Effective Communication

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

Sender Message Receiver 3 essential elements: 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.

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)

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

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

Barriers (continued) Deafness/hearing loss Blindness/impaired vision 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

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

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

Types of observation Cannot be seen or felt Commonly called symptoms 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

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

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”

Hearing impairment Make sure hearing aids working well (batteries) Guidelines for good communication Hearing impairment 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

Vision impairment 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

Stroke & communication occurs 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

Combative resident can 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

Angry behavior Disease 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

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.

Observation, reporting & documenting Documentation Observation, reporting & documenting

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

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.

Types of forms used in documentation 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

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

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

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