Effective Communication

1. Effective Communication

2. Communication:exchange of information, thoughts, ideas, and feelings Verbal Non-verbal • Spoken words • Written communication • Facial expressions • Body language • touch

3. 3 essential elements: Sender Individual who creates a message to convey information or ideas to another person Message Information, idea or thought Receiver Individual who receives the message from the sender Feedback is a method that can be used to determine if communication was successful. Occurs when the receiver responds to the message Allows the original sender to evaluate how the message was interpreted and to make any necessary adjustments or clarification. Feedback can be verbal or non-verbal.

4. Elements of effective communication: The message must be clear (use of terminology by both parties; explaining procedures in lay terms) The sender must deliver the message in a concise manner (correct pronunciation and good grammar) the receiver must be able to hear and receive the message (heavily medicated patient won’t hear message; hearing/visual impairments; foreign lang.) The receiver must be able to understand the message (attitudes/prejudice; ask question to make sure message is understood) Interruptions or distractions must be avoided (talking while answering the phone; loud noises, uncomfortable temperature)

5. Communication process Listening Non-verbal communication • Paying attention to and making an effort to hear what the person is saying • Allows you to perceive the entire message that a person is trying to convey • Involves use of facial expressions, body language, gestures, eye contact and touch • Health care worker must be aware of both their own and patient’s nonverbal behavior

6. Barriers to communication • Something that gets in the way of clear communication • Three common barriers: • Physical disabilities • Psychological attitudes/prejudice • Cultural diversity

7. Barriers (continued) Physical disabilities Psychological • Deafness/hearing loss • Blindness/impaired vision • Aphasia/speech impairments • Caused by prejudice, attitudes and personality • Moralizing • Lecturing • Over-reacting • Arguing • Prejudging • Advising

8. Cultural Diversity Barriers (continued) • Beliefs regarding health care • Language differences • Eye contact • Ways of dealing w/ terminal illness and/or severe disability • Touch

9. Recording & Reporting Must record and report all observations while providing care Must listen to what patient is saying, but observe with other senses as well

10. Types of observation Subjective Objective • Cannot be seen or felt • Commonly called symptoms • Usually statements or complaints made by patient/resident • Report in exact words • Can be seen or measured • Commonly called signs

11. Recording/documentation • Written observations must be accurate, concise and complete as well as neat and legible • Spelling and grammar should be correct • Only objective observations should be noted • Subjective data that the health care worker feels or thinks should be avoided • Errors should be crossed out neatly with a straight line, have “error” recorded by them, and initials of the person making the error

12. Telephone communication • Do not give info about staff or residents over the phone • Place caller on hold if you need to get someone to take the call • Follow facility policy on personal phone calls • Be cheerful when greeting a caller • Identify your facility • Identify yourself and your position • Listen closely to caller’s request • Get telephone number • Say “thank you” and “good-bye”

13. Guidelines for good communication • Make sure hearing aids working well (batteries) • Reduce noise in room • Get resident’s attention before speaking • Speak slow, clear and in good lighting • Directly face person • Do not shout • Lower pitch of your voice • Do not chew gum • Keep hands away from face • Repeat using different words • Use picture cards or notepad if needed • Don’t get frustrated Hearing impairment

14. Make sure glasses are clean • Identify yourself and explain what your doing • Provide good lighting • Orient person to time and place if needed • Use the face of imaginary clock as a guide to explain the position of objects in front of the resident • Do not move personal items or furniture without the resident’s knowledge • Offer large-print newspapers/magazine • Use large clocks in room • Get books on audiotape Vision impairment

15. Stroke & communicationoccurs when a clot or a ruptured blood vessel suddenly cuts off blood supply to the brain • Depends on severity of stroke • Keep questions and directions simple • Phrase questions so they can be answered with “yes” or “no” • Agree on signals such as shaking or nodding head • Use pencil and paper if resident able to write • Never call weaker side “bad side” • Use picture, gestures or pointing (communication boards or special cards to aid communication work well) • Keep call signal within reach and let them know you will come when they need you

16. Combative residentcan result from disease process affecting the brain, frustration, or part of personality • Block physical blow or step out of way • Stay at a safe distance • Stay calm • Be flexible and patient • Be neutral • Do not respond to verbal attacks (don’t argue) • Do not use gestures that could frighten/startle resident • Be reassuring and supportive • Leave resident alone if you can safely do so

17. Angry behaviorDisease process, fears, pain and loneliness • Stay calm • Do not respond to verbal attacks – don’t argue • Empathize with the resident • Try to find cause of anger • Treat resident with dignity and respect • Answer call light promptly • Stay at a safe distance if resident becomes combative

18. Inappropriate Behavior • Includes sexual advances and comments; residents removing clothes or touching themselves (Illness, dementia, confusion and medication) • Don’t over-react • Try to distract resident • Notify the nurse • Problems may mimic inappropriate behavior: clothes too tight, rash, too tight, etc.

19. Documentation Observation, reporting & documenting

20. Nursing Process • The RN is responsible for achieving “patient focused care” (you learned this in Role of NA) • He/she coordinates and delegates to other caregivers • Consists of 5 steps: • Assessment • Collect data about patient/resident (interviews, records, family & physical examination) • Patient has surgical incision due to hip replacement • Problem identification • “nursing diagnosis” – statement of patient problem; provides foundation for nursing care • Rick for infection related to surgical incision

21. Nursing Process continued • Planning • Care of the patient - “care plan” – identifies possible solutions to the identified problem within scope of practice • Establishes goals for the patient • May be kept in a file or “kardex” • Assess for s/s of infection q4h • Implementation • Carrying out the approaches listed on the care plan to help patient reach the goal • Documentation q4h of assessment for infection in kardex • Evaluation • Ongoing; determines whether patient is reaching goals; can be extended if need and goals can be changed when condition changes • no fever noted on vital signs sheet, no drainage from surgical site, etc.

22. Admission • History/physical exam • Care plans • Doctor’s orders • Doctor’s progress notes • Nursing assessment (MDS) • Nurse’s notes • Flow sheets • Graphic record • Intake/output record • Consent forms • Lab/test results • Surgery reports • Advance directives Types of forms used in documentation

23. Check for right patient, room, form, & chart • Fill out completely • Correct color of ink • Correct sequence of events • Correct spelling • Correct entries (brief/accurate) facts/not opinions • DO NOT • Use “ditto” marks • Use term patient • Use white-out for corrections • Single line through error with initials Charting Guidelines “If it’s not charted, it’s not done” Purpose is to record patient care and prove accountability for care given

24. Military Time clock Facilities use 24-hour clock to reduce confusion in am/pm hours. To change hours simply add 12 to the original hour: 3 + 12 = 15 3:00 pm = 1500 hours Hours from 12:00am – 12:00pm are written as 00:01-1200

25. Accident or unexpected event that happens during care given • Feeding a resident from the wrong tray • Fall or injury to the resident • Accusation against a staff member by a family • State & Federal guidelines to fill out incident report documenting facts about what happened • State what happened, time, place, condition of resident • State facts, not opinions • Do not write in medical record • Describe action taken • Include suggestions for change Incident reports