Communicating with patients who have cognitive impairments: simple language and checking understanding matter

Outline to guide the read

• Opening: caring communication with patients who have cognitive impairments is a two-way act—clarity plus respect.

• Core idea: use simple language and check for understanding frequently.

• How to do it: practical strategies like teach-back, open-ended questions, visuals, and pace.

• Pitfalls to avoid: jargon, rushing, limiting conversation, and ignoring patient concerns.

• Real-life moments: quick dialogue snippets that feel authentic and helpful.

• Tools and tips: plain-language resources, SBAR for team notes, and teach-back techniques.

• Culture and family: honoring language preferences and including loved ones when appropriate.

• Takeaway: small, patient-centered steps build trust, safety, and better care outcomes.

The cornerstone: speak plainly, check back, and listen deeply

If you walk into a room with a patient who has cognitive challenges, you’re doing more than delivering information. You’re creating a space where the person feels seen, safe, and involved in their care. The guiding rule is simple: use language that matches what they can process, and keep checking that you’re on the same page. That means avoiding medical slang, slowing your pace, and inviting the patient to participate in the conversation. It’s not about dumbing things down; it’s about meeting a person where they are, and that’s how dignity becomes a daily practice.

Plain language isn’t a gimmick; it’s a proven approach

Clear language is the backbone of effective communication. Think of it as reducing cognitive load—your words should be easy to grasp, not just easy to say. Here are a few practical shifts you can try:

• Use everyday words instead of medical terms. For example, say “high blood sugar” instead of “hyperglycemia,” unless the patient asks to hear the technical term.

• Make messages concrete and specific. “We’ll give your pill with a cup of water after you finish breakfast” is clearer than “You’ll take your medication in the morning.”

• Break information into bite-sized pieces. One idea per sentence keeps things tidy and easier to process.

• Pair words with a simple action or visual cue. A hand signal for “yes” or a pictured clock showing 2 PM helps bridge memory gaps.

The teach-back method: your ally in understanding

Here’s the thing: people can nod along while information slides by, and you might never know what they’ve actually absorbed. Teach-back closes that gap. After sharing essential instructions, invite the patient (or their caregiver) to explain it back in their own words. Phrasing matters, but the spirit matters more:

• “Could you tell me what you’ll do next to take your medicine?”

• “In your own words, what should we monitor today?”

• If their understanding isn’t spot on, try again with a fresh phrasing: “Let me explain that a little differently, and you tell me if that makes sense.”

If you’re comfortable, you can also use a show-me approach: ask them to demonstrate how they would take a medication or prepare a snack. This isn’t testing them; it’s confirming mutual understanding.

Practical communication moves that actually work

• Pace and tone matter. Slow down a notch, and soften the cadence when a patient seems uncertain. Short sentences, warm pauses, and a calm voice can make a big difference.

• Ask open-ended questions. “What would help you feel more comfortable right now?” invites participation and reveals concerns you might not guess otherwise.

• Use teachable moments. If a patient misses a detail, acknowledge it without judgment and offer a clearer restatement. “That part was important. Let me try again with a different example.”

• Offer obvious choices when possible. Giving two simple options—“We can do X or Y; which would you prefer?”—supports autonomy and reduces anxiety.

• Use nonverbal cues. Maintain eye contact, nod to show you’re listening, and avoid crossing your arms. A gentle touch on the arm can convey empathy when culturally appropriate.

• Bring in visuals. Large-print instruction cards, picture schedules, or a simple pill chart can anchor the conversation in something tangible.

• Include family or caregivers when appropriate. They often help interpret and reinforce messages, as long as the patient’s preferences and privacy are respected.

What to avoid in conversations with cognitively impaired patients

• Jargon overload. If you wouldn’t use it with a friend, don’t use it with a patient.

• Rushing through essential details. Quick chatter can leave important points behind.

• Limiting questions to yes/no only. You miss nuance and the chance to catch misunderstandings.

• Assuming cognitive status equals incapacity. Ask, verify, and involve—every patient deserves that chance.

• Talking over the patient or dismissing concerns. That erodes trust and safety.

Real-life moments: short dialogue sketches

Scenario 1: Dementia with a caregiver present

Nurse: “I’m going to show you a small chart with three pictures: breakfast, meds, and your blood pressure check.”

Patient: (points) “Meds?”

Nurse: “Yes, we’ll give your medicine after breakfast.”

Nurse: “Can you tell me what time you think breakfast is around?”

Patient: “After coffee?”

