Module 4:

Communication and Patient Lifespan

As a Healthcare Worker, you will be a key communicator between the facility and patients.

You will be required to explain procedures, ask, and answer questions, and meeting patient needs will be part of your tasks.

Developing strong communication skills is the ability to effectively relay information to patients, family members and other medical professionals. This skill is needed in the medical office and is just as important as mastering administrative and clinical task. 

Customer service is the friendly and courteous treatment of all persons entering the facility and is the most important part of communication to families and patients.

Prior to performing any tasks, inform the patient about the procedure to build trust an alleviate anxiety. The patient must understand the procedure to provide consent.

To facilitate communication, maintain a nonjudgmental attitude and demonstrate good listening skills.

Listening Skills are summarized as the ability to listen, understand and assure the message sender that you understand their message.

Communication Factors:

Message Sender:

the person who wants to communicate information

Message:

the information the person needs to send

Receiver:

person to whom the message is sent

Confirmation:

the way the receiver lets the sender know that the message has been received.

Types of communication

Verbal Communication:

spoken or written words

Non-verbal Communication:

facial expressions, posture, hand/body movements, and appearance

Written Communication:

Communication relayed in writing , examples are the patients care plan or patients electronic medical record

If the patient and the technician do not speak the same language, communicate through a trained Medical Interpreter. A medical Interpreter is a staff member who speaks the native language of the patient. All patients legally must have access to trained interpreter who speaks their native language. There for, all facilities have a medical interpreter department where you can request a person who speaks the patients native language for translation. Avoid using family members as interpreters; they may not communicate information accurately.

There may be obstacles when communicating with Patients, it is important that you consider these barriers of communication.

If your message was not heard correctly or not understood by the patient

If the resident cannot hear due to loss of hearing

you used words that the resident does not understand

You must always assure the patient clearly understands what you are communicating with them.

Sometimes when Residents cannot cope with stress, they may becomes defensive, these are some common defense mechanisms:

Denial (“I didn’t do that”)

Projection(Telling you that you did something that they did)

Displacement (They try to focus the attention on something someone else did)

Rationalization (They try to justify why they did something)

Repression (They try to insult or belittle you)

Regression (They go to a child like behavior, Pretend they can’t hear you, put their head down, act like a child)

When you are communicating with a patient, there is two types of information that will be received.

Objective Information

Information based on what you see, hear, touch or smell (based on your senses)

Subjective information

Information that cannot be or was not observed by you; it is based on what a patient thinks or something that was reported by a patient that may or may not be true

residents who have sensory losses

residents who have memory losses

residents who have vision loss

residents who have hearing loss

residents who have problems with speaking

residents who have problems with understanding

How can a NA assist residents with hearing impairment?

Make sure hearing aid is on and working

Reduce or remove distracting noise

Get resident’s attention before speaking

Speak clearly, slowly and in good lighting

Do not shout or mouth out words in an exaggerated way

Keep hands away from face while talking

THERAPEUTIC COMMUNICATION

Maslow’s theory is that people strive to meet their unmet needs, but the most basic needs must be met before the person is free to meet the needs at the next higher level.

A Human Being has six basic needs:

Food and water

Protection and shelter

Activity

Sleep and rest

Safety

Comfort, freedom from pain

Psychosocial Needs

Are needs having to do with social interaction, emotions, intellect, & spirituality

A human being has the following psychosocial needs:

Love and affection

Acceptance by others

Security

Self-reliance and independence in daily living

Sexuality and Intimacy

People continue to have sexual needs through their lives

Humans express their sexuality through different behaviors

Knock and wait for a response before entering resident’s rooms

Provide privacy if you encounter a sexual situation.

Spiritual Needs

As an NA you can help your residents with spiritual needs:

Learn about their religion

Assist with practice (never make judgments)

Respect all religious items

Report requests to see clergy to nurse

You should never:

Try to change someone’s religion

Tell a resident his/her belief or religion is wrong

Express judgments about a religious group

Holistic Care:

a type of care that involves considering a whole system, such as a whole person.

Cultural Diversity

Cultural Diversity:

people with varied backgrounds, experience and culture who live and work together in the world

Culture plays a part in determining all of these things:

Language

religion

food preferences

degree of comfort with touch

Patients and their Families

Families play an important role in the care of residents, they are vital in these and other ways:

Making Care Decisions

Communicating with the care team

Providing support and encouragement

Connecting with the Outside world

NA’s must treat residents’ families and friends in a professional manner, be respectful and nice

allow privacy for visits

Observe and report effects of visits on residents.

Remember Protected Health Information should never be shared with family or friends.

Lifespan and Development

Patients go through many changes during their entire lifespan, as a Nurse Aide you will be required to work with patients of all ages. Here are some stages of development:

Infancy (birth to 12 months)

Grow and develop quickly

Gain coordination from head to toe

Completely dependent

The toddler Period (1 to 3 years)

Formerly dependent, now gain independence 

Develops body control and coordinated movement

Learn to speak, gains bladder and bowel control

The Preschool years (3 to 6 years)

More social interactions

Play cooperatively with other kids

learn language

Know right from wrong

School Age Children ( 6 to 12 years)

Cognitive development (thinking and learning)

Get along with others in peer group

Develop a conscience and self-esteem

Puberty and Adolescence (12 to 18 years)

Secondary sex characteristics appear

Concern for body and peer acceptance

Changing moods due to hormonal changes

Early Adulthood (18 to 40 years)

Select a career, begin experiencing self sustainability

Live with a mate or venture away from childhood home

Raise children and start a family

Middle Adulthood (40 to 65 years)

More comfortable and stable

Has become proficient as a functional member of society

Becomes family foundation

may have “mid-life crisis”

Late Adulthood (65 years and older)

Apathy

A lack of interest.

