When communicating with a patient with a visual impairment which technique should the nurse use?

Qualifying as a registered nurse in Australia requires several years of higher education. A nurse's broad knowledge base then grows exponentially with every year of professional experience. Nurses play an integral role in the provision of quality healthcare and their expertise is highly valued across the community.

Table of Contents Show

Clear language for CALD and older patients
Calming toddlers and children
Defusing difficult situations
Communicating with families
Sharing patient information with other health professionals
Strategies for improving communication

However, all of this collective knowledge and experience would remain untapped if nurses didn’t have the skills to communicate effectively. Critically, nurses need to share important information with a multidisciplinary team responsible for the care of their patients. Additionally, they need to communicate sensitively with patients and families to establish connections, build trust and deliver optimal health outcomes.

A nurse with strong communication skills can make a significant difference to overall patient wellbeing. A nurse with high-level soft skills, including communication, brings much-valued sensitivity, dedication and empathy to improve individualised nursing care.

There are many ways nurses can modify their communication style to suit the situation and the needs of their patients. Here are some tips to be effective:

Clear language for CALD and older patients

Nurses may need to allocate additional time to explain procedures or medications to older patients or those from culturally and linguistically diverse (CALD) backgrounds. Clear, plain language is often necessary. As the Ausmed Guide to Communication Skills advises, “using complicated medical terminology, or ‘jargon’, isn’t a good way to talk to any patient, but it is particularly detrimental when speaking with the older patient.”

A family member will often take responsibility for managing the care of an older relative. In such cases, the nurse should try to include the older patient in any discussions relating to their care.

Calming toddlers and children

Paediatric patients can experience high levels of anxiety in a clinical setting and they don’t have the same coping mechanisms as adults. Nurses can assist by describing what is happening in age-appropriate language, empowering the child with a choice (such as choosing where they want to sit) and distracting with a toy or a story when appropriate. If the nurse needs to have a difficult or distressing conversation with the parents, this should take place away from the child.

Defusing difficult situations

Dealing with distressed or angry patients requires a high level of professionalism. Nurses need to ensure they’re not reactive when dealing with a patient who is aggressive or combative. Calm, positive language may de-escalate the situation. Nurses shouldn’t be disheartened by a negative encounter. According to the Ausmed guide, nurses need to be realistic in their communication goals. “Not every interaction has to be perfect. Communication evolves; be realistic with your expectations and be patient, yet motivated, to create small changes.”

Communicating with families

Families appreciate regular updates on the condition of their loved one. Sensitivity is particularly important in these situations. Nurses can assist by providing clear and comprehensive information while being mindful of the privacy rights of their patients.

When a large family group is present, it’s often best if one family member is appointed as the main contact, so the nurse and other healthcare professionals only need to convey key information once. This approach minimises the possibility of conflicting information circulating among the family group.

Interdisciplinary communication is now routinely facilitated via technology systems. These are designed to eliminate communication errors between doctors, nurses and other professionals involved in the patient’s care.

Of course, face-to-face communication between healthcare professionals is still a key aspect of multidisciplinary care. In these situations, it's important for nurses to be assertive and to represent the nursing or midwifery perspective while showing respect for the role and scope of practice of allied health professionals.

Strategies for improving communication

Look beyond verbal communication

As well as verbal communication, non-verbal and visual communication strategies can help nurses communicate effectively. Non-verbal communication is conveyed via body language, posture and gestures. Body language is critical when communicating with patients. Smiling, leaning in and maintaining eye contact reinforces verbal messages. Humour, when appropriate and natural, can also relieve tension and establish rapport.

When words and non-verbal communication conflict, people are likely to engage more with the non-verbal message. It’s imperative that verbal and non-verbal messages are aligned. Nurses can use ‘active listening’ techniques to enhance face-to-face communication. This can be as simple as having an open stance (no crossed arms) and nodding the head to indicate understanding.

Patients with a physical or cognitive impairment benefit greatly when visual communication tools are used to convey information. From printed sheets to the latest bedside tablet technology, these patients appreciate tools that allow them to absorb information at their own pace.

Utilise formal strategies

Across Australia, healthcare providers have implemented various formal policies to standardise the communication methods used by healthcare professionals in their organisation. These policies provide nurses with a solid framework, helping them meet their communication goals within a limited time period.

