NCM 114– A

CARE OF THE OLDER ADULT

_____________________________________

COMMUNICATING WITH OLDER ADULTS

_____________________________________

SUBMITTED TO: PROF. EMELIE J. TAN, RN, DNS

SUBMITTED BY: FATIMA MEDRIZA B. DURAN, BSN 3B

WESTERN MINDANAO STATE UNIVERSITY

COLLEGE OF NURSING

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TABLE OF CONTENTS

Table of Contents

I. Introduction _____________________ 3

II. Objectives _____________________ 3

III. Activity _____________________ 3

IV. Analysis _____________________ 5

V. Abstraction _____________________ 6

VI. Application _____________________ 15

VII. Additional Information _____________________ 16

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

At the end of this section, you will be able to:

1. Identify communication techniques that are effective with older adults
2. Identify the significance of nonverbal communication with older adults.
3. Discuss the verbal communication techniques used when sending and
receiving messages.
4. Differentiate between social and therapeutic communication
5. Discuss ways communication is affected by culture.

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

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to think and say it. This atmosphere of mutual respect and understanding helps build
trust and rapport.
Scenario:

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.

Nurse : Hello, Good Morning, what can I do for you? (Smiling)

Daughter : Good morning, we are here because my father is complaining about
his frequent headache and having blurry vision for two days now.
Nurse : He Sir, I am Tess, may I know you name?
Mr. Fuentes : I am Charlie Fuentes.
Nurse : How about your age Mr. Fuentes?
Mr. Fuentes : I am 78 years old.
Nurse : Thank you Mr. Fuentes. Ok, can you tell me exactly what you feel or
felt?
Mr. Fuentes : For two days now, I feel dizzy, and sometimes with blurred vision. I
do experienced headache, especially pain at the nape area.
Nurse : (with the information given… the nurse proceeds in taking the VS of
Mr. Fuentes.) Smiling… Mr. Fuentes, your VS are the following; for
blood pressure (BP): 150/90 mmHg, pulse (P): 90 beats/minute,
respiratory rate (RR): 2 breaths/minute, and temperature (T): 36.7°C.
Your BP is elevated.
Mr. Fuentes : It is my first time to have an elevated BP. What shall I do?
Nurse : (Holding the hands of Mr. Fuentes) I recommend for you to have a
check-up first from a physician. And you may come back again if
you need my help.
Mr. Fuentes : Thank you Nurse Tess.
Nurse : You’re welcome Mr. Fuentes.

Based on the scenario given, please answer the following question

1. When did the information sharing happened?

The information sharing took place the moment after Mr. Fuentes and the nurse
introduced themselves to each other, after gathering the other necessary
information and asking Mr. Fuentes’ complaints followed by vital signs taking.

2. Is it formal/therapeutic communication or informal/social communication? Why?

For a communication to be called formal/therapeutic, it’s important that a patient
accomplish goals that will help benefit his/health, thus, the communication that

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 took place is a formal/therapeutic communication as it helped for the client to
verbalize his complaints and describe what he feels. The nurse was also able to
obtain the client’s vital signs as it is also an important part in nurse-patient
communication or interaction.
3. Identify the different nonverbal communication used during the conversation.
The different nonverbal communication used during the conversation is the Space,
Distance and positioning of the interaction that took place, the time and timing,
the facial expressions (smiling) and touch when the nurse held the hands of Mr.
Fuentes to provide comfort.

4. Discuss the importance of acceptance, dignity, and respect in communication.

The key to developing a healthy and productive communication between people,
is acceptance, dignity and respect for other people. We have been taught from the
moment we were able to learn our ABC’s to respect other people. It is important
that this manifests in us because through respecting others, we are able to look
past our differences and communicate effectively. Acceptance is also a key factor
in effective communication because having an open mind and heart towards
others allows us to understand them much better. Dignity should also always be
there and no one should be harshly criticized for having a different opinion. When
communicating with older adults, it is vital that we address them respectfully. And
when we listen, we don’t just listen to have something to write and document. We
must actively listen, empathize and we must listen with pure intent and that is to
help the older adult. Barriers may make it hard for a communication to be
effective, but it’s important that we facilitate it to make the communication
effective for the client and for it to not only be effective but also therapeutic.

