CSA20112: ALLIED HEALTH – HEALTH CARE ASSISTANCE (PATIENT CARE)

PERFORM INTERACTIVE
WORKPLACE COMMUNICATION
CSACOR0041A

TRAINEE CONTENT GUIDE

MIC2020 SEPTEMBER 1, 2019

Melissa Reid MIDDLESEX INTERNATIONAL COLLEGE 0
INSTRUCTOR: MELISSA K. REID
PERFORM INTERACTIVE WORKPLACE COMMUNICATION (CSACOR0041A)

KEY TERMS
Acute illness Inpatient care Patient
Chronic illness Interdisciplinary health - Patient-focused care
Client care team Physician
Disease Long-term care (LTC) Rehabilitation
Holistic Nursing Team Resident
Hospice Outpatient care Terminal illness

1. INTRODUCTION TO HEALTHCARE
HOLISTIC HEALTH CARE SERVICES
Welcome to the world of health care. Today, there is a holistic approach to health care. That is,
the person’s emotional and physical needs are taken into consideration. Providing holistic care
means recognizing that each person you care for is unique and special, with individual needs
that are very different from those of the person in the next bed. While you carry out your daily
duties, you will have plenty of chances to get to know your patients or residents as individuals.
You will help to take care of your patients’ or residents’ emotional needs, as well as their
physical ones. This is the essence of holistic care. This type of care is called patient-focused
care, as this care focuses on the unique individual needs of each person. The physical, mental
and emotional needs are all considered.

PURPOSES OF HEALTH CARE

The purposes of health care are:
• Health promotion. The goal is to reduce the risk of physical or mental illnesses. People receive
teaching and counseling about healthy living. This includes diet, exercise, and the warning signs
and symptoms of illness. They learn how to manage and cope with health problems.
• Disease prevention. Risk factors and early warning signs of disease are identified. Measures
are taken to reduce risk factors and prevent disease. Immunizations prevent some infectious
diseases. Polio, measles, mumps, smallpox, and hepatitis B are examples. Simple lifestyle
changes can prevent health problems. For example, high blood pressure can lead to heart
attacks and strokes. Diet and exercise can help lower blood pressure.
• Detection and treatment of disease. This involves diagnostic tests, physical exams, surgery,
emergency care, and drugs. Often respiratory, physical, and occupational therapies are needed.
The nursing team observes signs and symptoms, gives care, and follows the doctor’s orders.
• Rehabilitation and restorative care. The goal is to return persons to their highest possible
level of physical and mental functioning and to independence. Independence means not relying
on or needing care from others. The rehabilitation process starts when the person first
seeks health care. The person learns or re-learns skills needed to live, work, and enjoy life.
Maintaining function is important. Help is given with making needed changes at home.

These purposes are related. For example, Mr. Parker has chest pain and problems breathing. He
goes to a hospital emergency department. After an exam and tests, the doctor diagnoses a
heart attack. Mr. Parker is admitted to the hospital for treatment. He receives teaching and

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counseling about heart attack risk factors and healthy living. The goals are to promote health
and prevent another heart attack. He begins a rehabilitation program. Activity starts slowly and
may progress from walking to jogging and swimming. Teaching and counseling focus on diet,
drugs, life-style, activity, and how to cope with fears and concerns. Successful rehabilitation
promotes health and may prevent another heart attack.

TYPES OF HEALTH CARE ORGANIZATIONS

Health care happens in many places. Nurse assistants work in many of these settings. In each
setting similar tasks will be performed. However, each setting is also unique, varying in size,
services, hours open, and staff. Staff members have special talents, knowledge, and skills. All
work to meet the person’s needs. There are two main types of health care facilities: those that
provide short-term care and those that provide long-term care. Short-term (acute) care is given
to persons with minor problems, and those who need surgery or care for acute illnesses or
injuries. An acute illness comes on suddenly and requires immediate treatment. Heart attacks,
severe burns, strokes, and uncontrolled diabetes are examples of acute conditions. Long-term
care is given to persons who have chronic conditions. A chronic illness is one that is treatable
but not curable and is expected to require lifelong care. There are also people in our care who
suffer from a terminal illness, an illness or injury from which the person is not expected to
recover. The person will die.

Nurse assistants work in many settings. Some work in doctor’s offices and clinics. Most work in
the following health care organizations:
• Hospital – provide assigned tasks under the direction of a professional nurse. Clients vary in
age and are usually acutely ill. Hospital services include emergency care, surgery, nursing
care, x-ray procedures and treatments, and laboratory testing and many others.

• Long Term Care Facility – (nursing homes, assisted living facility, nursing centers) provide
direct care service under the direction and immediate supervision of a charge nurse. Clients
usually cannot care for themselves and are elderly, disabled, and chronically and/or
terminally ill. Care needs range from simple to complex. Medical, nursing, dietary,
recreation, rehabilitation, and social services are provided. So are housekeeping and
laundry services.

• Home Health Agencies – provide personal and home care services for clients of varying
ages in their personal home. Many services are provided to people where they live. Services
are provided by nurses and nurse assistants and other health team members. Services
range from health teaching and supervision to bedside nursing care.

• Hospice – provide personal care services for clients in various settings who are terminally ill.
Client ages vary. Such persons no longer respond to treatments aimed at cures. Usually they
have less than 6 months to live. The physical, emotional, social, and spiritual needs of the
person and family are met. The focus is on comfort, not cure.

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• Acute Rehabilitation – provide personal care from a rehabilitation perspective for clients
who are recovering from a debilitating illness and are planning to return to independent
living. Ages vary. Works under the direction of a rehabilitation nurse.

Different words are used to refer to people who receive health care, depending on where that
health care is provided:
• The word patient is used to describe a person who is being cared for in a hospital.
o Patients who stay overnight in the hospital receive inpatient care.
o However not all patients stay overnight, some may come to the hospital to receive a
specific therapy, for example, chemotherapy for cancer or surgery to fix a broken
bone. This is called outpatient care.
▪ Outpatient care may also be delivered by other acute settings, such as a clinic
• The word resident is used to describe a person who is being cared for in a long-term care
setting because the long-term care facility becomes the person’s home, either temporarily
or permanently.
• The word client is used to describe a person who is being cared for in his or her home.

The Ministry of Health and Wellness is the Government body responsible for ensuring that
health services are adequate and that they are delivered efficiently according to standards.

THE INTERDISCIPLINARY HEALTH

CARE TEAM
Health care is provided by a team of people,
each with different areas of expertise and job
responsibilities. They work together with their
different knowledge and skill levels to provide
holistic care to the patient or resident. The job
of each member of the team is as important as
that of any other member. Think of the
members of the health care team as links in the
chain of care (Figure 1-1). Because a chain is
only as strong as its weakest link, each member
of the health care team must provide care to
the best of his or her ability. The patient or
resident is the focus of the care.

There are many health team members involved Figure 1-1: THE HEALTH CARE TEAM
in the care of a person. The nurse assistant is an Reference: Carter, P. J. (2007). Lippincott's
important member of the interdisciplinary Essentials for Nurse assistants: A Humanistic
health care team. This team includes the Approach to Caregiving. Lippincott Williams &
patient, the physician, the nursing team, and Wilkins.

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other who provide services to the patient (Table 1-1). The patient’s family is also included with
the permission of the patient.

The physician names the condition or illness (makes a diagnosis) and prescribes treatment.
There are physicians who may specialize in one specific area of medical practice, for example, a
cardiologist is a physician who diagnoses and treat patients who have disorders of the heart
and blood vessels.

The nursing team provides skilled nursing care. The team consists of registered nurses, practical
nurse, and nurse assistants. The registered nurse plans and directs the nursing care. Nurse
assistants provide delegated nursing tasks under the supervision of a registered nurse. All
members of the team provide direct patient care.

TABLE 1-1: INTERDISCIPLINARY HEALTH CARE TEAM MEMBERS

EXAMPLES OF MEMBERS OF THE INTERDISCIPLINARY HEALTH CARE TEAM (ADAPTED FROM: HEGNER, B.,
ACELLO, B., & CALDWELL, E. (2007). NURSE ASSISTANT: A NURSING PROCESS APPROACH. CENGAGE LEARNING.)

Patient The most important member of the team. The patient has input into the planning and
implementation of care. The family may participate if the patient gives permission or if the
patient is unable to participate.
Physician Licensed to diagnose and treat disease and prescribe medications. Many specialty areas
require additional education.
Registered Nurse (RN) Licensed to make assessments and plan, implement, and evaluate nursing care. Supervises
other nursing staff. Many specialty areas within nursing require additional education.
Nurse assistant Has completed an accredited and approved course, has passed a competency examination,
and is certified to provide direct patient care under the supervision of a licensed nurse.
SPECIALTY SERVICES
Chaplain Meets religious and spiritual needs of patients and provides emotional support
Dietitian Licensed to assess nutritional needs; plans menus and therapeutic diets and oversees food
services.
Occupational Therapist Assists patients to relearn activities of daily living, improve fine motor skills, and prevent
(OT) deformities. OT assistants and aides work under therapist supervision.
Physical Therapist (PT) Assists patients to relearn mobility and ambulation skills, improve gross motor skills, and
prevents deformities. PT assistants and aides work under therapist supervision.
Social Worker Assesses and provides services to meet the nonmedical, psychosocial needs of patients.
Speech Therapist Provides services to persons who have speech and swallowing disorders caused by illness
or trauma.
ANCILLARY CLINICAL
Pharmacist Fills prescriptions for medications and acts as an information resource for maintaining safe
drug therapy.
Phlebotomist Uses needles to puncture veins for the purpose of drawing blood.
Laboratory Technician Prepares specimens, operates automated analyzers, and performs manual tests.
Laboratory Technologist Performs complex laboratory tests and examines blood, tissue, and other body substances.

