Nursing diagnosis – READINESS FOR ENHANCED COMMUNICATION

READINESS  FOR  ENHANCED

COMMUNICATION

DEFINITION

A pattern of exchanging information and ideas with others that is suf-

ficient for meeting one’s needs and life’s goals, and can be strengthened

DEFINING CHARACTERISTICS

• Expresses willingness to enhance communication ability

• Can speak or write language clearly

• Forms words, phrases, and language with articulation

• Uses and interprets nonverbal cues appropriately

• Expresses satisfaction with ability to share information and ideas

with others

• Expresses needs in an assertive way

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Communication

• Roles and relationships

• Coping

• Values and beliefs

EXPECTED OUTCOMES

The patient will

• Maintain pulse within predetermined limit.

• Maintain blood pressure within predetermined limits.

• Have no arrhythmias.

• Exhibit skin that is warm and dry.

• Have no pedal edema.

• Maintain acceptable cardiac output.

• Verbalize understanding of reportable signs and symptoms.

• Understand diet, medication regiment, and prescribed activity level.

SUGGESTED NOC OUTCOMES

Cardiac Pump Effectiveness; Circulation Status; Tissue Perfusion:

Peripheral; Vital Signs

INTERVENTIONS AND RATIONALES

Determine: Monitor patient at least every 4 hr for irregularities in

heart rate, rhythm, dyspnea, fatigue, crackles in lungs, jugular venous

distension, or chest pain. Any or all of these may indicate impending

cardiac failure or other complications. Report changes immediately.

Perform: Provide an environment that diminishes space between the

patient and the nurse to eliminate barriers to communication such

as noise and lack of privacy.

Incorporate questions that are open-ended and start with such

words as “what,” “how,” and “could,” rather than “why.” Open-

minded, nonthreatening questioning encourages patient to discuss

issues of concern and improve communication skills.

Schedule frequent interdisciplinary treatment team meetings

regarding communication skill development with patient. Team

meetings with the patient can ensure continuity of care.

Inform: Educate patient and family members about the aging

process. Educating the patient and family will help them anticipate

processes that will naturally occur again.

Teach theory of assertive behavior and role-play assertive commu-

nication approaches. Assertive training can decrease passive or

aggressive communication patterns.

Include role-playing as a teaching strategy to model methods of

enhanced verbal and nonverbal communication skills. Role-playing in

a nonthreatening safe environment can enhance communication skills.

Attend: Encourage patient verbally and nonverbally to explore

strategies to enhance self-advocacy communication skills with health

care providers. Self-advocacy communication can guide a patient

toward autonomy, confidence, and independence.

Provide support through active listening, appropriate periods of

silence, reflection on feelings, and paraphrasing and summarizing

comments. Active listening techniques encourage patient

participation in communication.

Provide patient with clear explanations for everything that will

happen to him. Ask for feedback to ensure that the patient under-

stands. Anxiety may impair patient’s cognitive abilities.

Manage: Identify appropriate social agencies and support groups for

the patient and provide referrals to ensure ongoing opportunities for

the patient to increase social interaction.

SUGGESTED NIC INTERVENTIONS

Active Listening; Anticipatory Guidance; Assertiveness Training;

Behavior Modification; Social Skills; Relationship-Building Enhance-

ment; Simple Guided Imagery; Support Group

Reference

Whyte, R. E., et al. (2006, September). Nurses’ opportunistic interventions

with patients in relation to smoking. Journal of Advanced Nursing, 55(5),
568–577.

Nursing diagnosis – IMPAIRED VERBAL COMMUNICATION

IMPAIRED  VERBAL  COMMUNICATION

DEFINITION

Decreased, delayed, or absent ability to receive, process, transmit,

and use a system of symbols

DEFINING CHARACTERISTICS

• Disorientation to person, space,

• Dyspnea

time

• Impaired articulation

• Difficulty comprehending and

• Inability or lack of desire to

maintaining usual communica-
tion pattern

speak
• Inability to speak dominant

• Difficulty expressing thoughts

language

verbally (aphasia, dysphasia,
apraxia, dyslexia)

• Inappropriate verbalizations
• Lack of eye contact or poor

• Difficulty forming words or

selective attention

sentences (aphonia, dyslalia,
dysarthria)

• Stuttering or slurring
• Visual deficit (partial or

• Difficulty using or inability to

total)

use facial expressions or body
language

RELATED FACTORS

• Absence of significant others

• Differences related to develop-

• Altered perceptions

mental age

• Alteration in self-concept, self-

• Environmental barriers

esteem, or central nervous
system

• Lack of information
• Physical barriers (e.g.,

• Anatomical defect (e.g., cleft

tracheostomy, intubation)

palate, alteration of the neuro-
muscular visual system,
phonation apparatus)

• Physiological conditions
• Psychological barriers (e.g.,
psychosis, lack of stimuli)

• Brain tumor

• Side effects of medications

• Cultural differences

• Stress

• Decrease in circulation to

• Weakening of the

brain

musculoskeletal system

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Cardiac function

• Neurocognition

• Communication

• Respiratory function

EXPECTED OUTCOMES

The patient/family will

• Have needs met by staff members.

• Express satisfaction with level of communication ability.

• Maintain orientation.

• Maintain effective level of communication.

• Answer direct questions correctly.

59

SUGGESTED NOC OUTCOMES

Cognition; Communication; Communication: Expressive; Communi-

cation: Receptive; Information Processing

INTERVENTIONS AND RATIONALES

Determine: Observe patient closely for cues to his or her needs and

desires, such as gestures, pointing to objects, looking at items, and

pantomime to enhance understanding. Avoid continually responding

to gestures if the potential exists to improve speech to encourage

desire to improve.

Monitor and record changes in patient’s speech pattern or level of

orientation. Changes may indicate improvement or deterioration of

condition.

Perform: Speak slowly and distinctly in a normal tone when address-

ing patient, and stand where patient can see and hear you. These

actions promote comprehension.

Reorient the patient to reality: Call patient by name; tell him or

her your name; give him or her the background information (place,

date, and time); use television or radio to augment orientation; use

large calendars and communication boards (including alphabet and

some common words and pictures). These measures develop orienta-

tion skills through repetition and recognition of familiar objects.

Use short, simple phrases and yes-or-no questions when patient is

very frustrated to reduce frustration.

Inform: Instruct family members to use techniques listed above to

ease their frustration in communication with the patient.

Attend: Encourage attempts at communication and provide positive

reinforcement to aid comprehension.

Allow ample time for a response. Don’t answer questions yourself

if patient has ability to respond. This improves patient’s self-concept

and reduces frustration.

Repeat or rephrase questions, if necessary, to improve communication.

Don’t pretend to understand if you don’t, to avoid misunderstanding.

Remove distractions from the environment during attempts at

communication. Reduced distractions improve comprehension.

Manage: Review diagnostic test results to determine improvement or

deterioration of the disease process. Adjust the care plan

accordingly.

SUGGESTED NIC INTERVENTIONS

Active Listening; Communication Enhancement: Hearing Deficit; Com-

munication Enhancement: Speech Deficit; Learning Facilitation; Touch

Reference

Philpin, S. M., et al. (2005, May). Giving people a voice: Reflections on con-

ducting interviews with participants experiencing communication
impairment. Journal of Advanced Nursing, 50(3), 299–306.