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
After the completion of the
lecture/discussion, the student will:

1. Define communication

2. List and define the elements
of communication

3. List 5, good verbal
communication and non-
verbal communication skills

4. List ways to communicate
with clients who have visual
and hearing impairments

5. List the essential
components of answering
the phone correctly
1. Communication is the sharing of information.
The message a NA has to deliver may be affected by the
manner in which she/he stands, moves, and speaks.
When a NA communicates, she/he is not only conveying
words but also attitudes and feelings about her/himself
and the client.

2. Elements of effective communication:
Sender-the person who wants to communicate
information
Message-the information the person needs to send
Channel-method of sending information
a. Verbal spoken or written words
b. Non-verbal facial expressions, posture, hand/body
movements, and appearance
Receiver person to whom the message is sent
Conformation the way the receiver lets the sender
know that the message has been received

3. Verbal communication skills:
Get the receivers attention before you send a message
Use words the receiver understands
Choose the correct volume
Speak slowly and clearly
Be aware of tone of voice
Avoid swearing and slang
Avoid cultural or double meanings
Listen to the receiver without interrupting
Always ask questions and encourage the client to
respond



Handouts:
- Tips for Communicating with
Families
- Communicating with the Client
with Aphasia, Hearing
Impairment and Vision
Impairment

Role Play: Break the class into
senders and receivers. Give each
sender a written message to deliver.
Once they feel they have delivered
the message as effectively as
possible, have the receivers verbally
recite the message received.
Scenarios:
1. Angry family member- I do
my mothers wash. This is the
last time I am going to warn
you. Do not send her clothes to
the in-house laundry. You have
ruined my mothers clothes for
the last time.
2. Upset client-They gave me a
shower last night. I fell in the
shower room and my leg really
hurts. I dont think I should
stand on it. Can you help me?
(Client is smiling the entire
time she is relating her story.)




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 arms
tightly across chest, turning head away from speaker,
rolling eyes, and tapping your foot)

4. Communicating with clients who have communication
problems may be challenging at times.
Visually impaired clients 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 range
and call him/her by name
c. Arrange and manage the clients environment each
day/each shift
d. Use communication (verbal & nonverbal) to help the
client with visual impairment
e. Keep the clients glasses clean when on and in a safe
place when off






Suggestion: Use the phrase, See
something, say something to
summarize the importance of abuse
identification and reporting.



Handout:
Identify the facial expressions then
discuss the importance of non-
verbal communication when
describing behavior and labeling
behavior.
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
Hearing impaired:
a. Keep hearing aides clean and in a safe place when
not in use
b. 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 and
providing care
d. Always approach the client from the front, facing the
client directly, eye-to-eye
e. Reduce background noise as much as possible
f. 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 aides
responsibility. 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 to
give 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

SUPPLEMENTAL MATERIAL: HANDOUTS
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 other
person.
The more you concentrate on what is really going on with the other person, the more
effective you will be as a listener.


From Cornell Universitys Nursing Home-Family Matters Project, 1993
1.2.1

SUPPLEMENTAL MATERIAL: HANDOUTS
Communicating with the Client with Aphasia

1. Face the client and make eye contact before speaking
2. Say the clients name before asking questions
3. Speak slowly and clearly; using short, complete sentences
4. Pause between sentences
5. Determine whether the client understands what you said before continuing
6. Use nonverbal cures or communication aids whenever possible
7. 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 understands
9. 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 your
mouth clearly
4. Eliminate outside distractions and noise from the radio television, or other sources
5. 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 short
8. 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 called
4. Encourage the use of eyeglasses and help the client as needed-keep the glasses clean
5. 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 client
7. Guide the client as needed
8. Provide adequate light in the room
9. Encourage the client to listen to radio or television to keep up with current events
10. Be sure to inform the client when leaving the room



1.2.1

Facial Expression the Demonstrate Affect
Identify the Emotion Being Expressed
Facial Expressions SUPPLEMENTAL MATERIAL: HANDOUTS
1.2.1



1.


2.

3.













4.


5. 6.






7.

8.

9.



Facial Expression the Demonstrate Affect
Identify the Emotion Being Expressed
Facial Expressions SUPPLEMENTAL MATERIAL: HANDOUTS
1.2.1






10.


11. 12.











13.


14. 15.










16.


17. 18.



