To address how unconscious bias can influence paramedic-patient communication in subtle yet impactful ways.
For the paramedic: 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:
An elderly individual relying on a hearing aid that is not functioning now. They are confused and may become frustrated if they feel disrespected or patronized.
Paramedics:
Well-meaning but unaware of their bias towards hearing-impaired people whom they unconsciously classify as having limited intellectual abilities. Their attempts to communicate — such as raising their voices without facing the patient, using overly simplified language or talking over each other — suggest a lack of awareness about how to engage respectfully and effectively with someone who is hard of hearing. Their discomfort and hesitation further reflect a lack of preparedness, which may unintentionally reinforce the patient's feeling of being dismissed or misunderstood. They however find practical solutions – communicating in writing, involving a neighbour.
Background
The elderly man contacted emergency services about a problem with his ear.
Setting
The interaction takes place at then man’s flat. The neighbour next door is at home.
Roles Key Behaviours
Patient:
Behaviours:
Appears confused and has difficulty understanding what the paramedics are saying, especially if they are not facing him or speaking clearly. May respond inappropriately or repeat concerns about his ear, unaware that the issue is his hearing aid. Struggles to follow rapid or unclear speech and may become agitated or withdrawn if overwhelmed. Responds more positively when spoken to slowly, clearly, and with a calm, reassuring tone or to written communication.
Tone:
Hesitant or uncertain; may shift between cooperative and anxious depending on how he is approached.
Attitude:
Vulnerable and disoriented, but not resistant. Seeks reassurance and clarity. More engaged when approached with patience, eye contact, and gentle repetition.
Paramedics:
Behaviours:
Initially assume the patient can follow routine communication but quickly notice signs of confusion and hearing difficulty. May inadvertently speak too quickly or fail to face the patient while speaking. Once aware, they adapt by speaking slowly and clearly, facing the patient directly, using simple language, and checking understanding without being patronizing. They may repeat key points calmly and seek additional support (e.g., neighbour, writing) if needed.
Tone:
Begins slightly rushed, but shifts to calm, steady, and reassuring as they adjust to the patient’s needs.
Attitude:
Compassionate and open to adapting their approach. Initially focused on assessing the problem but willing to pause and prioritize effective, respectful communication.
Setup
Stage a home environment, representing the flat of an older person. Include household props. A neighbour can be placed nearby or accessible by door knock.
Brief the participants privately.
The simulation begins when the paramedics arrive at the flat and attempt to assess the situation.
The patient struggles to explain the issue due to hearing loss and confusion, repeatedly pointing to his ear.
Paramedics attempt to communicate, initially talking over each other or not facing the patient.
They begin using overly simplified or loud speech.
The patient becomes agitated due to confusion and the manner of communication.
A neighbour may be introduced to assist in clarifying the situation.
Paramedics are encouraged to reflect in real time, modify their communication (face the patient, use clear, natural speech), and recognize the patient’s need for calm, respectful interaction.
Resolution
The simulation concludes when:
Paramedics adjust their tone and approach, speaking clearly and calmly while maintaining eye contact.
The patient appears more relaxed and responsive.
Paramedics show insight into how their communication affected the patient and demonstrate a more effective approach.
By the end of the simulation, participants should:
- become 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 paramedic 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.
- Summarize main takeaways from the session, including the importance of empathy in nursing care and how effective communication can significantly improve patient outcomes.