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Nursing Assistant Chapter 5: Communication skills objectives • • • • • • • Define communication Describe the two major forms of communication Discuss techniques that promote effective communication Describe blocks to effective communication and discuss methods to avoid them Identify causes of conflict, and discuss ways of resolving conflicts Demonstrate proper telephone communication techniques Discuss the methods of reporting and recording information in a health care setting • Explain how the patient’s medical record makes communication easier among members of the health care team • Describe communication technologies that are being used in the health care field today What is communication? • Communication • • • • • • The exchange of information Constant back and forth flow of information Not just telling someone information All involved must actively participate Sender Reciever What is communication? • Communication Cont… • Message • Feedback What is communication? • Verbal communication • • • • Involves the use of language Spoken or written Sign language Tends to be deliberate What is communication? • Nonverbal communication • More subtle • Gives information through the use of: • • • • Facial expressions Gestures Body language Tone of voice • People may not say what they really mean Communicating effectively • As a nursing assistant you must be an effective communicator • Typically spend more time with patient than any other provider • Carefully observe for communication cues Communicating effectively • The sender creates a message • Information needs to be organized and relevant to the person who will be receiving it. Use language that the receiver understands. Speak clearly and loudly enough for the receiver to hear. Written messages should be legible. Communicating effectively • The sender delivers the message • Speaking directly to another person, or “face-to-face”, permits nonverbal communication to take place. Nonverbal communication is impossible with letters, memos, emails, and phone calls. When relying on written communication make sure your handwriting is neat and spelling is accurate. With the phone, make sure background noise is at a minimum. Communicating effectively • The receiver receives the message • The receiver must be physically able to receive the message, and mentally engaged in the communication exchange. Communicating effectively • The receiver provides feedback • Can be verbal or nonverbal. Sender should make effort to get response. Tactics that enhance communication • When you are the receiver, be a good listener • • • • • • • Active listening requires focusing your attention on the speaker Sit down or assume a relaxed posture do not appear rushed or in a hurry to move on Make eye contact Do not interrupt Focus on what they are saying, not what you want to say Provide good feedback Tactics that enhance communication • When you are the sender, make sure your message is clear • • • • • Speak clearly Use words the person can understand Tailor language to person Use interpreter if needed Picture boards Tactics that enhance communication • Learn techniques for encouraging people to talk • Ask open ended questions • Ask the question “Why” Tactics that enhance communication • Conversation 1: • Nursing Assistant: “good morning, Mr. Hopkins. Did you have breakfast this morning?” • Mr. Hopkins: “No.” • Nursing Assistant: “Why not?” • Mr. Hopkins: “I don’t know…I just wasn’t hungry, I guess.” Tactics that enhance communication • Conversation 2: • Nursing Assistant: “good morning, Mr. Hopkins. What did you have for breakfast this morning?” • Mr. Hopkins: “not much. They sent up scrambled eggs. I don’t care much for scrambled eggs, so I just had some toast and coffee.” • Nursing Assistant: “I didn’t know you didn’t like scrambled eggs! Let me see what I can do about that. Do you dislike eggs in general, or just scrambled? In the meantime, are you hungry?” Tactics that enhance communication • Provide and seek feedback • Repeat what is being stated or asked • Ask for feedback without being intimidating • “now repeat that information for me so that I know that you’ve got it” • “now, if you could just repeat those instructions for me so that I can make sure I didn’t leave anything out.” • Make the resident feel like they are helping you Tactics that enhance communication • Be mindful of your body language and tone of voice • Negative body language • • • • • • Crossing arms Tapping feet Tapping fingers Rolling eyes Looking at watch Looking at door Tactics that enhance communication • Positive body language • • • • • • Facing speaker Nodding Smiling Looking serious Occasional vocal sounds Eye level with speaker Tactics that enhance communication • Tone of voice • Avoid sharp or hurried • Use slow and soothing tone • Avoid baby talk Tactics that enhance communication • Remember the value of silence and a comforting touch • • • • • Says more than words can Most universal of all languages Be sensitive to individuals comfort level Establishes a bond Babies fail to grow and thrive without human touch Blocks to effective communication • Some behaviors and attitudes can block effective communication. • • • • • Not listening carefully “tuning out” “complainers” Being judgemental Assuming that someone else knows what you are thinking