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CHECK YOUR UNDERSTANDING

REVIEW QUESTIONS
1) Who is the focus of the health care
team’s efforts?
a) The doctor
b) The director of nursing 4) Nurse assistants are supervised by:
c) The nurse assistant a) Physician
d) The patient or resident b) The health team
c) Registered nurse
2) A health care program for dying persons d) Other nurse assistants
is a
a) Hospice 5) Health care is
b) Nursing home a) Occupationally orientated
c) Home care agency b) Patient-focused
d) Rehabilitation centre c) Cross-trained
d) Physician directed
3) You are a member of:
a) The interdisciplinary health care 6) A patient’s family may participate in the
team and the medical team care of a patient
b) The nursing team and the medical a) If they want to
team b) With the physician’s order
c) The interdisciplinary health care c) With the patient’s permission
team and the nursing team d) If they are available
d) The health team and the medical
team

7) State whether each statement is TRUE (T) or FALSE (F). Correct the false statement
a) T F The person’s emotional needs do not need to be considered during
treatment
b) T F The interdisciplinary heath care team is made up of many people with
different types of knowledge and skill levels.
8) Fill in the blanks
a) This organization provides inpatient or outpatient care for people with acute medical or
surgical conditions. _______________________
b) This organization focuses recovering from a debilitating illness and helping the person to
move from hospital to home care. _____________________
DISCUSSION QUESTIONS
9) Explain the difference between an acute illness and a chronic illness. Give one (1) example
of each.

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10) How do health care services benefit the community?

11) Angel’s Nursing Home is a small nursing home caring for 10 elderly residents. What type of
health care organization is Angel’s Nursing Home? How does a nursing home differ from a
hospital?
12) A patient with a hip replacement, learning to walk again. What type of health care
organization/facility would be best?

ACTIVITY
1) As a nurse assistant, in which type of health care setting would you most like to work?
Why?
2) There are various physicians who specialize in a particular area of medicine. Using the
sample table below, list 6 specialists.
Specialty Physician Type of Care
Example Cardiologist Diagnoses and treats patients who have disorders of the
Cardiology cardiovascular system

3) There are many health care organizations in Jamaica. State the names of at least two (2)
organizations as stated in the content. Use the sample below to record your results.
Type of Healthcare Name Parish/Location
Organization
Example Hospital Mandeville Regional Manchester
Hospital

4) Conduct a short research on the Ministry of Health and Wellness. Your one (1) page
research should contain the following information:
- The mission and vision of the Ministry
- The current Minister of Health
- Four (4) regional health authorities of the Ministry and the parishes served by each
health authority
- Divisions, Agencies & Councils

THINK ABOUT IT!

Think about what health care was like in Jamaica 100 years ago. How has health care delivery
changed since then? What aspects of the “old-fashioned” way of delivering health care were
good? What aspects were not so good? What aspects of modern health care delivery are good?
What aspects of modern health care delivery are not so good?

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KEY TERMS
Activities of daily living Interdisciplinary care plan Professionalism
(ADLs) Job description Report
Charge nurse Kardex Responsibility
Compassion Nursing care plan Scope of practice
Competency Nursing process Written Assignment Form
Delegation Nursing task
Empathy Oral Shift Report

2. THE NURSE ASSISTANT’S JOB

TRAINING & CERTIFICATION
Your training involves classroom lectures and hands-on practice of skills, as well as supervised
work experience in an actual health care setting. Your certification plan details the
requirements for certification of this qualification CSA20112V01 NVQ-J Level 2 in Health Care
Assistance (Patient Care) and the topics which are required for your training. The training ends
with a competency evaluation. This involves a written portion, consisting of 80 multiple choice
questions and a skills portion, where you will be asked to perform selected nursing skills. The
skills portion of the examination is conducted by an external assessor, the number of test
questions and the skills you will be asked to perform will depend on the assessor. You MUST
pass both the WRITTEN and PRACTICAL/SKILLS portions of the test to receive certification from
the National Council on Technical and Vocational Education and Training (NCTVET).

THE NURSE ASSISTANT AS A MEMBER OF THE NURSING TEAM

The nursing team, part of the health care team, is responsible for providing care to the patient
or resident. At a minimum, the nursing team consists of a registered nurse and a nurse
assistant. The nurse assistant assists the nurse in giving care to patients or residents by
performing basic nursing functions. Other members of the nursing team may include a charge
nurse, an RN who supervises the other nurses for a particular shift, and a head nurse, an RN
who is in charge of a department or section. Each health care organization has an RN who
directs all of the nursing care within that facility. This person is the director of nursing (DON).

Your nursing supervisor will give you the authority and responsibility for completing certain
tasks on his or her behalf. This is called delegation. After completing a task that has been
delegated to you, it is important to report back to update the nurse on the person’s condition,
and to let the nurse know that you have completed the task.

With “patient-centered or patient-focused care,” nursing care is designed around the needs of
the patient or resident and works to meet that person’s needs more efficiently. Members of the
nursing team are cross-trained to perform tasks that have in the past been done by other
departments. For example, a nurse assistant may be trained to draw blood for laboratory tests

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or to do an EKG instead of relying on technicians from another department to come and

perform those tasks.
The Nursing Council of Jamaica (NCJ) is a body set up by the Ministry of Health to regulate
nurses and control the profession of nursing and midwifery in Jamaica.

THE NURSING PROCESS

The doctor is responsible for diagnosing a person’s medical problems and ordering medication
or other therapies to correct those problems. However, the actual coordination, planning, and
implementation of that care require the efforts of other members of the health care team.
Those members involved with the patient’s or the resident’s care may include nurses, nurse
assistants, dietitians, social workers, and physical therapists. The patient or resident and his or
her family members also play an important role in this process, especially in the long-term care
setting. All health team members meet with the patient or the resident and family members to
develop a specific, individualized plan of care called an interdisciplinary care plan. As part of
the interdisciplinary care plan, the nursing team will then develop a specific plan of care for
each patient or resident called the “nursing care plan.”

The nursing process is used to create the nursing care plan. The five steps of the nursing
process are described in Box 2-1. As a nurse assistant you will be involved in the
implementation step of the nursing process. You will also help the nurse with the assessment
and evaluation steps of the nursing process by observing how your patients or residents are
doing and reporting this information to the nurse.
BOX 2-1 NURSING PROCESS

1. ASSESSMENT. The nurse gathers information about the patient or resident.

2. DIAGNOSIS. Using the information gathered during assessment, the nurse then develops a nursing
diagnosis, or a statement that describes a problem the person is having, as well as the cause of the
problem.
3. PLANNING. This involves making a plan for the person’s care. The nurse develops interventions
(actions that will be taken to help the person) and goals (descriptions of what the interventions are
meant to achieve).
4. IMPLEMENTATION. The interventions that were detailed in nursing care plan are carried out. The
nursing care plan specifies the team members who are responsible for doing each intervention.
5. EVALUATION. During the evaluation step, the nursing team checks the effectiveness of the nursing
care plan and revises it as necessary.

ROLES & RESPONSIBILITIES

Nursing care seeks to care for the whole person, meeting the person’s physical and emotional
needs. The nurse assistant may work in various health care settings and is usually the primary
“hands on” caregiver, performing tasks related to the person’s care. A nursing task is the
nursing care or a nursing function, procedure, activity, or work that can be delegated to nurse
assistants when it does not require an RN’s professional knowledge or judgement. To protect

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yourself, the person receiving care, and your employer, you must always work within your
scope of practice (that is, the tasks that you are legally permitted to do).

Be very familiar with the tasks that you are allowed to do, as detailed in the job description
given to you by your employer. Job descriptions vary from employer to employer, so you must
always read each new job description carefully to make sure you know your responsibilities.
Perform only the tasks listed in your job description. If the nurse delegates a task to you that is
outside of your scope of practice, or that you do not feel qualified to perform safely, you must
speak up and ask the nurse to reassign the task.

As a nurse assistant many of your responsibilities will involve the following:

• Assisting the client with activities of daily living (ADLs), such as eating, bathing, dressing,
grooming, using the toilet and moving.
• Observing and reporting findings to the RN
• Delivering physical care while promoting independence
• Providing emotional support
• Assisting with client comfort and safety
• Following directions given by the licensed nurse

As a nurse assistant, you will have a great deal of daily contact with the people in your care and
their family members. Getting to know the people in your care as individuals and taking a
genuine interest in them are things you can do to support them emotionally. A smile, a pat on
the shoulder, and a willingness to listen lets the person know that you care, and that she is not
alone.

