Communication & Cultural Diversity

Communication & Cultural Diversity Chapter 4

Verbal & Nonverbal Communication • Communication is exchange of information • Process of sending & receiving info • Feedback confirms message is understood • CNAs communicate with residents, family members, supervisors, & care team members • CNAs must be able to communicate clearly & respectfully in stressful & confusing situations

Verbal & Nonverbal Communication • Verbal Communication involves use of words & sounds, spoken or written. • Nonverbal Communication occurs without use of words • Includes how a person says something (tone of voice or emphasis of words can change meaning) • Body language(movements, facial expression, posture) reflects attitudes & feelings

Verbal & Nonverbal Communication • Positive nonverbal communication • Smiling • Making eye contact • Nodding your head • Nonverbal cues communicate feelings • When nonverbal cues conflict with verbal message, take time to clarify what’s going on • Communicate to nurse – not only what is verbally communicated, but your nonverbal observations as well.

Multiple choice • Which 3 things are needed for communication to take place? • Signs, symbols, & drawings • Sender, receiver, & feedback • Supervisor, residents, & family members • Loud voice, ability to speak, resident’s chart

Multiple choice • The 3 step process of communication occurs • Only once. • Over & over. • Only in formal meetings with the care team. • In a different order every time. • Which is an example of nonverbal communication? • Asking for a glass of water. • Pointing to a glass of water.

Multiple choice • Types of verbal communication include • Facial expressions • Nodding your head • Speaking • Shrugging your shoulders

Multiple choice • Which is an example of confusing/conflicting message? • Mr. Carter is smiling and tells you he is excited that his daughter is coming for a visit. • Mrs. Sanchez looks like she’s in pain & tells you her back is bothering her. • Ms. Jones agrees when you comment about a nice day, but looks angry. • Mr. Lee won’t watch his favorite TV show & says he is a little depressed.

Multiple choice • How would you clarify the previous confusing/conflicting message? • Tell the person that you know he/she is not telling the truth. • Ignore the conflicting message, just accept what the person has told you. • Ask the person to repeat what he/she just said. • State what you observed & asked if the observation is correct.

Short answer- Indicate whether the behavior sends a positive (P) or negative (N) message. • ___ An impatient or angry tone. • ___ Smiling • ___ Leaning forward • ___ Glancing at your watch • ___ Sitting up straight • ___ Slouching • ___ Crossing your arms in front of your body • ___ Listening carefully • ___ Hugs & warm touches • ___ Rolling your eyes.

Cultural diversity • Cultural diversity has to do with many people from varied backgrounds & experiences living together. • Culture is a system of learned behaviors that are considered to be the tradition of a group of people that passes them on from generation to generation • Culture may include knowedge, behaviors, beliefs, values, attitudes, religions, & customs

Cultural diversity • Positive responses to diversity • Understand differences in nonverbal communication & be sensitive • Gestures & hand motions • Comfortable distance when talking • Use of touch (may communicate threat) • Eye contact (may communicate disrespect) • Ask people how they wish to be treated • Don’t try to change their beliefs • Avoid bias/prejudice

Matching • ____ Positive responses to it include acceptance & knowledge. • ___ Learned behaviors that are the tradition of a group of people & are passed on. • ___ Prejudice • Bias • Cultural diversity • Culture

Barriers to communication • Resident doesn’t hear or understand you. • Speak clearly with a pleasant, professional tone • Use a low voice • If resident says can’t hear, speak more loudly • If resident wears hearing aid, check if it is on & working • Resident is difficult to understand • Be patient, ask resident to repeat or explain • State message in your own words to confirm understanding

Barriers to communication • Don’t use words receiver doesn’t understand • Avoid medical terms with residents • Speak in simple, everyday words • Ask what a word means if you don’t understand • Slang confuses the message • Slang words may not be understood & are unprofessional • Never curse or use profanity, even if resident does

Barriers to communication • Avoid using clichés (overused phrases that mean nothing) – respond with meaningful messages • Avoid asking “why” when resident makes a statement • Make residents angry & defensive • Don’t give advice – not within your scope of practice • Yes/no answers end a conversation – ask open-ended questions instead

Barriers to communication • Resident speaks a different language • Speak slowly & clearly • Keep message short & simple • Use gestures or pictures to help • Ask for help from family, friends, or staff that speak the language. • Be patient & calm

Accurate &effective communication • Be a good listener. Don’t interrupt. Restate the message in your own words to confirm. • Provide feedback as you listen. • Bring up topics of concern in a general, non-threatening way. • Let pauses happen. Allow resident to gather thoughts.