Facial Expression the Demonstrate Affect
Identify the Emotion Being Expressed
Facial Expressions SUPPLEMENTAL MATERIAL: HANDOUTS
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, laughter

2. Angry, frustrated, aggressive

3. Suspicious, disapproving, doubtful

4. Surprised, scared, horrified

5. Very sad, painful, grieving, hurt

6. Bored, not interested or dont care

7. Horrified, shocked, worried, afraid

8. Doubtful, distrusting, suspicious

9. Angry, enraged, disgusted

10. Exuberant, ecstatic, delighted

11. Flirty, Secretive, skeptical

12. Peaceful, calm, de-stressing

13. In a hurry, time conscious

14. Feeling ill or down, blue, apathetic

15. Disapproving, negative

16. Overwhelmed, perplexed, swamped

17. Sad, lonely, unhappy

18. Happy, cheerful, confident, positive interest

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: 1.2.2 Observes by using the senses of sight, hearing, touch and smell to report client behavior to the licensed professional/practitioner/supervisor.
Competencies Course Content Learning Activities
After the completion of the
lecture/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 must
be reported immediately

1. Use your senses to make observations:
Sight - what you see
a. The clients skin looks pale
b. Open areas on a clients skin
c. Sores in a clients mouth
d. The clients hand shakes or the client is too weak to
hold the glass
e. The client limps or cannot stand alone
f. The clients urine, stool, or sputum has an unusual
color
g. The clients emesis (vomit) has an unusual color
h. The client is not eating or having trouble eating
i. The client squints or bumps into things and people
j. The clients usual facial expression has changed
k. The client sleeps a lot or does not make facial contact
l. The clients breathing is different, labored or slow, or
the client gasps for breadth
m. A part of the clients body looks different or
abnormal to you
n. There is blood or leakage coming from some part of
the clients body or medical device, such as a drain
or intravenous (IV)
Sound - what you hear.
a. The client is coughing
b. The client is making a noise when breathing
c. The client is complaining of a change in his/her
condition (e.g. pain, numbness, swelling)
d. The client is crying
e. No response from the client when you speak to them
f. The client does not speak as clearly as they normally
do



Role play: a series of scenarios in
which students act as both clients
and NAs.

Client roles: The clients present a
series of status changes including:
Pressure ulcer changing
from stage 1 to 2
Client experiencing pain
during ROM
Client with new sense of
being lost and not knowing
what day it is
During catheter care a
student notices blood in the
catheter tubing

Student roles: Have the students
acting as NAs report what they
observe.

Have the entire group discuss the
results.










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: 1.2.2 Observes by using the senses of sight, hearing, touch and smell to report client behavior to the licensed professional/practitioner/supervisor.
Competencies Course Content Learning Activities
Smell - what you smell
a. The clients breath has an unusual odor
b. The clients emesis (vomit) has an unusual odor
c. An unusual odor in the clients urine or stool
d. That the clients dressing or wound has an unusual
odor
Touch - what you feel
a. The clients pulse is strong
b. The clients pulse is weak
c. The clients skin is warm, cool, or moist
d. A lump under the clients skin

2. Observations of a change in the client from their normal
status 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 food
jars to represent possible conditions,
such as;
- musty, soiled rag for an
infected wound
- applesauce and honey for a
fruity breath as in
hyperglycemia
- diluted ammonia for a UTI



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: 1.2.3 Documents observations using appropriate terms that are specific to the work environment.
Competency Course Content Learning Activities
After the completion of the
lecture/discussion, the student will:

1. Define the nurse aides legal
responsibility regarding
documentation
1. The nurse aide needs to be alert to problems or changes in
each clients physical or emotional condition. He/she is
legally 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 unsure
b. Research any unfamiliar terms and abbreviations
Components of both written and verbal forms of
communication used in sharing information on the health
care team include:
a. Timeliness
b. Legal responsibility
c. Completeness
d. Accuracy

2. Actual language of medicine:
Three components of words: prefix, root, suffix
Abbreviations - simple short hand forms of frequently
used words and terms

3. Review the list of commonly used abbreviations and medical
terms-refer to text book glossary and handout
Facilitate an exercise in which
students share information using
medical terms and abbreviations
(e.g., ADL, ROM, cyanosis,
dyspnea, apnea, dysphagia).

