NURS 445 Exam 2: Communication

Communicating with Professional and Nonprofessional Caregivers

In cases where the nurse must communicate information about the patient to another professional or nonprofessional caregiver, the nurse is the expert source of information and care should be taken to communicate clearly and with respect for other providers; nurses must be aware of their role as role models for paraprofessional providers.

Short-term memory

Limited in capacity and information remains for only a few seconds. Older adults can hold approximately 5-9 peices of information in short-term memory, such as a phone number. Some information in short-term memory is then encoded to be stored in long-term memory.

Speak in the direction of the person

Make sure you are in the same room and are looking at the individual. This will help the person to prepare to listen. Being in the same room eliminates an environmental barrier, as talking to a person in another room or across the room leads to a reduced speech signal to the listener (Strategies to Aid Individuals with Communication Impairments).

High frequency

Microscopic hair cells within the cochlea (in the inner ear) detect frequencies from sound waves and then send signals to the brain. The hair cells that detect ______ ______ sounds are the most vulnerable to damage. Once the hair cells are damaged, they do not repair themselves nor do new hair cells grow, so hearing loss is permanent.

Long-term memory

Much more expansive than short-term memory and there is no limit as to how long information can be stored here. There are two types, declarative memory and nondeclarative memory.

Conductive hearing loss

Occurs when the cause of hearing loss is located in the outer and/or middle ear. The sound wave cannot effectively reach the inner ear. where the sound signal is sent to the brain. Ear infections, punctured tympanic membrane, otitis media, broken bones in the ear, scarred eardrum, fluid in the middle ear, earwax buildup, birth defects, and genetic conditions can all cause this hearing condition.

Hearing changes

One in three adults aged 60 years and older and one in two adults over the age of 85 are reported to have some level of hearing loss.

Cataracts

Opaqueness of the lens that is the most common age-related eye disease and is reversed through surgical treatment.

Nursing interventions

Person-centered communication by which the nurse should provide information to promote health and healing and to engage patients in self-care.

Say names

Say the person's name before providing instructions to get hes/her attention. If memory is an issue, state your name as you enter the room so that the person does not have to guess who you are. When possible, use proper names instead of pronouns (Strategies to Aid Individuals with Communication Impairments).

IADLs

Shopping, using the telephone, balancing the checkbook.

Speak slower and pause between phrases

Slowing down the rate at which you speak allows you to speak clearer and provides distinct separation of words for better comprehension. Pause time between sentences allows for older adults whose retrieval and processing has decreased in speed to process and respond. This also helps individuals with hearing loss as well (Strategies to Aid Individuals with Communication Impairments).

Use touch to communicate

Some individuals have difficulty with attention and alertness due to cognitive issues, medication side effects, and/or medical health problems. Gently touch the person on the hand, shoulder, arm, or leg to help gain his/her attention. If you start speaking when the person is not attending, then you'll likely have to repeat your message (Strategies to Aid Individuals with Communication Impairments).

Language

Spoken, written, or signed, it is the symbol system used by a shared group of people for communication.

Compensatory strategies

Strategies for communication that focus on providing mechanisms to assist the person with the physical or neurological impairment. Different types of strategies include adapting the environment; using alternative augmentative communication, technological devices, or memory aids; and having communication partners alter how they communicate with the person.

Global aphasia

The damage to the left hemisphere is greater than with Broca's, so the effects on communication are more devastating. A person with global aphasia has very limited spoken language and may only use single words, which can sound like nonsense words. Comprehension of written and spoken information is significantly impaired. In addition, written expression is as equally impaired as the spoken form.

Presbyopia

The decreased ability of the eye lens to focus on nearby objects due to normal aging. Typically, people become aware of this loss of visual focus around the age of 45 years. This type of vision impairment may be corrected by wearing glasses or contact lenses. However, this condition increases as age increases, so glasses and lenses should be adjusted regularly.

Alzheimer's disease

The most common form of dementia and accounts for 60-80% of dementia cases. It is a progressive degenerative brain disease that first affects memory. Episodic memory is the first to be affected in individuals with this disease. The main difference between this disease and age related short-term memory loss is the rate at which episodic memory is lost (usually within seconds). As it progresses, physical movement, communication, cognition, personality, and emotional/mental health are affected. Pathological Changes. They do not usually remember instances from day to day; however, they usually remember stories from their past. One can use photo albums and encourage the patient to reminisce, so they do not have to rely so heavily on memory that is impaired (Affecting Cognition, Speech, Language).

