Communicating in a mask

by Rebecca Cameron @slt_dg

Previously published, July 10th 2020 in dghealth ‘Opinions & ideas in NHS Dumfries and Galloway. Thank you for sharing

When our multidisciplinary team was set up to create a poster and video helping to highlight the challenges of communicating in a mask, little did we know that this information would be so important as the weeks were to unfold….  As of Monday the 29th of June it has become mandatory for everyone to wear masks in clinical settings. The challenges that this poses to staff, patients and visitors cannot be underestimated.

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We put out a request on twitter for some feedback on what the lived experience was of having to wear masks all day. There was a lot of frustration, but I think that this comes from a good place; staff want to deliver excellent care for their patients. We know that it’s hard to hear, and hard to be heard in a mask. Shouting is bad for the voice and tiring, miscommunication can be catastrophic. You forget to hydrate and eat. You can no longer share a smile down the corridor, it feels isolating, communication becomes perfunctory, you lose the banter. It’s hot, claustrophobic… chafing.

There’s no doubt that this makes our jobs harder and there is no easy fix but we have a slogan in our office which is “improvise, adapt and overcome”. Here are some firsthand hints and tips of ways that other teams are doing this:

  1. Get regular breaks “I can manage about 2 hours in one then I start to get a bit headachy and hot and it all gets a bit much” “I feel claustrophobic and the patients say they can’t see what I’m saying even if they don’t have a hearing impairment, we all rely on lip reading a bit.”
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“Take your breaks, our manager bought everyone in the care home ice lollies in the heat to help us hydrate” “My hot flushes make it just unbearable in a mask but my manager’s been really good about letting me take a break”

  1. Keep drinking – sip water when you can. Wash your hands, take the mask off, wash your hands, go out of the clinical area, take a drink.
  2. Royal college of nursing advice – moisturise before and after putting mask on/off, wear moisturiser overnight and hydrate at home (links at the end)
  3. Glasses steaming up ? adjust so upper part of mask is tighter and fits flush to cheeks, wash glasses with soapy water before putting it on.
  4. Swap in and out with colleagues, can you write your notes up elsewhere, take a break in the wobble room? Think creatively about spaces.
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Link to video:

Communicating effectively can support patients to understand how to comply with specific treatment advice such as medical dosage, stay informed around their treatment plans and advice and to ensure that they can make their own decisions and give valid consent to any treatment.

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Something we’ve all been thinking about in speech therapy is how this will affect people who already experience communication difficulties, for example someone who has had a stroke, head injury or head and neck cancer, or someone living with a progressive disease such as motor neuron disease (MND), Parkinson’s or dementia.

When someone has comprehension difficulties, they need to rely on things other than the spoken word to aid their understanding – cues from your tone of voice, facial expressions, gestures, as well as environmental cues. If someone has difficulty expressing themselves, either because of language difficulties (e.g. being able to find the right word) or mechanical speech changes (difficulty making their speech clear or their voice loud enough), they may be relying on your facial expression to know if you have understood them.

A healthcare setting can be difficult for someone with communication support needs at the best of times – a different environment, different routine, lots of unfamiliar faces, background noise – but the measures now in place because of COVID-19 make the challenge greater. Now patients typically can’t see staff’s faces, don’t have face-to-face contacts with family, and sometimes need to communicate using the telecom systems.

So, how can we help? If someone has lived with communication changes for a while they or their family will likely know what works for them and what doesn’t.

Ask if they like having things written down, if they use a communication chart or book with pictures/photos/ symbols, if they find gestures helpful, or if they have a device they use to help them communicate. Make sure someone has any aids they need in place, e.g. glasses, hearing aids. Some people manage to communicate much more effectively with familiar listeners, so being in hospital without the support of friends and family can be really challenging.

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Talking on the phone may be particularly difficult, so trying to stay connected to loved ones in this pandemic can be an additional challenge – trying to set up a video call for someone might make all the difference for them. If someone has a new communication difficulty they may well be confused and scared by this change and there may be a bit more trial and error to what helps and what doesn’t, but as a starting point – use short, simple sentences; emphasize, repeat or write down key words; use gestures and relevant objects/pictures to support what you are talking about, even drawing something can give valuable extra information.

You can also try using a communication chart, both to support your speech, and as an option for the person to express themselves – there are some charts available through Beacon (patient & carer information leaflets -> Speech and Language Therapy -> patient communication charts). There are also some speech to text apps which may also be an option but we would have to be sure that the person reading the text is fully able to understand English – it may that British Sign Language (BSL) is indeed their first language and that English is not.  If someone with communication support needs does not understand why you are wearing a mask or is distressed like this, discuss in your team if wearing a clear visor instead a of a mask may be appropriate in some cases. However, there have been mixed reports of these steaming up when the speaker is talking – so this is not a fail-safe solution.

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Many people who are deaf or experience hearing loss rely heavily on visual cues to be able to communicate accurately and effectively. For those who use BSL it’s crucial to be able to see lip patterns and facial expressions – it’s all part of the language. The increased use of masks therefore presents a significant barrier around communication. Clear visors may be the only option in these cases. Public bodies have a legal obligation to ensure that they are meeting the needs of people who are deaf or who experience hearing loss.  It is absolutely vital that we make the necessary reasonable adjustments when we are working with people with sensory loss.  This is backed up by several pieces of legislation, including the Equality Act 2010 and the BSL (Scotland) Act 2015 but this should be more than just a legal duty though.   The Board also now has access to online interpreting through Sign Language Interactions. A clinician could be speaking to a patient in a consulting room with and ipad or laptop nearby and on the screen, a BSL interpreter is interpreting what is being said into BSL.

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Hopefully the hints in the poster have given you some tools to help overcome the significant challenges of communicating in a mask. We would like to acknowledge what a monumental task this is, and recognise that delivering excellent patient care while wearing PPE is very difficult. You are all heroes. Remember to take breaks, to keep hydrated and be kind to yourself.


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