1. Communication & Interpersonal Skills
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