1. Chapter 3: Communication Skills
Roosevelt Health Science
Clinical Rotations
Successful Nursing Assistant Care, 2nd Ed. (Ch. 3)
Simmers DHO Health Science, 8th ED. (Ch. 4)
Medical Assisting: Administrative & Clinical Competencies, 7th ED (Unit 4,5)

2. Chapter 3 Objectives Define important words
Explain types of communication
Explain barriers to communication
List ways that cultures impact communication
Identify the people you will communicate with in a facility
Understand basic medical terminology and abbreviations
Explain how to convert regular time to military time
Describe a standard resident/patient chart
Explain guidelines for documentation
Describe the use of computers in documentation
Explain the Minimum Data Set (MDS)
Describe how to observe and report accurately
Explain the nursing process
Discuss the nursing assistant’s role in care planning and at care conferences
Describe incident reporting and recording
Explain proper telephone etiquette
Describe the resident call system
Describe the nursing assistant’s role in change-of-shift reports and “rounds”
List the information found on an assignment sheet
Discuss how to organize your work and manage time.

3. Communication
Communication is the exchange of information with others.
Process of sending and receiving messages
People communicate with signs, symbols, and behavior.
Including words, drawings, and pictures

4. Verbal Communication Communicating verbally means using words.
Speaking and writing are examples
Verbal communication also includes the way that words are spoken or written.
The tone of voice and specific words chosen are important.
Written communication should be legible.

5. Nonverbal Communication
Communicating without using words.
Body language and touch are two examples.
Body language includes posture, body movements, facial expression, and gestures.
Nonverbal communication can be positive or negative.

6. Nonverbal Communication
Positive Nonverbal Communication
Smiling in a friendly manner
Leaning forward to listen
With permission, putting your hand over a resident’s hand while listening to her
Negative Nonverbal Communication
Rolling your eyes or crossing your arms
Tapping your foot
Pointing at someone while speaking

7. Keys to Communicating Properly
Use appropriate words. Make sure that patients are able to understand what you say. Use proper words and terms with care team members.
Be aware of your body language!
Use an acceptable tone of voice. Communicate concern and caring.
Wait for responses. Let pauses happen. Do not interrupt or try to finish the person’s sentences.
Practice active listening.
Use facts when communicating.

8. Active Listening
Involves giving patients your full attention while they are speaking.
Maintain good eye contact
Use phrases that encourage them to keep speaking and to clarify their communication.
Examples: Yes, Hmm, I see, I understand, Go on
Repeat the patient’s message to show you have been listening closely.
Show patients you are really interested in what they have to say by nodding and smiling.

9. Communication Barriers
Some patients have trouble understanding or using verbal communication due to a barrier that prevents proper communication.
Barrier- a block or obstacle

10. What would you do if……
The patient does not hear you, does not hear correctly, or does not understand?

11. The patient does not hear you, does not hear correctly, or does not understand?
Stand directly facing the patient
Speak slowly, make sure each word is spoken clearly
Speak in a low, pleasant, and professional voice
If the patient wears a hearing aid, check to see that it is on and works properly.

12. What would you do if……
The patient is difficult to understand?

13. The patient is difficult to understand?
Be patient
Take the time to listen
Ask the patient to repeat or explain
State the message in your own words to make sure you have understood.
If the patient becomes frustrated, take a break and try again in a few minutes or find someone else to listen with you.

14. What would you do if……
The patient speaks a different language than you do?

15. The patient speaks a different language than you do?
Be patient
Speak slowly and clearly
Keep message short and simple
Be alert for words the patient understands
Use pictures and gestures to communicate
Look for signs that the patient is only pretending to understand
Ask the patient’s family, friends, or other staff members who speak the patient’s language for help.

16. Things to Avoid
Using words that the patient/family does not understand.
Do not use slang. Do not curse.
Avoid clichés.
Clichés are phrases that are used repeatedly and do not really mean anything. Ex: “Everything will be okay.”
Asking “why”
Asking “why” makes the patient defensive. Try saying “Is there something else you want to do?” instead of “Why not?” when the patient does not want to participate in a specific activity.

17. Things to Avoid Giving advice Asking Yes/No questions
Offering your opinion is inappropriate. Patients and families should make decisions on their own or with help from doctors.
Giving medical advice is not within the scope of your practice.
Asking Yes/No questions
Ask open-ended questions; yes/no end a conversation
Conflicting verbal and nonverbal communication
Be aware of your body language and the patient’s body language!

