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IMPAIRED COGNITIVE PROCESSING

Impaired cognitive processing ability can interfere with the communication process and leads to anxi- ety and confusion.COMMUNICATION DEFICITS ASSOCIATED WITH SOME MENTAL DISORDERS

Clients with serious mental disorders may have a dif- ferent type of communication deficit resulting from a malfunctioning of the neurotransmitters that normally transmit and make sense out of messages in the brain.The responsibility for assessing ability to understand, to give consent, and to overcome communication difficulties rests with both social ser- vices and health care workers.Because there is a significant increase in the prevalence of children with developmental disabilities, more nurses will be caring for them both in clinical agencies and in the community (Betz, 2012).In addition to illness-related com- munication problems, social isolation and impaired coping may accompany the client's inability to receive or express language signals.In some forms of schizophrenia there are alterations in the biochemical neurotransmitters in the brain, which normally conduct messages between nerve cells and help orchestrate the person's response to the external environment.Atypical communication is often the first behavioral clue to cognitive impairment in young children, associated with conditions such as mental.For example, children with Down syndrome, have been shown to judge nonverbal facial expressions more positively than other children, which could lead to a misinterpretation of the nurses'

messages.As an example, some clients with mental disorders can perhaps have intact sen- sory channels, but they cannot process and respond appropriately to what they hear, see, smell, or touch.Understanding involves receiving new information and integrating it meaningfully with prior knowledge.You need to continually determine the extent of your clients' understanding and even their ability to understand self-care activi- ties.Cognitively impaired older clients may have altered communication pathways.Other communication problems occur with dif- ferent mental disorders.retardation, autism, and affective disorders.

IMPAIRED COGNITIVE PROCESSING

Impaired cognitive processing ability can interfere with the communication process and leads to anxi- ety and confusion. Understanding involves receiving new information and integrating it meaningfully with prior knowledge. Clients with impaired processing ability have to work harder and require more time for conceptual integration. The responsibility for assessing ability to understand, to give consent, and to overcome communication difficulties rests with both social ser- vices and health care workers. You need to continually determine the extent of your clients' understanding and even their ability to understand self-care activi- ties. Assess their use of alternative communication aids (Gibson-Mee, 2011).

Children. Because there is a significant increase in the prevalence of children with developmental disabilities, more nurses will be caring for them both in clinical agencies and in the community (Betz, 2012). Atypical communication is often the first behavioral clue to cognitive impairment in young children, associated with conditions such as mental. retardation, autism, and affective disorders. As these children grow, subtle distortions in communication may exist. For example, children with Down syndrome, have been shown to judge nonverbal facial expressions more positively than other children, which could lead to a misinterpretation of the nurses'

messages. Older Adults. Cognitively impaired older clients may have altered communication pathways. Although most older adults retain their mental acuity, we need to assess risks. Memory loss, for example, can interfere with client ability to correctly take prescribed medications.

COMMUNICATION DEFICITS ASSOCIATED WITH SOME MENTAL DISORDERS

Clients with serious mental disorders may have a dif- ferent type of communication deficit resulting from a malfunctioning of the neurotransmitters that normally transmit and make sense out of messages in the brain. Thirteen million Americans have a serious, debilitat- ing mental illness (U.S. Department of Health and Human Services, n.d.). Some of these have communi- cation difficulties. In addition to illness-related com- munication problems, social isolation and impaired coping may accompany the client's inability to receive or express language signals.

Other communication problems occur with dif- ferent mental disorders. As an example, some clients with mental disorders can perhaps have intact sen- sory channels, but they cannot process and respond appropriately to what they hear, see, smell, or touch. In some forms of schizophrenia there are alterations in the biochemical neurotransmitters in the brain, which normally conduct messages between nerve cells and help orchestrate the person's response to the external environment. Messages have distorted meanings. It is beyond the scope of this text to discuss the psychotic client's management. Basic communications strategies are described.

Some clients with mental disorders present with a poverty of speech and limited content. Speech appears blocked, reflecting disturbed patterns of per- ception, thought, emotions, and motivation. You may notice a lack of vocal inflection and an unchanging facial expression. A "flat affect" makes it difficult to truly understand your client. Illogical thinking pro- cesses may manifest in the form of illusions, halluci- nations, and delusions. Common words assume new meanings known only to the person experiencing them.

ENVIRONMENTAL DEPRIVATION AS RELATED TO ILLNESS

Communication is particularly important in nurs- ing situations characterized by sensory deprivation, physical immobility, limited environmental stimuli, or excessive, constant stimuli (Figure 17-1). Nurses need to show concern for the client in bewildering situa- tions, such as emergency departments or intensive care units (ICUs). Clients may be frightened, in pain, and may be unable to communicate easily with others, because of intubation or other complications. Research indicates that the absence of interpersonal stimula- tion and the subsequent gradual decline of cognitive abilities are related. Clients with normal intellectual capacity can appear dull, uninterested, and lacking in problem-solving abilities if they do not have frequent interpersonal stimulation