4 Communication and Cultural Diversity 1 Define the

4 Communication and Cultural Diversity 1. Define the term communication Define the following term: communication the process of exchanging information with others by sending and receiving messages.

4 Communication and Cultural Diversity Transparency 4 -1: Communication Process

4 Communication and Cultural Diversity 1. Define the term communication Remember these points about the communication process: • All three steps must occur before the process is complete. • During a conversation the process is repeated over and over. • Effective communication is a critical part of an NA’s job.

4 Communication and Cultural Diversity 2. Explain verbal and nonverbal communication Define the following terms: verbal communication involving the use of spoken or written words or sounds. nonverbal communication communicating without using words.

4 Communication and Cultural Diversity Transparency 4 -2: Body Language

4 Communication and Cultural Diversity 2. Explain verbal and nonverbal communication Think about these questions: Are there ever conflicts between what a person is communicating verbally and nonverbally? How can an NA use observation as a form of nonverbal communication with a resident?

4 Communication and Cultural Diversity 3. Describe ways different cultures communicate Define the following term: cultural diversity the different groups of people with varied backgrounds and experiences who live together in the world. bias prejudice. culture a system of learned behaviors, practiced by a group of people, that are considered to be the tradition of that people and are passed on from one generation to the next.

4 Communication and Cultural Diversity 3. Describe ways different cultures communicate Think about this question: How might culture influence or affect communication between an NA and a resident?

4 Communication and Cultural Diversity 3. Describe ways different cultures communicate Cultural background can affect all of these communication issues: • Distance/personal space • Touch • Eye contact

4 Communication and Cultural Diversity 4. Identify barriers to communication Define the following term: cliches phrases that are used over and over again and do not really mean anything.

4 Communication and Cultural Diversity Transparency 4 -3: Barriers to Communication

4 Communication and Cultural Diversity 4. Identify barriers to communication Think about this question: What are some examples of slang expressions? Do residents and NAs have the same understanding of slang?

4 Communication and Cultural Diversity 5. List ways to make communication accurate and explain how to develop effective interpersonal relationships These techniques can help an NA communicate clearly and effectively: • Be a good listener. • Provide feedback. • Bring up topics of concern. • Allow pauses. • Tune in to other cultures.

4 Communication and Cultural Diversity 5. List ways to make communication accurate and explain how to develop effective interpersonal relationships Techniques to help an NA communicate clearly and effectively (cont’d): • Accept residents’ religion (or lack of religion). • Understand touch. • Ask for more information. • Make sure communication aids are clean and working.

4 Communication and Cultural Diversity 5. List ways to make communication accurate and explain how to develop effective interpersonal relationships REMEMBER: Providing excellent care requires good communication and also requires that NAs build effective relationships with residents, family members, and the care team.

4 Communication and Cultural Diversity 5. List ways to make communication accurate and explain how to develop effective interpersonal relationships The following tips are helpful in building positive relationships: • Avoid changing the subject. • Do not ignore requests. • Do not talk down to people. • Sit near the resident. • Lean forward to show you are interested.

4 Communication and Cultural Diversity 5. List ways to make communication accurate and explain how to develop effective interpersonal relationships Tips for building positive relationships (cont’d): • Talk directly to the resident you are assisting. • Approach the person who is talking. • Use empathy. • Show residents’ families and friends that you have time for them, too.

4 Communication and Cultural Diversity 6. Explain the difference between facts and opinions Think about this question: What are some examples of facts? Examples of opinions?

4 Communication and Cultural Diversity 6. Explain the difference between facts and opinions REMEMBER: Understanding the difference between facts and opinions will help an NA communicate her observations of residents in a more professional way.

4 Communication and Cultural Diversity 7. Explain objective and subjective information and describe how to observe and report accurately Define the following terms: objective information based on what a person sees, hears, touches, or smells; also called signs. subjective information that a person cannot or did not observe, but is based on something reported to the person that may or may not be true; also called symptoms. incontinence the inability to control the bladder or bowels.

4 Communication and Cultural Diversity Transparency 4 -4: Using Your Senses

4 Communication and Cultural Diversity 7. Explain objective and subjective information and describe how to observe and report accurately Think about this question: What are some specific observations an NA might make using each of the senses shown on the transparency (smell, sight, hearing, touch)?

4 Communication and Cultural Diversity 8. Explain how to communicate with other team members NAs should keep the following in mind when communicating with their team members: • Keep the nurse informed of all important issues during the shift. • Communicate with other care team members as needed to provide quality care. • Always respect residents’ privacy when communicating with other care team members. • Be careful with communication—do not share information about diagnoses/condition changes. • When in doubt about what you can or should communicate, ask the nurse. • Use the chain of command to voice complaints.

4 Communication and Cultural Diversity 9. Describe basic medical terminology and abbreviations Define the following terms: cyanotic skin that is blue or gray. root part of a word that contains its basic meaning or definition. prefix the word part that precedes the root to help form a new word. suffix the word part added to the end of a root that helps form a new word.

