Impaired verbal communication

Domain 5. Perception-cognition
Class 5. Communication
Diagnostic Code: 00051
Nanda label: Impaired verbal communication
Diagnostic focus: Verbal communication

Effective communication plays a major role in healthcare delivery. Nurses have to constantly assess the patient's verbal communication ability so as to provide appropriate care for the patient. Nursing diagnosis is an important tool used by nurses to improve their management of patient health problems.

NANDA Nursing Diagnosis Definition

Impaired verbal communication nursing diagnosis is defined as difficulty expressing and understanding verbal information communicated through speaking, writing, symbols, and body language.

Defining Characteristics

Nurses use two categories to define impaired verbal communication. These are subjective and objective assessments of communication difficulties observed by the nurse while interacting with the patient.

Subjective Defining Characteristics

• Visible distress resulting from difficulty in communicating effectively
• Impaired ability to value and understand spoken language, writing, symbols, and body language
• Difficulties in expressing thoughts, feelings, and unmet basic needs

Objective Defining Characteristics

• Inability to have a cohesive conversation and express ideas clearly
• Difficulty making appropriate eye contact
• Lack of general knowledge relating to learned language

Related Factors

There can be many underlying causes that contribute to impaired verbal communication. Some of the related factors are:

• Cognitive impairment: Cognitive impairment due to aging, illness, or trauma may lead to an impaired verbal communication.
• Presence of altered sensory perception: Alterations in the sense of hearing, sight, touch, smell, and taste can lead to difficulty in verbal communication.
• Presence of changes in the level of consciousness: Changes in the level of consciousness due to drug overdose, psychological conditions, or postoperative complications can lead to decreased level of verbal communication.
• Use of unreliable language: If a person is using slang or dialect words, it can cause difficulty in verbal communication.

At Risk Populations

At risk populations include those individuals with certain preexisting conditions who are more likely to be affected by impaired verbal communication:

• Aged patients: Elderly individuals are at a greater risk of developing impaired verbal communication as they age.
• Patients with cognitive disabilities: Patients with any type of cognitive impairment can experience verbal communication difficulties.
• Context-specific communication barriers: Patients living in an unfamiliar cultural context may have difficulty communicating verbally due to confusion over accents or dialects.
• Patients with intellectual impairments: Intellectual or developmental delays can contribute to communication difficulties.

Associated Conditions

Patients with impaired verbal communication usually experience other physical and psychological issues. The associated conditions include:

• Behavioral disturbances: Behavioral disturbances can range from agitation to aggressive behaviors.
• Self-isolation: As a result of their verbal communication impairment, patients may isolate themselves from social contacts and interactions.
• Anxiety and depression: Patients may feel overwhelmed by their inability to communicate, leading to higher levels of anxiety and depression.
• Communication burnout: Patients may suffer from communication burnout due to often being misunderstood or feeling frustrated when trying to communicate.

Suggestions of Use

In order to best serve an individual with impaired verbal communication, it is important to understand the individual’s needs and how to meet them. Here are a few suggestions of use when working with these patients:

• Allow more time for answering questions.
• Ask the patient in simple, direct, and concrete language to clarify any misunderstandings.
• Provide alternate forms of communication such as pictures, drawings, gestures, and sign language.
• Use a variety of methods including music, art, and physical activities to supplement communication.
• Encourage the use of device-based communication tools (e.g., voice recognition or speech to text) that can help overcome the barrier of verbal communication.

Suggested Alternative NANDA Nursing Diagnoses

The following are alternative NANDA nursing diagnoses to guide the assessment and management of clients with impaired verbal communication:

• Readiness for enhanced verbal communication: This diagnosis reflects the patient’s need to strengthen their communication skills.
• Noncompliance with therapeutic regimen: Patients unable to verbally communicate can easily lack understanding and compliance with prescribed treatments and therapies.
• Decisional conflict: Patients may not be able to express their choices due to communication difficulties.
• Impaired social interaction: Social interactions with friends, family, and care staff may be reduced due to the verbal communication impairments.

