Professional Documents
Culture Documents
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TABLE OF CONTENTS
Table of Contents
I. Introduction _____________________ 3
V. Abstraction _____________________ 6
VIII. Appendices
A. Quiz _____________________ 18
B. References _____________________ 19
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COMMUNICATING WITH OLDER PERSONS
Introduction
The axiom that people are social beings is true for the elderly. Through
social interaction, people share joys and burdens, derive feelings of normalcy, validate
perceptions, and maintain a link with reality. Each of us who participates in
communication is a unique individual with our own personal values, beliefs,
perceptions, culture and understanding of how the world operates. This is particularly
important to remember when working with older adults. The older adults of today
formed their opinions, values, and beliefs in a very different society from ours today.
Whatever their background, older adults have had time to encounter many
situations, both good and bad. It is often difficult for a younger person to understand
the experiences that have made older adults whom they are today. The most effective
way to bridge the gulf between the generations is good communication.
Objectives
Try this!
Effective communication is not easy, even among people of the same age
group and background. Communication among people from different age groups and
background is even more challenging. This is particularly true when one of the parties
is older, however effective communication can occur if we respect the person’s right
to think and say it. This atmosphere of mutual respect and understanding helps build
trust and rapport.
Scenario:
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Mr. Fuentes is 78 years old and a widower for 4 years of Tetuan, Zamboanga
City. He is hypertensive and diabetic type 2. He has 3 adult children, the eldest is in
Europe, the youngest is in Manila and he stays with his middle child. All of his kids
are with their own family. They seldom visit him, especially the eldest and the
youngest, though they support him financially.
The daughter brought him to the health center because of the complaint of
headache and blurry vision. Upon examination, Mr. Fuentes presents with the
following vital signs (VS): blood pressure (BP): 150/90 mmHg, pulse (P): 90
beats/minute, respiratory rate (RR): 2 breaths/minute, and temperature (T): 36.7°C.
The scenario starts with the “nurse” entering the room.
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5. Outline the different skills and techniques utilized during the conversation.
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Think ahead!
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1. Illustrate the process of communication.
2. Discuss the part where you had your therapeutic communication and social
interaction with your grandparent.
3. List the nonverbal communication utilized during the interview.
4. Enumerate the experiences encountered during interview in respect with
acceptance, dignity and respect in communication with your grandparent.
5. List and describe the barriers encountered during the interview and how it
affects the communication the process.
Conversation 2
Conversation 3
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socialization. Both have a place in nursing. Nurses must be effective in both formal
and informal communication and must know how and when to use each type.
Nonverbal Communication
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proper title and name and then clarifying which form of address the person prefers. If
someone wishes to be called by a first name or a nickname, the person will usually
say so. In special situations, such as when a patient has dementia or other alterations
in cognition, first names may be most inappropriate, because that may be the only
name the person can remember.
People who are unskilled at working with older adults often use an
Elderspeak (adjustments to speech patterns, such as speaking more slowly or more
loudly, shortening sentences, or using limited or less complex vocabulary, that are
sometimes made by younger people when communicating with older adults. These
simplified speech patterns are implicitly based on the assumption that older adults
are cognitively impaired or incapable of understanding normal speech)
communication, which is seems patronizing and demeaning to older adults and
inappropriate. Use normal conversational tone of voice whenever possible.
Barriers to Communication
For effective communication, we must learn to identify the barriers that can
interfere with an exchange and the methods that help overcome these barriers.
Effective communication is not easy. More than just the ability to talk to someone,
communication involves all of the ways that we send messages to someone else,
including nonverbal ways. Different physical problems require different
communication approaches. Communication makes use of all of the senses. Hearing
and vision are the senses used most often in communication, but touch, smell, and
even taste also play a part in the relay of messages. It is important to remember this
when communicating with older adults, because their perceptions may be altered by
normal physiologic changes that occur with aging. Pain or extreme fatigue may make
communication difficult. It is best to limit conversation to essential topics during
these times. A variety of disease processes, such as strokes and dementia,
significantly affect communication processes and require specific approaches. Diverse
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social and cultural backgrounds of older adults also make the area of communication
a challenge for nurses.
● Hearing Impairment
● Aphasia
● Dementia
● Cultural differences
● Informing
Informing uses direct statements regarding facts. A good information
statement is clear, concise, and expressed in words the patient can understand.
When the nurse is informing, the nurse is active and the patient is passive.
Informing is the least effective form of communication because the patient is
not actively involved. When giving information, ask the patients to restate
what they understand using their own words. A message may need to be
repeated and rephrased to ensure understanding. This should be done tactfully
and with care not to show signs of annoyance or frustration.