18. Culture
A set of learned beliefs, values, and behaviors shared by a social, ethnic or age group.
CULTURE DOES NOT MEAN RACE
Cultures communicate in different ways
Use of eye contact
Is it a sign of respect and honesty or rude and aggressive?
Touching
Always get permission
Explain your intentions

19. Touching Acceptable Touch Unacceptable Touch
Give patients respectful personal care, such as bathing, dressing, feeding, and shaving.
Hugging, if the patient permits or asks for a hug.
Holding a patient’s hand when he/she asks you to.
Unacceptable Touch
Sitting on a patient’s lap or asking a patient to sit on your lap.
Kissing a patient
Hugging a patient who pulls away from you
Inappropriately touching or rubbing against a patient or staff members.

20. Who will you need to communicate with?
Doctors, Nurses, Supervisors, Managers, and Other Staff Members
Other Departments (Dietary, Radiology, Lab, etc.)
Patients
Family and Visitors
The Community

21. Medical Terminology
Prefix- comes at the front of the word. It works with a word root to make a new term.
Root- main part of the word that gives it meaning.
Suffix- found at the end of the word. A suffix does not form a full word.
Abbreviations are shorten ways to communicate more efficiently.
You will need to know these to read assignments, care plans, or charts.

22. Medical Terminology Common Prefixes: Common Suffixes: A- Without
Ab- Away from
Brady- Slow
Dys- Bad, difficult
Endo- Within
Hyper- Above, excessive
Hypo- Below, under, deficient
Infra- Below, inferior
Peri- Around
Super-,
Supra- Above, superior, more
Tachy- Fast, rapid
Common Suffixes:
-ac, -al, -ar, -ary, -eal,
-ia, -ic, -ory, -ous, -tic Pertaining to
-algia, -dynia Pain
-cyte Cell
-ectomy Removal of
-itis Inflammation
-kinesia, -kinesis Movement
-megaly Enlargement
-meter Measuring device
-oma Tumor
-opia Vision
-pathy Disease
-plasty Surgical repair
-pnea Breathing
-rrhage,
-rrhagia Heavy, excessive discharge
-rrhapy Suturing
-rrhea Discharge, flowing
-scope,
-scopy Instrument for viewing
-stenosis Narrowing
-stomy Opening
-tomy To cut
-uria Urine

23. Medical Terminology Root Words Colors (prefix or root) Cardi/o Heart
Chlor/o Green
Polrphyr/o Purple
Xanth/o, Luteus- Yellow
Cirrhos- Orange yellow
Chrom/o Color
Root Words
Cardi/o Heart
My/o, Muscul/o Muscle
Neur/o, Neuri- Nerve
Ren/o, Nephr/o Kidney
Hepat/o Liver
Gastr/o Stomach
Ur/o Urine
Osse/o, Oste/o Bone
Col/o, Colon/o Colon
Dent/o Teeth
Pulmon/o, Pneum/o Lung
Hem/o, Hemat/o Blood
An/o, Rect/o, Proct/o, Anus, Rectum
Colors (prefix or root)
Albus-, Leuk/o White
Cyan/o Blue
Erythr/o, Rhod/o Red
Melan/o Black

24. Time
Regular time is converted to military time (24-hour clock) at many medical facilities to document information.
In military time, the hours are 00 (midnight) to 23 (11 pm).
No am or pm; instead after 12 noon, 1:00 becomes 1300 (1 +12) , 2:00 becomes 1400 (2 + 12) , 3:00 becomes 1500 (3 + 12), etc.
Minutes and seconds are the same in military and regular time.

25. Standard Patient Chart
A chart is a legal record of a patient’s care, it is also called a medical record.
What is written in the chart is considered in court to be what actually happened.
It is the nursing assistant’s job to gather info and report it to the nurse. Writing down your observations and care is known as charting.
A computer is often used for charting, these are called Electronic Medical Records.
Charts and other medical info cannot be shared with anyone except for the care team (HIPAA).

