Chapter 2 Flashcards
Verbal communication
Use a spoken or written words. Oral reports are an example
Nonverbal communication
Communicating attitudes or emotions without using words.
Examples include:
body language movements
facial expression
posture
Deciding what to report
Anything that endangers residents including:
Falls
chest pain
severe headache
trouble breathing abnormal pulse, respiration, or blood pressure
change in mental status sudden weakness or loss of mobility
fever
loss of consciousness
change in level of consciousness
bleeding
swelling of a body part
change in general condition
bruises, abrasions, or other signs of possible abuse
Different languages (resident’s rights)
Speak in a language that residents can understand or find an interpreter. Picture cards and gestures can help with communication. CNAs should not use a different language when speaking with staff in front of residents
Ask a resident for more information
When they report symptoms, events or feelings. Have them repeat what they have said. Ask open-ended questions that need more than a yes or no answer.
Example: “did you sleep well last night?” should be replaced with “Can you tell me about your night and how you slept?”
Encourage the resident to offer facts and details.
Tips for proper communication
Always greet the resident by his or her preferred name (use first names only if asked to do so)
Identify them
Focus on the topic to be discussed
Face the resident while speaking and avoid talking into space
Talk with the resident, not other staff members while giving care
Listen and respond when the resident speaks
Praise the resident and smile often
Encourage the resident to interact with you and others
Be courteous
Tell the resident when you are leaving the room
Objective information (signs)
Based upon what a person sees, hears, touches or smells
Example: “Mr Hartman is holding his head and rubbing his temples.”
Symptoms
subjective information
Are based on what the resident reports (that may or may not be true.)
Example: “Mr Hartman says he has a headache”
An example of clear reporting of symptoms
“Mr Scott reports pain in left shoulder”
Senses used together information
Sight
hearing
touch
smell
Sight
Look for changes in the resident’s appearance.
Examples:
rashes redness paleness swelling discharge weakness sunken eyes changes in posture or gait
Hearing
Listen to what the resident has to say about their condition, family or needs.
Is the resident speaking clearly and making sense?
Do they show emotions such as anger, frustration or sadness?
Is their breathing normal?
Do they wheeze, gasp or cough?
Is their area quiet enough for him to rest as needed?
Touch
Does the residents skin feel hot or cool?
moist or dry?
Is the pulse rate normal?
Smell
Odors could suggest poor bathing, infections or incontinence.
The breath could suggest use of alcohol or tobacco, indigestion or poor mouth care.
Incontinence
The inability to control the bladder or bowels
Oral reports
Make written notes so that important details are not forgotten while waiting for the charge nurses availability.
After delivery, document when, why, about what and to whom an oral report was given.
Take notes when a member of The Care team gives you an oral report.
Telephone communication
Identify the facilities name, my name and my position.
Ask if it is okay to put a person on hold
Never give out any information about staff or residents
If somebody is calling to give a doctor’s order for a resident, find the nurse or take a message for the nurse.
Call lights
Make sure it’s within reach of the residents stronger hand and that the resident knows how to use it. (Each time you leave the room)
Respond immediately even if the resident is not on your assignment sheet
Overcoming barriers to communication:
If the resident does not hear you, does not hear correctly or does not understand:
face the resident. Speak slowly and clearly. Speak in a low voice using a pleasant tone. Check if they’re hearing aid is on and working.
Overcoming barriers to communication:
Resident is difficult to understand
Be patient. Take the time to listen. Ask the resident to repeat or explain the message. Restate the message in your own words to make sure that you have understood.
Overcoming barriers to communication:
Do not use words that are not understood easily by others
Do not use medical terms with resident’s or their families.
Use simple everyday words. No slang or profanity. (Even if the resident uses them)
Overcoming barriers to communication:
Cliches
Avoid using cliches. Listen to what a resident is really saying and respond with a meaningful message
Overcoming barriers to communication:
Why?”
