Communications.

Communications

Communications Explore Go Learn and Practice Go Reflect Go Reinforce Go

Explore You will play a game that will highlight the importance of effective communication. Explore Activity Demonstrate the importance of effective communication by having students play a communications game. Students will get into groups with one partner being given a worksheet with a drawing. Without seeing the worksheet, the other partner will replicate the drawing by following directions given by their partner. In the first round, no questions can be asked. In the second round, the partners may ask and answer questions. Ideally, the second drawing will be the most accurate and an example of effective communication. See the Explore section of the unit teacher manual for more information.

Communications TABLE OF CONTENTS Lessons Topic Overview Go
1 – 3 Communication Go 4 – 7 Interpersonal Communication Go 8 – 12 Communication Barriers Go 13 – 15 Patients Go 16 – 18 Documentation Go 19 – 21 Communication Technology Go TABLE OF CONTENTS

Overview You will learn about: Communication process
Communication barriers Types of documentation Unit Description In this unit, you will learn about communication skills. Specifically, you will learn about communication in the health care industry. You will also learn about types of communication, communication barriers, and communicating with individuals and with groups. In this unit, you will learn that: Communication is the process of exchanging messages. Few other professions require the level and range of communication skills that the health care industry does. A communication barrier can make it difficult for someone to send a clear message, understand the message being sent, or provide appropriate feedback. Attitudes and behaviors that are critical to successful communication include courtesy, respect, sensitivity to boundaries, and empathy. Documentation is perhaps the most critical communication that a health care worker will create.

Fedor Ivanov Scenario: Brought father to hospital
English is a second language Hospital staff not communicating effectively At the start of each unit, students are introduced to a health care worker or patient who share a scenario related to the unit topics. After completing the unit, students will answer the several questions about the scenario. The scenario is also presented in Curriculum Viewer in the Overview lesson for the unit. Fedor Ivanov My name is Fedor Ivanov. I am very worried about father. We rush him to hospital because he seemed upset and not feeling well and now the doctor tells us nothing! I ask to speak to someone two times and both times I hear that doctor is very busy and I must sit. When doctor did come, he asks about this thing he calls hypertension, but then he leaves again. He says nurse will come soon, but we are waiting still. My English is not so good, so maybe I misunderstand. My son, he speaks English very good, but he is young boy.

Questions What barriers prevented the hospital staff and Fedor from communicating? What could the hospital staff have done differently to communicate effectively with Fedor? What might happen if the hospital staff does not improve the way they communicate with Fedor? After completing the unit, students should answer the following questions from the unit assignment sheet. Students will be prompted to print the assignment sheet in Curriculum Viewer. A master copy is available in the unit teacher manual. What barriers prevented the hospital staff and Fedor from communicating? What could the hospital staff have done differently to communicate effectively with Fedor? What might happen if the hospital staff does not improve the way they communicate with Fedor?

Key Question Why is effective communication important in the health care industry? How do attitudes of respect and sensitivity affect communication? Key Question 1 Students will explain what they know about communication. A typical answer might be, “The information that is exchanged in the health care industry can be vital to patient health and successful patient treatment. Communication in this field can literally be the difference between lif and death. Additionally, communication in health care requires great sensitivity and attention to make patients comfortable and keep the encouraged.” Key Question 2 Students will explain what they know about respect and sensitivity. A typical answer might be, “Sensitivity and respect can be the difference between a message being heard and understood and a communication failure. When people’s lives and health are at stake, it is critical that patients and health care workers communicate effectively with one another. Effective communication relies on mutual respect and sensitivity among one another.”

Communication 1. Types of Communication Go 2. Communication Process Go
3. Quiz Go

Lesson 1 – Communication in Health Care
Process of exchanging messages health care workers patients patients’ families students and visitors administrators and business contacts. <LS.HS.Comm.Intro-P01-01.jpg> Communication in Health Care Communication is the process of exchanging messages. Few other professions require the level and range of communication skills that the health care industry does. In this atmosphere, accurate communication is vital. Health care professionals must communicate effectively and appropriately with other health care workers, patients and clients and their families, students, visitors, administrators, and business contacts. The greater responsibility for communication rests with the health care worker. Communication exists in many forms, including verbal, written, and nonverbal.

Lesson 1 – Verbal Communication
Use of language and words Most effective form Goals: Establish rapport Obtain information from patients Confirm understanding Relay information to other health care workers Give instructions to patients <LS.HS.Comm.Types.Verbal-P01-01.jpg> Verbal Communication Verbal communication is the use of language and words to send and receive information. Verbal communication can take place face-to-face or over the telephone. It can also occur one-to-one or in a group. Verbal communication is the form people use most often. And it is the most effective. It allows for instant feedback and discussion. It can end confusion instantly and bring about clarity and understanding. The goals for verbal communication in the health care environment can typically be put into one of the following categories. Establish rapport, or a connection Obtain information from patients Confirm understanding Relay information to other health care workers Give instructions to patients

Lesson 1 – Tone of Voice Expresses speaker’s feelings
Patients can pick up on fear, agitation, calmness, and confidence Adjust tone of voice appropriately to the situation <LS.HS.Comm.Types.Verbal-P03-01.jpg> Tone of Voice It has been said many times, “It’s not what you say, but how you say it.” This saying refers to tone of voice. A speaker’s feelings are expressed through tone of voice. A health care worker’s tone is very revealing to a patient. Patients can easily pick up on fear, agitation, calmness, and confidence from a health care worker’s volume, rate, and pitch. Health care workers must be aware of how they sound. If they can adjust their tone of voice appropriately to the situation, it can become an effective communication tool. They can use their tone to calm and reassure patients, even if the news is bad.

Lesson 1 – Language Choice
Translate medical terminology into lay terms At the same time, health care workers must avoid talking down to patients by over-simplifying their language. They should also be careful to enunciate words and avoid mumbling. <LS.HS.Comm.Types.Verbal-P04-01.jpg> Language Choice With all the medical terminology that health care workers are required to know, they practically speak a different language. They need that language when conversing with colleagues. However, when interacting with patients, they must translate the medical terminology into lay terms. Lay terms are everyday language that patients can understand. For example, instead of saying lumbar, say lower back. Instead of costae, say ribs. At the same time, health care workers must avoid talking down to patients by over-simplifying their language. They should also avoid making noises such as “uh” and “um,” which are meaningless. Finally, they should be careful to enunciate words and avoid mumbling. The result is health care workers that sound professional and knowledgeable. That professionalism builds patients’ confidence in health care workers.

Lesson 1 – Written Communication
Form of verbal communication Allows writer time to research and to organize thoughts Must: Be accurate and clear Be brief with logical organization Be free of grammar, spelling, and punctuation errors Use appropriate vocabulary <LS.HS.Comm.Types.Written-P01-01.jpg> Written Communication Written communication is a form of verbal communication. Depending on the situation, there are benefits to using written communication. Written communication allows the writer time to research and to organize thoughts. Additionally, once written communication is completed, it can be proofread and edited before it reaches its audience. Written communication must be accurate and clear. And it should be brief with logical organization. It should be free of grammar, spelling, and punctuation errors. Finally, written communication should include vocabulary that is appropriate for the reader. Health care workers use written communication for the following items. Messages and orders Test results Notes in patient charts Informed consent documents Procedures and policies Patient education material Surveys Letters and memos

Lesson 1 – Selecting the Correct Form
Would message be better delivered orally? Does the message require a written record? What format? <LS.HS.Comm.Types.Written-P02-01.jpg> Selecting the Correct Form Before using written communication, health care workers must first ask themselves if the message would be better delivered orally. They should also decide whether or not the message requires a written record. Once it has been determined that written communication is necessary, health care workers must decide what format the message should take. The written message could be a letter, , report, etc. Memos are typically used for internal communication. Internal communication occurs within an organization, such as between a physician and a nurse. Letters are often used for external communication. External communication includes items that are sent outside of the agency, such as to an insurance company or to the community.

Lesson 1 – Writing Memos Often used in the health care industry
Standard parts: TO: FROM: DATE: SUBJECT: body <LS.HS.Comm.Types.Written-P04-01.jpg> Writing Memos Memos are a form of written communication. They are used often in the health care industry, both in printed form and via electronic mail, or . Memos have some standard parts. TO: This part should include the names of all the people for whom the memo is intended. FROM: This part should include the name of the person sending the memo. DATE: This part should contain the date the memo is created. SUBJECT: This part should briefly state the purpose of the memo. The body of the memo follows these parts and includes the details of the message.

Lesson 1 – The Five W’s Who is the audience?
What is the purpose of the message? Why is the message important? When did or will the event occur? Where did or will the event take place? <LS.HS.Comm.Types.Written-P05-01.jpg> The Five W’s Once a format has been determined for written communication, health care workers must write the message using the five W’s. Who is the audience? What is the purpose of the message? Why is the message important? When did or will the event occur? Where did or will the event take place?

Lesson 1 – Nonverbal Communication
Used in addition to or as a substitute for language Includes: Eye contact and facial expressions Gestures and body language Physical appearance Touch Proximity <LS.HS.Comm.Types.Nonverbal-P01-01.jpg> Nonverbal Communication Nonverbal communication includes methods used in addition to or as a substitute for language. Nonverbal communication includes the following methods. Eye contact and facial expressions Gestures and body language Physical appearance Touch Proximity

Lesson 1 – Eye Contact and Facial Expressions
Direct eye contact sends a powerful and positive message Smiles and other facial expressions Be conscious of interpretation and own expression <LS.HS.Comm.Types.Nonverbal-P03-01.jpg> Eye Contact and Facial Expressions Eye contact is one form of facial expression. Direct eye contact usually sends a powerful and positive message. Smiles also generally communicate a positive message. However, an artificial smile can often be detected by others. Other facial expressions communicate, as well. A blank stare can indicate fever. A grimace can express pain. A bland look can suggest depression. Health care workers must be conscious of both interpreting facial expressions in others and in mastering their own expression to be sure that they are sending the appropriate message. Health care workers should strive for an open, friendly expression that is neither too solemn nor too cheerful.