4 Communication and Cultural Diversity Handout 4 -1: Abbreviations a before AAROM active-assistive range of motion abdomen ABR absolute bedrest ac, a. c. before meals AD Alzheimer’s disease ADC AIDS dementia complex ad lib as desired ADLs activities of daily living admission AED automated external defribrillator AHA American Heart Association AIDS acquired immune deficiency syndrome AIIR airborne infection isolation room AKA above-knee amputation, also known as am, AM AMA morning against medical advice, American Medical Association ambulate, ambulatory AMD age-related macular degeneration amt. amount ANS autonomic nervous system anterior a. p. /AP apical pulse approximately AROM active range of motion ASAP as soon as possible assistance as tolerated A, T, D admission, transfer, and discharge ax axillary BID, b. i. d. two times a day

4 Communication and Cultural Diversity Handout 4 -1: Abbreviations BKA bld BLS BM BP, B/P BPH BPM BR BRP BSC BSE C c Ca/CA CAD cal cath. CBC below-knee amputation blood basic life support bowel movement blood pressure benign prostatic hypertrophy beats per minute bedrest bathroom privileges bedside commode breast self examination centigrade, Celsius with calcium, cancer, carcinoma coronary artery disease calorie catheter complete blood count CBI CBR CCMS CDC CDE C. diff CEP CEU CHD CHF chol ck cl liq cm continuous bladder irrigation complete bedrest clean-catch midstream Centers for Disease Control and Prevention certified diabetes educator clostridium difficile competency evaluation (testing) programs continuing education unit coronary heart disease congestive heart failure cholesterol check clear liquid centimeter

4 Communication and Cultural Diversity Handout 4 -1: Abbreviations CMS CNA CNP CNS c/o CO 2 COLD COPD CP CPM CPR CRF C. S. CSF Centers for Medicare and Medicaid Services certified nursing assistant certified nurse practitioner central nervous system complains of, in care of carbon dioxide chronic obstructive lung disease chronic obstructive pulmonary disease cerebral palsy continuous passive motion cardiopulmonary resuscitation chronic renal failure Central Supply cerebrospinal fluid CVA CVP CVS CXR DAT DJD DKA DM DNR DO DOA DOB DON Dr. DRG drsg DVT Dx/dx cerebrovascular accident, stroke central venous pressure cardiovascular system chest x-ray diet as tolerated degenerative joint disease diabetic ketoacidosis diabetes mellitus do not resuscitate doctor of osteopathy dead on arrival date of birth director of nursing doctor diagnostic related group dressing deep vein thrombosis diagnosis

4 Communication and Cultural Diversity Handout 4 -1: Abbreviations ECG, EKG electrocardiogram ED emergency department EENT eye, ear, nose, and throat e. g. for example EMS emergency medical services ER emergency room ESRD end-stage renal disease et al. and other things ETOH alcohol examination F Fahrenheit, female FBS fasting blood sugar FDA Food and Drug Administration Fe iron FF force fluids FH family history fld fluid FS FSBS ft F/U, f/u FUO FWB fx FYI GAD gal GB GERD fingerstick blood sugar foot follow-up fever of unknown origin full weight-bearing fracture for your information generalized anxiety disorder gallon gallbladder gastroesophageal reflux disease geri chair geriatric chair GI gastrointestinal Gm, gm gram GP general practitioner GSW gunshot wound GTT glucose tolerance test

4 Communication and Cultural Diversity Handout 4 -1: Abbreviations GU GYN/gyn h, hr. H 202 H/A HAART HAV HBV HCV HDV HEV Hg HHA Hi-cal HIPAA genitourinary gynecology hour water hydrogen peroxide headache highly active antiretroviral therapy hepatitis A virus hepatitis B virus hepatitis C virus hepatitis D virus hepatitis E virus mercury home health aide high calorie Health Insurance Portability and Accountability Act HIV HMO HOB HOH H&P HPV HS/hs ht HTN H. U. C. Hx hyper hypo IBD IBS human immunodeficiency virus health maintenance organization head of bed hard of hearing history and physical human papillomavirus hours of sleep height hypertension Health Unit Coordinator history above normal, too fast, rapid low, less than normal irritable bowel disease irritable bowel syndrome

4 Communication and Cultural Diversity Handout 4 -1: Abbreviations IICU intermediate intensive care unit ICU intensive care unit ID identification I&D incision and drainage i. e. that is IM intramuscular In inch incontinent inferior I&O intake and output IQ intelligence quotient irr. , irrigation isolation I. V. , IV intravenous K+ potassium kg kilogram KS Kaposi’s sarcoma l liter L left lab lb LBP LE lg liq LLE LLQ LOC laboratory pound low back pain lower extremity large liquid left lower extremity left lower quadrant level of consciousness, level of care Low-cal low-calorie Low-fat/ low-fat, low-calorie Low-cal Low-Na low-sodium LPN Licensed Practical Nurse lt left LTC long-term care LTCF long-term care facility LUQ left upper quadrant