Nurse: “That works—about after your coffee. What should we do if you forget?”

Caregiver: “We’ll remind you.”

Nurse: “Right. And we’ll remind together. So, after breakfast we’ll take your medicine. Could you show me how you’d take it with a sip of water?”

Patient: (takes cup, nods) “Water.”

Nurse: “Perfect. You’re doing great. We’ll do this together.”

Scenario 2: Delirium but cooperative

Nurse: “We’re going to check your blood pressure now, okay? I’ll tell you each step.”

Patient: “Okay.”

Nurse: “First, I’ll feel your arm gently.”

Patient: “Okay.”

Nurse: “Now breathe in, slow … and out.”

Patient: “Breathe.”

Nurse: “That’s it. After the reading, I’ll tell you what it means in plain terms.”

Patient: “Plain terms?”

Nurse: “Exactly. Your blood pressure is a little high, but we’ll keep an eye on it and adjust if needed.”

Scenario 3: Stroke survivor with speech changes

Nurse: “Let’s try a quick check of understanding. What helps you explain what you need after therapy?”

Patient: “My arm…”

Nurse: “Your arm is weak—yes. We’ll practice a simple way to tell us what you want. Show me with your finger two words: ‘hurt’ or ‘help.’”

Patient: (points to ‘help’)

Nurse: “Good. So, when you need assistance, you point to the word that fits. And if you’re unsure, you can tap the table once to ask for help.”

A few tools that help teams stay in sync

• Teach-back: a reliable way to confirm understanding across shifts and with different caregivers.

• Plain-language guidelines: a quick reference to keep language consistent and clear.

• SBAR (Situation, Background, Assessment, Recommendation): a concise framework for sharing patient information within the team, so everyone’s on the same page.

• Visual aids and accessible handouts: large print, high-contrast colors, simple step-by-step visuals.

• Interpreters and culturally sensitive care: when language is a barrier, don’t skip using an interpreter. Respect the patient’s cultural comfort zones and preferences.

The human layer: culture, respect, and patient rights

Communication isn’t just about tools or phrases; it’s about honoring a person’s dignity. Some patients rely on family members to convey details; others want to speak for themselves even if it takes a moment longer. The nurse’s tone should acknowledge effort, not speed. When you pause, you give space for thoughts to settle, for a memory cue to surface, or for a caregiver to translate a nuance you might have missed. And if a patient prefers a quieter presence, that preference deserves equal regard—privacy, comfort, and autonomy are not optional add-ons; they’re core to care.

What this means for your everyday work

• Start with plain language in every encounter, even when time is tight. It’s faster in the long run because it reduces questions later.

• Use teach-back routinely. It’s not a test; it’s a communication safety net that protects both patient and team.

• Watch for signs of confusion, fatigue, or frustration. A quick check-in can prevent bigger miscommunications down the line.

• Build a habit of including caregivers or family when that aligns with the patient’s wishes. They’re often the ones who help implement the plan between shifts.

• Use visuals and written cues to reinforce what you say. A simple diagram or a one-page reminder can be a lifeline when memory or processing is challenging.

Where to turn for guidance

• Plain-language resources and readability tips can be found through national health literacy initiatives and hospital toolkits.

• Teach-back guidance is widely used across clinics and hospitals to ensure information sticks.

• If you’re ever unsure, reach for a quick team huddle or a quick consult with a speech-language pathologist. Collaboration often reveals a solution you didn’t see alone.

A closing thought: it’s about shared humanity

Here’s the practical upshot: when you communicate with someone who has cognitive impairments, you’re not just exchanging facts. You’re inviting trust, reducing fear, and anchoring safety. You’re showing that you value the person enough to check for understanding, to offer choices, and to keep the door open for questions and concerns. The small acts—the patient-friendly phrase, the gentle pause, the teach-back question—these are the threads that weave a caring, competent care experience.

If you’re thinking about how to carry this forward in your own care routine, start with one concrete change today. Try replacing a sentence that’s full of jargon with a simple version. Then add a teach-back moment to confirm understanding. If you keep that rhythm—clarity, confirmation, care—you’ll notice the tone of your interactions shift: from instructions being handed down to conversations that empower, protect, and respect.

In short: speak plainly, listen actively, and verify understanding often. It’s a straightforward approach, but it carries a lot of weight. And when the goal is to help patients feel safe and involved, that weight becomes a powerful ally in every shift. Nurse’s Touch conversations thrive on it—where clarity meets compassion, and every patient leaves feeling heard.