Transcript Nursing Assistant

Nursing Assistant
Chapter 5: Communication skills
objectives
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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
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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
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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:
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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
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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
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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
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Crossing arms
Tapping feet
Tapping fingers
Rolling eyes
Looking at watch
Looking at door
Tactics that enhance communication
• Positive body language
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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
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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.
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Not listening carefully
“tuning out”
“complainers”
Being judgemental
Assuming that someone else knows what you are thinking
Conflict resolution
• Conflict
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“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
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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
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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
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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