BASIC CONCEPTS

A communication deficit is an impairment in the abil- ity to receive, send, process, and comprehend concepts or verbal, nonverbal, and graphic symbol systems, as defined by the American Speech-Language-Hearing Association (ASLHA, 1993).In 2001, the World Health Organization (WHO)'s International Classification of Functioning, Disabil- ity and Health shifted away from a medical diagnosis model to a functional model (i.e., how the person with a sensory impairment functions in his or her everyday life).The degree of difficulty in com- municating is an interaction between the client's type of functional impairment, personal adaptability, and the health care environment (i.e., body factors, per- sonal factors, and environmental factors as stated in WHO's model).Communication deficits can also arise from the kind of sensory depri- vation that occurs in some agencies and units, such as intensive care units.Even when care is accessed, com- munication deficits interfere with the therapeutic rela- tionship and delivery of optimum care (Markov and Hazan, 2012).GOAL

Our primary nursing goal is to maximize our client's ability to successfully communicate and to interact with the health care system to ensure optimal health and quality of life.Severe cognitive and sensory deficits interfere with communication, decrease access to health care, and lead to feelings of frustration.Under this model, a communication disability definition includes any client who has any impairment in body structure or function that interferes with com- munication.Specifically, the client has a communica- tion difficulty because of impaired functioning of one or more of the five senses, or the client has impaired cognitive processing functioning.Two individuals can have the same sensory impairment but not be equally commu- nication disabled.These include deficits such as compromised hearing, vision, speech, language, or problems with cognitive processing (O'Halloran et al., 2012).Evidence shows us that when nurses are unable to understand them, clients with commu- nication disabilities become frustrated, angry, anxious, depressed, or uncertain.Many of these individ- uals report delays or difficulties obtaining health care.When working with these clients, you may need to modify communication strategies presented earlier in this textbook.Some clients become so frus- trated that they exhibit behavioral problems or even omit needed care.They may be congenital or acquired; they range from mild to severe.But other barriers may include staff's negative attitude or inability to adapt communication.Over- all, nearly one in six Americans has a sensory or com- munication deficit, which is nearly 50 million people (U.S. Department of Health and Human Services, n.d.).Assess every client's communication abilities.Improving access to care for these clients is one of the goals of Healthy People 2020.Any impairment of a client's ability to send and/ or receive information from health care providers may compromise his or her health, health care, and rights to make decisions.Each person compensates for his or her impairment in different ways.The client's deficit is one barrier.