Date post: | 04-Jun-2018 |
Category: |
Documents |
Upload: | shubham-dewangan |
View: | 220 times |
Download: | 0 times |
of 40
8/13/2019 1.2.1 - 1.2.15 Communication
1/40
8/13/2019 1.2.1 - 1.2.15 Communication
2/40
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.1 Demonstrates effective, abuse-free, verbal and non-verbal communication in keeping with the NA's role with clients and their families.
Competencies Course Content Learning Activities
Non-verbal skills:
Be aware of impact of personal appearance on receiver
Be aware of facial expressions used
Be aware of touch
Be aware of body position and movement
Use body language that encourages communication (e.g.smiling, nodding the head, making eye contact, leaning
toward the speaker) Avoid body language that discourages further
communication (e.g. frowning, scowling, wrapping armstightly across chest, turning head away from speaker,
rolling eyes, and tapping your foot)
4. Communicating with clients who have communicationproblems may be challenging at times.
Visually impairedclients may not see the caregiver;nurse aides should:a. Knock on the clients door and let him/her know you
are there
b. Stand within the clients visual and hearing rangeand call him/her by name
c. Arrange and manage the clients environment eachday/each shift
d. Use communication (verbal & nonverbal) to help theclient with visual impairment
e. Keep the clients glasses clean when on and in a safeplace when off
Suggestion: Use the phrase, See
something, say something to
summarize the importance of abuseidentification and reporting.
Handout:Identify the facial expressions thendiscuss the importance of non-
verbal communication when
describing behavior and labeling
behavior.
8/13/2019 1.2.1 - 1.2.15 Communication
3/40
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.1 Demonstrates effective, abuse-free, verbal and non-verbal communication in keeping with the NA's role with clients and their families.
Competencies Course Content Learning Activities
Hearing impaired:a. Keep hearing aides clean and in a safe place when
not in useb. Encourage clients to use their hearing aides and
check to see if they can hear you after the hearing
aide is in the clients ear
c. Gently touch the client on the hand or arm to gain
his/her attention before speaking to him/her andproviding care
d. Always approach the client from the front, facing theclient directly, eye-to-eye
e. Reduce background noise as much as possiblef. Use non-verbal communication as much as possible
to help the client compensate for his/her hearing loss
Answering the call bell promptly is vital. Clients rely on
the call bell to communicate their needs for assistance
5. Answering the telephone may also be the nurse aidesresponsibility. Knowing how to answer the phone is
essential. If you answer the telephone:
Identify the nursing unit
State your name and title
Ask a nurse to take the call if a physician is on the line togive orders
Avoid giving out personal information about clients
Write down the date, time of the call, name of the caller,and a brief message
Sign your name and title to the message
Inform the caller that you will deliver the message
8/13/2019 1.2.1 - 1.2.15 Communication
4/40
Tips for Effective Communication with Families
Communication Helpers
1. Door Openers: invitations to talk, letting the other person decide whether or not to proceed. Do you want to talk about it? You seem upset; is something bothering you?
2. Encouragers: Id like to hear more about your familys concerns.
3. Open-ended Questions: What do you hope your mother will gain from being here? What can we do to make things better for you and your family member?
These communication helpers can go a long way toward promoting good communication with
family members, but we also need to avoid Communication Blockers.
Communication Blockers
1. Blaming: Its your fault that your mother doesnt have appropriate clothes.
2. Always and Never: You never come to visit. You are always telling me what to do.
3. Name calling: That aide is really stupid if she would say that.
4. Labeling: Her daughter is such a typical WASP, she never shows any warm feelings toward
her dad.
5. Moralizing: Families who really care about their relatives come to visit every day.
6. Fixing Things Right Away: Remember that listening needs to be completed before the problem solving begins.7. Controlling: Good listening requires giving up control, which is no easy task especially when you
are feeling like you are already behind in your work.
You may need to put aside the task at hand and concentrate more fully on the otherperson.
1.2.1
8/13/2019 1.2.1 - 1.2.15 Communication
5/40
Communicating with the Client with Aphasia
1. Face the client and make eye contact before speaking2. Say the clients name before asking questions
3. Speak slowly and clearly; using short, complete sentences4. Pause between sentences
5. Determine whether the client understands what you said before continuing
6. Use nonverbal cures or communication aids whenever possible7. Repeat what the client said to help keep them focused
8. Give the client the benefit of the doubttalk to him or her even if you are not sure he or
she understands9. If client becomes frustrated, let him or her know what you understand; discuss another
subject for a while, then try again
Communicating with the Client with Hearing Impairment
1. Identify yourself to the client
2. Gently touch the client to get her attention
3. Make sure that the light source is behind the client, not you, so that the client can see yourmouth clearly
4. Eliminate outside distractions and noise from the radio television, or other sources5. Face the client when speaking-use hand gestures and facial expressions to help the client
understand you
6. Speak clearly and slowly
7. Keep sentences short8. Keep your hands away from your face when speaking
9. Stand or sit near the client
10. If the client uses a hearing aid, help insert it
Communicating with the Client with Vision Impairment
1. Identify yourself when approaching the client
2. Knock before entering the room
3. Call the client by the name the client wants to be called4. Encourage the use of eyeglasses and help the client as needed-keep the glasses clean5. Tell the client where items are-keep them in the same place so that the environment is
familiar
6. Describe the environment and objects in the room to the client7. Guide the client as needed
1.2.1
8/13/2019 1.2.1 - 1.2.15 Communication
6/40
Facial Expression the Demonstrate Affect
Identify the Emotion Being Expressed
1.2.1
1. 2. 3.
4. 5. 6.