Avoid asking “why?” When a resident makes a statement. “Why?” questions make people feel defensive.
Overcoming barriers to communication:
Advice
Never offer your opinion or give advice. Giving medical advice is not within the scope of your practice. It could be dangerous.
Overcoming barriers to communication:
Open-ended questions
Yes and no answers end conversations. Avoid them.
Overcoming barriers to communication:
Resident speaks a different language
Speak slowly and clearly. Be patient and calm. Keep messages short and simple. Be alert for words the resident understands as well as signs that the resident is only pretending to understand. Use pictures or gestures to communicate if necessary. Ask the residence family or other staff members who speak the same language for help.
Overcoming barriers to communication:
nonverbal communication
Be aware of body language and gestures. Look for nonverbal messages and clarify them.
Example: “Mr feldman, you say you’re feeling fine but you seem to be in pain. Can I help?”
Overcoming barriers to communication:
Defense mechanisms
Denial
Projection: seeing feelings in others that are really one’s own - “my teacher hates me”
Displacement transferring a strong negative feeling to safer situation. Example: and unhappy employee doesn’t stand up to his boss. He goes home and yells at his wife.
Rationalization colon making excuses to justify situation. Example: after stealing something, saying “everybody does it”
Repression: blocking painful thoughts or feelings from the mind such as a traumatic experience
Regression going back to an old, usually immature behavior. Example: throwing a temper tantrum as an adult
Overcoming barriers to communication:
Culture
When communicating with residents from a different culture ask yourself these questions:
What information do I need to communicate to this person?
Does this person speak English as a first or second language?
Do I need an interpreter?
Does this person have any cultural practices about touch or gestures I should adapt to?
Impairment
A loss of function or ability; it can be a partial or complete loss
Hearing impairment guidelines
Make sure that the hearing aid is turned on/clean daily.
Reduce or remove noise such as tvs, radios and loud speech. Close doors if needed.
Get the residence attention before speaking. Do not startle residence by approaching from behind. Walk in front or touch them lightly on the arm to let them know you are near.
Speak clearly, slowly and in good lighting. Directly face the person. The light should be on your face, not the residents. Ask if they can hear what you are saying
Do not shout. Do not mouth the words in an exaggerated way.
Keep the pitch of your voice low
If they hear better out of one ear try to speak or stand on that side
Use short sentences and simple words. Avoid sudden topic changes
Use picture cards or a notepad as needed
Avoid long, tiring conversations
Don’t pretend to understand if you do not. Ask the resident to repeat what was said. Observe the lips, facial expressions and body language. Then tell the resident what you think you heard. You can also request that the resident write the words down
Be understanding and supportive
Speak clearly slowly and in good lighting. Directly face the person
Vision impairment guidelines
Encourage the use of eyeglasses or contact lenses if worn
Make sure eyeglasses are clean. Make sure eyeglasses are in good condition and fit well. Report to the nurse if they do not.
Knock on the door and identify yourself as soon as you enter the room. Do not touch the resident until you have said your name. Explain why you are there and what you would like to do. Let the resident know when you are leaving the room.
Make sure there is proper lighting in the room. Face the resident when speaking.
When you enter a new room with the resident, Orient him to where things are. Describe the things you see around you. Try not to use words such as “see”, “look” or “watch”
Always tell the resident what you were doing while caring for them. Give specific directions such as “on your right” or “in front of you”. Talk directly to the resident whom you are assisting do not talk to other residents or staff members.
Is the face of an imaginary clock as a guide to explain the position of objects that are in front of the resident. Example: “there’s a sofa at 7:00”
Do not move personal items, furniture or other objects. Put everything back where you found it.
Tell the resident where the call light is and make sure it is within their reach.
Leave doors completely open or completely closed, never partly open.
