Hearing Difficulties

action on hearing loss

This week I have been finding out about hearing difficulties.  I have discovered that the main reasons for hearing loss are either sensorineural or conductive.

Sensorineural hearing loss occurs when either (or sometimes both) the hairs of the inner ear or the auditory nerve are damaged.  The latter is responsible for sending sound messages to the brain.

Conductive hearing loss occurs when the ear is blocked, usually due to earwax or glue ear.

ear diagram

Sensorineural

After repeated exposure to loud noises, such as excessively high volume music or work-related drilling and banging, the hairs of the inner ear can become damaged and flattened, or the auditory nerve itself may be damaged.  Additionally, the ageing process will also tend to produce a similar type of decline, but more gradual, from around the age of 40.  By later life, the hearing loss will tend to be very noticeable, and hence problematic.

Other less common and lesser known causes of hearing loss include: gene inheritance; infection complications from mumps, measles or rubella; Meniere’s disease – a combination of vertigo, tinnitus (ringing in the ears) and ear blockage; stroke and cardiovascular damage; the side-effects of some medications, such as antibiotics and cancer treatments; plus a benign growth, on or near to the auditory nerve, called an acoustic neuroma.

In the case of sensorineural hearing loss, an MRI scan will usually be taken, mainly to rule out the complications of an acoustic neuroma being present.  Although acoustic neuromas are small and slow growing, if they get larger they will produce symptoms such as dizziness, tinnitus and balance disturbances, or sometimes complications such as hydrocephalus (water on the brain).  Treatment would either be via surgery or radiation.  A hearing aid will also usually be offered for sensorineural hearing loss.

hearing aid types

Hearing aids are available free of charge on the NHS, and usually tend to be very good quality digital models.  Maintenance and batteries are also completely free for life.  Hearing aids will either be behind the ear (BTE), in the ear (ITE), in the canal (ITC) or completely in the canal (CIC).  The behind the ear hearing aids are standard NHS provision and come in a choice of discreet beige, brown or silver, although some brighter colours are available on request.  The other types of hearing aid, including the ‘invisible’ type, must be privately sourced by individuals, and tend to be quite costly (starting at around £300 for a single hearing aid, rising to as much as £3500 for a pair).  However, as NHS hearing aids are now more up-to-date, and of a very good quality, they are apparently much more acceptable to the majority of service users.  Two good quality hearing aid leaflets are available from Action on Hearing Loss, via http://www.actiononhearingloss.org.uk/supporting-you/factsheets-and-leaflets/hearing-aids.aspx

hearing aid

Typical NHS model

Conductive

After repeated build-up of ear wax, an accumulation of fluid or ear infections, conductive hear loss will be the result.  Less commonly, it may also be caused by a perforated ear drum or otosclerosis, an abnormal bone growth in the middle ear.

Conductive hearing loss is usually reversible by simple procedures such as removal of ear wax, medication or minor surgery.

Further support

Here in the UK, people with long-term hearing problems can seek further support and advice from the charity Action on Hearing Loss (formerly the Royal National Institute for the Deaf) and may even receive animal assistance from Hearing Dogs for Deaf People.

hearing dogs

Further References

Action on Hearing Loss. (2015). http://www.actiononhearingloss.org.uk/

Hearing Dogs for Deaf People. (2015). http://www.hearingdogs.org.uk/

National Health Service Choices. (2015). Hearing Aids. Accessed 25 June, 2015, from http://www.nhs.uk/Livewell/hearing-problems/Pages/hearing-aids.aspx

National Health Service Choices. (2015). Hearing Loss. Accessed 25 June, 2015, from http://www.nhs.uk/Conditions/Hearing-impairment/Pages/Introduction.aspx

Patient Information. (2015). Acoustic Neuroma. Accessed 25 June, 2015, from http://patient.info/health/acoustic-neuroma-leaflet

Patient Information. (2015). Otosclerosis. Accessed 25 June, 2015, from http://patient.info/health/otosclerosis-leaflet

Patient Information. (2015). Perforated Eardrum. Accessed 25 June, 2015, from http://patient.info/health/perforated-eardrum

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Hobbies and relaxation are essential for good mental health

When taking time to enjoy the weekend, I realised the importance of hobbies and general relaxation for promoting and maintaining good mental health.  Without time to switch off from our busy working lives, our stress levels can increase and, over time, can potentially remain at a constant high; this is very damaging for our health, in terms of weakened immunity, poor sleep, changes in appetite, hormonal changes, increased blood pressure and cardiovascular health, coupled with poor coping strategies such as excess alcohol intake.  The overall danger of long term unchecked stress is that it also increases the risk of depression, cancers and cardiovascular problems.  It is therefore somewhat essential that we take time out to pursue hobbies that we enjoy, in order to relax and look after our mental health.

