Communicating with Patients Who Have Developmental Disabilities

As a nurse, being able to communicate effectively with patients is crucial. But communicating with patients who have developmental disabilities may be more difficult at times.

Georgia Reiner, Risk Specialist, Nurses Service Organization (NSO), knows how to interact with these types of patients and answered our questions on what you can do to communicate with them better.

Why should nurses communicate differently with patients with developmental disabilities? When do they need to make sure that a parent or guardian is there?

People with developmental disabilities such as Down syndrome or who are on the autism spectrum face significant barriers to accessing quality care. Inadequate communication between the patient and health care providers is one of those barriers that can result in harm to the patient. Effective communication is the keystone for ensuring quality, patient-centered care for patients who have developmental disabilities. With skill and patience, nurses can help keep patients safe.

It is important to ask patients if they want their support worker or caregiver to stay with them.

What should nurses do to communicate better with these specific patients?

In order to communicate better with specific patients, nurses must establish the patient’s communication strengths and challenges and tailor their approach accordingly. Nurses need to document preferences in the patient’s health record so that they are accessible to all members of the team.

It is also very important for nurses to allow enough time to listen and understand that interactions may take longer. Nurses need to know that differences in muscle tone for some individuals may complicate reading their facial expressions or body language. Additionally, it is important to choose appropriate, concrete language. Explaining concepts clearly and directly while using specific words and visual aids can be very helpful.

How can they make sure that they are being clear while not “talking down” to these patients?

Nurses can make sure that they are being clear while not “talking down” to these patients by establishing rapport. They need to make sure that they are speaking directly to the patient—as opposed to a family member or caregiver—when possible. It is also important to avoid talking to an adult as if he or she is a child. Nurses should take time to assess the patient’s understanding and to validate their own perceptions to make sure they are understanding the patient. Nurses are encouraged to use the “teach-back” method to ask the patient to repeat the information back to them.

What are the most important concepts that nurses should keep in mind when communicating with these patients?

It is important for nurses to give patients with developmental disabilities exact instructions and explain what they are doing in sequence. Try to eliminate distractions where possible, by meeting in a private, quiet room.

Nurses should also avoid asking abstract questions, and instead be direct. For example, ask “Are you tired?” instead of “How do you feel?”

If the patient uses a communication device that you are not familiar with and the patient cannot show you how to use it, ask the caregiver to do so.

Let patients know they can bring a favorite item they like to have with them in order to help regulate sensory stimuli.

What should nurses never do while communicating with these patients?

Nurses should never shout; speak slowly, in a normal tone of voice.

Nurses should never assume that their body language and facial expressions will be understood. Respect differences in communication style. For example, many patients with autism spectrum disorder prefer avoiding eye contact.

Nurses should never touch a patient without telling them when and where before doing so. Act out or demonstrate actions for patients who prefer non-verbal communication.

What else is important for our readers to know about communicating with patients with developmental disabilities?

People with developmental disabilities deserve the best possible care from health care providers, including preventive health measures and appropriate management of health conditions. By being knowledgeable on how to effectively communicate with patients who have developmental disabilities, and practicing different communication strategies, nurses can become more confident, and provide patient-centered care. Through thoughtful communication and collaboration with caregivers, family, and the interprofessional team, nurses can help achieve the goal of optimal care—and optimal outcomes.

Nurses are only one segment of the interprofessional team, but they are frequently the strongest patient advocate. At the end of the day, working as a team, advocating for patients, providing information and education in the patient’s preferred communication style, and collaborating with caregivers and family members, can help nurses end the stigma of caring for patients with developmental disabilities and achieve the goal of optimal care and outcomes.