PERSPECTIVES

Colors, Symbols, and OtherCommunication IdeasSandra Kenney Weeks, MSN RN CRRN

Good communication is fun. It is alsoessential for the smooth operation of a re­habilitation unit. The use of colors andsymbols can promote effective teamcommunication with important benefitsto patients. At Lourdes Regional Reha­bilitation Center, we communicate manykinds of information via colors, symbols,and othermeans in order for staffto get in­formation quickly and clearly withoutcompromising patient dignity and confi­dentiality.

Using colors to communicateNames are important to our patients.

We print our patients' first and last namesin large letters on plain white 8-in. x lO­in. papers that are slipped into clear plas­tic covers attached to the backs of theirwheelchairs. This signage helps to in­crease name awareness and use, assist inpatient orientation, foster independence,and encourage socialization and a senseof community among rehabilitation pa­tients and visitors.

If, however, the patient is blind, on car­diac or sternal precautions, or for someother reason should not be self-propellinga wheelchair, that patient's name is ongreen paper. The green name backgroundalerts all staff members to offer to pushthese patients throughout the rehabilita­tion center, and not expect or encouragethem to push themselves. If a patient ison a dysphagia diet or requires otherswallowing strategies, that patient's nameis on blue paper. All staff members knowto turn any blue name paper over to readthe swallowing strategies listed by thespeech pathologist. If the patient is on ourrestraint alternative program (Weeks,1997) that patient's nameis on yellow pa­per. This color code alerts all staff mem­bers to the patient's increased potentialfor falls, without the discomfort and em­barrassment imposed by restraints. Us-

ing colors in this way conveys much in­formation about safety precautions with­out compromising patient dignity.

When patients are admitted to ourunit, the nurse asks if they have any ob­jection to posting their full names outsidetheir rooms, on the back of their wheel­chairs, and on the assignment board.Rather than objecting, our patients havebeen delighted with the use of their namesand appear to take pride in personalizingthe unit as their own while they are withus. We explain the color codes to patientsand family members, and they participatein team conferences and in daily interac­tions with team members in evaluatingthe sensitivity and need for continued useof the color codes throughout the reha­bilitation stay. Our written policy on post­ing patient names on the rehabilitationunit states that no name will be posted ifthe patient or family objects, but no onehas ever objected. Our policy also statesthat patient information will never belinked to a patient's posted name.

Use of symbolsPatients' names, besides being at­

tached to wheelchairs, appear on a largemagnetic patient-nurse assignment boardin the hall near the nurses' station. Hereis where we use symbols to communicateinformation to each other. A skillet mag­net alerts us to get a patient up early be­cause he or she is going to the kitchen foran activities-of-daily-living (ADL) cook­ing evaluation. In contrast, a shirt mag­net placed by a patient's name tells nurs­es not to get this patient up in the momingbecause occupational therapy plans anADL dressing evaluation. A cafe magnetby a name tells us this patient has electedto join the recreational therapist or fam­ily and friends in the hospital cafeteriafor lunch or dinner,and won't beeating onthe unit. A number by a name tells the

nurse that this patient and nurse arescheduled for a team conference and forexactly what number of the many con­ferences they are scheduled. A large "X"by a name tells the transport aid that thisnewly admitted patient has been assessedby nurse and physician, has an order fora pretherapy admission X-ray, and shouldbe transported to radiology as soon aspossible so that therapy admission eval­uations can begin. illustrations on a smallposter in the nurses' lounge facilitatequick and accurate interpretation of ourcommunication codes by staff membersnew to the unit.

Staggered ShiftsWhile colors and symbols have im­

proved communication on the unit, ourneeds have produced many other changesthat work well for us. One of these ideasis for a staggered shift change. We foundthat our patients and visitors were frus­trated in their inability to get assistanceat shift change time because, althoughdouble the staff was present, everyonewas talking to each other and no one wasanswering lights. While our nurses con­tinue to work 7 am-3 pm, 3-11 pm, and11 pm-7 am, our nursing assistants havechanged to 7:30 am-4 pm, 4 pm-mid­night, and midnight-8 am.

The nursing assistant on duty contin­ues to meet patient needs while the on­coming nurse is in report. By the time theoncoming nursing assistant arrives forwork, that shift's nurses are out of report,caring for patients, and able to give thenursing assistant a brief report. This hasimproved continuity of care to patients,decreased interruptions during report(thereby decreasing time nurses spendaway from the patient while getting re­port) and improved communication ofbasic information to nursing assistantsso they can better protect themselves and

190 Rehabilitation Nursing> Volume 24, Number 5· Sep/Oct 1999

patients, and assist the nurses in caringfor patients.

