2.2.2: Barriers to effective communication

Language Barriers

If a patient’s first language is a different language than that of the HHA/PCA, speak slowly and clearly with short and simple messages. Consider using pictures or pointing to objects if it is difficult to explain or for the patient to understand certain words. For instance, if the patient is having trouble understanding when the HHA/PCA asks if he would like to use the bedpan, they could show or point to the bedpan to convey their message. If their patient does not speak their language at all, they should speak to their supervisor about using a translator to assist them and their patient to communicate while they provide care. In some instances, family members may be able to translate for the patient. A word of caution with using family members to translate is that the patient may not be able to tell them what he or she really wants or feels as they may not want to upset their family member if their wishes go against what their family wants.

Hearing Impairment

In patients who have a hearing impairment, meaning they have difficulty with hearing or are deaf, the HHA/PCA must be sure to stand directly in front of the patient so that the patient may see them during communication. If they have a hearing aid, check to make sure it is turned on, that the volume is high enough, and that the batteries are in good working order. Speak in a low, clear, and pleasant voice. Be careful not to shout or yell. Higher pitched tones such as yelling are not effective in helping a person hear. Even if the person can’t hear what is being said, they will feel as if they are being yelled at by the body language they see. Be cautious to not become frustrated as a patient will pick up on all nonverbal communication.

Visual Impairment

If a patient has a visual impairment, do not forget that voice is not the only part of the conversation. It is important that they be able to see body language and facial expressions in order to understand the full effects of the message. If a patient wears glasses, be sure they are on and that the lenses are clean. In patients who are legally blind, Home Health Aides/Personal Care Aides should be careful to let them know where they are in relation to them and explain in detail any information that they could not pick up on without seeing. For example, if they are reading to a patient who is legally blind and there is a picture they cannot see, they should explain to the patient the picture in detail so that they can see it with their mind’s eye. When serving meals to a patient who is legally blind, they should place eating utensils where they can reach and tell them where they are in relation to their hands. Use the clock method to let them know where their food is. For example, “Mrs. King, your mashed potatoes are at 6:00.”

Aphasia/Speech Impairment

Sometimes people have speech impairments that make it difficult for them to send messages so that others can understand. Aphasia is a language disorder in which a patient has difficulty understanding or expressing language. People can develop aphasia as a result of a stroke, brain injury, or dementia. Listen very carefully to what a patient is trying to convey. Home Health Aides/Personal Care Aides should ask them for clarification if they are not sure of a word. They should not just nod and agree if they do not understand what they have said. It is just as, and perhaps even more frustrating for them to feel misunderstood or not heard as it is for Home Health Aides/Personal Care Aides to have trouble understanding their patient. In some instances, alternatives to voice may be used as effective means of communication. These can include white boards, chalk boards, and note paper so that the patient may write down what they wish to communicate. Providing these materials to the patient lets them know that the HHA/PCA cares about what they have to say and wants to ensure their needs are met.

Cognitive Impairment

If a patient has a cognitive impairment, meaning that they have difficulty processing (understanding) information, take extra time when explaining something to them. They may need a longer period of time to try to understand the message being sent. Avoid long sentences. Use shorter, simple ones. Allow time for the patient to process what was said before moving on to the next sentence or topic. Check with the patient to make sure they understand. Sometimes people will agree with someone even if they do not understand, as they may be embarrassed or do not want you to become frustrated with them. Remember to be patient and kind. Home Health Aides/Personal Care Aides must watch their tone of voice, facial expression, and body language, as these all convey their true feelings.

Yes/No Questions

Yes and no questions tend to shorten a conversation. For example, if Home Health Aides/Personal Care Aides ask a patient, “Does it hurt?” their response will be either yes or no. If they respond yes, they are still unsure about the meaning and extent of the pain. If instead they ask, “Tell me about your pain,” they are opening the lines of communication for the patient to be descriptive about their pain. This makes it more likely that they will understand how their patient feels and will be able to care for them properly. Asking a patient, “How many children do you have?” results in a shorter conversation versus, “Tell me about your children.” Try to use open–ended questions in order to allow the patient the chance to speak in more depth. Open-ended questions will show the patient that what they have to say is important. Closed–ended questions such as yes/no questions end the conversation quickly and demonstrate to the patient that their thoughts are not important.

Asking “Why?”Questions

Asking “why?” when a patient makes a statement is another way to quickly end a conversation. It also could make the person feel defensive. If a patient does not want to do something, such as take a bath, don’t simply ask, “Why?” Say something instead such as, “You usually enjoy your bath. Tell me how you are feeling today.” The patient may then be more likely to share their thoughts and feelings.

Use of Clichés

Clichés are catch phrases people use repeatedly that do not really mean anything at all. People tend to use clichés when they are unsure of what to say. The use of clichés, especially when someone is trying to convey their feelings is a sure way to end a conversation. Home Health Aides/Personal Care Aides should try to avoid using clichés such as, “Oh, it will be alright,” “Things will get better,” “I know just how you feel,” or “We are never given more than we can handle”. Phrases, or clichés, like these tend to end conversations. They can also make a person feel patronized or as if you are treating them like a child.

Using clichés conveys to the person with whom you are speaking that you do not want to explore their true feelings. You can never guarantee an outcome such as a patient getting better, so be cautious to not say that they will get better. Home Health Aides/Personal Care Aides cannot truly understand how their patient feels as they have not walked in their shoes. Instead, they should try phrases such as, “I understand that this seems scary for you. What can I do to make you feel more comfortable?” or “You seem very anxious right now. Tell me how you are feeling.” This allows their patient the room to explore their thoughts. It also demonstrates that they care about how the patient feels. Be cautious too, with using clichés as they tend to be culturally relevant, meaning they do not have the same meaning from one culture to the next.

Self Check Activity \(\PageIndex{1}\)

True or False

1. To help improve communication between a HHA/PCA and a patient, ensure eyeglasses are on and hearing aides are in if the patient wears them. ________

2. It is okay to tell a patient, “Things will get better”, “Don’t worry” and “I know how you feel” to help them feel better and to cheer them up. _______

3. Using closed-ended questions such as ‘yes/no’ and ‘why’ questions will help to encourage a patient to express themselves. ________

4. Providing patients with a chalkboard or paper and a pen can be a useful way to help them express themselves if they have trouble with speech. _______

5. It is important to be patient and to watch nonverbal communication cues such as tone of voice and body language when communicating with a person with a speech or cognitive disorder.

Answer

1. True

2. False

3. False

4. True

5. True

Feedback:

1. It is important to ensure a person with a visual or hearing impairment can communicate with others as well as possible. Ensure patients who need them have glasses on and hearing aids in to best help them communicate with others.

2. Telling a patient not to worry and that “Things will get better” are uses of clichés. Clichés are catch phrases people use repeatedly that do not really mean anything at all. They discount what another person is feeling and discourage them from fully expressing their feelings and thoughts.

3. Closed-ended questions such as “yes/no” and asking many “why?” questions are ways to end conversation and discourage a patient from fully expressing their feelings and thoughts. Instead, use open-ended questions such as, “Tell me about your pain.”

4. Providing alternative forms of communication such as a chalkboard or paper and pen may help a person who has difficulty speaking communicate their needs to others.

5. People with a speech or cognitive disorder may be especially aware of body language being used by people with whom they are communicating. It is important to be aware of nonverbal messages such as tone of voice and posture that you send during communication.