Portray client scenarios - what
would they document and when?
Completion of ADLs
following care plan
Client experiencing pain
during ROM
Client awaking with
difficulty breathing
Client with a choking
episode at breakfast

Handouts:
List of Medical Abbreviations
Forming words





SUPPLEMENTAL MATERIALS: HANDOUT
1.2.3


Example of Facility Approved Medical Abbreviations

1. ABD abdomen
2. AC before meals
3. Ad Lib as desired
4. ADM admission or admitted
5. A.M. or am morning
6. BID, bid twice a day
7. B.M., bm bowel movement
8. B.P. or BP blood pressure
9. BRP bathroom privileges
10. c with
11. Ca cancer
12. Cath catheter
13. CBC complete blood count
14. Cc cubic centimeter
15. c/o complained of
16. CVA cerebral vascular accident
17. CPR cardiopulmonary resuscitation
18. Disch or D/C discharge
19. drsg dressing
20. DR doctor
21. Dx diagnosis
22. EKG electrocardiogram
23. ED, ER emergency department, emergency room
24. EEG electroencephalogram
25. FBS fasting blood sugar
26. FF force fluids
27. hs hour of sleep
28. ht height
29. ICU intensive care unit
30. LPN licensed practical nurse
31. med medicine
32. NA nursing assistant, nurse aide
33. OOB out of bed
34. pc after meals
35. q every
36. ROM range of motion
37. SOB shortness of breath
38. TLC tender loving care
39. WBC white blood count
40. wt weigh
41.



FORMING WORDS


SUPPLEMENTAL MATERIALS: HANDOUT
1.2.3

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 into
action or service)
-er (a person or
thing that)
abuser a person who uses or
treats someone or
something in a way that is
different from the
acceptable way
Example: 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 be
Example: 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 or
cutting open
Example: When you study anatomy, you learn about the separate parts of the body.

physio- (of the
body)
-ology (a science
or knowledge of)
physiology science of the normal
function of a living body
or its parts
Example: We must know about the kidneys, heart, lungs, and blood vessels to understand blood
physiology.

Forming Medical Words
Prefix Root Suffix Word Meaning
cardio -ology cardiology science of heart function and disease
cardio -ologist cardiologist specialist who studies and treats heart disease
cardio -vascular cardiovascular having to do with the heart and blood vessels
cardio -pulmonary cardiopulmonary having to do with the heart and lung
myo- cardium myocardium heart muscle

Copied with permission: StayWell. The American Red Cross Nurse Assistant Training, 2
nd
ed. 2008. StayWell.
Yardley, PA.
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: 1.2.4 Explains the importance of reporting observations and measurements to the licensed professional/practitioner/supervisor.
Competencies Course Content Learning Activities
After the completion of the
lecture/discussion, the student will:

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 between
members 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 be
observed but is based on something that the client
reported (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. Mood
ii. Alertness
iii. Awareness
iv. Level of independence
v. Skin
vi. Appetite
vii. 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 pain
b. Routinely upon completion of care
Why it is important to report:
a. Ensures client safety
b. Satisfies client needs
Present client scenarios and discuss
actions to be taken by the nurse
aide:
Client with sudden, chest
pain
Client with a reddened, skin
area over the left hip the
size of a quarter
Client is suddenly confused
and does not know where
they are or who you are

Have the students document what
they would have observed based on
what you said.
Who would they report to and
when?
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: 1.2.5 Explains the importance of maintaining the clients record.
Competencies Course Content Learning Activities
After the completion of the
lecture/discussion, the student will:

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 of
written communication used by the health care members to
document all elements of the clients medical condition and
progress.

2. Key elements:
Importance of Accurate Charting:
a. Legal document
b. Confidential
c. Not charted = not done
Key points of proper documentation:
a. Remember it is a legal document
b. Make objective observations/measurements
c. Use black/blue ink
Actual charting purpose:
a. Communicating to team members
b. Documenting delivery of care
c. Providing evidence that care was actually provided
d. Providing evidence that care has been provided
(regulatory agency).
e. Documenting for insurance purposes and
reimbursement
f. NAs are responsible for making charting part of their
daily routine and making sure tasks are completed
and recorded
Basic Rules:
a. Be precise and exact
b. Do not skip over lines
c. Use only approved abbreviations, simple direct
terminology
d. Never erase or write over a notation
e. Chart after all procedures are completed
f. Always record the date, (military) time, and
signature















Handout:
Review Charting Guidelines


















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: 1.2.5 Explains the importance of maintaining the clients record.
Competencies Course Content Learning Activities
3. The clients record is a permanent, legal document that
includes 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 of
information 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 to
document this care on the Generic
ADL Flow Sheet.



