Impaired verbal communication describes an inability to receive, relay, or process language. The reasons for this can range broadly from a language barrier to a physical barrier impeding speech. Conditions such as autism can cause developmental speech delays, while a stroke can lead to a wide array of speech deficits.
Some impairments can be overcome with therapy and therapeutic devices, while others may be permanent. The nurse supports the patient with impaired verbal communication by meeting them where they are. The nurse remains patient, always attempting to communicate effectively, and using any devices or techniques available to them.
In this article:
- Causes (Related to)
- Signs and Symptoms (As evidenced by)
- Expected Outcomes
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- References
Causes (Related to)
The following are common causes of impaired verbal communication:
- Brain tumor or damage
- Cleft palate
- Auditory deficit
- Physical barrier from tracheostomy or intubation
- Language barrier
- Developmental delay
- Psychological barrier
- Dementia
Signs and Symptoms (As evidenced by)
The following are common signs and symptoms of impaired verbal communication:
- Stuttering or slurring words
- Refusal to speak/mute
- Difficulty forming words (dysarthria)
- Difficulty expressing thoughts (aphasia)
- Difficulty comprehending or maintaining communication
- Inability to use facial or body expressions
- Disorientation
- Inappropriate verbalization (nonsensical speech, flight of ideas)
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for impaired verbal communication:
- Patient will establish a method to communicate clearly to meet their needs.
- Patient will participate in speech therapy or other therapy to assist with effective communication.
- Patient will utilize devices and equipment to augment verbal communication.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to impaired verbal communication.
1. Assess for conditions that affect speech.
Neurological conditions such as stroke, tumors, cerebral palsy, autism, or other hearing impairments can affect the patient’s ability to communicate verbally.
2. Evaluate mental status.
Psychological conditions such as schizophrenia, manic depressive, or bipolar disorders may disrupt speech as the patient may refuse to communicate or display rapid speech. It is also important to evaluate the patient’s other cognitive functions and overall mood.
3. Assess for a language barrier.
If a patient does not communicate effectively or seems to refuse to communicate, ensure they are being spoken to in their native language.
4. Assess for aphasia.
Patients with brain injuries such as a stroke may have aphasia, which is an impairment to either understand or express language. Those with Wernicke’s aphasia comprehend speech but the words they speak may not make sense or have meaning. Global aphasia causes the patient to not be able to express themselves or understand little to no spoken language. Another common form of aphasia is Broca’s aphasia, which results in difficulty forming grammatically correct sentences.
5. Note physical obstructions.
The presence of a tracheostomy or endotracheal tube will impede the patient’s ability to speak.
6. Investigate if the patient communicates in other ways.
If a patient cannot or is hesitant to verbally communicate, assess if they use sign language or prefer to write or draw requests.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with impaired verbal communication.
1. Use aids and devices.
Assistive devices such as text-to-speech, Teletypewriters (TTY) or Telecommunications Device for the Deaf (TDD) assist those with speech impairments. Picture boards and other apps can help children communicate.
2. Sign language.
Nurses can implement important words and phrases into their profession to communicate with patients. Commonly used phrases in the hospital, such as “pain” “bathroom” or “water” can be useful to learn.
3. Use an interpreter.
An interpreter should always be used when communicating with a patient who does not speak the nurse’s language. In a medical setting, using family members, friends or other staff is discouraged and a professional interpreter should always be sought.
4. Pay attention to nonverbal cues and gestures.
Patients may have specific gestures or cues they use to communicate. It may take time for the nurse to learn what these are but should be respected and reciprocated. It is important that the nurse ensure any communication tools that may help the patient communicate are available.
5. Display proper speech etiquette.
Never speak loudly at a speech-impaired person unless they are hard of hearing. Maintain eye contact and allow the patient to see your mouth; do not turn away when speaking. Give the patient plenty of time to respond.
6. Incorporate speech-language therapy.
Speech-language therapists can assist by using language and articulation activities for children. They can teach exercises to strengthen the mouth and tongue muscles and breathing exercises to help with resonance issues.
7. Involve the family.
Family members often know how to best communicate with the patient and can teach the nurse what the patient is trying to say. Though the nurse should always speak directly to the patient, they can ask the family for assistance to clarify information. However, family involvement should also be at the discretion of the patient.
8. Try short questions with short answers.
Patients who have difficulty forming words or who are aphasic may require longer to process speech and respond. Try sticking to shorter questions and allow plenty of time to respond. Do not ask multiple questions together. Asking questions that only require a “yes” or “no” answer may be best when possible.
9. Continue speaking to the patient even if they can’t respond.
Patients with a tracheostomy or physical barrier or who have dysphagia or dementia should still be spoken to as a person.
