Unit 4
Attitudes that promote communication
We hear people all the time, but are we listening? Ask yourself: how you would like others to listen to you?
All successful communication requires good listening. Show the other person that you are paying attention by using proper body language. This means using eye contact and facial expressions to show interest. Stand or sit at the same level of the other person and avoid crossing your arms while they speak.
Let the other person talk without interruption. Notice their tone of voice; it can add meaning to their words. Give them your full attention. Don’t try to form your own response or you may miss an important verbal or non-verbal cue.
Everyone appreciates the chance to express themselves. We can all tell when the other person is truly listening and making a sincere effort to understand us, with respect and empathy. Remember the words of successful businessman and millionaire, Malcom Forbes: “The art of conversation lies in listening.”
Courtesy and respect:
Say "Please" and "Thank you"
Use the resident's preferred name
Knock prior to entering the resident's room
Keep emotions under control
Show empathy-put yourself in the other person's shoes to better understand how they may be thinking or how they feel.
Actions and Responses that Promote Effective Communication Between CNA and Residents:
Always identify yourself with name and job title, explain what care you are going to give. Provide opportunities for the resident to express thoughts, opinions, and feelings. When a resident is speaking listen attentively to the resident's comments. You should allow enough time for communication and observe for cues to understand the resident's responses.
As they always say "Actions speak louder than words!" Observe the resident's nonverbal behavior during interaction, such as:
Body position or posture
Facial expression
Body activity, such as restlessness or turning away
Physical distant
Touch
It can convey a variety of messages (caring, calming, control)
Being touched can elicit a variety of responses (calming, alarm, fear)
Listen carefully to expressed thoughts and feelings, and tone of voice. Look at the person speaking and make eye contact. Express acceptance of residents and their thoughts. Repeat back what the resident has said to summarize and validate.
Focus on concerns of the resident and understand the resident's personal history, past behaviors and patterns. Don't talk about your own personal situation or personal problems. Don't criticize other staff, residents, or the facility. Remember you are part of a team!
Be aware of barriers to effective listening and communication of residents, such as:
Environmental distractions
Hearing impairment or visual impairment
Difficulty processing information
Difficulty expressing speech (aphasia, dysphasia)
Inability to understand language used for communication.
Be aware of barriers to effective listening and communication that the CNA may experience, such as:
Environmental distractions
Not concentrating on what the resident is saying, i.e. thinking about unrelated matters
Not understanding differences in culture, ethnic, lifestyle, or religious expression
Inability to understand language used for communication
Remember that you must use the same general concepts of good communication with the resident's family and friends. Family may need suggestions about how to "visit" with the resident. Provide information on providing care for the resident. If they voice concern about the resident inform the nurse of this concern. Behavior or communication between resident, family, and staff may reflect distress from the changes in the resident's situations.
Examples:
Family may express guilt or grief at placing the resident in the facility
Resident may express anger or sadness from placement in the facility or from functional changes due to illness
Resident and family may not understand the resident's health problems or facility expectations
Resident or family may be concerned by matters outside the facility, such as finances
The CNA should avoid involvement in family arguments or decision-making.
Identify and use actions and responses that promote effective Communication between CNA and other staff members. Use the same general concepts of good communication as above. You are responsible to make sure that he/she understands direction and assignments that have been made. If you have not been trained to do an assigned task, then it is your responsibility to say so.
Information to report to the nurse:
Situations that could result in harm to a resident
Any change in resident's physical condition
Personal information about the CNA that could interfere with his/her performance
Resident care that the CNA is unable to provide or complete
All complaints from residents and visitors
Answering the Resident's call signal or pager notification
The call light system is one of the major communication technologies that link nursing home staff to the needs of residents. By providing residents the ability to request assistance, the system becomes an indispensable resource for patient-focused health care.
You should answer as soon as call signal or pager is activated. Turn off call signal when you enter resident's room. A page should remain in "active" mode not turned off. When resident's request has been met, replace the call signal device where the resident can reach it.