8/13/2019 1.2.1 - 1.2.15 Communication
7/40
Facial Expression the Demonstrate Affect
Identify the Emotion Being Expressed
1.2.1
10. 11. 12.
13. 14. 15.
8/13/2019 1.2.1 - 1.2.15 Communication
8/40
Facial Expression the Demonstrate Affect
Identify the Emotion Being Expressed
1.2.1
This handout is for the instructor
The following are suggested interpretations to the facial expressions activity.
Allow students to share their interpretations.Discuss the importance of non-verbal communication when describing behavior and
labeling behavior. (e.g. a perception between staff members and/or clients and staff)
1. Humorous, very happy, laughter2. Angry, frustrated, aggressive3. Suspicious, disapproving, doubtful4. Surprised, scared, horrified5. Very sad, painful, grieving, hurt6. Bored, not interested or dont care7. Horrified, shocked, worried, afraid8. Doubtful, distrusting, suspicious9. Angry, enraged, disgusted10.Exuberant, ecstatic, delighted11.Flirty, Secretive, skeptical12.Peaceful, calm, de-stressing13.In a hurry, time conscious14.Feeling ill or down, blue, apathetic15.Disapproving, negative16.Overwhelmed, perplexed, swamped
8/13/2019 1.2.1 - 1.2.15 Communication
9/40
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.2 Observes by using the senses of sight, hearing, touch and smell to report client behavior to the licensed professional/practitioner/supervisor.
Competencies Course Content Learning Activities
After the completion of thelecture/discussion, the student will:
1. List 5 ways a nurse aide can
make observations using
each of the senses of sight,sound, smell, and touch
2. List observations which mustbe reported immediately
1. Use your senses to make observations: Sight - what you see
a. The clients skin looks paleb. Open areas on a clients skinc. Sores in a clients mouthd. The clients hand shakes or the client is too weak to
hold the glasse. The client limps or cannot stand alonef. The clients urine, stool, or sputum has an unusual
colorg. The clients emesis (vomit) has an unusual colorh. The client is not eating or having trouble eatingi. The client squints or bumps into things and peoplej. The clients usual facial expression has changedk. The client sleeps a lot or does not make facial contact
l. The clients breathing is different, labored or slow, orthe client gasps for breadthm. A part of the clients body looks different or
abnormal to you
n. There is blood or leakage coming from some part ofthe clients body or medical device, such as a drain
or intravenous (IV)
Sound- what you hear.
a. The client is coughingb. The client is making a noise when breathingc. The client is complaining of a change in his/her
condition (e.g. pain, numbness, swelling)
d. The client is cryinge. No response from the client when you speak to themf. The client does not speak as clearly as they normally
do
Role play:a series of scenarios inwhich students act as both clients
and NAs.
Client roles:The clients present a
series of status changes including:
Pressure ulcer changingfrom stage 1 to 2
Client experiencing painduring ROM
Client with new sense ofbeing lost and not knowing
what day it is
During catheter care astudent notices blood in the
catheter tubing
Student roles:Have the studentsacting as NAs report what they
observe.
Have the entire group discuss the
results.
8/13/2019 1.2.1 - 1.2.15 Communication
10/40
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.2 Observes by using the senses of sight, hearing, touch and smell to report client behavior to the licensed professional/practitioner/supervisor.
Competencies Course Content Learning Activities
Smell- what you smella. The clients breath has an unusual odorb. The clients emesis (vomit) has an unusual odorc. An unusual odor in the clients urine or stoold. That the clients dressing or wound has an unusual
odor Touch- what you feel
a. The clients pulse is strongb. The clients pulse is weakc. The clients skin is warm, cool, or moistd. A lump under the clients skin
2. Observations of a change in the client from their normalstatus must be reported to the supervisor immediately:
Changes in a clients physical or mental status
Changes in a clients reactions or behavior Clients health statements indicating that he/she senses a
change
All sensory observations as noted above Clients health complaints or concerns Abnormal observations gained by use of your senses Client care preferences
Prepare various odors in baby foodjars to represent possible conditions,
such as;- musty, soiled rag for an
infected wound
- applesauce and honey for afruity breath as in
hyperglycemia
- diluted ammonia for a UTI
8/13/2019 1.2.1 - 1.2.15 Communication
11/40
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.3 Documents observations using appropriate terms that are specific to the work environment.
Competency Course Content Learning Activities
After the completion of thelecture/discussion, the student will:
1. Define the nurse aides legal
responsibility regarding
documentation
1. The nurse aide needs to be alert to problems or changes ineach clients physical or emotional condition. He/she islegally responsible for recording and documenting complete
and accurate details of all care they provide. Legally, if it is
not charted, it is not done. The nurse aide must know some commonly used
medical abbreviations to communicate with the staff
verbally and in writing Never assume an understanding of words:
a. Seek clarification if unsureb. Research any unfamiliar terms and abbreviations
Components of both written and verbal forms ofcommunication used in sharing information on the health
care team include:a. Timeliness
b. Legal responsibilityc. Completenessd. Accuracy
2. Actual language of medicine:
Three components of words: prefix, root, suffix
Abbreviations - simple short hand forms of frequentlyused words and terms
3. Review the list of commonly used abbreviations and medicalterms-refer to text book glossary and handout
Facilitate an exercise in whichstudents share information usingmedical terms and abbreviations
(e.g., ADL, ROM, cyanosis,
dyspnea, apnea, dysphagia).
Portray client scenarios - what
would they document and when?
