IMPAIRED VERBAL COMMUNICATION Nursing Care Plan

Impaired Verbal Communication

Definition
The state in which a person experiences, or is at risk to experience,
difficulty exchanging thoughts, ideas, wants, or needs with
others
Defining Characteristics
Major (Must Be Present)
Inappropriate or absent speech or response
Impaired ability to speak or hear
Minor (May Be Present)
Incongruence between verbal and nonverbal messages
Stuttering
Slurring
Word-finding problems
Weak or absent voice
Statements of being misunderstood or not understanding
Dysarthria
Aphasia
Language barrier
Related Factors
Pathophysiologic
Related to disordered, unrealistic thinking secondary to:
Schizophrenic disorder
Psychotic disorder
Delusional disorder
Paranoid disorder
Related to impaired motor function of muscles of speech secondary to:
Cerebrovascular accident (“Brain attack”)
Oral or facial trauma
Brain damage (e.g., birth/head trauma)
Central nervous system (CNS) depression/increased intracranial
pressure
Tumor (of the head, neck, or spinal cord)
Chronic hypoxia/decreased cerebral blood flow
Nervous system diseases (e.g., myasthenia gravis, multiple sclerosis,
muscular dystrophy, Alzheimer’s disease)
Vocal cord paralysis/quadriplegia

Related to impaired ability to produce speech secondary to:
Respiratory impairment (e.g., shortness of breath)
Laryngeal edema/infection
Oral deformities
Cleft lip or palate Malocclusion or fractured jaw
Missing teeth Dysarthria
Related to auditory impairment
Treatment Related
Related to impaired ability to produce speech secondary to:
Endotracheal intubation
Surgery of the head, face, neck,
or mouth
CNS depressants
Tracheostomy/tracheotomy/
laryngectomy
Pain (especially of the mouth
or throat)
Situational (Personal, Environmental)
Related to decreased attention secondary to fatigue, anger, anxiety, or pain
Related to no access to or malfunction of hearing aid
Related to psychologic barrier (e.g., fear, shyness)
Related to lack of privacy
Related to unavailable interpreter
Maturational
Infant/Child
Related to inadequate sensory stimulation
Older Adult (Auditory Losses)
Related to hearing impairment
Related to cognitive impairments secondary to (specify)

Author's notes
Impaired Communication is clinically useful with individuals with communication-
receptive deficits and language barriers.
Impaired Communication may not be useful to describe communication
problems that are a manifestation of psychiatric illness or coping
problems. If nursing interventions focus on reducing hallucinations, fear,
or anxiety, Confusion, Fear, or Anxiety would be more appropriate.

Goal
The person will report improved satisfaction with ability to communicate
as evidenced by the following indicators:
• Demonstrates increased ability to understand.
• Demonstrates improved ability to express self.
• Uses alternative methods of communication, as indicated.
Interventions
Identify a Method to Communicate Basic Needs
• Assess ability to comprehend, speak, read, and write
• Provide alternative methods of communication
• Use a computer, pad and pencil, hand signals, eye blinks,
head nods, and bell signals.
• Make flash cards with pictures or words depicting frequently
used phrases (e.g., “Wet my lips,” “Move my foot,” “I need a
glass of water,” or “I need a bedpan”).
• Encourage the person to point, use gestures, and pantomime.
• Using alternative forms of communication can help decrease
anxiety, isolation, and alienation; promote a sense of control;
and enhance safety (Iezzoni et al., 2004).
Identify Factors that Promote Communication
• Create atmosphere of acceptance and privacy
• Provide a non-rushed environment
• Use techniques to increase understanding
• Face the client and establish eye contact if possible.
• Use uncomplicated one-step commands and directives.
• Have only one person talk (following a conversation among
multiple parties can be difficult).
• Encourage the use of gestures and pantomime.
• Match words with actions; use pictures.
• Terminate the conversation on a note of success (e.g., move
back to an easier item).

• Validate that the client understands the message.
• Give information in writing to reinforce.
Initiate Health Teaching and Referrals, If Needed
• Seek consultation with a speech or audiology specialist.
Pediatric Interventions
• Use age-appropriate words and gestures (see Delayed Growth
and Development, Table II.2).
• Initially talk to parent and allow the child to observe. Gradually
include the child.
• Approach the child slowly and speak in a quiet, unhurried,
confident voice.
• Assume an eye-level position.
• Use simple words and short sentences.
• Talk about something not related to the present situation
(e.g., school, toy, hair, clothes).
• Offer choices as much as possible.
• Encourage the child to share concerns and fears.
• Allow the child an opportunity to touch and use articles (e.g.,
stethoscope, tongue blade).
Geriatric Interventions
• If the person can hear with a hearing aid, make sure that it is
on and functioning.
• If the person can hear with one ear, speak slowly and clearly
into the good ear. (It is more important to speak distinctly than
to speak loudly.)
• If the person can read and write, provide pad and pencil at all
times (even when going to another department).
• If the person can understand only sign language, have an interpreter
with him or her as much as possible.
• Write and speak all important messages.
• Validate the person’s understanding by asking questions that
require more than “yes” or “no” answers. Avoid asking, “Do
you understand?”
• Assess if cerumen impaction is impairing hearing.

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