1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Section 2: Overcoming Unique Communication Barriers Module 3: Overcoming Communication Barriers

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Topic Overview: Unique Barriers How can we communicate better with: –Children? –Teens? –The elderly? –The blind? –The hearing-impaired? –The speech-impaired?

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Age Barriers to Communication

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Age Barriers Communication concerns: –Young children –Adolescents –Geriatric –Caregivers How can you relate to their life experience?

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Communicating with Young Children Speak softly Sit at their level Treat them with respect Inform before you perform Talk throughout each step and give praise

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Communicating with Teenagers Speak as you would to an adult Respect their independence Obtain health information from them instead of a parent (they may be reluctant to be honest if a parent is present) Ask personal questions privately Allow silence so they can express opinions

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Communicating with Older Adults Reduce background noise Begin conversation with casual topics Keep sentences and questions short Allow them to answer at their own pace Explain findings in simple language Observe body language for understanding Speak plainly and have them repeat instructions

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Vision and Hearing Barriers to Communication

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Visually Impaired There are approximately 10 million blind and visually impaired persons in the United States. 1.3 million Americans are legally blind 5.5 million elderly are blind or visually impaired 55,200 children are legally blind

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Communicating with the Visually Impaired Greet them by name as soon as you enter the room Speak directly to them in a natural tone and speed Explain ahead of time the reason for touching Give clues that you are listening Explain and demonstrate sounds

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Communicating with the Visually Impaired (cont.) Make sure explanations are precise and thorough Notify them when you leave the room and when you return Feel free to use words that refer to vision Indicate the end of the conversation Ask if they need assistance before trying to help them

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Seating Patients with Visual Impairment Ask if they would like assistance Offer them your arm by tapping the back of your hand against the palm of their hand Relax and walk at a comfortable pace Pause when you change direction Once in the operatory, place the patient’s hand on the seat of the patient chair

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Hearing Impaired 1 of every 10 persons has significant hearing loss Presbycusis Everyone who lives long enough will develop some hearing loss 45% to 50% of persons 75 and older have some hearing loss

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Communicating with the Hearing Impaired Move closer to the person Never shout Reduce background noise Talk face to face and at eye level Do not wear a mask when explaining or asking questions Use a notepad to write out words Make sure the person understands you

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Speech Barriers to Communication

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Speech Impairment Difficulty with speech does not have anything to do with intelligence.

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Forms of Speech or Voice Impairment Dysarthria Aphasia Laryngectomy

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Dysarthria Speech problems caused by muscles involved with speaking or nerves controlling them Difficulty expressing certain words Slurred speech Speaking at a slow or rapid rate Drooling Limited tongue movement

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Dysarthria (cont.) Mumbling Abnormal rhythm Nasal or stuffy sound Chewing and swallowing difficulty

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Causes of Dysarthria Poorly fitting dentures Stroke Brain injury Severe alcoholism

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Aphasia Disorder from damage to language centers of the brain Trouble putting words in proper order in a sentence Diminished ability to understand oral directions, read, or write; or no ability to speak at all

22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Causes of Aphasia Stroke Gunshot Severe blow to the head Traumatic brain injury Brain tumor Alzheimer’s disease Transient ischemic attack

23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Voice Impaired Laryngectomy is the surgical removal of the voice box because of cancer Artificial larynx held against the neck transmits an electronic sound Esophageal voice is achieved by pumping air into the upper esophagus and releasing it Surgical voice restoration fits a prosthesis between the trachea and esophagus Silent mouthing of words

24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Communicating with Patients Who Have a Speech Impairment Book longer appointment times Speak directly to the patient Develop a tolerance for silence Do not talk while the patient is formulating a response Do not finish the patient’s sentences Establish a code for yes and no Use visual aids for explanations

25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Communicating with the Voice Impaired Give the patient plenty of time to speak Do not hurry the patient Ask the patient to repeat if you do not understand Watch the patient’s lips Never assume that the patient is playing a joke if you hear an electronic-sounding voice

26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Recap: Unique Barriers to Communication Providing patient-centered care involves learning to communicate effectively with patients even when unique barriers to communication are present. Unique communication concerns include: –Age barriers –Vision and hearing barriers –Speech barriers