15 3 Communication Skills 1. Define important words in this chapter 2. Explain types of communication 3. Explain barriers to communication 4. List ways that cultures impact communication 5. Identify the people you will communicate with in a facility 6. Understand basic medical terminology and abbreviations 7. Explain how to convert regular time to military time 8. Describe a standard resident chart 9. Explain guidelines for documentation 10. Describe the use of computers in documentation 11. Explain the Minimum Data Set (MDS) 12. Describe how to observe and report accurately 13. Explain the nursing process 14. Discuss the nursing assistant s role in care planning and at care conferences 15. Describe incident reporting and recording 16. Explain proper telephone etiquette 17. Describe the resident call system 18. Describe the nursing assistant s role in change-of-shift reports and rounds 19. List the information found on an assignment sheet 20. Discuss how to organize your work and manage time Supplemental Tools transparency 3-1 communication process transparency 3-2 body language transparency 3-3 barriers to communication transparency 3-4 24-hour clock transparency 3-5 using your senses handout 3-1 prefixes handout 3-2 roots handout 3-3 suffixes handout 3-4 abbreviations handout 3-5 scientific method chapter 3: exam Assignments textbook reading, pp. 31-49 workbook exercises, pp. 17-25 Overview of Teaching Strategies Nursing assistants will need to communicate clearly and accurately with many different people on the job. This chapter describes the process of communication, barriers that make communication difficult, and techniques to overcome these difficulties. Students will learn how to properly document care, including the use of medical terminology and military time. They will also learn about care conferences and their role in them, as well as incident reporting and telephone etiquette. The importance
16 of the resident call system will be emphasized, and students will learn strategies for organizing work and managing their time. 1. Define important words in this chapter textbook pp. 31-32 workbook p. 17 Pronounce and define each of the key terms listed in the Learning Objective on pages 31-32. 2. Explain types of communication textbook pp. 32-34 workbook p. 17 Verbal communication Nonverbal communication Body language Active listening 3-1 communication process Describe the communication process. Emphasize that the process occurs over and over with the sender and receiver switching roles during a conversation. 3-2 body language Discuss the importance of body language in communication. Describe the signals that the two people on the transparency are sending to each other through their body language. Review the following examples of positive nonverbal communication: Smiling in a friendly manner Leaning forward to listen With permission, putting your hand over a resident s hand Review examples of negative nonverbal communication: Rolling your eyes Crossing your arms in front of you Tapping your foot Pointing at someone while speaking Review the following guidelines for good communication: Use appropriate words. Be aware of your body language. Use an acceptable tone of voice. Wait for responses and let pauses happen. Practice active listening. Use mostly facts when communicating. 3. Explain barriers to communication textbook pp. 34-35 workbook pp. 17-19 Barrier 3-3 barriers to communication Review the barriers to communication shown on the transparency and in the book: Resident does not hear, does not hear correctly, or does not understand you. Resident is difficult to understand. NA, resident, or others use words that are not understood. NA uses slang or profanity. NA uses clichés. NA responds with why. NA gives advice. NA asks questions that only require yes/no answers. Resident speaks a different language. NA or resident uses nonverbal communication.
17 4. List ways that cultures impact communication textbook pp. 35-36 workbook p. 19 and Discussion Culture Review some factors that are influenced by culture that are important to understand in a healthcare setting: Eye contact Touch Language Review the examples of acceptable and unacceptable touch on pages 35-36 of the textbook. Ask students if they can think of any other examples. Discussion Ask students to share stories about the culture they grew up in. Ask them to describe how their culture influences the factors listed above, and if there are any other culture considerations they can think of that would be useful on the job. 5. Identify the people you will communicate with in a facility textbook pp. 36-37 workbook p. 20 Review the many different people students will communicate with on the job, including: Doctors, nurses, supervisors, and other staff members Other departments Residents Families and visitors The community Role Play Ask students to take turns pretending to be nursing assistants on the job and different people they will need to communicate with. Ask for class feedback on effective techniques for communicating well with each group. 6. Understand basic medical terminology and abbreviations textbook pp. 37-38 workbook p. 20 Edema Root Prefix Suffix Distribute Handouts 3-1 prefixes 3-2 roots 3-3 suffixes Discuss the structure of medical terms, explaining that many are constructed of a root, prefix, and suffix. Emphasize that students will soon learn what the various word parts mean and be able to recognize them on the job. Distribute Handout 3-4 abbreviations Ask students to read the list of abbreviations at home. Explain that abbreviations help healthcare workers communicate more efficiently. Mention any abbreviations that are used at your facility. Game Break the class into small groups. Give each group a number of word parts and abbreviations from the textbook and handouts to write on 3x5 index cards. The students should write the word part or abbreviation on one side and the definition on the other. Show the cards to the class, alternating between word parts/abbreviations and meanings, and give points to the students who give the correct answers first. If there are other abbreviations and word parts used frequently in your facility, add these to the list as well.