Accurate & effective communication • Tune in to cultural differences. • Respect the resident’s beliefs or lack of beliefs. • Understand the importance of touch. Ask permission before touching them. • Ask for more information

Accurate & effective communication • Make sure hearing aids, glasses, and dentures are clean & in good working order. • Avoid changing the subject. • Don’t ignore any request. Honor the request if you can, explain why if you can’t. Always report the request to the nurse.

Accurate & effective communication • Don’t talk down to elderly or disable people. • Sit near the person who has started the conversation. • Lean forward when someone is speaking to you. • Talk directly to the person, not to other staff. Don’t gossip or criticize other staff.

Accurate & effective communication • Approach the person who is talking to you, even if you are in another area of the room. • Put yourself in other people’s shoes (empathy). Try to imagine the difficulties they face. • Show resident’s family & friends you have time for them, too. Ask questions about residents’ personal preferences, history, habits & routines.

Multiple Choice • One way to be a good listener is to • Finish a resident’s sentences for him. • Pretend you understand, even if you don’t. • Restate the message in your own words. • Fill in any pauses to avoid awkwardness. • Active listening involves • Focusing on the sender & giving feedback. • Avoiding speaking to the resident if you can’t understand her. • Finishing sentences for her when you know what she’s going to say. • Talking about your own personal problems.

Multiple Choice • Mrs. Velasco is a new resident. Simon, a nursing assistant is giving her a bath before bedtime. He notices that she seems to have difficulty speaking English & seems nervous. What can Simon do to make her more comfortable? • Give her advice about how to fit into American culture. • Finish her sentences for her so that she will not have to speak. • Use some words & phrases that he is familiar with in her language. • Avoid speaking to her while giving care.

Multiple Choice • When residents report symptoms or feelings, it’s a good idea to • Interrupt the resident • Ignore the resident • Avoid speaking • Ask for more information • During conversations with a resident, a nursing assistant should • Talk with other staff members. • Use affection terms like “dear” or “honey”. • Call the resident by the name she prefers. • Avoid using the resident’s name.

Multiple Choice • Which of the following statements reflects a way for nursing assistants to have a good relationship with residents? • An NA should fold her arms In front of her while the resident is talking. • An NA should chat with other staff members if the resident she is assisting is unable to talk. • An NA should ignore a resident’s request if she knows she cannot fulfill it. • An NA should be empathetic & try to understand what residents are going through.

Multiple Choice • Mr. Kohutko is an elderly resident who has terminal cancer. He is telling Katie, a nursing assistant, that he is very depressed about dying. He feels he has left many things unfinished. Hearing all this makes Katie uncomfortable. How should she respond? • Try to ignore what he is saying. • Try to change the subject to something more cheerful. • Listen to the resident & ask questions when appropriate. • Tell him you know how he feels.

Observe & report accurately • Objective information is collected by your senses. • Sight – look for changes in appearance • Hearing – listen for emotions, confusion, breathing patterns • Touch – Does skin feel warm or cool, moist or dry? Is the pulse rate regular? • Smell – Odors suggest poor hygiene, infection, or incontinence. • Subjective information is based what a resident reported to you that may or may not be true.

Observe & report accurately • Signs – what you observe about the resident • Symptoms – what the resident reports to you. • The nurse needs both kinds of facts to make decisions about care & treatment. Clearly note both objective & subjective information in any report. • A CNA is not expected to make diagnoses based on signs & symptoms, just report them!

Short answer- Indicate whether each observation is objective (O) or subjective (S). • ____ Skin rash • ____ Crying • ____ Rapid pulse • ____ Headache • ____ Nausea • ____ Vomiting • ____ Swelling • ____ Cloudy urine • ____ Wheezing • ____ Feeling sad REMEMBER: OBJECTIVE OBSERVATIONS ARE SIGNS. SUBJECTIVE OBSERVATIONS ARESYMPTOMS.

Observe & report accurately • Communicate observations regularly to charge nurse. • Refer questions to the nurse. Never tell residents (or their friends & family) any new information. That’s the doctor or nurse’s responsibility. • Always respect the resident’s privacy, be sure other residents or family don’t overhear your report.

Observe & report accurately • All resident information is confidential, & should be shared with other staff only as needed to provide quality care. • Use the chain of command to voice any complaints you may have. • Go to charge nurse with complaints of possible abuse. Check policies or procedures if complaint is unresolved. If you believe the charge nurse has abused a resident, communicate this to his/her supervisor.