SUPPLEMENTAL MATERIAL: HANDOUT


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 single
line 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).

15. Follow facility policy concerning computerized documentation (such as Care Tracker
Kiosk)






SUPPLEMENTAL MATERIAL: HANDOUT


Generic ADL Flow Sheet


Section # _________
Date: _____________
Floor #____________


ROOM # CLIENT
B
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e
a
k
f
a
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t

%

B
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L
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c
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%

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P
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B
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t
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D
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s




















KEY: 1 = Self 2 = Assist 3 = Total 4 = Refused

Safety Device Key Bath Key
Activity Key BM Key
Bd = 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 = Personal
Alarm
SR = Side rails PB = Partial Bath Amb. = Ambulatory
S = Small
M = Medium
L = Large

Any additional
information will be
placed on the back
of this sheet

CBR = Complete Bedrest


1.2.5
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: 1.2.6 Demonstrates effective, communication skills with supervisor/manager/charge nurse, staff and other disciplines.
Competencies Course Content Learning Activities
After the completion of the
lecture/discussion, the student will:

1. Define how the nurse aide is
a vital link in the
communication chain

2. List the skills needed to
effectively communicate
within the health care team

3. Define what is meant by
chain of command and
why it is an important tool
for the nurse aide
1. The nurse aide serves as the communication link between the
health care team and clients.
Effective communication within the nursing team and
with other health care members is essential.
The nurse aide must:
a. Understand tasks delegated; ask for clarification
when unclear
b. Realize that he/she functions as the eyes and ears
of the nurse, physical therapist, dietician, social
worker, etc.
c. Gather information.
d. Share observations of clients status (i.e., ADL
ability)
e. Alert health care members to changes in client that
influence care needed

2. Reinforce communication techniques emphasizing:
Receivers are good listeners.
Senders make sure message is clear.
Utilization of feedback to assure or clarify message.
Mindfulness of body language and tone of voice.
The ability to read, write and speak English at the level
necessary for performing NA duties.
Listening and responding to verbal and non-verbal
communication in an appropriate manner.
The use of accepted, health care terminology to record
and report observations, action, and information
accurately and in a timely manner.





Handout:
- Five Elements of Effective
Communication
- Guidelines for Effective,
Verbal Communication with
Co-Workers, Manager, and
Supervisors
- Factors that Affect Non-
Verbal Communication

Demonstration: Ask volunteers to
demonstrate a feeling (i.e. sadness,
pain, joy) by using non-verbal
communication. Other students try
to name the feeling and the clues
that were demonstrated.

Scenarios for discussion:
1. The client is on a restorative,
ambulation program and the
Physical Therapist asks the
nurse aide about the clients
progress. The client walked this
morning 100 feet with minimal
contact guard and no
breathlessness.

2. The client does not like the
meal provided and will not eat.
What should the nurse aide do?




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: 1.2.6 Demonstrates effective, communication skills with supervisor/manager/charge nurse, staff and other disciplines.
Competencies Course Content Learning Activities
3. Chain of Command:
Describes the line of authority and communication in
health care
If a nurse aide has a problem within the nursing
department, 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 with
another department, that nurse aide will communicate
with her/his charge nurse first
By utilizing the chain of command, the nurse aide can
help facilitate communication and solve problems.

Handout - Case Study:
Charge nurse chooses not to assist
nurse aide with a clients care.



SUPPLEMENTAL MATERIAL: HANDOUT






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 received
the message

---------------------------------------------------------

Effective Verbal Communication has 2 parts:

1. What you say
2. How you say it

----------------------------------------------------------

Guidelines for Effective, Verbal Communication with co-workers, managers, and supervisors

1. Get the Receivers attention before you start talking
2. Use words that the Receiver understands
3. Choose the right volume
4. Speak slowly and clearly
5. Be aware of your tine of voice
6. Listen to the Receiver

----------------------------------------------------------

Factors that Affect Non-Verbal Communication

1. Personal appearance
2. Facial expressions
3. Touch
4. Body position and movement


Copied with permission: The American Red Cross. Nurse Assistant Training, 2
nd
ed. 2008. StayWell.
Yardley, PA.
1.2.6

SUPPLEMENTAL MATERIAL: HANDOUT










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.
















