Transcription
[Music] In this video, our subject is patient and resident rights and communication. We will discuss two concepts central to the idea of providing quality, holistic care.
The first of these concepts is communication, the process of exchanging information with others. We will introduce the sender-receiver feedback model of communication, the tactics to enhance communication, and reporting and recording.
The second concept we'll discuss is patient and resident rights, which take the form of guidelines established to protect the people we care for and which are intended to create an atmosphere of open communication among all those who are involved in a person's care.
As a nursing assistant, you must have good communication skills. You must be able to send and receive messages effectively. Not only will you rely on these skills when interacting with your patients or residents, you will rely on them when interacting with your co-workers too. In fact, although you are not trained to diagnose or treat medical problems, you will be the eyes and ears of the nurses, physical therapists, dieticians, social workers, and other members of the healthcare team. Relaying vital information about the condition of your patients or residents to these team members is an essential part of your job. By communicating effectively, you will be able to provide care that is both competent and compassionate, and you will be able to safeguard the rights of your patients and residents effectively and consistently.
[Music] Communicating is not just about telling someone something that is giving information; it is also about listening and observing, that is, receiving information. Communication involves at least two people: a sender and a receiver. The sender is the person with the information to give, and the receiver is the person for whom the information is intended. Through feedback, or a return message, the receiver lets the sender know whether the message was received and understood correctly.
There are two main ways of sending a message: verbal communication and non-verbal communication. Verbal communication is written or spoken communication, that is, information exchange based on the transmission of words. Verbal communication is generally intentional. Examples of verbal communication include having a conversation with someone, either in person or over the telephone, writing letters, and sending email.
Non-verbal communication, on the other hand, does not use words. In non-verbal communication, a person conveys information through the use of facial expressions, gestures, and body language. Unlike its verbal counterpart, non-verbal communication is often unintentional. A person may not intend to send the message, but someone watching the person receives the message anyway. Non-verbal communication can enhance or detract from verbal messages you are trying to send. For example, negative body language, such as crossing your arms, tapping your feet or fingers impatiently, or looking at your watch or toward the door, tells the other person that you are probably not interested in what he or she is saying. By exercising care in the non-verbal communication you are sending, you can be more certain that your intended message is being received by others. In much the same way, careful attention to non-verbal communication you are receiving can provide you with clues to a part of a person's message you might otherwise miss.
"How do you feel?" "You look uncomfortable." "I'm feeling a little warm and lightheaded. I think I need to sit down or I'm going to be sick." People frequently don't say what they really mean. They may be too shy to speak their mind, for instance, or may not want to be a burden to you, so they hold something back. So when, for example, a person does not complain about pain using words, he may display his pain in another non-verbal way, by grimacing, perhaps. Being observant and aware of other people's non-verbal cues will give you a greater understanding of what your patients or residents are feeling and thinking, and modifying or controlling your own non-verbal communication will greatly increase your effectiveness as a nursing assistant.
[Music] There are many tactics that you can use to enhance communication with others. Let's review four key tactics.
Tactic one: When you are the receiver, be a good listener. Watch what happens when a resident's attempt at communicating is blocked by his intended audience's lack of attention.
"Okay, now I'm just going to help you out of your belt and help you out of your robe. Seems to be getting warmer outside. I hate being cooped up in this place all the time. When I was at home, I used to get outside all the time instead of watching that darn TV. A... enjoy that sunshine. Okay, now I'm just going to help you get your legs up on your bed. Okay. Would, would you like to be out there enjoying that sunshine? The bed. Okay, now can you raise your buttock a little bit for me, please? Thank you. But can't you open the windows in this stn place? At home, I used to keep them open most all the time. Okay, now I'm just going to cover your up so you don't get a chill. Good. I'll check back in a bit. Okay, and tomorrow we'll go back to the lounge and watch that show of yours again. Okay."
"That darn TV. Oh, how'd it go with Mr. Riley? Did he enjoy going to the lounge this afternoon?"
"He always does. He got to watch a little bit of his program, got to look outside the window into the garden, and now he's resting until dinner. He sure is a talker, though. I think he enjoys going down to the lounge every day, seems to, anyway."
