Impaired Verbal Communication Nursing Diagnosis and Nursing Care Plan

Impaired Verbal Communication Nursing Care Plans Diagnosis and Interventions

Impaired Verbal Communication NCLEX Review and Nursing Care Plans

Verbal communication is the act of giving and receiving, information or in other words, talking, writing, and listening or reading.

This ability started from a simple vocalization or merely emitting of sounds from the mouth, and then evolved to an extraordinary capability to verbally communicate in a form of a language that is supported by an organized system of words, symbols, and characters. 

Our capability to verbally communicate in a form of a language, words, may it be spoken, written, or signed has been a distinctive trait that sets us apart from other lower species.

Nowadays, verbal communication is only effective if the person communicating is clear or comprehensible. Having a clarification is a key component of verbal communication. Effective communication requires the transmission of information and clarification of points made, expansion of ideas, and exploration of factors that fall out of the original thoughts transmitted.

When using verbal communication to express oneself, a variety of issues might occur. Due to the breakdown in communication, misinterpretations can happen.

Whether encountering the patient in the hospital or in the community, the nurse’s responsibility is to recognize when communication has become ineffective and then to use strategies to improve the transfer of information.

Causes of Impaired Verbal Communication

Impaired verbal communication is a condition in which the ability to process or transfer information is delayed, reduced, or absent. In most cases, the incapacity to process and transmit nonverbal communication and symbols are also present. 

Adult speech impairment is caused by a variety of factors that result in a reduced ability to speak or non-audio speech. The first is spasmodic dysphonia, which is caused by a malfunction in the brain’s basal ganglia. The next condition is aphasia, which is common among stroke patients. Patients with a brain tumor, Alzheimer’s disease, and those who have suffered a head injury are also affected.

Vocal problems, particularly in the laryngeal area, can also cause speech impairment. Those who have a tracheostomy, as well as those who have had surgery or had their voice box removed, may experience speech or verbal impairment. The inability to speak, the inability to comprehend words and sentences, and, in some cases, the inability to find the right words to say are all signs and symptoms of impaired verbal function.

Signs and Symptoms of Impaired Verbal Communication

Inability to speak is one of the common signs of impaired verbal communication. However, if the patient is able to speak, the words and sentences may be incomprehensible. and this is still considered as impaired verbal communication. Occasionally, the patients may not be able to find the right words to say and in some cases may be frustrating for them. 

Here are some signs and symptoms a patient may display and some point to its existence.

  1. The inability to recognize, comprehend or locate words.
  2. Difficulty vocalizing words, distinguishing between them, and maintaining a normal communication pattern.
  3. Inability to recall common words, names of well-known people, places, and things.
  4. Problems in receiving or sending the necessary sensory to allow understanding
  5. Derailment, poor speech illogicality, or thought blocking are signs of a disruption in cognitive associations.

Impaired Verbal Communication Nursing Diagnosis

Impaired Verbal Communication Nursing Care Plan 1

Cerebral Palsy

Nursing Diagnosis: Impaired Verbal Communication related to neurologic impairment secondary to cerebral palsy as evidenced by difficulty vocalizing words and difficulty discerning and maintaining the usual communication pattern. 

Desired Outcome: The patient will be able to avoid damage or trauma by sticking to his or her treatment plan to control or eliminate seizure activity.

Impaired Verbal Communication Nursing InterventionsRationale
Pay attention to nonverbal signs and learn about the patient’s requirements.The nurse should plan adequate time to attend to all the patient’s needs. In the case of communication impairment, care measures may take longer to complete.
Maintain a comfortable and calm manner. Allow plenty of time for the child to answer.When a child’s speech is rushed, it becomes less clear, and communication is hampered.
When chatting with the patient, keep distractions like the television and radio to a minimum.By removing such distractions, the child’s concentration is maintained, and the amount of inputs sent to the brain for interpretation is reduced.
Provide another mode of communication.If speech is difficult, the patient may communicate themselves via alternative forms such as flashcards, whiteboards, hand signals, or a picture board.
As much as possible, engage the patient’s family and significant others in the care plan.Participation and dedication to the strategy are increased.
As needed, arrange for the child to see a speech therapist.A speech therapist helps a cerebral palsy patient in learning to talk slowly and to coordinate his or her lips and tongue to create speech sounds.
Examine the patient’s regular seizure pattern and teach him or her how to recognize the warning indications of an upcoming seizure.To teach the patient and his or her caregiver how to detect a seizure and how to prevent the patient from harm. This is to help both the patient and his or her caregiver feel less hopeless.

