n = 311) the Registered Nurses’ familiarity with hearing aids through their ex-
Mean Score (SD) Mean Score (SD) periences in the care of the patient or their own family member who
had a hearing aid.
Overall Score 65.4 (11.2) 59.8 (10.7) 0.0084
The laws and policies (L/P) category's overall score was 42.3% with
General Knowledge 46.4 (23.7) 38.9 (21.4) 0.079
Hearing Aids 78.6 (15.5) 74.6 (13.0) 0.129
the overall score of the general knowledge (GK) category the lowest of
Communication 76.4 (13.4) 72.2 (17.0) 0.197 all four categories of knowledge at 39.5%. The low percentage of cor-
Strategies rect responses in these two categories suggests that any educational
Laws and Policies 50.0 (23.1) 41.6 (30.3) 0.153 intervention include material related to these two categories.
Note. p-value calculated from two-sample t-test.
7. Conclusions
course scored higher in the overall test and in each assessment test
7.1. Limitations, indications, and future recommendations
category than those who did not attend a course. The difference be-
tween the two subgroups for the overall test was statistically significant
The use of a convenience sample limited the generalizability of
(t = −2.65, p = 0.0084) and the general knowledge category ap-
findings to the larger population of all RNs. It is recommended that this
proached significance (t = 1.76, p = 0.079). These findings suggest
research study be replicated in other clinical and academic settings with
attendance at a prior educational course or workshop had a positive
a larger, more representative sample of RNs to allow generalizability.
influence on the test scores.
The knowledge assessment tool had several limitations. The first

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A.L. Ruesch
limitation is the demographic section of the test tool. As there were no
participants in the pilot study who answered “yes” to taking a course on
hearing impairment and communication, it did not prompt further in-
quiry about the course taken by the participant. A future re-
commendation would be to add two questions to the demographic
question regarding taken a course on hearing impairment and com-
munication: (a) when was the course taken and (b) what was the
content of the course. Additional questions to be added to the demo-
graphic section would be the participant's race and gender to allow
further description of the sample population.
The second limitation of the test tool is that the Cronbach's alpha
was < 0.70 for each of the knowledge categories or subscales assessed.
A recommendation would be to complete a factor analysis on each of
these four categories and the knowledge assessment test tool questions
to help to further explore why each item within each category of scale
was not sufficiently correlated to conclude that they were measuring
the same overall scale.
The results of this study demonstrate the need to provide RNs with
more information on all aspects of hearing impairment and effective
communication strategies when caring for a hearing impaired patient.
This study revealed that those who had attended a prior educational
course had higher test scores overall and in each of the categories as-
sessed. Clinical and academic nurse educators should incorporate in-
formation surrounding hearing impairment and effective communica-
tion strategies when caring for a hearing impaired patient into future
programming.
Clinical and academic nurse educators could use this knowledge
assessment tool to measure the RNs' knowledge level prior to and post
educational intervention. Educational modules for RNs for continuing
education credits could be developed for use in staff enhancement
programs or as online training. These educational modules could not
only improve the nurses' knowledge of hearing impairment and effec-
tive communication when interacting with a hearing impaired patient
but also demonstrate compliance with The Joint Commission's re-
quirement that the hospital's staff effectively communicates with pa-
tients when providing care, treatment, and services (TJC, 2010). Edu-
cational sessions could be developed and incorporated into all
undergraduate and graduate nursing curriculum that would include
hands on clinical experiences to enable the student to have interaction
and immediate feedback with a person who has a hearing impairment,
including deafness. RNs with a greater understanding of hearing im-
pairment and effective communication when caring for a hearing im-
paired patient are able to provide safe quality care to their patients in
addition to facilitating a more positive patient experience.
Future research needs to be conducted that replicates this study to
include other interprofessional members of the healthcare team such as
physicians, nurses’ aides, and social workers. This study could also be
done in other settings such as a rehabilitation hospital, a long term care
facility, an academic setting, or a physician practice. Future research
should also include determining if increased knowledge and behavior
change occurred post educational program, and did it improve the
overall patient experience, quality of care while reducing negative pa-
tient outcomes and health care costs in caring for the hearing impaired
patient in the hospital.
Conflict of interest and funding statement
There are no conflicts of interest. No funding was received for this
study.
Contributors and acknowledgments
Joseph J. Napolitano, PhD, MPH, RN, CRNP assisted in the research
study with the data analysis/interpretation and the writing and proof-
reading of this article.
149
Nurse Education in Practice 28 (2018) 144–149
Appendix A. Supplementary data
Supplementary data related to this article can be found at http://dx.
doi.org/10.1016/j.nepr.2017.10.017.
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