COGNITIVELY IMPAIRED PATIENTS and RESIDENTS
At the end of this class, you will be able to:
- Define communication.
- Describe three kinds of
- Communicate with people who
have cognitive impairments.
Those who give care in the hospital, nursing home or
in a person's own home communicate with their patients and residents many times
every day. It is very important that we able to speak to and communicate with
those that we care for, even when they have a problem with their thinking, or
WHAT IS COMMUNICATION?
The purpose of communication is to send a message from one person to another.
This message can be sent with spoken words, by writing and with the person's
Communication can be:
- Oral, and
- Sent with body
Some examples of written communication are letters, notes and signs, like
the ones you see on the street.
Some examples of spoken, or oral, communication are:
- singing a song and
- watching a television
Body signs also send a message. When a patient has a sad face and their
teeth are tight together, they may be trying to tell you that they are in pain.
When a person grunts or taps their table with their hand, they may be trying to
get you to look at them.
Nursing assistants and others who take care of
patients and residents also send messages with body signs. For example, when
you stand in a patient's room with your arms crossed in front of you or on your
hips while you tap your foot on the floor, you are telling the patient that you
are in a hurry. You do not even have to say one word. The person may get your
message and know that you are in a hurry.
Communication has a:
- A sender of the message and
- A receiver of
Nursing assistants, and other people who take
care of patients and residents, must be able to send and get messages from the
people that they take care of.
The sender of the message must send the message
in a way that the receiver of the message understands it. Our patients must be
able to understand the message that we are trying to send to them.
We must also be able to understand a message that a patient or resident is
trying to send to us. We must be able to understand what our patients are
trying to tell us, even when they are confused and/or not able to speak. We
must also be a good receiver of the message.
Sending a message to a confused, sleepy or
unconscious person is not always easy. It takes special skills. It also takes
special skills to send a message to a person that has a mental problem or
It is also not easy to get, or receive, a message from a person that is
confused, sleepy or not alert and oriented. This, too, takes special skills.
WHAT IS A COGNITIVE IMPAIRMENT?
A cognitive impairment is a loss that makes it difficult for a person to send
message and/or to get a message from another person. It makes it hard for us to
communicate with the person with this kind of loss. The patient or resident is
not able to think, speak, understand and/or remember. It can last for only a
short time or it can last for a long time.
For example, some drugs can make a person not
able to speak to you or understand what you are trying to tell them while they
are taking a certain drug. For example, drugs that calm a person down can make
our patients not able to speak clearly. This loss may be just for a short
period of time. This person may be able to again think and speak clearly as
soon as this drug has been stopped. People with Alzheimer's disease, on the
other hand, have this loss for a long time. It will not go away. It will only
great worse as the disease continues. (Take our class on Alzheimer's disease to
learn more about it.)
Some groups of people who may not be able be able to
speak and/or understand a message from a nursing assistant include:
- young children and
- many old people.
These people may not be able to send a message
to you. They may also not be able to get a message from you. For example, the
older person may not be able to speak or understand your message. They may be
confused and not able to communicate because of their old age, an illness or
medicines. Young children and babies are also not able to talk with you. You
must use special skills when the patient or resident does not understand what
you are trying to say. At times, you should include the parent of the young
child or the family members of an older person in your talks with the patient
Some other people who may not be able to
communicate include those who have:
disease and other forms of dementia. Many people with Alzheimer's disease
and other kinds of dementia have trouble sending and receiving a message.
- had a stroke or
People that have had a stroke may have trouble thinking. Some may know
what they want to say, but they just can not find the word that will send
a message to other people. This is called expressive aphasia. They may
also have trouble understanding a message from other people. This is
called receptive aphasia.
- a brain injury. People that
have had an accident with a head or brain injury may have trouble both
sending and getting a message. They may also be disoriented and even in a
- a mental illness. People with
a severe mental illness may be unable to communicate because of their
illness or as a side effect of the medication that they are taking.
- a developmental
This kind of problem is found in about 1 in 10 families in our country. A developmental
problem can happen before a person is born, when they are born or while
they are growing up as a young child. Some of these people are not able to
talk or understand what a person is saying to them.
- severe sleepiness. It is
difficult to communicate with people that are very sleepy and lethargic.
We often see these kinds of patients in our hospitals and nursing homes.
- a coma state. You should
always speak to a person in a coma in the same way that you would speak to
them when they are awake, however, they may not understand what you are
saying and they will not be able to tell you what they want or need.
HOW TO COMMUNICATE WITH PATIENTS AND
RESIDENTS THAT HAVE COGNITIVE PROBLEMS
You must use simple, plain words that a person can understand when you
communicate. Do not use words like "hospital", "NPO",
"ambulate" or "void" if the person does not know what these
special healthcare words mean. You should say, "You can not eat or drink
anything after 12 midnight", instead of saying "NPO". You may
want to ask the person if they "would like to walk", instead of
asking them if they "would like to ambulate". Also, use the word
"urinate" or show the male patient the urinal, instead of using the
word "void" unless the person understands that word.
Some of the other things that you should do to
help when you communicate with a person who is cognitively impaired are:
- include the
family and friends in the communication when a patient or resident is not
able to understand what you are trying to say;
- ask the family
and friends how the person can be helped to communicate with you;
- speak in a plain
way, using words that are simple. For example, instead of asking if the
person is hungry, ask, "Would you like to eat some eggs?";
- talk to patients
and residents in a place that is quiet and that does NOT have a lot of
distractions. Turn off the radio and TV while you are talking to the
person, after you ask them if you can;
- make sure that the
person can see you. Turn on the lights if the room is too dark;
- keep the message
as short and simple as you can. Many people do best with short talks
rather than long ones with a lot of information at one time. It is better
to talk for a couple of short sessions, rather than one or two long ones;
- discuss one
thing at a time;
- repeat the
message as often as needed;
- ask one
question at a time and listen to or observe for the answer;
- draw pictures or write things
down for the person if this helps them understand what you are trying to
- let the
patient draw a picture or write things down for you if this makes it
easier for them to tell you what they want or need;
"yes" or "no" questions. For example, if you want to
know if a patient wants to eat fruit, ask "do you want an apple or a
pear?", instead of "do you want to eat
a piece of fruit?";
- use real objects
whenever you can. For example, show the person the real object, like an
apple, if you are asking the patient if they would like to eat it.
- speak slowly
and in a clear way;
- talk with a
low pitch, not with a high pitched voice;
- face the
person that you are talking to;
- make eye
contact with the person
- listen to the
- look at the
person's face. Is the person trying to tell you something? Do they look
like they are in pain? Are they holding a part of their body, like their
hand or their head? Do they look sad? Do they look angry?;
- give the person their
eyeglasses and hearing aid, if they wear them;
- always show
respect and caring; and
- communicate with touch
and a calm voice when you want to tell a person that you care and they can
not understand the spoken word.
Communication is a very important part of patient care. You must use the
special skills described in this class when your patient has a cognitive
impairment so that messages can be sent and received.
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Copyright © 2010 Alene Burke