● Direct Questioning
It is best to keep communication conversational and not too aggressive.
Too many direct questions can overwhelm an older person and may block
rather than expand communication. Direct questioning is helpful when nurses
need to obtain specific information or in emergency situations when time is
precious. Direct questions tend to include the words who, what, when, where,
do you, and don't you. Direct questioning is appropriate when information
must be obtained quickly; however, if it is overused, patients may become
defensive.
● Using Open-Ended Techniques
Open-ended communication techniques include open-ended questions,
reflective statements, clarifying statements, and paraphrasing. These
techniques allow the patient more leeway to respond, thus establishing a more
empathetic climate. The patient is more likely to feel that you are interested in
him or her personally and not just trying to fill out a stack of forms. Examples
of open-ended techniques include the following: “And after you moved to the
nursing home, what happened?”; “And then?”; “That must have been
frightening!”; “What I heard you say is …”; “It sounds like you think (feel)
…” Open-ended techniques allow patients to express more about their feelings
and perceptions. They also allow verification that the information being
relayed is accurate.
● Confronting
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Confronting is used when there are inconsistencies in information or
when verbal and nonverbal messages appear contradictory. Confrontation is
one of the most difficult communication techniques to use and should be used
only after good rapport has been established. It is never advisable to confront a
highly agitated or confused person, because conflict and a breakdown in
communication will result. Confrontation should be used only when there is
adequate time to explore the problem and come to some form of resolution.
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• Make sure there is adequate time, free from interruptions, to deal
with the expected emotional response.
• Determine what the person already knows and, if possible, how much
they want to know.
• Recognize that ethical and cultural variations may influence the way
information is delivered.
• Use simple, direct, but sensitive language to begin the message, such
as, “I'm afraid I have bad news for you.”
• Respond to the person's emotional reaction, for example, “I'll try to
help you. Is there anything I can do?” or “Do you want to talk about how
you're feeling?”
• Develop a follow-up plan. Help the older person and significant
others with appointments, referrals, transportation, and so forth.
• Communicate significant information to other caregivers as part of a
plan of care.
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• Do not prejudge or assume that you already know what the person is
going to say. You may be wrong.
• Be aware of your own feelings regarding the issue under discussion.
Keep feelings separate from facts. The fact that someone does not do what you
want does not mean that the person does not like you or that he or she is doing
it to upset you.
• Avoid blaming the other person. Look for ways to solve
disagreements.
• Accept that difficult conversations are part of life and that things do
not always go right.
• Learn from both negative and positive interactions, and try to
improve future communication.
• Try to achieve a win-win solution.
When you call a physician, start by identifying who you are (name and
title), the patient or patients you are calling about, and the specific reason for
the contact. Plan ahead and have a focus for the communication. Gather any
assessment data you might need before calling the physician. Know what you
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want to report or find out. Be organized, clear, precise, and complete. Provide
background information. Remember, the physician is not looking at the chart
and may see the older adult once a month, or even less frequently in the case
of an independent older adult. Provide all necessary and relevant information
that might be needed. Identify the patient by name, major diagnoses, and any
medications related to currently presenting symptoms or concerns. Be
prepared to clarify any data or information that the physician may request.
Keep a list of issues to be reported or discussed with each physician so that all
issues can be covered in one interaction. This will prevent repetitive
interruptions for both the physician and the nurse. Identifying parameters (or
guidelines) when the physician wishes to be contacted (e.g., patient's blood
sugar over 200 and blood pressure under 120 systolic) can minimize problems
related to under or over notification.
● Patient Teaching
It has been said that “you can't teach an old dog new tricks.” Research
has shown that this is not true. Older adults can learn new things. It has been
established that mental abilities, such as numeric tasks, word fluency,
inductive reasoning, and spatial orientation develop through the first four
decades of life and then hold fairly stable until the seventies in most
individuals, even longer in others. Although younger individuals tend to do
better at learning information that requires memorization, older individuals
compensate by using the verbal skills, experience, and judgment they have
acquired over time. Learning is maximized when it can draw on the previous
experiences of older adults.
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Adult learners are oriented toward problem solving, and they view
learning as most desirable when it is relevant to their own lives. Teaching will
be most effective when the patient recognizes and accepts the importance of
learning new information or techniques. Older adults will be more willing to
learn when the topic is important to them. For this reason, the nurse should try
to determine ahead of time those things the older patient thinks are most
important. Prioritize teaching by starting with the area that the patient
perceives to be most important, then linking that information to the other
things the nurse thinks are necessary or important. Work in small, discrete
blocks of information, proceeding from simple, more familiar concepts to
more complex or difficult ones. Success breeds success: when older adults
realize that they have mastered one skill or piece of information, they are more
likely to have a positive attitude toward additional learning.