Lesson 1 – Gestures and Body Language
People use their bodies instead of words Posture also conveys a message. Read and use gestures and body language <LS.HS.Comm.Types.Nonverbal-P04-01.jpg> Gestures and Body Language What can the tapping of a foot imply? Crossing the arms? Waving? In addition to facial expressions, people can communicate through body language and gestures. Body language sends powerful messages to others. At times, people use their bodies instead of words, such as when someone nods or shakes the head. Posture also conveys a message. People who stand up straight exude confidence, while people who slouch appear unsure of themselves. Health care workers must be skilled both in reading and in using gestures and body language effectively. They should be sure to lean forward slightly when interacting with patients. This body language shows interest in the patient.

Lesson 1 – Physical Appearance
Uniforms send the message that they belong to the health care field Physical appearance is also expressed by grooming <LS.HS.Comm.Types.Nonverbal-P06-01.jpg> Physical Appearance In the health care industry, many workers wear uniforms. Their uniforms send the message that they belong to the health care field. Depending on the patient, this message can have positive or negative effects. Some patients take comfort from the image of someone in uniform, while others are intimidated or frightened by it. Health care workers must be aware of these opposing views and be sensitive to how they interact with patients based on how their appearance is received. In addition to uniforms, physical appearance is also expressed by grooming. Someone who is well-groomed communicates a positive message. Someone that is disheveled and not properly groomed can send a negative message. Piercings, facial hair, and overdone make-up can negatively communicate to others.

Lesson 1 – Touch Touch can communicate many things.
Touch can also be misinterpreted Be conscientious to touch patients with only kindness and respect. <LS.HS.Comm.Types.Nonverbal-P07-01.jpg> Touch Touching patients is required in many areas of the health care field. Touch can communicate many things. Touch can also be misinterpreted, which can be a serious matter. Special licensing that is required for health care workers provides them with some protection against some misinterpretations. However, health care workers must always be conscientious to touch patients with only kindness and respect. Patients can easily detect an inappropriate or uncaring touch. Communication in touch can also be expressed in how quickly and comfortably a health care worker moves with a patient. Beyond clinical touching that is required, health care workers may also feel inclined to give patients reassuring touches in the appropriate context. In some cases, a kind, concerned hand on a patient’s shoulder can communicate far more than words can.

Lesson 1 – Proximity Physical space between people Includes:
Distance between people Height Odor Sensitivity and professionalism are required when patient proximity is an issue <LS.HS.Comm.Types.Nonverbal-P08-01.jpg> Proximity Proximity refers to the physical space between people. The distance between people is one aspect of proximity. The appropriate distance between people varies among cultures. Health care workers must often invade patients’ personal space in order to perform their duties. Sensitivity and professionalism are required when patient proximity is an issue. Proximity can also be communicated through height. In communication between two people, if one is standing and one is sitting, the person who is standing communicates authority over the other person. In the health care industry, there are many cases where a health care worker will stand over a patient who is seated or lying down. Health care workers must be sensitive to how their proximity affects patients. Health care workers should sit down as often as possible when communicating with patients. Finally, proximity can also include odors. Health care workers who have close contact with patients should be aware of the type of body soap and deodorant they use. They should limit or forgo perfume or cologne and practice good oral hygiene.

Lesson 2 – Communication Process
Communication is a process. The sender-receiver model is a way to break down the process into steps. Use with active listening <LS.HS.Comm.Models-P01-01.jpg> Communication Process Communication is a process. The sender-receiver model is a way to break down the process into steps. This model can be used together with active listening skills to create effective communication.

Lesson 2 – Sender-Receiver Model
The sender is the person who encodes, or gives, information. The receiver is the person who decodes, or accepts, the information. The message is the information that is being communicated. Other elements include frame of reference and feedback. <LS.HS.Comm.Models-P02-01.jpg> Sender-Receiver Model The sender-receiver model includes a sender, receiver, and a message. Other elements include frame of reference and feedback. The sender is the person who encodes, or gives, information. The receiver is the person who decodes, or accepts, the information. The message is the information that is being communicated. In a working model, the sender gives a message. The receiver accepts the message and decodes the message based on his or her frame of reference, or experiences and values. The receiver gives a response, called feedback. The sender then interprets the feedback based on his or her own frame of reference. This confirms to the sender whether or not the original message was received properly.

Lesson 2 – Active Listening Skills
Show interest. Be alert. Maintain eye contact. Avoid interrupting. Pay attention. Avoid thinking ahead for a response. Try to ignore personal prejudices. Ignore distractions by moving to a quiet place. Watch the speaker closely for nonverbal contradictions. Maintain a positive attitude. <LS.HS.Comm.Models-P07-01.jpg> Active Listening Skills Active listening is another important part of the communication process. Listening is paying attention to hear what the sender is saying. Good listeners have these skills in common. They: Show interest. Be alert. Maintain eye contact. Avoid interrupting. Pay attention. Avoid thinking ahead for a response. Try to ignore personal prejudices. Ignore distractions by moving to a quiet place. Watch the speaker closely for nonverbal contradictions. Maintain a positive attitude.

Lesson 2 – Restatement, Reflection, and Clarification
Restatement involves repeating the message back to the sender in the receiver’s own words. Reflection involves responding with empathy. Clarification occurs when the receiver asks questions to get a more concise explanation or to clear up any confusion about the message. <LS.HS.Comm.Models-P08-01.jpg> Restatement, Reflection, and Clarification Among other listening skills, active listening also involves reflection, restatement, and clarification. Restatement involves repeating the message back to the sender in the receiver’s own words. For example, a patient explains that she has a headache. The health care worker responds, “You say you have a headache.” Restatement verifies that the correct message has been heard and understood. Reflection involves responding with empathy. For example, a patient explains and shows the health care worker that he has a splinter in his palm. The health care worker responds sincerely, “Oh yes, I can see the splinter. They are really painful, aren’t they?” Clarification occurs when the receiver asks questions to get a more concise explanation or to clear up any confusion about the message. For example, a child patient complains that her belly hurts. The health care worker responds, “Can you point on your belly exactly where it hurts?”

Lesson 2 – Other Effective Communication Skills
Be conscious of your own body language, including posture and eye contact. Avoid any display of anger. Speak slowly, softly, and clearly. <LS.HS.Comm.Models-P11-01.jpg> Other Effective Communication Skills Not all communication skills involve listening. There are other skills that enhance communication. Be conscious of your own body language, including posture and eye contact. Avoid any display of anger. Speak slowly, softly, and clearly.

Lesson 3 – Quiz In this lesson, you will take a quiz on types of communication and communication processes.

Interpersonal Communication
4. General Guidelines Go 5. Group Communication Go 6. Directions Go 7. Quiz Go

Lesson 4 – Attitudes and Behaviors
Adopt acceptable attitudes and behaviors Courtesy Respect Sensitivity to boundaries Empathy <LS.HS.Comm.Interpersonal.Attitudes-P01-01.jpg> Attitudes and Behaviors Successful communication requires that people adopt acceptable attitudes and behaviors. Attitudes and behaviors that are critical to successful communication include courtesy, respect, sensitivity to boundaries, and empathy.

Lesson 4 – Courtesy Involves being polite, gracious, helpful, and considerate Overcome personal and other issues unrelated to the job <LS.HS.Comm.Interpersonal.Attitudes-P02-01.jpg> Courtesy To show courtesy involves being polite and gracious. It also includes helpfulness and consideration. All these attributes are required in the health care field. Successful health care workers are courteous to their patients and coworkers. Those who show little courtesy towards others will quickly gain a poor reputation. Everyone has a bad moment or even a bad day now and then. However, it is important to overcome personal and other issues unrelated to the job and to focus on performing the work at hand with courtesy. For example, Gina works as a nurse in a family practice. She must get a patient, Edward Moses, from the waiting room and take his vital signs for the physician. She opens the door to the waiting room and calls, “Mr. Moses?” Edward Moses, an elderly gentleman, rises slowly and grasps the walker in front of him. Gina, seeing his approach, opens the door wider to accommodate him and the walker and waits patiently with a welcoming smile until he is safely through the door.

Lesson 4 – Respect Approach another person with a feeling of esteem or regard Theme in any study of communication in health care Without proper respect, communication can quickly veer towards failure. <LS.HS.Comm.Interpersonal.Attitudes-P03-01.jpg> Respect Respect is an overriding theme in any study of communication in health care. Respect is to approach another person with a feeling of esteem or regard. Health care workers must show respect towards patients and coworkers and their differences. Without proper respect, communication can quickly veer towards failure. When people are not treated with respect, they tend to withdraw from the conversation. For example, Gina directs Mr. Moses to the second door on the left. He continues past this door. Gina realizes that he hasn’t heard her instruction. Patiently and sincerely, she says a little louder, “Mr. Moses, we’ll be in this room today.” He hears her this time and turns around and enters the correct room.

