To address how unconscious bias can influence nurse-patient communication in subtle, yet impactful ways.
For the nurse: to develop sensitivity in communication and learn to adapt to patients’ needs. To practice respectful and adaptive communication strategies for hearing-impaired patients.
For the patient: to practice assertiveness and advocating for respectful communication as well as managing feelings of frustration and anger.
Briefly discuss communication challenges with hearing-impaired patients and strategies to overcome them. Discuss stereotypes or misconceptions about hearing impairment that affect the quality of care and the patient’s experience.
Scenario Overview
Characters
Patient:
A middle-aged individual relying on a hearing aid that is not functioning now . They are independent and articulate but may become frustrated if they feel disrespected or patronized.
Nurse:
Polite and well-meaning but unaware of her bias towards hearing-impaired people whom she unconsciously classifies as having limited intellectual abilities. She does not realise that her tone may be perceived as patronizing by some patients.
Background
The patient has come for a regular checkup. While they were waiting in line, their hearing aid alerted them that the battery is out.
Setting
The interaction takes place at a busy outpatient clinic reception desk. The reception desk is fitted with a transparent protection shield.
Roles Key Behaviours
Patient:
Behaviours:
Speak clearly and assertively, occasionally requesting clarification or repetition when unable to hear. Display frustration or impatience if they sense they are being patronized. Respond positively to respectful, clear communication.
Tone:
Assertive and articulate but may turn defensive.
Attitude:
Independent and capable, with a low tolerance for condescension. Open to collaboration when treated as an equal and given appropriate support.
Nurse:
Behaviours:
Initially adopt a slower or overly simplified manner of speech, possibly using exaggerated gestures or facial expressions. Adjust communication style when the patient expresses frustration.
Tone:
Initially unintentionally patronizing. Shifts to neutral and respectful when aware of the patient’s discomfort.
Attitude:
Well-meaning but unaware of internal bias. Open to feedback and willing to improve communication to meet the patient’s needs.
Simulation Flow
Setup
Set props to simulate a clinic reception. Equip the reception desk with a computer, a transparent barrier and optionally environmental sounds like chatter, typing from other Ss or from recording.
Introduction
Introduce the scenario and brief the participants on their roles privately.
Execution
The simulation begins with the patient approaching the counter and stating that their hearing aid battery has died.
The nurse, preoccupied with the computer, responds by speaking louder but does not make eye contact.
The patient expresses difficulty hearing and attempts to clarify the issue.
The nurse unconsciously begins to speak in a patronizing tone and simplified language.
The patient feels offended. The nurse is prompted to reflect and adapt their behaviour.
Resolution
The simulation ends when the patient acknowledges the nurse's improved communication, and the nurse demonstrates an understanding of their initial mistake.
By the end of the simulation, participants should:
- Be aware of signs of unconscious bias in interactions with hearing-impaired individuals.
- Develop strategies for adapting their communication style to meet the patient's needs.
- Reflect on possible own unconscious bias in interactions with hearing-impaired patients .
Possible Disruptors or Twists
Escalated patient frustration: the patient becomes visibly more frustrated if the nurse is dismissive or condescending.
An additional noise distraction (e.g., a phone ringing) increases the communication challenge.
- Self-reflection – the participants express their immediate emotional reactions to the simulation.
- Analysis - explore together what happened during the simulation and why.
- Highlight strengths and areas for improvement.
- Summarise main takeaways from the session, including the importance of empathy in nursing care and how effective communication can significantly improve patient outcomes.