Communication

Communication Basics

• Exchange of information, thoughts, ideas, and feelings

Verbal

• Spoken words

• Written communication

Non-verbal

• Facial expressions

• Body language

• Touch

• Posture

• Gestures

• Tone/Volume of Voice

Communication Process

Listening

• 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

Non-verbal Communication

• Involves use of facial expressions, body language, gestures, eye contact and touch

• Healthcare worker must be aware of both their own and patient’s nonverbal behavior

3 Essential Elements

Sender

• 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

• Feedback is the method that can be used to determine if communication was successful

• Occurs when the receiver responds to the message

• Allows original sender to evaluate how the message was interpreted and to make any necessary adjustments or clarification

• Feedback can be verbal or non-verbal

Elements of Effective Communication

• Message must be clear

  • (USE OF TERMINOLOGY BY BOTH PARTIES; EXPLAINING PROCEDURES IN LAY TERMS)

• 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)

Barriers

Barriers

• Something that gets in the way of clear communication

• Three common barriers are:

  • Physical disabilities

  • Psychological attitudes/prejudice

  • Cultural diversity

Physical Disabilities

• Deafness/hearing loss

• Blindness/impaired vision

• Aphasia/speech impairments

Psychological/Prejudice

• Caused by prejudice, attitudes and personality

  • Moralizing, lecturing, over-reacting, arguing, prejudging, advising

Cultural Diversity

• Beliefs regarding health care, language differences, eye contact, ways of dealing w/terminal illness and/or severe disability, touch

Impairments

Hearing Impairment

• Make sure hearing aids work well (batteries)

• Reduce noise in room

• Get resident’s attention before speaking

• Speak slow and clear and in good lighting

• Directly face the person

• Don’t shout

• Lower pitch of voice

• Don’t chew gum

• Keep hands away from face

• Repeat using different words

• Use picture cards or notepad if needed

• Don’t get frustrated

Visual 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 newspaper/magazine

• Use large clocks in room

• Get books on audiotape

Behavior and Communication

Stroke and Communication

• Occurs when a clot or 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, use pictures gestures or pointing (communication boards or special cards to aid communication work well),

  • Never call weaker side the “bad side” say “side with the deficit”

  • Keep call signal within reach and let them know you will come when they need you

Angry Behavior

• Disease process, fears pain and loneliness

• Stay calm

• Don’t 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

Combative Resident

• Can result from disease process affecting the brain, frustration, or part of personality

• Block physical blows and step out of the way

• Stay at a safe distance

• Stay calm

• Be flexible and patient

• Be neutral

• Don’t respond to verbal attacks/don’t argue

• Don’t use gestures that could frighten/startle the resident

• Be reassuring and supportive

• Leave resident alone if you can safely do so

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, etc.

Observations, Reporting, and Documentation

(Obs.) Subjective

• Cannot be seen or felt

• Commonly called symptoms

• Usually statements or complaints made by the patient/resident

• Report in exact words

(Obs.) Objective

• Can be seen or measured

• Commonly called signs

Recording & Reporting

• Must record and report observations while providing care

• Must listen to what patient is saying, but observe with other senses as well

• Smell

  • Breath or body odor

• Sight

  • Change in appearance

• Hearing

  • Words, tone and breathing

• Touch

  • Skin and pulse

Documentation (Online)

• 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 (what observer thinks not like symptoms) 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

Types of Forms (Documentation)

• Admission

• History/physical exams

• 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

• Advanced directives

Charting Guidelines

• Must be charted

• Purpose is to record patient care and prove accountability for care given

• Check for right patient, room, form, and 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 the term patient (just say the name)

  • Use white-out for corrections

    • Single line through error with initials

Incident Reports

• 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, and condition of patient/resident

  • State facts not opinions

  • Do not write in medical record

  • Describe action taken

  • Include suggestions for change

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”

Medical Abbreviations

Basic

• po: by mouth/per os (latin)

• qd: every day

• VS: vital signs

• BP: blood pressure

• HR: heart rate

• RR: respiratory rate

• T: temperature (capital T)

• HTN: hypertension

• ENT: ear nose and throat

• MA: medical assistant

• NP: nurse practitioner

• PA: physician assistant

• MD: medical doctor

Route Abbreviations (How is it taken?)

• IM: intramuscular

• IV: intravenous

  • gtt: drip

• SC or SQ: subcutaneous

• PO: by mouth (per os)

• INH: inhaled

Time Related Abbreviations

• QD: every day

• QOD: every other day

• QID: four times a day

• BID: twice a day

• TID: three times a day

• AC: before meals

• PC: after meals

• Qh: every hour (can be adjusted to be every hours Q_h)

• PRN: as needed

Other Common Abbreviations

• Dx: diagnosis

• Rx: prescription

• Sx: symptom

• Hx: history

• CC: chief complaint

• c/o: complains of

• Fx: fracture

• Px: prognosis

• DOB: date of birth

• DOD: date of death

• d/c: discontinue, discharge

• DNR: do not resuscitate

• DNI: do not intubate

• NPO: nothing by mouth

• N/V: nausea, vomiting

• SOB: short of breath

• h/o: history of

Patient Assessment Abbreviations

• c/o: complains of

• s/s: signs and symptoms

• WNL: within normal limits

• SOB: shortness of breath

Nursing Process

• The RN is responsible for achieving “patient focused care”

• 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 (not like normal diagnosis, more on how to help patient)

      • Risk for infection related to surgical incision

  • Planning

    • Care of patient - “care plan” - identifies possible solutions to the identified problem within scope of practice

    • Establishes goals for the patient

    • May be kept in file or “Kardex”

      • Assess for s/s of infections 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 needed and goals can be changed when condition changes

      • No fever noted on vital signs sheet, no drainage from surgical site, etc.