IMPAIRED VERBAL COMMUNICATION
Decreased, delayed, or absent ability to receive, process, transmit,
and use a system of symbols
• Disorientation to person, space,
• Impaired articulation
• Difﬁculty comprehending and
• Inability or lack of desire to
maintaining usual communica-
• Inability to speak dominant
• Difﬁculty expressing thoughts
verbally (aphasia, dysphasia,
• Inappropriate verbalizations
• Lack of eye contact or poor
• Difﬁculty forming words or
sentences (aphonia, dyslalia,
• Stuttering or slurring
• Visual deﬁcit (partial or
• Difﬁculty using or inability to
use facial expressions or body
• Absence of signiﬁcant others
• Differences related to develop-
• Altered perceptions
• Alteration in self-concept, self-
• Environmental barriers
esteem, or central nervous
• Lack of information
• Physical barriers (e.g.,
• Anatomical defect (e.g., cleft
palate, alteration of the neuro-
muscular visual system,
• Physiological conditions
• Psychological barriers (e.g.,
psychosis, lack of stimuli)
• Brain tumor
• Side effects of medications
• Cultural differences
• Decrease in circulation to
• Weakening of the
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Cardiac function
• Respiratory function
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.
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
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
SUGGESTED NIC INTERVENTIONS
Active Listening; Communication Enhancement: Hearing Deﬁcit; Com-
munication Enhancement: Speech Deﬁcit; Learning Facilitation; Touch
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.