MOD: Physical Impairments
Communication Overview
Communication deficits affect patients when they cannot communicate in their usual and familiar ways.
Such deficits may be temporary, as seen during:
Postoperative intubation.
Acute changes involving a new diagnosis.
Some communication deficits can lead to permanent changes in abilities, resulting in conditions such as aphasia, hearing loss, and blindness.
General Ways to Maximize Communication
Nurses should implement the following strategies to enhance communication with patients:
Learn and understand the patient’s preferred communication techniques.
Allow adequate time for responses and arrange for interpreters if necessary.
Position oneself at face level with the patient to facilitate communication.
Speak distinctly and slowly, maintaining a moderate tone, to ensure clarity.
Provide alternative tools for communication such as paper and pencil or word boards.
Speech and Language Deficits
Language serves as our basic method of communication with the world, encompassing:
Receiving information from others.
Conveying personal needs and feelings to others.
Speech and language deficits can arise from:
Developmental delays.
Illness or injury.
These deficits impact an individual’s ability to receive and express information effectively.
Aphasia Definition and Types (1 of 2)
Aphasia: Defined as "absence or impairment of the ability to communicate through speech, writing, or signs because of brain dysfunction."
Types of aphasia include:
Expressive (motor) Aphasia: Difficulty in expressing or forming words.
Receptive (sensory) Aphasia: Difficulty in understanding language.
Global Aphasia: Characterized by both expressive and receptive language deficits.
Aphasia Assessment and Nursing Role (2 of 2)
Nurses must evaluate:
The specific type of aphasia affecting the patient.
The methods that the patient employs to communicate.
Nurses collaborate with the healthcare team to develop an individualized communication plan for each patient.
Importance of sensitivity and respect in communication efforts to align with the patient’s capacity to understand.
Interventions for Communicating with Patients who are Aphasic
Suggested interventions include:
Allow patients ample time to formulate thoughts and respond to information.
Concentrate on the patient’s strengths in communication.
Utilize nonverbal communication techniques such as touch, facial expressions, and sounds as appropriate.
Provide alternative communication methods (e.g., picture boards, paper, pencil, or word boards) when verbal methods fail.
Avoid lengthy discussions; maintain conversations brief and focused.
Hearing Loss Overview (1 of 2)
Hearing loss may arise due to:
Aging.
Trauma.
Disease processes.
Hearing loss can be present at birth or develop due to environmental factors.
Patients may miss environmental cues and subtle changes in voice, resulting in safety concerns and impacts on relationships.
Hearing Loss Assessment (2 of 2)
Important factors in assessing hearing loss include:
Onset and type of hearing loss.
Utilization of hearing aids and their effectiveness.
Relevant medical conditions or circumstances impacting hearing.
Environmental factors, including background noise and conversational pace.
Typically, high-pitch sounds are less perceptible to individuals with hearing loss.
Interventions for Communicating with Patients with Hearing Loss
Employ effective communication strategies:
Utilize the communication method that suits the patient best (e.g., interpreters as necessary).
Speak in a moderate tone and at a reasonable volume; do not yell at the patient.
Face the patient while speaking to enhance understanding.
Vision Loss Overview
Nurses must assess:
Type of vision loss, such as light perception, shadows, or complete blindness.
Aids the patient uses for vision, including Braille, canes, or glasses.
Medical conditions associated with vision loss.
Circumstances that have led to vision impairment.
Vision loss may hinder patients' abilities to read written materials and perceive nonverbal cues.
Interventions for Communicating with Patients with Vision Loss
Recommended strategies include:
Announce your arrival and state your name when approaching the patient.
Speak normally; avoid loud voices or exaggerated enunciation.
Orient the patient to their surroundings, mentioning furniture and other obstructions ahead of time.
Explain procedures beforehand, allowing the patient to anticipate what is about to occur.
Continually describe the activities happening nearby.
Inform the patient when you are leaving the room to avoid confusion.
Sensory Deprivation in Intensive Care Settings
Environments such as intensive care units, emergency rooms, and recovery rooms can lead to sensory deprivation and impairment in communication, characterized by:
Sudden communication ability changes (e.g., due to intubation).
Unfamiliar sounds and alarms that contribute to disorientation.
Nurses must create an individualized communication plan that includes both the patient and their family in the perioperative context to mitigate disorientation.
Nurses can help by providing vision correction aids (e.g., glasses, hearing aids) until recovery from anesthesia.
Interventions for Communicating with Patients in the ICU
Key practices for communication in the ICU setting include:
Introduce yourself by stating your name and role before initiating any interventions.
Assume the patient hears everything; adjust communication based on observed responses.
Regularly orient the patient to their environment, clarifying sights, sounds, and personnel involved.
Engage in one-sided conversations if the patient is unable to respond, utilizing eye contact and appropriate touch.
Nurse-Patient Communication in ICU (Happ et al., 2011)
Positive Communication Behaviors
Behaviors identified as effective include:
Asking tagged yes-no questions to facilitate responses.
Providing response choices to enhance communication.
Physically assisting patients when needed.
Suggesting modes of communication tailored to the patient’s capabilities.
Repeating patient responses to ensure understanding.
Augmenting comprehension through clarifications.
Greeting the patient by name with appropriate physical contact.
Asking open-ended questions when the patient matches the capability to respond.
Maintaining eye contact to enhance connection and understanding.
Negative Communication Behaviors
Behaviors that hinder effective communication documented include:
Inappropriately removing alternatives for communication.
Failing to gain patient attention before interaction.
Not providing necessary assistance when requested.
Asking questions that the patient cannot answer, leading to frustration.
Ignoring attempts by the patient to communicate.
Not allowing sufficient wait time for responses from the patient.
Interrupting the patient during their message delivery.
Failing to gain attention before starting a conversation.
Engaging in self-talk or mumbling, which diverts focus from the patient.
Speaking too quickly for patients to comprehend.
Not maintaining visual contact during interactions.
Summary
Physical impairments significantly impact patients' abilities to communicate effectively with nursing staff.
Patients often adapt and continue to find means to communicate irrespective of the nature, cause, or duration of their impairments.
Nurses play a critical role in identifying, implementing, and supporting patients' preferred communication methods, thus promoting better healthcare interactions and outcomes.