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Communicationg with nonverbal patients can prove challenging for nurses who have limited time and often little experience dealing with a patient's unique medical condition and limitations.

The elderly woman sat silently in her wheelchair, staring out the window of the assisted living facility. Vascular dementia and Parkinson's disease had robbed her of her health and speech.

The past few days, the typically pleasant patient with a contagious smile had been agitated and combative. The facility's new charge nurse had alerted the attending physician, who prescribed the anti-psychotic drug Respiradol to calm her down.

However, later that day, the patient's daughter visited and expressed concern about her mother's sudden aggressive behavior. The daughter asked the charge nurse if her mother had been checked for possible infections. She hadn't. So the nurse called the physician and requested more tests.

The test results solved the mystery: The patient had a urinary tract infection that caused her a great deal of discomfort-pain that, because of her condition, she was unable to verbalize.

On their behalf

Communicating with nonverbal patients can prove challenging for nurses who have limited time and often little experience dealing with a patient's unique medical condition and limitations. Both juvenile patients with autism and developmental delays and adults who suffer from Alzheimer's, strokes and other neurological conditions often are unable to verbally pinpoint the cause of their pain or distress.

"It is especially crucial for nurses to serve as advocates for their nonverbal patients," said Cynthia Emmons, RN, of the Encephalogic Medical Group in Oxnard, Calif. "If they suspect that a doctor is off-base in their treatment plan, they need to speak up on behalf of the patient."

Effective communication with nonverbal patients is an issue of paramount concern to the Alzheimer's Association. According to a 2002 study published in the University of North Carolina's Annual Review of Public Health, the number of people living with Alzheimer's will double by the year 2050, even if major treatment breakthroughs occur before then.

"In the years to come, nurses will see a definite increase in the number of patients who are unable to verbally communicate," said Elizabeth Edgerly, Ph.D., area program director for the Northern California chapter of the Alzheimer's Association. Although patients with Alzheimer's and other dementia can communicate emotionally, they "gradually lose their ability to remember and use words," she said.

Edgerly and other staff at the association routinely offer in-services to physicians and nurses on how to better communicate with nonverbal patients. "If a patient [with a neurological condition] has a sudden cognitive or behavioral change, one of the first things to consider is an acute illness," Edgerly said. "With neurological diseases, you don't see abrupt changes with a patient's condition, so a sudden change signifies that something else is happening."

The association offers guidelines to health care providers on how to effectively work with nonverbal patients. It recommends speaking directly to patients and treating them with respect and dignity. It also suggests avoiding open-ended questions that can add to the patient's confusion and stress, and instead recommends asking specific questions that require a yes or no answer.

Edgerly also shows nurses how to recognize and interpret a patient's facial expressions, use gestures and visual aids and speak in short, simple sentences when explaining procedures and tests.

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