Conflict resolution • Conflict • • • • • • “discord resulting from differences between people” One persons expectations differ from another One person misunderstands another One persons needs/wants conflict with anothers Some degree of conflict is inevitable Fairly common in health care Conflict resolution • Conflict • Makes most people uncomfortable • Good communication is essential to preventing conflict Conflict resolution • Approaches for resolving conflict • Ask to speak privately with the person you have conflict with (try this first) • During the conversation, focus on the specific area of conflict • Be specific about what you understand the problem to be, and express why you are upset • Don’t be accusatory • Be prepared to hear how the other person may feel toward you or the problem Conflict resolution • Approaches for resolving conflict • Be gracious enough to apologize for misunderstanding the other person, or for being the one who was misunderstood • Ask the other person for insight into solutions for resolving the conflict • Sometimes it is necessary to “agree to disagree” • Focus on things you have in common • If you are unable to resolve on your own, seek the advice of your supervisor Telephone communication • Primary tool of communication in health care • Make sure voice is pleasant and unhurried • Caller can hear a smile • Confidentiality is key Telephone communication • Telephone etiquette • • • • • • Answer the telephone promptly, within the first three rings Answer with a pleasant greeting Identify yourself with name and title Ask “how may I help you?” Know the phone system Ask permission to place on hold Telephone communication • Telephone etiquette • Offer to take a message • Nursing assistants do not, do not, do not take doctors orders!!!!!! • No personal calls at nurses station Communication among members of the healthcare team • Nursing assistant plays important role in gathering and sharing information • Opportunity to make observations • Something that you notice a change in the resident’s physical or mental condition • Objective data • Information you obtain directly • Through measurement • Through your five senses Communication among members of the healthcare team • Subjective data • Cannot be easily measured or assessed • Usually a person’s complaint, or symptom Reporting • Spoken exchange of information between health care team members • Observations that suggest a change in the patient’s condition • Observations regarding the patient’s or resident’s response to a new treatment or therapy • A patient’s or resident’s complaints of pain or discomfort • A patient’s or resident’s refusal of treatment • A patient’s or resident’s request for clergy Reporting • When reporting information, follow the guidelines for effective communication • Make sure the information you are reporting is accurate • When reporting numbers, write them down • Report observations in an orderly efficient manner • Avoid adding information that is not relevant • Use correct terminology • Reporting is also routinely used when shifts change to keep staff members aware of patient’s conditions Recording (Charting) • Medical Record (Chart) • Legal document • Usually organized in sections • Contains the following forms • Admission sheet • • • • • Name Address Phone number Gender birthday Recording (Charting) • Medical Record (Chart) • Medical history • Dictated and typed • Previous surgeries, medical conditions, medications, allergies, current diagnosis • Sometimes called an H&P • Nursing history • • • • • Completed by nurse at time of admission Information about limitations or disabilities Bowel and bladder habits Dietary info Ambulation aids Recording (Charting) • Medical Record (Chart) • Physician’s order sheet • Used by the doctor to communicate what needs to be done • Medication Administration Record (MAR) • All ordered medications listed here • Used to record when medications are given • Physician progress note • Physician records their notes and observations and response to treatment Recording (Charting) • Medical Record (Chart) • Narrative nurse’s notes • Used by nurse to document the person’s complaints and actions taken by staff • Graphic sheet • Vitals • Frequency of urination and BM • Food and fluid intake • Miscellaneous documents • Lab reports, radiology reports, etc. Recording (Charting) • Medical Record (Chart) • The information contained in a person’s medical record is considered confidential and is only to be read by members of the health care team who are directly involved in the care of that person and need access to the information in the record to provide care • To keep patients and residents safe, each form in the medical record must be stamped or printed with the patient’s information Recording (Charting) • Kardex • Card file containing condensed versions of each patient’s or resident’s medical record The nursing process • Interdisciplinary care plan • Directs the efforts of the health care team members • Nursing care plan • Specific plan developed by the nursing team for each patient The nursing process • ADoPIE • Assessment • Information is gathered • Diagnosis • Nursing diagnosis • Statement that describes a problem (NOT A medical diagnosis) • Planning • Develops interventions • Implementation • Executing the interventions • Evaluations • Were the interventions effective