My favourite way to unwind is, undoubtedly, by reading books.  For purposes of relaxation, my reading material has to be fiction; non-fiction books are what I associate with study.  My chosen areas of fiction are very diverse, and range across titles such as Thomas Hardy’s Tess of the D’Urbervilles, the Scandinavian noir of Henning Mankell’s Wallander series, Jeffrey Archer’s Clifton Chronicles, George R. R. Martin’s Game of Thrones series to Susan Hill’s Simon Serrailler series.  Reading is a fantastic hobby that can transport you virtually anywhere; the pure escapism is wonderful and very hard to beat.  I established myself as a ‘bookworm’ from a very young age, and it is a love that has never abandoned me, and has helped to keep me sane!  Non-fiction books additionally serve me well, but the intellectual stimulation that they produce requires more concentration, and are hence less of an easy read.  Intellectual stimulation is good however, and for me is essential for a healthy state of mind.

susan hill   thomas hardy   mankell

The other way that I relax is by walking with my Basset Hound dogs.  Research has repeatedly shown that spending time with dogs is good for our mental health, as well as physically reducing our blood pressure levels through stroking and interaction.  As well as making loyal pets and companions, our canine friends are used as pat dogs for the elderly and for people living with dementia.  For me, it is my dogs’ qualities of loyalty, unconditional love, and the humour that they bring that makes them special; I cannot imagine a home and a life without dogs.  I also love the essential exercise through walking that accompanies owning a dog.  Walking is a great way to relax, to improve general mood and physical well-being.  Walking can also be an effective way to maintain or reduce weight.  Daily dog walks additionally allow people (and dogs) to connect with other people, whether they are other dog walkers, or neighbours / local residents.  Meeting other people is good for the mind, as it guards against isolation and strengthens our support networks.

barney basset

As well as having dogs, I also share my home with a beautiful Horsefield tortoise.  The tortoise’s dietary requirements form part of the daily dog-walking routine, as it is an excellent opportunity to gather fresh vegetation, such as dandelions, clover, grass and so forth.  The tortoise also shares many of my own vegetable dietary components, but there is nothing quite like being in touch with nature and gathering free food from the surrounding countryside.

tortoise

Although not one of my regular hobbies, this weekend I re-discovered the simple pleasures that can be gained from sharing ‘childhood’ box games with family or friends.  For a rush of competitive adrenaline, I find the best game is Frustration (sometimes called Pop-up); while for a longer more considered game, I personally enjoy Monopoly, draughts or Scrabble.

frustration game

Whatever your choice of hobby or pastime, it does not really matter, just so long as it is relaxing.  Working, resting and playing are all equally important, and can all be beneficial for our overall brain and body health.

Transition from student to nurse

Last week I completed my university module concerning preparation for role transition – from student to becoming a nurse.  It culminated with my delivery of a 20 minute power point presentation, which reflected on my learning journey – where I was at the beginning, where I am now and where I need to get to.  There were certain criteria which had to be met, and hereby follows an outline of the main material that I covered.

Choosing and using a reflective framework was the key requirement, and the one that I used was Gibbs (1988).  I like the way that the headings prompt and guide the reflective process, and I particularly like the Action Plan stage, because past learning is used to inform future learning too.

reflective cycle

I used Gibbs Reflective Cycle to frame all of my presentation, and directly used the headings and order as illustrated above, e.g. description, feelings, evaluation, and so forth.

Another key requirement was to carry out self-assessments in order to determine my learning needs.  I used the Honey and Mumford Learning Styles Questionnaire (1992) (- reflector, theorist, activist and pragmatist), the VARK 80 item questionnaire (visual, auditory, reading and writing, kinaesthetic), a Key Skills (2003) assessment and the NMC (2010) Standards for Pre-registration Nursing.