Make sure any assistive devices are on and working

This includes hearing aids, assistive listening devices, and electronic AAC devices. If the person needs glasses to see, make sure he/she has easy access to them. If the person has difficulty hearing, ask the person to wear their hearing aids or properly place hearing aids before speaking (Strategies to Aid Individuals with Communication Impairments).

Tinnitus

This is a continual, abnormal sound in one or both ears. It is generally caused by some mild hearing loss and can be extremely annoying to the person. This interferes with being able to adequately hear speech.

Position yourself in the person's direct line of vision

This will let the person know that you are engaging in communication with him/her. Also, it provides visual information about what is being said. The person will be able to look at your lips and perhaps fill in what he/she does not understand simply by hearing. If understanding of nonverbal communication is still intact, positioning yourself in front of the person will allow for him/her to tune into the nonverbal communication (posture, facial expression, gestures). Another element to keep in the mind is lighting: Be sure that their is adequate lighting so the person can see you. Individuals with vision impairments often require more lighting than those without vision issues (Strategies to Aid Individuals with Communication Impairments).

Simplify vocabulary and avoid jargon

Try to use language that is easy to understand; refrain from using slang and medical jargon, especially. Watch to see if the person understands what you are saying. If you think he/she did not understand or he/she says that they do not understand, rephrase your sentence (Strategies to Aid Individuals with Communication Impairments).

Declarative memory

Type of long term memory that includes episodic (events), semantic (concepts), and lexical (word) memory.

Nondeclarative memory

Type of long-term memory that includes motor skills, cognitive skills, reflex responses, priming, and codition responses. Repetition typically strengthens this type of memory.

Limit the number of speakers

Typically, group settings and social events have numerous people speaking at the same time or rapidly taking turns. This requires quick processing to be able to understand and keep up with the conversation. Because older adults are slower to process and respond to the information, it is best to limit the number of people speaking. This is less cognitively demanding for the individual (Strategies to Aid Individuals with Communication Impairments).

Health literacy

What should be considered when planning teaching or educational materials?

Mixed hearing loss

When both conductive and sensorineural hearing loss is present.

Dual sensory impairment

When one experiences a loss in both vision and hearing. 21% of individuals over the age of 70 experiences this condition.

Person-first language

Whether or not the patient is present, one should refer to the patient in this way. This stresses the person as an individual who has some condition or disease instead the condition or disease as a defining factor of the individual. For example, say or write person with dementia instead of dementia or demented patient and a person with a hearing loss, not a hearing-impaired person. This communicates respect for the individual (Strategies to Aid Individuals with Communication Impairments).

Facilitation/Collaboration

Work together, involve the person. Enable the person to do what otherwise he/she wouldn't be able to do by providing the missing parts of the action. Example: "What is it you are looking for Mrs. Smith? Can I help? Tell me what it is and we can look for it together." (Strategies for Communication with Persons with Dementia that Support Personhood).

Validation

Acknowledge the person's emotions/feelings and respond. Example: "Mrs. Johnson, it sounds like you would like to wait for your bath." (Strategies for Communication with Persons with Dementia that Support Personhood).

Recognition

Acknowledge the person, know their name, affirm uniqueness. Example: "Come along Mrs. Jones, your dinner is being served."(Strategies for Communication with Persons with Dementia that Support Personhood).

Eliminate or minimize background noise

Additional sounds compete with the speech sounds, making it more difficult to determine what was said. Music, television, and other conversations all makes it more difficult to attend to the conversation at hand (Strategies to Aid Individuals with Communication Impairments).

Provide additional time for the person to respond

After asking a question or making a comment that you expect a response from, wait 5-10 seconds for a response. Since processing time slows in adults with and without pathological conditions, providing additional time allows for the person to process what was said, plan what to say, and then provide an oral or written response (Strategies to Aid Individuals with Communication Impairments).

Vision changes

Age-related changes can start occurring in one's 30s. Over time, the cornea become less sensitive and the pupils decrease to about one-third of their size during young adulthood. It also takes longer for one's eyes to adjust from light to dark environments, such as walking out of a movie theater on a sunny day. The lenses become less flexible and slightly yellowed and cloudy. Visual acuity also decreases as age increases. Contrasting warm and cool colors should be used when creating visuals such as calendars, instructions, and signs. (Changes Throughout the Typical Aging Process).