5. Outline the different skills and techniques utilized during the conversation.
The different skills and techniques utilized during the conversation were
OPEN_ENDED QUESTIONS when the nurse asked Mr. Fuentes to describe how
he was feeling. DIRECT QUESTIONING, when the nurse asks forward questions
to the client. And lastly, INFORMING, when the nurse told Mr. Fuentes about his
elevated blood pressure and the next steps to take.

Think ahead!

The nursing profession is a specific activity that requires a certain communication

skill. Effective communication is one of the foundations of good nursing care. The
honest forms of nurse-patient communication include verbal and non-verbal
communication (e.g., body language, facial expression, gestures, and distance
between you and your patients). Effective nurse-patient communication can improve
quality of care, clinical outcomes, and a nurse-patient relationship that enhances
patient satisfaction. However, effective nurse-patient communication is the biggest
challenge for nurses and requires much more than experience and skills.

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 Let’s get started!
Situation: Interview your grandparent. Make an NPI.
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.

Nurse Client Analysis

“Hello! Good Afternoon po Ma’am
Idang.”
(Moderate eye contact, Good and open
posture, In face to face position to the
client, Smiles, Waves)
“Ako po si Fatima, 3rd year nursing
student po ng WMSU. Ako po ang
magiging student nurse niyo simula
po ngayon hanggang January 9.”
(Moderate eye contact, Good and open
posture, In face to face position to the
client, Smiles)
“Hello! Good Afternoon din.”
- (Waves hand
- Smiles
- Maintains moderate eye contact
- Good and open posture
- In face to face position to the nurse.)
“Ako naman si Nurhaida Duran. Nagagalak
kitang makilala”
- (Maintains moderate eye contact
- Good and open posture
- In face to face position to the nurse.)
It shows that the nurse
recognizes the client as a
person, an individual that gives
the client fulfillment of her
worthiness. In addition, it does
not imply and hold the notion
of value that is of being “good
or bad”.
Informing the client of the facts
increases her knowledge about
the topic and what to expect on
the interaction. It also builds
trust with the client.

“Ma’am. gusto ko pong malaman

niyo na yung mga information pong
makukuha ko galing sa inyo ay wala
na po akong ibang pagsasabihan
hangga’t wala pong permiso niyo.” To set up a means of respecting
No response
the patient’s right to keep
private any information about
his mental and physical health
and related care. This also
means allowing only those
“Makikinig po ako sa mga sasabihin dealing with patient’s care to
ninyo tsaka magbibigay din po kame have access to the information
ng mga activities na makakatulong sa that the patient divulges.
inyo at makakapagbigay din ng
kasiyahan” Setting up the lucid boundaries
No response
of relationship time, date, place
and duration of meetings
“Kamusta naman po kayo?” clearly orients the patient when,