Completion of ADLsfollowing care plan
Client experiencing painduring ROM
Client awaking withdifficulty breathing
Client with a choking
episode at breakfast
Handouts:List of Medical Abbreviations
Forming words
8/13/2019 1.2.1 - 1.2.15 Communication
12/40
1.2.3
Example of Facility Approved Medical Abbreviations
1. ABD abdomen2. AC before meals3. Ad Lib as desired4. ADM admission or admitted5. A.M. or am morning6. BID, bid twice a day7. B.M., bm bowel movement8. B.P. or BP blood pressure9. BRP bathroom privileges10. c with11.Ca cancer12.Cath catheter13.CBC complete blood count14.
Cc cubic centimeter15.c/o complained of
16.CVA cerebral vascular accident17.CPR cardiopulmonary resuscitation18.Disch or D/C discharge19.drsg dressing20.DR doctor21.Dx diagnosis22.EKG electrocardiogram23.ED, ER emergency department, emergency room24.EEG electroencephalogram25.FBS fasting blood sugar26.FF force fluids27.hs hour of sleep28.ht height29.ICU intensive care unit30.LPN licensed practical nurse31.med medicine32.NA nursing assistant, nurse aide33.OOB out of bed34.pc after meals35 q every
8/13/2019 1.2.1 - 1.2.15 Communication
13/40
FORMING WORDS1.2.3
Prefix Root Suffix Word Meaning
re-(again or
back)
use (to put into
action or service)
-able (that can be) reusable that can be used again
Example: The blanket and spread may be reusable linens.
ab- (away; from;away from)
use (to put intoaction or service)
-er (a person orthing that)
abuser a person who uses ortreats someone or
something in a way that is
different from the
acceptable wayExample: The abuser is often someone the victim knows.
ab- norm (standard;
pattern)
-al (pertaining to) abnormal not as it should be; not in
the usual pattern
Example: The persons bowel elimination pattern has become abnormal.
ab- norm -ality (the
condition of being
a condition in which
things are not as they
should beExample: The test on the specimen shows whether there is an abnormality.
co- (with) operate (work) cooperate to work together with
someone
Example: When people on the team cooperate, the work is more easily done.
trachea- (tube
that carries air to
the lungs;windpipe)
-tomy (cutting
into)
tracheotomy surgical operation of
cutting into the trachea
Example: A nurse assistant must provide special care to someone who has had a tracheotomy.
ana- (living) -tomy (cutting
into)
anatomy study of a living body
based on dissection orcutting open
Example: When you study anatomy, you learn about the separate parts of the body.
physio- (of thebody)
-ology (a scienceor knowledge of)
physiology science of the normalfunction of a living body
or its parts
Example: We must know about the kidneys, heart, lungs, and blood vessels to understand blood
physiology.
8/13/2019 1.2.1 - 1.2.15 Communication
14/40
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.4 Explains the importance of reporting observations and measurements to the licensed professional/practitioner/supervisor.
Competencies Course Content Learning Activities
After the completion of thelecture/discussion, the student will:
1. Define what is meant by
objective reporting
2. List 4, key elements of
documentation and site 2
examples of each
1. Reporting- the spoken exchange of information betweenmembers of the health care team. Observations may be
objective or subjective.
Objective information- based on what is seen, heard,and sensed.
Subjective information- anything which cannot beobserved but is based on something that the clientreported (may or may not have actually happened).
2. Key elements of reporting observations:
What to report:a. Vital sign measurements.b. ADL assistance provided.c. Client response to care.d. *Change in clients:
i. Moodii. Alertnessiii. Awarenessiv. Level of independencev. Skin
vi. Appetitevii. Sleep Habits
How to report:
a. Directly to nurse in charge (verbal)b. Written on flow sheets (written)
When to report:a. Immediately for any changes in skin condition,
mental alertness, abnormal vital signs, difficulty
breathing, sudden complaint of painb. Routinely upon completion of care
Why it is important to report:
a. Ensures client safetyb. Satisfies client needs
Present client scenarios and discussactions to be taken by the nurse
aide:
Client with sudden, chestpain
Client with a reddened, skinarea over the left hip thesize of a quarter
Client is suddenly confusedand does not know where
they are or who you are
Have the students document what
they would have observed based onwhat you said.
Who would they report to andwhen?
8/13/2019 1.2.1 - 1.2.15 Communication
15/40
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.5 Explains the importance of maintaining the clients record.
Competencies Course Content Learning Activities
After the completion of thelecture/discussion, the student will:
1. Define the need for
maintaining the clients
record
2. List the key points of proper
documentation
3. List what is included in the
clients medical record
1. Recording in the clients medical record is a method ofwritten communication used by the health care members to
document all elements of the clients medical condition andprogress.
2. Key elements:
Importance of Accurate Charting:a. Legal documentb. Confidentialc. Not charted = not done
Key points of proper documentation:a. Remember it is a legal documentb. Make objective observations/measurementsc. Use black/blue ink
Actual charting purpose:
a. Communicating to team membersb. Documenting delivery of carec. Providing evidence that care was actually providedd. Providing evidence that care has been provided
(regulatory agency).
e. Documenting for insurance purposes andreimbursement
f. NAs are responsible for making charting part of their
daily routine and making sure tasks are completedand recorded
Basic Rules:a. Be precise and exactb. Do not skip over linesc. Use only approved abbreviations, simple direct
terminology
d. Never erase or write over a notation
e. Chart after all procedures are completedf. Always record the date, (military) time, and
signature
Handout:Review Charting Guidelines
8/13/2019 1.2.1 - 1.2.15 Communication
16/40
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.5 Explains the importance of maintaining the clients record.
Competencies Course Content Learning Activities
3. The clients record is a permanent, legal document thatincludes the following:
The clients history
Progress notes
Physician orders
Medications
Treatments
Flow sheets X-ray and lab reports
Exercise: Briefly describe morning(AM care) to include mouth care,
breakfast and voiding x1.
