Nursing the patient with severe communication impairment (summary)



Good communication between hospital nurses and their patients is very important and the need for pre and post-qualification training in communicating with a wide range of patients is essential. This paper aims to get a better understanding of the experiences of nurses in communicating with patients who have severe communication impairment (SCI).

Patients who are unable to speak, either permanently or temporarily, have been found to experience anxiety and frustration because of difficulties in communicating with nurses.

There is evidence that communicative interactions between nurses and patients SCI are minimal and often ineffective.

The researchers look at possible reasons for this, how it could be improved and issues that were identified by nurses working with people with SCI.

What did the authors do?

Twenty nurses who had cared for at least two patients with SCI in the previous 12 months were interviewed using a standard set of questions that were developed by a working group made up of nursing professionals and people with communication impairment.

The nurses worked on a number of different ward types, but not intensive care, geriatric units that focussed on dementia or units focussing on laryngectomy or head and facial surgery.

The interview aimed to explore the nurses' views and of positive and negative experiences of issues related to communication.

What did they find?

The results are summarised under a number of different headings.

  • Most of the nurses reported they had had some training in a range of disabilities. Only half had had training on communicating with people with SCI and none had training from a speech and language therapist (SLT) about specific communication strategies.
  • None of the nurses were aware of hospital policies relating to communication.
  • Half of the responses showed frustration at lack of success in communicating with these patients and a lack of AAC strategies to help.
  • Many felt patients with SCI were either less cognitively able or more severely ill than patients without communication impairment.
  • When communication was successful more than half of the responses included the use of an AAC strategy, including sign/gesture, alphabet boards or communication aids. Other strategies included giving time, seeking help, a quiet environment and the need to devise a system of communication jointly with the patient and SLT.
  • The nurses had a number of strategies to facilitate interactions, such as being aware of the patients' non-verbal cues, establishing a way of indicating 'yes' and 'no', and repeating back what had been understood to be sure it was correct.
  • Most nurses described caring for patients with SCI as either 'difficult' or 'very difficult', mainly due to the increased time needed.
  • 19 of the nurses believed that SCI could affect the patients' recovery and might increase the length of a hospital stay.
  • Sometimes nurses were informed about a patient having SCI in advance of admission, but usually without specific information. It was felt that more detailed information about how the patient communicated would be useful on admission, together with advice on AAC systems from an SLT.
  • The importance of good information, verbal, written and demonstrations, at shift handover were identified as important.
  • The nurses were familiar with a number of AAC systems and thought these should be provided by therapists in hospitals, but also perceived the role of the SLT to be to deal with swallowing problems.
  • There was a lack of interdisciplinary working in developing AAC systems which led to problems in its use, including a lack of appropriate vocabulary and difficulty positioning equipment appropriately.


The sample of nurses interviewed was small and they were all from the same city. In addition they were not randomly selected, but although their nursing experiences were varied their responses were quite consistent.


The nurses identified several possible strategies to improve care for patients with SCI, particularly the need for training in the use of AAC and better access to AAC systems.

Things you may want to look into:

Nurses' perceptions of communication training in the ICU 

SPEACS-2: Intensive Care Unit 'Communication Rounds' with Speech Language Pathology 

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication 

Communication boards in critical care: patients' views 

Added to site September 2014