Hearing aids

Amplify the frequencies in which hearing loss in present. They do not amplify all frequencies unless that person displays hearing loss across all frequencies.

Aphasia

An acquired (not present at birth) language impairment and occurs when there is damage to language center in the brain. It is most often a result of a stroke, but can result from trauma and illness as well. If cognition, personality, or speech is impaired, then it does not fit the diagnosis of this impairment. All types of this impairment share one common feature: anomia, which is a naming impairment (Affecting Cognition, Speech, Language).

Cognition changes

As people age, there is a gradual decrease in brain mass and neuronal function that results in cognitive changes. Long-term and short-term memory declines as people age. Because of brain changes, individuals over 65 "are slower in perceiving, processing, and reacting especially when the situation requires rapid processing of complex information". The overall knowledge a person has does not diminish; however, the time that it takes to process and retrieve that information does increase. This can appear to family members and care providers that knowledge is impaired, so it is important to provide adequate time for older individuals to process and respond.

Include the patient

Be sure to include the individual in the conversation. If conversations that are taking place with the patient in the room, speak as though the person can understand you. Do not have conversations about the person in front of him/her and not include him/her, especially if you say something that might be hurtful or embarrassing to the person (Strategies to Aid Individuals with Communication Impairments).

Wernicke's asphasia

Caused by damage to Wernicke's area of the brain. People with this aphasia have fluent speech with low content. Individuals will say real or nonsense words, but the string of words has no clear meaning. Comprehension of spoken and written information is impaired, as is repetition. Unlike Broca's aphasia, those with this type of aphasia are generally unaware of their communication deficits (Affecting Cognition, Speech, Language).

Diabetic retinopathy

Changes in the eye as a result of diabetes that can cause blindness.

Nonverbal

Communication basics that includes tone of voice and physical behaviors such as body language and eye contact.

Dynamic

Communication basics that is an ongoing exchange of information with feedback.

Verbal

Communication basics that relies on knowledge of a common language as well as the ability to produce words.

Restorative strategies

Communication strategies that address rebuilding skills that are impaired. For example, a man with nonfluent aphasia might focus on saying common single-words to help communicate his wants and needs. As his ability to say these words increases, more words are taught.

Use short, direct, clear phrases

Comprehension of complex sentences becomes more difficult as people age. Use short phrases, but remember to still use respectful language. Limit instructions to one or two steps at a time. Using short, clear phrases may help reduce the number of times you repeat the information.

Broca's aphasia

Comprehension remains intact, but spoken communication is nonfluent. Speech is slow, efforful, and choppy and often lacks proper grammatical markers, such as "-ed" at the end of a verb to indicate past tense. Individuals have difficulty initiating speech, but they provide good content. Most people with this language impairment are aware of their impairments and try to self-correct.

Negotiation

Consult the person about preferences, desires, needs. Example: "That was a nice bit of fresh air. I'm ready for my dinner now; would you like to join me?" (Strategies for Communication with Persons with Dementia that Support Personhood).

Sensorineural hearing loss

Damage that occurs in the inner ear and/or auditory nerve fiber. This type of hearing loss is the most common in older adults. Causes include short- or long-term exposure to loud noises, otoxicity, Meniere's disease, and tumores.

Demential

Defined as memory loss accompanied by speech and language impairments and/or decline in executive functioning. Because changes in memory occur with normal aging, the symptoms have to be significant enough to interfere with social, occupational, or daily activities. Different types of this disease include Alzheimer's disease, vascular dementia, dementia with Lewy bodies, mixed dementia, and frontotemporal demential. When looking at family pictures in a patient's room, refrain from asking, "Who is this?" or "What's her name?"Instead, make a comment about that picture or ask multiple choice or yes/no questions - for example, "This is a beautiful picture. Is this your daughter?"(Pathological Changes Affecting Cognition, Speech, Language).

ADLs

Dressing, grooming, toileting, eating, bathing.

Provide written information in large, easy-to-read print

For individuals who have difficulty seeing written text, make sure that text is in an easy-to-read, large font. Stick to high-contrasting colors (e.g., black ink on white paper) and avoid using blue and green ink (Strategies to Aid Individuals with Communication Impairments).

Speak into the ear with less or no hearing loss

For those who have hearing impairments, be sure to look in their charts for information about their hearing. If one ear has better hearing, position yourself so that you are speaking in the direction of that ear (Strategies to Aid Individuals with Communication Impairments).