Handout: Refer to the Generic ADL
Flow Sheets to discuss the types ofinformation that should be recorded
using appropriate abbreviations.
For additional practice, create
fictitious clients with specific
information about their care during
an 8 hour shift. Ask students todocument this care on the Generic
ADL Flow Sheet.
8/13/2019 1.2.1 - 1.2.15 Communication
17/40
1.2.5
Charting Guidelines
1. Always use a black pen with non-erasable ink when documenting information
2. Use correct spelling, punctuation, and grammar
3. Write legibly and neatly
4. Include the date and time for each entry
5. Do not erase, mark out, or cover an error with white out-if you make an error, draw a singleline through the incorrect entry-write error over the entry and sign your initials-enter the
correct information after the marked portion
6. If you use abbreviations, use only the accepted ones for your facility
7. Avoid skipping lines or leaving blank spaces
8. Make sure that each record that you use includes the correct clients name and room
number
9. Record only what you have observed or what care you have given
10. Never chart a treatment, procedure, or care provided until it has been completed
11. Always chart information in an accurate, factual, and concise manner-never record your
opinions, interpretation, or judgments
12. When possible, use the clients exact words-use quotation marks when quoting a client
13. Be descriptive when noting an observation-use exact measurements whenever possible
14. Sign all entries with your name and title-check your facilitys policy regarding signing a
chart entry. (i.e., A. Smith, NA).
8/13/2019 1.2.1 - 1.2.15 Communication
18/40
SUPPLEMENTAL MATERIAL: HANDOUT
Generic ADL Flow Sheet
Section # _________
Date: _____________Floor #____________
ROOM # CLIENT
Brea
kfast
%
Brea
kfas
t
AM/cc
's
Supp
lemen
t
Lunc
h%
Lunc
h
PM/cc
's
Ba
th
Ora
lCare
Shampoo
Shave
Na
ils
Ac
tiv
ity
Sa
fetyDev
ice
Vo
iding
Observa
tions
TPR
,I&O
,e
tc.
Ins
t.Initials
KEY: 1 = Self 2 = Assist 3 = Total 4 = Refused
Safety Device Key Bath Key Activity Key BM KeyBd = Bed Alarm Mat = Mats on Floor BB = Bed Bath SH = Shower W/C = Wheelchair
Ch = Chair Alarm SSB = Safe Seat Belt TB = Tub Bath WP = Whirlpool G-C = Geri-chair
PA = PersonalAlarm
SR = Side rails PB = Partial Bath Amb. = Ambulatory
S = SmallM = Medium
L = Large
Any additionalinformation will beplaced on the backof this sheet
CBR = Complete Bedrest
1.2.5
8/13/2019 1.2.1 - 1.2.15 Communication
19/40
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
8/13/2019 1.2.1 - 1.2.15 Communication
20/40
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.6 Demonstrates effective, communication skills with supervisor/manager/charge nurse, staff and other disciplines.
Competencies Course Content Learning Activities
3. Chain of Command: Describes the line of authority and communication in
health care
If a nurse aide has a problem within the nursingdepartment, all communication regarding that problem
will be directed to his/her immediate supervisor (charge
nurse)
In the event that a nurse aide experiences a problem withanother department, that nurse aide will communicate
with her/his charge nurse first
By utilizing the chain of command, the nurse aide canhelp facilitate communication and solve problems.
Handout - Case Study:
Charge nurse chooses not to assistnurse aide with a clients care.
8/13/2019 1.2.1 - 1.2.15 Communication
21/40
Five Elements of Effective Communication
Communication Element Description of the Element
Sender The person who wants to communicate information
Message The information the person sends
Channel The way the message is sent verbally (talking), nonverbally(facial expressions, body movements) or in writing
Receiver The person to whom the message is sent
Confirmation The way the receiver lets the sender know that he has receivedthe message
---------------------------------------------------------
Effective Verbal Communication has 2 parts:
1. What you say2. How you say it
----------------------------------------------------------
Guidelines for Effective, Verbal Communication with co-workers, managers, and supervisors
1. Get the Receivers attention before you start talking2. Use words that the Receiver understands3. Choose the right volume4. Speak slowly and clearly5. Be aware of your tine of voice6. Listen to the Receiver
----------------------------------------------------------
Factors that Affect Non-Verbal Communication
1.2.6
8/13/2019 1.2.1 - 1.2.15 Communication
22/40
CASE STUDY:
When a charge nurse chooses not to assist a nurse aide with a clients care
LPN Cathy Complainer is the charge nurse for South Hall. She passes medications to 20 clients. Two
nursing assistants, Kathy Constant and Rella Reliable, are assigned to give routine care to the same 20
clients. Kathie Constant went on break. Clara, a client, is screaming I have to go to the bathroom!
Clara requires assistance of two caregivers to go to the bathroom. Cathy Complainer is busy passing out
her medications. Rella Reliable asks for help, but the LPN is reluctant to leave her medication cart and
says, Clara will just have to wait, and besides, its not my job!
QUESTIONS:
1. What should the nursing assistant do?2. What other issues, are part of this scenario?3. Discuss ways to improve or develop effective teamwork.
1.2.6
8/13/2019 1.2.1 - 1.2.15 Communication
23/40
Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.7 Communicates thoughts, feelings, and ideas to justify decisions or support position on workplace issues.Competency Course Content Learning Activities
After the completion of the
lecture/discussion, the student will:
1. Define the terms assertive,aggressive, and passive,
and how they relate to nurse
aide communication.
