Posted: 10/19/2020 5:25:31 PM

Communication Barriers and the CNA’s Voice

In a single journey within the healthcare system, a patient receives care from different workers across many disciplines. Many teams work together. To reach optimal patient experience, communication among healthcare workers is vital.

Communication failure is one of the leading causes of accidents, errors, and other untoward events that usually lead to patient harm, according to the Joint Commission for Hospital Accreditation. Other than that, it also leads to conflicts, stress, and low morale among staff.

Have you witnessed any untoward events such as patient harm because of miscommunication among healthcare team members? How did it go? What happened to the patient?

As a CNA, you can help avoid mistakes caused by poor communication by first knowing what causes it and then doing your part to prevent it.

Barriers to effective communication and what the nursing assistant can do:

1. Culture of accepting faulty communication.

Let’s try to recall your days as a newbie when you were introduced to terms that were not in your nursing books. These terms make sense to only a few people who understand their hidden meaning. Like codes, you’re supposed to know what they mean.

You probably just got used to it without attempting to correct that practice. An example is saying, "We have a hit" to mean 'a newly admitted patient'. A study says healthcare workers tend to accept this culture, which makes them ignore red flags.

What you should do: Avoid using slang terms that are only known to a certain number of people. Be precise to avoid confusion.

2. Personality differences.

Some personality types tend to keep to themselves and leave their observations unsaid, assuming that other members of the healthcare team who are 'more knowledgeable' and in authority would notice anyway. Also, staff with low self-esteem may find it difficult to approach a supervisor to express their thoughts.

What you should do: If you are the shy and introvert type of person, it helps to remember that you are obliged to report any observations that concern the patient. If you know someone in your team who is always reluctant to speak up, encourage them to express their thoughts, and provide reassurance.

3. Fear.

Many nursing assistants are hesitant to speak their mind mainly because they believe that they don’t have the voice to do so and that their opinions don't matter. They fear being ridiculed and judged for saying what’s on their mind. It’s an instinct of self-preservation that tries to protect oneself, of avoiding trouble, but at the expense of the patient.

What you should do: The best approach to this dilemma is to not be a part of a bullying culture. Be on the side that truly cares for what others have to say. Help them overcome their fear by engaging them in conversations and regularly asking for their feedback.

4. Cultural differences.

With the US' growing ethnic and cultural diversity, miscommunication becomes more common as the healthcare sector employs people from different cultural backgrounds. Some may not have a firm grasp of the English language, which could be a huge barrier to effective communication.

Assertive co-workers may give constructive criticisms, and staff from a more conservative culture may view this as too bold and rude. So instead of accepting the feedback, they tend to ignore it.

On the other hand, being timid may be regarded as incompetence. Conflicts and misunderstandings arise because of these differences, and patient care suffers.

What you can do: Acknowledge that cultural differences exist. Always seek clarification when their message is not precise. Ensure that you and your co-workers are on the same page.

5. Vague Requests.

In a very busy shift, the staff are usually in a hurry to get things done, and they unintentionally cut short their requests, too. And this habit is dangerous because the message they send across becomes confusing and vague.

What you can do: Use the check-back technique where you repeat what they had just said in a question form and then wait for their confirmation. If the nurse says, "I and O every 4” you may say, “I need to measure their intake and output every 4 hours, right?”. When the nurse confirms the request, then you know exactly that the needed action is clear and correctly understood.

The CNA’s voice is powerful and significant, just like that of any other staff. Be committed to ensuring that proper communication becomes the norm in your workplace.

Posted: 10/12/2020 5:04:31 PM

The Biggest Takeaways of Making Lists and Taking Notes

What nursing assistant task is so old school yet still as effective as ever?

Yup. It's making lists and taking notes. That small notebook and the pen in your pocket is indispensable because, with all the hustle and bustle of work, it is quite dangerous to rely on mental notes of everything you need to do and document.

Why do you need lists?

1. Lists put all the things you need to do in numbers.

Our brain processes data better when details are numbered. Take these tips in this article, for example. You'd remember them more effectively when they are in a list-form rather than when there are in paragraphs.

Lists create order and when details are organized, you get the bigger picture. It gives you a pretty good idea of how long your day’s going to be. You also unconsciously start recognizing which things should be accomplished right away, which brings us to the second advantage.