Lesson 4 – Sensitivity to Boundaries
Sensitivity is ability to see and appreciate the personal traits of others Sensitivity to boundaries is ability to recognize and observe the emotional and physical limits of others <LS.HS.Comm.Interpersonal.Attitudes-P05-01.jpg> Sensitivity to Boundaries Sensitivity is the ability to see and appreciate the personal traits of others. Specifically, sensitivity to boundaries is the ability to recognize and observe the emotional and physical limits of others. Health care workers must be sensitive to their patients’ boundaries. Crossing these boundaries can occur with something as simple as using a patient’s first name rather than addressing them as Mr. Smith or Mrs. Brown. Crossing boundaries can also occur if a health care worker stands too close to a patient or touches a patient without asking permission first. For example, when it is time to take Mr. Moses’ blood pressure, Gina realizes that he must remove his jacket first. She asks him, “Mr. Moses, I need you to take off your jacket so that I can take your blood pressure. May I help you remove it?” He thankfully agrees.

Lesson 4 – Empathy Ability to share in someone else’s feelings or emotions Patients who are lonely or facing serious surgeries or terminal illnesses are in special need of empathy <LS.HS.Comm.Interpersonal.Attitudes-P06-01.jpg> Empathy Empathy is the ability to share in someone else’s feelings or emotions. Empathy is a trait of successful health care workers. Countless situations with patients require empathy. Patients who are lonely or facing serious surgeries or terminal illnesses are in special need of empathy. For example, when talking with a patient who has recently found out about a terminal illness, a health care worker might say something such as, “Mrs. Winters, I’m so sorry that you and your family are facing this situation.”

Lesson 4 – Diversity Put aside all personal and cultural bias
Treat all people fairly, equally, and with sensitivity Be aware that others have cultural and personal biases <LS.HS.Comm.Interpersonal.Diversity-P01-01.jpg> Diversity Health care workers continually encounter patients and coworkers of diverse backgrounds. When dealing with people who are different from themselves, health care workers must put aside all personal and cultural bias. They must treat all people fairly, equally, and with sensitivity. Health care workers must be aware that others have cultural and personal biases, as well. Their biases may affect how they interact with health care workers who are diverse from them. However, in patient situations the greater responsibility lies with the health care workers. They must always be on guard against unjustified differences in care based on any form of diversity. Diversity, or variety, occurs in many forms. Diversity includes the following: Race Gender Age Ethnicity Socioeconomic status Occupation Health status Religion Sexual orientation

Lesson 4 – Diversity (continued)
Diversity includes the following: Race Gender Age Ethnicity Socioeconomic status Occupation Health status Religion Sexual orientation <LS.HS.Comm.Interpersonal.Diversity-P01-01.jpg> Diversity (continued) Health care workers continually encounter patients and coworkers of diverse backgrounds. When dealing with people who are different from themselves, health care workers must put aside all personal and cultural bias. They must treat all people fairly, equally, and with sensitivity. Health care workers must be aware that others have cultural and personal biases, as well. Their biases may affect how they interact with health care workers who are diverse from them. However, in patient situations the greater responsibility lies with the health care workers. They must always be on guard against unjustified differences in care based on any form of diversity. Diversity, or variety, occurs in many forms. Diversity includes the following: Race Gender Age Ethnicity Socioeconomic status Occupation Health status Religion Sexual orientation

Lesson 4 – Criticism Constructive criticism can build people up and inspire them to do better. Non-constructive criticism serves only to tear people down and discourage them. Be prepared to accept and give constructive criticism <LS.HS.Comm.Interpersonal.Criticism-P01-01.jpg> Criticism Criticism is a part of everyone’s life. Constructive criticism can build people up and inspire them to do better. For example, a manager may tell an employee with a cluttered workspace that organizing it might make it easier to find things and make him more productive. However, non-constructive criticism serves only to tear people down and discourage them. For example, in the same cluttered workspace situation, the manager may simply tell the employee that his desk is a mess and no wonder he cannot find anything. Health care workers must be prepared to both accept and give constructive criticism. They must also learn to handle non-constructive criticism and to refrain from giving it to others.

Lesson 4 – Accepting Constructive Criticism
When people receive constructive criticism, they should appreciate it. People who receive criticism should avoid making excuses, getting angry, and blaming others. <LS.HS.Comm.Interpersonal.Criticism-P02-01.jpg> Accepting Constructive Criticism When people receive constructive criticism, they should appreciate it. They might even thank the other person for taking the time to point out the situation. They should make sure that they understand exactly what they did wrong so that they can make efforts to improve. People who receive criticism should avoid making excuses, getting angry, and blaming others.

Lesson 4 – Giving Constructive Criticism
When giving criticism, people should put themselves in the other’s place. Choose words carefully and speak kindly and considerately Allow the other person a moment to accept what is said <LS.HS.Comm.Interpersonal.Criticism-P04-01.jpg> Giving Constructive Criticism When giving criticism, people should put themselves in the other’s place. They should try to imagine how the criticism might be received. Then they should choose their words carefully and speak kindly and considerately and allow the other person a moment to accept what they are saying. For example, a health care worker might be tempted out of frustration to tell a coworker that her entries in patient charts are sloppy and illegible. Instead, the health care worker should tell the coworker that she is having trouble reading some of her notes and that she wants to make sure that she gets the right information.

Lesson 5 – Group Communication
Health care workers must effectively communicate with their colleagues. Health care workers must put aside all personal prejudice and treat team members fairly and equally and so that they can communicate effectively in group situations. Successful group situations also involve an understanding of communication patterns, interaction, and participation. <LS.HS.Comm.Groups-P01-01.jpg> Group Communication Although many communications in the health care industry focus on health care worker and patient interaction, health care workers must also effectively communicate with their colleagues. Just as with patients, prejudice towards coworkers and team members based on race, ethnicity, religion, sex, age, financial status, and disabilities have absolutely no place in the health care industry! Health care workers must put aside all personal prejudice and treat team members fairly and equally and so that they can communicate effectively in group situations. Successful group situations also involve an understanding of communication patterns, interaction, and participation.

Lesson 5 – Communication Patterns
Chain-of-communication pattern Wheel-of-communication pattern All-channel communication pattern <LS.HS.Comm.Groups-P03-01.jpg> Communication Patterns In professional organizations, important information often must be passed on to all employees. Most organizations have a systematic way of sharing information. These systems are called communication patterns. A chain-of-communication pattern starts at the top of the organization and then flows down to the bottom. A wheel-of-communication pattern has a central hub where the information originates. This hub gives the information to all the spokes of the wheel. An all-channel communication pattern allows for small departments or groups to distribute information to all other groups, and vice versa. This is an open communication style that is usually encouraged by today’s organizations.

Lesson 5 – Group Interaction
Conformity occurs when individuals change their opinions or beliefs to match that of the group. In some instances, conformity can be bad, as it may cause people to go against their beliefs and values. In the professional world, conformity can be good. It is good when people conform to behave appropriately in the professional atmosphere. <LS.HS.Comm.Groups-P06-01.jpg> Group Interaction Group interaction is different than one-on-one interaction. One noticeable difference is the atmosphere of conformity. Conformity occurs when individuals change their opinions or beliefs to match that of the group. In some instances, conformity can be bad, as it may cause people to go against their beliefs and values. However, in the professional world, conformity can be good. It is good when people conform to behave appropriately in the professional atmosphere. For example, it is good for health care workers to conform to standards of treating all patients fairly and equally. It is also good for health care workers to conform to standards for medical procedures.

Lesson 5 – Group Participation
Understand the group goals and own roles within the group In meeting situations, group members must: Be prepared. Use active listening skills. Focus on the discussion. Share relevant ideas. Respect others. Follow through with assignments. <LS.HS.Comm.Groups-P07-01.jpg> Group Participation To participate effectively in a group, people need to understand the group goals and their own roles within the group. In meeting situations, group members must be sure that they are prepared for meetings with research and other contributions. During meetings, they must use their active listening skills to become informed members. They must focus on the discussion and take notes. Members should also share their relevant ideas and respect the ideas of others. They should avoid interrupting others while they are speaking. Finally, they must follow through with any assignments that are given.

Lesson 6 – Directions In the health care field, it is critical that directions are carried out correctly. In order for this to occur, directions must both be given and taken accurately. <LS.HS.Comm.Directions-P01-01.jpg> Directions In the health care field, it is critical that directions are carried out correctly. In order for this to occur, directions must both be given and taken accurately. The ability to give and take directions are communication skills that all health care workers need to have.

Lesson 6 – Giving Directions
When giving directions: Keep instructions simple and brief Give directions in a logical, chronological order Adjust language and complexity to the patient’s ability Have the patient restate Correct any misunderstanding <LS.HS.Comm.Directions-P03-01.jpg> Giving Directions Health care workers may need to give directions to coworkers and to patients or their family members. When possible, health care workers should write directions in addition to giving them verbally. That way, if the patient or coworker does not carry out the directions until later, they will not have to rely on their memories. When giving directions, health care workers should: Keep instructions simple and brief. Give directions in a logical, chronological order. Always adjust their language and the complexity of directions according to the patient’s ability to comprehend. Have the patient restate the process to ensure that a patient understands. Correct any misunderstanding.

Lesson 6 – Following Directions
When following directions: Be diligent Ask questions Take notes Follow through <LS.HS.Comm.Directions-P04-01.jpg> Following Directions Health care workers must also take and follow directions given by coworkers. Following directions shows professionalism and respect for both coworkers and patients. When following directions, health care workers must: Be diligent in paying close attention to directions Ask questions until they fully understand what is expected of them if the instructions are unclear. Take notes so that they can remember not only to perform the task, but the key instructions for carrying it out. Be certain to follow through with the directions at the appropriate time and place.