Before leaving the resident check for other needs. Such as:
Resident comfort
Repositioning
Offering a drink
Use of Telephone, Cell Phone or Intercom:
Identify speaker's location
Identify speaker's name and job title
Speak slowly and clearly
When taking a message, write it downs, verify information before hanging up
Remember confidentiality when using facility phones
Communicating with Resident who has a vision or hearing impairment
You should approach a resident with vision/hearing impairment from within their field of vision, usually from the front. Sit or stand at the same level as the resident. With a resident who has a hearing impairment, speak slowly and clearly using a low-pitched voice. Use nonverbal communication to provide clues. If a resident has glasses, check to see that they are clean, properly placed, and they fit. If a resident has hearing aid, check for functioning batteries and presence of ear wax. Glasses and hearing aids should be stored, so that they are not damaged or lost. Make sure before sending resident's clothing to laundry to check pockets for glasses or hearing aids.
Communication with a Resident who has a Cognitive Impairment or confusion
There are many challenges you will face when working as a certified nursing assistant (CNA), and one of the most difficult is working with residents who are cognitively impaired. The word cognitively is derived from the word cognition, and the word cognition means of or relating to, conscious thinking. Cognitive impairment is defined as the inability to perform complex intellectual tasks.
Typical behaviors for long-term confusion:
Loss of the ability to care for self
Unable to recognize familiar persons or surroundings
Memory loss, particularly for recent experiences
Impaired judgement
Beginning approaches for communicating with a resident who is confused
Approach the resident from within his/her field of vision
Speak and act in a calm, friendly manner. Avoid sudden or loud actions.
Use short, simple words and sentences. Offer simple choices.
If the resident does not understand a spoken request, try to demonstrate the request.
Follow a consistent routine.
If the resident is unwilling to participate in care or in an activity, do not force him/her to participate. Arguing with a confused resident is ineffective communication and does not show respect.
The #1 cardinal rule for communicating with a person living with dementia is never argue. It is better to back off and approach later.
WHAT ARE THE CAUSES OF COGNITIVE IMPAIRMENT?
There are many, many diseases and medical conditions that can result in cognitive impairment: the list of possible causes is very long. However, the common theme is that there has been some damage or compromise, either permanent or temporary, to the parts
of the brain that control the higher intellectual functions. Although there are many, many possible causes of cognitive impairment, the majority of cases of cognitive impairment are due to a few, relatively common issues.
Permanent Causes of Cognitive Impairment:
Alzheimer’s disease
Brain tumor
Cerebrovascular accident (CVA): Commonly called a stroke. A stroke is caused by bleeding in the brain or by a clot that lodges in a blood vessel in the brain. In either case, there can be permanent damage to the
brain.Chronic drug abuse, e.g., chronic use of alcohol, amphetamine, or other illicit
substances.Traumatic brain injury
Temporary Causes of Cognitive Impairment:
Dehydration
Fever
Infections- particularly UTI (bladder infections)
Intoxication with alcohol or drugs
Hypoglycemia (a.k.a. low blood sugar)
Hypotension
Hypoxia (Low oxygen content in the blood)
Infections
Medication side effects
Transient ischemic attack: A transient ischemic attack (TIA) is similar to a stroke
but the damage is not permanent.Withdrawal from alcohol or drugs
The permanent causes of cognitive impairment listed above cause death to the brain cells by several different mechanisms. They completely block blood flow to the brain; there is traumatic damage to the brain; or they cause damage to the brain by interfering with normal metabolism of the brain.
Many of the temporary causes of cognitive impairment disrupt the higher intellectual abilities because they interfere with the metabolism of the brain. The brain needs oxygen and food - the food being glucose, or blood sugar - to operate, and the brain and the central nervous system are extremely sensitive to a lack of oxygen or glucose. Without adequate supplies of these nutrients, some level of cognitive impairment will be seen. Elderly people are especially at risk because they may have frail health and pre-existing medical conditions and without glucose and oxygen cognitive abilities will suffer.