Her/his functions include: • Assisting to accomplish tasks as

• Assisting clients with personal needs directed by charge nurse such as:
while promoting independence in the f) Collecting specimens
following personal care areas: g) Measuring and recording vital signs
a) Hygiene h) Transporting clients
b) Nutrition i) Cleaning client’s environment
c) Elimination j) Cleaning and caring for equipment
d) Mobility k) Isolation/transmission precautions
e) Reporting all client changes of l) Answering call lights
condition m) Observing clients and report findings
n) Measuring and recording intake and
output
o) Assisting in admission, transfer, and
discharge
p) Fire and disaster drills

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In all activities the nurse assistant will support client independence using restorative nursing
techniques. Nurse assistants should respectfully decline to perform tasks they are not legally
able to perform even if directed to do so by a supervisor.

The nurse assistant role may vary, depending on the work site.

Home Health/Home Care: average, long-term care facility can

a) Health care and assistance with provide.
activities of daily living (ADLs) are
provided to individuals who are ill or Outpatient Care:
disabled but living at home a) Facility provides services for less than 24
b) Services include: hospice care; physical, hours. It is for individuals who need
speech, occupational, or respiratory treatment or surgery that require short
therapy; nutrition and foodservices, etc. term (less than 24 hours) skilled
c) Nursing care given by a nurse assistant services.
is delegated and reviewed by a licensed
nurse every 2 weeks Assisted Living:
a) Facility provides care for clients who are
Facilities that care for the developmentally more independent and do not need
disabled: skilled services
a) Services that are designed to assist in b) Clients may need help with ADLs
the care of mentally and physically (showers, meals, dressing, and
impaired individuals. supervision with medication
b) Individual being cared for is called a administration)
“client.”
Adult Day Care:
Acute-Care: a) Provides services for clients during day
a) Care is provided for individuals who are light hours. The clients need some help
acutely ill or injured but are not ill
b) Provides immediate or short-term care b) The service provides a break for primary
for persons of all ages with a variety of care givers
health problems c) The facility may be part of another
c) Individual being cared for is called a facility or be free standing
“patient.”
d) Services include: emergency, diagnostic, Physicians’ Offices/Clinics:
medical, surgical a) Care for individuals is on a short-term
basis
Sub-Acute Care: b) Nurse assistants take vital signs and
a) Facility can be located in a hospital or other measurements
long-term care facility c) Nurse assistants may be trained to carry
b) Care is provided for residents who need out additional medical procedures
more care and observation then the under the physician’s or nurse’s
supervision

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Rehabilitation Facilities: baby clinics, and AIDS

a) Care is given to outpatients or those testing/counseling Nurse assistants
spending a period of time recuperating provide basic skills, such as measuring
in a long-term care facility vital signs, and assist with
b) Care is designed to restore examination/record keeping
independence and mobility
c) Patients make many visits over weeks to
months. Long-Term Care Facilities (LTC):
a) Care provided for individuals discharged
Community Health Centers/Public Health from an acute care hospital who are not
Nursing Clinics: ready to return home- some people will
a) Care is given to outpatients never return home and will live in the
b) Health teaching and monitoring of facility permanently.
chronic conditions are provided i. Individuals being cared for are
c) Centers may also provide reproductive known as “resident.” Facility is the
health services, breast and cervical client’s “home.”
cancer screening, immunizations, well-

BOX 2-2 TASKS OUTSIDE THE NURSE ASSISTANTS SCOPE OF PRACTICE*

▪ Giving medications (including oxygen) – ▪ Supervising other nurse assistants – this is

medications must be administered by a RN or the RN’s legal responsibility. You will not be
a doctor. trained to supervise others. Supervising others
▪ Receiving verbal orders (in person or over the can have serious legal problems.
telephone from doctors – the person’s ▪ Performing procedures that require sterile
primary care provider may give verbal orders technique – with sterile technique, all objects
for the person’s care over the telephone or in in contact with the person are free from
person. Only the RN can receive these verbal microorganisms. It requires skills and
orders and act on them. knowledge beyond your training.
▪ Diagnosing illness and prescribing treatments ▪ Inserting or removing tubes from a person’s
– only doctors and advanced nurses can body (bladder, esophagus, trachea, nose,
diagnose and order treatments for illnesses ears) – Nurse assistants are usually not
and injuries. allowed to insert or remove medical
equipment from a person’s body.
*Nurse assistants’ scope of practice may be expanded with additional training to perform more advanced skills

IDENTIFYING ALLOCATED NURSING TASKS

In order to perform your job tasks effectively, you must be able to carry out your work
instructions that are given to you by your supervisor. There are various ways in which you can
identify your allocated tasks at work.

• In order for you to give the required level of performance, you must be able to identify and
interpret your job requirements accurately and that means you have to read your job
description (workplace documentation) carefully

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• Your supervisor will give an oral shift report at the start of your shift, you should listen
carefully and take notes to aid your memory. This report contains new information about
patients as well as the assignments for your shift.
• Determining your duties from the Kardex (Figure 2-1). A Kardex is a file card that lists
important health information that the health care team needs to know about the patient. It
would include – when vital signs must be taken; what diet the patient is on; whether the
patient can ambulate and any special treatments.

FIGURE 2-1: SAMPLE KARDEX

Vital sign measurements

Medication to be and times measured
administered
(dosage, route, time)

Scheduled treatments for

the patient with date &
time
IV therapy dosages
and time

Personal Data of patient

Reference: Rashotte, J., Varpio, L., Day, K., Kuziemsky, C., Parush, A., Elliott-Miller, P., ... & Roffey, T. (2016). Mapping communication spaces: The development
and use of a tool for analyzing the impact of EHRs on interprofessional collaborative practice. International journal of medical informatics, 93, 2-13.

It is important that you take notes and write FIGURE 2-2: WRITTEN ASSIGNMENT FORM
down your assignments for the day so you don’t
forget them. Some facilities have a written
assignment form (Figure 2-2) that you can use to
take notes on the supervisor’s instructions or to
fill in your duties from the Kardex. The notes you
take on this form will help you remember
everything you need to do so you can plan your
day. Then as you complete each duty, you can
check it off. As you work with each patient, take
notes about things you should remember to tell
your supervisor. You may also choose to note information like vital signs so you have everything
in one place when it comes time to do charting. Carry your assignment sheets with you and
make notes as you finish each job.
You should be guided by the institution’s policy for completing the assignment form.

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You will need to learn shorthand when taking notes. At first, it may seem confusing but
eventually you’ll get the hang of it. This will require you to have a good handle of medical
terminology, which you will learn as we go through the course. You will learn various forms of
short hand such as:
▪ Acronyms – e.g. RN stands for Registered Nurse, MD stands for medical doctor
▪ Shortening of words – e.g. pt for patient, dept for department
▪ Abbreviations from non-English words – most medical abbreviations are taken from the
Latin language. E.g. “PO” means “per orem” in Latin and “by mouth” in English.

THE ART OF CAREGIVING

The skills of caregiving require kindness, empathy and compassion. Empathy is the quality of
seeking to understand another person’s situation, point of view or feelings. Compassion is the
quality of recognizing another person’s hardship, accompanied by a desire to help relieve that
hardship. A framework for providing quality care by helping you to put the person in your care
first is based on the five (5) principles of care (Figure 2-3):
▪ Keep the person safe. As a nurse
assistant, you are responsible for
protecting the people in your care from
harm.
▪ Protect the person’s dignity. Dignity is
the quality of being worthy of respect. In
addition to treating the people in your
care with respect, you will help them to
maintain their sense of dignity by
fostering their sense of self-esteem, or
self-respect.
FIGURE 2-3: 5 PRINCIPLES OF CARE
▪ Foster the person’s independence. Being
able to make decisions and do things for Reference: American Red Cross (2013). American
oneself is important for maintaining a Red Cross Nurse Assistant Training Textbook.
sense of dignity and self-esteem. Krames StayWell Strategic Partnerships Division
▪ Protect the person’s privacy. Keep a
person’s private business private, and do
not allow private things to be seen or overheard by other people.
▪ Practice good communication skills. Be available to talk, listen and respond to a person’s
thoughts and feelings. Tell the person about the care you plan to provide, and involve the
person in making decisions about her care.