1. NAs can be assertive, valuable, team members.
Define and discuss assertive, aggressive, and passivebehavior and how it is communicated.
Assertivebehavior:a. Speaking upb. Asking for what you want and need to knowc. Saying no to things you do not want or should not
do
d. Behaving confidentlye. Being direct yet considerate of others
Aggressivebehavior (often confused for assertiveness):a. Being pushyb. Being stubbornc. Not sharingd. Always pushing to have your waye. Being manipulative
f. Making threats Passivebehavior (opposite of assertive):
a. Going along with othersb. Not speaking upc. Accepting situations even when they are
uncomfortabled. Doing what you need to do in order to get what you
want without making anyone angry
Handout: Discuss and demonstrate
assertive, aggressive, and passive
communication styles.
Handouts:
- Conduct the Assertiveness
Survey- Review and discuss actions for
Using AssertivenessEffectively
Role play using assertive,
aggressive, and passivecommunication styles.
8/13/2019 1.2.1 - 1.2.15 Communication
24/40
Group Discussion
Guide students in sharing perspectives of Assertive, Aggressiveand Passivebehaviors. Ask student toshare examples of anecdotes from their experiences. For example;
Examples of Assertivebehavior are:
__ Speaking up
__ Asking for what you want (Use sentences that begin with I (I want, I need)Saying what you want is being assertive. (There is no guarantee you will get it)
__ Saying no to things you do not want or should not do (Repeat no if needed. Dont give reasons orexcuses. Walk away)
__ Behaving confidently (body language)
__ Being direct while being considerate of others (being assertive is different is different from being
aggressive)
Examples of Aggressivebehavior are:
__ Being pushy
__ Never giving in
__ Being loud
__ Not sharing
__ Always having to have your way
__ Being manipulative
__ Making threats
Examples of Passivebehavior are:
Going along with others
1.2.7
8/13/2019 1.2.1 - 1.2.15 Communication
25/40
Assertiveness Survey
1. Explain to students that using assertiveness is another way to modify ones behavior to achieve
desired results. Tell then they are going to find out how assertive they are.
2. Post the following point system on the white/black board or flip chart 1 point for almost always 2 points for sometimes 3 points for never
3. Tell the students to take out a pencil or pen and a piece of paper to keep track of their own scores
during this activity. Write numbers 1 through 9 and leave a space after each number.
4. Explain that you are going to read sentences that describe things they may do in their lives.
5. After each sentence students should write down how often they do that particular thing - almost
always, sometimes or never and the number of points for that response. (or pick one option)
Assertiveness Survey
Read each sentence below aloud to students.
1. I talk about my feelings when Im upset2. I say no to things I shouldnt do without feeling guilty3. I tell people when Im angry4. I ask for what I want or need.5. I ask questions if I dont fully understand what someone is telling me.6. I say how I really feel even when I know my friends disagree. I tell people when they make me
feel good.
7. When I disagree with someone, I try not to make that person feel bad.8. When people hurt me, I let them know how I feel.9. I look for solutions to problems instead of just complaining
After the Survey
Ask the students to add up the number of 1s they have. This total is their assertiveness level.
1.2.7
8/13/2019 1.2.1 - 1.2.15 Communication
26/40
Using Assertiveness Effectively
Read the situations and go through the list of responses.
Situation Assertive Action Ineffective Action
A person says no to yourrequest.
Decide whether it is important to
keep trying to get what you want
and, if so, keep trying.
Give in right away.
You decide to keep trying to get
the person to comply with your
request.
Tell the person you understand
his/her position (if you do).
Tell the person his or her idea is
wrong or silly
Repeat what you want andexplain why it is important.
Repeat what you said and
demand to know why yourrequest was denied. If that
doesnt work, whine.
Speak in a firm voice, look into
the persons eyes and stand tall.Glare at the person and shout.
Keep your hands by your side or
hold them in your lap.
Make angry gestures and pound
on the table.
You must refuse someones
request.
Say no firmly and explain
why.
Say, No. Thats that. The case
is closed.
The person asks again.Listen carefully to what theperson says; then say no
politely.
Yell, Didnt you hear me? Isaid no!
The person asks again.Ask the person to stop
pressuring you.Ask, Are you deaf?
The person asks again.Excuse yourself and walk awayfrom the situation
Tell the person to leave youalone
1.2.7
P i Obj i 1 2 Ti Cl b Cli i l
8/13/2019 1.2.1 - 1.2.15 Communication
27/40
SUPPLEMENTAL MATERIAL: HANDOUT
Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.8 Demonstrates speaking, listening, writing, and social skills that supports participation as an effective, team member.Competencies Course Content Learning Activities
After the completion of the
lecture/discussion, the student will:
1. List 2 reasons whycommunication is vital on
the health care team
2. List 6 qualities of an
effective team
communication.
1. Communication will happen verbally and non-verbally,directly and indirectly.
Health care team members communicate with oneanother to provide coordinated and effective client care.
2. Qualities of a good communicator:
Positive in all contexts
Open and courteous
Reports problems through the chain of command Is clear and concise in both verbal and written
communication
Provides and seeks feedback
Avoids and dispels gossip
Is mindful of body language and tone of voice
Resolves conflicts immediately
Activity: Turn with your back to the
students and speak a direction in amonotone voice. For example:
Take out a piece of paper and writethe first three words that come to
your mind when you hear these
words good team player.
Pause for a few seconds then turn
around and discuss the barriers toeffective communication.
Repeat the direction using properinflections and facing the students.
Discuss their responses to the
assignment. Observe and recognize
their tonal inflections, smiles, nods,or note taking as demonstration of
speaking, listening, writing and
social skills.