The BATHE technique, for example, prompts nurses to ask patients a series of open-ended questions. The acronym stands for Background, Affect, Trouble, Handling and Empathy. The BATHE technique is designed to take a maximum of five minutes, making it an efficient way to procure important information that may inform the care provided.

Similarly, the Teach-back strategy reminds nurses to ask patients if they have understood the information received. The patient is asked to repeat the information in their own words. This reveals any gaps in understanding and also encourages the patient to ask questions.

Formal strategies are particularly important during transitions of care when the risk of communication errors increases. This can lead to poor health outcomes, patient distress or inappropriate patient care.

Nurture intuition

While the use of formal policies and strategies is a fundamental necessity, nurses need to develop their own intuitive skills when communicating with patients and colleagues. Compassion, awareness and professionalism inspire trust in the nurse-patient relationship, ultimately leading to better outcomes for all.

Discover how a Master of Nursing from JCU Online can boost your communication skills and take your career to the next level. Get in touch with our Enrolment team on 1300 535 919.

Better patient outcomes usually come down to great communication.

Not assuming anything, being clear, empathetic, and speaking in layman's terms.

But, the challenge increases for eye health practitioners.

With 55 per cent of meaning communicated through body language, and only seven per cent through spoken word[1], it is imperative health professionals maximise their communication skills for blind and low vision patients.

Psychologist Courtney McKee, who herself has low vision, regularly sees clients who have had bad experiences in consulting rooms.

“Health professionals know their specialty so well, they can tell you the ins and outs of a condition, but sometimes forget how important good communication can be,” she said.

“Give the patient the control in a situation; address them, not their carer or family member; explain the examination process before you touch them; and provide good verbal instructions that they can understand.”

Caption: Psychologist Courtney McKee.

Here are simple tips to communicate better with blind and low vision patients:

Identify yourself Don't assume the person will recognise you by your voice. Eg. “Hi Donna, it’s Dr Smith. How’re you?” Similarly, say goodbye when you finish a conversation and indicate when you are leaving the room. Eg. “Hi Donna, I’m heading off now. See you soon.”
Talk to the patient, not their carer or family member Remember, they’re not deaf. Address the patient, and if they’re over 18, they should be the one making the decisions on their healthcare.
Continue to use body language This will affect the tone of your voice and give a lot of extra information to the person who is blind or has low vision.
Use everyday language Don't avoid words like "see" or "look" or talking about everyday activities such as watching TV or videos. Also use accurate and specific language when giving directions. For example, "the door is on your left", rather than "the door is over there".
Always ask first to check if help is needed Don’t assume you know better. Ask the patient if they would like some assistance. Don’t grab their arm, announce what you’re doing first. Eg. “Would you like to take my arm and follow me to the consulting room? I’ll walk you to the chair.”
Avoid situations where there is competing noise This is a good general consulting tip for sighted patients too. Noisy rooms are particularly distracting to patients as they can’t give their undivided attention. Tip: in particularly noisy environments, get the patient to repeat any directions you give so you are confident they have understood.
Announce what you are going to do When examining the patient, announce what they should expect. Eg. “Mrs Smith, I’m just going to use my hand to have a look at your left eye.”
Modify instructions to match the lived experience of the patient
For example, if the person has no central vision, they may not understand how to “look straight ahead”. So they may prefer you to direct them to move their eyes left, right, up and down until they are positioned correctly for the assessment.

After speaking to many patients going through consultations, Ms McKee said the best piece of advice she could give is refer people to support services early.

“Many say they wish their doctor had connected them with vision rehabilitation services early, either by speaking to them about these services directly, by training their reception staff to have this conversation, or by simply having written information (e.g. brochures) available in the waiting area.”

For more advanced help, the sighted guide technique is a good skill to learn when you greet people and assist them to move between the waiting room and your clinic room.

Vision Australia provides training in this skillset and can work with you and your reception staff.

Contact Vision Australia on 1300 84 74 66

For more tips in assisting patients with a vision condition, visit Vision Australia’s website information section.

[1] Mehrabian, A., & Wiener, M. (1967). Decoding of inconsistent communications. Journal of Personality and Social Psychology, 6, 109-114 & Mehrabian, A. (1968). Inference of attitudes from the posture, orientation, and distance of a communicator. Journal of Consulting and Clinical Psychology, 32, 296-308.