Communication and Interpersonal Skills
What you must know
The nurse aide's job is to pass accurate information along and to make the resident feel understood. Know the difference between subjective information (what the resident tells you: "My back hurts") and objective information (what you observe or measure: "Resident grimaced when repositioned; pulse 92"). Chart objective facts only. Never write opinions such as "resident was being difficult."
Therapeutic techniques include active listening, open-ended questions, restating, clarifying, silence, and offering choices. Barriers include medical jargon, speaking too fast, background noise, and your own body language. With a resident who has hearing loss, face the person, get attention first, lower the pitch of your voice rather than shouting, and cut background noise. With a resident who has aphasia, ask yes/no questions, allow time, and never finish sentences for them. With a confused resident, use short sentences, one instruction at a time, validation, and redirection.
Know your reporting chain: report changes promptly to the licensed nurse. SBAR (Situation, Background, Assessment, Recommendation) organizes the call - the "assessment" you give is what you observed, not a diagnosis.
Traps
Choices that promise "always" or "never"; telling the resident not to worry; explaining a diagnosis; arguing with a delusion; giving a resident's condition or room number to an unknown caller.
Rule of thumb
When a resident makes an unrealistic statement, respond to the feeling, not the fact.
Worked example: A resident with dementia says, "My mother is coming at noon." Her mother died years ago. Do not say, "Your mother is dead." Say, "You sound like you miss your mother. Let's walk to the dining room together," then document and report the change.