Lesson 7 – Quiz In this lesson, you will take a quiz on interpersonal communication.

Communication Barriers
8. Personal Barriers Go 9. Cultural Barriers Go 10. Physical Barriers Go 11. Environmental Barriers Go 12. Quiz Go

Lesson 8 – Communication Barriers
Many types of barriers A communication barrier: make it difficult to send a clear message understand message being sent provide appropriate feedback. <LS.HS.Comm.Barriers-P01-01.jpg> Communication Barriers Not all communication fits neatly into a communication model. Instead, there are many things that can interfere with effective communication. A communication barrier can make it difficult for someone to send a clear message, understand the message being sent, or provide appropriate feedback. Communication barriers can be environmental and personal. And they can be caused by physical disabilities, psychological issues, and cultural diversity.

Lesson 8 – Personal Communication Barriers
Can occur within either participant in communication Can result from emotions and attitudes, resistance to change, preconceptions, and self-absorption Can form out of prejudice and personality, including traits such as closed-mindedness, judging, belief in stereotypes, and preaching or moralizing <LS.HS.Comm.Barriers.Personal-P01-01.jpg> Personal Communication Barriers Recall that a communication barrier can make it difficult for someone to send a clear message, understand the message being sent, or provide appropriate feedback. Personal barriers can occur within either participant in communication. They can result from emotions and attitudes, resistance to change, preconceptions, and self-absorption. Additionally, personal barriers can form out of prejudice and personality, including traits such as closed-mindedness, judging, belief in stereotypes, and preaching or moralizing.

Lesson 8 – Emotions and Attitudes
Extreme emotions interfere with ability to concentrate Attitudes can create barriers. These attitudes may include: Prejudice Selective comprehension Complacency <LS.HS.Comm.Barriers.Personal-P02-01.jpg> Emotions and Attitudes Emotions and feelings can cause barriers. Extreme emotions, good and bad, can interfere with a person’s ability to concentrate on a conversation. Personal attitudes can also create barriers. Prejudice towards groups based on race, ethnicity, religion, sex, age, financial status, and disabilities have absolutely no place in the health care industry! Health care workers must put aside all personal prejudice and treat patients and coworkers fairly and equally. Selective comprehension and selective memory can cause communication problems. Selective comprehension is when people only hear what they want to hear. They ignore all else. The result is that they fail to receive the whole message. Selective memory is when a person only recalls part of a message. Finally, an attitude of complacency, or indifference, can create barriers. In these cases, people may not act on a message if they do not care enough to do so. This can be dangerous if patients are complacent in taking medications or following prescribed health care procedures.

Lesson 8 – Preconceptions
Preconceptions are similar to prejudice. Typically directed toward to a single person, rather than a group Create barriers when people disregard what another is saying simply because they disagree or they do not care for the other person <LS.HS.Comm.Barriers.Personal-P04-01.jpg> Preconceptions Preconceptions are similar to prejudice. Preconceptions are typically directed toward to a single person, rather than a group. Preconceptions create barriers when people disregard what another is saying simply because they disagree or they do not care for the other person. This close-minded behavior can result in miscommunication. Health care workers must put aside all preconceptions when interacting with patients and coworkers.

Lesson 8 – Resistance to Change
Health care workers may have resistance themselves, or they may have to deal with a patient’s resistance. Be flexible and open-minded Communicate the benefits of change in a positive way to patients <LS.HS.Comm.Barriers.Personal-P05-01.jpg> Resistance to Change Resistance to change can create communication barriers. Health care workers may have resistance themselves, or they may have to deal with a patient’s resistance. Either way, it must be overcome. Some people cling to the established method of doing things. They may do so to the extent that they reject new ideas. Health care workers must be flexible and open-minded towards changes in procedures that can improve health care for patients. Likewise, they must become skilled at communicating the benefits of change in a positive way to patients that reject new ideas.

Lesson 8 – Self-Absorption
When people are preoccupied, they can miss much of the message coming from another person Put own issues aside and focus 100% on their patients <LS.HS.Comm.Barriers.Personal-P07-01.jpg> Self-Absorption Self-absorption can inhibit good communication. When people are preoccupied with their own problems, schedules, day-dreaming, and other issues, they can miss much of the message coming from another person. Health care workers must put their own issues aside and focus 100% on their patients.

Lesson 8 – Overcoming Personal and Psychological Communication Barriers
Poor attitudes alienate patients Patients will attach little value to what is said Learn to overcome or put aside personal and psychological barriers <LS.HS.Comm.Barriers.Personal-P08-01.jpg> Overcoming Personal and Psychological Communication Barriers A health care worker who has these attitudes while communicating with patients is likely to alienate them. The result is that patients will attach little value to what the health care worker is saying. They may simply stop listening. And because health care workers have very important information to convey to patients, this situation must be avoided. Health care workers must overcome or put aside their personal prejudices and beliefs when working with patients. Each patient must be treated equally, yet as an individual with a unique personality. Health care workers can learn to overcome psychological communication barriers through observation. Observing how a co-worker who is a skilled communicator handle a variety of situations can be invaluable. In some cases, patients may be the source of barriers out of fear, anxiety, or their own prejudices and attitudes. Health care workers must also develop “thick skin” to keep negative patient attitudes from interfering with their work. Often, patient fear can be the true source of negativity. Health care workers should calmly and gently encourage patients to discuss their fears and feelings. Then health care workers should do what they can to reassure and comfort them.

Lesson 9 – Cultural Communication Barriers
Values, beliefs, and customs that are common among a group of people Barriers include: language health practices and beliefs eye contact religion <LS.HS.Comm.Barriers.Cultural-P01-01.jpg> Cultural Communication Barriers Recall that a communication barrier can make it difficult for someone to send a clear message, understand the message being sent, or provide appropriate feedback. Perhaps the most complicated communication barriers result from cultural differences. Culture includes values, beliefs, and customs that are common among a group of people. They are passed from one generation to the next. Cultural communication barriers include language, health practices and beliefs, eye contact, and religion.

Lesson 9 – Language Most obvious communication barrier
Speak slowly and use simple words and gestures or pictures. Find an interpreter, if possible. <LS.HS.Comm.Barriers.Cultural-P02-01.jpg> Language Language may be the most obvious communication barrier. How can two people who speak different languages communicate? If the patient has some English-speaking ability, the health care worker can speak slowly and use simple words and gestures or pictures. If the patient has no English-speaking ability, then the health care worker should find an interpreter, if possible. In many cases, the patient may be accompanied by a family member that has some English-speaking abilities. Even with an interpreter present, health care workers must be conscious to speak directly to the patient.

Lesson 9 – Health Beliefs
Beliefs about health practices and treatments may conflict Patient has the right to refuse treatment Be sensitive to these cultural conflicts Work with patients to make sure that they are getting the required care and treatment <LS.HS.Comm.Barriers.Cultural-P04-01.jpg> Health Beliefs Some cultures have beliefs about health practices and treatments that conflict with what the health care worker prescribes. In these cases, the health care worker must keep in mind that the patient has the right to refuse treatment. The patient may also supplement the prescribed treatment with their own culturally-accepted methods. Health care workers should be sensitive to these cultural conflicts and work with patients to make sure that they are getting the required care and treatment. Before continuing to the next page, take a few minutes to read the Health Beliefs chart shown at left.

Lesson 9 – Eye Contact Differing cultural views on what is or is not appropriate eye contact can inhibit good communication. In some cultures direct eye contact is viewed as disrespectful. Respect and adjust to the patient’s cultural differences <LS.HS.Comm.Barriers.Cultural-P05-01.jpg> Eye Contact Eye contact is not a communication barrier in that it prevents communication from taking place. However, differing cultural views on what is or is not appropriate eye contact can inhibit good communication. For example, in some cultures direct eye contact is viewed as disrespectful. People of these cultures prefer to look down when speaking to someone. For a health care worker who feels that eye contact is an important part of communicating with patients, this can be frustrating. But, they must respect and adjust to the patient’s cultural differences.

Lesson 9 – Religion Organized belief in a higher power
Influence many aspects of people’s lives including birth, life, diet, illness, and death Be aware of common religious influences <LS.HS.Comm.Barriers.Cultural-P07-01.jpg> Religion Religion is an organized belief in a higher power. Religious beliefs can influence many aspects of people’s lives including birth, life, diet, illness, and death. It is helpful for health care workers to be aware of some common religious influences so that they can effectively treat and interact with patients of various backgrounds. Before continuing to the next page, take a few minutes to read the Religious Beliefs chart shown at left.

Lesson 10 – Physical Communication Barriers
Patients who are physically or mentally impaired provide challenges when trying to communicate important health information. Physical challenges that can effect communication include: Problems with hearing, vision, and speech Mental challenges Current physical and mental state <LS.HS.Comm.Barriers.Physical-P01-01.jpg> Physical Communication Barriers Recall that a communication barrier can make it difficult for someone to send a clear message, understand the message being sent, or provide appropriate feedback. Patients who are physically or mentally impaired provide challenges when trying to communicate important health information. Some examples of physical challenges that can effect communication include problems with hearing, vision, and speech, other physical challenges, mental challenges, and current physical and mental state.