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CHECK YOUR UNDERSTANDING

REVIEW QUESTIONS

1) Which one of the following is a nurse 3) Which of the following statements

assistant’s responsibility? about delegation is true?
a) Administering medications a) It is outside the nurse assistant’s
b) Communicating verbal orders scope of practice to decline a
related to the person’s medical care delegated task
to the nurse b) When one person delegates a task
c) Assisting people with activities of to another, that person gives the
daily living (ADLs) other person the authority and the
d) Analyzing and interpreting data responsibility to complete the task
on his or her behalf
2) Empathy is the quality of: c) Nurse assistants may delegate tasks
a) Acting in a way to gain the trust of to other members of the health care
others team
b) Pitching in to work as part of a team d) All of the above
c) Recognizing another person’s
hardship, accompanied by a desire 4) A task is in your job description. Which
to help relieve that hardship is false?
d) Seeking to understand another a) The nurse must delegate the task to
person’s situation, point of view or you
feelings b) The nurse can delegate the task if
the person’s circumstances are right
c) You must have the necessary
education and training to complete
the task
d) You must have clear directions
before you perform the task
5) Read the scenario below. Fill in the blanks using the appropriate terms. Write down the
correct order of the steps in the boxes provided.
Mrs. Chang has been admitted to the long-term care facility where you work because her
Alzheimer’s disease has progressed to the point where she is in longer able to manage many
basic activities, such as bathing, dressing and using the toilet. Nurse Rogers, the nursing
team leader, is responsible for preparing a nursing care plan for Mrs. Chang. She will use the
nursing process to prepare this plan. The nursing process is organized into a series of steps.
(continued on next page)

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______________________ The nursing team carries out the interventions detailed in the
nursing care plan.
______________________ The nursing team checks the effectiveness of the plan and
revises it as necessary.
______________________ The nurse describes the problems that Mrs. Chang is having, as
well as the cause of the problems.
______________________The nurse examines Mrs. Chang and asks questions about her
abilities, habits and needs.
______________________ The nurse makes a plan for Mrs. Chang’s care.
1 2 3 4

6) Name 5 activities of daily living (ADLs).

DISCUSSION QUESTIONS
7) Why is it important to perform tasks that are within your scope of practice?
8) Differentiate between the interdisciplinary care plan and the nursing care plan. Who uses
the nursing care plan?
9) Identifying your nursing tasks is an important aspect of your job daily. Describe 3 ways in
which you can determine what your various tasks are for the day.
10) List 4 differences between a RN and a NA.
11) How may your role as a nurse assistant in a doctor’s office differ from being a nurse
assistant in a long-term care facility?

ACTIVITY
1) Research 4 other nursing tasks which are outside of your scope of practice.
2) The charge nurse has asked you to remove Mr. Roger’s feeding tube. How will you respond?
Why?
3) Think of someone you know who is currently receiving health care services, or who has
received health care services in the past. Interview the person and find out how they feel
about the care he or she received, or is receiving? Discuss any positive and/or negative
feelings they may have and why.

THINK ABOUT IT!

A. What do you think the most rewarding part of being a nurse assistant will be? What do you
think might be the most challenging part for you?

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KEY TERMS
Positive Attitude Courtesy Professionalism
Hygiene Decorum Ethics
Confidentiality Integrity Work ethics

3. WORK ETHICS & PROFESSIONALISM

ETHICS
As a nurse assistant, you will be a professional caregiver. You will have the training and
knowledge to perform a certain role, that of the nurse assistant. But being a professional is
about more than having certain training, credentials or qualifications. It is about having a
positive attitude toward your job, and doing your job to the best of your ability at all times.
Help others see you as the professional that you are through your actions and appearance.
Professionalism involves following laws, being ethical, having good work ethics, and having the
skills to do your work.

Laws are rules of conduct made by government bodies. The word ethics is derived from the
Greek word ethos, which means “belief that guide life”. Ethics deals with right and wrong
conduct (moral principles). It involves choices and judgments about what to do or what not to
do. An ethical person does the right thing. Your own personal code of ethics is influenced by the
beliefs and principles (values) that you choose to live by. These beliefs and principles are in turn
influenced by many different factors, including your upbringing, your religious or spiritual
beliefs, your culture and your life experiences.

Ethical behavior also involves not being prejudiced or biased. To be prejudiced or biased means
making judgments and having views before knowing the facts. Judgments and views usually are
based on one’s values and standards. They are based on the person’s culture, religion,
education, and experiences. The person’s situation may be very different from your own. For
example:
• Children think their mother needs nursing home care. In your culture, children care for
older parents at home.
• A person has many tattoos and body piercings. You do not like tattoos or body piercings.
• An older man does not want life-saving measures. You believe that everything must be
done to save a life. Do not judge the person by your values and standards. Do not avoid
persons whose standards and values differ from your own.

As a nursing assistant, you need to think about how you feel about certain moral and ethical
issues. Only then will you be able to understand that although another person’s values may
differ from yours, that person’s values are as important to him or her as yours are to you.
Ethical dilemmas can arise when we attempt to judge other people by our own ethical
standards.

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In the workplace, certain behaviors (conduct), choices, and judgments are expected. Work
ethics deals with behavior in the workplace. Your conduct reflects your choices and judgments.
Each profession has a code of ethics that guide decision-making and behavior for the people
who practice that profession.

WORKING AS A PROFESSIONAL
As a nursing assistant, it is important that you approach your work in an official and disciplined
manner with the right kind of attitude and decorum (appropriateness of behavior, conduct,
dress, speech) that your work environment demands. A strong work ethic is what distinguishes
an average employee from a great employee. Two nursing assistants can have solid skills and be
very good at getting their work done on time, but the nursing assistant with the strongest work
ethic will be the one who enjoys the most success. There are various qualities that a person
with a strong work ethic has, such as:

A. A professional attitude
One definition of a professional is a person who has training that allows him or her to become
licensed or certified to do a certain job. But even people who have jobs that do not require
licensure or certification can behave in a professional manner. Being a professional also means
having a positive attitude. A person’s attitude is apparent from things he says (and the way he
says them), the way he behaves, and the way he looks. Having a professional, positive attitude
means that you are caring and compassionate toward your patients or residents and that you
are committed to doing your job to the best of your ability at all times.

B. Punctuality
Being punctual means that you are on time or a little bit early. Many people are relying on you!
Your patients or residents need you to help them. The staff members working the shift before
yours need to go home so that they can attend to their families and other responsibilities, just
as you need to attend to yours when you are at home. Being late is sometimes unavoidable.
However, it is important to plan your time wisely to prepare for any mishaps that may happen
along the way.

C. Reliability
Reliability means that others can count on you to come to work every day as scheduled and to
remain there during your entire shift. Have an emergency plan in place for transportation and
childcare before the need arises, and try to keep yourself healthy to decrease your need to take
sick days. Poor attendance is another major reason people lose their jobs. Reliability also means
that others can count on you to do your job well with minimal supervision. Your supervisor
should not feel the need to look over your shoulder or check up on you to make sure your work
has been finished.

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D. Accountability
An accountable person accepts responsibility for his or her actions and the results of those
actions. Being accountable means that you can accept criticism that is intended to help you
improve, admit a mistake, and work to correct the situation.

E. Conscientiousness
A conscientious nursing assistant attends to details and goes the extra mile to complete a task
with care. Conscientious nursing assistants take their assignments seriously and make sure they
follow directions carefully. They demonstrate responsibility by asking for additional explanation
or clarification when necessary, seeking help with difficult tasks, and admitting that they may
not know how to perform a particular task.

F. Courtesy and respect

Being polite and having good manners is correct in any situation. Use phrases such as please,
thank you, and excuse me. Show respect for your patients or residents by addressing them as
they prefer to be addressed. If in doubt, err on the side of formality (“Dr. Smith,” “Mrs. Jones,”
“Mr. Davis,” “Miss Thomson”). Avoid using “baby talk” or “talking down” to patients or
residents. Show respect for your co-workers by not saying anything negative about them to
others. Do not speak poorly about your place of employment to others, even if there are things
that you are not happy with. If the person you are speaking to is a patient or resident (or a
family member of a patient or resident), he or she may begin to question the quality of care
that is being given.

G. Honesty
An honest person tells the truth and acts with integrity. He or she does not lie, cheat, or steal.
Honesty is a critical quality for a health care worker to have.

H. Cooperativeness
Being able to cooperate, or work as part of a team, is essential in the health care field.
Remember how important your part of the chain of care is and what an essential role you play
in providing for the care and comfort of your patients or residents. Making an effort to get
along with your co-workers will make your work easier and will ease the burden on your co-
workers as well. A good nursing assistant does not wait for a co-worker to ask for help. Rather,
he or she sees a need and offers a helping hand. You may have to work with a person you may
not like, but a professional is able to put his or her personal feelings aside for the benefit of the
patient or resident.

I. Empathy
Empathy means that you are able to try to imagine what it would feel like to be in another
person’s situation. There are times when other people will really try your patience, but if you
think of how you would feel if you were in a similar situation, you may find that you are able to
understand the offending behavior better. Empathy gives us another perspective and helps us
to be kinder and more tolerant.

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MAINTAINING A PROFESSIONAL APPEARANCE

As a health care professional, you are expected to look a certain way. Many of the standards
that relate to a health care worker’s appearance are based on principles of safety and infection
control. However, maintaining a clean, neat appearance serves another purpose as well. As a
nurse assistant, you represent your employer and your facility or agency. You will spend a great
deal of time interacting with the people in your care, and with their family members. When you
make an effort to present a neat, clean appearance, the people in your care feel more assured
that you will do the same for them. Guidelines for maintaining a professional appearance are
given in Box 3-1.

