3.9 Putting It All Together

Patient Scenario

Mrs. Rosas is a 76-year-old patient admitted to the cardiology floor with an exacerbation of congestive heart failure. The patient’s primary language is Spanish, and she has a limited understanding of English. The patient’s daughter reports that the patient has been experiencing increased swelling in her ankles and increased shortness of breath over the last three weeks. Her daughter also reports that the patient has noted unexplained weight gain. During the admission assessment the nurse attempts to collect additional information related to current symptoms, diet, and history. The patient nods in response to questions and converses quietly in Spanish with her daughter.

Applying the Nursing Process

Assessment: The nurse notes that the patient does not respond to questions appropriately and is unable to converse in English. She defers to her daughter to provide interpretation of questions and relay information.

Based on the assessment information that has been gathered, the following nursing care plan is created for Mrs. Rosas.

Nursing Diagnosis: Impaired Verbal Communication related to cultural incongruence as evidenced by inability to speak the language of the caregiver.

Overall Goal: The patient will use effective communication techniques.

SMART Expected Outcome: Mrs. Rosas will utilize interpreter services in order to receive information and express needs throughout her hospitalization.

Planning and Implementing Nursing Interventions:

The nurse will provide patient with interpreter services in order to facilitate patient communication. In-person interpreter or language line telephone services will be utilized to ensure that the patient receives information about her care. The nurse will eliminate distractions such as the television, hallway noise, etc., to decrease sources of additional stimuli in the communication experience. The nurse will communicate directly with the patient, utilizing appropriate eye contact, and nonverbal cues to enhance the communication experience.

Sample Documentation

Mrs. Rosas has impaired verbal communication due to limited English proficiency. She requires education regarding cardiac diet, fluid restriction, and exacerbation warning signs. Interpreter services have been utilized to ensure that communication and education needs are appropriate. Mrs. Rosas communicates freely through the interpreter and acknowledges understanding of the education that has been provided. 

Evaluation

During the patient’s hospitalization, Mrs. Rosas engages with staff through the use of interpreter services and actively participates in her own care.