2. It’s easier for you to prioritize.

With all your to-do’s in one place, you’d be able to pinpoint which items you need to do first. Pro tip: color-code your list, like mark urgents red, less urgents green, and non-urgents blue. With one glance, you’ll know what to accomplish in the next hour and which ones you can do later.

3. You can update it at any time.

There are times when you just can’t finish a task. Do you need to reschedule? Do you need to follow up? A comment beside an entry within the list will do the trick.

4. It gives you a sense of achievement.

Every box that you tick as accomplished on your list is like an earned badge. Each checkmark means that you are one step closer to your daily goal. Fewer checkmarks also mean that you have to double-time to be more productive. In both ways, it summarizes your success for the day.

5. It saves time.

Without creating lists, there is a big chance that you’ll forget details, so you waste time and lose your focus by trying to remember the forgotten details. This could be dangerous and put patients at risk. You might also need to repeat procedures, such as vital sign measurements, when you can’t recall the patient’s data. Making lists avoids these inefficiencies.

6. It gives you confidence.

Lists are a sign that you are prepared for the day. You get more work done. And that feels good! More confidence also means less stress and better focus.

Making notes is equally important because it’s proof that you are paying attention and doing your job as a CNA. When you jot down details, your memory improves. Recording patient data right after you get them leads to accurate documentation, which is a big responsibility. Keep in mind that tasks that you’ve completed but not documented are considered undone, and that counts against your credibility.

When to take notes and what to write down:

1. Verbal orders and requests from the nurse

It is always recommended to jot down any requested task by the nurse and include it to your to-do list. This way, you can allocate time and resources to perform your duties.

2. Patient requests, complaints

Most patient concerns cannot wait. Better take note of their needs and address them as soon as you're able.

3. Patient data such as vital signs measurements, intake, and output, new observations

As soon as you finish taking their vitals, record the results, or else you need to retake them once you've forgotten. You should also include any changes in the patient’s condition.

4. Staff meeting particulars

Writing down highlights of the meeting will help you remember and follow memos.

Lists and notes are vital to a CNA's everyday success so always keep a notebook and pen handy.

Posted: 10/2/2020 11:12:47 AM

Engaging Patients in Meaningful Conversation is Sincerity at Its Best

Having meaningful conversations with a patient face-to-face is fast becoming a rarity in this time of advanced technology. With Wi-Fi-ready gadgets available to patients, they readily communicate with someone in the outside world, which is actually good for them. They can connect with family and friends through texts, emails, chat, and video calls. But once they put their phones down, they are left on their own. And this tells a totally different story.

In nursing homes, loneliness and isolation are common problems in older adults. Older patients are not so keen on using mobile phones to communicate. They are more comfortable with personal interactions.

Some patients have confusion and memory issues. Others experience pain and bodily weakness, making communication more difficult. Because of these situations, interacting with the patient in a deeper sense pose a big challenge to CNAs.

If you are tempted to just go through the motions of your tasks and forego talking with patients, be careful not to fall for this mistake.

Are you facing the same dilemma? Do you find connecting with patients an extra burden?

Engaging patients in meaningful conversations is a very sincere act of caring. It shows that you do listen and are truly interested in their wellbeing. As a result, they express their thoughts and feelings more comfortably. It builds and strengthens trust. It leads to a better patient experience.

The advantages do not stop here. Taking your conversations beyond ‘hi’ and ‘hello’ make the patient feel valued and heard. They feel good about themselves and the world in general. It reduces loneliness and isolation, too. All these positive outcomes improve the patient’s physical, mental, and emotional health.

How to have meaningful conversations with patients

1. Be an active listener.

While talking is a vital factor in any conversation, listening is just as important. In order for patients to feel heard, you should be able to reflect back what they have just said, and this requires attentive listening. This way, they feel well understood.

2. Use open-ended questions to start conversations.

Make it a habit to ask questions that encourage the patient to talk more. Avoid questions that are answerable by only ‘yes’ or ‘no’. Start your question with “What do you think of…” “Tell me about…”

3. Encourage the patient to share what's important to them.

The topic could be about the patient’s family, their former jobs, and the things that they enjoy. Talk about their favorite TV shows. If the patient loves sports and their game was just aired, ask something like, “What do you think of the game tonight?”

