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Have pen and paper to hand, and encourage writing when necessary. Provide another medium of communication. E

The person with impaired voice (dysphonia)

The dysphonia may fluctuate from a mild hoarseness to not being able to voice at all. Early referral to a speech and language therapist for assessment and advice on vocal hygiene may be required.

Principles table 5.12 Supporting communication for the person with dysphonia

Principle Rationale

Have pen and paper to hand, encourage writing when necessary. Provide another medium of communication. E

Encourage the patient to talk gently and avoid either shouting or whispering. This can strain the voice. E

Avoid having to talk where there is background noise. The individual would then need to strain unnecessarily. E

Face-to-face communication is preferable. Keep telephone calls to a minimum. The patient will then be able to use non-verbal communication to transmit their message. E

Encourage regular sips of water. To maintain hydration and keep the throat area moist. E

Use closed questions so the individual doesn’t need to make lengthy replies.

Discourage frequent throat clearing. Instead, encourage a firm swallow if possible or gentle throat clearing. Discourage lengthy responses to questions. E

Be aware if the room atmosphere is dry (placing a bowl of water beside the radiator will help humidify/moisten the air). A humid atmosphere is preferable to reduce local irritation. E

The person who is blind or partially sighted

Sight loss may vary from mild to complete. Any sight loss is a significant issue when caring for patients. They will rely more on other senses, especially their hearing. Good communication practice is essential and you may need to be the eyes for the patient and relay information they are not aware of, for example the patient’s visitor has arrived and is waiting. It is important to be open about the visual impairment and identify the preferred method(s) for each person. No single method will suit all. Even the same person might use different methods at different times and under different circumstances.

Blind and partially sighted people have the same information needs as everyone else and need accessible information in a suitable format such as large-print documents, Braille or audio information. Access to information facilitates informed decisions and promotes independence.

Principles table 5.13 Communication with someone who is blind or partially sighted

Principle Rationale

Always say who you are when you arrive. Normal cues are not available to the blind or partially sighted. E

In situations where there might be confusion as to who is being spoken to, use the patient’s name or a light touch when you are addressing them. As above.

Explain precisely where you are. So people can orientate towards you. E

Ensure glasses are clean and within reach.

Clear and careful explanations and checking understanding verbally are essential. We communicate a substantial essence of meaning non-verbally.

Blind people therefore do not receive this information so it is harder to gain full understanding. E

Indicate to a patient when you are leaving. Normal cues are not available to the blind or partially sighted. E

The person who is deaf or hard of hearing

As with blindness, the severity of the impairment will vary. If a hearing aid is used, make sure it is fitted and working. Remember that hearing aids amplify everything, even background noise. More severe hearing loss will not benefit from an aid and these patients might rely on lip reading and/or signing or writing.

Principles table 5.14 Communicating with someone who is deaf or hard of hearing

Principle Rationale

Find a suitable place to talk: somewhere quiet with no noise or distractions, with good lighting. Make sure that the light is not behind you. So the person can clearly see your face, and lip reading and expression can contribute to understanding. E,C

Be patient and allow extra time to for the consultation/conversation. It is likely to take longer than normal. E

Depending on