APPLY EFFCTIVE COMMUNICATION SKILLS IN NURSING Practice

INTODUCTION:
I am going to talk about Cerebral Palsy which is a nervous system disorder.
In this disorder clients have dysarthria, a speech impediment, that makes it difficult for them to communicate. In nervous system the ability to communicate may be impaired by factors that include:

* Damage to the speech centres in the brain, * Damage to the temporal lobes, which hinders the perception and interpretation of stimuli, * Damage to the cranial nerves responsible for movement of the lips, tongue, pharynx and larynx, * Limited motor function that hinders non-verbal communication gestures, * Visual or hearing deficits, * Altered levels of consciousness or mental status. ( Maureen farrell et al:(2005) Australia, Medical Surgical Nursing “Neurological Function” (see pp1896-1910), * Funnel, koutoukidis, et al:(2005) Australian, “Neurological Health” (see chapter 43, pg745).

CEREBRAL PALSY:
Cerebral Palsy comprises a group of neuromotor disorders resulting from prenatal, perinatal or postnatal cerebral hypoxia or damage. Thesedisorders is highest in premature infants or in infants who have experienced a difficulty birth resulting in cerebral damage. There are three common types of cerebral Palsy, although some individual may have symptoms of more than one type. The three types of cerebral palsy are spastic, athetoid or dyskinetic, and ataxic.

CEREBRAL PALSY IN ADULTS:
Children with special needs grow into adults with special needs. The parents of these children pursue structure and focused therapy in order to prepare them for their adult life. Once early adulthood is reached these children face adult issues which most of them are universal to men and women, but others are gender specific. Some of the more common hurdles that adults with Cerebral Palsy face include: nutrition, women's issue, exercise, communication, medical and detal care.

RISK FACTORS OF CEREBRAL PALSY INCLUDE:

* Chromosomal abnormalities, * Prenatal factors such as maternal infections, exposure to harmful chemicals or mulnutrition, * Perinatal factors such as premature birth or instrumental delivery causing cerebral anoxia, Postnatal factors such as trauma, infection or malnutrition causing cerebral damage.

CEREBRAL PALSY SYMPTOMS: * All forms of the cerebral palsy disorder carry the symptoms of irregular muscle tone, reflexes, posture, coordination and motor development. These conditions often manifest themselves as;

* Spasticity (the condition of certain muscle in the body being continuously contracted), * Paralysis ( a loss of muscle function), * Seizures (temporary convulsions), * Dysarthria (speech impediment), * Stiffness of the limbs, * Bladder control problems, * Impaired tonque movement.

CEREBRAL PALSY SCREENING:

* Revised Denver Pre-screening Development Questionnaire (R-DPDQ) - * Early Motor Pattern Profile (EMPP) – checks for muscle tone, reflex, and body movement problems, * Testing for Motor Milestones. It involves checking if the baby has motor skills appropriate to its age, * Ultrasound, * Computer Tomography (CT scan), * Magnetic Resonance Imaging (IMI). ( Maureen farrell et al:(2005) Australia, Medical Surgical Nursing “Neurological Function” (see pp1896-1910.

EFFECTS THIS CONDITION MAY HAVE ON COMMUNICATION:
In this disorder the ability to communicate may be impaired by factors such as damage to the speech centres in the brain, damage to the cranial nerves responsible for movement of the lips, tongue, and range of motor deficits which make the patient to experience sensory deficits such as speech, visual or hearing impairment. The above factors may affect the ability of patient to express himself verbally or non-verbally, and ability to understand the spoken words or written word.

The loss or impairment of the ability to communicate is devastating and frustrating to the patient and to their significant others, often resulting in fear and depression, so it is important for adults with this disorder to maintain open communication lines with people around them. Speech therapist is involved in the treatment of a client with a communication problem, the nurse must be aware of prescribed therapy so that it can be continued when the speech therapist is not with the patient. It is important for the nurse to assume a calm, reassuring and supportive manner that conveys a sense of acceptance of the patient’s behaviour. (Cerebral Palsy Website; ( Maureen farrell et al:(2005) Australia, Medical Surgical Nursing “Neurological Function” (see pp1896-1910),

ROLE OF SPEECH THERAPIST:
The speech therapist is involved in the client goal-setting process, assessing, diagnosing and treating communication disorder, such as the formation and perception of speech, the ability to articulate words, understand and initiate speech. The speech therapist works closely with the nurses and the family to achieve effective communication strategies for the client. A speech therapist may also be involved in the management of an individual whose chewing and swallowing abilities are impaired, for example, after a cerebrovascular accident. The speech therapist liaises closely with the nurse, dietician and the family to achieve safe swallowing strategies for the client. (Funnel, koutoukidis, et al. (2005) Australian, “Rehabilitation Nursing” chapter 48, pp 871-872)

STRATEGIES THAT HEALTH PROFESSIONAL'S MAY USE TO FACILITATE COMMUNICATION IN THIS TYPE OF SITUATION INCLUDE:

-Consulting with speech therapist to assist the client to relearn communication skills and implement communication strategies that can be continued by the health professional, family and significant others when she/he is not with the client. -Providing alternatives methods of communication such as; -Using pad and pencil, alphabet letters, hand signals, eye blinks, head nods bell signals. -Making flash cards with picture or words depicting frequently used phrases (e.g. “Wet my lips,” glass of water, bedpan), -Encouraging the client to point and use gesture and pantomime, -Use of communication skills such as active listening, asking questions and clarifying. Active listening skill requires attention and concentration, to hear not only the words but the feelings or meaning that are often hidden behind the words. Nurses can demonstrate readiness to listen by reducing environmental distraction and adopting a posture of involvement such as -Sitting at a comfortable distance away from the client, an open relaxed posture, facing the client and making eye contact. -Asking open and closed questions to gain information from the client, -Clarifying to gain understanding of what the client has said. - Encouraging the client to make a conscious effort to slow speech down and to speak louder (e.g., “Take a deep breath between sentences.”), - Asking the client to repeat words that are unclear, - If speech is unintelligible, to teach the client to use gestures, written messages, and communication cards, - It is important not to alter my speech, tone, or type of message, because the client's ability to understand is not affected; to speak on an adult level, - Educating family on these strategies so that they can be able to communicate with their loved one. (Funnel, koutoukidis, et al: (2005) Australian, “Communication” chapter 31, pp446-452).

REFERENCES

Funnel, koutoukidis, et al:(2005) Tabbners nursing care; 4th Ed;Churchchill Livingstones; NSW; Australian,“Neurological Health” (see chapter 43, pg745) Rehabilitation nursing (see chapter 48, pp 871-872), “Communication” (see chapter 31, pp. 446-452). Maureen Farrell et al. (2005) Medical Surgical Nursing Australia, “Neurological Function” (see pp1896-1910).

Cerebral Palsy (accessed June 21/09, 8.56PM). http://www.resource4cerebralpalsy.com/topics/whatiscerebralpalsy.html Cerebral Palsy Image (accessed June 22/09, 9.56PM). http://www.thankyoubrain.com/practicalemoryResearch.htm Flash CardS Image . http://www.google.com