1. Barriers to Communication
Communication barrier – Anything that gets in the way of clear communication.

2. Three Common Barriers Physical disabilities
Psychological attitudes and prejudice
Cultural diversity

3. Physical Disabilities may include:
Deafness or hearing loss
Blindness or impaired vision
Aphasia or speech disabilities

4. To improve communication with the hearing impaired…..
Use body language such as gestures and signs.
Speak clearly in short sentences.
Face the individual to facilitate lip reading.
Write messages if necessary.
Make sure hearing aids are working properly.

5. To improve communication with the visually impaired…….
Use a soft tone of voice.
Describe events that are occurring.
Announce your presence as you enter a room.
Explain sounds or noises.
Use touch when appropriate.

6. What about someone with aphasia or speech impairments…..
They have difficulty remembering the correct words, may not be able to pronounce certain words, and may have slurred speech.
The health care worker must be patient.
Allow them to try and speak.
Encourage them to take their time.
Repeat message to assure accuracy.
Encourage them to use gestures or point to objects.
Provide pen and paper if they can write.
Use pictures with key messages to communicate.

7. Psychological barriers are often caused by:
Prejudice
Attitudes
Personality

8. Stereotypes such as “dumb blondes” or “fat slob” cause us to make snap judgements about others that affect the communication process.
Health care workers must learn to put prejudice aside and show respect for all individuals. Is that possible?
Do all patients have the right to quality health care?

9. Health Care workers should:
Allow patients to express their fears or anger.
Encourage them to talk about their feelings.
Avoid arguing.
Remain calm.
Talk in a non-threatening tone of voice.
Provide quality care.

10. Cultural Barriers
Each cultural group has beliefs and practices regarding health and illness.
Some cultures believe the body needs balance-if the body is cold, they eat hot foods.
Some cultures believe illness is due to demons and evil.
Some cultures believe health is a reward from God, and illness is punishment from God.

11. Cultural beliefs must be respected
Patients may practice their cultural remedies in addition to modern healthcare techniques.

12. Cultural diversity may interfere with communication in other ways:
Language differences-people who don’t speak English may have a difficult time communicating. You should:
a. Speak slowly.
b. Use nonverbal communication (smile).
c. Avoid tendency to speak louder.
d. Find an interpreter.

13. Cultural Barriers Cont.
Eye contact- in some cultures, it’s not acceptable , and looking down is a sign of respect.
Terminal illness- in some cultures, the patient is NOT told his/her prognosis, and family members are responsible for making care decisions.
Touch- in some cultures, it is wrong to touch someone on the head.
Personal care-in some cultures, only family members provide personal care.
Respect and acceptance of cultural diversity is essential for any health care worker.

14. Recording and Reporting…
Health care workers must listen carefully AND make observations.
They use their senses to: 
See ∆ Color of skin, swelling or edema
∆ Presence of rash or sore
∆ Color of urine or stool
∆ Amount of food eaten

15. They use their senses to:
Smell
∆ Body odor
∆ Unusual odors of: breath, wounds, urine and stool

16. Touch
Pulse
Dryness and temperature
of skin
Perspiration
Swelling

17. Hearing
∆ Respirations
∆ Abnormal body sounds
∆ Coughs
∆ Speech

18. Observations:
Observations should be reported accurately-use facts and report what you saw, not the reasons.
NOT-”Mr. Ruiz is in pain.”
INSTEAD- “Mr. Ruiz is moaning and holding his side.”
Observations on a patient’s health record (chart) should be accurate, concise, and complete.

19. Observations: Objective observations – what was seen.
DO NOT record what you feel or think.
If a patient’s statement is recorded, use the patient’s words and use quotation marks.
Sign entries with name and title of the person recording the information.
Cross out errors neatly with a straight line, write error, and initial error.

20. SOAP NOTES
Subjective
Objective
Assessment
Plan

21. SUBJECTIVE — . These are symptoms the patient verbally expresses or as stated by a significant other. These subjective observations include:
the patient's descriptions of pain or discomfort,
the presence of nausea or dizziness,
when the problem first started, and
a multitude of other descriptions of dysfunction, discomfort, or illness the patient describes. 

