I teach a lot of people NVDA as part of my day job. Those with remaining vision find it important to ...
* use a clear voice they can be comfortable with. This might mean buying a license, which might be the price of an annual JAWS membership in the US but far cheaper than JAWS in the rest of the world and of course is usable in perpetuity.
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* Adjust NVDA's visual settings to both highlight what it's talking about, and the object presentation and document formatting settings to not say too much. Generally those who can see some want the text read more than whether things are headings, list items or so on. Reducing the verbosity will almost certainly improve your experience and reduce the listening fatigue. Particularly section
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* NVDA can optionally read what the mous is moving over, but this is only desirable sometimes. Learn the keyboard shortcuts to toggle mouse tracking, adjust punctuation and pause/resume speech early on.
* the training materials from the
$1 are inexpensive and thorough. It's not the most exciting thing to read through, but in the absence of a trainer to work with you it's almost certainly the next best thing. They will provide you with a comprehensive grounding in not only NVDA but the use of Windows from the keyboard, which is tied in closely to the way NVDA works. Start with the basic training then work your way through whatever else you need.
* Pay particular attention to learning about NVDA's browse and focus modes for navigating the web, it's one of the biggest differences between something like NVDA and a tablet-based screenreader. Browse mode is also brilliant in some office packages for proofreading.
* Find something that works and stick with it. Whether that's Microsoft Office, Google Docs, Jarte etc. Hopping between software that does a similar job is irritating for everyone but can be more so for a screen reader user.
* Look into useful NVDA addons if you need to. windows magnifier has one, as does Outlook, which provides extra convenient keyboard shortcuts if you are using that app.
Just afew top-of-the-head thoughts.