P i Obj ti 1 2 Ti Cl L b Cli i l
8/13/2019 1.2.1 - 1.2.15 Communication
28/40
SUPPLEMENTAL MATERIAL: HANDOUT
Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.9 Demonstrates actions for asking appropriate questions to clarify meaning, understand outcomes or solve problems.Competencies Course Content Learning Activities
After the completion of the
lecture/discussion, the student will:
1. Define why clearcommunication is necessary
2. Define the concepts of open-ended and close-ended
questions
1. Clear communication with clients and coworkers is an
essential element in the delivery of care. As the receiver ofcommunication, it is important that a nurse aide clearly
understand the message.Never assume-when in doubt, askquestions.
Questions are used to clarify communication and reachmutual understanding.
2. There are two types of questions:
Close-ended question will result in a yes/no answer. Itdoes not provide a great deal of information. It will oftenbegin with words such as are, can, do, did,
have, when, where, and why.
Open-ended question require an answer beyondyes/no. It will provide more information. It often beginswith words such as how, what, show me,
describe, and suppose.
Small, group discussion.
Dividing the class into groups. Each
group should have a volunteer toserve as one of the following: (see
handout)
- A client with a problem- A supervisor with a directive
- A coworker with a problem
Each volunteer will have a script
describing his/her issue. In thescript, have initial, limited
information in bold print.
Direct the remaining students toquestion the volunteer to gain
clarity and decipher the full script.
Have one group use only close-
ended questions-compare results
1.2.9
8/13/2019 1.2.1 - 1.2.15 Communication
29/40
Scripts for Group Discussion
Scenario #1 A client with a problemMrs. Allens call light has just gone on. Mrs. Allen has expressive aphasia. As you enter theroom you notice that her language board is across the room on her dresser. She is distressed and
keeps pointing to the bathroom.
Scenario # 2 A supervisor with a directiveThe supervisor has been asked to address a concern brought to her attention by the dietary
department. The dietary aide states that trays are delivered to the dining room on a timely basis.
When trays are delivered, the clients are seated at the tables, but there are no nursing aidesavailable to assist the clients. This happens pretty frequently and the clients are complaining that
their food is often cold.
Scenario # 3 A coworker with a problemRita, a fellow coworker appears stressed and at wits end. No one will ever help me! Ill never
get done today. It is 9:00 and two of her assigned clients need a complete shower. Both clientsare total assist of two to transfer from bed to the shower chair, then back to bed to be dressed and
then up in their chair.
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
8/13/2019 1.2.1 - 1.2.15 Communication
30/40
SUPPLEMENTAL MATERIAL: HANDOUT
Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.10 Explains the concept of diversity and why it is important.Competencies Course Content Learning Activities
After the completion of thelecture/discussion, the student will:
1. Define diversity
2. List what can be achievedwhen a nurse aide
acknowledges and accepts
each client as an individual
3. List 4 ways a nurse aide will
experience the need to
identify, and thereforerespect, diversity in the
health care setting
1. Diversityhas to deal with the different groups of peoplewith varied backgrounds and experiences living in the
community.
Diversity has enriched the country, yet problems canarise when people are not sensitive to, or respectful of,
the cultural uniqueness of each individual.
2. Through listening, acknowledging, and accepting each
person as an individual with a diverse background, the nurseaide will:
Be able to portray positive responses to diversityincluding accepting and knowledge
Be aware of and eliminate bias and prejudice
Focus on compassionate, respectful, and culturallysensitive care
Treat clients and coworkers as they wish to be treated
3. Areas where diversity and health care often intersect include:
Beliefs and practices associated with food
Religious beliefs and practices
Attitudes towards health, sickness and death
Touch, personal space, and eye contact, which are used
and interpreted differently among different cultures
Discussion: Direct each student towrite a definition of diversity and
then proceed to discussion thisterm.
Discussion: Students are to think ofsomeone they respect.
Discuss the reason(s) they respect
that person.How is respect demonstrated?
What could you do if you heard
someone making fun of theperson you respected?
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
8/13/2019 1.2.1 - 1.2.15 Communication
31/40
SUPPLEMENTAL MATERIAL: HANDOUT
Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.11 Describes cultural diversity and how the nurse aide manages cultural differences among people.Competencies Course Content Learning Activities
After the completion of thelecture/discussion, the student will:
1. Define what is meant by
cultural diversity
2. List ways in which
individual cultures affect a
clients life
3. List 10 guidelines for
working with culturally
diverse clients
1. Cultural diversity- how individuals differ in appearance,beliefs, and behaviors based on country of origin, ethnic
background, and upbringing.
Culture a set of values, beliefs, normal activities,possessions, rules, codes, and assumptions about life that
generally define groups of people giving them
commonality.
Culture is not genetically determined, it is learned.
Culture continues and is ongoing; it is passed fromgeneration to generation.
2. Cultures affect every aspect of an individuals life including:
Personal values
Attitudes and beliefs
Religious beliefs
Decision making Response to illness and health care systems
Interpersonal relationships
Food preferences and dietary practices
Gender related roles
Traditions
Language
Identity
Acceptable behaviors
Skin color
Beliefs about older persons and their role in society
Class discussion: How many cultures are
represented in the class?
Have students describe theircultures and traditions
Ask again, How manycultures are there in the class?