Impaired Verbal Communication Nursing Care Plan 2

Schizophrenia

Nursing Diagnosis: Impaired Verbal Communication related to altered perceptions due to biochemical alterations in the brain, and cognitive impairment secondary to schizophrenia as evidenced by difficulty establishing verbal communication, inability to discern usual or normal communication patterns, cognitive disturbances such as hallucinations, delusions, poverty of speech, problems with coordination, motor functions.  

Desired Outcome: The patient should be able to build a reality-based cognitive process, establish the relationship, seek aid and support as required, remain calm and oriented, verbalize being in control of his/her life, and communicate effectively.

Impaired Verbal Communication Nursing InterventionsRationale
Assess and analyze the patient’s speech clarity and cognitive abilities. Evaluate if the incoherence in speech is long-term or if it occurs suddenly, as in an exacerbation of symptoms.To aid in the establishment of a baseline, as well as short- and long-term objectives. Also, establishing a baseline allows the development of realistic goals, which serve as the basis for effective care planning.
When interacting with the patient, speak slowly, keep the voice low, and use clear, and simple sentences.In a patient with schizophrenia, a loud or high-pitched voice might cause anxiety, agitation, or disorientation. It is possible to assist the patient to comprehend what is being stated by using basic language and speaking clearly.
Determine how long the client has been on psychotic medicine.Antipsychotic medications at therapeutic doses enhance clear thinking and reduce derailment or looseness of association.
Maintain a peaceful, quiet, and distraction-free atmosphere.Keep anxiety from escalating out of control, leading to disorientation, hallucinations, and delusions.
Throughout the day, schedule short, frequent interactions with a customer.Short periods of time are less stressful, and regular appointments allow a client to build a sense of familiarity and security.
If there is trouble understanding a patient, gently let him or her know. Pretending to comprehend reduces the nurse’s credibility and trustworthiness in the eyes of the patient.
When the client is ready, give him or her the following ways to reduce anxiety, lower voices, and “worrying” thoughts:

Concentrate on important tasks.

Learn how to replace negative ideas with positive ones.

Learn to substitute sensible statements for irrational ideas.

Deep breathing exercises should be done.Read aloud.

Seek assistance from a staff member, family, or other supportive individuals.

Use a peaceful visualization or listen to music to help bring relaxation.
Assisting the client in using anxiety-reduction techniques can aid improve functional communication.   

Impaired Verbal Communication Nursing Care Plan 3

  Down Syndrome

Nursing Diagnosis: Impaired Verbal Communication related to delayed growth and development secondary to Down Syndrome as evidenced by mild hearing loss and  poor speech intelligibility.

Desired Outcome: Within the limits of his or her current abilities, the child or the patient will be able to execute motor, social, and/or expressive skills typical of his or her age group. The child or the patient will engage in age-appropriate self-care and self-control activities. The child will be able to construct a communication channel through which his or her requirements may be conveyed.

Impaired Verbal Communication Nursing InterventionsRationale
Educate parents about Down syndrome and how to care for a child with the condition.Give parents the information about their child’s condition. Provide parents with information on how to care for their children who have Down syndrome.
Ensure proper nourishment. Assess the child’s swallowing abilities, offer information on proper food administration, and provide adequate nutrition guidance.Examine the child’s swallowing abilities. Give parents information on how to properly feed their children. Good nourishment should be provided to the child.
Consultations should be held regularly. Encourage parents to have their children’s hearing and vision tested on a regular basis.Encourage parents to participate in offering motor exercises and directions to their children so that they can talk. Encourage parents to allow their children to practice in their regular activities.
Give emotional and motivational assistance. The family caregiver requires assistance during these difficult times; they require strong support and instruction to help in communicating with others.Allow the child to play with other children their own age so that they may readily socialize. Allow children the flexibility and freedom to express themselves in a fatherly manner.

Impaired Verbal Communication Nursing Care Plan 4

Tracheostomy 

Nursing Diagnosis: Impaired Verbal Communication secondary to the presence of an artificial airway (tracheostomy) as evidenced by difficulty in speaking, difficulty in maintaining the usual communication pattern and verbalized feelings of frustration. 

Desired Outcome: The patient will adopt a form of communication to address his or her interests and to communicate effectively to people and situations, and he or she may learn coughing methods to clear mucus and keep an open airway.