BOX 3-1 NURSE ASSISTANT DO’s AND DON’Ts

DO wear a clean, pressed uniform daily; clean shoes; and DON’T wear dangly or excessive jewelry. A confused person
your name badge/photo ID in accordance with your or a child may pull necklaces, bracelets or dangly earrings.
employer’s policies. (Mend any removed buttons, tears or Wearing rings and bracelets makes it difficult to wash your
spoiled zippers) hands properly. Although some employers permit employees
to wear a plain wedding band, it is safest to avoid wearing
DO bathe or shower, shampoo your hair and brush your rings while you are at work.
teeth regularly. (Practice good hygiene)
DON’T wear excessive make-up (modest in amount and
DO keep your nails short, filed smooth, free of polish, and colour. Avoid a painted and severe look.)
clean. This helps to prevent accidental scratches when you
are providing care, and is also important for infection DON’T wear fragrance (for example, perfume or cologne or
control. (Nails must be natural) after shave lotion). The scents may offend, nauseate, or
cause breathing problems in patients or residents.
DO keep your hair neatly styled and pulled back from your
face. If not secured, long hair can get tangled in DO try to select a uniform style that will cover tattoos.
equipment, or a confused person or a young child may pull
it. Keeping hair off your face is also important for infection DO remove visible body piercings.
control; you do not want to be reaching up to move your
hair out of the way with dirty hands or gloves. DON’T wear undergarments that show through your clothing
(for example, avoid wearing dark-colored undergarments
under a light-colored uniform).

To care for your patients or residents to the best of your ability, you must first care for yourself,
both physically and emotionally. By taking proper care of yourself, you demonstrate that you
are a professional who takes his or her responsibilities seriously. It is important to focus on
maintaining your physical and emotional health. Staying physically fit keeps your body strong
and helps to prevent many types of job-related injuries. Taking steps to maintain your
emotional health helps to prevent emotional burnout.

RESPONSIBILITIES OF EMPLOYER/EMPLOYEE
When you accept the responsibility of patient care, you have a duty or obligation to perform
certain functions and are held accountable for your actions, behavior and conduct. As such, you
are responsible for giving patient care under the supervision of a registered nurse.

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In addition to your responsibilities to your patient and their families, you have the following
responsibilities to your employer:

• To perform assignments as trained

• To communicated courteously with others in the work environment
• Punctuality
• Neat and tidy personal appearance
• To treat the facility’s resources, equipment and products with care
You are required to follow these and all other rules outlines in the employee handbook and in
the facility’s job description of the nursing assistant position.
You should note that your employer also has responsibilities to you and the other employees in
the work environment. These include:

• Providing a clean, safe, healthy environment – including safe, well-maintained tools and
equipment and appropriate personal protective equipment
• Adequate training on work procedures
• Providing an environment where diversity is valued and that is free from discrimination
and harassment Also, treating employees with dignity and respect.
• Providing adequate compensation – wages should be at the accepted industry level
• Providing required benefits such as health insurance, sick leave, maternity leave,
disability insurance and leave etc.
• To handle all business with transactions with integrity and honesty
Both you and your employer should recognize and carry out these important workplace
responsibilities.

SERVICE EXCELLENCE
Service excellence refers to the ability to assistants will always seek to:
consistently anticipate, meet and exceed • Be the best, give the best care, and treat
the needs and expectations of your all health care team members in the
patients/clients, families and colleagues best possible manner
(team members). It requires: • Be honest and trustworthy both with
• Communicating clearly and objectively clients and health care team members
• Exercising common sense • Manage mistakes responsibly
• Being tactful in dealing with others • Empathize with clients and families
• Exercise confidentiality with client and • Always behave with understanding and
team health information respect
• Display patience
• Answer call lights promptly
To maintain service excellence, nurse

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CHECK YOUR UNDERSTANDING

REVIEW QUESTIONS

1. A nursing assistant’s personal cleanliness is 5. What type of nursing assistant has a

referred to as: professional attitude?
a. Sanitization a. A nursing assistant who acts smarter
b. Neatness than the other nursing assistants
c. Hygiene b. A nursing assistant who is certified
d. Fashion c. A nursing assistant who is committed to
doing to doing his or her best at all
2. Qualities that characterize a good work times
ethic include all of the following except: d. A nursing assistant who is always late to
a. Reliability work
b. Punctuality
c. Honesty 6. Ethics is
d. Tardiness a. Making judgments before you have the
facts
3. What type of nursing assistant accepts b. Knowledge of right and wrong conduct
responsibility for his or her actions? c. A behavior that meets your needs, not
a. An accountable nursing assistant the person’s
b. A respectful nursing assistant d. A health team member’s skills, care and
c. A courteous nursing assistant judgement
d. A punctual nursing assistant
7. Which statement reflects a good work
4. Which is NOT a courteous act? attitude?
a. Saying “please” and “thank you” a. “It’s not my fault.”
b. Wanting others to open doors for you b. “I’m sorry. I didn’t know”
c. Saying “I’m sorry” c. “That’s not my job”
d. Complimenting others d. “I did it yesterday. It’s your turn”

DISCUSSION QUESTIONS
8. Peggy reported for duty wearing bracelets, long earrings, and pale pink nail polish. Her uniform
was clean and crisp, but the hem was hanging down on one side. Her shoes were dirty.
a. List the ways in which her appearance can be improved
b. Explain the appropriateness/inappropriateness of her behavior

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9. Why is it important to follow your facility’s policy on professional behavior? What are possible
consequences of failing to do so?
10. Suggest 6 additional tips/guidelines for professional behavior that was not addressed in the
content.
11. Identify four (4) responsibilities that nursing assistants have to:
i. Patients
ii. Employers
12. What are four (4) responsibilities that employers have to their employees?
13. Identify three (3) ways in which an employer can provide a clean, safe, environment.

ACTIVITY

Ethical decisions play an important aspect in the everyday lives of nursing assistants. Ethics is
about what you should or should not do. One of your responsibilities is to understand the law
as it relates to identifying, preventing and reporting abuse, exploitation and neglect. Conduct a
2-page research on the following:
a. Neglect
b. Abuse and list 5 types of abuse
c. Signs of both physical and psychological abuse
d. Exploitation

THINK ABOUT IT!

Your best friend Sasha is also a nursing assistant at the nursing home where you work. She has a
very difficult time managing her personal life and her professional life. Many times, Martha has
asked you to clock her in when you get to work so that your supervisors will not see that she is
late. This makes you uncomfortable, but you do not want to lost Martha’s friendship. What
should you do?

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KEY TERMS
Active listening Communication Open-ended questions
Barrier Decoding Paraphrasing
Body language Encoding Perception
Clarify Listening Summarizing
Close-ended questions Non-verbal communication Verbal communication

4. COMMUNICATION SKILLS
INTRODUCTION
Communication is a two-way process in which information is exchanged (shared). Information
can be sent orally, in writing, and through body language. Nursing assistants communicate with
their patients, with visitors, with their coworkers, and with their supervisors when they are
working. As a nursing assistant, you will need to receive and send information:
• About your observations and care of patients
• During interactions with patients and visitors
• About your patient’s feelings.

The key to understanding what communication is lies within the word “exchange.” If you
exchange gifts with another person, you give that person a gift, and, in return, you receive one
back. Communicating is not just about telling someone something (giving information). It is also
about listening and observing (receiving information). For communication to be effective, all of
the people who are involved must actively
participate in the exchange of information
(Fig. 4-1).

COMMUNICATION METHODS
There are two major forms of
communication, verbal communication
and nonverbal communication.
a. Verbal communication uses words,
either spoken or written, to exchange
information. Examples of verbal
communication include telephone
conversations, written notes and FIGURE 4-1: EFFECTIVE COMMUNICATION
memos, e-mail and text messages, and Reference: Carter, P. J. (2007). Lippincott's Essentials for Nurse
ASL (American Sign Language) that is assistants: A Humanistic Approach to Caregiving. Lippincott
used to communicate with people who Williams & Wilkins.
are deaf. Verbal communication tends
to be more direct—when we use

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language to express a thought, it is usually with the intent of giving specific information to
another person.
b. Nonverbal communication, on the other hand, tends to be more indirect. This is sharing
information and feelings through body language, including gestures, body position,
movement, facial expressions and tone of voice. Being aware of nonverbal cues can give
you a better understanding of what other people are truly feeling and thinking as it makes
up majority of our day-to-day communication (See Figure 4-2). As a nursing assistant, you
must be a successful communicator, both as a sender and a receiver of information, with
both those you care for and your co-workers.

Your message is: Figure 4-2 Make sure your body language and
7% words + 38% tone of voice tone, pitch and quality of your voice match the
+ 55% body language message you intend to send
= Total Communication

As a nurse assistant, you will use both verbal and nonverbal methods to communicate with
others. For example, when you are caring for a person with dementia, it is often most effective
to show, as well as tell, the person what you need him to do. If you want the person to sit
down, you could say, “Mr. Greene, please sit here” (verbal communication) while patting the
seat of the chair (nonverbal communication). To reassure a person, you might say, “I’m here for
you” (verbal communication) while gently resting your hand on the person’s hand (nonverbal
communication). You must also be aware of the methods others are using to communicate with
you. Paying attention to a person’s nonverbal body language can give you important
information, in addition to what the person may tell you. For example, a person may not
complain of pain, but the way she carries her body or the expression on her face when she
moves a certain body part may tell you that something is wrong.