Lesson 10 – Hearing Challenges
Deaf patients: Use sign language if possible. Utilize body language and gestures. Face the patient when speaking. Hard-of-hearing patients: Speak clearly at a moderate pace. Keep sentences short and uncomplicated. <LS.HS.Comm.Barriers.Physical-P02-01.jpg> Hearing Challenges Receiving messages can be challenging for people who are hearing-impaired. Hearing challenges range from deafness to hard-of-hearing. When communicating with deaf patients, health care workers who know sign language have an advantage. They will be able to communicate with a deaf person with ease. However, for the many health care workers who do not know how to sign, they must compensate in some way to overcome this barrier. They must utilize body language and gestures to help emphasize their words. Additionally, they must speak clearly, using brief sentences. Many hearing-impaired people are skilled at lip-reading. And so, health care workers must be sure to face the patient when speaking. For patients who are hard-of-hearing, health care workers should be sure to face them when speaking, speak clearly at a moderate pace, and keep sentences short and uncomplicated. Health care workers should also tactfully ask for feedback to make sure the patient understands the message. If health care workers are not able to communicate effectively using these tips, then they should write important messages on paper so that they are sure that the patient receives the message.

Lesson 10 – Vision Challenges
Blind patients: Speak softly to them. Announce your presence. Describe procedures as they are happening. Explain unusual noises. Low-vision patients: Volunteer to turn on more lights. Use bigger body gestures. <LS.HS.Comm.Barriers.Physical-P04-01.jpg> Vision Challenges Vision challenges range from blindness to low vision. Both cases may result in communication challenges. People who are blind can hear the message, but that is all. They cannot see the health care worker’s body language, gestures, or facial expressions. Health care workers must be sensitive to this barrier by speaking softly, announcing their presence, describing procedures as they are happening, and explaining unusual noises. Health care workers may also find it effective to use touch with great sensitivity when dealing with vision-impaired patients. For patients who have low vision, the health care worker must be tactful in determining what the patient can and cannot do. If the patient appears to have some trouble seeing, ask if you can turn on more lights. If it appears that the patient is not reading small gestures and body language, use them more grandly.

Lesson 10 – Speech Challenges
Aphasia Speech problems that originate with damage to the brain Patients may struggle both with speaking and with writing Health care workers must be patient and considerate by speaking clearly and simply. Dysarthria Trouble with particular sounds and slurring words Health care workers should be patient and encourage these patients to speak slowly and to use hand gestures. <LS.HS.Comm.Barriers.Physical-P05-01.jpg> Speech Challenges Challenges with speech can include aphasia or dysarthria. In either case, the patient is likely able to receive messages without problem. However, they may have multiple challenges with sending messages. Patients with aphasia have speech problems that originate with damage to the brain from tumors, strokes, or diseases. They may struggle both with speaking and with writing. When communicating with an aphasia patient, it is critical that health care workers exhibit patience. They should speak in a normal tone of voice and use simple language and phrases. They should be aware that the patient may not understand what they are saying. Health care workers should also show consideration by asking questions that will require brief answers and to restate patient answers to be certain that they have received the correct information. Patients with dysarthria have trouble with particular sounds and words or may slur words. It is often caused by some form of influence on the body, such as medication or alcohol. It can also be caused by facial or tongue weakness. Health care workers should encourage these patients to speak slowly and to use hand gestures. They should allow patients plenty of time to express themselves.

Lesson 10 – Physically or Mentally Challenged
When interacting with a patient in a wheelchair, it is respectful for the health care worker to also be seated. Health care workers must also be sensitive to patients who are mentally or emotionally challenged. They must be prepared for anything and treat these patients with calmness, respect, and courtesy. <LS.HS.Comm.Barriers.Physical-P07-01.jpg> Physically or Mentally Challenged Health care workers must be sensitive to patients with physical challenges. For example, when interacting with a patient in a wheelchair, it is respectful for the health care worker to also be seated. This position places the health care worker and the patient at the same level. Health care workers must also be sensitive to patients who are mentally or emotionally challenged. The affects and abilities of such patients have a wide range. And so, health care workers must be prepared for anything and treat these patients with calmness, respect, and courtesy. If health care workers are concerned about a patient’s ability to understand important information about treatment, they should try to talk to a family member of the patient, if possible. Health care workers must be sure to get permission before discussing the patient’s information with another person.

Lesson 10 – Current Physical or Mental State
Patients may not be able to communicate clearly if they are: Very ill or in physical pain On strong medication Upset or confused Experiencing a great deal of stress Understand the context of the situation when interacting with patients. <LS.HS.Comm.Barriers.Physical-P08-01.jpg> Current Physical or Mental State Communication barriers can occur with people who are experiencing physical pain or mental anguish. A patient who is very ill or has physical pain may not be able to focus on anything other than that. On the other hand, a patient on strong pain medication may also have difficulties communicating because of the effects of the medicine on the body. In addition to physical pain, a patient who is upset, confused, or is experiencing a great deal of stress may not be able to communicate effectively. Health care workers must understand the context of the situation when interacting with patients. They must be alert to situations that might interfere with effective communication.

Lesson 11 – Environmental Communication Barriers
Environmental barriers include: Noise and activity levels Physical arrangement and comfort Time <LS.HS.Comm.Barriers.Environmental-P01-01.jpg> Environmental Communication Barriers Environmental barriers include noise and activity levels, physical arrangement and comfort, and time.

Lesson 11 – Noise and Activity Levels
Control the noise and activity levels in common areas where patient-health care worker conversations might take place <LS.HS.Comm.Barriers.Environmental-P02-01.jpg> Noise and Activity Levels A noisy or active environment makes it difficult for both the patient and health care worker to follow a conversation. It can also make patients anxious. Health care workers should strive to control the noise and activity levels in common areas where patient-health care worker conversations might take place. If the noise and activity are unavoidable and patients are bothered by them, health care workers should try to find a quiet place to continue these conversations.

Lesson 11 – Physical Arrangement and Comfort
Partitions and dividers Room temperature Make the physical arrangement welcoming and comfortable <LS.HS.Comm.Barriers.Environmental-P04-01.jpg> Physical Arrangement and Comfort Physical arrangement can create communication barriers depending on personal preference. In some health care facilities, patients may have to communicate with clerical workers through glass. These may make some patients feel unwanted or isolated. Likewise, health care workers who are performing patient education classes may be intimidated by speaking from a stage to seated patients. They may be more successful and feel less inhibited seated in a circle with patients. In addition, if the setting is either too hot or too cold, patients and health care workers may be uncomfortable and, therefore, distracted. Health care workers should try to make the physical arrangement as welcoming and comfortable as possible for themselves and for patients.

Lesson 11 – Time Communication barrier if not enough of it is devoted to interacting with a patient <LS.HS.Comm.Barriers.Environmental-P05-01.jpg> Time Time can be a communication barrier if not enough of it is devoted to interacting with a patient. A hurried conversation or exam can result in lost or overlooked patient information. It can also leave the patient feeling unimportant and distrustful. Health care workers who are in a hurry must be very careful to make their time limits invisible to their patients.

Lesson 12 – Quiz In this lesson, you will take a quiz on communication barriers.

Patients 13. Interaction Go 14. Education Go 15. Quiz Go

Lesson 13 – Patient Interaction
Feeling confident, comfortable, and competent during patient interaction takes practice and experience. Patient interaction involves several stages: Preparation Introduction Assessment Treating and monitoring Feedback and follow-up <LS.HS.Comm.Patient.Interaction-P01-01.jpg> Patient Interaction Patient interaction is a part of most health care workers’ jobs. Feeling confident, comfortable, and competent during patient interaction takes practice and experience. After all, health care workers must communicate effectively with patients while also trying to accurately assess their health status. Patient interaction involves several stages. Preparation Introduction Assessment Treating and monitoring Feedback and follow-up

Lesson 13 – Preparation Take a moment to prepare
Review the patient’s chart: Patient’s name Health history Chief complaint Special needs or precautions <LS.HS.Comm.Patient.Interaction-P04-01.jpg> Preparation Health care workers should take a moment to prepare before entering a hospital room or an exam room. They should take this moment to review the patient’s chart. They should familiarize themselves with the name, health history, and the chief complaint. The chief complaint is the reason that the patient is acquiring medical help. Charts also give health care workers critical information about any special needs or precautions concerning the patient.

Lesson 13 – Introduction Enter the room calmly and formally introduce yourself. Name Position Purpose for being there Be positive and genuine <LS.HS.Comm.Patient.Interaction-P05-01.jpg> Introduction First impressions last. So, health care workers must be conscious of how they present themselves when they greet a patient. Health care workers should enter the room calmly and formally introduce themselves to the patient. They should give their name, position, and their purpose for being there. Perhaps more important than the actual words is the manner in which they are delivered. Health care workers should leave any bad feelings behind before entering a patient’s room. Patients can easily sense a negative or artificial manner. Their initial reception of a health care worker can affect their feelings towards that person for the rest of their association.

Lesson 13 – Assessment Make observations and evaluate a patient’s condition Assessment includes the patient’s: Appearance Personality Attitude Reaction to the health care worker Vital signs <LS.HS.Comm.Patient.Interaction-P06-01.jpg> Assessment Assessment is when a health care worker makes observations and evaluates a patient’s condition. The health care worker is looking for signs that can shed light on the patient’s health status. These signs can include the patient’s appearance and color, personality, attitude, and reaction to the health care worker’s presence. Assessment also includes vital signs. A health care worker’s ability to assess and observe a patient improves with experience.

Lesson 13 – Treating and Monitoring
Treating a patient involves reading and following a doctor’s orders. Describe the procedure in lay terms Monitor the patient, looking for any signs of change, good or bad <LS.HS.Comm.Patient.Interaction-P07-01.jpg> Treating and Monitoring Treating a patient involves reading and following a doctor’s orders. Before treating a patient, the health care worker should describe the procedure in lay terms and explain why it is being done and what it should accomplish. While treating a patient, health care workers should encourage the patient and give positive reinforcement. Health care workers must constantly monitor the patient, looking for any signs of change, good or bad. If the patient is suddenly doing badly, the health care worker should stop the treatment and get help.

