Communication and Interpersonal Skills
What you must understand
Communication has a sender, a message, a channel, a receiver, and feedback. Much of the message is nonverbal - tone, posture, facial expression, and touch - and it often outweighs the words. Use active listening, open-ended questions when the resident can answer them, restating, and clarifying. Avoid medical jargon.
Adapting to the resident
- Hearing loss: face the resident, make sure lighting is on your face, speak clearly at a slightly lower pitch, reduce background noise, do not shout, and write things down if needed.
- Vision loss: identify yourself on entering, say when you are leaving, describe what you are about to do, and orient the resident to where objects are placed.
- Aphasia after a stroke: use simple yes/no or choice questions, allow time, use gestures and picture boards, and do not finish their sentences unless asked.
- Confusion: one step at a time, calm tone, no "why did you...?" questions.
- Different language: use a trained interpreter rather than a family member when possible.
Reporting
Use SBAR - Situation, Background, Assessment, Recommendation - and give facts, not opinions. "Mr. Lee is short of breath, respirations 28 and he is using his neck muscles to breathe; I think the nurse should come now" is a report. "Mr. Lee looks bad" is not.
Traps
Asking a confused resident open-ended "why" questions. Discussing the resident with family in front of them. Charting "resident seems depressed" instead of describing what you saw. Promising confidentiality you cannot keep.
Rule of thumb
Report the who, what, when, and how much, then what you think the nurse needs to do - and never chart what you did not personally see or measure.