You will use your communication skills to:

▪ Comfort, reassure, and teach your patients or residents
▪ Share information about changes in your patients’ or residents’ health status with other
members of the health care team
▪ Accept or decline assigned tasks and seek additional clarification about how to do those
tasks as necessary to express

Tips on how to be a good communicator are given in Box 4-1.

ELEMENTS OF COMMUNICATION
Communication exists between at least two people that begins when one person wants to
communicate with another. The communication process is a system that involves an
interrelated, interdependent group of elements working together as a whole to achieve a
desired outcome or goal. We can study communication in much the same way we study
biological systems within our own bodies

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There are seven (7) major elements of the communication process:

1. Sender – The sender begins the communication process by forming the ideas, intentions
and feelings that will be transmitted. The sender makes the decision to communicate.
The sender also determines the purpose of the message – to inform, persuade, or
entertain.
2. Encoding – This is the process by which the information is put in a form that the receiver
can understand. (Creating the message)
3. Message – This is the information which is being communicated. The sender encodes an
idea then determines whether or not to inform, persuade or entertain. After deciding
what message to send, the sender uses symbols to get the message across to others.
Words are symbols, which can represent objects, ideas, and feelings.
4. Channel – This is the means (pathways or devices) by which messages are
communicated. Channels may be described in two (2) different ways.
a) The form in which messages are sent to receivers: verbal and nonverbal
communication. We use our five senses to receive messages from others. We may
watch a football match on TV, smell fresh bread baking as we pass the local bakery,
taste the flavors and seasonings in a tasty meal, or hug a friend to console him when
his family member died.
b) The manner of presentation employed in communication. The sender may speak
face-to-face with the receiver, over the radio, phone call, or electronic message.
5. Receiver – The person (or persons) who the sender’s message was intended for.
6. Decoding – This is the act of interpreting messages. Receivers decode messages based
on past experiences, perceptions, thoughts and feelings.
7. Feedback – This is the return process in communication, it tells the sender that the
receiver has interpreted the message. The receiver sends back some response to the
sender or acknowledges receipt of the message. The communication loop is complete
only after feedback has been provided. Feedback is essential for finding out whether or
not the message has been properly received, decoded, accepted and used by the
receiver.

BARRIERS TO COMMUNICATION

The human communication system can be compared with a radio or telephone. Just as in radio
transmissions, where distorting can occur at any point along the channel, there can be similar
barriers in human communication. The sender information may be insufficient or unclear. Or
the message can be ineffectively or inaccurately encoded. The wrong channel of
communication may be used. The message may not be decoded the way it was encoded.

Barriers (noise) are any obstacles or difficulties that come in the way of communication. They
may be physical, mechanical, psychological cultural or linguistic in nature. Physical noise refers
to conspicuous distractions in the environment that make it difficult to hear or pay attention.
For example, when the environment is excessively hot or excessively cold, or when one is in a
noisy nightclub, one may tend to focus more concern on the situation than on the message.

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Physical noise can inhibit communication at any point in the process—in the sender, in the
message, in the channel, or in the receiver.

Psychological noise alludes to mechanisms within individuals that restrict a sender’s or

receiver’s ability to express and/or understand messages clearly. For example, senders with
limited vocabularies may have difficulty translating images into symbols that can be understood
easily by receivers. Receivers with inflated self-concepts may filter messages that disagree with
their self-perceptions and put energy into defending themselves rather than into understanding
the messages. Psychological noise most often results in defensiveness that blocks the flow of
communication between sender and receiver.

STRATEGIES FOR EFFECTIVE COMMUNICATION

Nursing assistants communicate with clients during all aspects of care. During each interaction
the nurse assistant will learn many things about the client that will broaden his/her
understanding of each individual client and in so doing will improve the delivery of client care.
Client/patient needs may include information, advice, support and encourage. To encourage
effective communication, we can build upon the elements of good communication (sender,
receiver, message…). There are four (4) basic techniques that you will need to use in order to
explore the interests and concerns of the patient:
1. Active Listening – Listening is not just hearing what someone says to you; it is an active
process. (Hearing is a passive awareness of sound). As an active listener, you can direct the
flow of the conversation by responding to what the speaker says through comments and
questions. In order to do this, you need to show empathy or understand the speaker’s
feelings. By re-stating or paraphrasing in your own words what has been said, this checks
that your understanding is correct.
2. Questioning – Effective questioning and listening are closely interrelated and are both
critical aspects of communication. Questioning skills allow you to clarify (to make
something clearer by explaining in greater detail) your understanding. There are two main
type of questions:
i. Close-ended question – will result in a yes/no answer. It does not provide a great
deal of information. It will often begin with words such as “are,” “can,” “do,” “did,”
“have,” “when,” “where,” and “why.”
ii. Open-ended question – require an answer beyond yes/no. It will provide more
information. It often begins with words such as “how,” “what,” “show me,”
“describe,” and “suppose.”
3. Summarizing – This is useful to demonstrate to both clients/patients and colleagues that
you have listened to them and are able to sum up what they have said.
4. Speaking – It is important that when speaking to clients/patients or colleagues that your
message is clear. As a result, you must follow guidelines for speaking and making the
message clear to the receiver.

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10 GUIDELINES TO ENCOURAGING EFFECTIVE COMMUNICATION (See BOX 4-1 for further

guidelines for effective communication)

• Be aware of body language, facial expressions and how we appear to clients. This is
important to every client but especially to the clients from different cultures who may speak
a different language. A nurse aide, who appears relaxed, friendly, non-threatening and not
rushed, can more quickly put the client at ease. When the client is at ease, communication
can flow more easily. (See Table 4-1)
• Get the client’s attention. Get down to his/her level, which may mean that you bend, stoop
or sit down to make eye contact while speaking or listening. Be aware of the client’s cultural
attitudes with regards to touching and direct eye contact.
• Call clients by their desired name. In many cultures the preference may be Mr. or Mrs. or
Miss. Abide by their preference.
• Look for non-verbal cues of the client while they are speaking, for example, do they seem
upset, are they frowning, smiling, etc.? Take in the whole message, verbal and non-verbal.
• Be an active listener, that is, listen carefully and allow the client time to express their self.
Paraphrase, that is, repeat back to the client what you understood them to
say. This is to check if your understanding is correct.
• Be patient, do not rush the client. Show the client that you care about them, their needs
and opinions.
• Speak in a clear, concise manner. Communication can fail when the other person does not
fully understand your message. Do not talk to an adult as if they are a child. Use words that
have the same meaning for you and the client. Avoid medical words and words that the
client is not familiar with. (See Box 4-1 for tips on ensuring your message is clear)
• Don’t jump to conclusions or make assumptions. Listen to exactly what the client is saying
and how he/she feels. Don’t be judgmental. Allow clients their opinion and treat them
respectfully.
• Ask questions if you do not understand and give the client feedback about what you do or
don’t understand.
• Remember the importance of touch. A caring touch, such as a hand on the shoulder, a pat
on the back or a hug, is often a good way to make someone feel special or emphasize what
you are saying.
• Be patient. People with memory problems may ask the same question many times. Do not
call attention to the repetition. Accept the memory loss as part of their disability.
• Include the client in conversation when others are present. This includes when a co-worker
is assisting you with care.

In your work as a nurse assistant, your ability to communicate can have a positive impact on the
health and well-being of the people in your care. It is important that you actively work to
become a more effective communicator.

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BOX 4-1 GUIDELINES FOR BEING AN EFFECTIVE COMMUNICATOR

When you are the sender, make sure your

message is clear Provide and seek feedback
■ Think about what you want to say. Present the ■ When you are the receiver, ask questions and
information in a logical, organized way. repeat information back to the sender so that he
■ If your message is written, make sure your or she knows that his or her message was
handwriting is neat and your spelling is accurate. received and understood.
■ Speak clearly at a normal pace, and avoid ■ When you are the sender, seek feedback from
mumbling. Unless the person is hearing impaired, the receiver to make sure that he or she
there is no reason to raise your voice. understood your message. This is always
■ Use words that the person you are speaking to important, but especially so when the person may
understands. When appropriate, use simple, be embarrassed about an inability to understand
common words in place of more technical words. you (for example, if the person has hearing loss or
If necessary, use an interpreter. speaks a language that is different from yours).
■ Face the person you are speaking to. ■ Observe for nonverbal cues that indicate that
■ Make sure that the person you are speaking to the receiver did not understand your message. For
is able to physically receive the message. For example, the person may be nodding his or her
example, if the person wears a hearing aid, make head but looking confused.
sure it is turned on.
Avoid behaviors that block effective
When you are the receiver, be a good listener communication
■ Focus your attention on the speaker. ■ Avoid being judgmental. A person who is
■ Sit down and do not appear rushed or in a judgmental forms quick opinions about whether
hurry. or not another person is right or wrong. A
■ Make eye contact with the speaker. judgmental attitude can be revealed through body
■ Do not interrupt or try to finish the speaker’s language or comments you make and indicates to
sentences. the other person that you do not respect his or
her thoughts, beliefs, or feelings.
Learn techniques for encouraging people to talk ■ Avoid assuming that another person knows
■ Ask open-ended questions instead of “yes/no” what you are thinking. Instead, keep others
questions. For example, instead of asking “Did you informed about what you have done and what
have breakfast this morning?” ask “What did you you expect them to do.
have for breakfast this morning?” ■ Avoid “tuning out” others. Always listen
■ Rephrase what the person says to you. For carefully.
example, if a resident says that she feels sad and ■ Avoid negative body language, such as tapping
lonely, instead of asking Why?” say “You’re feeling your fingers or foot impatiently, constantly
sad and lonely?” This invites the person to talk looking at your watch or toward the door, crossing
more about what she is feeling your arms, and rolling your eyes.
■ Observe for and ask questions about nonverbal ■ Avoid using slang or foul language
signals the person may be sending.
■ Remember the value of silence and a
comforting touch.