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
8/13/2019 1.2.1 - 1.2.15 Communication
32/40
SUPPLEMENTAL MATERIAL: HANDOUT
Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.11 Describes cultural diversity and how the nurse aide manages cultural differences among people.Competencies Course Content Learning Activities
3. Guidelines for working with culturally diverse clients: Learn about other cultures
Understand your own feelings; this will help you acceptand understand others
Realize how your attitude may affect clients-a personcannot feel comfortable when he/she does not feel
accepted
Help clients feel comfortable and accepted so they willbe able to maintain independence and health
Be aware that culture and religion influence a personsbeliefs and practices in regard to health as well as the
causes and cures of disease
Observe individual reactions to pain, which are ofteninfluenced by culture
Seek understanding in communication with clients who
speak a different language Be aware of differences in body space requirements,
privacy issues, family issues, family interactions, and
levels of formality
Realize that hand gestures may have different meaningsto clients of different cultures
Be aware that you may seem strange to the client
Remember that being different does not lessen a
persons value Understand how you would feel in similar circumstances
and be sensitive to the individuals of a different culture-have empathy
1.2.11
8/13/2019 1.2.1 - 1.2.15 Communication
33/40
A Definition of Culture:
Different cultures are made up not only of different styles of food, clothing, music, and art,but also of different languages and different rules for dealing with social situations.
A concise definition of culture is:a set of attitudes, beliefs, values, and behaviors that agroup of people share.
Learning to appreciate cultural differences can do more than prevent hurt feelings; it canimprove relations with other members of the caregiving team and help in understanding the
sometimes baffling behavior of clients in your care.
Cultural Diversity in the Nursing Home:
Many of the clients living in long term care facilities today spent their younger years in asegregated society. For example, the older clients may have been born in the old country
meaning Russia, Italy, Ireland, etc. When the client came to the United States, he/she may
have settled in an area where everyone had the same ethnic origins. Sometimes, especially
for women who did not work outside the home, coming to a nursing home may be their firstexperience with people who are different from themselves.
It can be frightening to be cared for by people who are different from you and who share nocommon bonds, no similar backgrounds. For many clients, this is the first time they are
dependent upon people they know very little about. The preconceptions about other groups
that they may have learned from their parents, grandparents or other family are brought withthen to the nursing home.
Nursing home staff are also culturally and ethnically diverse, which impacts on thecommunication we have with co-workers and supervisors. The best approach to
understanding the differences is to ask questions and listen carefully to the answers. We
should not assume that things have the same meaning for people from a different culture.
For example, touching means different things in different cultures. Even facial expressionsare not understood in the same way. Therefore, we need to use effective communication
skills to make sure that we understand the feelings and the meanings behind what people say.
In a long term care facility, handling situations that arise as a result of cultural differencescan be a challenging job, but it is an area in which nursing assistants can make a differencefor clients from varied backgrounds. We all know how good it feels to be accepted for who
1.2.11
8/13/2019 1.2.1 - 1.2.15 Communication
34/40
Six Steps to Cultural Understanding
1. Denial of DifferencesThe attitude were all the same under the skin discounts the very, real differences among
people from other cultures. This attitude refuses to see the differences at all.
2. DefensivenessIn this step, differences are acknowledged, but ones point of view is considered right,
and differences from that view are considered wrong.
3.
Minimizing DifferencesIn this step, differences are recognized, but are granted no importance. This step could becalled the So What step.
4. AcceptanceThis step recognizes and appreciates the importance of cultural differences.
5. Adapting to RealityIn this step, empathy and communication skills are used to bridge cultural differences.
6. Ongoing LearningThis final step involves a habitual respect for others differences and a growing
understanding of the skills needed to live and work together.
Tips for Honoring the Differences in Others
1. Learn and use some key words of the languages around you.2. Watch how others of the same culture communicate. Observe how members of your own
relate to one another. Compare the two ways without judging either one better than theother.
3. Be sensitive to others customs, holidays, and religious practices. Express your interest byasking respectful, polite questions. Be prepared to share some of your own customs withthem as well.
4. Examine the attitudes and beliefs you have about other groups of people. Where did yourattitudes and beliefs come from?
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
Primary Objective: 1 2 Time: Class: Lab: Clinical:
8/13/2019 1.2.1 - 1.2.15 Communication
35/40
Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.12 Demonstrates respect for differences among clients and people.Competencies Course Content Learning Activities
After the completion of thelecture/discussion, the student will:
1. Define the impact of
understanding the
differences among clientsand people. Why is it
important?
2. List 4, important aspects that
help a nurse aide respect the
differences among clients.
3. List what the nurse aide will
accomplish by respecting
individual difference.
1. Everyone we come in contact with is an individual withhis/her own unique differences.
When giving care and working within the health careteam, nurse aides must take into account that an
individualized approach to care is a landmark of quality.
When care givers better understand the differencesamong the needs of different people, the quality of careimproves.
2. There are four, important aspects in the development ofproviding care to different individuals and working in a
diverse climate. They are: (acronym DOOR)
Dont judge anyone you meet or care for
Obtain the services of an interpreter as soon as possible,if you need one
Observe everyone carefully to look for changes in
condition and to learn from them about what makes themdifferent-respect their differences
Respect everyone
3. The nurse aide will accomplish the following when he/shetreats each client as an individual:
Respect the differences among clients, coworkers andvisitors in all interactions/contacts
Perform tasks and communicate in a manner thatembodies understanding and sensitivity towards
everyone
Review each clients care plan for individualaccommodations regarding customs and habits. Bring
any concerns to the professional nurse before providingcare
Seek a way of understanding when communicating witha client who speaks a different language
Small group discussion: How many different
individuals are represented inthe room?
- How do they differ?
- How are they alike?