Source Unknown: Submitted by a PA Nurse Aide Training Program, 2011


1.2.6



Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.

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 passive
behavior and how it is communicated.
Assertive behavior:
a. Speaking up
b. Asking for what you want and need to know
c. Saying no to things you do not want or should not
do
d. Behaving confidently
e. Being direct yet considerate of others
Aggressive behavior (often confused for assertiveness):
a. Being pushy
b. Being stubborn
c. Not sharing
d. Always pushing to have your way
e. Being manipulative
f. Making threats
Passive behavior (opposite of assertive):
a. Going along with others
b. Not speaking up
c. Accepting situations even when they are
uncomfortable
d. 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 Assertiveness
Effectively


Role play using assertive,
aggressive, and passive
communication styles.

SUPPLEMENTAL MATERIAL: HANDOUT



Group Discussion

Guide students in sharing perspectives of Assertive, Aggressive and Passive behaviors. Ask student to
share examples of anecdotes from their experiences. For example;

Examples of Assertive behavior 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 or
excuses. Walk away)

__ Behaving confidently (body language)

__ Being direct while being considerate of others (being assertive is different is different from being
aggressive)


Examples of Aggressive behavior are:

__ Being pushy

__ Never giving in

__ Being loud

__ Not sharing

__ Always having to have your way

__ Being manipulative

__ Making threats


Examples of Passive behavior are:

__ Going along with others

__ Not speaking up

__ Accepting situations even when they are uncomfortable

__ Doing what you need to do to get what you want without making anyone angry or hurt


Copied with permission from; The American Red Cross. Nurse Assistant Training, 2
nd
ed. 2008. StayWell. Yardley,
PA.
1.2.7

SUPPLEMENTAL MATERIAL: HANDOUT




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 upset
2. I say no to things I shouldnt do without feeling guilty
3. I tell people when Im angry
4. 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.
Ask a few students to share their scores.
Display the Assertiveness Scale and discuss survey results. Explain that most people score below 5.
Discuss factors that affect assertiveness such as:
a. Sometimes it is harder for women or for members of some cultural groups to be assertive.
b. Some cultures teach children not to ask for what they want.
c. Some cultures teach women to do what they are told whether they want to or not.

Copied with permission from; The American Red Cross. Nurse Assistant Training, 2
nd
ed. 2008. StayWell. Yardley,
PA.
1.2.7

SUPPLEMENTAL MATERIAL: HANDOUT




Using Assertiveness Effectively

Read the situations and go through the list of responses.


Situation Assertive Action Ineffective Action
A person says no to your
request.
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 and
explain why it is important.
Repeat what you said and
demand to know why your
request 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 the
person says; then say no
politely.
Yell, Didnt you hear me? I
said no!
The person asks again.
Ask the person to stop
pressuring you.
Ask, Are you deaf?
The person asks again.
Excuse yourself and walk away
from the situation.
Tell the person to leave you
alone.
The person asks why you dont
like him or her.
You say you are rejecting her
request, not her.
You say its because she annoys
you.


Copied with permission from; The American Red Cross. Nurse Assistant Training, 2
nd
ed. 2008.
StayWell. Yardley, PA.
1.2.7

SUPPLEMENTAL MATERIAL: HANDOUT


Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.

Objective: 1.2.8 Demonstrates speaking, listening, writing, and social skills that supports participation as an effective, team member.
Competencies Course Content Learning Activities
After the completion of the
lecture/discussion, the student will:

1. List 2 reasons why
communication 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 one
another 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 a
monotone voice. For example:
Take out a piece of paper and write
the 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 to
effective communication.

Repeat the direction using proper
inflections 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.

SUPPLEMENTAL MATERIAL: HANDOUT


Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.

Objective: 1.2.9 Demonstrates actions for asking appropriate questions to clarify meaning, understand outcomes or solve problems.
Competencies Course Content Learning Activities
After the completion of the
lecture/discussion, the student will:

1. Define why clear
communication 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 of
communication, it is important that a nurse aide clearly
understand the message. Never assume-when in doubt, ask
questions.
Questions are used to clarify communication and reach
mutual understanding.

