NURSING DIAGNOSIS: Impaired verbal communication

related to:
  1. impaired function of the muscles that are used to produce speech;
  2. ischemia in the dominant cerebral hemisphere (ischemia of Wernicke's area in the temporoparietal cortex will result in receptive [fluent, sensory] aphasia; ischemia of Broca's area in the frontal cortex will result in expressive [nonfluent, motor] aphasia).
Desired Outcome
The client will communicate needs and desires effectively.
Nursing Actions and Selected Purposes/Rationales
  1. Assess client for impaired verbal communication (e.g. inability to speak, difficulty forming words or sentences, difficulty expressing thoughts verbally, inappropriate verbalization). Validate verbal responses with an assessment of nonverbal behavior in order to determine if client is experiencing receptive aphasia.
  2. Implement measures to facilitate communication:
    1. answer call signal in person rather than using the intercommunication system
    2. maintain a patient, calm approach; listen attentively and allow ample time for communication
    3. maintain a calm, quiet environment so that client can concentrate on communication efforts, does not have to speak loudly, and is able to hear others clearly
    4. ask questions that require short answers, eyeblinks, or nod of head if client is having difficulty speaking and/or is frustrated or fatigued
    5. schedule rest periods before visiting hours and speech therapy sessions to maximize communication ability during those times
    6. when speaking to client, face him/her; speak slowly; use direct, short statements; repeat key words; present only one idea or thought at a time; and avoid using unrelated gestures
    7. provide materials such as magic slate, pad and pencil, computer, word cards, and/or picture board if appropriate; try to ensure that placement of intravenous line does not interfere with client's use of these communication aids
    8. consult speech pathologist or therapist regarding methods for dealing with speech impairments; reinforce exercises and techniques recommended.
  3. Inform significant others and health care personnel of techniques being used to facilitate client's ability to communicate. Stress the importance of consistent use of these techniques.
  4. Encourage significant others and staff to talk to client even if he/she is unresponsive or unable to communicate.
  5. Consult appropriate health care provider (e.g. speech pathologist, physician) if client experiences increasing impairment of verbal communication.