Unit of competency details

Descriptor 

This unit of competency describes the skills and knowledge required conduct hearing assessments

Application 

Work performed involves preparing the environment, establishing client relationship, undertaking hearing assessments, interpreting the results of the hearing assessments, developing realistic goals with client and referring client if required to an appropriate facility

All tasks are conducted in accordance with industry standards, organisation policies and procedures, and infection control guidelines

Employability Skills 

This unit contains Employability Skills

Elements define the essential outcomes of a unit of competency.

The Performance Criteria specify the level of performance required to demonstrate achievement of the Element. Terms in italics are elaborated in the Range Statement.

ELEMENT 

PERFORMANCE CRITERIA 

1. Prepare for hearing assessments

1.1 Ensure information , including required forms are accessible and ready for use

1.2 Prepare the environment  suitably for hearing assessments

1.3 Check equipment and instruments  for assessments and calibrated for use

1.4 Ensure personal protective equipment  is available and used if required

2. Establish a positive relationship with the client 

2.1 Take client case history and explain practice/hearing service administrative procedures to client

2.2 Determine client's expectations

2.3 Gain informed consent  from clients where applicable

2.4 Give client the opportunity to ask questions and discuss concerns

2.5 Identify and meet special needs of client

2.6 Maintain confidentiality  of client information

3. Conduct otoscopy

3.1 Follow personal hygiene /infection control  procedures

3.2 Conduct otoscopy in a non-threatening manner to produce valid, reliable and accurate results and in accordance with relevant policy and procedures

3.3 Identify abnormalities of the ear canal 

3.4 Identify contra -indications for proceeding  with further hearing assessments

3.5 Make referral  to appropriate agency for further assessment and treatment if required

4. Conduct hearing assessments

4.1 Identify significant features of client history

4.2 Select appropriate hearing assessment/s and explain procedure to client

4.3 Wear appropriate personal protection  clothing correctly and follow infection control procedures 

4.4 Conduct assessments to produce valid, reliable and accurate results and in accordance with relevant policy and procedures

4.5 Use results to identify specific hearing loss and/or any abnormal functions

4.6 Record results in accordance with relevant policy and procedures

5. Conduct speech audiometry testing

5.1 Verify audiograms

5.2 Assess speech discrimination abilities and their implications for rehabilitation

5.3 Identify any possible retro-cochlear pathology

6. Review results of hearing assessments with client

6.1 Communicate results of assessments  clearly and simply to the client

6.2 Discuss options to support client and consider with client

6.3 Negotiate and establish realistic goals for the client

6.4 Record, document and file results in accordance with relevant policies and procedures

6.5 Comply report, including recommendations for further assessment or referral  to an appropriate facility or hearing aid fitting

7. Clean and store equipment

7.1 Clean equipment and attachments in accordance with manufacturers' requirements and infection control procedures

7.2 Store equipment and attachments in accordance with organisation policy and procedures

REQUIRED SKILLS AND KNOWLEDGE 

This describes the essential skills and knowledge and their level required for this unit.

Essential knowledge :

The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes knowledge of:

• Anatomy of the ear, including peripheral auditory system
• Appropriate physical environment for audiometric assessments of all types
• Appropriate practices to ensure efficient use of power and other resources
• Australian and international standards that apply to the conduct of a hearing assessment
• Causes and types of hearing loss
• Hearing aids and their functioning
• Temporary Threshold Shift and Permanent Threshold Shift and their implications for assessment
• The characteristics of speech tests (e.g. carrier phrase versus no carrier phrase, recorded versus live voice, open versus closed set tests)
• The common physical abnormalities of the peripheral auditory system
• The interrelationships with other professions
• The materials that can be used for speech testing, particularly in relation to what the test is designed to assess, who the test is appropriate for and the reliability/validity of particular tests

Essential skills :

It is critical that the candidate demonstrate the ability to:

• Compare assessment results across and within assessments to ensure they are cohesive
• Conduct the full range of hearing assessments accurately and reliably
• Correctly select required hearing assessment
• Establish effective working relationships with external agencies
• Interpret and record results accurately and identify options available to clients
• Interpret pure tone audiometry and impedance audiometry test results accurately
• Meet client needs and establish realistic goals through effective communication with client
• Operate audiometry equipment and instruments correctly and in accordance with manufacturers' specifications
• Perform hearing assessments, including otoscopy, accurately
• Recognise and respond correctly when a client is not giving true thresholds
• Select and use appropriate equipment and instruments
• Use test results to determine type of hearing loss
• Write comprehensive and accurate reports

In addition, the candidate must be able to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes the ability to:

• Use interpersonal skills to relate to people from a range of social, cultural and religious backgrounds and physical and mental abilities
• Use numeracy skills including the ability to interpret data and record client results
• Use oral communication skills-language competence required to fulfil job role in a safe manner and as specified by the organisation. Assessors should look for skills in asking systematic questions, providing clear information, listening to and understanding client areas of concern, and demonstrating ethical practice and procedures in dealing with clients. Effective verbal and non verbal communication skills with a range of internal and external persons are essential together with competence in English or a community language, depending on the client group
• Use problem solving skills including an ability to use available resources and determine accuracy of test results
• Use reading and writing skills-literacy competence required to fulfil job roles safely and effectively. The level of skill required involves reading and documenting clinical information and understanding procedure manuals
• Work with others

EVIDENCE GUIDE 

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.

