Communication and Interpersonal Skills
Types and barriers
Communication is verbal and nonverbal. Tone, facial expression, posture, and touch carry as much as words. Barriers include hearing loss, aphasia, language, culture, pain, fear, and dementia. For hearing loss, face the person, get their attention, lower your pitch, reduce background noise, and never shout from another room. For aphasia, ask yes/no questions, allow time, use pictures, and do not finish sentences out of impatience. Make sure glasses and hearing aids are on and working before you begin.
Therapeutic versus nontherapeutic
Therapeutic techniques include open-ended questions, restating, reflecting, summarizing, silence, and acknowledging feelings. Nontherapeutic: 'why' questions, false reassurance ('don't worry'), giving advice, changing the subject, judging, and medical jargon. Report objectively. Not 'she was a pain,' but 'she grimaced and pulled her arm away when I moved it.'
SBAR and documentation
Use SBAR - Situation, Background, Assessment, Recommendation - to report a change to the nurse. Documentation should be timely, factual, and in black ink; correct errors with a single line, your initials, and the date, never with white-out or erasure.
Traps
Arguing with a resident about a delusion or hallucination. Saying 'I know how you feel.' Promising something you cannot keep. Vague charting such as 'resident fine' - it says nothing and protects no one.
Rule of thumb
If a resident's words or behavior have changed, report it. The aide describes the behavior; the nurse interprets it.