Major Depression

A type of mental illness that may cause a person to lose interest in everything he once cared about.

Bipolar Disorder

Type of mental illness that causes a person to swing from deep depression to extreme activity.

COMMUNICATION IN SPECIAL SITUATIONS

Patient Anxiety: It is common for patient to be anxious in a doctor’s office, this reaction is commonly known as the white-coat syndrome.

Angry patient: Anger may occur for many reasons. Anger may be a mask for fear about an illness or the outcome of surgery. As a EKG Technician, you will encounter angry patients and will need to help them express their anger constructively.

Patients of other cultures: our beliefs, values, use of language and views of the world are unique to us, but they are also shaped by our cultural background. In any health-care setting, you will most likely have contact with patients of diverse cultures and ethnic groups. Each culture and ethnic groups have their own acceptable behavior, traditions and values. Rather than viewing these differences as a barrier of communication, strive to understand and be tolerant of them.

Patient with visual impairment: when communicating with a Patient who has a visual impairment, be aware of what you say and how you say it. Since people with visual impairments cannot usually rely on nonverbal clues, your tone of voice, fluctuation of speech and volume take on greater importance.

Patient with a hearing impairment: hearing loss can range from mild to severe. How you communicate depends on the degree of impairment and on whether the patient has effective use of a hearing aid. Following are some tips to help you communicate effectively with a hearing-impaired patient:

Find a quiet area to talk and try to minimize background noise.

Position yourself close to and facing the patient.

Speak slowly, so the patient can follow what are you are saying.

Remember that elderly patients lose the ability to hear high-pitched sounds first. Try speaking in lower tones.

Speak in a clear, firm voice, but do not shout, especially if the patient wears a hearing aid.

To verify understanding, ask questions that will encourage the patient to repeat what you said.

Whenever possible, use written materials to reinforce verbal information.

The patient who is mentally or emotional disturbed: when working with this type of patient, you need to determine his/her level of comprehension.

COMMUNICATING WITH FAMILY AND FRIENDS OF PATIENT

Remember that you are representing yourself and the facility to others.

Maintain an open, friendly and supportive relationship with Patients’ families and friends.

Protect Patient privacy and confidentiality as required under the HIPAA Privacy Rule.

When asked, tell family and friends something about the Patient’s activities such as

“He ate a good breakfast” or “She has been very talkative this morning.”

Escort visitors to the supervisor for problems, complaints or reports on a Patient’s condition.

Here are some tips to improve communication:

It is important to remain calm if the patients become agitated or confused.

Avoid raising your voice or appearing impatient.

If you do not understand, ask the patient to repeat what he said.

Terminally patients: terminally ill patients are often under extreme stress and can be a challenge to treat.It is important that health-care professionals respect the right of terminal patients and treat them with dignity

ACCEPTING ONE’S OWN MORTALITY IS A DEVELOPMENTAL STAGE OF LIFE

How to care for dying residents

In a book called On Death and Dying Dr. Elisabeth Ross identified five stages of dying:

Denial: refusal to believe one is dying

Anger: “Why me?”

Bargaining: “Yes, me but…..”

Depression: need to mourn and review one’s life

Acceptance: preparing for death

Advanced directives

Legal documents that allow people to choose what kind of medical care they wish to have if they are unable to make those decisions themselves.

Durable power of attorney for health care

a signed, dated, and witnessed paper that appoints someone else to make the medical decisions for a person in the event he or she becomes unable to do so.

Do-not-resuscitate (DNR)

an order that tells medical professionals not to perform CPR.

All of these factors influence feelings and attitudes about death:

Experience with death

Personality type

Religious beliefs

The following are signs of approaching death:

Blurred vision that gradually fails

diminished sense of touch

decreasing blood pressure

Cheyne-Stokes

Rattling or gurgling sound as person breaths

Incontinence

Cheyne-Stokes respirations

Slow, irregular respirations or rapid, shallow respirations.

Keep these guidelines in mind as you care for dying residents:

Care for mouth and nose

Comfort

Environment

Emotional and spiritual support

Ways to treat dying people and their families with dignity:

Respect their wishes in all ways possible.

Do not isolate or avoid a resident who is dying

Listen if they want to talk

Keep the resident comfortable

Remember hearing is usually the last sense to leave the body

Postmortem Care

Remember these guidelines for postmortem care:

Rigor Mortis may make the body difficult to move

Bathe the body gently

Place drainage pads where needed

close eyes

Palliative care

Care that focuses on the comfort and dignity of the person, rather than on curing him or her

Hospice care

Special care that focuses on the dignity and comfort of a dying person.

These are the goals of hospice care:

Promote the comfort of residents

Preserve the dignity of residents