4. Find a common interest.

Being on the same page as your patient will make your conversation spontaneous and fun. And who said you can’t have fun? As long as the focus is on the patient, you can both enjoy the interaction.

5. Avoid giving your opinion.

One thing to remember about making conversations with patients is that it should be purposeful. The aim is to help patients express themselves so that they are the center of attention. Your opinion will not be helpful in this regard. Instead, ask about the patient’s thoughts on the matter and respect their views.

6. Never discuss your personal life and problems.

Again, bear in mind that you are the person helping your patient and not the other way around. If you start talking about yourself, that is a sign that you've crossed boundaries.

7. Start a conversation during baths, daily walks, and other lengthy procedures.

Many CNAs are hesitant to spend precious time engaging with patients because of their many pending tasks. You probably mutter to yourself, “Who’d have the time for a chat?”

In the real world of patient care, this is quite understandable. What you can do is to take advantage of time-consuming activities to initiate a conversation.

8. If the patient does not want your company and refuses to talk, ask what you can do for them.

Sometimes, as much as we like to get your patient to talk, they really prefer to be left alone. And this not always a problem. We have to learn how to respect their need for privacy and space. You can still offer your help in other ways.

9. When your patient asks sensitive questions, focus on their feelings.

For example, a patient asks, “Am I going to die?”

It’s not your place to answer them directly primarily because it’s only the nurse or physician who can discuss such issues. What you can do instead is ask about their feelings: “Do you feel scared? Tell me how you feel.” Acknowledge your patient’s emotions. Say ‘I’m sorry that you’re upset.”

10. Wrap it up.

Say, “Thank you for chatting with me. It’s time well spent.”

Patients always long for sincerity in every aspect of their care, and what’s a better way of showing it than by engaging them in meaningful conversations!

Posted: 9/28/2020 5:34:51 PM

The Frustrated Patient: How to Understand and Help

Adam, a 63-year old retired teacher, keeps going to see his doctor because of his pain and fatigue. After weeks and months of tests and laboratory procedures, the doctor still could not find what’s wrong with him. He met with other physicians, too. During the first few weeks, he was very patient in waiting for his turn to be seen. He answered all of the nurses’ and doctors’ questions. He willingly underwent procedures. He took medications as prescribed, but the fatigue seemed to worsen instead of getting better.

In his succeeding visits, his impatience becomes apparent. He started raising his voice and demanded more from his doctors. With no relief and no concrete explanation from the healthcare team, he started screaming, “You’re all incompetent!”

Adam is frustrated. And a frustrated patient is an upset patient, who would likely be an angry one when their concerns remain unaddressed.

There are many patients like Adam. Nursing assistants like yourself must learn to deal with their frustrations before it escalates into anger and other negative emotions.

How to understand and help a frustrated patient

1. Try to determine the source of the frustration.

Unless the healthcare team explores the very cause of the patient's frustration, it will be hard to pacify them. Patients become exasperated for these usual reasons:

a. They feel ignored and taken for granted.

When patients feel unheard, they start negatively asserting themselves. They may turn to verbal abuse. They tend to find more things to be angry about, which adds to their list of things not going their way.

One of your jobs as a CNA is to listen to them and find out why they feel unimportant. It is in such situations where your role as an advocate will come in handy. Advocating for your patient means reaching out so that you can relay their message to the right people more clearly.

Another way ease the patient’s heavy burden is to get them involved in their own care and in making decisions regarding their health. Provide choices whereby possible.

b. There is little or no progress in treatment or diagnosis.

Patients lose their cool when their complaints remain unexplained. They get distressed when their health condition does not improve or even worsens amidst medical treatment. And it’s quite understandable when this happens.

As a CNA, you can see to their comfort and meet their other health needs. Encourage them to talk about their feelings and recognize their ordeal.

c. They have difficulty adjusting to a loss of a bodily function.

A patient’s frustration can also easily stem from their inability to function as normally as before. As they lose their independence, it leads to hopelessness and depression.

You can show more empathy as a nursing assistant by helping your patient with their activities of daily living. Make them feel good about themselves, too.

2. Calm yourself.

Dealing with patient frustration is not an easy task. You may get yelled at and be the object of their resentment. It's important to control one's emotions so that you can still be an efficient CNA.

3. Don’t give up.

Frustrated patients are challenging to deal with and it is tempting to give up and ignore them altogether. But that just brings you back to problem number one, which is where patients start feeling disregarded. And the vicious cycle continues.