Lesson 13 – Feedback and Follow-Up
Assess the patient again. Ask patients how they are feeling. Take vital signs. Give patients feedback about the treatments. Let patients know how well they performed. Give pointers or tips about getting better results the next time. <LS.HS.Comm.Patient.Interaction-P08-01.jpg> Feedback and Follow-Up After completing treatment for patients, health care workers should assess the patients again. They should ask patients how they are feeling and take vital signs. Then health care workers should give patients feedback about the treatments. They should let patients know how well they performed and give any pointers or tips about getting better results the next time. Health care workers should be sure to leave patients on a positive note by thanking them, wishing them well, and reminding them of when they should return. After leaving patients, health care workers must be diligent about documenting what took place.

Lesson 14 – Patient Education
One-on-one conversation or as a presentation to a group Patient education literature <LS.HS.Comm.Patient.Education-P01-01.jpg> Patient Education Health care workers often find themselves in the role of teacher. Patients are the students. Patient education can occur in one-on-one conversation or as a presentation to a group. Patient education can also occur in the written form, called patient education literature. Patient education is very important. Not only is it an opportunity to answer questions, it is also an opportunity to teach patients about living a healthy lifestyle.

Lesson 14 – Patient Questions
Patient questions often create patient education situations. Be prepared to answer these questions: How did I get it? How long will it last? Am I going to die? Is it curable? Will I need medication? Will I need surgery? Will I be the same after I have recovered? <LS.HS.Comm.Patient.Education-P02-01.jpg> Patient Questions Patient questions often create patient education situations. When patients have been diagnosed with conditions or are facing health problems, they will likely want answers to these types of questions. How did I get it? How long will it last? Am I going to die? Is it curable? What can I do to get back to normal? Are you sure that is what I have? How do you know? Will I need medication? Will I need surgery? Will I be the same after I have recovered? These questions present opportunities to comfort patients. They also allow opportunities to educate patients about their conditions. And they help patients get on track towards recovery or management.

Lesson 14 – One-on-One Conversation
In one-on-one situations, health care workers must teach patients about treatments, procedures, therapy, and equipment. Make sure patients fully understand what is expected of them <LS.HS.Comm.Patient.Education-P04-01.jpg> One-on-One Conversation In one-on-one situations, health care workers must teach patients about treatments, procedures, and therapy. In addition, health care workers may need to teach patients how to use equipment, such as call buttons, remote controls, and medical equipment that is used in treatments. Health care workers are responsible for making sure patients fully understand what is expected of them. To ensure understanding, health care workers should ask questions and gauge patient answers for level of understanding.

Lesson 14 – Group Presentation
Health care workers may be required to deliver presentations for patient education purposes. To prepare, health care workers should ask the following questions: Who is the audience? What is the audience’s interest in the topic? Should the presentation be formal or informal? Are supporting materials necessary? What type of audiovisual will be most effective? <LS.HS.Comm.Patient.Education-P05-01.jpg> Group Presentation At times, health care workers may be required to deliver presentations for patient education purposes. Health care workers must be well prepared for presentations. They should be sure to ask themselves these important questions while developing patient education presentations. Who is the audience? What is the audience’s interest in the topic? Should the presentation be formal or informal? Are supporting materials necessary? What type of audiovisual will be most effective?

Lesson 15 – Quiz In this lesson, you will take a quiz on patient interaction.

Documentation 16. Documentation Go 17. Reporting Go 18. Quiz Go

Lesson 16 – Types of Documentation
Many types of documentation and they vary from one agency to another Some standard documentation includes: Health histories Notes Initial evaluations Progress reports Discharge reports <LS.HS.Comm.Docs.Documents-P01-01.jpg> Types of Documentation There are many types of documentation, and they vary from one agency to another. However, some forms of documentation are fairly standard. They include health histories, notes, initial evaluations, progress reports, and discharge reports.

Lesson 16 – Health Histories
Provides the doctor with important information about the patient Health histories generally include: General Statistical Data Chief Complaint Present Illness Review of Systems Past History Family History Personal/Sociocultural History <LS.HS.Comm.Docs.Documents-P03-01.jpg> Health Histories Perhaps the most standard document in the health care industry is the patient health history or medical history. The health history is typically completed on a patient’s first visit to a doctor. It can be completed by the patient alone, or by a health care worker and the patient together. The information included in a health history is confidential and should be treated sensitively. This document provides the doctor with important information about the patient. The doctor uses it to make a diagnosis and prescribe treatment. Most health histories contain the same type of information including, but not limited to, the following items. General Statistical Data: Includes the patient’s name, address, phone, age, and other relevant data such as employment and health insurance information. Chief Complaint (CC): The chief complaint is the patient’s reason for seeking medical help. The chief complaint should be recorded in the patient’s own words, enclosed with quotation marks. For patients who are getting a routine physical and have no chief complaint, the health care worker should record something similar to the following: Patient states he is getting a physical examination and has no complaints. Present Illness (PI): Present illness is a detailed description of the patient’s chief complaint. The health care worker should note what the patient has done for the symptoms, if the treatment has helped, how long the patient has been experiencing the symptoms, if the patient has experienced the symptoms before, and any over-the-counter (OTC) medications the patient has taken. Review of Systems (ROS): A review of systems is a review of all the body’s systems to uncover problems that the patient is not aware of. Past History (PH): Past history includes any major illnesses, surgeries, injuries, allergies, and unusual childhood diseases (UCHD) that the patient may have had. Dates of these incidents or the age of the patient when the incidents occurred should also be included. Past history should also document patient immunizations and medications. Family History (FH): A family history should include the past and present health of the patient’s biological mother, father, and siblings. If any of these family members are deceased, the age and cause of death should be recorded. Personal/Sociocultural History (PSH): The personal history includes the patient’s personal life history, self-concept, and coping patterns. Personal history should also include lifestyle information, such as diet, exercise, use of tobacco products, and consumption of alcohol. For women, personal history should also include number of pregnancies, number of children, any abortions, and menstrual cycle issues.

Lesson 16 – SOAP Notes SOAP is an acronym for:
Subjective Objective Assessment Plan All employees know where to look for information and in what format they will find it Eliminate some excess writing and reading for health care workers <LS.HS.Comm.Docs.Documents-P08-01.jpg> SOAP Notes SOAP is an acronym for Subjective, Objective, Assessment, Plan. SOAP notes consistently contain information on these four areas. When an agency uses SOAP notes, then all employees know where to look for information and in what format they will find it. These notes eliminate some excess writing and reading for health care workers.

Lesson 16 – Narrative Notes
Tells the patient’s story Chronological order Can describe how a patient’s status, treatment, etc. has changed More time-consuming than the SOAP method. <LS.HS.Comm.Docs.Documents-P09-01.jpg> Narrative Notes The narrative note method tells the patient’s story. The advantage to the narrative method is that health care workers can describe how a patient’s status, treatment, etc. has changed. With SOAP notes, there is not a category for changes, and so health care workers would need to read all the notes to determine what change has occurred. Narrative notes occur in chronological order as the events take place. The disadvantage to this method is that it can be more time-consuming than the SOAP method.

Lesson 16 – Initial Evaluation
Groundwork for a patient’s file An initial evaluation includes: Patient identification information Referral information: reason, referral history, referral diagnosis, requested treatment, complicating factors Evaluation Diagnosis with rationale for treatment Treatment plan: prescriptions, follow-up appointments, frequency and duration, goals <LS.HS.Comm.Docs.Documents-P11-01.jpg> Initial Evaluation An initial evaluation is the groundwork for a patient’s file. An initial evaluation includes an assessment of the patient’s condition, the plan for treatment, and the goals for recovery. Specifically, an initial evaluation includes: Patient identification information Referral information: reason, referral history, referral diagnosis, requested treatment, complicating factors Evaluation Diagnosis with rationale for treatment Treatment plan: prescriptions, follow-up appointments, frequency and duration, goals

Lesson 16 – Progress Report
Contains information regarding a patient’s on-going care, treatment, and progress Occur over a specified length of time, which can be days, weeks, months, etc. Support and give evidence of the need for the patient’s continued medical care <LS.HS.Comm.Docs.Documents-P12-01.jpg> Progress Report A progress report contains information regarding a patient’s on-going care, treatment, and progress. Progress reports occur over a specified length of time, which can be days, weeks, months, etc. The purpose of a progress report is to support and give evidence of the need for the patient’s continued medical care. Notes in a progress report can be written in either the SOAP or narrative format. Progress reports should contain the following information. Patient information Current evaluation Diagnosis: review of the original diagnosis and then addressing any new diagnoses Treatment: what was accomplished and what has occurred since the last treatment Assessment: the patient’s reaction to the treatment Complications: problems or reactions that resulted from treatment Recommendations, changes, goals: suggestions or changes for treatment, new short- and long-term goals, follow-up schedule

Lesson 16 – Progress Report (continued)
Progress reports should contain the following information: Patient information Current evaluation Diagnosis Treatment Assessment Complications Recommendations, changes, goals <LS.HS.Comm.Docs.Documents-P12-01.jpg> Progress Report (continued) A progress report contains information regarding a patient’s on-going care, treatment, and progress. Progress reports occur over a specified length of time, which can be days, weeks, months, etc. The purpose of a progress report is to support and give evidence of the need for the patient’s continued medical care. Notes in a progress report can be written in either the SOAP or narrative format. Progress reports should contain the following information. Patient information Current evaluation Diagnosis: review of the original diagnosis and then addressing any new diagnoses Treatment: what was accomplished and what has occurred since the last treatment Assessment: the patient’s reaction to the treatment Complications: problems or reactions that resulted from treatment Recommendations, changes, goals: suggestions or changes for treatment, new short- and long-term goals, follow-up schedule