Choose the right place and time for teaching. The right place depends
on the material the session will cover. Information that is viewed as personal
or private is best taught in a quiet space away from others. More general
information (such as nutrition teaching or stress reduction) may be best taught
in a group, where older adults are free to share personal experiences and
solutions with others. Wherever teaching takes place, the space should be
adjusted for the older adult. The temperature should be set appropriately,
chairs should be supportive and comfortable, lighting should be adequate and
free of glare, and bathrooms should be readily accessible. Snacks and
beverages are appreciated by most older adults and can make a group learning
session a positive social interaction.
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Modifications may be needed to compensate for common sensory
changes experienced with aging. Face older individuals when speaking. Speak
clearly. Try to avoid microphones or amplifiers that might distort sounds or
interfere with hearing aids. Repeat information, and use visual cues or
materials to reinforce a verbal message. Reinforce verbal information with
printed material and audiovisual aids, such as videos. Encourage hands-on
practice. Use as many senses as possible, but not necessarily all at once, as this
may be confusing.
Given a situation: In your neighborhood, look for two person who are talking.
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Additional information
INTRODUCTION: Hello, I'm May, the evening shift nurse, are you ready for shift
report on Mrs. Reynolds in room 168A?
SITUATION: You are communicating the 11:00 P.M. change-of-shift report for a
long-term patient who had suffered a stroke and requires total care.
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speech therapy, she can become upset and teary if she gets overwhelmed. Her family
resides 2,000 miles away and visit every 6 months. She keeps a stuffed Care Bear by
her side at all times.
ASSESSMENT: Mrs. Reynolds is alert and responds to her name with eye contact. T
97.8°, P 80, R 24, BP 127/81, O2 saturation 97% on room air. G-tube placement
confirmed, patent, and flushed with 10 mL residual. During dinner, Mrs. Reynolds
grasped the spoon in her left hand but required assistance bringing it to her mouth.
READBACK: Ask receiving nurse if there are any questions and to read back notes
for clarification.
APPENDICES
A. Quiz:
Instruction: Without reviewing answer the following questions. Write your answer on
the space provided.
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_____1. Which of the following best defines therapeutic communication?
A. Has a specific purpose
B. Is the only form of professional communication
C. Should never be used in social setting
D. Requires no special skills, just willingness to listen.
_____2. Why is it important for you to be cautious when using medical jargon with an
older adult client?
A. It could become an opportunity to instruct client
B. It could become an effective abbreviated communication shortcut
C. It could become an indicator of formal communication
D. It could become a communication barrier.
_____3. The nurse is engaging the client in social conversation. What is the benefit of
social conversation in the health care setting?
A. It lets the client know that he/she is considered to be a person, not just a
patient.
B. It encourages sharing intimate details
C. It establishes the nurse’s role as a health care provider
D. It blocks more meaningful therapeutic communication.
_____4. You are informing a patient about an upcoming procedure. What statement
would you demonstrate effective communication?
A. “Mr. Cruz, your leis to be x-rayed in the x-ray department in an hour.”
B. “X-ray is coming to get you for an AP and lateral of your chest.”
C. “You can’t eat anything after supper because of some lab works.”
D. “Mrs. Pardo, the OR has notified us that they’re running behind.”
Answer: A. Clear, concise information in words that the patient can understand is the
most effective method of providing information. Medical jargon should be avoided.
_____5. What is true to direct questions?
A. They can get a lot of information quickly.
B. They can help the patients organize their thoughts.
C. They get minimum response answers of "yes" and "no."
D. They make patients think that they are contributing to their health care.
_____6. What is the goal of empathetic listening?
A. It encourages the patient to divulge information.
B. It allows for time to pose another question to the patient.
C. It indicates the conversation has come to a close.
D. It allows the nurse to interpret what the patient has said.
_____7. Successful communication is dependent on the following, except.
A. The need to share information to someone else
B. Using perfect grammar
C. Assessing or correcting communication barriers
D. Emphatic listening
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_____8. What would be the basis of your communication approach on for the most
effective communication? Except
A. Level of education
B. Income level
C. Perspective
_____9. All are considered as nonverbal communication, EXCEPT?
A. Choice of words
B. Voice tone
C. Facial expression
D. Body Language
B. REFERENCES
Books
Mauk, K.L. (2010), Gerontological Nursing Competencies for Care. 2nd ed. Jones
and Bartlett.
Williams, P. (2016) Basic Geriatric Nursing. 6th Edition. Elsevier, Inc. eBook.
Electronic Sources
https://minoritynurse.com/3-principles-of-effective-nurse-patient-communication
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