"Well, good. Listening is perhaps the most useful communication skill, especially in the healthcare setting. Listen actively. Give the speaker your full attention and really focus on what he or she is communicating to you. Be patient and allow for pauses in the conversation while the speaker collects his or her thoughts. When the person has finished speaking, ask questions to clarify information, information that you did not understand."
Let's look at that same situation again.
"Okay, I'm just going to help you out of your belt and your robe. Okay. It seems to be getting warmer outside. I'm sick of being cooped up inside like this. At home, I used to like getting out instead of sitting in front of that darn TV. Just get outside and enjoy the sunshine. You did. Springtime is my favorite time of year. How about you?"
"Sure doesn't feel like springtime in here, though. Feels more like an old folks' home. Maybe if I spoke to the nurse, we could start going outside when the weather's nice. Maybe you do that instead of watching TV so much."
"You... that sounds fine. You know, at home I used to keep the window open quite a bit. Maybe I can speak to her about that too. What do you think?"
"Now you're talking. How'd it go with Mr. Riley? Did he enjoy going to the lounge this afternoon?"
"I think he got a little homesick, feeling a little cooped up indoors. He said he would like to be outside on nicer days, and he asked about having his window open too. I think we could arrange something."
"Sounds like you're listening to him. Does he like to talk?"
"Yes, and I'm glad he does. I didn't realize he was getting tired of being indoors. I'm sure glad he told me."
"Well, good. The result? Better communication because the person receiving the message was focused and actively listening."
Tactic two: When you are the sender, make sure your message is clear. Let's watch what happens when a nursing assistant is sending a message that is less than clear.
"Wow, this looks nice. We've got... you say we're having rice today?"
"No, no, these are potatoes. Not rice. Tomatoes and rice? I never heard of such. When did we start having n... For heaven's sake, sounds awful."
"No, no, no. These are potatoes, green beans, and fruit."
"Okay, well, well, I suppose I'll give it a try. I don't suppose I have any choice in the matter."
"In order for communication to be effective, messages must be communicated clearly, using words that the person you are speaking to understands. One person may not be able to understand another person for a variety of reasons. Two people may not speak the same language, or one person may have a physical problem that makes certain forms of communication less effective than other methods, as in the example you've just seen, with the person who is hard of hearing. Or one person may be from a different age or cultural group and may not understand the other person's use of slang. Also, be aware that medical terminology is often unfamiliar to people who do not work in the healthcare field. When communicating with people who are having trouble understanding you, you must seek alternative ways of getting your message across."
Let's look at that same situation again.
"Wow, this looks nice. At the top of your plate, we have mashed potatoes. Okay. On your right side, we got green beans. Can you see them? Yes. Green beans. Good. At the bottom of your plate, we have... growed chicken. Oh, good. That's going to be good. And on your left side, we have mixed fruit. Oh, wonderful. Very good. Why don't we start with the fruit?"
"Facing the person directly, speaking a bit more loudly, and using hand gestures as appropriate are all effective ways of ensuring that a person with hearing loss understands your message and, as a result, is more receptive to care. Other communication aids include notepads for writing messages and medical sign boards, which are boards with pictures on them that the person can point to. If a person speaks a language different from yours, an interpreter who is fluent in both languages may be useful."
Tactic three: Learn techniques for encouraging people to talk. When you invite a person to say more, you not only gain information that could be useful, you demonstrate to the person that you care about him or her as an individual. In this example, notice the type of question that is asked and the type of answer it generates.
"Mr. Riley, are you ready to join the other residents for Bingo?"
"No."
"But you were looking forward to it, right?"
"No."
"Don't you feel up to it?"
"No."
"Is there something else you'd rather do instead?"
"No."
"A question that can be answered with a simple yes or no is called a closed question. These are the kind of questions asked by this nursing assistant, and as you saw, such questions do not lead to very informative conversations. One way you can invite a person to say more is by asking open-ended questions, that is, questions that allow a wider variety of longer answers. Another way is to rephrase what the person has told you as a question, inviting the person to elaborate. Look at how the conversation changes when the nursing assistant employs these techniques."
"Mr. Riley, all ready to join the other residents for Bingo?"
"No, but you were looking so forward to it earlier."
"I just don't feel like it, that's all."
"Don't feel like it? I used to sit with Bill Palmer. They were buddies, you know."
"That's right. You used to help each other with game pieces, didn't you?"