Lesson 16 – Discharge Report
A discharge report has two functions: It releases the patient back to their regular lifestyle, sometimes with some restrictions. It gives a record of the interactivity among health care providers, as it documents the patient’s success from the initial evaluation to release. <LS.HS.Comm.Docs.Documents-P13-01.jpg> Discharge Report A discharge report has two functions. It releases the patient back to their regular lifestyle, sometimes with some restrictions. It also gives a record of the interactivity among health care providers, as it documents the patient’s success from the initial evaluation to release. It should contain the same pattern of information found in the progress report, along with final outcomes and assessments. Therefore, discharge reports should contain the following information. Patient information Final evaluation Diagnosis: review of original and any changes Treatment: what was accomplished Assessment: the patient’s successful response to the treatment Complications: problems that may result from treatment Recommendations and goals: documentation of any restrictions and short- and long-term goals, list of medications, follow-up schedule

Lesson 16 – Discharge Report (continued)
Discharge reports should contain the following information: Patient information Final evaluation Diagnosis Treatment Assessment Complications Recommendations and goals <LS.HS.Comm.Docs.Documents-P13-01.jpg> Discharge Report (continued) A discharge report has two functions. It releases the patient back to their regular lifestyle, sometimes with some restrictions. It also gives a record of the interactivity among health care providers, as it documents the patient’s success from the initial evaluation to release. It should contain the same pattern of information found in the progress report, along with final outcomes and assessments. Therefore, discharge reports should contain the following information. Patient information Final evaluation Diagnosis: review of original and any changes Treatment: what was accomplished Assessment: the patient’s successful response to the treatment Complications: problems that may result from treatment Recommendations and goals: documentation of any restrictions and short- and long-term goals, list of medications, follow-up schedule

Lesson 17 – Documentation Guidelines
Use a black ink pen. Write neatly and concisely Always include signature Correct errors appropriately. <LS.HS.Comm.Docs.Reporting-P02-01.jpg> Documentation Guidelines These standards of documentation should be observed by health care workers. Use a black ink pen. Write information neatly and in concise language. Sign any information inserted into a patient file. Signature should always include the author’s name or initials, the position or title, and the date and time. Correct errors appropriately. If errors are made, the author should draw a single line through the error, write the word “error,” and initial it. Errors should never be erased or covered with correction fluid. Do not leave empty spaces between lines of data. Record items in chronological order. Only use abbreviations that are approved by the agency. Do not record information performed or observed by another health care worker. When necessary, destroy documents properly using a paper shredder. Double-check for the correct patient, chart, and form.

Lesson 17 – Documentation Guidelines (continued)
Do not leave empty spaces Record items in chronological order. Only use abbreviations that are approved by the agency. Do not record information performed or observed by another health care worker. Destroy documents properly Double-check for the correct patient, chart, and form <LS.HS.Comm.Docs.Reporting-P02-01.jpg> Documentation Guidelines (continued) These standards of documentation should be observed by health care workers. Use a black ink pen. Write information neatly and in concise language. Sign any information inserted into a patient file. Signature should always include the author’s name or initials, the position or title, and the date and time. Correct errors appropriately. If errors are made, the author should draw a single line through the error, write the word “error,” and initial it. Errors should never be erased or covered with correction fluid. Do not leave empty spaces between lines of data. Record items in chronological order. Only use abbreviations that are approved by the agency. Do not record information performed or observed by another health care worker. When necessary, destroy documents properly using a paper shredder. Double-check for the correct patient, chart, and form.

Lesson 17 – Fact versus Opinion
Be careful to only include facts and to conceal own opinions Subjective and objective observations <LS.HS.Comm.Docs.Reporting-P04-01.jpg> Fact versus Opinion When documenting or reporting patient information, health care workers must be careful to only include facts and to conceal their own opinions. For example, “I think Mr. Jones has a fever,” is an opinion. “Mr. Jones has a temperature of 101ºF,” is a fact. To understand the difference between fact and opinion, it is helpful to distinguish between subjective and objective observations.

Lesson 17 – Subjective and Objective Observations
Subjective observations are often called symptoms. They are not seen or felt. Instead, they are comments or complaints made by the patient. Objective observations are typically called signs. They can be measured or seen. <LS.HS.Comm.Docs.Reporting-P05-01.jpg> Subjective and Objective Observations In the health care industry, subjective observations are often called symptoms. They are not seen or felt. Instead, they are comments or complaints made by the patient. For example, a patient may say, “I feel really warm.” Objective observations are typically called signs. They can be measured or seen. For example, the patient may have a temperature reading of 102.5ºF.

Lesson 17 – Making Objective Observations
Observe: Sight - Unusual skin color, swelling, rashes, sores Smell - Body odor or unusual odors from the breath, urine, stools, or wounds Touch - Pulse and the condition of the skin, including temperature, swelling, and dryness or perspiration Sound - Respirations, coughing, and impaired or slurred speech <LS.HS.Comm.Docs.Reporting-P07-01.jpg> Making Objective Observations During patient interaction, health care workers must constantly make observations. They must use all of their senses while observing patients. With the sense of sight, health care workers should watch for unusual skin color, swelling, rashes, sores. They should also take notice of unusual urine and stool color. They might also notice if abnormal quantities of food have been eaten or left on patient plates. With the sense of smell, health care workers should be aware of any body odor or unusual odors from the breath, urine, stools, or wounds. With the sense of touch, health care workers should pay attention to pulse and the condition of the skin, including temperature, swelling, and dryness or perspiration. With the sense of hearing, health care workers should listen to respirations and be alert for unusual body sounds, coughing, and impaired or slurred speech.

Lesson 17 – Documenting Observations
Both subjective and objective observations have a place in patient documentation. Objective observations should make up most of the report. Subjective statements made by the patient may also be included. However, they should be recorded in the patient’s exact words and quotation marks should surround them. <LS.HS.Comm.Docs.Reporting-P09-01.jpg> Documenting Observations Both subjective and objective observations have a place in patient documentation. Objective observations should make up most of the report. These observations are based on factual data that result from a procedure or therapy that has been performed on or by the patient. Subjective statements made by the patient may also be included. However, they should be recorded in the patient’s exact words and quotation marks should surround them. This notation clearly indicates to other health care workers that the observations inside the quotation marks are the statements made by the patient. Subjective observations should never be made by a health care worker. Nor should any such information be recorded in the patient file.

Lesson 17 – Eliciting Information
Know how to ask the right questions in order to get the information Ask broad questions that encourage patients to reply with more than “yes” or “no” answers. <LS.HS.Comm.Docs.Reporting-P12-01.jpg> Eliciting Information Health care workers must be skilled at eliciting information from patients. In addition to being a good listener, health care workers must know how to ask the right questions in order to get the information that they require. They should ask broad questions that encourage patients to reply with more than “yes” or “no” answers. For example, when eliciting information about a patient’s chief complaint, the health care worker might ask, “Why have you come to see the doctor today?” Once the patient gives an answer, the health care worker should continue to encourage the patient by asking, “What other symptoms do you have?”

Lesson 17 – Confidentiality
The information that goes into a patient’s file is confidential. Be sensitive to confidentiality: Ask patients for personal information in a private environment. Be careful to close file folders before setting them down. <LS.HS.Comm.Docs.Reporting-P13-01.jpg> Confidentiality The information that goes into a patient’s file is confidential. Health care workers must be sensitive to that confidentiality. They should ask patients for personal information in a private environment. Additionally, they should be careful to close file folders before setting them down where someone else might see them.

Lesson 18 – Quiz In this lesson, you will take a quiz on documentation.

Communication Technology
19. Telephone Skills Go 20. Other Technology Go 21. Quiz Go

Lesson 19 – Telephone Communication
May be the first communication patients have with a health care agency Creates an impression <LS.HS.Comm.Tech.Phone-P01-01.jpg> Telephone Communication A telephone conversation may be the first communication patients have with a health care agency. This initial conversation can create an impression that patients may hold onto for the rest of their connection with the agency. So, all health care workers should be trained in and use proper telephone etiquette.

Lesson 19 – Telephone Etiquette: Greeting
Good telephone etiquette includes a proper greeting. Identify yourself, the agency, and possibly the department <LS.HS.Comm.Tech.Phone-P03-01.jpg> Telephone Etiquette: Greeting Good telephone etiquette includes a proper greeting. When health care workers answer the phone, they should identify themselves, the agency, and possibly their department right away. For example, “Good morning, this is Cameron Peters in cardiology at St. Paul’s Hospital. How can I help you?”

Lesson 19 – Telephone Etiquette: Voice
Use a clear voice with a normal volume. Vary tone, pitch, and volume for emphasis Hold the phone’s mouthpiece about one inch from the mouth <LS.HS.Comm.Tech.Phone-P04-01.jpg> Telephone Etiquette: Voice Health care workers should strive for a clear voice with a normal volume. They should be careful to enunciate words clearly. When appropriate, they should vary tone, pitch, and volume for emphasis. Additionally, health care workers should hold the phone’s mouthpiece about one inch from the mouth. They should always avoid eating or drinking while on the telephone.