Frustration in a patient is a complicated matter that has lasting negative effects. If the patients’ concerns are not addressed in the right way, they may stop being cooperative. The patient may abruptly discontinue their medications and other treatments. At its worst, they may abandon all hopes of getting better, slip into depression, and be in a worse condition than they are already in.

Patients need more support during these difficult times and CNAs can be instrumental in finding solutions to ease their burdens.

Posted: 9/21/2020 2:47:47 PM

Encouraging Independence in Older Adults

Caring for older adults is a challenge and a privilege for nursing assistants. Helping older adults when they need assistance is a hefty task. Oftentimes, CNAs must see the fine line between doing things for the older patient and encouraging them to be independent to create a balance. CNAs must make sure that their patients receive proper care, and still safely carry on with activities of daily living.

What is independence and how important is it for older patients?

Being independent is having full control of one’s life, including being able to make decisions and do things on one’s own. Independence is inherent to human beings. It is essential to achieve happiness and to feel fulfilled. In a random interview of older adults, a respondent named Irma says, “[Independence] is everything. It’s so important.”

Independence is important in older patients because it preserves their dignity. They feel good about themselves if they can do things that they like. It also gives them a sense of purpose, which is good for their mental health. It also promotes physical exercise and preserves bodily functions.

To understand how older people value independence, consider this: Most older patients were once able-bodied individuals who enjoyed their freedom moving about, going places, and doing the things they love. They were all achievers when they were younger. When they get sickly and weak in their later years, the things that they cannot do keep piling up. And with their loss of independence, goes also their self-esteem.

As a CNA, you can help them have the quality of life they deserve. Here are some tips to guide you:

1. Make your older patients part of the healthcare team.

Older patients appreciate a sense of control in their own health. You can help older patients in this regard by listening to them and including them in conversations. Give them choices. Even confused patients can choose between two sets of clothes. Allow older patients to teach you, like how to make their favorite tea. It might also be interesting to ask for the recipe for their signature dish.

2. Make adaptations in an older patient’s environment.

Use adaptive equipment whereby possible to keep them safe while being independent. Adaptive equipment are devices that are used to help with performing activities of daily living, such as eating, bathing, toileting, dressing, and grooming.

a. Put a shower chair in the bathroom if they have an arm or leg weakness.

b. A buttonhook is great for those with arthritis, hand tremors, or uncoordinated arm movements. This device can be used to fasten their clothes with buttons.

c. Use raised toilet seats for those with difficulty sitting down from a standing position or those with standing up from a sitting position.

d. Provide adaptive utensils such as finger spoons and forks.

e. Keep frequently used items within easy reach. Avoid putting daily supplies in high cupboards or low cabinets.

3. Have older patients use remote controls.

These technological wonders can give them the choice of what to watch on TV or music to play. Thermostat remote controls allow them to set the room temperature to a comfortable level.

4. Help older patients use electronic devices such as tablets and mobile phones.

Aren’t we glad these inventions exist? With gadgets that are connected to the internet, older patients can watch the news, connect with friends and family, look for information online, and much more.

5. Keep your older patient’s assistive devices, such as canes and walkers as well as their eyewear and hearing aids accessible.

These items are very important so that they can move about and perform tasks safely.

6. Do everything to prevent falls and other accidents.

Being independent is helpful only if patients are safe. Older patients are prone to mishaps so it is crucial to keep the environment clutter and hazard-free. Ensure adequate lighting in places where they frequent. Also, helping them become independent does not always mean leaving them alone. Sometimes, it is safer to supervise an older patient performing an activity than leaving them on their own.

7. Help older patient’s finish tasks that are too difficult.

Older patients like to be independent but would welcome help when needed to finish an activity. For example, when bathing, have them wash on their own but clean the areas that they are unable to reach.

Older patients need to feel that they are still serving a purpose and not merely existing or being just a bother. As a CNA, you can give their life back by helping them become independent while safely cared for. It is therefore best to avoid doing everything for the patient even if it means taking longer than usual to finish a task.

Understand that by letting them do things on their own, there would be spills and other similar mess. You might need to clean up frequently after them. But it is only in this way that they can regain a sense of control and be respected for their decisions. Remember, there is dignity in being independent.

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