Module 3 Communication & Interpersonal Skills. Maslows Hierarchy of Needs Levels build upon each other Lowest level- Physiological Second level – Security.

Module 3

Communication & Interpersonal Skills

Maslow’s Hierarchy of Needs

Levels build upon each other Lowest level- Physiological Second level – Security Third level – Belonging Fourth level – Esteem Fifth level – Self Actualization

Recognize/Report Behaviors Reflecting Unmet Human Needs Physical Needs unmet:

– Irritable, cold, weak, c/o hunger or cold– Changes in VS & LOC

Psychological Needs unmet:– Anxious, depressed, aggressive, angry– Physical ailment with no apparent cause– Expresses feelings of loneliness & worthlessness

Unmet needs may result from illness, disease,or injury, but may also contribute to development of illness

CNA Response to Behavior

Look beyond the behavior – rude, uncooperative, demanding

Remember there is an underlying need for comfort & understanding

Respond with patience, caring, sympathy, concern, kindness, empathy

If problem continues, ask licensed nurse

Communication

Definition – sharing of ideas, thoughts, information, & feelings with at least one person, even if unspoken

Therapeutic communication – used to promote optimal wellness

Routes– Internal senses – see, hear, touch– External senses – spoken, written, gesture

Steps in Communication

Message Sender Receiver Interpretation What happens when you play the

telephone game?

Methods of Communication

Verbal – the spoken word Nonverbal – most honest

– Conscious vs. unconscious– Body language– Touch– Written – red dots, name tags, uniforms, falling

stars– Electronic – devices to create sound, computers,

touch pads

Reasons for Communication Breakdown Verbal barriers –

– Criticism– Value statements– Interruptions– Judgment– Language differences– Changing subjects– Excessive talking– Pat answers – “Don’t worry, I know how you feel”

Communication Breakdown

Non-verbal– Body language– Eye contact– Cultural differences

Communication Breakdown

Physiological/aging factors– Hearing loss– Vision loss– Response time– Medications

Communication Breakdown

Not listening– Lack of concentration – preoccupied,

distracting noises, monotone voice, negative attitude

Selective hearing Emotional response to word/situation

Effective Communication Skills

Introduce self Call person by formal name or request Explain all tasks Use short sentences, ask for feedback Eye contact Speak clearly, avoid criticizing Clarify information Use words that are understood Friendly/positive tone Ensure confidentiality

Effective Communication for Special Needs Language/cultural differences

– Ask for INTERPRETER– Know cultural beliefs – word use, gestures, touching

Visually impaired– Describe surrounding– Identify self, don’t touch until they’re aware– Explore room with resident, don’t rearrange– Explain, let resident know when finished– Keep doors open, don’t speak loudly– Monitor meals

Effective Communication for Hearing Impaired Gain attention of resident, may use touch Determine which ear has loss Check for hearing aid function Determine % or loss & high/low tone loss Face resident – don’t chew gum, eliminate

background noise, stand on side of better ear Speak slowly, directly, clearly, NOT LOUDLY Short sentences, simple words, repeat if need Watch nonverbal cues, ask to repeat info

Effective Communication for Aphasia (physically impaired) Provide writing materials if speech

difficulty Let use own words, give time to speak Use picture or point boards

Conflict IS

Occurs when what a person has & what a person wants are different

A pattern of energy Nature’s primary motivation for change

Conflict IS NOT

Always negative Always a contest Always a sign of poor management Able to take care of itself if left alone Always resolvable

Conflict Handling Modes

Competing– Assertive & uncooperative– Power-oriented– Useful for:

• Standing up for rights• Defending an important position• Trying to win

Conflict Handling Modes

Accommodating– Unassertive & cooperative– Involves self-sacrifice– Useful for:

• Charitable causes/ generosity• Obeying orders• Yielding to another point of view

Conflict Handling Modes

Avoiding– Unassertive & uncooperative– Does not address the conflict– Useful for:

• Diplomatic side-stepping• Avoiding until a better time• Withdrawing from a threatening situation

Conflict Handling Modes

Collaborating– Assertive & cooperative – seeks to satisfy

both sides– Useful for:

• Gaining additional insights• Avoiding negative competition for resources• Solving interpersonal problems

Conflict Handling Modes

Compromising– Somewhat assertive & cooperative– Solutions mutually satisfying – acceptable

to all– Middle ground mode– Useful for:

• Splitting the difference• Making concessions• Finding a quick middle ground position

Areas of Concern for Conflict

Attendance & Punctuality Safety – Personal & Resident Professional Behavior Attitude Appearance & Hygiene Performance