4 Communication and Cultural Diversity Handout 4 -1: Abbreviations LVN M. D. MD MDROs Licensed Vocational Nurse medical doctor muscular dystrophy multidrug-resistant organisms MDR-TB multidrug-resistant tuberculosis MDS minimum data set meds medications med-surg medical-surgical mg milligram MI myocardial infarction minute m. L milliliter mm millimeter mm Hg millimeters of mercury MO microorganism moderate MRI MRSA magnetic resonance imaging methicillin-resistant staphylococcus aureus MS multiple sclerosis MSDs musculoskeletal disorders MSDS material safety data sheet MSW medical social worker MUFA monounsaturated fat MVA motor vehicle accident Na sodium N/A not applicable NA nursing assistant Na. Cl sodium chloride NAS no added salt NATCEP Nurse Aide Training and Competency Evaluation Program N/C no complaints, no call NCS no concentrated sweets

4 Communication and Cultural Diversity Handout 4 -1: Abbreviations neg NF NG, ng NIBP NKA NKDA no noc NPO NVD NWB O 2 OB ob/gyn OBRA occ negative nursing facility nasogastric non-invasive blood pressure monitoring no known allergies no known drug allergies number night nothing by mouth nausea, vomiting, and diarrhea non-weight-bearing oxygen obstetrics and gynecology Omnibus Budget Reconciliation Act occasionally OCD OD O. D. OG OOB O&P OPD O. R. ord. ORIF ortho os O. S. OSHA OT obsessive-compulsive disorder overdose right eye orogastric out of bed ova and parasites outpatient department operating room orderly, ordered open reduction, internal fixation orthopedics mouth left eye Occupational Safety and Health Administration occupational therapist, occupational therapy

4 Communication and Cultural Diversity Handout 4 -1: Abbreviations OTC over-the-counter (medication) O. U. both eyes oz ounce p after P. A. physician’s assistant PAD peripheral artery disease pc, p. c. after meals PCA patient-controlled anesthesia PDR Physician’s Desk Reference PE pulmonary embolism Peds/peds pediatrics PEG percutaneous endoscopic gastrostomy peri care perineal care per os by mouth PET positron emission tomography p. H parts hydrogen PH past history PHI protected health information phy. ex. physical exam PID pelvic inflammatory disease PM/pm afternoon PMH past medical history PNS peripheral nervous system PO (per os) by mouth positive post op after surgery PPD purified protein derivative (test for tuberculosis) PPE personal protective equipment pre op before surgery preparation

4 Communication and Cultural Diversity Handout 4 -1: Abbreviations p. r. n. , prn when necessary prog. Progress PROM passive range of motion Pt/pt patient pt. pint PT physical therapist, physical therapy PTH parathyroid hormone PTSD post-traumatic stress disorder PUFA polyunsaturated fat PVD peripheral vascular disease PWB partial weight-bearing q every q 2 h, q 3 h, every two hours, q 4 h every three hours, every four hours QA quality assurance Q&A questions and answers qam qd qh, qhr qhs q. o. d. qt. quad R R, rt. RA RBC RDT reg. rehab REM req. resp. RF RLE every morning every day every hour every night at bedtime every other day quart quadrant, quadriplegic respirations, rectal right rheumatoid arthritis red blood cell registered dietician regular rehabilitation rapid eye movement requisition resident respiration restrict fluids right lower extremity

4 Communication and Cultural Diversity Handout 4 -1: Abbreviations RLQ RN RNA R/O ROM RR R/rt. RT RUE RUQ Rx s S&A s. c. SCA SCDs SIDS right lower quadrant registered nurse restorative nursing assistant rule out range of motion respiratory rate right respiratory therapy/therapist right upper extremity right upper quadrant prescription, treatment without sugar and acetone subcutaneously sudden cardiac arrest sequential compression devices sudden infant death syndrome sl SLE sublingually systemic lupus erythematosus SLP speech-language pathologist sm. small SNAFU situation normal, all fouled up (slang) SNF skilled nursing facility SNS somatic nervous system SOB shortness of breath SP Standard Precautions S. P. D. Supply, Processing, and Distribution specimen ss one-half S&S, S/S signs and symptoms SSE soapsuds enema ST standard, speech therapy staphylococcus

4 Communication and Cultural Diversity Handout 4 -1: Abbreviations STAT/stat immediately Std prec Standard Precautions STDs sexually-transmitted diseases STIs sexually-transmitted infections streptococcus suppository surgery T. , temperature TB tuberculosis tbsp. tablespoon T, C, DB turn, cough, and deep breathe THR total hip replacement TIA transient ischemic attack t. i. d. , tid three times a day TKR total knee replacement TLC tender loving care TPN T. P. R. trach. tsp. TWE Tx, tx U/A, u/a UE UGI UNK, unk URI US USDA UTI vag. VAP total parenteral nutrition temperature, pulse, and respiration tracheostomy teaspoon tap water enema traction, treatment urinalysis upper extremity upper gastrointestinal unknown upper respiratory infection ultrasound United States Department of Agriculture urinary tract infection vaginal ventilator-acquired pneumonia

