As nursing staff, you’ll encounter patients and colleagues who are deaf or hard of hearing every day. But are you deaf-aware?
It’s now estimated as many as one in three adults in the UK are affected to some degree by hearing loss, so we spoke to Claire Holland, deputy CEO of disability awareness charity Enhance the UK, to find out how small changes can build trust, improve care and strengthen communication with your patients.
Every interaction matters
When nursing staff make small, meaningful adjustments for patients with hearing loss, Claire – who is Deaf – says the positive impact cannot be underestimated.
My nurse explained exactly what would happen and made sure I understood
“I avoided attending smear tests for years, despite having needed treatment in the past, because previous traumatic experiences had left me feeling vulnerable and anxious. When a deaf-aware nurse joined my GP practice, I tried again.”
“The nurse took time to explain exactly what would happen and she made sure I understood. We agreed that she would gently tap my leg just before the procedure would start, and then she came up the bed, where I could see her, to let me know everything was done.
“She also asked the golden question: 'Is there anything I can do to make this more accessible for you?'”
Ask the question
Latest research from the Royal National Institute for Deaf People (RNID) and SignHealth highlights how health care staff aren’t asking that simple question often enough.
The 2025 report, Still Ignored: the fight for accessible healthcare, finds that 69% of people who are deaf or have hearing loss say they’ve never been asked about their information and communication needs when accessing NHS care.
With more than half of the UK population over 55 experiencing hearing loss, coupled with an ageing population, and at least 50,000 children in the UK who are deaf, there’s a clear and urgent need for better awareness and an increase in inclusive practices.
So how can you be more deaf-aware?
Five ways to support your D/deaf patients
Building deaf awareness into your daily duties can help you and your patients communicate more confidently. Here are Claire’s top five suggestions to get you started.
1. Identify patients who may have hearing loss
Claire advises that many people who have hearing loss haven’t necessarily been diagnosed, and won’t be wearing hearing aids. So even those with mild hearing loss can struggle in loud environments like a busy waiting room or hospital ward.
Look out for signs, such as:
- someone turning their ear towards the sound of your voice
- focusing on reading your lips as you speak
- asking you to repeat what you’ve said
- responding inappropriately to a question
- appearing confused by what you’ve said.
2. Make it easier for lip readers
Claire points out that only 30 to 40% of sounds can be seen on the lips, so you can help by:
- making sure you have someone’s attention before you start talking, and face people directly
- avoiding standing in front of a window or light source, so your face isn’t in shadow
- remember to “key someone in” by making it clear straight away what it is you want to talk about
- speak clearly and audibly – not too loud or too slowly. Normal conversational speed has a rhythm that lip readers find easier to translate
- if someone hasn’t understood you the first time, remember to “repeat, repeat, then rephrase”
- as a last resort, especially if you’re in a very noisy environment, try writing down what you need to say.
3. Ensure your patients fully understand
It can be incredibly fatiguing for those who are D/deaf or hard of hearing to follow spoken conversation. Extra effort is needed to interpret and process information – whether that’s from guessing missing words, lip-reading or simply having to concentrate harder in louder environments.
Claire recommends using plain English, speaking in short sentences and, where possible, trying to stick to one concept per sentence.
It’s important that your patients fully understand. Make sure there’s time to repeat or revisit a topic, to avoid causing any confusion.
4. Ask your D/deaf patients about their communication preferences
This isn’t just good practice; it’s law. The accessible information standard (AIS) requires all providers of NHS care or other publicly funded adult social care ensure people with disabilities or sensory loss receive information and communication support in a way they can understand.
This standard doesn’t just refer to how someone is contacted. “It’s supposed to be embedded in all elements of care,” advises Claire.
It includes identifying, then recording people’s needs so all staff can ensure those needs are met; flagging this information on records; sharing it as part of routine treatment, ongoing care, referral, discharge and handovers; and reviewing this regularly.
5. Understand that medical and cultural deafness are different
Claire says it’s important to recognise that many people who are D/deaf are incredibly proud of their deafness – it’s a key part of their identity.
She acknowledges not everyone will feel that way, but, for many, hearing loss is not viewed as a problem. Claire recommends approaching deafness in a neutral way, not from a medical perspective.
Know your terminology
- Use the term D/deaf or hard of hearing, unless someone describes themselves as "hearing impaired", or tells you that is their preference.
- We use Deaf (with a capital D) for those who see their deafness as part of their identity and culture rather than as a disability. These are usually people who were born Deaf or became Deaf before they started to learn to talk, and tend to communicate using British Sign Language (BSL) as their first language.
- We use deaf (with a lowercase d) to refer to those who aren’t culturally deaf BSL users.
Understanding basic BSL
BSL is the signed language of the UK’s Deaf community. It uses a combination of hand shapes, facial expressions, lip patterns and body language. It's not to be confused with Makaton, which is a communication aid for hearing people with learning disabilities or communication difficulties, that uses sign, speech, and symbols.
Claire explains it takes the average person seven years to become fluent in BSL. And just like spoken English, there are regional differences, so a slight misshape of the hand can change the meaning of a sign. But learning just a few common words can help improve trust and respect.
Learning to fingerspell
Learning the alphabet in BSL can be incredibly helpful and can be picked up fairly quickly. Make a start by learning to sign your name or perhaps a medical term you use frequently with your patients.
If you're interested in finding about more about deaf-awareness training, visit the Enhance the UK website.
Further information
Read more about the accessible information standard (AIS). You can also review and self-assess your own AIS compliance using NHS England’s self-assessment framework.
Visit RCN Learn to increase your understanding of how best you can support pregnant women who have hearing loss or are D/deaf.
If you're an RCN member with lived experience of disability and/or neurodivergence, the Peer Support Network could be for you.
Visit Enhance the UK for more information on deaf awareness and basic BSL training.