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“Maari ko po bang maitanong kung
bakit?”
“Lagi po bang nangyayari sa inyo
yan?”
No response
“Nakatutulong naman po ba sya?
Effective po ba sya para sa inyo?”
“Maari ko po bang maitanong kung
ano pang ibang ginagawa ninyo
upang makatulong sa hypertension
ninyo?”
“Kamusta naman po ang effects non
para sa inyo?”
“Ano ano pong mga kinakain ninyo?”
“Ayos lang naman ako. Medyo pagod at
masakit ang katawan.”
“Bale, nageexercise kasi ako araw-araw at
mukhang napasobrahan ata ako kahapon.”
“Hindi naman, sadyang napasobra lang ata
talaga ako kahapon at hindi nakapag warm
up.”
(Laughs and smiles)
“Diagnosed kasi ako with hypertension, kaya
minemake sure ko na nakakapag exercise pa
rin ako. Sabi nga nila, yun ang key, healthy
lifestyle”
“Effective naman sya para sa akin at
talagang nakakatulong. Nakakagaan sa
pakiramdam at hindi masyadong nananakit
yung binti ko pagka nageexercise ako.”
“Ah, madalas akong mag-fasting. Hindi lang
for religion purposes kundi health purposes
din.” (Smiles)
“Actually, sobrang ganda. Hindi nag anon
kataas ang BP ko, hindi na rin mataas
masyado ang sugar ko, di gaya ng dati.
Binabantayan ko rin yung mga kinakain ko.”
“Mga rich in fiber na pagkain at less carb at
oil. Mga steamed fish and chicken, mga
gulay.”
where, and how will begin, go
on and finally end.
It allows the patient to take the
initiative to introduce the topic.
It also simplifies that the patient
has the lead in the interaction
and to think of an interesting
topic for them.
This means delving further into
a subject or an idea. This also
explores the patient to help
them examine the issue more
fully, not only superficially.
Helps the client appraise his
own rather than accept the
opinion of others.
This means delving further into
a subject or an idea. This also
explores the patient to help
them examine the issue more
fully, not only superficially
This means delving further into
a subject or an idea. This also
explores the patient to help
them examine the issue more
fully, not only superficially.
This means concentrates on a
single important point.
This means delving further into
a subject or an idea. This also
explores the patient to help
them examine the issue more
fully, not only superficially.
This means concentrates on a
single important point.
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“Hello po Ma’am Idang. Kamusta “Hello. Okay naman ako” It shows that the nurse
naman po kayo?” (Maintains moderate eye contact, Good and open recognizes the client as a
(Moderate eye contact, Good and open posture, In face to face position to the nurse, person, an individual that gives
posture, In face to face position to the Smiles, Nods) the client fulfillment of his
client. Smiles, Waves) worthiness. In addition, it does
not imply and hold the notion
of value that is of being “good
or bad”.
“Ah, nastress kasi ako dahil tumaas It allows the patient to take the
“Napansin ko pong medyo matamlay initiative to introduce the topic.
po kayo ngayon.” nanaman yung BP ko.”
(Maintains moderate eye contact, Good and open It also simplifies that the patient
(Moderate eye contact, Good and open has the lead in the interaction
posture, In face to face position to the nurse.)
posture, In face to face position to the and to think of an interesting
client, Slightly leaning forward)
topic

This gives the patient an

“Ano pong nangyari o ano pong “Naisip ko baka yung kinain naming encouragement to continue on
ginawa ninyo na sa tingin niyo ay nung New Year, marami kasing bawal at what he is saying. It also
nagging dahilan ng pagtaas po ng BP oily. Hindi rin naman ako nakapagpigil.” indicates that the nurse is
ninyo?” listening and following what
the patient is talking about
without taking away the
initiative for the interaction.

“Ah ganun po ba?”
“Sa tingin po ninyo, ano pong “Kailangan ko na talaga icontrol ang
pwede ninyong gawin para hindi sarili ko pagdating sa mga ganitong
na ito maulit?”
“Good Afternoon, Ma’am Idang.”
“Oo, tapos may dessert pa. Kaya ayun, This gives the patient an
encouragement to continue on
sumama ang pakiramdam ko.”
what he is saying. It also
indicates that the nurse is
listening and following what
the patient is talking about
without taking away the
initiative for the interaction.
This directs the patient’s
actions, thoughts and feelings
bagay.” back to the patient and
encourage patient to recognize
and accept his own feelings.
This means planning in advance
what he might do in certain
situations. Making definite
plans increases the likelihood
that the client will cope more
effectively in a similar
situation.
“Good Afternoon din.” It shows that the nurse
recognizes the client as a
person, an individual that gives
the client fulfillment of her
worthiness. In addition, it does
not imply and hold the notion

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 of value that is of being “good
or bad”.

“Kamusta po kayo?” “Ok lang naman.” It allows the patient to take the
initiative to introduce the topic.
It also simplifies that the patient
has the lead in the interaction
and to think of an interesting
topic for them.