Our night nursing assistants begin get­ting early risers up and dressed around 6am. The day nursing assistants coming inat 7:30 am join the night nursing assis­tants, who stay until 8 am. Working to­gether, the night and day nursing assis­tants provide a double overlap with theoccupational therapy dressing evalua­tions, enabling most patients to be up,dressed, and to breakfast in time to eatand get back to the bathroom and to ther­apyby 9 am.

Using voicemailWe use one voicemail number to send

messages to the entire rehabilitation team.This saves the sender's time and ensuresthat all rehabilitation team members getinformation they may need. Any teammember can send information to the restof the team. One voicemail is transmittedto the admissions coordinator, socialworkers, physical therapy, occupationaltherapy, speech therapy, recreational ther­apy, the rehabilitation psychologist, thedietitian, the nurse manager, assistantnurse managers, and the physiatrists' sec­retary. Messages routinely sent includeadd-on or canceled admissions and dis­charges, changes in the team conferenceschedule, weight-bearing changes, in­fection control information, dischargedate or site and other related issues, case

management needs, cancellation or re­sumption of therapy related to medical is­sues, code status, issues of sternal, car­diac, fall, skin, or other precautions, andvacation alerts. The receivers can act onthe information or ignore and erase themessage if unneeded.

Twenty-four-hour meetingsCommunication on the nursing unit is

enhanced by our 24-hour staff meetingsheld every other month. The nurse man­ager works from 7 am one morning to 7am the next and facilitates I-hour staffmeetings on all shifts at 10 am, 2, 4 and 9pm, and 3 am. All nurses, nursing assis­tants, and unit secretaries on duty attendone of the meetings, and many otherscome in on their days off. This is actual­ly a series of round-robin meetings heldover 24 hours with a beginning agendathat grows as the meetings unfold. We av­erage between 60 and 80 topics in this se­ries of I-hour meetings. Many topics areroutine or have been posted as notices,but many are new ideas. Some sugges­tions can be acted on immediately, whileothers require follow-up or further dis­cussion. The nurse manager takes noteswhile facilitating the meetings, capturingnames of the speakers and their sugges­tions and comments, and types detailedminutes during the 11 pm-7 am shift.Minutes are left with a volunteer whomakes 75 copies for distribution to all

nursing staff members and to our admin­istrator and vice president. We have con­ducted our staff meetings in this mannerfor 9 years and have found this to be anexcellent way to communicate, problem­solve, come up with new ideas, augmentperformance improvement, and maintaina diary of changes over the years.

There will always be a need for goodcommunication among members of therehabilitation team. Many of our patients'frustrations come from impaired abilityto communicate. We who have the abili­ty need to find as many ways as possibleto communicate quickly, clearly, and ef­fectively with team members while main­taining patient dignity. We hope our sug­gestions will assist you in your care.

At the time this article was written, SandraWeeks was a rehabilitation nurse manager atLourdes Regional Rehabilitation Center inCamden, NJ. She is now the clinical nurse'managerfor the Comprehensive Rehabilita­tion, Brain Injury, and Transitional CareUnits at Wake Forest University Baptist Med­ical Center in Winston-Salem, NC. Addresscorrespondence to her at 261 Kings Mill Dri­ve, Advance, NC 27006.

ReferenceWeeks, S.K (1997). RAP: A restraint alternative

protocol that works. RehabilitationNursing, 22,154-156.

CURRENT ISSUEScontinuedfrom page 189

should be at a level that the target audienceunderstands. These concepts are essentialif rehabilitation programs are to ensure asuccessful, viable future. The rehabilitationnurse has the knowledge and expertise notonly to assist with data collection, but alsoto participate in the analysis and evaluationof the outcomes data. Implementing prac­tice changes to promote quality care andpositive outcomes for our rehabilitation pa­tients is an essential element of the role ofthe rehabilitation nurse. By understandingthe importance of monitoring outcomes, therehabilitation nurse acts as an invaluableteam member who is instrumental in facil­itating change to promote the bestpossibleoutcome for the patient.

Terrie Black is a rehabilitation consultant atthe Hospital for Special Care, New Britain,

CT.Address correspondence to her at the hos­pital, 2150 Corbin Avenue, New Britain, CT06053

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