SWOT

The results of all these self-assessments were collated into a SWOT analysis – strengths, weaknesses, opportunities and threats.  The weaknesses were then used to create SMART goals – specific, measurable, achievable, relevant and time-bound, and propositions of how these goals would be achieved.

SMART

Besides these basic requirements, a discussion of role transition was also included.  The work of Duchser (2012) was used to illustrate the three stages of role transition within the first year of becoming a nurse; with transition shock taking place in the first 3-4 months of becoming a nurse, followed by a middle stage of lots of new learning and knowledge acquisition, then a final few months of finding stability and settling down.

The presentation was a personal challenge, because I am not a natural public speaker.  I enjoyed putting the slides together however, and I practised presenting them a few times each day for a couple of weeks before the actual day.  I am glad that I had the courage to approach the challenge, but am now looking forward to commencing my next piece of assessed work – a 6,000 word report on evidence based practice, which is something that I am more familiar and comfortable with.

References

Chartered Institute of Personnel and Development. (2015). SWOT analysis factsheet. Retrieved 17 May, 2015, from http://www.cipd.co.uk/hr-resources/factsheets/swot-analysis.aspx

Department for Education and Skills. (2003). Skills Strategy White Paper- 21st Century Skills: realising our potential. Cm 5810 The Stationery Office.

Duchser, J. B. (2012). From Surviving To Thriving: Navigating the First Year of Professional Nursing Practice (2nd ed.). Canada: Nursing the Future.

Gibbs, G. (1998). Learning by Doing: A Guide to Teaching and Learning. London: FEU.

Honey, P., & Mumford, A. (1992). The manual of learning styles (3rd ed.). Maidenhead: Peter Honey.

Nursing and Midwifery Council. (2010). Standards for Pre-registration Nursing Education. Retrieved from http://www.nmc.org.uk/standards/additional-standards/standards-for-pre-registration-nursing-education/

VARK Questionnaire Version 7.1 Retrieved 17 May, 2015, from http://vark-learn.com/the-vark-questionnaire/

Choosing how to die

As a 54 year old British man recently chose to end his life in a Swiss Dignitas clinic, the debate over assisted dying has reignited once again.  The media have documented, how the gentleman, Jeffrey Spector, was afraid that an inoperable tumour, growing on his spine, would cause him to become paralysed and dependent upon others.  Many people have felt that the father of three took his life too soon, and that there was always a chance that he would not become paralysed at all.  For others however, it was felt that Mr. Spector had made the right decision, and was extremely brave to do so.  Regardless of the split in opinions that exist, this gentleman was able to end his life exactly how he chose.  With foresight of the reactions, Jeffrey Spector was quoted as saying, ‘Some people will criticise me, but do not judge me.  Never judge anyone unless you have worn their shoes.’  People generally have some degree of choice in how they live their lives, so surely they should also be able to make some choices with around how they die.

In response to Mr. Spector’s story, many people have recently contacted the media, and have courageously shared personal accounts of how they helplessly watched family members die, while enduring pain and a low quality of life.  Most of these people expressed how they wished assisted dying had been a viable option for their loved one.  In the United Kingdom however, it still remains an illegal issue.

Discussion, over the last week, has inevitably compared human end of life care options to those available to our pets.  If euthanasia for people was legalised however, parts of the public still state reservations about where the boundaries of decisions should lie, and how issues of capacity should be guided and dealt with; for example, a person living with late stage dementia.  Naturally, there are some huge ethical considerations, but if clear guidance was put in place, there is surely possible scope for a suitable assisted dying bill.

Most nurses choose to go into the profession, in order to help make people well again; but for a smaller, yet significant, amount of nurses, their job is to help the dying, whether this is through providing comfort at the culmination of a natural elderly lifespan, or through a degenerative or terminal illness.  Nurses, working in environments such as hospices or as part of organisations like Macmillan, do a fantastic and valuable job; and, arguably, it takes a special kind of person to fulfil that role well.

Death can be a discomforting subject, and I am still personally unsure what I feel, deep down, about assisted dying.  I do know, however, that people need to talk more openly about end of life and palliative care, because if they succeed in avoiding discussion entirely, death will eventually become inevitable, either for themselves or a loved one.  No, it is not a nice thought, but as humans we are not immortal.  Yes, of course, our main focus should be on living our lives to the full and best of our abilities; however, a comfortable death, with some degree of choice, should also warrant some focus in bringing about life’s conclusion.