Recognition, negotiation, validation, facilitation/collaboration

Four Strategies for Communication with Persons with Dementia that Support Personhood

Use gestures to aid in communication

Gestures help clarify the message when perhaps not all of it was understood. Pointing and demonstrating actions may help to aid understanding (Strategies to Aid Individuals with Communication Impairments).

Write out information

If the person does not understand you, write down key words, phrases, or sentences so the person can read the information. This will help ensure that the message is clearly communicated (Strategies to Aid Individuals with Communication Impairments).

Summarize

If the person forgets the topic being discussed, summarize what has been said to help guide the person back into the conversation.

Request clarification

If you did not understand the intent of the person's message, ask questions that help he/she to clarify. another option is to say what you think was said and ask the person if you understood correctly (Strategies to Aid Individuals with Communication Impairments).

Lack of opportunities; social networks

(Communication obstacles facing older adults): Older adults experience an increase ______ ___ ______ for communication. As age advances, ______ ______ decline as children leave home and spouses and significant other die.

Aphasia and dementia

(Communication obstacles facing older adults): Two common causes associated with old age that interfere with the nurse's ability to communicate with the older adult.

Teach-back method

(Cultural competence and health literacy): After providing health information, nurses should have patients repeat back to them what information they have received. This is an easy and effective method to assess comprehension of health teaching.

Communication in end-of-life care

(Cultural competence and health literacy): Communication during this part of one's life is of critical importance and may be complicated by emotional distress and prior relationships with family and significant others. Providing information may be especially difficult for healthcare workers when the news is bad or when listening skills of patients and families are poor.

Elderspeak

(Intergenerational Communication): Younger persons, such as nurses, that often modify their speech when they talk to older adults. Modifications inlcude simplication - measurable reductions in complexity of grammar and vocabulary- and clarification strategies, which include adding repetitions and stressing and altering the pitch of one's speech, resulting in speech that is overly caring and controlling and less respectful than normal adult-to-adult speech. This type of speech is widespread in community and elder-care settings. It is similar to baby talk.

Communication Basics

- How we provide and receive information from others. - Conveys a message between a sender and a receiver. - Dynamic: ongoing exchange of information with feedback. - Relies on intact senses, physical and cognitive processes needed to send and receive messages, and a conducive environment. - Verbal: relies on knowledge of a common language as well as the ability to produce words. - Nonverbal: includes tone of voice and physical behaviors such as body language and eye contact.

Person-Centered Communication

- Integral part of person-centered care. - Reflects focus on the patient and their unique perceptions and experiences with health and illness. - Nursing interventions: providing information to promote health and healing and to engage patients in self-care. - Confirms uniqueness of the patient and allows the patient to participate in his or her own care.

Families and significant others

- Nurses can support family members caring for older adults by assisting them to overcome communication barriers that occur as a normal part of aging and with pathological conditions such as terminal illness, stroke, and dementia. - Healthcare providers must be aware of the need to include the older adult in communication regarding health matters as much as possible. - Permission to communicate about the health condition with family and significant others is a key privacy issue that may be complicated if older adults become infirm or unable to communicate.

Presbycusis

A gradual hearing loss in both ears that typically begins in one's 50s. Possible factors include: noise exposure over the course of a lifetime, illness and progression of disease, ototoxins, genetic predisposition, and natural deterioration of the inner ear. The most common complaint of this hearing condition is that the person can hear what was said, but does not understand what was said. People with high-frequency hearing loss often claim that the speaker is mumbling.

Anomia

A naming impairment associated with all forms of aphasia.

Macular degeneration

A progressive degeneration of eye tissue and the effects are irreversible.

Encourage use of clues

There are times when we all struggle with finding the word we want to say. Since this typically occurs more often in older adults, encourage them to provide clues so that you can then guess the word. For example, you should suggest them to describe appearance, function, and/or location (Strategies to Aid Individuals with Communication Impairments).

Speech

The production of sounds used for communication.

Speech and language changes

The rate of speech slows and articulation (pronunciation of sounds) becomes less clear because of the slowing rate of cognitive processing as well as declining strength and range of movement of the mouth, tongue, and jaw. Poor detention (loss of teeth) or dentures that do not fit properly are also factors that influence articulation Pathological Changes (Affecting Cognition, Speech, Language).

Glaucoma

The slow and progressive deterioration of optic nerve fibers; peripheral vision is impaired first, followed by central vision. Number one disease that causes blindness.