Overcoming Communication Barriers

What skill does a nurse need to overcome communication barriers?

The nurse must identify barriers and develop effective communication strategies.

What can happen when poor communication continues?

Medical errors and poor client outcomes may occur.

Who can experience poor communication with the nurse?

Clients and other members of the health care team.

What are common communication barriers?

Language differences, cultural differences, speech or hearing impairments, developmental or cognitive disorders, and environmental factors.

How common is speaking a language other than English at home in the United States?

From 2017 to 2021, about 1 in 5 people age 5 and older spoke another language at home.

Why is language diversity increasing in the United States?

More people are moving to the United States from other countries.

Which languages are common but underrepresented among nurses who speak them?

Spanish and Indo-European languages, such as German, French, and Italian.

How can a language barrier affect health care?

It can cause misunderstandings about important health care decisions.

What should a nurse use when a client speaks a different language?

A qualified medical interpreter.

Where may a qualified medical interpreter be available?

In person or by telephone.

When must a health care facility provide qualified interpreter services?

When the facility receives federal funding, such as Medicare or Medicaid reimbursement.

Since when have interpreter services been required at federally funded health care facilities?

Since 2000.

What does CLAS stand for?

Culturally and Linguistically Appropriate Services.

Who developed and revised the National CLAS Standards?

The Department of Health and Human Services Office of Minority Health.

What do the CLAS Standards guide health care facilities to provide?

Culturally and linguistically appropriate services.

According to CLAS Standards, how should a nurse communicate with a client who speaks another language?

Use a qualified medical interpreter and provide understandable language assistance.

Should family members be used as medical interpreters?

No, especially family members younger than 18 years.

Why should a child not be used as a medical interpreter?

The child may misunderstand medical information or translate it incorrectly.

Why can using a family member as an interpreter affect privacy?

The client may not want the family member to know the health information.

How might a family interpreter change the message?

The family member may change or leave out information to avoid upsetting the client.

Why should smartphone translation apps usually not be used for medical interpretation?

They may be inaccurate and may not protect private health information under HIPAA.

What must nurses develop to overcome cultural communication barriers?

Cultural competence means being able to understand and respect people from different cultures.

How can nurses build cultural competence?

Learn which behaviors are acceptable and unacceptable in the cultures they commonly serve.

Why should nurses learn about a client's culture?

It helps them understand the client's actions and avoid misunderstandings.

How should a nurse respond to cultural beliefs and customs that are different?

Show respect and compassion.

Which communication skills show respect and caring across cultures?

Active listening and other therapeutic communication skills.

How can cognitive or developmental impairments affect communication?

They can make it difficult to exchange and understand information.

What conditions can cause cognitive or developmental communication problems?

Dementia, stroke, or autism.

What can cause temporary problems with a person’s thinking (cognitive abilities)?

Medication Side effects (adverse effects) from medicines or using drugs for pleasure (recreational drug use).

What words should a nurse use with a client who has a cognitive or developmental impairment?

Use simple, uncomplicated words.

What language should a nurse avoid with a client who has trouble understanding?

Avoid medical terms.

How should the nurse speak to a client who has trouble understanding?

Speak clearly and at a slower pace.

What environment can improve communication?

A well-lit, supportive area with little noise or distraction.

Why should the nurse observe the client's body language?

It may show information the client cannot or does not want to say.

How can a nurse make sure a client can see and hear the speaker?

Face the client and make sure needed assistive devices are being used.

What assistive devices may improve communication?

Hearing aids and eyeglasses.

What may the nurse do if medication or recreational drugs are causing the impairment?

Wait for the effects to fade when it is safe and appropriate.

How should health care providers speak to clients with disabilities?

Speak normally and respectfully using a normal tone of voice.

Should a nurse shout when speaking to a client with a disability?

No. Use a normal tone unless the client asks otherwise.

Where should a nurse position themselves when speaking with a client with a disability?

Sit or stand at the client's eye level and make appropriate eye contact.

What should a nurse ask before helping a client with a disability?

Ask whether the client needs assistance.

What should a nurse do when approaching a client with vision loss?

Identify and introduce themselves.

What should a nurse say before leaving a client with vision loss?

Tell the client that they are leaving the room.

How should a nurse guide a client with vision loss?

Allow the client to take the nurse's arm.

How can a nurse help a client with vision loss sit down?

Place the client's hand on the back or arm of the seat.

How should directions be given to a client with vision loss?

Give specific directions or use clock cues if the client prefers them.

What is an example of a specific direction for a client with vision loss?

“Left about 10 feet.”

What is an example of a clock cue for a client with vision loss?

“The door is at 10 o'clock.”

In what formats can health information be given to a client with vision loss?

Large print, Braille, audio, printed material, or an electronic screen-reading program.

What should a nurse first ask a client with hearing loss?

Ask how the client prefers to communicate.

What environmental change helps a client with hearing loss?

Reduce background noise and distractions.

What should the nurse check about a client's hearing device?

Make sure it works and the client is using it.

How can a nurse get the attention of a client with hearing loss?

Visually wave or lightly touch the client before speaking.

Should a nurse exaggerate words when speaking to a client with hearing loss?

No. Speak normally and clearly.

Should a nurse raise their voice when speaking to a client with hearing loss?

Only if the client asks the nurse to do so.

How should a nurse speak to a client who lip reads?

Face the client and keep hands and objects away from the mouth.

What should the nurse avoid while communicating with a client who has hearing loss?

Do not turn away or walk around while speaking.

How much spoken information is usually understood through lip reading?

Only about 30%.

What should the nurse be ready to do when a client lip reads?

Repeat information or questions when needed.

What service may a client with hearing loss need?

A sign language interpreter.

When an interpreter is present, whom should the nurse speak to?

Speak directly to the client, not the interpreter.

Should the nurse speak to the client even if the client looks at the interpreter?

Yes. The nurse should still speak directly to the client.

Why should the nurse pause while using a sign language interpreter?

To give the interpreter time to translate accurately and completely.

What additional communication aids can help a client with hearing loss?

Real-time captioning and written materials.

Why is it important for a nurse to identify a communication problem?

The nurse can’t create a good communication plan if the problem isn’t identified.

What basic strategies help with most communication barriers?

Show respect and empathy, do not interrupt, use supportive body language, and give simple, honest messages.

How can the nurse check that information was understood?

Use communication enhancers such as reflecting and summarizing.

What is reflecting in communication?

Repeating or directing the client's thoughts and feelings back to the client.

What is summarizing in communication?

Reviewing the main points of the conversation.