4 Communication and Cultural Diversity Handout 4 -1: Abbreviations VD VRE venereal disease vancomycin-resistant enterococcus VS, vs vital signs W/A, WA while awake WBC white blood cell/count w/c, W/C wheelchair WNL within normal limits wt. weight yr. year

4 Communication and Cultural Diversity Handout 4 -2: Prefixes, Roots, Suffixes Prefixes a, an: without, not, lack of analgesic = without pain ante: before, in front of antepartum = before delivery bi: two, twice, double bifocal = two lenses brady: slow bradycardia = slow pulse, heartbeat contra: against contraceptive = prevents pregnancy dis: apart, free from disinfected = free from microorganisms dys: bad, painful dysuria = painful urination endo: inner endoscope = instrument for examining the inside of an organ epi: on, upon, over epidermis = outer layer of skin erythro: red erythrocyte = red blood cell ex: out, away from exhale = to breathe out hemi: half hemisphere = one of two parts of the brain hyper: too much, high hypertension = high blood pressure

4 Communication and Cultural Diversity Handout 4 -2: Prefixes, Roots, Suffixes Prefixes (cont’d) hyper: too much, high hypertension = high blood pressure hypo: below, under hypotension = low blood pressure inter: between, within interdisciplinary = between disciplines leuk: white leukocyte = white blood cell mal: bad, illness, disorder malformed = badly made micro: small microscopic = too small for the eye to see olig: small, scant oliguria = small amount of urine patho: disease, suffering pathology = study of disease per: by, through perforate = to make a hole through peri: around pericardium = sac around the heart poly: many, much polyuria = much urine post: after, behind postmortem = period after death

4 Communication and Cultural Diversity Handout 4 -2: Prefixes, Roots, Suffixes Prefixes (cont’d) pre: before, in front of prenatal = period before birth sub: under, beneath subcutaneous = beneath the skin supra: above, over suprapelvic = located above the pelvis tachy: swift, fast, rapid tachycardia = rapid heartbeat

4 Communication and Cultural Diversity Handout 4 -2: Prefixes, Roots, Suffixes Roots brachi(o): arm abdomin(o): abdomen brachial = pertaining to the arm abdominal = pertaining to the abdomen bronchi, bronch(o): bronchus aden(o): gland bronchopneumonia = inflammation of lungs adenitis = inflammation of a gland card, cardi(o): heart angi(o): vessel cardiology = study of the heart angioplasty = surgical repair of a vessel using a balloon cephal(o): head arterio: artery arteriosclerosis = hardening of artery walls arthr(o): joint arthrotomy = cut into a joint cephalalgia = headache cerebr(o): cerebrum cerebrospinal = pertaining to the brain and spinal cord

4 Communication and Cultural Diversity Handout 4 -2: Prefixes, Roots, Suffixes Roots (cont’d) cyan(o): blue chole, chol(o): bile cyanosis = blue, gray, or purple tinge to the skin due to lack of oxygen in the blood cholecystitis = inflammation of the gall bladder colo: colonoscopy = examination of the large intestine or colon with a scope cost(o): rib costochondral = pertaining to a rib crani(o): skull craniotomy = cutting into the skull cyst(o): bladder, cystitis = inflammation of the bladder derm, derma: skin dermatitis = inflammation of the skin duoden(o): duodenum duodenal = pertaining to the duodenum, the first part of the small intestine

4 Communication and Cultural Diversity Handout 4 -2: Prefixes, Roots, Suffixes Roots (cont’d) gyneco, gyno: woman encephal(o): brain gynecology = study of diseases of the female reproductive organs encephalitis = inflammation of the brain hema, hemato, hemo: blood gaster(o), gastro: stomach hematuria = blood in the urine gastritis = inflammation of the stomach hepato: liver geron: aged hepatomegaly = enlargement of the liver gerontology = study of the aged hyster(o): uterus gluco: sweet hysterectomy = surgical removal of the uterus glucometer = device used to measure blood glucose glyco, glyc: sweet glycosuria = glucose (sugar) in the urine

4 Communication and Cultural Diversity Handout 4 -2: Prefixes, Roots, Suffixes Roots (cont’d) mast(o): breast ile(o), ili(o): ileum mastectomy = excision of the breast ileorrhaphy = surgical repair of the ileum laryng(o): larynx laryngectomy = excision of the larynx lymph(o): lymphocyte = type of white blood cell mamm(o): breast mammogram = x-ray of the breast melan(o): black melanoma = mole or tumor, may be cancerous mening(o): meninges; membranes covering the spinal cord and brain meningitis = inflammation of the membranes of the spinal cord or brain necro: death necrotic = dead tissue

4 Communication and Cultural Diversity Handout 4 -2: Prefixes, Roots, Suffixes Roots (cont’d) ot(o): ear nephr(o): kidney otology = science of the ear nephrectomy = removal of a kidney pharyng(o): pharynx pharyngitis = inflammation of the throat, sore throat neur(o): nerve neuritis = inflammation of a nerve onc(o): tumor oncology = study of tumors ophthalm(o): eye ophthalmologist = eye doctor phleb(o): vein phlebitis = inflammation of a vein pneo/pnea: breathing tachypnea = rapid breathing pneum: air, gas, respiration oste(o): bone pneumonia = inflammation of the lung osteoarthritis = disease of the joints pod(o): foot podiatrist = foot doctor