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Sends a Positive Message Sends a Negative Message

Tone of Voice ▪ Moderate volume ▪ Too loud or too soft
▪ Calm, relaxed pace ▪ Sharp, rushed pace
▪ Clear ▪ Mumbling
▪ Sighing loudly
Facial ▪ Smiling ▪ Frowning
Expressions ▪ Concerned (depending on situation) ▪ Grimacing
▪ Eye rolling
▪ Yawning
Gestures ▪ Sitting down ▪ Checking watch or looking toward
▪ Patting a person’s arm or holding a to the door
person’s ▪ Glancing away from the person as
▪ Nodding as the person speaks he or she talks
▪ Making a good eye contact (unless this is
considered disrespectful in the person’s
culture)
Body Position ▪ Positioning yourself to be at eye level with ▪ Standing over the person
& Movement the person ▪ Crossing your arms
▪ Leaning toward the person as he or she ▪ Tapping your feet
talks ▪ Slouching

TABLE 4-1: BODY LANGUAGE (NONVERBAL COMMUNICATION)

MESSAGES SENT FROM BODY LANGUAGE (REFERENCE: AMERICAN RED CROSS (2013). AMERICAN RED CROSS
NURSE ASSISTANT TRAINING TEXTBOOK. KRAMES STAYWELL STRATEGIC PARTNERSHIPS DIVISION)

COMMUNICATING WITH PEOPLE WITH SPECIAL NEEDS

We rely very much on our senses of hearing and sight for effective communication. There are
many reasons why communication with patients may be impaired. The patient may: a) be
hearing impaired b) be vision impaired c) have aphasia d) be disoriented e) be from a culture
different from the nurse assistants.

COMMUNICATING WITH A PERSON WHO SPEAKS A LANGUAGE

DIFFERENT FROM YOURS
Some of your patients or residents may not speak the same
language that you do. When caring for a person who speaks a
foreign language:
■ Use hand gestures or a picture board (Fig. 4-3) to communicate
very basic ideas.
■ You may need to use an interpreter to avoid misunderstandings.
FIGURE 4-3: PICTURE BOARD

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COMMUNICATING WITH A PERSON WHO IS HEARING IMPAIRED

You may care for patients or residents who have been deaf since birth or who have become
completely or partially deaf as a result of a disorder that affects the ear. In addition, many older
people gradually lose the ability to hear high-pitched sounds as part of the normal aging
process. When this occurs, the older person has trouble telling the difference between similar-
sounding high-pitched sounds like th and s. This can lead to frequent misunderstandings. When
caring for a person with hearing loss:
■ Always approach the person from the front, and gently touch the person on the hand or arm
to gain their attention before speaking.
■ Face the person when you are speaking to him or her. This gives the person a clear view of
your mouth, which is helpful if the person lip-reads. Avoid chewing gum or speaking unusually
fast because these actions can make it hard for the person to read your lips. If the person needs
glasses, make sure he or she is wearing them so that your lips can be seen clearly.
■ Use a note pad to write down important questions or directions so that the person can read
them. Or use gestures to explain what you are saying
■ Consider learning sign language or using a sign language interpreter.
■ If a person who uses a hearing aid seems unable to hear you, make sure the hearing aid is
turned on and that the volume is turned up high enough. If the hearing aid still does not seem
to be working, check the batteries to see whether they need to be replaced.
■ If the person does not seem to understand what you say, change your words, not the volume
of your voice, unless you spoke too softly.
■ Reduce background noise as much as possible

COMMUNICATING WITH A PERSON WHO IS VISUALLY IMPAIRED

Visual impairment may have many causes, such as cataracts (a clouding of the lens of the eye
that is caused by aging, injury or other diseases) or diabetes. When caring for a person with
impaired sight, use your communication skills to help orient the person to surroundings and
events.
■ Knock on the person’s door or tell him right away that you are there so that you don’t startle
him. Stand where he can see you, and call him by name: “Good morning, Mr. Wilson.” Then tell
him who you are.
■ Describe the person’s surroundings and tell him what is going on. Describe the people or
events in a way that helps to create a mental picture: “Mr. Wilson, your daughter Susan is here,
and she’s wearing a beautiful red dress.” Or “It’s sunny today, and the patio door is open if you
would like to go outside.”
■ As you move through a skill, describe each step as you are doing it. When using a piece of
equipment, describe it to the person. If it doesn’t cause an infection control risk and if he is
interested, let him touch what you are holding.
■ When helping the person move around, encourage him to hold your arm just above your
elbow for support, describe where you are going and mention things that are in your path:
“We’re going up three steps now.”

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COMMUNICATING WITH A PERSON WHO HAS SPEECH DIFFICULTIES

There are many reasons why a person might have trouble speaking clearly. People who are
completely deaf often do not speak clearly. A person who has had a stroke may lose the ability
to form sounds into meaningful words. Surgical procedures affecting the mouth or vocal cords
can make it difficult or impossible for a person to speak. So can medical devices, such as
breathing tubes. When caring for a person who has trouble speaking:
■ Ask “yes/no” questions when all you need is basic information.
■ If you cannot understand what the person is saying, please tell the person that you did not
understand and look for other ways to help the person communicate. For example, you might
offer the person a note pad so that she can write down what she needs to tell you or a picture
board so that she can point to what she needs.

USING THE TELEPHONE

As a nursing assistant, you will usually be required to answer the telephone, either at the
nursing station or in a patient’s or resident’s room. The way you handle yourself on the
telephone reflects directly on your facility (See Box 4-2 for general policies regarding phone
usage). When using the telephone, always remember to:
▪ Be professional ▪ Respect the privacy of your
▪ Identify yourself patients/clients
▪ Be courteous
▪ Take accurate messages

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BOX 4-2 HOW TO USE THE TELEPHONE

▪ If the person the caller wants to speak to is
▪ Answer the telephone promptly within the
unavailable, offer to take a message. When
first three rings
taking a telephone message, be sure to write
▪ Answer with a pleasant greeting such as
down the date and time of the call, the name
“Good morning” or “Good afternoon.”
of the caller, a telephone number where the
▪ Identify yourself by name and title and by
caller can be reached, and your name. Write
your unit or floor according to facility policy:
clearly, and ask the caller to spell his or her
“Paediatrics; Mary Smith, CNA, speaking.”
name if you are not sure how to spell it. Be
▪ Asks the caller, “How may I help you?”
sure to deliver the message to the person for
▪ Know how to perform basic functions using
whom it was intended.
your facility’s phone systems such as
▪ A nursing assistant is not to take the doctor’s
transferring calls, or placing a caller on hold
orders or receive or give results of diagnostic
▪ If placing a call on hold, ask his/her
tests. Calls of such nature should be handled
permission first, “May I put on hold for a
by the nurse.
minute?” Be aware of the length of time a
▪ Know your facility’s policy regarding what
caller has been on hold; if the time becomes
information can be provided over the
excessive (more than 5 minutes), ask the
telephone and at to whom.
caller if he/she wants to continue to hold,
▪ Do not use the telephone to make or receive
leave a message or call back later.
personal calls.