Critical aspects for assessment and evidence required to demonstrate this competency unit :

• The individual being assessed must provide evidence of specified essential knowledge as well as skills
• Observation of workplace performance is essential for assessment of this unit
• Consistency of performance should be demonstrated over the required range of situations relevant to the workplace
• Where, for reasons of safety, space, or access to equipment and resources, assessment takes place away from the workplace, the assessment environment should represent workplace conditions as closely as possible

Access and equity considerations :

• All workers in the health industry should be aware of access and equity issues in relation to their own area of work
• All workers should develop their ability to work in a culturally diverse environment
• In recognition of particular health issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on health of Aboriginal and Torres Strait Islander people
• Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on health of Aboriginal and/or Torres Strait Islander clients and communities

Context of and specific resources for assessment :

• Access to appropriate workplace, equipment and instruments where assessment can take place or the simulation of realistic workplace setting, including access to equipment for assessments
• Relevant organisation policy, guidelines, procedures and protocols
• Relevant professional bodies policies and guidelines on the conduct of screening hearing tests
• Relevant legislative and regulatory documents
• Relevant publications of the National Acoustic Laboratories
• Access to professional library for accurate and current relevant information
• Manufacturers' specifications for the use and storage of equipment

Method of assessment 

• Observation in the work place (if possible)
• Written assignments/projects or questioning should be used to assess knowledge
• Case study and scenario as a basis for discussion of issues and strategies to contribute to best practice.
• Clinical skills involving direct client care are to be assessed initially in a simulated clinical setting (laboratory). If successful, a second assessment is to be conducted during workplace application under direct supervision.
• Practical case presentation
• Case studies and scenarios
• Interviews/Questioning
• Role plays

Related units :

• This unit can be assessed independently, however holistic assessment practice with other audiometry units of competency is encouraged

RANGE STATEMENT 

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.

Information may include :

• Client medical history
• Referral letter
• Correspondence
• Consent forms
• Current standards
• Information for clients

Environment may include :

• Consulting room
• Acoustically treated assessment room

Equipment and instruments may include :

• Audiometer (clinical, screening and diagnostic)
• Headphones
• Otoscope (hand held and video)
• Screening tympanometer
• Recorded speech sources
• Sound field audiometer
• Impedance audiometer
• Computer

Equipment checking must include :

• Acoustic calibration and integrity check of an audiometer
• All parts are correctly assembled

Personal protective equipment may include :

• Gloves
• Masks
• Eye protection

Clients may include :

• Adults
• Aged persons

Informed consent may include :

• Written
• Verbal
• Implied

Confidentiality of client information may include :

• Legal and ethical requirements
• Secure location for written records
• Telephone conversations
• Offering a private location for discussions
• Information disclosed to an appropriate person consistent with the responsibility of this position
• Adherence to the Privacy Act

Personal hygiene /infection control procedures may include :

• Washing hands
• Current National Health and Medical Research Council (NHMRC) guidelines for infection control in health care settings
• Standard Precautions and Additional Precautions as defined by the NHMRC
• Current Australian Standards
• Local Government ordinances
• Other legislative requirements

Relevant policies and procedures may include :

• Organisation
• Industry standards (state and national)
• Office of Hearing Services
• Contract requirements
• relevant Commonwealth and state/territory privacy legislation
• Research organisations e.g. National Acoustic Laboratory (NAL)
• Relevant state/territory OHS bodies
• Industry professional bodies
• Relevant Australian standards

Abnormalities of the ear canal may include :

• Excessive cerumen
• Foreign body
• Discharge from the ear
• Signs of inflammation/infection
• Atresia
• Exostosis
• Collapsed ear canals
• Presence of grommets
• Otitis externa
• Perforated tympanic membrane

Contraindications for proceeding with further tests include :

• Excessive cerumen
• Foreign body
• Discharge from the ear
• Signs of inflammation/infection
• Atresia
• Exostosis
• Collapsed ear canals
• Presence of grommets
• Otitis externa
• Perforated tympanic membrane

Referral agencies may include :

• Audiologist
• Medical practitioner
• Medical facilities
• Rehabilitation centres
• Self help organisations

Hearing assessments must include :

• Pure tone audiometry assessments ie air conduction screening and threshold assessments, threshold air and bone conduction assessments with masking as required, Stenger
• Impedance audiometry assessments ie screening tympanometry and contralteral stapedius reflex recording, stapedial reflex delay
• Speech audiometry assessments using at least two levels, one being at least 10dB above PB max ie phonetically balanced monosyllables, AB words, spondees

Results of hearing assessments may include :

• Sensori-neural hearing loss
• Conductive hearing loss
• Mixed hearing loss
• Identification of non-organic hearing loss

Options for client may include :

• Fitting of a hearing aid or assistive listening device
• Referral to a general practitioner
• Referral to a local support group for training in communication strategies

Indications for medical referral include :

• Visible evidence of cerumen accumulation or the presence of a foreign body which precludes assessment or taking an impression
• Previously unreported apparent or confirmed perforation
• Reported pain, discomfort or tenderness in the ear
• Any history of active drainage from the ear during the past 3 months and/or apparent infection
• A hearing loss associated with a traumatic insult to the ear
• Chronic dizziness or vertigo
• Reported facial numbness, weakness or asymmetrical facial movements
• A hearing loss of sudden or recent onset
• Unilateral hearing loss
• Unilateral tinnitus
• Sudden onset of tinnitus
• Reported feeling of blockage or fullness in ear(s)
• Rapid deterioration in audiometric thresholds

Indications for audiological referral include :

• An air bone gap of 20dB or greater at 500, 1000 or 2000Hz
• An asymmetrical sensory-neural loss (a difference of >20dB at 500, 1000 or 2000Hz and/or30dB at 3000, 4000 or 6000HZ)
• A significant difference in speech discrimination scores between ears
• Evidence of fluctuations in audiometric thresholds