4 Communication and Cultural Diversity Handout 4 -2: Prefixes, Roots, Suffixes Roots (cont’d) thorac(o): chest proct(o): anus, rectum thoracotomy = incision into chest wall proctology = study of the rectum pulm(o): lung pulmonary = relating to the lungs splen(o): spleen splenomegaly = enlarged spleen stomat(o): mouth stomatitis = inflammation of mouth therm(o): hot, heat thermoplegia = heatstroke thromb(o): blood clot thrombus = blood clot blocking a vessel toxic(o), tox(o): poison toxicology = study of poisons trache(o): trachea, windpipe tracheostomy = incision to make an artificial airway urethr(o): urethra urethritis = inflammation of urethra

4 Communication and Cultural Diversity Handout 4 -2: Prefixes, Roots, Suffixes -itis: inflammation -cyte: cell stomatitis = inflammation of the mouth leukocyte = white blood cell -ectomy: excision, removal of splenectomy = removal of spleen -emesis: vomiting hyperemesis = excessive vomiting -emia: blood condition anemia = lack of red blood cells -ism: a condition hyperthyroidism = condition caused by an excessive production of thyroid hormones -logy: study of hematology = study of the blood -megaly: enlargement splenomegaly = enlarged spleen -oma: tumor melanoma = mole or tumor, may be cancerous -osis: condition halitosis = bad breath

4 Communication and Cultural Diversity Handout 4 -2: Prefixes, Roots, Suffixes (cont’d) -ostomy: creation of an opening ileostomy = creation of an opening into the ileum -phagia: to eat dysphagia = difficulty swallowing -phasia: speaking aphasia = absence of speaking -otomy: cut into -phobia: exaggerated fear laparotomy = cutting into the abdomen acrophobia = fear of high places -pathy: disease -plasty: surgical repair myopathy = disease of the muscle angioplasty = surgical repair of a vessel using a balloon -penia: lack -plegia: paralysis leukopenia = a lack of white blood cells paraplegia = paralysis of lower portion of the body -rrhage: excessive flow hemorrhage = excessive flow of blood

4 Communication and Cultural Diversity Handout 4 -2: Prefixes, Roots, Suffixes (cont’d) -scopy: examination using a scope colonoscopy = examination of the large intestine or colon with a scope -stomy: creation of an opening colostomy = opening into the colon -tomy: incision, cutting into thoracotomy = incision into chest wall -uria: condition of the urine dysuria = painful urination

4 Communication and Cultural Diversity 10. Explain how to give and receive an accurate report of a resident’s status All • • of the following occurrences should be reported immediately: Falls Chest pain Severe headache Difficulty breathing Abnormal pulse, respiration, or blood pressure Change in mental status Sudden weakness or loss of mobility

4 Communication and Cultural Diversity 10. Explain how to give and receive an accurate report of a resident’s status Occurrences to report immediately (cont’d): • High fever • Loss of or change in consciousness • Bleeding • Change in condition • Signs of abuse

4 Communication and Cultural Diversity 10. Explain how to give and receive an accurate report of a resident’s status REMEMBER: An NA must use facts, not opinions, in making reports.

4 Communication and Cultural Diversity 10. Explain how to give and receive an accurate report of a resident’s status Think about this question: Why should an NA make written notes about reports given to a supervisor?

4 Communication and Cultural Diversity 10. Explain how to give and receive an accurate report of a resident’s status An NA should document the following about an oral report: • When • Why • About what • To whom

4 Communication and Cultural Diversity 11. Explain documentation and describe related terms and forms A medical chart is a legal record of a resident’s care. It includes the following information: • Admission sheet • Resident’s medical history • Doctor’s orders • Progress notes • Lab/test results • Graphic sheet • Nurse’s notes • Flow sheet/ADL sheet (see Figure 4 -9, p. 42 of text)

4 Communication and Cultural Diversity 11. Explain documentation and describe related terms and forms Current documentation is very important for many reasons: • Guarantees clear and complete communication • Provides legal record of treatment • Protects NA and employer • Provides up-to-date record of resident’s status

4 Communication and Cultural Diversity 11. Explain documentation and describe related terms and forms NAs should always follow these guidelines for documentation: • Document care immediately after it is given. • Think before writing. Be brief and clear. • Use facts, not opinions. • Write neatly with black ink. • Correct errors properly (see Figure 4 -10, p. 43 of text). • Sign full name and title. • Document per care plan.

4 Communication and Cultural Diversity 11. Explain documentation and describe related terms and forms REMEMBER: If something is not documented, legally speaking it was not done. It is very important for NAs to document carefully, and immediately after care is given.