Lesson 19 – Telephone Etiquette: Courtesy
Be polite, gracious, helpful, and considerate Use the other person’s name and say “please” and “thank you.” Be careful not to interrupt the other person <LS.HS.Comm.Tech.Phone-P06-01.jpg> Telephone Etiquette: Courtesy Courtesy involves being polite, gracious, helpful, and considerate. When using the telephone, health care workers should be courteous to all callers. They should use the other person’s name and say “please” and “thank you.” They should smile while they speak because this will come through in their voice. They should be conscious not to interrupt the other person.

Lesson 19 – Telephone Etiquette: Attention
Atmosphere around the telephone can be very busy and noisy Focus on the caller <LS.HS.Comm.Tech.Phone-P07-01.jpg> Telephone Etiquette: Attention Depending on what field of health care work they are in, the atmosphere around the telephone can be very busy and noisy. When on the telephone, health care workers must block out what is going on around them and focus on the caller. Giving undivided attention to the callers shows interest and concern for them.

Lesson 19 – Taking Telephone Messages
Phone messages should include: The full name of the caller with the correct spelling The caller’s telephone number with the area code and extension number, if applicable The best time of day to return the call A brief message about the nature or purpose of the call The date and time the call was received A brief note of any action that was taken Their own initials in case there are any questions about the message <LS.HS.Comm.Tech.Phone-P09-01.jpg> Taking Telephone Messages In some cases, health care workers may be required to take a telephone message. They must be sure to include all the important information in the message, including: The full name of the caller with the correct spelling The caller’s telephone number with the area code and extension number, if applicable The best time of day to return the call A brief message about the nature or purpose of the call The date and time the call was received A brief note of any action that was taken Their own initials in case there are any questions about the message

Lesson 19 – Test Results and Triage
The telephone should not be used to communicate bad news or complex information. The telephone is often used for triage. <LS.HS.Comm.Tech.Phone-P10-01.jpg> Test Results and Triage The telephone is a great communication tool in the health care field. In addition to receiving calls from patients, health care workers must also make calls to patients. Health care workers should use proper telephone etiquette when calling patients to remind them of appointments, to follow-up on treatment, and to give simple test results. The telephone should not be used to communicate bad news or complex information. In these cases, it is important to see the patient face-to-face. The telephone is also often used for triage. In these cases, a patient and health care worker discuss the patient’s condition over the telephone and determine whether the patient should be seen by a physician immediately or whether an appointment can be scheduled for a later date. Health care workers must be very cautious when using the telephone to triage a patient. They must be certain that the patient is in no danger before advising that a future appointment be made.

Lesson 19 – Answering Machines and Services
Used to deliver a message to callers and record calls from patients. Answering services are more efficient in that the caller will be connected to an operator. <LS.HS.Comm.Tech.Phone-P12-01.jpg> Answering Machines and Services Many health needs occur after hours and on weekends when health care agencies may be closed. Agencies use answering machines or answering services so that emergency cases can receive a response. An answering machine is used to deliver a message to callers and record calls from patients. The message typically has instructions for callers with emergencies. A health care worker is assigned to check the machine either at regular intervals while the agency is closed or on the next business day. Answering services are more efficient in that the caller will be connected to an operator. That operator works for the answering service and is not a health care professional. The operator is responsible for taking calls and information, and then contacting the health care worker that is on duty to cover emergencies.

Lesson 20 – Electronic Communication
Automatic routing telephone systems (ARU) Paging systems Cellular phones Facsimile, or fax, machines Electronic mail. <LS.HS.Comm.Tech.ETools-P01-01.jpg> Electronic Communication In addition to the telephone, there are several other ways to communicate technologically in the health care industry. Some of these include the following tools. Automatic routing telephone systems (ARU) Paging systems Cellular phones Facsimile, or fax, machines Electronic mail.

Lesson 20 – Automatic Routing Units
Many telephone calls can be answered simultaneously Directions instruct the caller to press a number on the telephone key pad to reach a person or a department. <LS.HS.Comm.Tech.ETools-P02-01.jpg> Automatic Routing Units Many health care agencies have an automatic routing unit (ARU). With ARUs, many telephone calls can be answered simultaneously. A recorded message provides a series of directions. The directions instruct the caller to press a number on the telephone key pad to reach a person or a department. Nearly all ARUs are programmed so that callers with emergencies can get through to someone with the press of just one button.

Lesson 20 – Paging Systems
Pagers beep and display either a telephone number or a digital text message. Pagers cannot be used for two-way communication. <LS.HS.Comm.Tech.ETools-P03-01.jpg> Paging Systems Pager or beeper systems are effective communication tools in the health care industry. Workers have pagers with numbers assigned to them. When health care workers are needed, their pagers will beep and display a telephone number that they can call to get the message. Or, the pager may display a digital text message that gives the worker the actual message, in some cases making a phone call unnecessary. Pagers cannot be used for two-way communication.

Lesson 20 – Cellular Phones
Two-way communication tools Private patient information should never be discussed using cellular phones <LS.HS.Comm.Tech.ETools-P05-01.jpg> Cellular Phones Unlike pagers, cellular phones are two-way communication tools, which make them very efficient. However, cellular phone signals can be picked up by scanners. So, private patient information should never be discussed using cellular phones. Additionally, cellular phones can be more costly than other forms of communication.

Lesson 20 – Fax Machines Used to quickly transmit data over telephone lines When using a fax machine: Get patient permission before faxing records. Never fax financial information. Contact the receiver before and after sending a fax. Attach a cover sheet that contains a confidentiality statement. ***<LS.HS.Comm.Tech.ETools-P06-01.jpg>*** Fax Machines Fax machines are a valuable tool in the health care industry. They are used to quickly transmit data over telephone lines. Both the sender and the receiver must have fax machines in order for the process to work. Papers are placed in the sender’s fax machine. The sender dials the receiver’s fax machine phone number. The pages are then copied by the sender’s machine similar to a photocopy machine. But in this case, the duplicate page is printed at the receiver’s fax machine. In some cases, confidentiality can be a problem when using a fax machine. Newer models allow for passwords that can prevent pages from being printed until the password is entered. Otherwise, health care workers should take some precautions to ensure confidentiality, including: Get patient permission before faxing records. Never fax financial information. Contact the receiver before and after sending a fax. Attach a cover sheet that contains a confidentiality statement.

Lesson 20 – Electronic Mail
Communication among health care workers, agencies, and insurance companies Often takes the place of printed interoffice communication Should never be used to communicate confidential patient information because s can be intercepted <LS.HS.Comm.Tech.ETools-P07-01.jpg> Electronic Mail Electronic mail, or , is an effective form of written communication. It is used widely in the health care industry. Communication among health care workers, agencies, and insurance companies all take place using . often takes the place of printed interoffice communication. The cost for is very low. However, should never be used to communicate confidential patient information because s can be intercepted.

Lesson 21 – Quiz In this lesson, you will take a quiz on communication technology.

Reflect Unit Questions Go Key Questions Go

Reflect – Unit Questions
How can you apply active listening skills to your everyday life and the lives of those around you? Compare and contrast subjective and objective information in reporting. Your patient is very hard-of-hearing and speaking loudly does not seem to be working. What should you do? Do you think that you have any personal barriers that would prevent you from communicating effectively with another person? If so, what can you do to overcome your own personal communication barriers? Reflection Use the items below to engage students in critical thinking and discussion. Ask students to write answers to the following questions in their student journal. Then discuss each of the questions as a class. The questions are also located in the unit teacher manual. How can you apply active listening skills to your everyday life and the lives of those around you? Compare and contrast subjective and objective information in reporting. Your patient is very hard-of-hearing and speaking loudly does not seem to be working. What should you do? Do you think that you have any personal barriers that would prevent you from communicating effectively with another person? If so, what can you do to overcome your own personal communication barriers?

Reflect – Key Question Why is effective communication important in the health care industry? How do attitudes of respect and sensitivity affect communication? Key Question 1 Students will explain what they know about communication. A typical answer might be, “The information that is exchanged in the health care industry can be vital to patient health and successful patient treatment. Communication in this field can literally be the difference between lif and death. Additionally, communication in health care requires great sensitivity and attention to make patients comfortable and keep the encouraged.” Key Question 2 Students will explain what they know about respect and sensitivity. A typical answer might be, “Sensitivity and respect can be the difference between a message being heard and understood and a communication failure. When people’s lives and health are at stake, it is critical that patients and health care workers communicate effectively with one another. Effective communication relies on mutual respect and sensitivity among one another.”

Reinforce Project Communication Skit
You will write and perform skits that demonstrate good and poor communication skills. Student Tasks With a partner, write two skits – one demonstrating poor communication skills and one demonstrating good communication skills. Perform the skit according to teacher’s instructions. Explain communication skills demonstrated in the skit. Self-assess project performance. Submit work according to teacher’s instructions.

Reinforce Project Culture and Religion
You will research and present information on a culture or religion, specifically its views on health care. Student Tasks Research a culture or a religion and how it relates to health care. Write a brief report on the culture or religion by using the Culture Research or Religion Research form. Prepare a presentation and a visual aid. Practice presenting and fielding questions with a partner. Self-assess project performance. Submit work according to teacher’s instructions.

Reinforce Project Medical Records
You will practice several filing techniques, including alphabetical, numerical, and categorical. Student Tasks Sort items alphabetically, numerically, and categorically. Submit work according to teacher’s instructions.

Reinforce Project Telephone Etiquette
You will take a telephone message during a role-play exercise. Student Tasks Perform telephone role play scenarios in groups of four. Take a thorough telephone message. Submit work according to teacher’s instructions.

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