“Tulad po nang aming binanggit nung “Ah oo nga pala.” Informing the client of the facts
unang araw ng nakasalamuha namin increases her knowledge about
kayo, ang ating huling araw ay the topic and what to expect on
January 9 which is today.” the interaction. It also builds
trust with the client.

“Sa nakalipas na apat na linggo heto “Oo. Iyon nga ang mga napag-usapan This is organizing and summing
na po yung nagawa natin: natin.” up which has gone before and
nagexercise, nagkakwentuhan, natuto seeks to bring out the important
kung paano magmanage ng sugar and points of discussion and to
BP, kumain, at iba pa.” increase awareness and
understanding of both
participants. It omits irrelevant
and organizes the pertinent
aspects of interaction. It allows
both patient and the nurse to
depart with the same ideas and
provide a sense of closure at the
completion of each discussion.
This is more effective with
movements of hands, moderate
eye contact and good and open
posture.
“May iba pa po ba kayong gusting “Wala na.” (Smiles) Asking for patient to describe
sabihin?” feelings, perceptions, and views
of their situations. To
understand the client, the nurse
must see things from her
perspective.

“Kung ganun po, maraming salamat

It shows that the nurse
po Ma’am Idang. sa tiwala pong “Salamat sayo at galingan mo. Bye.”
recognizes the client as a
ibinigay ninyo sa amin, sa
person, an individual that gives
cooperation at sa maganda po
the client fulfillment of her
ninyong pagtanggap. Ingat po kayo
worthiness.
parati.”
Format for the NPI.

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 Read and Ponder

People use communication to perform many functions in their day-to-day

activities, including employment, social and leisure activities, community
involvement, personal relationships, and meeting needs for daily living. Many of
these functions change with typical aging. People retire from careers. Their social
circles and personal relationships may change as they adjust their life roles and
change their activity patterns. They may require more services such as health care
services or in-home help to meet their daily needs. With these changing roles, the
effects of communication disorders also change. 

Information Sharing (Framing the Message)

Verbal communication involves sending and receiving messages using words.

Some verbal communication is formal, structured, and precise; some is informal,
unstructured, and flexible. Formal or therapeutic commination have a specific intent
or purposes. Informal or social communication is less specific and are used for
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 takes place without words. We are communication

all the time, whether we are aware of it or not. Research shows that nonverbal
communication is mostly utilized compared with verbal communication.

Formal or Therapeutic Communication

Therapeutic communication is conscious and deliberate process used to gather

information related to patient’s overall health status and to respond with verbal and
nonverbal approaches that promote the patient’s well-being or improve the patient’s
understanding of ongoing care. This type of communication is a skill that requires
time, effort, and practice to develop. Effective verbal communication requires the
ability to use variety of techniques when sending and receiving messages.

Informal or Social Communication

The informal communication is the casual and unofficial form of

communication wherein the information is exchanged spontaneously between two or
more persons without conforming the prescribed official rules, processes, system,
formalities and chain of command. This type of communication can demonstrate that
you think of the patient as a real person. Likewise, older patients often like to know
something about the nurses who care for them.

Nonverbal Communication

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 Because so much of communication is nonverbal, it is essential that we
examine each aspect of nonverbal communication to consider its effect on out
interactions with the older adult.

 Symbols  Eye Contact

 Tone of Voice  Pace or Speed of
 Body Language Communication
 Space, Distance, and Position  Time and Timing
 Gestures  Touch
 Facial expressions  Silence

(Read. Read. Read…)

