NRG 303: Care of the Older Person

LECTURE 5: COMMUNICATING WITH OLDER ADULTS

JASMINE BETINOL I LEC
2nd SEMESTER I S.Y 2024 I MIDTERM: WEEK 5

COURSE OUTLINE: MIDTERM 2. TONE OF VOICE

1. Communication techniques • is one of the most influential elements of
2. Empathetic listening communication. There are factors in the sound of
3. Significance of nonverbal communication your voice that give meaning (conscious and
4. Verbal communication techniques unconscious) to the message you’re sending

Communication is the process of exchanging information:
sending messages back and forth between individuals or
groups of people
EFFECTIVE COMMUNICATION
Requires the following:
• The need of desire to share information
• Acceptance that there is value and merit in what the
other person has to say, demonstrated by a willingness
to treat the other person with genuine dignity and
respect
• Understanding of factors that may interfere with or
become barriers to communication
• Development of the skills and techniques that facilitate
effective interchange of information
3. BODY LANGUAGE
• Another part of nonverbal communication involves
watching for the messages that patients are
communicating to us through their body language
4. SPACE, DISTANCE, AND POSITION
• Proxemics the study of the use of personal space in
communication
• Personal space refers to how close we allow
someone to get to us before we feel uncomfortable.
• Public space - a distance of 12 feet or more away
• Social space – a distance of between 4 and12 feet
• Personal space- a distance of 18 inches to 4 feet
• A nurse who communicates from within this space is
usually viewed as concerned and interested

5. GESTURES
INFORMATION SHARING
(FRAMING THE MESSAGE) • Are a specific type of nonverbal communication
intended to convey ideas
• Verbal Communication – involves sending and
receiving messages using words. It can be formal, • Are highly cultural and generational: some that are
structured, and precise; some is informal, acceptable in one culture may be offensive in
unstructured, and flexible another
• Formal or Therapeutic Communication – have a • Are helpful for people who cannot use words.
specific intent and purpose (APHASIA)
• Informal or Social Conversations – are less
6. FACIAL EXPRESSIONS
specific and are used for socialization
• The human face is most expressive, and facial
FORMAL OR THERAPEUTIC COMMUNICATION expressions have been shown to communicate
across cultural and age barriers
• Is type of communication looks easy and natural
when performed, but it is a skill that requires time, • Humans respond to facial expressions from the time
effort, and practice to develop they are born

