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.

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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.

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