Objective Assessment

Contextualizing Inclusivity

Always approach assessment with cultural humility because you cannot know and fully understand all cultures and whether exposing or having the area around the ear touched is culturally acceptable. A cultural humility approach involves a life-long process of reflection and self-critique to address power imbalances within systems and develop mutually beneficial partnerships and relationships (Tervalon & Murray-Garcia, 1998). Healthcare professionals should engage in continuous, critical reflection on power and privilege, and find ways to interact with clients of all genders, sexes, races, ages, and abilities. For example, some clients may wear head coverings or coverings over their head including the ears: some Muslim women wear hijabs that cover their heads or niqabs that cover their faces; some Sikh individuals wear turbans; and some married Jewish women cover their hair with scarves or wear wigs. Additionally, for some clients, touch (i.e., physical assessment) from a person of the opposite gender may not be permissible or encouraged. For example, some Muslim women may prefer or require a female healthcare provider, while others may feel that receiving healthcare from a male practitioner can be medically necessary and is therefore permitted. Another issue to consider is the historical and intergenerational trauma associated with forced cutting of hair in residential schools, so some Indigenous clients may be hesitant to have the area around their ears (and their hair) touched. Cultural humility begins with exploring a client’s needs and also using a trauma-informed approach, whereby gaining consent first is always recommended.

Hearing screening is recommended for people of all ages, but specific recommendations vary by age and jurisdiction. As a nurse, you can conduct a basic screening during each client encounter by observing whether the client hears you, watches your lips move, frequently asks you to repeat yourself, and other cues that may suggest a hearing impairment. In Ontario, Canada, the Infant Hearing Program involves screening for all newborns, continued monitoring of children who are at risk of hearing loss, and language development services when needed (Ministry of Children, Community and Social Services, 2023). With a physician’s referral, hearing assessments by audiologists are covered by OHIP (Ontario Health Insurance Plan). 

Hearing aids and cochlear implants are sometimes used for hearing impairment. These devices can be quite expensive but may be partially or fully covered by workplace insurance and government programs.