2. There are two types of questions:
Close-ended question will result in a yes/no answer. It
does not provide a great deal of information. It will often
begin with words such as are, can, do, did,
have, when, where, and why.
Open-ended question require an answer beyond
yes/no. It will provide more information. It often begins
with words such as how, what, show me,
describe, and suppose.
Small, group discussion.

Dividing the class into groups. Each
group should have a volunteer to
serve 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 the
script, have initial, limited
information in bold print.

Direct the remaining students to
question the volunteer to gain
clarity and decipher the full script.

Have one group use only close-
ended questions-compare results


SUPPLEMENTAL MATERIAL: HANDOUT


1.2.9
Scripts for Group Discussion

Scenario #1 A client with a problem
Mrs. Allens call light has just gone on. Mrs. Allen has expressive aphasia. As you enter the
room 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 directive
The 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 aides
available 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 problem
Rita, 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 clients
are 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.

SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
SUPPLEMENTAL MATERIAL: HANDOUT


Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.

Objective: 1.2.10 Explains the concept of diversity and why it is important.
Competencies Course Content Learning Activities
After the completion of the
lecture/discussion, the student will:

1. Define diversity

2. List what can be achieved
when 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 therefore
respect, diversity in the
health care setting
1. Diversity has to deal with the different groups of people
with varied backgrounds and experiences living in the
community.
Diversity has enriched the country, yet problems can
arise 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 nurse
aide will:
Be able to portray positive responses to diversity
including accepting and knowledge
Be aware of and eliminate bias and prejudice
Focus on compassionate, respectful, and culturally
sensitive 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 to
write a definition of diversity and
then proceed to discussion this
term.

Discussion: Students are to think of
someone 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 the
person you respected?


SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
SUPPLEMENTAL MATERIAL: HANDOUT


Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.

Objective: 1.2.11 Describes cultural diversity and how the nurse aide manages cultural differences among people.
Competencies Course Content Learning Activities
After the completion of the
lecture/discussion, the student will:

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 from
generation 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 their
cultures and traditions
Ask again, How many
cultures are there in the class?
SECTION 1: INTRODUCTION TO HEALTHCARE NATCEP
Unit 2: Communication Skills
SUPPLEMENTAL MATERIAL: HANDOUT


Primary Objective: 1.2 Time: Class: Lab: Clinical:
Demonstrates appropriate and effective, communication skills.

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 accept
and understand others
Realize how your attitude may affect clients-a person
cannot feel comfortable when he/she does not feel
accepted
Help clients feel comfortable and accepted so they will
be able to maintain independence and health
Be aware that culture and religion influence a persons
beliefs and practices in regard to health as well as the
causes and cures of disease
Observe individual reactions to pain, which are often
influenced 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 meanings
to 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


SUPPLEMENTAL MATERIALS: HANDOUTS


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 a
group of people share.

Learning to appreciate cultural differences can do more than prevent hurt feelings; it can
improve 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 a
segregated 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 first
experience 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 no
common 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 with
then to the nursing home.

Nursing home staff are also culturally and ethnically diverse, which impacts on the
communication 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 expressions
are 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 differences
can be a challenging job, but it is an area in which nursing assistants can make a difference
for clients from varied backgrounds. We all know how good it feels to be accepted for who
we are, and the nursing assistant is often in a position to help new clients or co-workers who
find their surroundings unfamiliar.

By talking and listening to people who view the world differently, looking beyond
stereotypes, and thinking about the ways we are shaped by our own culture, we can help.
1.2.11

SUPPLEMENTAL MATERIALS: HANDOUTS


Six Steps to Cultural Understanding

1. Denial of Differences
The 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. Defensiveness
In this step, differences are acknowledged, but ones point of view is considered right,
and differences from that view are considered wrong.

3. Minimizing Differences
In this step, differences are recognized, but are granted no importance. This step could be
called the So What step.

4. Acceptance
This step recognizes and appreciates the importance of cultural differences.

5. Adapting to Reality
In this step, empathy and communication skills are used to bridge cultural differences.

6. Ongoing Learning
This 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 the
other.

3. Be sensitive to others customs, holidays, and religious practices. Express your interest by
asking respectful, polite questions. Be prepared to share some of your own customs with
them as well.

