1. Effective Communication

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

19. Observation, reporting & documenting
Documentation
Observation, reporting & documenting

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

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

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

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

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

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