4 Communication and Cultural Diversity Transparency 4 -5: 24 -hour Clock

4 Communication and Cultural Diversity 11. Explain documentation and describe related terms and forms These guidelines are helpful when converting regular time to military time: • To change the regular hours between 1: 00 p. m. to 11: 59 p. m. to military time, add 12 to the regular time. • Minutes and seconds do not change. • Midnight may be written as 0000 or 2400; NAs should follow facility policy.

4 Communication and Cultural Diversity 12. Describe incident reporting and recording Define the following terms: incident an accident, problem, or unexpected event during the course of care that is not part of the normal routine in a healthcare facility. sentinel event an accident or incident that results in grave physical or psychological injury or death.

4 Communication and Cultural Diversity 12. Describe incident reporting and recording The following events are considered incidents: • Falls • Damage • Mistakes in care • Requests outside scope of practice • Sexual advances or remarks • Unsafe or uncomfortable situations • Injuries • Blood or body fluids exposure

4 Communication and Cultural Diversity 12. Describe incident reporting and recording NAs must follow these guidelines for incident reporting: • Tell what happened. • Tell how the person tolerated the incident. • State facts only. • Do not write about anything in the incident report on the medical record. • Describe action taken. • Include suggestions for change.

4 Communication and Cultural Diversity 13. Demonstrate effective communication on the telephone Effective telephone communication involves the following steps: • Identify yourself politely before asking to speak to someone. • Ask for the person with whom you need to speak. • State the reason for your call. • Leave a brief message if the person you are calling is not available. • Thank the person who takes the message for you.

4 Communication and Cultural Diversity 13. Demonstrate effective communication on the telephone The following steps are important when answering the telephone: • Identify the facility’s name, self, and position. • Place caller on hold if necessary. • Write down messages. Ask for correct spelling of names. Get a number. • Say, “Thank you, ” and “Goodbye. ”

4 Communication and Cultural Diversity 13. Demonstrate effective communication on the telephone REMEMBER: NAs should never give out information about staff or residents over the phone.

4 Communication and Cultural Diversity 14. Understand guidelines for basic office machines and computers The following office machines may be in use at LTCFs: • Photocopier • Fax machine • Calculator • Computer

4 Communication and Cultural Diversity 14. Understand guidelines for basic office machines and computers REMEMBER: HIPAA privacy guidelines apply to computer use. If a facility uses computers for documentation, the NAs must make sure that nobody can see private information on the screen.

4 Communication and Cultural Diversity 15. Explain the resident call system REMEMBER: An NA must always answer call lights, no matter what. Call lights must be left within residents’ reach and answered promptly every time the resident pushes the button.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs Define the following terms: impairment a loss of function or ability. farsightedness the ability to see objects in the distance better than objects nearby; also known as hyperopia. nearsightedness the ability to see things near but not far; also known as myopia.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs Define the following terms: cerebrovascular accident (CVA) a condition that occurs when blood supply to a part of the brain is blocked or a blood vessel leaks or ruptures within the brain; also called a stroke. hemiplegia paralysis on one side of the body. hemiparesis weakness on one side of the body.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs Define the following terms: expressive aphasia slurred speech or an inability to speak. receptive aphasia inability to understand spoken or written words. emotional lability laughing or crying without any reason, or when it is inappropriate.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs Define the following terms: dysphagia difficulty swallowing. combative violent or hostile behavior.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs The following guidelines are important when communicating with residents with hearing impairment: • Make sure hearing aid is on and working. Clean hearing aid as instructed. • Reduce or remove noise. • Get residents’ attention first. • Speak clearly, slowly, and in good lighting. • Do not shout or mouth words in an exaggerated way. • Lower pitch of voice. • Keep hands away from face while talking.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs Guidelines for communicating with residents with hearing impairment (cont’d): • Speak to side with better hearing. • Use short sentences and simple words. • Repeat what was said using different words if necessary. • Use picture cards or notepads. • Be patient and empathetic. • Ask resident to repeat what was said when necessary. Observe body language. • Be understanding and supportive.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs The following guidelines are important when communicating with residents with vision impairment: • Make sure eyeglasses are on, clean, and in good condition. • Identify self when entering room. • Make sure there is proper lighting. Face resident when speaking. • Orient residents to new areas. • Use imaginary clock as a guide. • Tell resident what you are doing. Talk directly to resident. • Do not move items. Put anything you move back where it was found.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs Guidelines for communicating with residents with vision impairment (cont’d): • Tell resident where the call light is. • Leave door completely open or closed. • When assisting resident with walking, walk slightly ahead, letting resident grasp your arm. • Encourage use of other senses. • Use large clocks or clocks that chime. • Offer large-print books, audio books, digital books, and Braille books if necessary. • Do not play with guide dogs.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs The following guidelines are important when communicating with residents who have experienced CVA/stroke: • Keep questions and directions simple. • Phrase questions that can be answered with a “yes” or “no. ” • Agree on signals. • Give residents plenty of time to respond. • Use a pencil and paper if possible.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs Guidelines for communicating with residents who have experienced CVA/stroke (cont’d): • Use terms weaker or involved to refer to affected side. • Keep call light within reach. • Use verbal and nonverbal communication. • Use communication boards or special cards.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs REMEMBER: Even if residents are not able to speak, it is important that care team members not talk about them as if they are not there.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs The following guidelines are important when communicating with residents who are demonstrating combative behavior: • Block blows or step out of way. • Allow the resident time to calm down before the next interaction. • Ensure resident is safe and give him space. • Remain calm. Lower tone of voice. • Be flexible and patient. • Stay neutral. Do not respond to verbal attacks or argue. • Do not use gestures that could frighten or startle resident. • Be reassuring and supportive. • Consider what provoked the resident.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs The following guidelines are important when communicating with residents who are demonstrating angry behavior: • Stay calm. • Do not respond to verbal attacks or argue. • Empathize. • Try to find out cause. • Be respectful. Explain what you are going to do. • Answer call lights promptly. • Stay at a safe distance.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs There is a difference between assertive and aggressive behavior. A person is behaving assertively when he • Expresses thoughts, feelings, and beliefs in a direct and honest way. • Respects his own needs and feelings and those of other people. A person is behaving aggressively when he • Expresses thoughts, feelings, and beliefs in ways that humiliate, disgrace, or overpower the other person. • Shows little or no respect for the needs or feelings of others.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs REMEMBER: NAs should report aggressive behavior from residents.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs The following guidelines are important when communicating with residents who are demonstrating inappropriate behavior: • Report behavior. • Be professional and do not overreact. • Try distraction. • Gently direct resident to private area.