18 7. Explain how to convert regular time to military time textbook pp. 38-39 workbook pp. 20-21 3-4 24-hour clock While looking at the transparency, explain how to convert regular time to military time: To change the regular hours between 1:00 p.m. to 11:59 to military time, add 12 to the regular time. Minutes and seconds do not change. Midnight may be written as 0000 or 2400; follow facility policy. 8. Describe a standard resident chart textbook p. 39 workbook p. 21 Medical chart Charting Emphasize that a resident s chart is the legal record of a resident s care, and that what is written on the chart is considered to be what actually happened. Review the information found on a resident s chart: Admission forms Resident s history and results of exams Care plans Doctor s orders and progress notes Nursing assessments Notes from nurses and other specialists Flow sheets Graphic record Intake and output record Consent forms Lab and test results Surgery reports Advance directives Emphasize that the information in a resident s chart must be kept confidential. 9. Explain guidelines for documentation textbook pp. 39-40 workbook p. 21 Review the guidelines for accurate documentation: Keep all information confidential. Document care immediately after it is given. Never document care before it is given. Use black ink. Sign each note you make. Use only facts when documenting. If an error is made, draw one line through it and initial it and write the date. Write the correct information. Use only your facility s accepted abbreviations and terms. Use comparisons to describe size. Optional Learning Activity Bring in some medical charts from your facility with fictitious resident names and information on them. Have the students practice documenting on the charts, including use of abbreviations and error correction. 10. Describe the use of computers in documentation textbook pp. 40-41 workbook p. 21 Review the general rules for computer use in the facility: Do not share your password or log-in ID with anyone. Do not access personal e-mail or inappropriate websites from work. Log off and/or exit the web browser when done with charting or using the computer.
19 Be careful about who can see PHI on the screen, as HIPAA guidelines apply to computer use. Optional Learning Activity If your facility uses computers to document resident care, show these computers to the students and, if practical, let them practice using the appropriate programs. Emphasize HIPAA regulations and remind students to always be aware that PHI must be kept confidential. 11. Explain the Minimum Data Set (MDS) textbook p. 41 workbook p. 22 Minimum Data Set (MDS) Discuss the important points about the MDS: Assessment tool developed by the federal government Detailed form for assessing residents Details what to do if problems are identified Completed for each resident within 14 days of admission and again each year Must be reviewed every 3 months New MDS is done when there is any major change in resident s condition Emphasize that nursing assistant reports on changes in residents conditions are very valuable as they may trigger needed assessments. 12. Describe how to observe and report accurately textbook pp. 41-43 workbook pp. 22-23 Care plan Objective information Subjective information Orientation Vital signs Critical thinking Emphasize to students that nursing assistants spend more time with residents than any other care team members and are likely to observe more changes in residents. Explain that care plans are created by nurses who collect information from staff. 3-5 using your senses Explain the difference between objective and subjective information. Emphasize that objective information is collected by using the senses of sight, hearing, smell, and touch. Reinforce these points by using the transparency. Review other ways to observe residents accurately: Note changes in orientation. Check vital signs. Report any changes in ability. Report other important changes, such as appetite, ability to go to the bathroom, and mood. Remind students that critical thinking for nursing assistants involves making good observations to get help for potential problems. Discuss signs and symptoms that should be reported right away, including: Wheezing Difficulty breathing Chest pain and pressure Pain in calf of leg Blurred vision Slurred speech Vomiting Sudden limp or change in ability to walk Numbness or loss of feeling in one side or in arms or legs Abdominal pain Change in vital signs Headache Falls
20 Optional Handout 3-5 scientific method Some states require that this information be taught to students. If required by your state, discuss the brief explanation of the scientific method found on the handout. 13. Explain the nursing process textbook p. 43 workbook p. 23 Nursing process Review the five steps of the nursing process: Assessment Diagnosis Planning Implementation Evaluation 14. Discuss the nursing assistant s role in care planning and at care conferences textbook p. 44 workbook p. 24 Care conference Emphasize the importance of nursing assistants observations in planning care. 15. Describe incident reporting and recording textbook pp. 44-45 workbook p. 24 Incident Sentinel event Incident, occurrence, or event report Review events in the facility that are considered incidents: An accident or problem during the course of care An error in care A fall or injury to a resident or staff member An accusation against staff members Emphasize that an incident report must be filled out if a nursing assistant is injured on the job in any way, even if it seems minor. Optional Learning Activity Describe to the students an occurrence in a facility in which a resident is given the wrong meal at dinner time and becomes slightly ill as a result. Have the students write individual incident reports, then lead a group discussion in which the class writes a final incident report. 16. Explain proper telephone etiquette textbook p. 45 workbook p. 24 Review the rules for telephone etiquette: Cheerfully greet callers. Identify your facility, yourself, and your position. Listen closely to the caller s request and write down any messages. Get a telephone number if needed. Thank the caller and say Goodbye. Review rules for general telephone use: Do not give out staff or resident information over the phone. Ask before placing a caller on hold. Ask for training to transfer calls. Follow facility policy regarding cell phone use.