22. OBJECTIVE —These objective observations include symptoms;
that can actually be measured seen, heard, touched, felt, or smelled.
Included in objective observations are vital signs such as temperature, pulse, respiration, skin color, swelling and the results of diagnostic tests.

23. ASSESSMENT — is the diagnosis of the patient's condition
ASSESSMENT —  is the diagnosis of the patient's condition. In some cases the diagnosis may be clear, such as:
a contusion. However, an assessment may not be clear and could include several diagnosis possibilities. 

24. PLAN — The plan may include:
laboratory and/or radiological tests ordered for the patient, medications ordered, treatments performed (e.g., minor surgery procedure),
patient referrals (sending patient to a specialist), patient disposition (e.g., home care, bed rest, short-term, long-term disability, days excused from work, admission to hospital), patient directions (e.g. elevate foot, RTO 1 week), and follow-up directions for the patient.

25. SOAP Note Example Patient Name: Robert Kryle DOB: 12/31/1961
Record No. K-6112r809  
Date: 09/09/1999  
S—Pt. states that she has always been overweight. She is very frustrated with trying to diet. Her 20 year class reunion is next year and she would like to begin working toward a weight loss goal that is realistic. NKDA, NKA.  
O—WT = 210 lbs HT = 60, Chol = 255 BP = 120/75  
A—Obese at 183% Ideal Body Weight (IBW), hypercholesterolemia  
P—Long Term Goal: Change lifestyle habits to lose at least 70 pounds over a 12 month period. Short Term Goal: Client to begin a 1500 Calorie diet with walking 20 minutes per day. Instructed Pt on lower fat food choices and smaller food portions. Client will keep a daily food and mood record to review next session. Follow-up in one week.  

26. Soap Note Two example…. Patient Name: Paul Kessler DOB: 11/03/1961
Record No. K-470pk624  
Date: 21/8/2008     
S—Mild burning with frequent urination, a thin discharge that is worse in the A.M., irritation at the urinary opening at tip of penis, NKA.  
O—Discharge with gram stain negative for gonorrhea, showing large numbers of WBCs. Chlamydia test is positive.  
A—Non-Gonorrheal Urethritis  
P—Doxycycline 100mg BID for 10 days or Erythromycin 500mg QID for 10 days or Tetracycline 500mg QID for 10 days. Increase fluid intake, avoid alcoholic beverages. Pt education on safe sex practices.   

27. Test your gray matter….
What is the best way for a nurse to assess a patient’s concerns about her scheduled mastectomy? -Ask the pt. husband how the pt. feels,- The nurse should bring up the subject while taking the pts. VS and making the bed,- The nurse should close the door, sit down, and ask the pt. how she is feeling about the surgery,- Observe the pt, for signs of fear and anxiety.
If you are talking to a person who has a speech impairment who has difficulty completing a sentence you should: -Offer the person an opportunity to write the word or words you are unsure of – Smile, nod your head, and pretend you understand – Ask the person to start over and try to speak more slowly and clearly – Anticipate what the person is trying to say and complete the sentence.

28. A medical office assistant asks a pt. if she has net her deductible
A medical office assistant asks a pt. if she has net her deductible. The pt. doesn’t answer. What should the medical office assistant do next? –Ask “Why are you so embarrassed?” – Charge the full amount of the bill – Ask “Do you understand what I’m asking?”- Make a note on the chart that the pt. is uncooperative.
A Latino pt. comes to the ER and expresses concern about being treated by a Caucasian physician. The health care worker should: Allow the pt, to express his/her fears without being judgmental – Tell the pt. that the physician is a good one and he/she had nothing to worry about – Say nothing to the pt. but inform the doctor of the pts. Hostility – Find a Latino healthcare worker in the hospital who can verify the doctor’s credentials to the pt.

29. A medical assistant believes a child needs stitches
A medical assistant believes a child needs stitches. How should he report this to the doctor? – “We have a child who is going to need stitches.” – “Your next pt. is a child.” – “We have a child with a 2 inch laceration under her chin.” – “Your next pt. is going to be a handful. It’s a child who popped her chin.”
What is the correct way to signify that an entry on a medical record was made in error? – Circle the error and write “EE” (entry error) beside it- Erase the error completely – Use “white-out” to paint over the error, writing the correct information over the top of the dryed “white out.” – Cross out the error with a straight line, write “error” and initial it.