As a healthcare professional, you know the importance of good communication with patients. However, when a client has a speech disorder, it can be challenging, and sometimes frustrating, to understand what’s being said, or even wonder if what you are communicating is being understood. According to the American Speech-Language-Hearing Association, 60-90% of long-term care and nursing home residents have impaired speech. Learning effective techniques will benefit both you and your patients.
Many diseases and conditions can cause speech difficulties:
• Cancer, especially oral and laryngeal
• Degenerative diseases, such as ALS and Huntington’s
• Brain injuries
• Tracheostomies and Ventilator-dependent patients
• Hearing loss
What can you do when caring for a patient with a speech or language disorder? Here are some tips:
1. Keep in mind that communication will take longer, up to twice as long as a patient who is able to speak easily. Don’t rush the patient and he will feel more relaxed.
2. Look at the patient when you speak. The patient may offer non-verbal cues that will help you understand what is being conveyed. Gestures can be especially useful, as well as pictures or actual items.
3. When you are asking questions, go slowly and ask just one question at a time. Wait for the response before continuing. When your day is busy, this can be hard to do, but it shows respect for the patient.
4. Don’t pretend to understand. Ask the patient to repeat what she just said to say it a different way. If you still can’t understand, ask her to write it down or point to a picture.
5. When family or friends are present, talk directly to the patient, not the others. It’s insulting to the patient to act as if he’s not there.
6. If a patient has no speech, ask simple questions that can be answered with a “yes” or “no.” Begin by saying, “Show me how you answer ‘yes.’ Show me how you answer ‘no.’” Make a sign for the patient’s room and note it in the care plan for the entire staff.
7. Keep paper and a pen at the patient’s bedside for those who prefer to write, whether as a way to support communication or as the primary way to “talk.”
Many patients use Augmentative and Alternative Communication (AAC) aids. These are valuable tools that make it easy for everyone. AAC devices include signing, picture boards, alphabet charts, electronic methods, and computer programs. Always treat the AAC as a vital piece of equipment that belongs to the patient. It should be available at all times. If it’s an unfamiliar system, ask the patient to demonstrate. Spend time learning how the patient uses the AAC.
What if you truly cannot understand what the patient is trying to tell you? Step back and ask simple questions, and supply a choice of possible answers:
1. “Can you tell me what we are talking about?” or “Can you tell me who we are talking about?” Then proceed to list recent events or a list of people who care for the patient.
2. “Are we talking about something that happened today?” “Yesterday?” “Or something that will be happening?” Offer suggestions based on what the patient has been experiencing or that you know from the family or other staff members.
3. “Is there something you need me to do for you?” Try to determine if the patient has an urgent need or has a request. Sometimes it can be simple, such as adjusting the room temperature or changing a television channel.
When you invest a little time with a patient who has a speech or language disorder, you may quickly understand how to communicate in a way that is satisfying for both of you.
Try reviewing the course material on the communication skills from our course library.
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