21 17. Describe the resident call system textbook p. 45 workbook pp. 24-25 Emphasize that the call light is the residents lifeline and must always be answered immediately. Remind students that ignoring a call light is abuse. Emphasize that a call light must always be left within the resident s reach before leaving the room. If available, show students the type of call system used at your facility and explain how to use it. 18. Describe the nursing assistant s role in change-of-shift reports and rounds textbook pp. 46-47 workbook p. 25 Rounds Review the guidelines for start-of-shift reports: Arrive on time. Listen for your assignment and for information about all residents in your area. Listen carefully to information from the prior shift. Ask any questions you have about your residents. Explain that the nursing assistant s role for endof-shift reports is to report information gathered about residents during the shift. 19. List the information found on an assignment sheet textbook p. 47 workbook p. 25 Code status Code Review the information typically found on an assignment sheet: Residents names and room numbers Medical diagnosis Code status Activity level Range of motion (ROM) exercises Bathing information Diet orders Fluid orders Bowel and bladder information How often to measure vital signs Treatments to be performed Tests and procedures to be performed 20. Discuss how to organize your work and manage time textbook pp. 47-48 workbook p. 25 Prioritize Discuss the tips for organization and time management: Plan ahead. Identify the most important tasks and get those done first. Make a schedule. Combine activities. Get help when needed. Discuss the get help item and where it may come from for the NA. Chapter Review Exam distribute chapter 3: exam (appendix c, pp. 292-295) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams.
22 Answers to Chapter Review in Textbook 1. Communicating verbally means using words. Nonverbal communication is communicating without using words. 2. Answers will vary. 3. Yes/no answers end a conversation. 4. Answers will vary. 5. Culture is a set of learned beliefs, values, traditions, and behaviors shared by a social, ethnic, or age group. 6. Answers include: Use an interpreter. Use picture cards and flash cards. Learn a few words or phrases in a resident s native language. 7. Introduce him- or herself, identify the resident, and explain the procedure to be done 8. No 9. A root is the main part of the word that gives it meaning. A prefix comes at the front of the word and works with a word root to make a new term. A suffix is found at the end of a word and is added to a prefix and/or root to make a working medical term. 10. 2033 hours 11. 1110 hours 12. Answers include: admission forms; resident s history and results of physical examinations; care plans; doctor s orders; doctor s progress notes; nursing assessments; nurse s notes; notes from physical therapists, occupational therapists and other specialists; flow sheets; graphic record; intake and output record; consent forms; lab and test results; surgery reports; and advance directives 13. Only other members of the care team 14. Immediately after care is given 15. Answers include: Documentation provides an up-to-date record of each resident s status and care. Documentation is a legal record of all resident care. Documentation is important for planning residents care. 16. Yes 17. The MDS manual is an assessment tool developed by the federal government. It gives longterm care facilities a structured, standardized approach to care. When nursing assistants report on changes in residents, it may trigger a needed assessment. 18. Sight, hearing, smell, and touch 19. For the nursing assistant, critical thinking is making good observations to get help for potential problems. 20. S 21. O 22. S 23. O 24. O 25. Assessment, diagnosis, planning, implementation, evaluation 26. Care plans are prepared from the observations of staff caring for the resident. 27. An accident, problem, or unexpected event during the course of care 28. After the incident occurs, the report must be completed as soon as possible. 29. Good morning, good afternoon, or good evening 30. The call system allows the resident to call for help when needed. 31. Listen closely. Take notes. Offer valuable information gathered about residents to staff. 32. Answers include: names and room numbers of residents; the medical diagnosis of each resident; code status; activity level; range of motion (ROM) exercises; bathing information; diet orders; fluid orders; bowel and bladder information; vital signs and how often to measure them; treatments to be performed; and special tests and other procedures to be performed 33. Answers will vary, but may include visiting with residents while providing care. 34. Identify the most important things to get done. Do these first.