"Well, I'll miss Mr. Palmer tonight, but maybe we can cheer each other up by spending a little time together. You, me, and the other residents. What do you say?"
"All right. Okay."
"Okay, wait here a moment while I grab us a lap blanket. Okay."
"By avoiding questions that could be answered with a simple yes or no and by using the technique of rephrasing, the nursing assistant was able to engage the resident in the conversation, resulting in a positive outcome."
Tactic four: Be mindful of your body language. Watch the following exchange and see what unspoken messages are being communicated.
"I can hardly wait to see those grandchildren of mine."
"Oh, thank you, dear. I hope my hair's not all frizzy today. What do you think?"
"No, I think with just a little brushing, it'll look just fine. Would you like a little help?"
"Oh, thank you, dear. I wonder if I'd look nicer in that lavender blouse of mine."
"I think you might just want to stick with what you have on for your grandchildren. I think during their last visit, didn't they draw on you a little bit?"
"Oh, I see. Yes, I guess I don't want to change after all. Okay, I guess we're all set here. I'm just going to go across the hall to Mr. Crawley's room. His call button has been on for quite some time. We've been so busy today, but when your family gets here, I'll be sure to stop by and see if you need anything. Okay?"
"Uh, yes. I'll see you then. Good."
"Good listeners focus on the person who is speaking. This nursing assistant was using negative body language and was letting the speaker know, through this non-verbal communication, that she was uninterested in what the speaker had to say. Now look at the difference positive body language can make."
"I can hardly wait to see those grandchildren of mine."
"Thank you, dear. I hope my hair is not all frizzy today. What do you think?"
"No, I think with just a little brushing, we'll be just fine. Would you like a little help?"
"Oh, thank you. I wonder if I'd look nicer in that lavender blouse of mine."
"I think you might just want to stick with what you have on for your grandchildren. I think during their last visit, didn't they draw on you a little bit?"
"Oh, you're right. Maybe I better not change again after all. Okay, I think we're all set here. I'm just going to dash over to Mr. Crawley's room. His call button's been on for quite some time. We've just been so busy today, but when your family gets here, I'll be sure to stop by and see if you need anything. Okay?"
"All right. I'll see you then."
"Positioning your body so that you are at eye level with the speaker lets the person know that you are interested in what she is saying. Nodding, reacting appropriately to what the person is telling you, and indicating that you have the time to listen promote communication by making the speaker feel comfortable. Eye contact, a relaxed stance, physical proximity to the person you are talking to, and a gentle touch are all examples of positive body language that help to enhance communication."
In summary, those four key tactics for enhancing communication are: be a good listener, make sure your message is clear, learn techniques for encouraging people to talk, and be mindful of your body language.
[Music] As a nursing assistant, you will play a vital role in gathering information about the health status of patients or residents in your care, and you will use the techniques of reporting and recording to share this information with the other members of the healthcare team. By reporting and recording, you ensure that everyone who is responsible for the care of a particular patient or resident has the same information about that person's status and care.
The information you gather will come from observations you make during the course of the workday. An observation is something you notice about a patient or resident, typically related to a change in the person's physical or mental condition. Observations can be objective or subjective. Objective data are obtained through your senses and by measurements and include things you can see, such as redness or a skin rash; things you can smell, such as urine with a strong, unusual odor; things you can hear, such as wheezing when a person breathes; things you can touch, such as cool, clammy skin; and measurements that you take, such as vital signs and intake and output. Subjective data are collected through information given to you by the patient or resident, such as a complaint of pain, dizziness, or nausea.
"I'm feeling a little warm and lightheaded. I think I need to sit down or I'm going to be sick." Often, it is useful to supplement subjective observations with objective ones. Always report subjective data in the person's own words, without adding your own opinions, and report your objective data as well.
"Hi."
"Hi, Amy. I just got finished taking Mr. R's vital signs after that incident in the hallway."
"Oh, how's he doing?"
"Okay, but as we were ambulating, he said to me, 'I feel... um... very warm and lightheaded, and I think I need to sit down before I get sick.' His temperature is 99, pulse 92, respiration 16, and blood pressure 172 over 100, and his face was flushed."
"Okay, good. Well, I'm glad you told me. Sounds like you're closely observing him. Um, tell him to stay in bed, and that I will be right in to check on him. Okay?"