Acceptance, Dignity, and Respect in Communication
Empathy is defined as the willingness to attempt to understand the
unique world of another person. It is the ability to put oneself in another
person's place and to understand what he or she is feeling and thinking in that
situation. Empathetic listening involves actively trying to truly understand the
other person. Effective communication starts with proper introductions.
Determine how each older adult wishes to be addressed. It is presumptuous to
become too familiar with older adults by addressing them by their first names.
It is better to start by using the older adult's 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.
To communicate effectively, we must first learn to listen actively and
empathetically. Listening is more than simply hearing. Hearing involves the
ability of the ears to detect sound, whereas listening involves interpretation.
We have not really listened until we understand for certain what was intended
by the speaker. We cannot simply listen to the words; we must listen for the
meaning of the words. Active listening skills are needed in all areas of
nursing, but particularly in dealing with older adults. Empathetic listening
requires sensitivity to the strengths and limitations of the aging individual

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 (e.g., hearing changes, vision changes, fatigue, and pain). Empathetic listening
involves patience when an older adult needs extra time to voice a response, or
repeats the same thing many times. It includes a willingness to spend time
getting to know the older adult better as a human being, not just as another
body in need of skilled physical care. Listening to an older person reminisce
about his or her life can help the nurse gain better understanding of the
person's values, perceptions, strengths, needs, and concerns. Too often, nurses
provide excellent physical care to people they have not taken the time to
know. Nurses need to stop talking “over” patients while they do procedures,
put away their clipboards, and sit down and really talk with older patients
more often. Empathetic listening requires the ability to focus on the aging
person, not simply on the tasks at hand. If we do not really listen, our older
patients are likely to stop talking and we will all be poorer for the loss.
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
social and cultural backgrounds of older adults also make the area of communication
a challenge for nurses.

 Hearing Impairment
 Aphasia
 Dementia
 Cultural differences

Skills and Techniques

 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

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 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
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.

 Communicating with Visitors and Families

Be prepared to interact with the friends, family members, and visitors
of your patient. These people make up the older adult's social network and
support system. Families and friends are interested and concerned about what
is happening to their loved ones. Not only do they turn to nurses for
information and reassurance, but they can also be a good source of
information. These significant others, as they are often called, can help in
many ways if nurses are responsive to them. Many of the older adult's
significant others are themselves senior citizens. Communication with these

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 individuals may also require special attention and the use of special
techniques. It is important to take the time to develop good rapport with your
patients' significant others. Good communication with these important people
can do a great deal to facilitate care. Because they have known the patient
longer and better than the nursing staff, they are often able to detect subtle
changes before trained nurses can. Many times, nurses need to rely on the
significant others to interpret the behaviors and communications of older
adults. Listen to what they have to say.

 Delivering Bad News

No one likes to get bad news, and no one likes to be the one who has to
tell someone else bad news. Most people try to avoid this daunting task.
Ideally, this task should be performed by the most experienced and
knowledgeable person, such as the physician, but, occasionally, the nurse must
be the one to break bad news to an older adult. This could be information
regarding the patient's health or about someone close to the patient, for
instance, the death of a spouse or other loved one. The EPEC Project, funded
by the Robert Wood Johnson Foundation, has developed guidelines for
physicians that have relevance for nursing practice. Important concepts
include the following:
• Prepare yourself. Make sure you have all of the information and that
it is accurate.
• Think through what you want to say so that the message is
compassionate and culturally sensitive.
• Establish an environment respectful of patient's privacy.
• Determine whether anyone else (chaplain, family members, etc.)
should be present when the news is delivered.
• 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.

 Having Difficult Conversations

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 Emotionally loaded topics are likely to generate strong emotions and
often lead to conflict. Conflict is a normal and routine part of human
interaction; it can occur between older adults and adult children, nurses and
older adults, nurses and patients' families, nurses and other nurses, or nurses
and physicians. Difficult conversations may occur in clinical areas or in-home
settings involving friends and family members. Some people prefer to avoid
conflict entirely and pretend it does not exist, but avoidance just delays
solving problems that need to be addressed. The following guidelines are
suggestions based on conflict resolution research:
• Pick a place that is private and a time when you will be free from
distractions.
• Try to focus on a single topic; do not bring up old grievances that get
in the way.
• If a conversation is not going well, take a look at your own feelings
and motivations. Are you reacting to this issue or to another issue that was
problematic in the past?
• Express your feelings using “I” statements, such as “I get upset when
… doesn't get done” rather than “you” statements, such as “You always ignore
what I ask you to do.”
• Respect the right of the other person to agree or disagree.
• Keep a balance between talking and listening. Try not to dominate
the conversation.
• View each communication as a new opportunity to learn something
about the other person and about his or her unique feelings, beliefs, and
perspectives. Listen to the other person and seek clarification as to his or her
reasons and feelings.
• 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.

