Which assessment would the nurse make when caring for a 4-year-old child who stutters

Impaired verbal communication describes an inability to receive, relay, or process language. The reasons for this can range broadly from a language barrier to a physical barrier impeding speech. Conditions such as autism can cause developmental speech delays while a stroke can lead to a wide array of speech deficits.

Some impairments can be overcome with therapy and therapeutic devices while others may be permanent. The nurse supports the patient with impaired verbal communication by meeting them where they are. The nurse remains patient, always attempting to communicate effectively, and using any devices or techniques available to them.

Causes of Impaired Verbal Communication (Related to)

• Brain tumor or damage 
• Cleft palate 
• Auditory deficit 
• Physical barrier from tracheostomy or intubation 
• Language barrier 
• Developmental delay 
• Psychological barrier 
• Dementia 

Signs and Symptoms (As evidenced by) 

• Stuttering or slurring words 
• Refusal to speak/mute 
• Difficulty forming words (dysarthria) 
• Difficulty expressing thoughts (aphasia)
• Difficulty comprehending or maintaining communication 
• Inability to use facial or body expressions 
• Disorientation  
• Inappropriate verbalization (nonsensical speech, flight of ideas)

Expected Outcomes

• Patient will establish a method to communicate clearly to meet their needs 
• Patient will participate in speech therapy or other therapy to assist with effective communication 
• Patient will utilize devices and equipment to augment verbal communication

Nursing Assessment for Impaired Verbal Communication

1. Assess for conditions that affect speech.
Neurological conditions such as stroke, tumors, cerebral palsy, autism, or other hearing impairments can affect the patient’s ability to verbally communicate.

2. Evaluate mental status.
Psychological conditions such as schizophrenia, manic depressive, or bipolar disorders may disrupt speech as the patient may refuse to communicate or display rapid speech.

3. Assess for a language barrier.
If a patient does not communicate effectively or seems to refuse to communicate, ensure they are being spoken to in their native language.

4. Assess for aphasia.
Patients with brain injuries such as a stroke may have aphasia which is an impairment to either understand or express language. Those with Wernicke’s aphasia comprehend speech but the words they speak may not make sense or have meaning. Global aphasia causes the patient to not be able to express themselves or understand little to no spoken language.

5. Note physical obstructions.
The presence of a tracheostomy or endotracheal tube will impede the patient’s ability to speak.

6. Investigate if the patient communicates in other ways.
If a patient cannot or is hesitant to verbally communicate, assess if they use sign language or prefer to write or draw requests.

Nursing Interventions for Impaired Verbal Communication

1. Use aids and devices.
Assistive devices such as text-to-speech, TTY or TDD assists those with speech impairments. Picture boards and other apps can help children communicate.

2. Sign language.
Nurses can implement important words and phrases into their profession to communicate with patients. Commonly used phrases in the hospital such as “pain” “bathroom” or “water” can be useful to learn.

3. Use an interpreter.
An interpreter should always be used when communicating with a patient who does not speak the nurse’s language.

4. Pay attention to nonverbal cues and gestures.
Patients may have specific gestures or cues they use to communicate. It may take time for the nurse to learn what these are, but should be respected and reciprocated.

5. Display proper speech etiquette.
Never speak loudly at a speech-impaired person unless they are hard of hearing. Maintain eye contact and allow the patient to see your mouth, do not turn away when speaking. Give the patient plenty of time to respond.

6. Incorporate speech-language therapy.
Speech-language therapists can assist by using language and articulation activities for children. They can teach exercises to strengthen the mouth and tongue muscles and breathing exercises to help with resonance issues.

7. Involve the family.
Family members often know how to best communicate with the patient and can teach the nurse what the patient is trying to say. Though the nurse should always speak directly to the patient, they can ask the family for assistance to clarify information.

8. Try short questions with short answers.
Patients who have difficulty forming words or who are aphasic may require longer to process speech and respond. Try sticking to shorter questions and allow plenty of time to respond. Do not ask multiple questions together. Asking questions that only require a “yes” or “no” answer may be best when possible.

9. Continue speaking to the patient even if they can’t respond.
Patients with a tracheostomy or physical barrier or who have dysphagia or dementia should still be spoken to as a person.

10. Hang signage and document accordingly.
Once the best form(s) of communication have been discovered, document in the chart and hang signage so other staff members are aware of how to best communicate with the patient.

References and Sources

1. American Heart Association. (2018, December 4). Types of Aphasia. American Stroke Association. Retrieved December 15, 2021, from https://www.stroke.org/en/about-stroke/effects-of-stroke/cognitive-and-communication-effects-of-stroke/types-of-aphasia
2. Assistive Devices for People with Hearing, Voice, Speech, or Language Disorders. (2019, November 12). NIDCD. Retrieved December 15, 2021, from https://www.nidcd.nih.gov/health/assistive-devices-people-hearing-voice-speech-or-language-disorders
3. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
4. Rowden, A. (2021, January 5). Speech therapy: For adults, kids, and how it works. Medical News Today. Retrieved December 15, 2021, from https://www.medicalnewstoday.com/articles/speech-therapy

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