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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.

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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.


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

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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

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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

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Facial Expression the Demonstrate Affect

Identify the Emotion Being Expressed

1.2.1

1. 2. 3.

4. 5. 6.

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1.2.1

10. 11. 12.

13. 14. 15.

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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

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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.


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.

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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.


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

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Objective: 1.2.3 Documents observations using appropriate terms that are specific to the work environment.

Competency Course Content Learning Activities


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

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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

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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.

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Objective: 1.2.4 Explains the importance of reporting observations and measurements to the licensed professional/practitioner/supervisor.



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?

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Objective: 1.2.5 Explains the importance of maintaining the clients record.



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

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Objective: 1.2.5 Explains the importance of maintaining the clients record.


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.

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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).

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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

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Objective: 1.2.6 Demonstrates effective, communication skills with supervisor/manager/charge nurse, staff and other disciplines.


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.

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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

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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

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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.

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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

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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

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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

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Objective: 1.2.8 Demonstrates speaking, listening, writing, and social skills that supports participation as an effective, team member.Competencies Course Content Learning Activities



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

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Objective: 1.2.9 Demonstrates actions for asking appropriate questions to clarify meaning, understand outcomes or solve problems.Competencies Course Content Learning Activities



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

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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.



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Objective: 1.2.10 Explains the concept of diversity and why it is important.Competencies Course Content Learning Activities


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?



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Objective: 1.2.11 Describes cultural diversity and how the nurse aide manages cultural differences among people.Competencies Course Content Learning Activities


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?



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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

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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

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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?



Primary Objective: 1 2 Time: Class: Lab: Clinical:

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Objective: 1.2.12 Demonstrates respect for differences among clients and people.Competencies Course Content Learning Activities


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

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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




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y j . C ass: ab: C ca :


Objective: 1.2.13 Identifies elements of one's own, cultural formation and their potential impact in nursing practice.Competency Course Content Learning Activities


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?




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y j


Objective: 1.2.14 Uses effective, communication skills to promote clients well-being.Competency Course Content Learning Activities


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.




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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.




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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


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.