4 Communication and Cultural Diversity 16. List guidelines for communicating with residents with special needs REMEMBER: An NA must never hit a resident, no matter how the resident behaves. Hitting is considered abuse and may result in termination and/or legal action.

4 Communication and Cultural Diversity Exam Multiple Choice. Choose the correct answer. 1. What is the correct order of the three-step communication process? (A) Sender sends message. Receiver receives message. Receiver provides feedback. (B) Receiver sends message. Receiver receives message. Sender provides feedback. (C) Sender sends message. Sender receives message. Receiver provides feedback. (D) Receiver sends message. Receiver receives message. Receiver provides feedback. 2. Which of the following is an example of nonverbal communication? (A) Asking for a cookie (B) Pointing to a cookie (C) Writing a note requesting a cookie (D) Shouting for a cookie

4 Communication and Cultural Diversity Exam 1. Types of verbal communication include (A) Reading (B) Nodding one’s head (C) Crossing one’s arms (D) Writing 2. Which of the following is an example of a barrier to communication? (A) NA uses medical terminology with the resident. (B) NA asks the resident to repeat a sentence. (C) NA speaks the same language as the resident. (D) NA speaks clearly using a professional tone of voice.

4 Communication and Cultural Diversity Exam 1. Which of the following are ways for NAs to avoid barriers to communication? (A) The NA should use slang so that the resident understands more easily. (B) The NA should respond with “Why? ” when resident makes a statement. (C) The NA should use medical terminology when talking with the resident so the resident will more easily understand his condition. (D) The NA should ask open-ended questions that require more than yes or no responses. 2. An example of active listening is (A) NA looking around the room while the resident is speaking (B) NA finishing the resident’s sentences to make communication faster (C) NA focusing on the resident and providing feedback (D) NA talking constantly so that there are no pauses in the conversation

4 Communication and Cultural Diversity Exam 1. Which of (A) Mrs. (B) Mrs. (C) Mrs. (D) Mrs. 2. Which of the following is an example of objective information? (A) “Mrs. Johnson says she has a rash on her torso. ” (B) “There are raised, red marks the size of pinpricks on Mrs. Johnson’s torso. ” (C) “Mrs. Johnson must have a rash because she looks uncomfortable. ” (D) “Mrs. Johnson needs some lotion. ” the following statements is an example of a fact? Silva needed help to get to the bathroom today. Silva needs more friends. Silva looks happy when her daughter visits. Silva is too thin.

4 Communication and Cultural Diversity Exam 1. Why is it important for an NA to consider a resident’s cultural background when communicating with him? (A) It is not important to consider cultural background. (B) Because the resident will certainly want to tell stories about his culture. (C) Because the NA might know somebody with the same background and she can tell the resident about that person. (D) Because cultural background helps determine how people communicate and can help the NA communicate better with the resident. 2. What is a proper way for an NA to respond if a resident does not hear her or does not understand her? (A) The NA should speak more quickly. (B) The NA should speak more softly or whisper. (C) The NA should speak slowly and clearly. (D) The NA should shout.

