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Module 3

Module 3. Communication & Interpersonal Skills. Maslow’s Hierarchy of Needs. Levels build upon each other Lowest level- Physiological Second level – Security Third level – Belonging Fourth level – Esteem Fifth level – Self Actualization.

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Module 3

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  1. Module 3 Communication & Interpersonal Skills

  2. Maslow’s Hierarchy of Needs • Levels build upon each other • Lowest level- Physiological • Second level – Security • Third level – Belonging • Fourth level – Esteem • Fifth level – Self Actualization

  3. Recognize/Report Behaviors Reflecting Unmet Human Needs • Physical Needs unmet: • Irritable, cold, weak, c/o hunger or cold • Changes in VS & LOC • Psychological Needs unmet: • Anxious, depressed, aggressive, angry • Physical ailment with no apparent cause • Expresses feelings of loneliness & worthlessness • Unmet needs may result from illness, disease,or injury, but may also contribute to development of illness

  4. CNA Response to Behavior • Look beyond the behavior – rude, uncooperative, demanding • Remember there is an underlying need for comfort & understanding • Respond with patience, caring, sympathy, concern, kindness, empathy • If problem continues, ask licensed nurse

  5. Communication • Definition – sharing of ideas, thoughts, information, & feelings with at least one person, even if unspoken • Therapeutic communication – used to promote optimal wellness • Routes • Internal senses – see, hear, touch • External senses – spoken, written, gesture

  6. Steps in Communication • Message • Sender • Receiver • Interpretation • What happens when you play the telephone game?

  7. Methods of Communication • Verbal – the spoken word • Nonverbal – most honest • Conscious vs. unconscious • Body language • Touch • Written – red dots, name tags, uniforms, falling stars • Electronic – devices to create sound, computers, touch pads

  8. Reasons for Communication Breakdown • Verbal barriers – • Criticism • Value statements • Interruptions • Judgment • Language differences • Changing subjects • Excessive talking • Pat answers – “Don’t worry, I know how you feel”

  9. Communication Breakdown • Non-verbal • Body language • Eye contact • Cultural differences

  10. Communication Breakdown • Physiological/aging factors • Hearing loss • Vision loss • Response time • Medications

  11. Communication Breakdown • Not listening • Lack of concentration – preoccupied, distracting noises, monotone voice, negative attitude • Selective hearing • Emotional response to word/situation

  12. Effective Communication Skills • Introduce self • Call person by formal name or request • Explain all tasks • Use short sentences, ask for feedback • Eye contact • Speak clearly, avoid criticizing • Clarify information • Use words that are understood • Friendly/positive tone • Ensure confidentiality

  13. Effective Communication for Special Needs • Language/cultural differences • Ask for INTERPRETER • Know cultural beliefs – word use, gestures, touching • Visually impaired • Describe surrounding • Identify self, don’t touch until they’re aware • Explore room with resident, don’t rearrange • Explain, let resident know when finished • Keep doors open, don’t speak loudly • Monitor meals

  14. Effective Communication for Hearing Impaired • Gain attention of resident, may use touch • Determine which ear has loss • Check for hearing aid function • Determine % or loss & high/low tone loss • Face resident – don’t chew gum, eliminate background noise, stand on side of better ear • Speak slowly, directly, clearly, NOT LOUDLY • Short sentences, simple words, repeat if need • Watch nonverbal cues, ask to repeat info

  15. Effective Communication for Aphasia (physically impaired) • Provide writing materials if speech difficulty • Let use own words, give time to speak • Use picture or point boards

  16. Conflict IS • Occurs when what a person has & what a person wants are different • A pattern of energy • Nature’s primary motivation for change

  17. Conflict IS NOT • Always negative • Always a contest • Always a sign of poor management • Able to take care of itself if left alone • Always resolvable

  18. Conflict Handling Modes • Competing • Assertive & uncooperative • Power-oriented • Useful for: • Standing up for rights • Defending an important position • Trying to win

  19. Conflict Handling Modes • Accommodating • Unassertive & cooperative • Involves self-sacrifice • Useful for: • Charitable causes/ generosity • Obeying orders • Yielding to another point of view

  20. Conflict Handling Modes • Avoiding • Unassertive & uncooperative • Does not address the conflict • Useful for: • Diplomatic side-stepping • Avoiding until a better time • Withdrawing from a threatening situation

  21. Conflict Handling Modes • Collaborating • Assertive & cooperative – seeks to satisfy both sides • Useful for: • Gaining additional insights • Avoiding negative competition for resources • Solving interpersonal problems

  22. Conflict Handling Modes • Compromising • Somewhat assertive & cooperative • Solutions mutually satisfying – acceptable to all • Middle ground mode • Useful for: • Splitting the difference • Making concessions • Finding a quick middle ground position

