06.05 Patients with Communication Difficulties

In this lesson, we’re going to look at the communication difficulties we can face with our patients.

At some point, I’m sure you’ll run across a patient that you have a difficult time communicating with. Even if you don’t speak their language or they have some physical impairment, you’ve gotta find a way to communicate with them.

The first thing that we need to recognize is that communication difficulties are barriers and that there is a breakdown in communication. What we’re going to look at today is identifying where in the process of communicating with them that it’s breaking down. It’s easy to say “Ugh! I’m so frustrated because my patient doesn’t get it.” If you look at where in the process it’s happening you’ll understand why.

In particular, in this lesson, we’re going to look at what we call input, processing and output. This has to do with where in the process the barrier is. Don’t forget that it’s a two way street, and that you could also have a barrier in your communication, so it’s important to look at that too.

With input, ask yourself this question, “Is there something that’s literally keeping the patient from taking the information from me?” An example of this is hearing loss. You can talk to them until you’re blue in the face, but if they literally can’t hear you, they have a difficulty with input.

Now we’ll look at processing. This is where the bulk of your communication difficulty (and probably frustration) will occur.

It’s ok to be frustrated. But if you can quickly figure out why the patient doesn’t “get it,” then you can find ways to get around it.

This is literally the part where they hear what you’re saying, but they can’t process it. Examples of this are language or education barriers. Maybe they don’t understand what you’re saying because of language. In pediatrics, there’s an issue where toddlers cannot understand what you’re saying and follow commands. It doesn’t mean that there’s a neurologic problem - it just means that they can’t comprehend and process what you may be asking them to do. Distraction is another one, especially during grief or loss. Sometimes patients just can’t keep it together and they’ll “hear” you, but they aren’t really listening. Mental health is another one, especially for patients with illnesses like schizophrenia. They may be so distracted by audible hallucinations that they may not pay attention.

One final place you may run into an issue is with medical terminology. By the time you graduate nursing school, you’ll be a pro at understanding medical terms. But remember to make sure that what you’re communicating is brought down to the patient’s level of understanding. If not, stuff gets lost and the patient may stay noncompliant or may become frustrated.

The last one is output. This is where the patient is communicating information back to you, and there’s a barrier preventing the patient from expressing themselves.

Examples of this are patients who are mute (maybe because of a hearing deficit) or laryngeal disease or illness. Maybe they’ve had surgery and can’t speak. Or maybe they have a breathing tube. If they can’t talk, then maybe they can write - and if they can’t do that, then you recognize that they have a general output barrier. A great example of this is Stephen Hawking. He couldn’t speak and he had some pretty significant motor deficits in his hands, so he used his computer to communicate. He would be a prime patient with communication difficulties, and his doctors and medical team provided him with an alternative.

So where do you start?

First, identify what kind of barrier it is. Is it input, processing or output? Also, sometimes, it’s more than one (an example here would be maybe a patient who is both deaf and mute).

Use the nursing process. Is this a result of disease, illness, or injury. Is the illness or injury permanent or temporary? Will correcting it help your patient?

Also, find alternatives. Maybe the only thing they may be able to do is blink to respond because of an injury. I saw these patients all the time. I’d always ask the patient in yes or no questions and I’d have them blink once for yes and two for no. That helps give them a way to communicate.

Be appropriate to the situation. If your patient is having audible hallucinations, they may be distracted. So find ways to make information succinct so that it sticks. Also, use your resources like other health care providers in different disciplines. Chaplain or grief counselors, or medical translators for patients that speak different languages - these are going to be the people you need to grab to communicate with your patient.

Also educate your patients. Find ways to make learning easier and find the patient's best way to learn. Go check out the lesson on education to get some more tools on other methods to educate your patient.

So, today, we really focused on communication and building our relationships with our patients who may have difficulty communicating. Also focus on being professional with your patients.
So let’s recap:

Recognize that patients with communication difficulties are having barriers in the communication process, so identify the cause.

Is this an input, processing or output difficulty? Once you identify it, you can address it.

Be therapeutic. Use your therapeutic communication to talk to your patients.

Educate them and provide resources to your patient. Sometimes you need a team to achieve your patient’s goals.

And finally, really focus on alternatives for your patient to communicate. Give them an option. If not, you may both grow frustrated.

So that’s our lesson on helping patients with communication difficulties. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!