"Okay, I'll do that. Okay. Good. Good work. Thanks, Amy."
"The nursing assistant gathered objective facts to add to the resident's subjective statements and then organized this information in a logical way to relay it to the nurse. Not only did she tell the nurse about the resident's symptoms, she gave the nurse objective data that may help the nurse determine what is causing those symptoms. What you just saw was an example of reporting. Reporting is the spoken exchange of information about a patient or resident in your care. Nursing assistants use reporting to communicate information to the nurse. Information that is reported usually includes observations that suggest a change in the patient's or resident's condition, observations that have to do with response to treatment, complaints of pain or discomfort, refusal of treatment, and requests for clergy or other services."
In addition to reporting information, you may also be responsible for recording or charting it, which is writing the information down rather than conveying it through speech. Recording is a critical step in the process of communicating about your patients and residents with other members of the healthcare team. Recording may be done on flow sheets or in the person's medical record or chart. Remember, a medical record is a legal document detailing the care that was provided to the person in your facility. If your facility requires you to record in the medical record, make sure you follow facility policy carefully and use only approved abbreviations and terminology. Also, remember that in a liability situation, care not recorded is care not provided. That means if you fail to make a record of the care you provide, legally, it will be assumed that you did not provide that care at all.
[Music] In 1973, the American Hospital Association, or AHA, first adopted a series of statements called the Patient's Bill of Rights. These statements, which have evolved over the years along with the healthcare industry, were designed to guide the way patients, healthcare providers, and administrators of healthcare organizations, such as hospitals, interact with each other. If you work in a hospital setting, you will be responsible for helping to ensure that the rights of the patients you care for are not violated.
In 1987, a similar set of guidelines called Resident Rights was included in the Omnibus Budget Reconciliation Act, also known as OBRA. Resident Rights outlines the rights of residents of long-term care facilities. If you work in a long-term care facility, you must take care to ensure that these rights are observed and maintained.
Three rights that are common to both patients and residents are the right to privacy, the right to confidentiality, and the right to autonomy, or choice.
Privacy is the right to keep certain information and aspects of oneself away from the examination of others. Think about how you would feel if you were in a healthcare facility and needed help with things most people like to do in private, things such as getting dressed, bathing, or using the toilet. Nursing assistants help to protect their patients' and residents' right to privacy when they close the door and draw the curtain before performing procedures, and when they use bath blankets to keep the person's body covered during procedures such as giving a bed bath, assisting with perineal care, or dressing and undressing.
Patients and residents also share a right to confidentiality. Confidentiality means keeping personal information that someone shares with you to yourself. Confidentiality applies not only to spoken and observed information but also to written information. The right to confidentiality has been further reinforced by the Health Insurance Portability and Accountability Act, or HIPAA. HIPAA is a federal regulation that helps to keep personal information about a patient or resident, such as that found in a medical record, private. HIPAA regulates who has the right to see a person's medical records, data, or other private information; sets standards regarding how a person's medical information is to be stored or transmitted from one place to another; and requires that healthcare organizations set policies that allow a patient or resident to have access to his or her medical records.
Nursing assistants help to protect a person's right to confidentiality in a number of ways, specifically by only discussing a patient or resident when it is necessary to exchange information about that person's care with someone else who is directly involved in caring for that person, and by being careful about where these conversations take place, never in public areas such as the elevator; by handling medical charts properly, and this includes following the facility's policies regarding proper use of the computer if computers are used for charting; and by being aware of the facility's policies regarding proper use of the telephone and following these policies, for example, regarding what information, if any, can be given out about patients and residents over the telephone and to whom.
The third common right is the right to autonomy, or choice. Patients and residents have the right to make decisions regarding their care. Nursing assistants help patients and residents maintain their right to choice when they respect the person's personal preferences, for example, with regard to what clothing to wear or what personal care products to use. The right to autonomy also means that a patient or resident can refuse procedures and treatments. However, in such cases, the nursing assistant should always report this to the nurse immediately.
As a nursing assistant, you will play a vital role in protecting the rights of the people you care for. Central to this responsibility, and key as well to many of the other responsibilities you will have, is the ability to communicate clearly. Effective communication among the members of the healthcare team is essential to ensure that patients and residents receive top-quality, safe care that respects the rights of everyone concerned.
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