Impaired Verbal Communication Nursing InterventionsRationale
Evaluate the client’s communication skills.    Although standard tracheostomy tubes allow the vocal cords to move, no airflow travels across them when the cuff is inflated, making vocalization impossible.  
Evaluate the effectiveness of nonverbal communication approaches.    To communicate with others, the client may employ hand gestures, facial expressions, and changes in body position. Others, on the other hand, may have problems comprehending these nonverbal approaches. Each new approach must be evaluated for efficacy and, if required, modified.
Allow the patient to discuss feelings of frustration and worry because of not being able to convey demands.  The inability to communicate increases a client’s sense of isolation and might lead to feelings of powerlessness.
Provide emotional support to the client and others who are close to him or her.Communication difficulties are a cause of aggravation for everyone concerned.
Put the patient in a room near the nurse’s station.This allows the nursing personnel to easily observe the individual.
Always maintain a call light in a convenient location.    Respond quickly to the light. An immediate answer reduces tension and feelings of powerlessness.
If the client can nod or speak “yes” or “no” responses, attempt to construct questions in such a way that the client can utilize these responses.When clients are unable to communicate in a simple manner, they might become quickly frustrated.
Provide alternate communication channels: Hand motions
Word-and-picture cards
For individuals who are unable to write, use a picture board.
Pad of paper
Providing a range of communication tools gives the client extra avenues through which to transmit information.
Allow the customer time to express his or her wants.The nurse should schedule enough time to attend to all areas of client care. When there is a communication breakdown, care measures may take longer to perform.

Impaired Verbal Communication Nursing Care Plan 5

Stroke

Nursing Diagnosis: Impaired Verbal Communication related to impaired cerebral circulation secondary to stroke as evidenced by inability to talk (dysarthria), inability to modulate voice, discover and name words, difficulty in identifying things, difficulty in interpreting written/spoken language, and inability to generate written communication.

Desired Outcome: The patient will demonstrate a comprehension of the communication issues, The patient should be also able to construct a way of communication through which his or her requirements may be conveyed and lastly he/she must be able to make good use of his or her resources.

Impaired Verbal Communication Nursing InterventionsRationale
Distinguish between aphasia and dysarthria.Aids in determining the region and degree of brain involvement, as well as the patient’s trouble with any or all communication process phases.
Examine the patient for aphasia.Aphasia is the inability to comprehend or articulate one’s own speech. The patient may have receptive aphasia or Wernicke’s speech area impairment, which causes trouble interpreting spoken words. The patient may also have expressive aphasia or impairment to Broca’s speech regions, resulting in trouble speaking appropriately, or both. The type of disability determines the sort of intervention. Aphasia is a problem in the use and interpretation of linguistic symbols that can affect both sensory and motor components (inability to comprehend written or spoken words or to write, make signs, speak). The Boston Diagnostic Aphasia Examination (BDAE) is a test for diagnosing aphasia.
Check for dysarthria in the patient.Dysarthria is a motor speech condition characterized by injured, paralyzed, or weak muscles needed to create speech. A person with dysarthria understands, reads, and writes language but has trouble pronouncing words. The patient may lose the ability to monitor his or her verbal output and be ignorant that speech is not appropriate.
Ask the patient to repeat short phrases or sentences or to obey simple orders (“Close and open your eyes,” “Raise your hand”).Wernicke’s aphasia and receptive aphasia tests. Language output is fluent with normal pace and intonation in Wernicke’s aphasia. However, due to paraphrastic faults, the text is sometimes difficult to interpret.
Ask the patient to name the items pointed to him/her.Broca’s aphasia and expressive aphasia tests. Broca’s aphasia is a non-fluent aphasia in which spontaneous speech production is significantly reduced and regular grammatical structure is lost (Acharya & Wroten, 2017). The patient may recognize an object yet be unable to identify it.
Make small noises with the patient (“dog,” “meow,” “Shh”).Dysarthria is identified because motor components of speech (tongue, lip movement, and breath control) can impact articulation and may or may not be accompanied by expressive aphasia.
Examine the patient for indications of depression.A patient suffering from aphasia may feel despondent. Inability to engage, communicate, or participate in a discussion can lead to frustration, rage, and pessimism. Make the environment suitable to dialogue and be aware of the patient’s responses and wants. To alleviate anxiety and frustration, the nurse can offer crucial emotional support and empathy.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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