Observe & report accurately • Take notes in report & as you give care, so you don’t omit important details. • Be brief & accurate! Anything that endangers residents must be reported immediately. • Falls Severe headache • High fever Loss of consciousness • Bleeding Change in level of consciousness • Chest pain Trouble breathing • Bruises/abrasions Loss of mobility • Abnormal vital signs Sudden weakness • Change in resident’s condition

Multiple Choice • When giving information to other members of the care team about a resident, a nursing assistant should • Discuss it in the hallway around other residents. • Make a diagnosis of the resident’s condition. • Share information with anyone who asks about the resident’s condition. • Make sure he respects the resident’s right to privacy.

Multiple Choice • The health professional who should give a resident’s family and friends information about any new diagnoses is • A doctor. • A nursing assistant. • An activities director. • A physical therapist. • Report information will be shared with • Resident’s friends & families • Other residents on the same floor • The nursing assistant’s family • Members of the care team.

Multiple Choice • Which of the following is true of oral reports? • Nursing assistants should use mostly facts when making oral reports. • Nursing assistants should use mostly opinions when making oral reports. • Nursing assistants should make oral reports directly to the resident’s family and friends. • Nursing assistants do not need to make oral reports, they only need to make written reports.

Multiple Choice • Which of the following should be reported to the nurse IMMEDIATELY? • Trouble sleeping. • Falls. • Visits from family. • Requests for toileting assistance. • What is the best way to remember important details for an oral report? • Rely on your memory. • Repeat the info to a friend or another resident. • Write notes & use them for your report. • Tell another nursing assistant to remind you.

Medical records are legal documents • What is written in the chart is considered in court to be what happened. • If you gave care, but didn’t document it, it did not legally happen. • Failure to document can cause harm to resident & legal problems for you & your employer.

Charting guidelines • Do not record care before it has been done. • Write notes as soon as possible after you have completed care. • Think before you write. Be as brief & clear as possible. • Document facts, not opinions.

Charting guidelines • Write neatly, use black ink. • If you make a mistake, draw line through it, write correct word or words, initial, & date. Never erase or use white out. • Sign full name & title. Use correct date. • Document as care plan specifies.

Multiple Choice • The large amount of time a CNA spends with residents will allow her to • Diagnose resident illnesses. • Determine treatment. • Notice things about residents that others may not notice. • Give medication to residents. • When should notes be written? • Before care is given. • Immediately after care is given. • At the end of the shift. • Whenever there’s time.

Multiple Choice • Which of the following is true of a resident’s medical chart? • A medical chart is the legal record of the resident’s care. • All care does not need to be documented. • Documentation can be put off until the nursing assistant has time to do it. • Medical charts only contain the resident’s name, address, and date of birth.

Charting guidelines • Some agencies require you to use the 24 hour clock (military time) in documentation. • No colon is used between the hour & minutes in military time. • Do not use am & pm in military time. • Add 12 to the hour from 1 pm – 11:59 pm. • Midnight can be written 0000 or 2400. (✔policy)

Convert to military time • 2:10 pm • 4:40 pm • 10:00 am • 8.25 pm Convert to regular time. • 0600 • 2320 • 1927 • 1800

Incident reporting & recording • An INCIDENT is an accident or unexpected event. • Error in care – wrong meal tray or medication • Fall or injury to resident, visitor, or staff • Accusation by resident or family against staff • Exposure to blood or body fluids • Resident or family requests something out of scope of practice • Sexual advances or remarks • Anything that makes you uncomfortable or unsafe

Incident reporting & recording • Reporting & documenting incidents is done to protect everyone involved. • Complete report ASAP & give it to the charge nurse, so you don’t forget details. • State only facts, no opinions. • Tell what happened, time, mental & physical condition of the person. • Describe action taken to give care. • Tell person’s reaction to the incident.

Incident reporting & recording • If you didn’t see what happened, only record a brief account of what you found or afterwards. • Quote witnesses or the person, as appropriate. • Never write anything in the incident report on the medical record (incident reports are confidential). • Suggestions to prevent future incidents are also required.

Multiple Choice • An incident is • An accident or unexpected event in the course of care. • Any interaction between staff & residents. • A normal part of the facility routine. • Any event in a resident’s day. • Incidents should be reported to • The resident’s family. • The charge nurse. • All staff on duty at the time of the incident. • The doctor on call.

Multiple Choice • Which of the following would be considered an incident? • A resident complains of a headache. • A resident on a restricted-sodium diet receives & eats a regular, non-restricted meal. • A resident wants to watch TV in the common living area. • A resident needs to be transferred from his bed to a chair.

True or false • ____ Documentation of incidents helps protect the resident, employer, & individual staff member. • ____ The information in an incident report is confidential. • ____ If you do not actually see an incident, but arrive after it has already occurred, you should document what you think happened. • ____ The documentation of an incident should include the name of the person responsible for the incident. • ____ Incident reports should be factual.

Communication & Cultural Diversity