26. Standard Patient Chart
Information found in the medical chart includes:
Admission Forms
Patient History and Physical Exam Findings
Care Plans
Doctor’s Orders
Doctor’s Progress Notes
Nursing Assessments
Nurse’s Notes
Notes from PTs, OTs, and other specialists
Flow sheets
Graphic Record
Intake and Output Record (I&O)
Consent Forms
Lab and test results
Surgery reports
Advanced Directives

27. Accurate Documentation
Keep all info in the chart confidential
Document immediately after care is given. Record notes carefully. Never record any care before it is done.
Use Black Ink when documenting. Write neatly.
Sign each note you make in the chart. Sign your name and title. Use correct date and time.
Use only facts, write exactly what the person said, or what you see, hear, smell, or touch. Avoid “seems,” “appears to be,” or “looks like.”

28. Accurate Documentation
If you make a mistake, draw one line through it. Write the correct information. Put your initials and the date. DO NOT ERASE. DO NOT USE CORRECTIVE FLUID.
Use only your facility’s accepted abbreviations and terms.
Use comparisons to describe size instead of words like “large,” “medium,” or “small.”
Ex: “There is a spot of blood on her bandage the size of a dime.”
Some facilities require documentation on a “check-off” sheet.

29. Computers in Documentation
Many facilities use computers to document information about the patient.
They will train staff on computer use.
Computers can easily store information that can be retrieved when needed.
Vital signs, laboratory results, radiologic reports, and comments from other physicians.
Using a computer for charting is faster and more legible than writing by hand.
Staff input information each time they enter and leave the room.
Some facilities have a computer in every resident’s room.

30. Computers in Documentation
General rules for computer use:
Do not share your personal password or login ID with anyone
Do not access personal accounts at work
Do not view inappropriate websites from work
Log off the computer when you are done with charting or using the computer
HIPAA guidelines apply to computer use. Be careful about who can see private or protected health information on the computer screen.

31. Minimum Data Set (MDS)
MDS is a manual that is used as an assessment tool for long-term care facilities.
Developed by the Federal Government in 1990, and is updated periodically.
Gives detailed guidelines for assessing residents, and provides a protocol when problems are identified.
Gives facilities a structured, standardized approach to care.
Facilities must complete the MDS for each resident within 14 days of admission, and again each year.
They must also be reviewed for each patient every 3 months.
A new MDS is done when there is any major change in a resident’s condition.

32. Who spends the most time with a patient/resident?

33. Who spends the most time with a patient/resident?
Nursing Assistants!

34. Care Plans
Care Plan- written plan for each patient created by the nurse.
Outlines steps and tasks that the care team must perform to help the patient reach his/her goals.
To plan care, nurses must collect info from staff.
Includes objective and subjective information

35. Signs v. Symptoms Objective Information Subjective Information
Based on what you see, touch, or smell.
Also called signs
FACT
Subjective Information
Info collected from something that patients or their families report to you.
May not be accurate
Also called symptoms
OPINION

36. Using the 4 senses
Sight: look for changes in appearance, such as redness, swelling, rashes, discharge, changes in the eyes or ears or ability to move.
Hearing: Listen to what the resident tells you. Make sure he is making sense. Check to see if his breathing is normal. Note if he is coughing or gasping. Report if he is showing emotions, such as anger or sadness.
Smell: Check for odors coming from the resident’s body or mouth. Odors can indicate an infection, a need for bathing, or poor mouth care.
Touch: Note if the skin seems hot or cool. Check to see if it is dry or moist.

37. Other Observations
Note any changes in orientation. Does the patient know who she is, who you are, where she is, and what year it is?
Check to see if the patient’s vital signs are normal or abnormal.
Report any changes in ability. Has there been a change in the patient’s ability to move a part of her body?
Report other important changes, such as changes in weight or overall appetite, changes in ability to go to the bathroom, and changes in mood.

38. When to report?
Accurate documentation and prompt reporting are important to patients’ well-being.
Determining when to report immediately require critical thinking.
Critical Thinking is making good observations and promptly reporting all potential problems.
Things that should be reported immediately include:
Sudden limp
Numbness or loss of feeling in one side of the body or one arm or leg
Abdominal pain
Change in vital signs
Severe headache
Patient Falls
Wheezing and/or breathing difficulty
Chest pain and pressure
Pain in calf of leg
Blurred vision
Slurred speech
Vomiting

39. Nursing Process
Organized method used by nurses to determine patients’ needs, plan the appropriate care to meet those needs, and evaluate how well the care plan is working.
5 steps
Assessment
Diagnosis
Planning
Implementation
Evaluation

40. Assessment and Diagnosis
Getting information from many sources, such as medical history and a physical assessment, and reviewing it; the purpose is to identify actual or potential problems.
Diagnosis
The identification of health problems after looking at all the patient’s needs; complete to make a care plan.