10. Hang signage and document accordingly.
Once the best form(s) of communication have been discovered, document it in the chart and hang signage so other staff members are aware of how to best communicate with the patient.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for impaired verbal communication.
Care Plan #1
Diagnostic statement:
Impaired verbal communication related to disordered thinking secondary to schizophrenic disorder as evidenced by inappropriate speech.
Expected outcomes:
- Patient will be coherent and oriented to reality.
- Patient will demonstrate congruence of verbal and nonverbal behavior.
Assessment:
1. Assess ability to comprehend, speak, read, and write.
This information will give the nurse a proper baseline for communicating with the patient.
2. Assess factors that promote communication.
Schizophrenia is a chronic and recurrent condition. Knowing what communication method worked before or the factors contributing to effective communication would assist the nurse in establishing an open environment for expression.
3. Explore emotional responses toward disordered thoughts.
Exploring the patient’s feelings towards their beliefs, thoughts, and experiences will help the nurse create a more emphatic environment for healing. This would also help identify any possible harm the patient thinks of doing to inflict harm on themself or others.
Interventions:
1. Keep communication simple, speaking in short sentences, using appropriate words, and using all modes for accessing information.
This technique will help the patient to stay focused on one thought and facilitate comprehension.
2. Provide reality orientation by responding with simple, straightforward, honest statements.
Patients with schizophrenia with disorganized thoughts are typically disoriented from reality. Firm and constant reorientation can help the patient reorient themselves.
3. Administer medications as ordered.
Disordered thinking of the patient is often managed through pharmacological means. Patients with schizophrenia are usually prescribed with second-generation antipsychotic drugs such as olanzapine, risperidone, or quetiapine to manage symptoms of psychosis and revert to their functional ability.
4. Collaborate with a psychiatrist to perform psychosocial therapies.
Psychiatrists are trained to perform cognitive behavioral therapy (CBT) or other forms of psychosocial treatments that help in managing the negative symptoms of schizophrenia, improve disease insight, and prevent relapse.
Care Plan #2
Diagnostic statement:
Impaired verbal communication related to cognitive impairment secondary to stroke, as evidenced by aphasia.
Expected outcomes:
- Patient will use effective communication techniques.
- Patient will demonstrate understanding during conversations.
Assessment:
1. Assess the patient’s primary and secondary means of communication.
Patients with aphasia experience difficulty in understanding or expressing spoken or written language. Knowing their preferred method would help the nurse relay information effectively.
2. Assess the kind of aphasia that the patient has.
- Broca’s Aphasia (Motor): Patients can understand but struggle to articulate speech.
- Wernicke’s Aphasia (Receptive): Patients can articulate speech but struggle to understand speech.
- Global Aphasia: Total loss of ability to understand and speak.
Knowing the kind of aphasia will direct the nursing interventions appropriate to the patient.
3. Assess any negative emotions towards aphasia.
Patients with aphasia often experience frustration and anxiety for not being able to communicate or express effectively what they want. Any negative emotions towards communication might lead to social isolation.
Interventions:
1. Provide clear, simple directions.
The patient with dysphagia may require directions to be repeated frequently. Tasks need to be explained in straightforward steps at a time.
2. Allow adequate time for the patient’s response.
If the patient feels rushed, communication problems are worsened. The patient may need more time to process information and formulate a verbal response cognitively.
3. Provide opportunities for spontaneous conversation.
The patient needs frequent opportunities to talk without expecting any outcome. This method decreases the patient’s anxiety about communication abilities.
4. Teach techniques to improve speech.
- Ask to talk slowly and say each word clearly.
- Encourage them to speak in short phrases.
- If verbal communication is difficult, ask the patient to write a message or draw a picture.
Poor communication can cause frustration, anger, hostility, depression, fear, confusion, and isolation.
5. Collaborate with a speech therapist.
A comprehensive multidisciplinary plan of care may be required to improve the patient’s communication ability.
References
- Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
- American Heart Association. (2018, December 4). Types of Aphasia. American Stroke Association. Retrieved December 15, 2021, from https://www.stroke.org/en/about-stroke/effects-of-stroke/cognitive-and-communication-effects-of-stroke/types-of-aphasia
- Assistive Devices for People with Hearing, Voice, Speech, or Language Disorders. (2019, November 12). NIDCD. Retrieved December 15, 2021, from https://www.nidcd.nih.gov/health/assistive-devices-people-hearing-voice-speech-or-language-disorders
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- Cleveland Clinic. (2022). Aphasia. https://my.clevelandclinic.org/health/diseases/5502-aphasia
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- Hany, M., Rehman, B., Azhar, Y., et al. (2023). Schizophrenia. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK539864/
- Rowden, A. (2021, January 5). Speech therapy: For adults, kids, and how it works. Medical News Today. Retrieved December 15, 2021, from https://www.medicalnewstoday.com/articles/speech-therapy