People Bingo- Exercise
1.2.12
8/13/2019 1.2.1 - 1.2.15 Communication
36/40
People Bingo
Has lied about
their age
Has taken
care of a sick
friend or
relative
Has a tattoo Is a religious
person
Has been on a
diet
Has always
lived in a city
Has lived with
a family
member who
passed away
Parents or
grand-
parents came
from anothercountry
Speaks a
language other
than English at
home
Travels more
than 10 miles
to work or
training
Has dyed their
hair more than
once
Speaks
another
language
Your
Name
Has children
over the age of
eighteen
Sings in a
choir
Was raised on
a farm
Has more than
three siblings
Plays a musical
instrument
Has lived with
his or her
grandparents
Reads the
newspaper in
the morning
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
Primary Objective: 1.2 Time: Class: Lab: Clinical:
8/13/2019 1.2.1 - 1.2.15 Communication
37/40
y j . C ass: ab: C ca :
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.13 Identifies elements of one's own, cultural formation and their potential impact in nursing practice.Competency Course Content Learning Activities
After the completion of thelecture/discussion, the student will:
1. Define the way a nurse aide
can improve communication
with a client of a differentculture.
1. Culture and experience have shaped out thinking. Clientsand coworkers may come from a different culture and mayhave different experiences which shape the way they think.Our individual and cultural wants and needs are unique to us.
Nurse aides are obliged to respond positively andwithout prejudice to each client. A nurse aide must
understand the clients individual culture and how it maybe perceived by clients and coworkers.
Communication in this regard is critical. Communicationstarts from within:a. Knowing yourself is important when working with a
wide range of people from different cultures and
communities.b. Past experiences can affect how we relate to people
we see as different from ourselves. The nurse aide
must be sensitive to this and not allow previously
formed opinions to adversely affect the care theyprovide.
Nurse aides may communicate openly about theirrespective cultures in an effort to increase their clients
comfort level.
Small group discussion:
Arrange group of 3-4students with one member of
the group volunteering to
share information about their
culture and beliefs. After thevolunteer shares their
responses to the first, 4questions, and all members ofthe group discuss #5.
1. Where did you grow up?
2. What foods did you like toeat?
3. How did you celebrate theholidays?
4. Do you have grandparents?What role do they play
within the family?
5. How does the volunteersbackground/culture comparewith the other members of
the group? What was
similar? What was
different?
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
Primary Objective: 1.2 Time: Class: Lab: Clinical:
8/13/2019 1.2.1 - 1.2.15 Communication
38/40
y j
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.14 Uses effective, communication skills to promote clients well-being.Competency Course Content Learning Activities
After the completion of thelecture/discussion, the student will:
1. List and define the 10
cardinal rules to encourage
effective communication
Nursing aides communicate with clients during all aspects of care.During each interaction, the NA will learn many things about each
client that will broaden his/her understanding of each individualclient and in so doing will improve the delivery of client care.
1. To encourage effective communication we can build uponthe 5 elements of good communication (sender, receiver,
message) discussed previously by adding 10, additional
rules: Be aware of body language, facial expressions and how
we appear to clients. This is important to every client but
especially to the clients from different cultures who may
speak a different language. A nurse aide, who appearsrelaxed, friendly, non-threatening and not rushed, can
more quickly put the client at ease. When the client is at
ease, communication can flow more easily.
Get the clients attention. Get down to his/her level,which may mean that you bend, stoop or sit down to
make eye contact while speaking or listening. Be aware
of the clients cultural attitudes with regards to touching
and direct eye contact.
Call clients by their desired name. In many cultures thepreference may be Mr. or Mrs. or Miss. Abide by their
preference.
Look for non-verbal cues of the client while they arespeaking, for example, do they seem upset, are they
frowning, smiling, etc.? Take in the whole message,
verbal and non-verbal.
Be an active listener, that is, listen carefully and allowthe client time to express their self. Paraphrase, that is,
repeat back to the client what you understood them to
say. This is to check if your understanding is correct. Be patient, do not rush the client. Show the client that
you care about them, their needs and opinions.
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
Primary Objective: 1.2 Time: Class: Lab: Clinical:
8/13/2019 1.2.1 - 1.2.15 Communication
39/40
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.14 Uses effective, communication skills to promote clients well-being.Competency Course Content Learning Activities
Speak in a clear, concise manner. Do not talk to an adultas if they are a child. Use words that have the samemeaning for you and the client. Avoid medical wordsand words that the client is not familiar with.
Dont jump to conclusions or make assumptions. Listento exactly what the client is saying and how he/she feels.
Ask questions if you do not understand and give theclient feedback about what you do or dont understand.
Dont be judgmental. Allow clients their opinion andtreat them respectfully.
Be patient. People with memory problems may ask thesame question many times. Do not call attention to therepetition. Accept the memory loss as part of their
disability.
Include the client in conversation when others arepresent. This includes when a co-worker is assisting youwith care.
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
Primary Objective: 1.2 Time: Class: Lab: Clinical:
i d ff i i i kill
8/13/2019 1.2.1 - 1.2.15 Communication
40/40
Demonstrates appropriate and effective, communication skills.
Objective: 1.2.15 Communicates in a respectful, adult manner in accordance with the clients stage of development and cultural background.Competencies Course Content Learning Activities
After the completion of thelecture/discussion, the student will:
1. Define why it is important to
be aware of the clients stage
of development and culturalbackground
2. List 4, developmental tasksof the elderly
1. The nurse aide must be aware of his/her own attitudestoward cultural differences and seek to understand andrespect those differences among clients.
Persons in late adulthood (65 years and older)experience many physical, psychological, and social
changes. This group is referred to as the elderly.
It is important that the nurse aide becomes familiar withthese changes and treats clients with understanding and
respect.
2. Developmental tasks of the elderly are:
Adjusting to decreased physical strength and loss ofhealth.
Adjusting to retirement and reduced income.
Developing new friends and relationships.
Preparing for death.