 Improving Communication between Older Adult and Physician

Clear communication between the older adult and their physician is
essential. Most physicians are aware of effective communication protocols,
but, because of time constraints or other factors, they may not always use

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 these techniques. Ineffective communication can result in frustration for both
parties and can contribute to a lack of adherence by the patient. Also, it is not
uncommon for an older adult to become passive, evasive, or tentative when
talking with the physician. The nurse can often help minimize these problems
by (1) suggesting that the patient keep a written list of concerns and questions
so nothing is forgotten; (2) asking the physician to repeat and summarize
directions to the patient; (3) identifying printed materials that support the
physician recommendation; (4) suggesting that a trusted friend or family
member be present to take notes and help the older adult express concerns; or
(5) acting as a patient advocate by asking the physician to clarify questions or
concerns the patient has verbalized to you.

 Communicating with Physicians

Mutual respect and a willingness to collaborate for the good of the
older adult can form a strong basis for good interactions. Thus, will have a
significant impact on the quality of care given to older patients.
Difference in training may lead to nurse-physician communication
difficulties. To improve the communication, many facilities uses the ISBAR-
R communication that is concise yet complete. ISBAR-R is an acronym that
stands for Introduction, Situation, Background, Assessment,
Recommendation, and Readback.

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
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.

Emergency situations need to be handled immediately, but these make

up a small portion of nurse-physician interaction. Most communications
involve either routine or somewhat urgent information that can be handled in a
more methodical, planned manner. It is helpful to determine whether there is a

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 best time and method to use when contacting the physician regarding
nonemergency situations, such as telephone, cell phone, Fax, e-mail, texting,
or others. Planning ahead to identify the best time and methods approved by
your facility will optimize communication and enhance care of the patient
while minimizing frustration.

 Patient Teaching

Education plays an important role in promoting and maintaining the

health of older adults. Teaching may be a one-on-one session or a group
experience. The ability to teach, explain, and motivate is increasingly part of
the role of today's nurse. To perform this role successfully, you need to know
basic principles and techniques of adult education and adaptations specific to
older adults.

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.

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

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 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.

When selecting a teaching time, avoid times when the patient is

stressed, fatigued, or in pain; all of these situations interfere with the patient's
ability to process information accurately. Also, avoid times when older adults
may be distracted by things of higher priority to them, such as a favorite
television show or anticipated visit from friends or family. When selecting a
time for teaching, make sure there is adequate time to discuss the important
information. Remember that older individuals will need more time to process
information. Avoid trying to teach too much at one time. Break teaching into
manageable blocks of concepts to allow time for reflection and learning.
Whenever possible, provide printed materials to supplement and reinforce the
content. Practical examples or illustrations may be more effective than a quick
recitation of facts. If the teaching involves a psychomotor skill, such as
drawing up insulin or changing a dressing, the older adult should receive one
or more demonstrations of the skill and then be given ample opportunities to
practice and perform the skill with supervision. Be patient and supportive,
regardless of the amount of time needed. Remember, the goal is learning, not
speed.

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.

See if you can do this

Given a situation: In your neighborhood, look for two person who are talking.

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 1. What is their body language communicating?
They are both standing and are utilizing different facial expressions and hand
gestures.

2. Think of a person you consider to be a good communicator. Next think of a

person you consider to be a poor communicator. Get a paper and put a line in
the middle, write the name of the effective communicator on one side and the
ineffective communicator on the other side. List the characteristics that make
that communicator effective or ineffective. Compare and contrast your
findings
For a good communicator, I would consider Jacinda Ardern, current prime
minister of New Zealand, as one. A good communicator knows how to listen
and respect other people’s beliefs. For the poor communicator, Donald Trump
would be a good example. A poor communicator does not know how to listen
actively. With a good communicator, you are already able to come up with
resolutions. While for the poor ones, it will always be a cycle of ineffective
communication.

