Communication Disorders and Nursing Education Communication Disorders of Patients in Nursing Education

Effective communication is vital in healthcare, and when communication disorders arise, they can present significant barriers for both patients and healthcare providers. In nursing education, understanding these disorders and implementing appropriate strategies is critical for delivering quality care. This section will explore different types of communication disorders, focusing on aphasia and dysarthria as common communication hurdles, and offer strategies that nursing educators can adopt to better manage and support patients with these conditions.

What are Communication Disorders?

Communication disorders can affect the ability to send, receive, process, or comprehend verbal, nonverbal, or graphic messages. These disorders may involve language, speech, or both. They can be caused by various conditions, such as strokes, brain injuries, neurological diseases, or developmental disorders.

A common cause of communication disorders is a cerebrovascular accident (CVA), or stroke, which can lead to impairments in speech, language comprehension, and the ability to express thoughts. Strokes are a leading cause of long-term disability, with approximately 800,000 Americans experiencing strokes annually, and more than 7 million people living with its effects (American Heart Association & American Stroke Association, 2017). Depending on the severity and location of brain damage, a patient may experience aphasia, dysarthria, or other forms of communication impairment.

Aphasia as a Communication Hurdle

Aphasia is a language disorder caused by damage to the brain’s language centers, most commonly resulting from a stroke. It affects the ability to produce or understand speech, and to read or write, but does not affect intelligence. Around 1 million Americans are affected by aphasia, and its severity can vary widely based on the extent of the brain injury (National Aphasia Association, 2017).

Types of Aphasia:

1. Global Aphasia: The most severe form of aphasia, affecting both expressive (speaking) and receptive (understanding) communication, as well as reading and writing abilities. This usually results from extensive brain damage.
2. Expressive Aphasia (Broca’s Aphasia): Individuals can understand what is being said but have difficulty conveying their thoughts. Speech may be halting and limited to a few words or phrases.
3. Receptive Aphasia (Wernicke’s Aphasia): People with this type can speak fluently but have trouble understanding spoken or written language. They may speak in long, nonsensical sentences without realizing they are not communicating effectively.
4. Anomic Aphasia: The least severe form, characterized by difficulty in finding the correct words, especially nouns and verbs. Individuals often resort to circumlocution, describing what they want to say when they cannot recall a specific word.

Nursing Educator Strategies for Aphasia Disorders

Nurses play a crucial role in assisting patients with aphasia to communicate effectively. The following strategies can help facilitate communication:

1. Create a Supportive Environment:
   • Ensure the patient’s full attention and eliminate distractions. Choose a quiet, private space for communication to reduce frustration and embarrassment.
   • Allow plenty of time for the patient to respond. Avoid rushing them or completing their sentences, as this can increase frustration and hinder communication efforts.
2. Use Simple Language:
   • Speak slowly and clearly, using short, simple sentences. Avoid jargon or complex language that might confuse the patient. Repeat key points and use different wording if necessary to aid understanding.
3. Establish a Communication System:
   • Develop a consistent yes/no response system, such as shaking the head, blinking, or squeezing hands. All staff should use the same method to avoid confusing the patient.
   • Use gesture-based communication, such as pointing to objects or pictures, to allow patients to express basic needs.
4. Incorporate Visual Aids:
   • Communication boards with pictures, symbols, or letters can help patients convey their thoughts. High-tech devices with voice output may also assist patients with more severe language impairments.
   • Use personalized visual aids relevant to the patient’s care. For example, create boards that include pictures of medications, food, or daily activities.
5. Encourage Nonverbal Communication:
   • Patients with expressive aphasia can benefit from exaggerated facial expressions and gestures. Encourage the use of these cues to express emotions or requests when words fail.
6. Involve Family Members:
   • Family members can provide insight into the patient’s previous communication habits, preferences, and effective methods for enhancing communication. Involving them in the teaching process can improve outcomes.
7. Praise Efforts:
   • Provide positive reinforcement for all attempts at communication, no matter how small. The focus should be on successful communication, not perfect speech.

Dysarthria as a Communication Hurdle

Dysarthria is a speech disorder caused by damage to the nerves or muscles involved in speaking, which can result from conditions such as Parkinson’s disease, multiple sclerosis, or myasthenia gravis. Patients with dysarthria may have slurred, slow, or quiet speech, and in severe cases, their speech may be nearly unintelligible. Unlike aphasia, dysarthria does not affect language comprehension but rather the physical act of speaking.

Types of Dysarthria:

1. Flaccid Dysarthria: Caused by damage to the lower motor neurons, leading to weak, floppy muscles. Speech may sound breathy or nasal.
2. Spastic Dysarthria: Caused by damage to the upper motor neurons, resulting in stiff muscles and slow, strained speech.
3. Ataxic Dysarthria: Associated with cerebellar damage, causing a lack of coordination in speech muscles, resulting in slurred or jerky speech.
4. Hypokinetic Dysarthria: Often associated with Parkinson’s disease, leading to reduced volume and monotone speech.
5. Mixed Dysarthria: A combination of different types, often seen in conditions like multiple sclerosis or amyotrophic lateral sclerosis (ALS).

Nursing Education Regarding Dysarthria Disorders

Nurses can employ the following strategies to improve communication with patients suffering from dysarthria:

1. Control the Communication Environment:
   • Reduce background noise and distractions. Patients with dysarthria may struggle to speak clearly in environments with competing sounds.
2. Speak Clearly and Face the Patient:
   • Look at the patient while speaking and pay attention to their facial expressions and body language for additional cues. Ensure the patient is rested, as speech may become more difficult with fatigue.
3. Encourage Slow Speech:
   • Gently remind the patient to slow down if their speech becomes too rapid to understand. Slower speech can improve clarity.
4. Ask Yes/No Questions:
   • Use questions that require a yes or no response to make communication easier for the patient. This reduces the strain of forming complete sentences.
5. Utilize Nonverbal Communication:
   • Encourage the use of writing, gestures, or communication boards when verbal communication is difficult. Portable electronic devices, such as voice synthesizers, can also assist patients in expressing themselves.
6. Repeat or Rephrase Information:
   • When understanding is difficult, ask the patient to repeat their message or write it down. You can also rephrase what you think the patient said to ensure clarity.
7. Support Speech Therapy:
   • Collaborate with speech-language pathologists to reinforce strategies and exercises that may improve muscle strength and coordination for speech. Include family members in sessions to help them better understand the patient’s challenges and how to assist in communication.

Conclusion

Communication disorders such as aphasia and dysarthria significantly affect patients’ ability to engage in healthcare. Nursing education plays a pivotal role in teaching nurses how to effectively communicate with these patients. By using simple, clear language, visual aids, alternative communication methods, and involving family members, nurses can help bridge communication gaps. Additionally, partnering with speech therapists and implementing customized strategies for each patient’s needs ensures that communication, despite its challenges, remains effective.

Nurses must be patient, adaptive, and supportive to help patients with communication disorders express their needs, understand medical information, and participate in their care.