If the resident needs guidance and getting around, walks slightly ahead. Let them touch or grasp your arm lately. Walk at their pace, not yours
Give assistance with cutting food and opening containers as needed
Large print books, audio books digital books and Braille books are available
If the resident has a guide dog, do not play with, distract or feed it
Encourage the use of other senses, such as hearing touch and smell. Encourage them to feel and touch things, such as clothing furniture or items in the room
Signs of a mental health disorder
Confusion disorientation agitation anxiety depression
Guidelines to communication with residents who have mental health disorders
Speak to them like adults
Use simple, clear statements in a normal tone of voice
Be sure that what you say and how you say it show respect and concern
Be honest and direct, as you would with any resident
Avoid arguments
Maintain eye contact and listen carefully
Combative behavior
Must always be reported and documented so the care team can be aware of it.
Combative behavior guidelines
Never retaliate or threaten a resident
Remain calm. Lower the tone of your voice. Stand at least an arms length away
Allow the resident time to calm down before the next interaction
Stay neutral. Do not respond to verbal attacks. Do not argue or accuse the resident of wrongdoing. If you must respond, say something like “I understand that you’re angry and frustrated. How can I make things better?”
Keep your hands open and in front of you
Be reassuring and supportive
Consider what provoked the resident. Was it a change in caregiver? A change in routine? Get help to take the resident to a quieter place if needed
Report inappropriate behavior to the nurse
Expressions of anger
Yelling threatening throwing things pacing withdrawing being silent sulking
always report angry behavior to the nurse
Anger behavior guidelines
Stay calm. Do not argue or response to verbal attacks
Empathize with the resident. Try to understand what he or she is feeling
Try to find out what caused their anger. It’s an attentively. Remain silent. This may help the resident explain
Treat them with dignity and respect. Explain what you are going to do and when you will do it.
Answer call lights promptly
Stay at a safe distance if the resident becomes combative
Inappropriate behavior
When a resident tries to establish a personal rather than professional relationship
Examples: asking personal questions requesting visits on personal time asking for or doing favors giving tips or gifts lending or borrowing money
Sexual advances may include:
Sexual words, comments or behavior that makes the person to whom they were directed feel uncomfortable
Examples:
removing of clothing
touching themselves (sometimes mentally ill/confused residents may have problems that mimic inappropriate sexual behavior such as an uncomfortable rash, tight clothing or a need to use the bathroom. If you encounter a resident in an embarrassing situation remain professional and do not overreact. Try to distract the resident. If this does not help they should be taken to a private area and the nurse should be notified.)
Address the inappropriate behavior directly by saying something like “that makes me uncomfortable” or “I can’t really talk about my personal life on the job.”
Safety check when exiting a residence room
Is the call light within reach of the residents stronger hand?
Is the room tidy? Are the residents items in their proper places?
Is the furniture in the same place as I found it?
Is the bed in its lowest position?
Does the resident have a clear walkway around the room and into the bathroom?
Guidelines to preventing falls
Clear all walkways of clutter, trash, throw rugs and cords
Use rugs with a non-slip backing
I have residents where non-skid, sturdy shoes. Make sure shoelaces are tied
Residents should not wear clothing that is too long or drags on the floor
Keep items that are used often close to residents, including call lights
Immediately clean up spills on the floor
Report loose handrails immediately
Mark uneven flooring or stairs with tape of a contrasting color to indicate a hazard
Improve lighting where needed
Block wheels and move foot rests out of the way before helping residents into or out of wheelchairs
Lock bed wheels before helping a resident into and out of bed or when giving care
After completing care return beds to their lowest position
Can’t help when moving residents. Keep residents walking aids, such as canes or walkers, within their reach
Offer help with elimination needs often. Respond to these requests immediately
Leave furniture in the same place as you found it
Know which residents are at risk for falls. Pay attention so that you can give help often
If a resident starts to fall, being a good position to help support them. Never try to catch a falling resident. Use your body to slide them to the floor. If you try to reverse the fall, you may hurt yourself and/or the resident
Report report all falls to the nurse and complete an incident report even if they say they are fine
