Impaired Verbal Communication | Nursing Care Plan for Ventilatory Assistance

Nursing diagnosis: impaired verbal Communication related to physical barrier, such as ET or tracheostomy tube; neuromuscular weakness or paralysis

Possibly evidenced by

Inability to speak

Desired Outcomes/Evaluation Criteria—Client Will

Communication: Expressive Ability

Establish method of communication in which needs can be understood.

Nursing intervention with rationale:

1. Assess client’s ability to communicate by alternative means.

Rationale: Reasons for long-term ventilatory support are various; client may be alert and be adept at writing (such as chronic COPD with inability to be weaned) or may be lethargic, comatose, or paralyzed. Method of communicating with client is therefore highly individualized. Note: The inability to talk while intubated is a primary cause of feelings of fear.

2. Establish means of communication, for example, maintain eye contact; ask yes/no questions; provide magic slate, paper and pencil, or picture or alphabet board; use sign language as appropriate; and validate meaning of attempted communications.

Rationale: Eye contact assures client of interest in communicating; if client is able to move head, blink eyes, or is comfortable with simple gestures, a great deal can be done with yes/no questions. Pointing to letter boards or writing is often tiring to client, who can then become frustrated with the effort needed to attempt conversations. Use of picture boards that express a concept or routine needs may simplify communication. Family members and other caregivers may be able to assist and interpret needs.

3. Consider form of communication when placing IV.

Rationale: IV positioned in hand or wrist may limit ability to write or sign.

4. Place call light or bell within reach, making certain client is alert and physically capable of using it. Answer call light or bell immediately. Anticipate needs. Tell client that nurse is immediately available should assistance be required.

Rationale: Ventilator-dependent client may be better able to relax, feel safe (not abandoned), and breathe with the ventilator knowing that nurse is vigilant and needs will be met.

5. Place note at central call station informing staff that client is unable to speak.

Rationale: Alerts all staff members to respond to client at the bedside instead of over the intercom.

6. Encourage family and SO to talk with client, providing information about family and daily happenings.

Rationale: SO may feel self-conscious in one-sided conversation, but knowledge that he or she is assisting client to regain or maintain contact with reality and enabling client to feel part

of family unit can reduce feelings of awkwardness.

7. Evaluate need for or appropriateness of talking tracheostomy tube.

Rationale: Client with adequate cognitive and muscular skills may have the ability to manipulate talking tracheostomy tube.