The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [163]
Preprocedural considerations
Equipment
Communication aids
Communication aids or equipment are referred to as augmentive or alternative communication (AAC). AAC may range from basic picture charts or books to electronic aids and computer programs and may support communication when the patient presents with a severe dysarthria or a severe expressive and/or receptive aphasia. Box 5.13 provides suggestions to facilitate realistic expectations and successful use of AAC.
Box 5.13 Suggestions to facilitate realistic expectations and successful use of AAC
An early referral to the speech and language therapist to assess the appropriateness of the use of AAC.
With the addition of any aid (no matter how simple or sophisticated), communication becomes more complex and difficult as it involves another step in the process, that is, changes from a two-way to a three-way process.
Patients need to be motivated to use aids.
The use of aids requires planning, extra concentration and time, listening, watching and interpretation by both patient and conversation partner.
Patients with various forms of communication difficulty
The person with aphasia
Principles table 5.10 Supporting communication for the person with aphasia
Principle Rationale
Be aware of where the aphasic patient is within their disease trajectory.
Be aware if the patient has impaired attention, concentration and/or memory. This will affect what you say and how you check for understanding. E
Minimize distractions – both visual and auditory. Make it easier for both parties to concentrate. E
Allow enough time, with a calm, friendly, encouraging approach. Develop and maintain rapport. E
Use a notebook to record key information. This minimizes miscommunication particularly if the information is new or complex, the patient is anxious or their memory function is impaired. E
Frequent signposting and checking understanding. To make sure the patient understands the purpose of the conversation. E
Talk directly to the patient and ask them what is/isn’t helpful.
Have a pen and paper for both people to use during the conversation. Writing or drawing can support what is being said. E
Speech should be clear, slightly slower and of normal volume.
Use straight-forward language, avoiding jargon. Medical terminology is inevitably long and complex but can be clearly written in the notebook for future reference. E
Say one thing at a time and pause between ‘chunks’ of information. Allow time for understanding and for questions. E
Structure questions carefully and make use of closed questions. Limit the need for complex expression. E
Regularly check the patient’s understanding.
Declare a change of topic clearly. It can be harder for some patients to recognize when the topic has changed. E
Be prepared for their and your frustration. You might have to come back to a topic at another time. Abilities may fluctuate, so what helps one moment might not work another time. E
The person with impaired speech (dysarthria)
The dysarthria may range from mild, slightly slurred or imprecise speech to being unintelligible (this is different from aphasia where language is not affected).
Principles table 5.11 Supporting communication for the person with dysarthria
Principle Rationale
Be encouraging but honest and open if you are having difficulty understanding. This allows the patient to repeat things or express things in another way that may be more understandable. E
Ask if they use any strategies to help their speech. Patients may well know what helps most. E
Encourage a slower rate of speech and regular pauses. Ensure adequate breathing between words and phrases. E
Find a quiet environment to speak. Reduce distractions and make it easier to concentrate. E
Allow more