3. Compare your own communication skills to those of the people whose names
you wrote down. Which one are you more like? How? What can you do to
become more effective in your communication ability?
If I were to compare myself to any of these two, I would choose Prime
Minister Jacinda. I am an effective speaker, if I say so myself. However, there
are some things that needs changes. Such as my inability to comprehend well
in pressure and my tendency to panic in front of people. Just like any skill, it’s
important to constantly want to improve. With this, I believe that in order for
me to become more effective in communicating, I need to practice more.
Engage in discussions and debates some more, practice talking to people and
read more in order to improve.

Additional information

Basic Strategies for Communicating with Impaired Older Adults

 Try not to startle the person when starting a communication.

 Identify yourself; remind the person who you are.
 Communicate when the person is most alert.
 Eliminate or reduce noise and distractions.
 Make sure you have the person's attention before speaking.
 Focus on abilities, not disabilities.
 Select topics of interest to the person.
 Use a variety of words or descriptions until meanings are clear.
 Ask clear, specific questions; one question at a time.
 Pay attention to the emotional context of conversation.
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  Use pictures and gestures in addition to words.
 Have the person sit up for conversation whenever possible. Keep messages
simple and repeat as needed.
 Do not interrupt. Maintain a slower pace of communication.
 Make sure the person doesn't have any other needs before you leave.

Example of ISBAR-R Communication

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.

BACKGROUND: Mrs. Reynolds, a former lawyer, is a 57-year-old patient who was

admitted in this facility two years ago after her stroke. Three days ago, Mrs. Reynolds
spoke her first 2 words since her stroke. Her physician has ordered speech therapy to
work with her twice a week. She is on a soft diet with thickened liquids. During
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.

RECOMMENDATION: Monitor VS twice a shift. Check patency of G-tube before

medications and beginning overnight feeding. Allow her to grasp items as hand
exercise. Perform light ROM exercises and administer antianxiety medication before
bedtime. Provide a skin check during your shift.

READBACK: Ask receiving nurse if there are any questions and to read back notes
for clarification.

BP, Blood pressure; G-tube, gastrostomy tube; P, pulse; PRN, as

needed; R, respirations; ROM, range of motion; T, temperature; VS, vital
signs.

(From de Wit S, O'Neill PA: Fundamentals of Nursing, ed 4, St. Louis, 2014,

Saunders.)

Modification in Preparing or Selecting Printed Materials for Older Adults

 Limit the amount of material on a single page.

 Allow enough white space so that material is clear and distinct.
 Use at least a 12-point font for printed materials.

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  Use thicker letters rather than fine print.
 Avoid elaborate fonts; stick with simple, basic lettering.
 Stick to one style of font per document.
 Use a normal mixture of capital and small letters.
 Select paper and ink of strongly contrasting colors.

APPENDICES

A. Quiz:

Instruction: Without reviewing answer the following questions. Write your answer on
the space provided.

__A___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.
___D__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.
__A___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.
__A___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.”
___A__5. What is true to direct questions?

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 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.
___D__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.
___C__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
__B___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
___A__9. All are considered as nonverbal communication, EXCEPT?
A. Choice of words
B. Voice tone
C. Facial expression
D. Body Language

___D__10. Which of the following statements is not a representation of “elderspeak?”

A. “Ok, honey, let’s get a bath now.”
B. Oh, dear! We better get you a clean diaper.”
C. “Today is Thursday, Mr. Cruz. It’s your dialysis day.”
D. “My gracious Ann! What are you doing here in the kitchen?”

B. REFERENCES

Books

Eliopoulos, C. (2005). Gerontological Nursing. 6th ed. Lippincott Williams &

Wilkins.

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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