Aphasia is a communication impairment—a difficulty in expressing, a difficulty in understanding, or a combination of both—resulting from cerebral impairments.
Use Techniques that Enhance Verbal Expression.
Make a Concerted Effort to Understand the Person.
Allow enough time to listen.
Rephrase messages aloud to validate what was said.
Acknowledge when you understand, and do not be concerned with imperfect pronunciation at first.
Ignore mistakes and profanity.
Do not pretend you understand if you do not.
Observe nonverbal cues for validation (eg, answers yes and shakes head no).
Allow person time to respond; do not interrupt; supply words only occasionally.
Teach Techniques to Improve Speech.
Ask to slow speech down and say each word clearly, while providing the example.
Encourage client to speak in short phrases.
Explain that client’s words are not clearly understood (eg, “I can’t understand what you’re saying.”).
Suggest a slower rate of talking, or taking a breath before beginning to speak.
Ask client to write down message, or to draw a picture, if verbal communication is difficult.
Focus on the present; avoid controversial, emotional, abstract, or lengthy topics.
Explain the Benefits of Daily Speech Practice. Consult with Speech Therapist for Specific Exercises.
Acknowledge Client’s Frustration and Improvements.
Verbally address frustration over inability to communicate, and explain that both nurse and client need to use patience.
Maintain a calm, positive attitude (eg, “I can understand you if we work at it.”).
Use reassurance (eg, “I know it’s difficult, but you’ll get it.”); use touch if acceptable.
Maintain a sense of humor.
Allow tears (eg, “It’s OK. I know it’s frustrating. Crying can let it all out.”).
Give the person opportunities to make care-related decisions (eg, “Would you rather have orange juice or prune juice?”).
Provide alternative methods of self-expression
Helping (tasks such as opening mail, choosing meals)
Identify Factors that Promote Comprehension.
Assess Hearing Ability and Use of Functioning Hearing Aids.
Assess Ability to See, and Encourage the Person to Wear Glasses if Indicated.
Explain that seeing better will increase understanding of what is happening in the environment.
Even if the person is blind, look at him or her when talking to “throw” voice in that direction.
Speak When the Person is Ready to Listen.
Achieve eye contact, if possible.
Gain the person’s attention by a gentle touch on the arm and a verbal message of “Listen to me” or “I want to talk to you.”
Modify your Speech.
Speak slowly; enunciate distinctly.
Use common adult words.
Do not change subjects or ask multiple questions in succession.
Repeat or rephrase requests.
Do not increase volume of voice unless person has a hearing deficit.
Match your nonverbal behavior with your verbal actions to avoid misinterpretation (eg, do not laugh with a coworker while performing a task).
Try to use the same words with the same task (eg, bathroom vs toilet, pill vs medication).
Keep a record at bedside of the words to maintain continuity.
As the person improves, allow him or her to complete your sentences (eg, “This is a…[pill]”).
Use Multiple Methods of Communication.
Use flash cards.
Show what you mean (eg, pick up a glass).
Write key words on a card, so client can practice them while you show the object (eg, paper).
Show Respect when Providing Care.
Avoid discussing the person’s condition in his or her presence; assume client can understand despite deficits.
Monitor other health care providers for adherence to plan of care.
Talk to the person whenever you are with him or her.
Initiate Health Teaching and Referrals, if Indicated.
Teach communication techniques and repetitive approaches to significant others.
Encourage family to share feelings concerning communication problems.
Explain the reasons for labile emotions and profanity.
Explain the need to include the person in family decision making.
Seek consultation with a speech pathologist early in treatment regimen.