INFORMAL OR SOCIAL COMMUNICATION 7. EYE CONTACT

• Small talk; pleasantries; and conversations • Looking someone in the eye is perceived in our
culture and other cultures as a measure of honesty.
Eye contact is often interpreted to be a sign of
COMMUNICATION DOs and DON’Ts WHEN WORKING
attentiveness and acceptance
WITH OLDER ADULTS
DO DON’T
Identify yourself Assume that the person
knows who you are
Address the person using Use “baby talk” or
their preferred name (e.g., patronizing names such as
Mrs. Smith and Bill) “sweetie” or “honey”
Speak clearly and slowly in Shout
a low tone of voice
Get to know the person Make generalizations about
older people
Listen empathetically Pay too much attention to
tasks and forget the person
Pay attention to body Consider nonverbal
language, yours and theirs messages as insignificant
Use touch appropriately and Be afraid to use touch as a 8. PACE OR SPEED OF COMMUNICATION
frequently method of communication • The resulting difference in rate of speech and
movement
NONVERBAL COMMUNICATION • "Slower is Better "
9. TIMING
1. SYMBOLS
• Related to the pace of communication but has other
• In the health care setting, uniform styles and colors
distinct implications as well. The amount of time a
help patients distinguish the various caregivers
person must wait after seeking attention is important
1 l Transcripted for educational by: Khelzy A. De Gracia, SN
Note: For educational purpose only. No copyright infringement intended.
 10. TOUCH
• Touch is a form of communication. No words are
required, and there is no need for high level sensory
or cognitive functioning
• Caring touch is a basic need for all humans, and
many older adults suffer from touch deprivation
11. SILENCE
• Saying nothing is also saying something
• At times, no words are necessary; silence is
therapeutic
• Silence is a language too
Acceptance, dignity, and respect in communication
Effective communication starts with proper introductions.
Determine how each older adult wishes to be addressed
12. EMPATHY
• Willingness to attempt to understand the unique
world of another person.
• The ability to put oneself in another person’s place
and to understand what he or she is feeling and
thinking in that situation.
There is a reason we have two ears and only one mouth. We
are supposed to listen
BARRIERS TO COMMUNICATION
1. Hearing impairment
2. Aphasia
3. Dementia
4. Cultural differences
HEARING IMPAIRMENT
The following actions are likely to be beneficial:
1. Stand in front of the person, at eye level
2. Do not eat or drink while you are having a
conversation
3. Keep your hands away from your face when
speaking
4. Try different ways (words) of saying the same thing
5. Speak more slowly and slightly louder while
modulating the voice to a lower pitch
6. Avoid exaggerated mouth motions during speech
7. Use visual cues or written materials that support the
spoken words
APHASIA
Some commonly recommended approaches include the
following:
• Keep messages simple but adult
• Use nonverbal modes of communication, such as
picture boards, gestures, yes/no responses, and
facial expressions
• Use visual aids to support
• Try increasingly specific guesses or questions to
determine concern (e.g., is something wrong with
your meal? The coffee? It’s too hot?)
• Praise attempts to speak and avoid correcting or
criticizing errors
• Reassure the person that it is okay to be frustrated,
but avoid empty platitudes such as “you’ll be fine”
Basic Strategies for Communication with Impaired Older
Adults:
• Try not to startle the person when staring 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 variety of words or descriptions until meaning
are clear
• Ask clear, specific questions: one question at a time
• Pay attention to the emotional context of
conversation
• 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
DEMENTIA
• Causes both cognitive and language deficits. The
older person suffering from dementia has no control
over these changes
CULTURAL DIFFERENCES
• Cultural Considerations (language courses for
health care workers): Many community colleges
and multicultural centers offer special courses in
languages for health care providers. Often, these
courses are specifically designed to meet the needs
of local community. This benefits the minority
communities as well as the nurses, who have the
opportunity to become particularly desirable
employees
Some basic rules to keep in mind when working with as
interpreter include the following:
• Ask short questions and provide brief units of
information so that the interpreter does not lose the
main idea in translation
• Avoid excessively technical language
• Avoid slang, idioms, or colloquial expressions
• Encourage the interpreter to give you the response
using the patient’s own words, without input or
paraphrasing, whenever possible
• Focus on the patient, not the interpreter
• Listen for emotional tone and nonverbal clues when
the patient responds, even if you do not understand
the words
• Allow enough time
• Make sure that there is mutuality by encouraging
the patient to ask questions of the staff though the
interpreter
SKILLS AND TECHNIQUES
• Direct questioning
• Informing
• Using open-ended techniques
• Confronting
1. INFORMING
• It 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
2. DIRECT QUESTIONING
• It is best to keep communication conversational and
not too aggressive
2 l Transcripted for educational by: Khelzy A. De Gracia, SN
Note: For educational purpose only. No copyright infringement intended.
 3. USING OPEN-ENDED TECHNIQUES
• Open-ended communication techniques include
open-ended questions, reflective statements,
clarifying statements, and paraphrasing
4. DIRECT QUESTIONING
• Confronting is used when there are inconsistencies
in information or when verbal and nonverbal
messages appear contradictor.
o Confrontation is one of the most difficult
communication techniques to use and
should be used only after good rapport has
been establish
Communicating with visitors and families
“The significant others”
DELIVERING BAD NEWS
Important concepts include the following:
• Prepare yourself. Make sure you have all of the
proper 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
HAVING DIFFICULT CONVERSATIONS
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”
• Keep a balance between talking and listening. Try to
not 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 the difficult conversations are part of life and
that things do not always go right
IMPROVING COMMUNICATION BETWEEN OLDER
ADULT AND PHYSICIAN
Additional Tips for Improving Nurse-Physician
Communication:
• Work at developing professional relationships
• Know what you want to find out or report when calling
• Assume that you are both on the same team
• Report good news, not jus problems and bad news
• At some point, try to meet face to face with
physicians you speak with on the phone
• Do not seek our conflict, but be prepared that it may
happen occasionally
ISBAR EXAMPLE
• The quality of communication between nurses and
physicians can have a significant impact on the
quality-of-care older patients receive
• ISBAR-R is an acronym that stands for
Introduction, Situation, Background,
Assessment, Recommendation, and Readback
REMEMBER
Plan ahead Plan ahead and have a focus for the communication
and have
Gather Gather any assessment data you might need before calling
the physician
Know Know what you want to report or find out. Be organized,
clear, precise, and complete
Provide Provide background information
Provide Provide all necessary and relevant information that might be
needed
Identify Identify the patient by name, major diagnosis, and any
medications related to currently presenting symptoms or
concerns
Be Be prepared to clarify any data or information that the
physician may request
PATIENT TEACHING
Education plays an important role in promoting and
maintaining the health of older adults
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
• 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 strongly contrasting colors
Remember when doing Health Teaching:
1. Face older individuals when speaking. Speak clearly
2. Try to avoid microphones or amplifiers that might
distort sounds of interfere with hearing aids
3. Repeat information, and use visual cues or materials
4. Reinforce a verbal message. Reinforce verbal
information with printed material and audiovisual
aids, such as videos
5. Encourage hands-on practice. Use as many senses
as possible, but not necessarily all at once, as this
may be confusing
3 l Transcripted for educational by: Khelzy A. De Gracia, SN
Note: For educational purpose only. No copyright infringement intended.