4 Communication and Cultural Diversity Exam 1. Which of the following statements is true of touch? (A) All people like to be touched. (B) Nursing assistants do not need to touch residents. (C) Nursing assistants can softly pat residents’ shoulders to communicate caring. (D) All residents will feel more comfortable when there is little physical contact. 2. Positive responses to cultural diversity include (A) Valuing and respecting each person as an individual (B) Seeing all people from a certain culture as being the same (C) Preferring people of one culture over those of other cultures (D) Making assumptions about a person based on stereotypes about their culture

4 Communication and Cultural Diversity Exam 1. Which of the following senses is not used in making observations? (A) Sight (B) Touch (C) Smell (D) Taste 2. With whom should nursing assistants use medical terms and abbreviations? (A) Residents (B) Nurses (C) Residents’ friends (D) Visitors

4 Communication and Cultural Diversity Exam 1. Which of the following should an NA report about a resident to the nurse immediately? (A) Family fighting (B) Chest pain, high fever (C) Watching too much TV (D) Acting lonely 2. The part of the word that is added to the end of a root to form a new word is called a(n) (A) Root (B) Prefix (C) Suffix (D) Abbreviation

4 Communication and Cultural Diversity Exam 1. When should documentation be recorded? (A) Immediately after care is given (B) At the end of the shift (C) Whenever there is time (D) Before the care is given 2. Careful charting is important because (A) The NA does not want to get in trouble. (B) The resident must be able to read the chart. (C) The family will want to take the chart home regularly to study it. (D) It is the only way to guarantee clear and complete communication among the care team.

4 Communication and Cultural Diversity Exam 1. Which of the following shows the correct conversion of 0530 to regular time? (A) 12: 30 a. m. (B) 12: 30 p. m. (C) 5: 30 a. m. (D) 5: 30 p. m. 2. Which of the following shows the correct conversion of 2: 35 p. m. to military time? (A) 2435 hours (B) 1435 hours (C) 2235 hours (D) 1235 hours

4 Communication and Cultural Diversity Exam 1. Which of the following occurrences is considered an incident and requires a report to be completed? (A) A resident uses the call light frequently. (B) A resident yells at a family member. (C) A resident accuses an NA of abusing her. (D) The NA arrives 10 minutes late to work. 2. Which of the following is an example of proper telephone communication at work? (A) “Good morning, Linda Manor Care Facility, Susan Jones speaking. ” (B) “We’re all really busy right now. You’ll have to call back later. ” (C) “Sandra is not working today. Her cell phone number is 555 -1212. ” (D) “Jeanie no longer works here. She was fired two months ago. ”

4 Communication and Cultural Diversity Exam 1. A nursing assistant may ignore a resident’s call light when (A) The resident uses it too often for unimportant reasons (B) The nursing assistant has had conflict with the resident in the past (C) The nursing assistant just finished giving care to that resident (D) Never 2. Why must an NA be concerned about privacy if documentation is done on a computer? (A) Because it is common for computer hackers to target long-term care facilities (B) Because the federal government is monitoring all computers in LTC facilities to ensure that HIPAA is followed (C) Because residents will probably try to sneak a look at other residents’ information (D) Because the information is confidential and somebody who is not part of the care team might see the screen

4 Communication and Cultural Diversity Exam 1. If a (A) (B) (C) (D) 2. One way that an NA can help a resident who is visually impaired is to (A) Move the furniture to make it easier for the resident to get around (B) Keep the lights very low (C) Use the face of an imaginary clock to explain the position of objects (D) Walk behind the resident, lightly pushing the client forward resident has a hearing impairment, the NA should Face away from the resident when speaking Face the resident with the light on the NA’s face Shout so that the resident can hear the NA Exaggerate the words so that the resident can read the NA’s lips

4 Communication and Cultural Diversity Exam 1. What can a nursing assistant do to help with communication with a resident who has had a stroke? (A) The NA should ask questions that require longer answers to help keep the resident mentally active. (B) The NA should refuse to use pictures to communicate so that the resident will be motivated to speak more. (C) The NA should talk constantly so the resident won’t feel uncomfortable if speaking is difficult for him. (D) The NA should use smiles or gestures to convey information.

4 Communication and Cultural Diversity Exam 1. What is the best way a nursing assistant can respond to a combative resident? (A) The NA should tell the resident that he will be discharged from the facility if he does not stop what he is doing. (B) The NA should let the resident know that other NAs will refuse to care for him if he continues the behavior. (C) The NA should remain calm and lower the tone of her voice. (D) The NA should stand as close as possible to the resident. 2. Why is it important for a nursing assistant not to overreact when a resident behaves inappropriately? (A) It may actually reinforce the behavior. (B) Other residents may then copy the behavior. (C) The NA’s supervisor will be angry with him. (D) The NA might surprise the resident.

4 Communication and Cultural Diversity CHAPTER 4 PRACTICE 1. When should documentation be recorded? (A) Immediately after care is given (B) At the end of the shift (C) Whenever there is time (D) Before the care is given 2. Which of the following is an example of a barrier to communication? (A) NA uses medical terminology with the resident. (B) NA asks the resident to repeat a sentence. (C) NA speaks the same language as the resident. (D) NA speaks clearly using a professional tone of voice. 3. Which of the following senses is not used in making observations? (A) Sight (B) Touch (C) Smell (D) Taste

4 Communication and Cultural Diversity CHAPTER 4 PRACTICE 1. A-IMMEDIATELY AFTER CARE IS GIVEN 2. A- NA USES MEDICAL TERMINOLOGY WITH THE RESIDENT 3. D- TASTE