Nurse's Pocket Guide

impaired verbal COMMUNICATION
Desired Outcomes/Evaluation
Criteria—Client Will:
• Verbalize or indicate an understanding of the communication
difficulty and plans for ways of handling.
• Establish method of communication in which needs can be
expressed.
• Participate in therapeutic communication (e.g., using silence,
acceptance, restating, reflecting, active-listening, and
I-messages).
• Demonstrate congruent verbal and nonverbal communication.
• Use resources appropriately.
Actions/Interventions
NURSING PRIORITY NO.1.To assess causative/contributing factors:
• Review history for neurological conditions that could affect
speech, such as stroke, tumor, multiple sclerosis (MS), hearing
or vision impairment.
• Note results of neurological tests (e.g., electroencephalogram
[EEG]; computed tomography [CT]/magnetic resonance imaging
[MRI] scans; and language/speech tests [e.g., Boston Diagnostic
Aphasia Examination, the Action Naming Test, etc.]).
• Note whether aphasia is motor (expressive: loss of images for
articulated speech), sensory (receptive: unable to understand
words and does not recognize the defect), conduction (slow
comprehension: uses words inappropriately but knows the
error), and/or global (total loss of ability to comprehend and
speak). Evaluate the degree of impairment.
• Evaluate mental status, note presence of psychiatric conditions
(e.g., manic-depressive, schizoid/affective behavior).
Assess psychological response to communication impairment,
willingness to find alternate means of communication.
• Note presence of ET tube/tracheostomy or other physical
blocks to speech (e.g., cleft palate, jaws wired).
• Assess environmental factors that may affect ability to communicate
(e.g., room noise level).
• Determine primary language spoken and cultural factors.
• Assess style of speech (as outlined in Defining Characteristics).
• Note level of anxiety present; presence of angry, hostile behavior;
frustration.
• Interview parent to determine child’s developmental level of
speech and language comprehension.
• Note parent’s speech patterns and manner of communicating
with child, including gestures.
Information in brackets added by the authors to clarify and enhance
the use of nursing diagnoses.
168 Cultural Collaborative Community/Home Care