  23. Areas of Concern for Conflict • Attendance & Punctuality • Safety – Personal & Resident • Professional Behavior • Attitude • Appearance & Hygiene • Performance

  24. Lines of Authority • Communication with employee: Inquiry & Advocacy • Bracket – create an open mind so people can listen to another point of view • Paraphrase – validate & confirm what they heard • Check perceptions – Reads between the lines, helps to understand/empathize • Ask probing questions – get more information & deepen understanding

  25. Lines of Authority • Communication with first line supervisor: objective reporting • Timely reporting: when & where • Plan for remediation • Clarification of concerns • Goals setting for behavior changes • Expectations & Time frame for remediation • Follow-up

  26. Line of Authority • Confidentiality • Constructive Feedback • Info given to & received by an individual about their performance • Goal is to improve performance • Vehicle to promote constructive relationships • Monitors how things are going • Creates a way to review ongoing issues • Keeps lines of communication open

  27. 4 E’s of Constructive Feedback • Engage – set the stage • Preparation & link feedback to common goals • State what you want to discuss • Empathize • Environment & Timing • Educate • Describe observations & impact of behavior • Remain objective • Enlist • Elicit person’s response & guide towards sol’n

  28. Touch as Communication • Cultural beliefs regarding touch • Modesty – covering face, arms, head • Touch of body after death • Hugging • Body Language • Hands, eyes • Gestures • Posture • Regression • Personal Space

  29. Basic Defense Mechanisms • Regression – reverting to childish behavior (thumb sucking) • Rationalization – unconscious, developing socially acceptable reasons to explain behavior (can’t give up smoking because you might gain wt) • Projection – unconscious, places own intolerable feelings onto others (Cheater accuses others of cheating)

  30. Basic Defense Mechanisms (cont) • Displacement – substituting one innocent person for another (mad at your mom so you hit your brother) • Denial – can’t believe that it is true (my children would never do that) • Conversion – substituting acceptable physical symptoms for unacceptable emotions (feel sick when it is time to take the test)

  31. Basic Defense Mechanisms (cont) • Repression – pushes thoughts & ideas into the subconscious where they do not recall them (has fond memories of an abusive mother) • Sublimation – unacceptable emotions are expressed in socially acceptable way (exercises when angry)

  32. Basic Defense Mechanisms (cont) • Substitution – replacing an unattainable goal with an acceptable one (can’t sing on tune so plays the guitar) • Identification – patterning self after another, hero-worship (I want to be just like Mrs. McGrory)

  33. Family Communication • Family structures differ – single parent, two parents, primary caregiver, extended family, & appointed guardian, conservator, or responsible party • Show respect for all family structures • Listen, courteous, respectful, supportive • Avoid involvement in family matters – give privacy • Maintain confidentiality • Allow family to help with care

  34. Family Communication • Family needs info • Telephone & visiting hours • Location of refreshments & business office • Gift shop & public restrooms • Orient to resident activity & appointment areas • Use family as resource to gather info about preferences

  35. Socio-cultural Factors • Culture – characteristics of a group of persons (attitudes, beliefs, religion, values, likes, & dislikes) • Influences reaction of residents to health care like food preference, family practices, hygiene habits, & clothing styles • Rituals – beliefs, ceremonies • Beliefs about health care

  36. Emotional reactions to illness • Stress as a result of illness • Individual differences • Heredity, experiences, environment • Physical loss or disability • Many losses • Spouse, family, friends • Homes, control of life, disease, meals, driving • Function & independence

  37. Emotional response to illness • Emotional reactions • Anger, grief, dependency • Suspicion, loneliness, guilt • Uselessness, feelings of damage • Depression, helpless • Anxiety, frustration, fear • To help: • Observe for signs of stress & listen • Patience & understanding, promptly meet needs • Focus on abilities • Treat with dignity, be non-judgmental

  38. Communication Patterns • Organizational chart of nursing unit • Methods of communication • Verbal vs. nonverbal • Written – chart, Kardex/care plan, report sheets, ADLs. What do you do when resident asks to see the chart? • Electronic – computer, fax, telephone, intercom • Legal aspects • Must document what is reported verbally to nurse • Must document statements from family or resident • Subjective vs. objective data

  39. Effective Communication • Identify self • Verbal reports – brief, organized • Appropriate – diagnosis, changes, allergies, activity, elimination, special needs, diet, VS, code status • Timing – when to report changes • Place & location

  40. Effective Communication • Take notes when on telephone • Name of person the message is for • Correct spelling of caller’s name • Time called • Clarify message by repeating it & telephone number to caller • Sign your name & title to the message

  41. Answering call lights • Go to resident at once, quietly, and friendly manner • If on intercom, call resident by name, I.d. yourself, politely inquire to need • Make sure call light is ALWAYS within reach

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