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CHECK YOUR UNDERSTANDING

REVIEW QUESTIONS
1. Which one of the following is an open- 5. Michael is taking care of Miss Jordan, who
ended question? has a hearing loss. Miss Jordan is wearing
a. “Are you Mrs. Brown?” her hearing aid, but it does not seem to be
b. “Mr. Jones, when you were growing up, working. What should Michael do first?
what was your favorite meal?” a. He should raise his voice
c. “Are you feeling okay, Mrs. Smith?” b. He makes sure that the hearing aid is
d. “It’s beautiful outside today, Mrs. turned on and that the volume is high
Murphy! Do you want to go for a walk?” enough
c. He should remove the hearing aid and
2. Which one of the following is an example of replace its batteries.
positive body language? d. He should report the problem to the
a. Nodding encouragingly as someone nurse immediately.
speaks
b. Crossing your arms across your chest 6. To communicate, you should do the
c. Tapping your feet or fingers following EXCEPT:
d. Rolling your eyes a. Use terms with many meanings
b. Be brief and concise
3. An example of an action that blocks c. Present information logically and in
effective communication is: sequence
a. Interrupting d. Give facts and be specific
b. Not listening carefully
c. Being judgmental 7. Verbal communications include:
d. All of the above a. Talking and listening
b. Facial expressions
4. Which one of the following is an example of c. Reading reports
nonverbal communication? d. Using a fax machine
a. Using sign language to communicate
with a deaf person 8. For successful communication occur, all of
b. Recording vital sign measurements in a the following elements must be present
patient’s or resident’s chart EXCEPT:
c. Gently touching a patient or resident on a. Receiver
the shoulder to reassure her b. Hearing
d. Making a telephone call c. Feedback
d. Sender

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9. Demonstrating your understanding of a

message by stating the message in your 10. The portion of communication that has the
own words is greatest influence on the receiver’s
a. Channeling interpretation of the message is the
b. Rephrasing and restating a. Tone of the voice
c. Paraphrasing b. Body language
d. Reorganizing c. Pitch of the voice
d. Eye contact

11. Place an “X” next to the proper ways to communicate with a person who is hearing impaired
i. _________ face the person while iii. _________ use a note and write
talking to him down important questions or
ii. _________ use sign language directions

12. Place a “V” next to statements that are examples of verbal communication, and an “N” next to
the statements that are examples of nonverbal communication.
i. _________ use of language, either iv. _________ making a telephone call
spoken or written v. _________ tapping your fingers on
ii. _________ gently touching a patient the table because you are bored
or resident on the shoulder to vi. _________recording vital sign
reassure her measurements in a patient’s or
iii. _________ making a face when you resident’s chart
put weight on a painful leg

13. On the line provided, write 1 if the statement is a barrier to communication or a 2 if it is an

effective way to communicate.
i. ____ belittling a person’s feelings v. ____ listening
ii. ____ changing the subject vi. ____ staying within sight of the
iii. ____ showing an interest in client at eye level
discussion vii. ____ pacing yourself to the speed at
iv. ____ seeming to be too busy which the client talks
DISCUSSION QUESTIONS
14. Describe three (3) reasons why it is important for a nurse assistant to be an effective
communicator.
15. With the aid of a diagram, outline the steps of effective communication.
16. Differentiate between open-ended and closed-ended questions. Give an example of each.
17. Why is it important to note and respond appropriately to client’s/patient’s non-verbal cues?
18. Give four (4) guidelines for active listening.
19. Give four (4) important points that you should bear in mind when speaking to clients/patients.
20. Describe three (3) functions of body language
21. What are the different types of non-verbal communication?
22. How can body language support or contradict the verbal message?
23. When taking a telephone message, what should be noted?

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KEY TERMS
Flow sheet
Medical record (chart) Recording (documenting) Subjective data
Nursing notes Reporting Symptoms
Objective data Signs

5. COMMUNICATION AMONG THE HEALTH CARE TEAM

MAKING OBSERVATIONS
The amount of time you will spend with your patients or residents, combined with the duties
you are responsible for performing daily (e.g., bathing, feeding, ambulating, toileting), means
that you may notice things about your patients or residents that other health care team
members may overlook. These things you notice are called observations. Your observations
may be based either on objective data or subjective data. Objective data—such as an elevated
temperature, a rash, or a low urine output—are called signs. Objective data is information that
you obtain directly, through measurements or by using one of your five (5) senses (sight, smell,
taste, hearing and touch). Subjective data—such as pain, nausea, or dizziness—are called
symptoms. Subjective data is information that you get second-hand, based on the perception
of the patient (it cannot be measured or observed first-hand).

Using your senses to make observations:

• Sight - what you see different or abnormal to you

a. The client’s skin looks pale l. There is blood or leakage coming from
b. Open areas on a client’s skin some part of the client’s body or
c. Sores in a client’s mouth medical device, such as a drain or
d. The client’s urine, stool, or sputum intravenous (IV)
has an unusual color
e. The client’s emesis (vomit) has an  Sound - what you hear.
unusual color a. The client is coughing
f. The client is not eating or having b. The client is making a noise when
trouble eating breathing
g. The client squints or bumps into c. The client is complaining of a change in
things and people his/her condition (e.g. pain, numbness,
h. The client’s usual facial expression swelling)
has changed d. The client is crying
i. The client sleeps a lot or does not e. No response from the client when you
make facial contact speak to them
j. The client’s breathing is different, f. The client does not speak as clearly as
labored or slow, or the client gasps they normally do
for breadth
k. A part of the client’s body looks

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 Smell - what you smell

a. The client’s breath has an unusual
odor  Touch - what you feel
b. The client’s emesis (vomit) has an a. The client’s pulse is strong
unusual odor b. The client’s pulse is weak
c. An unusual odor in the client’s c. The client’s skin is warm, cool, or
urine or stool moist
d. That the client’s dressing or wound d. A lump under the client’s skin
has an unusual odor

As you make observations you must decide what information to pass on to other members of
the health care team. When deciding what to report, focus on the word change. Observations
of a change in the client from their normal status must be reported to the supervisor
immediately:

 Changes in a client’s physical or mental status (mental awareness)

 Changes in client’s mood
 Changes in a client’s reactions or behavior
 Changes due to a response to a new treatment or therapy
 Changes in the level of independence
 Client’s health statements indicating that he/she senses a change
 All sensory observations as noted above
 Client’s health complaints or concerns
 Abnormal observations gained by use of your senses
 Client care preferences for example, refusal of treatment or request for pastor

RECORDING AND REPORTING

Nursing assistants use two methods of communicating observations about their patients or
residents and documenting the care provided so that other health care team members are kept
“in-the-know.” These methods are reporting and recording.

REPORTING
Nursing assistants use reporting to communicate information to the nurse throughout the shift.
Reporting is also used when shifts change to keep the staff members who are just arriving at
work aware of all the information that is necessary to ensure a smooth continuation of care for
the patient or resident.

When reporting, remember to be a good communicator. Make sure the information that you
are reporting is accurate—refer to the patient or resident by name and room number, and if
you are reporting measurements, such as vital signs, write the numbers down so that you do
not forget them or report them incorrectly. Report your observations in an orderly, concise
manner. Avoid adding information that is not relevant to what you are trying to communicate.

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Use correct and confidentiality. Make sure that you are familiar with these policies, and follow
them carefully.

RECORDING

The medical record is usually organized in sections with specific forms contained in each
section. Some of these forms provide general information about the patient or resident. Others
are specific to a particular health care department. The forms used may vary depending on the
type of facility or health care agency. These may include:
• Admission sheet
• Medical history
• Nursing history
• Physician’s order sheet
• Medication administration record (MAR)
• Physician’s progress notes
• Narrative nurse’s notes
• Graphic sheet

Your employer will have specific policies about whether or not nursing assistants are allowed to
record information in the medical record. If you are allowed to record information in the
medical record, remember that the medical record is a formal record of the care the person
received from the health care facility, and it can be retrieved at any time and used in a court of
law as evidence in a lawsuit.

The information contained in a person’s medical record is considered confidential and is only to
be read by members of the health care team who are directly involved in the care of that
person and need access to the information in the record to provide that care .

GUIDELINES FOR RECORDING

• Write legibly, using dark blue or black ink, according to facility policy. Writing legibly
avoids miscommunication. A pen is used not a pencil because a pencil can be erased,
allowing someone to make changes unknown. Dark blue or black ink is best.
• Always sign or initial your entry (according to facility policy). By signing you identify
yourself as the person to be consulted if further clarification is necessary. It also
means you accept LEGAL responsibility for what you have written.
• Only record observations you have made, or care that you have given. Do not make
entries for another person.
• Date and time your entries correctly. The date and time that actions or observations
were made are essential for the medical record.

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• Use appropriate medical terminology and approved facility abbreviations when

recording. Using correct terminology and abbreviations will prevent others from
having to second-guess your meaning.
• Record information in a timely manner. If you must wait to record something, keep
it in your notepad so that you ensure you record accurate information. If you don’t
you may forget!
• If you make an error, do not erase, use correction fluid to cover or scribble through
the mistaken entry. Simply draw a line through the mistake and initial it according to
facility policy. Striking through an error is the only legal way to indicate a change in
the medical record. Erasing it or using correction fluid to correct could be seen as an
attempt to hide or change existing information.

HOW TO RECORD TIME

Most facilities use the 24-hour time clock (“military time”) to record the time in a person’s
medical record. With the 24-hour time clock, it is not necessary to note whether the time is in
the morning (A.M.) or evening (P.M.) because each hour has its own specific number. When
time is stated according to the 24-hour time clock, the first two numbers indicate the hour and
the last two numbers indicate the minute.

On the 24-hour time clock, the hours from 1:00 A.M. to 12:00 P.M. (noon) are the same as on a
regular clock. To indicate a time between 1:00 P.M. and 12:00 A.M. (midnight), add “12” to the
time on the regular clock.

Regular Clock Time 24 Hour Clock Time

2:00 AM 0200
2:00 PM 1400
2:24 AM 0224
2:24 PM 1424

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