Altered perception
Central nervous system diseases
Developmental disabilities
Flaccid facial paralysis
Hemifacial spasm
Motor neuron disease
Neoplasms
Neurocognitive disorders
Oropharyngeal defect
Peripheral nervous system diseases
Psychotic disorders
Respiratory muscle weakness
Sialorrhea
Speech disorders
Tongue diseases
Tracheostomy
Treatment regimen
Velopharyngeal insufficiency
Vocal cord dysfunction
Communication: Expressive Ability
Goal
The person will demonstrate improved ability to express self as evidenced by the following indicators:
- Relate decreased frustration with communication.
- Use alternative methods as indicated.
Active Listening, Communication Enhancement: Speech Deficit
Level 1 Fundamental Focused Interventions
Identify a Method for Communicating Basic Needs
See Impaired Communication for general interventions.
Level 2 Extended Focused Interventions (all settings)
Identify Factors That Promote Communication for Those with Dysarthria (Slurred or Slow Speech)
R:Dysarthria is caused by paralysis, weakness, or inability to coordinate the muscles of the mouth (Norris, 2019).
- Do not alter your speech or messages because comprehension is not affected; speak on an adult level.
- Encourage the individual to make a conscious effort to slow down speech and to speak louder (e.g., "Take a deep breath between sentences").
- Ask the individual to repeat unclear words; observe for nonverbal cues to help understanding.
- If the person is tired, ask questions that require only short answers.
- If speech is unintelligible, teach use of gestures, written messages, and communication cards.
Level 3 Advanced Focused Interventions (advanced specialty)
Identify Factors That Promote Communication for Those Who Cannot Speak (e.g., Endotracheal Intubation, Tracheostomy)
R:Research reported that individuals treated with mechanical ventilation experience a moderate to extreme level of psychoemotional distress because they cannot speak and communicate their needs (*Khalaila, Zbidat, & Anwar, 2011).
- Reassure that speech will return, if it will. If not, explain available alternatives (e.g., esophageal speech, sign language).
- Do not alter your speech, tone, or type of message; speak on an adult level.
- Use gestures, head nods, mouthing of words, writing, use of letter/picture boards, and common words or phrases tailored to meet the individual's needs.
R:Every attempt must be made for successful communication. Results of one study reported that individuals used about 3 communications while unable to speak, including squeezing hands (92%), shaking or nodding the head (86%), lip reading (83%), facial expressions (83%), pen and paper (57%), word or picture charts (17%), alphabet boards (6%), and electronic voice output (5%) (*Grossbach Stranberg, & Chlan, 2011).
- Utilize stress-reducing and comfort interventions with every encounter.
R:Research has supported that interventions to prevent emotional distress among individuals with mechanical ventilation should target those with communication difficulties (*Khalaila, Zbidat, & Anwar, 2011).
- Touch
- "It must be frightening to be in your situation. Is there anything I can do to make you feel better, safer?"
- Ensure the call bell system is always visible and available.
Promote Continuity of Care to Reduce Frustration
Observe for Signs of Frustration or Withdrawal
- Verbally address frustration over inability to communicate. Explain that both nurse and individual must use patience.
- Maintain a calm, positive attitude (e.g., "I can understand you if we work at it.").
- Use reassurance (e.g., "I know it's difficult, but you'll get it.").
- Maintain a sense of humor.
- Allow tears (e.g., "It's OK. I know it's frustrating. Crying can let it all out.").
- For those with limited speaking ability (e.g., can make simple requests, but not lengthy statements), encourage letter writing or keeping a diary to express feelings and share concerns.
- Anticipate needs and ask questions that need a simple yes or no answer.
R:After survival, perhaps the most basic human need is to communicate with others. Communication provides security by reinforcing that they are not alone and that others will listen. Researchers have reported that "difficulty in communication" was a positive predictor of patients' psychological distress, and length of anesthesia was a negative predictor. Fear and anger were also positively related to difficulty in communication (*Khalaila, Zbidat, & Anwar, 2011).
Maintain a Specific Care Plan
- Document the method of communication that is used (e.g., "uses word cards," "points for bedpan," alphabet board, picture board writing materials).
- Record directions for specific measures (e.g., allow him to keep a urinal in bed).
Level 2 Focused Interventions (pediatrics) (Hockenberry, Rodgers, & Wilson, 2018)
- Establish a method of communication appropriate for age.
- If a young child is deprived of vocalization, teach basic language gestures (time, food, family relationships, emotions, animals, numbers, frequent requests).
R:The ability to communicate with people in the environment increases the child's independence, self-esteem, and self-actualization and decreases fear.
- Ensure that the family and child are connected to services for hearing impaired.
R:Svirsky et al. reported that children identified with a hearing loss who begin services early may be able to develop language (spoken and/or signed) on a par with their hearing peers (*2000).