Lines of Authority

Communication with employee: Inquiry & Advocacy– Bracket – create an open mind so people can

listen to another point of view– Paraphrase – validate & confirm what they heard– Check perceptions – Reads between the lines,

helps to understand/empathize– Ask probing questions – get more information &

deepen understanding

Lines of Authority

Communication with first line supervisor: objective reporting

Timely reporting: when & where Plan for remediation

– Clarification of concerns– Goals setting for behavior changes– Expectations & Time frame for remediation– Follow-up

Line of Authority

Confidentiality Constructive Feedback

– Info given to & received by an individual about their performance

– Goal is to improve performance– Vehicle to promote constructive relationships– Monitors how things are going– Creates a way to review ongoing issues– Keeps lines of communication open

4 E’s of Constructive Feedback Engage – set the stage

– Preparation & link feedback to common goals– State what you want to discuss

Empathize– Environment & Timing

Educate– Describe observations & impact of behavior– Remain objective

Enlist– Elicit person’s response & guide towards sol’n

Touch as Communication

Cultural beliefs regarding touch– Modesty – covering face, arms, head– Touch of body after death– Hugging

Body Language– Hands, eyes– Gestures– Posture– Regression

Personal Space

Basic Defense Mechanisms

Regression – reverting to childish behavior (thumb sucking)

Rationalization – unconscious, developing socially acceptable reasons to explain behavior (can’t give up smoking because you might gain wt)

Projection – unconscious, places own intolerable feelings onto others (Cheater accuses others of cheating)

Basic Defense Mechanisms (cont) Displacement – substituting one innocent

person for another (mad at your mom so you hit your brother)

Denial – can’t believe that it is true (my children would never do that)

Conversion – substituting acceptable physical symptoms for unacceptable emotions (feel sick when it is time to take the test)

Basic Defense Mechanisms (cont) Repression – pushes thoughts & ideas

into the subconscious where they do not recall them (has fond memories of an abusive mother)

Sublimation – unacceptable emotions are expressed in socially acceptable way (exercises when angry)

Basic Defense Mechanisms (cont) Substitution – replacing an unattainable

goal with an acceptable one (can’t sing on tune so plays the guitar)

Identification – patterning self after another, hero-worship (I want to be just like Mrs. McGrory)

Family Communication

Family structures differ – single parent, two parents, primary caregiver, extended family, & appointed guardian, conservator, or responsible party

Show respect for all family structures– Listen, courteous, respectful, supportive– Avoid involvement in family matters – give privacy– Maintain confidentiality– Allow family to help with care

Family Communication

Family needs info– Telephone & visiting hours– Location of refreshments & business office– Gift shop & public restrooms– Orient to resident activity & appointment

areas– Use family as resource to gather info about

preferences

Socio-cultural Factors

Culture – characteristics of a group of persons (attitudes, beliefs, religion, values, likes, & dislikes)– Influences reaction of residents to health

care like food preference, family practices, hygiene habits, & clothing styles

– Rituals – beliefs, ceremonies– Beliefs about health care

Emotional reactions to illness

Stress as a result of illness– Individual differences

• Heredity, experiences, environment

Physical loss or disability– Many losses

• Spouse, family, friends• Homes, control of life, disease, meals, driving• Function & independence

Emotional response to illness Emotional reactions

– Anger, grief, dependency– Suspicion, loneliness, guilt– Uselessness, feelings of damage– Depression, helpless– Anxiety, frustration, fear

To help:– Observe for signs of stress & listen– Patience & understanding, promptly meet needs– Focus on abilities– Treat with dignity, be non-judgmental

Communication Patterns

Organizational chart of nursing unit– Methods of communication

• Verbal vs. nonverbal• Written – chart, Kardex/care plan, report sheets, ADLs.

What do you do when resident asks to see the chart?• Electronic – computer, fax, telephone, intercom

Legal aspects– Must document what is reported verbally to nurse– Must document statements from family or resident– Subjective vs. objective data

Effective Communication

Identify self Verbal reports – brief, organized

– Appropriate – diagnosis, changes, allergies, activity, elimination, special needs, diet, VS, code status

– Timing – when to report changes– Place & location

Effective Communication

Take notes when on telephone– Name of person the message is for– Correct spelling of caller’s name– Time called– Clarify message by repeating it &

telephone number to caller– Sign your name & title to the message

Answering call lights

Go to resident at once, quietly, and friendly manner

If on intercom, call resident by name, I.d. yourself, politely inquire to need

Make sure call light is ALWAYS within reach