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Face masks: how nurses can overcome the communication barrier and reassure patients

Compulsory face coverings pose particular challenges when patients are deaf or have dementia
Nurse wearing a face mask – COVID-19 face coverings pose communication challenges for healthcare staff and people who are deaf or have dementia

Compulsory face coverings pose particular challenges when patients are deaf or have dementia

Face coverings will be a fixture of health and social care for the foreseeable future Picture iStock

This article was updated on 2 March 2021 to include fresh sources of information

Face coverings are going to be with us for quite some time and will present an additional communication hurdle for most of us. The wearing of face coverings is compulsory in hospitals, on public transport and in places where social distancing is not always possible. This has meant we have all needed to find new ways to communicate with each other.

Finding new ways of communicating has been especially critical in health and social care. We have all had to be mindful of recognising communication difficulties, and innovative in overcoming them for our patients

Compulsory face coverings pose particular challenges when patients are deaf or have dementia

Nurse wearing a face mask – COVID-19 face coverings pose communication challenges for healthcare staff and people who are deaf or have dementia
Face coverings will be a fixture of health and social care for the foreseeable future Picture iStock

This article was updated on 2 March 2021 to include fresh sources of information

Face coverings are going to be with us for quite some time and will present an additional communication hurdle for most of us. The wearing of face coverings is compulsory in hospitals, on public transport and in places where social distancing is not always possible. This has meant we have all needed to find new ways to communicate with each other.

Finding new ways of communicating has been especially critical in health and social care. We have all had to be mindful of recognising communication difficulties, and innovative in overcoming them for our patients and the people important to them.

View our COVID-19 resource centre

Why face masks will pose challenges for communication

Wearing face coverings will create an extra challenge for many of us. Some will find it difficult, not least people who are deaf or those who have dementia or cognitive impairment, a learning disability or other conditions such as stroke, chronic obstructive pulmonary disease or asthma.

The situation has been made even more difficult in health and social care because most people are not able to have someone with them to provide help and support in hospitals, at appointments or during treatments, at the moment.

The apprehension of seeing and communicating with staff wearing masks, which alter the sound and quality of the voice and prevent visual prompts, will make even mild hearing loss much more apparent. People who are deaf, older people and others with hearing loss all rely on lip reading to fill the gaps of speech that they miss.

People who are deaf or hard of hearing already say they feel isolated when it’s difficult to hear clearly what people around them are saying. This means many will be at risk of not understanding basic information and instructions and for others, extra mental exertion will be required to listen over background noise.

It can feel uncomfortable to acknowledge when you did not hear something and embarrassing to ask people to repeat themselves. Being deaf, hard of hearing or having cognitive impairment or dementia can already feel isolating, particularly when there is no way to understand or unravel what the people around you are feeling or saying. For many, important messages in pictures and written word will help as a visual reminder and prompt.

Advice on how to communicate clearly with patients

There are practical things we can do to help us all to understand each other:

Be self-aware iconBe self-aware
When we are stressed it is easy to allow our feelings to be reflected in our voice, body language and eyes. Take a moment before you see the next patient, think about what information you need to give using any tools that you have – drawing, writing, and so on. Take another moment to breathe and then to focus on the patient’s needs. It is important to allow enough time to complete interventions without rushing ourselves or our patients

Demonstrate your respect icon

Demonstrate your respect
Smile and approach patients from the front, ideally at their eye level. Use your eyes, eyebrows and smile. Even if a person cannot see your mouth, your smile will be reflected in your eyes. Use your body language to create a calm situation. Try not to make sudden moves. Be flexible and patient. Humour may help

Speak clearly icon

Speak clearly… and don’t shout
Hospitals are noisy environments. They can be overwhelming and produce all kinds of background noise that will make hearing more difficult and may create anxiety. As practitioners we should pronounce our words clearly and speak loudly enough, but without raising our voice or its tone. Do not shout. Shouting can feel patronising to the individual

Use friendly body language
As patients are not able to see our faces or even hear us clearly, we need to use our body language to show we are professional, calm and in control of the situation, particularly if the messages we are giving are difficult, upsetting or sad

Observe your patient iconObserve your patient
Use what you can see to communicate more effectively. Look carefully, listen to what your patients are trying to get across to you and shape your behaviour accordingly

Take advantage of technology
Make use of apps such as a speech recorder on smartphones that turns speech into text


Other struggles with masks, and the loss of non-verbal communication

Face masks bring other struggles too. Most of us feel uncomfortable wearing them, they make us hot and bothered and our glasses get steamed up. For those who wear behind-the-ear hearing aids, there is a risk of these being caught up – we have heard that aids can be lost or broken after getting tangled in the elastic of a face covering. And then there is the worry about wearing masks correctly.

All this in an already stressful situation can make patients feel more anxious and agitated. Staff will need to be mindful of this, particularly when people are looking lost.

Across cultures, unspoken communication has always provided unique opportunities and it can be the most effective way of connecting with someone. Unfortunately face masks can hide pleasure, sadness, frustration, annoyance and fear – emotions we show on our faces without having to say a word.

People who are deaf and those living with dementia are often skilled at interpreting facial signals and feelings and so rely on this ability.

As practitioners, it is our responsibility to be more aware of how we come across when people cannot see our face, and we cannot see theirs, all emotion hidden behind masks. We need to be able to judge and react to our patients’ feelings and worries while managing continued social distancing and face covering.

We will all have to learn to pay greater attention to our own and our patients’ non-verbal cues.

Communicating while wearing a mask – sources of information for nursing staff

  • Royal National Institute for Deaf People (RNID): Information for people who are deaf or have hearing loss on how face-coverings regulations apply to them
  • National Deaf Children’s Society: Face masks and communication – coronavirus information for families of deaf children
  • Mencap: easy-read guidance on face coverings
  • Imperial College Healthcare NHS Trust: Read my lips – the downside of PPE for people with hearing loss, and what we can all do to help. Blog by neurology consultant Helen Grote, who is deaf, on practical steps healthcare staff can take to make life easier for people who are deaf or have hearing loss,

Age UK clinical lead for professionals and practice Lesley CarterLesley Carter is clinical lead for professionals and practice at Age UK, a former director of nursing and a dementia nurse consultant at the Department of Health

This article was originally published on 8 July 2020

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