41. Planning, Implementation, and Evaluation
In agreement with the patient, goals are set and a care plan is created to meet the patient’s needs.
Implementation
Putting the care plan into action; giving care.
Evaluation
A careful examination to see if goals were met or progress was achieve; if progress is slow or if the problem worsened, the care plan must be changed.

42. Care Conference
Care plans may be written at a special care conference, where member of the care team meet to share and gather ideas.
CNA’s share observations from resident care. Always talk to the nurse before the care conference if you are not sure what to say.
Care plans are usually kept at the nurse’s station in a Kardex (type of card file) or by the resident’s room.

43. Incidents
An incident is an accident, problem, or unexpected event during the course of care.
Ex: Patient falls while being taken to the bathroom
Sentinel event- unexpected occurrence involving death or serious physical or psychological injury.
Ex: Patient falls out of bed and breaks hip
Incident reports- documentation reporting the incident and the response to it.
Confidential and based on facts
Give to Charge Nurse
Always fill one out, even if the event seemed minor
Complete as soon as possible after the incident occurs so that the details are not forgotten.

44. Telephone Etiquette
Greet the caller cheerfully, with “Good morning,” “Good afternoon,” or “Good evening.”
Identify the facility: “Evergreen Skilled Nursing”
Identify yourself and your position
Listen closely to the caller’s request. Write down messages. Ask for correct spelling of names.
In emergencies, take action immediately
Say “Thank you,” and “Goodbye”

45. Telephone Etiquette
Do not give out any information about staff or patients over the phone.
Refer patient status questions to a supervisor
Always ask someone to be hold, before you got get a supervisor or someone else.
You may need to transfer a call. You should be trained at the facility on how to do this
Follow specific phone, cell phone, and pager policies at the facility.

46. Patient Call System
Patients signal staff when they need them for whatever purpose through the call system.
Sometimes called signal light or call light
Always respond to call lights promptly, it can save someone’s life.
Do not ignore call lights, doing so can be considered neglect or abuse under the law.
Answer call lights for patients other than your own.
Always leave the call light within the patients’ reach before leaving the room.

47. Shift Change Reports
There are start-of-shift reports and end-of-shift reports.
CNAs go to start, Nurses go to both
The care team gather to discuss and plan patients’ care for a shift.
Shifts vary from 8, 10, or 12 hours
At start of shift reports, listen to important information about all of the residents in the area.
Examples of information passed on to the next shift are appetite problems, complaints of pain, or a change in the ability to move.
Special information shared during a report may include new admissions and transfers or discharges from the facility.
Before the end of shift report, tell the nurses about such things as changes in pulse or temperature and skin changes that could signal that start of pressure sores.

48. Rounds Physicians tend to make rounds Nurses may round, separately
Staff members move from room-to-room and discuss each patient and the care plan.
This is what you see on tv
Physicians tend to make rounds
Nurses may round, separately

49. Assignment Sheet
An assignment sheet lists all patients and has all of the tasks that you must do for them.
Certain tasks are done daily (ADLs)
You may asked to do range of motion (ROM), exercises done to bring joints through a full range of movement.
Code status- lists whether the patient has an advanced directive or not.
A “code” is when a group of specially-trained staff provide advanced life support during a medical emergency.

50. Assignment Sheet Includes Names and room numbers Medical diagnosis
Code status
Activity level
ROM
Bathing orders
Diet orders
Fluid orders
Bowl and bladder information
How often to take vital signs
Treatments to be performed
Special tests and other procedures to be performed

51. Organizing
In order to complete assignments each day, you must learn to organize your work.
After you receive your assignment, make rounds on all of your patients.
Check to see if any patients require immediate help or care.
Answer call lights, make sure all patients can reach the call light.
Write down any reminders on a notepad. Write down anything important on the assignment sheet.

52. Organizing Decide the order of patients you will see.
Making a schedule will help you to be realistic about what can be done during the day.
Prioritize and combine activities.
Each facility will have its own schedule of events and care.
Do not be afraid to ask for help.

53. Communication Super important
Includes spoken, written, and body language
Ask for help when you need it
Have a positive attitude and body language, so show that you are approachable.