4. Examine the attitudes and beliefs you have about other groups of people. Where did your
attitudes and beliefs come from?

5. Make a friend from another cultural group.

6. Defend people who are different from you when you hear others using stereotypes to
describe them.
1.2.11
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: 1.2.12 Demonstrates respect for differences among clients and people.
Competencies Course Content Learning Activities
After the completion of the
lecture/discussion, the student will:

1. Define the impact of
understanding the
differences among clients
and 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 with
his/her own unique differences.
When giving care and working within the health care
team, nurse aides must take into account that an
individualized approach to care is a landmark of quality.
When care givers better understand the differences
among the needs of different people, the quality of care
improves.

2. There are four, important aspects in the development of
providing 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 them
different-respect their differences
Respect everyone

3. The nurse aide will accomplish the following when he/she
treats each client as an individual:
Respect the differences among clients, coworkers and
visitors in all interactions/contacts
Perform tasks and communicate in a manner that
embodies understanding and sensitivity towards
everyone
Review each clients care plan for individual
accommodations regarding customs and habits. Bring
any concerns to the professional nurse before providing
care
Seek a way of understanding when communicating with
a client who speaks a different language
Small group discussion:
How many different
individuals are represented in
the room?
- How do they differ?
- How are they alike?


People Bingo - Exercise

SUPPLEMENTAL MATERIALS: HANDOUTS


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 another
country

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

Is first-born
in their family





Has children
under the age
of six

Has lived in
more than one
state

Knows how to
polka

Loves to cook
1.2.12
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: 1.2.13 Identifies elements of one's own, cultural formation and their potential impact in nursing practice.
Competency Course Content Learning Activities
After the completion of the
lecture/discussion, the student will:

1. Define the way a nurse aide
can improve communication
with a client of a different
culture.
1. Culture and experience have shaped out thinking. Clients
and coworkers may come from a different culture and may
have 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 and
without prejudice to each client. A nurse aide must
understand the clients individual culture and how it may
be perceived by clients and coworkers.
Communication in this regard is critical. Communication
starts 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 they
provide.
Nurse aides may communicate openly about their
respective cultures in an effort to increase their clients
comfort level.
Small group discussion:

Arrange group of 3-4
students with one member of
the group volunteering to
share information about their
culture and beliefs. After the
volunteer shares their
responses to the first, 4
questions, and all members of
the group discuss #5.

1. Where did you grow up?

2. What foods did you like to
eat?

3. How did you celebrate the
holidays?

4. Do you have grandparents?
What role do they play
within the family?

5. How does the volunteers
background/culture compare
with the other members of
the group? What was
similar? What was
different?
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: 1.2.14 Uses effective, communication skills to promote clients well-being.
Competency Course Content Learning Activities
After the completion of the
lecture/discussion, the student will:

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 individual
client and in so doing will improve the delivery of client care.

1. To encourage effective communication we can build upon
the 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 appears
relaxed, 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 the
preference may be Mr. or Mrs. or Miss. Abide by their
preference.
Look for non-verbal cues of the client while they are
speaking, 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 allow
the 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.

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: 1.2.14 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 adult
as if they are a child. Use words that have the same
meaning for you and the client. Avoid medical words
and words that the client is not familiar with.
Dont jump to conclusions or make assumptions. Listen
to exactly what the client is saying and how he/she feels.
Ask questions if you do not understand and give the
client feedback about what you do or dont understand.
Dont be judgmental. Allow clients their opinion and
treat them respectfully.
Be patient. People with memory problems may ask the
same question many times. Do not call attention to the
repetition. Accept the memory loss as part of their
disability.
Include the client in conversation when others are
present. This includes when a co-worker is assisting you
with care.

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: 1.2.15 Communicates in a respectful, adult manner in accordance with the clients stage of development and cultural background.
Competencies Course Content Learning Activities
After the completion of the
lecture/discussion, the student will:

1. Define why it is important to
be aware of the clients stage
of development and cultural
background

2. List 4, developmental tasks
of the elderly
1. The nurse aide must be aware of his/her own attitudes
toward cultural differences and seek to understand and
respect 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 with
these changes and treats clients with understanding and
respect.

2. Developmental tasks of the elderly are:
Adjusting to decreased physical strength and loss of
health.
Adjusting to retirement and reduced income.
Developing new friends and relationships.
Preparing for death.