Usage Tips

When assessing a patient for impaired verbal communication, nurses must pay attention to their communication patterns and look out for potential red flags. Also, nurses must be aware of the potential risk factors and always open to learning new skills and techniques that may help them better assess, diagnose, and manage patients with impaired verbal communication.

NOC Outcomes

NOC outcomes related to impaired verbal communication include:

• Communication: A measure of the effectiveness of communication with others.
• Interpersonal Relationships: A measure of the quality of relationships with family and other significant people.
• Psychosocial Adaptation: A measure of adaptability to physical, emotional and social stressors.
• Social Interaction: A measure of effectiveness in establishing and maintaining social contacts.

Evaluation Objectives and Criteria

Evaluation objectives and criteria allow nurses to measure progress and check whether patients are achieving improved verbal communication skills. Evaluation objectives must be tailored to the individual’s needs and goals while criteria must be measurable and realistic. Some examples of evaluation objectives and criteria include:

• Objective: To increase the patient’s ability to communicate needs and receive support.
  Criteria: Patient will demonstrate increased ability to communicate needs, be able to initiate conversations, and express feelings with less apprehension.
• Objective: To enable the patient to form meaningful interpersonal relationships. Criteria: Patient will display an understanding of communication protocols, express appropriate feelings, and build trust in relationships.

NIC Interventions

NIC interventions related to impaired verbal communication include:

• Alternative Communication Strategies Training: This intervention focuses on teaching alternative strategies to facilitate communication. These strategies may include sign language, use of drawings and pictures, talking boards, and partner-assisted scanning.
• AAC Device Programing: This intervention is aimed at helping patients develop their skills in using assistive devices to communicate.
• Communication Rights Advocacy: This intervention is intended to help educate and inform patients about their right to communicate and the services available to them.
• Cognitive-Linguistic Enhancement: This intervention focuses on improving language and comprehension skills.

Nursing Activities

Nursing activities related to impaired verbal communication include:

• Assess the patient’s level of verbal communication.
• Formulate goals for therapy and interventions.
• Implement therapeutic interventions to improve patient’s verbal communication.
• Collaborate with interdisciplinary team to assess the patient’s capacities and level of assistance needed.
• Refer the patient to other specialists as appropriate.
• Include family and caregivers in the treatment plan meetings.
• Provide emotional support and guidance to the patient.
• Monitor the patient’s progress and response to therapy.

Conclusion

Impaired verbal communication is a common diagnosis among patients, and nurses must be able to recognize, assess, and manage a variety of communication barriers. Understanding the underlying causes of a patient’s impaired verbal communication, as well as their strengths and weaknesses, is key to providing effective care and achieving positive treatment outcomes.

FAQs

• How can nurses assess verbal communication?
  Nurses can assess verbal communication by observing the patient's communication patterns and language skills. Additionally, nurses can use tests such as the Expressive One Word Picture Vocabulary Test or the Token Test to evaluate the patient's verbal communication abilities.
• What are some alternatives for communicating when verbal communication is impaired?
  When verbal communication is impaired, there are several alternative methods of communication that may be used. These include sign language, gestures, drawings and pictures, talking boards, and partner-assisted scanning.
• What are some associated conditions of impaired verbal communication?
  Common associated conditions of impaired verbal communication include behavioral disturbances, self-isolation, anxiety and depression, and communication burnout.
• What are the NOC outcomes related to impaired verbal communication?
  NOC outcomes related to impaired verbal communication include Communication, Interpersonal Relationships, Psychosocial Adaptation, and Social Interaction.
• What are some nursing activities for patients with impaired verbal communication?
  Nursing activities for patients with impaired verbal communication include assessing the patient’s level of verbal communication, implementing therapeutic interventions, collaborating with interdisciplinary teams, providing emotional support, and monitoring the patient's progress.