Assessing the communication needs of clients

Remember that assessment of the activity of communicating is only part of a holistic nursing assessment and should not be undertaken in isolation without reference to or consideration of the client’s other activities of living.

The specific points to consider when assessing a client’s ability to communicate include:
• Physical
Are their senses intact?
Do they have any disorder or diseases affecting their sensory organs, for example laryngeal palsy, tinnitus, cerebral vascular accident (CVA)?
Are they able to hear satisfactorily?
Do they require any hearing aids? Are these functioning?
How does the individual normally communicate: do they lip read, sign or Braille or use any speech aids such as a possum, robot or speaking tube?
Do they have any speech impediment or impairment?
Are they able to gesticulate, show affection or distaste?
Can they control pitch and/or tone?
Can they see satisfactorily or do they have/need spectacles or contact lenses?
Can they read and/or write?
Is their cognitive ability impaired?
Are there any physiological signs of nervousness, for example dilated pupils, tremor, perspiration?

• Psychological
Are they worried, nervous or frightened?
Are they depressed, anxious or excitable?
What is their level of intelligence?
Can they understand complex language?
What is their range of vocabulary?
Are they self-confident/timid?
Do they seem angry or upset? Are there any signs of actual or potential aggression or violence?

• Sociocultural
What is their first language or mother tongue?
Do they possess a second or third language and if so how fluent are they?
Do they understand the local dialect and colloquialisms?
Are there any cultural issues surrounding communication and body language, for example social status, eye contact, proximity or touch?
Do they use any unfamiliar jargon or abbreviations?
Do they need an interpreter?

• Environmental
Is the environment too hot, too cold or poorly ventilated?
Is it too light or too dark?
Does the client prefer a quiet environment or do they prefer background noise?
Do they wish to communicate in a more private place or are they happy to discuss issues at the bedside in hearing distance of others?
Are there any physical barriers to communication, for example furniture arrangement, size or type of room?
Is the environment safe for client, self and others should the client become aggressive or violent?

• Politico-economic
What communication channels does the individual use or prefer, for example telephone, newspapers, TV, email, Internet?
Is the individual computer literate?
Are they familiar with their rights/responsibilities, for example Data Protection Act?

Some of the barriers to effective communication are listed below:
• Failing to undertake a holistic assessment
• Failing to establish or explain the purpose of the interaction
• Failing to listen
• Failure to establish an environment of warmth and acceptance
• Personality, for example a person who is shy or introverted or, conversely, one who is domineering
• Lack of trust
• False reassurance
• Physical state, for example too tired or in too much pain
• Layout of furniture, for example sitting behind a desk or table
• Emotional state, for example too angry to listen
• Stress; seeming to be too busy
• Lack of privacy
• Visual impairment
• Environmental noise
• Hearing impairment
• Preoccupied
• Personal attitudes and values
• Status
• Religious/cultural beliefs
• Culture of the ward/institution
• Using closed questions inappropriately
• Using inappropriate language, colloquialisms and jargon
• Using leading questions inappropriately
• Misinterpreting or failing to clarify the essence of what has been or is being said
• Inappropriate use of facts
• Interrupting
• Not saying what you really mean
• Mode of dress, for example uniform, ‘grunge’-look
• Standing over the person rather than being on the same level
• Missing verbal and non-verbal cues and inferences
• Giving advice
• Changing the subject
• Finishing sentences for clients
• Minimizing the other person’s feelings
• Using trite expressions
• Jumping to conclusions
• Prolonged silence
• Probing.