2.2 Effective & Therapeutic Communication in Healthcare

Effective & Therapeutic Communication in Healthcare

Communication is the foundational skill of nursing assistance. In long-term care, effective communication involves far more than exchanging words; it requires building trust, demonstrating empathy, identifying changes in physical or emotional condition, and transmitting accurate clinical observations to the healthcare team. Certified Nursing Assistants (CNAs) spend more direct time with residents than any other healthcare staff. Mastering therapeutic communication techniques, recognizing communication barriers, distinguishing objective from subjective data, and utilizing structured reporting tools like SBAR are critical responsibilities for every CNA in Arkansas.

Verbal and Non-Verbal Communication Techniques

Communication occurs through both verbal channels (spoken or written words) and non-verbal channels (body language, facial expressions, and touch). Studies show that over 80% of human communication is communicated non-verbally. CNAs must align their verbal statements with positive non-verbal cues to build a therapeutic relationship.

Verbal Communication Strategies

• Clear, Moderate Tone: Speak slowly, clearly, and at a moderate volume and pitch. Avoid using medical jargon (e.g., say "high blood pressure" instead of "hypertension," or "bowel movement" instead of "defecation").
• Open-Ended Questions: Ask questions that encourage residents to share thoughts rather than giving simple one-word answers. For example, ask "How did you sleep last night?" rather than "Did you sleep okay?"
• Active Listening: Give your full attention to the resident. Focus on what they are saying without interrupting, planning your response, or rushing through care tasks. Nod periodically and restate key points to confirm understanding (e.g., "It sounds like your left shoulder is feeling stiff today.").
• Avoiding False Reassurance: Never offer empty promises such as "Everything is going to be completely fine" when a resident is anxious or facing medical challenges. Instead, offer realistic support: "I am right here with you, and I will report your discomfort to the nurse immediately."

Non-Verbal Communication Cues

• Eye Level Positioning: Never stand over a seated or bedbound resident when speaking. Standing creates an unconscious display of authority and power. Lower yourself by sitting in a chair or kneeling beside the bed so you are at eye level.
• Open Body Posture: Maintain an uncrossed, relaxed posture with your hands at your sides or open. Avoid crossing your arms across your chest, tapping your feet, or constantly checking the clock, as these signals convey impatience, defensiveness, or agitation.
• Facial Expressions and Eye Contact: Maintain warm, friendly eye contact (adjusted for cultural preferences) and a pleasant facial expression. Be aware that micro-expressions of frustration or disgust during heavy personal care tasks (like changing incontinence briefs) can deeply hurt a resident's dignity.
• Therapeutic Touch: A gentle touch on the hand, arm, or shoulder can convey deep warmth, comfort, and reassurance, provided the resident is comfortable with physical contact.

Overcoming Communication Barriers

Residents in long-term care facilities often experience physical, sensory, or cognitive impairments that hinder normal communication. CNAs must adapt their techniques to overcome these barriers effectively:

Hearing Loss

• Position yourself directly in front of the resident in a well-lit area so they can see your mouth and facial expressions.
• Lower the pitch of your voice; high-pitched tones are harder for older adults to hear. Speak clearly without shouting, as shouting distorts sound patterns.
• Reduce ambient background noise by closing doors or turning down televisions and radios.
• Verify that hearing aids are properly inserted, clean, turned on, and equipped with working batteries.

Visual Impairment

• Always identify yourself by name and title immediately upon entering the resident's room (e.g., "Good morning, Mrs. Lee, this is Sarah, your nursing assistant.").
• Explain what you are doing before touching the resident or moving equipment.
• Describe room layouts, meal plates, and object locations clearly. Use the clock-face orientation for meal trays (e.g., "Your scrambled eggs are at 6 o'clock, toast is at 3 o'clock, and coffee is at 10 o'clock.").
• Ensure the resident's prescribed eyeglasses are clean and worn continuously during waking hours.

Speech Impairment and Aphasia

Aphasia is a language disorder resulting from brain damage, often caused by a stroke (cerebrovascular accident).

• Expressive Aphasia: The resident understands what is said but struggles to speak or express words.
• Receptive Aphasia: The resident can speak but cannot comprehend written or spoken language.
• Intervention: Use simple yes/no questions, picture communication boards, gesture prompts, and give ample time (at least 10–15 seconds) for the resident to process and respond without interrupting or speaking for them.

Communication Adapting Guide

Objective vs. Subjective Data Collection

CNAs serve as the "eyes and ears" of the healthcare team. When observing and reporting on resident health, CNAs must understand the fundamental difference between objective data and subjective data:

• Objective Data (Signs): Measurable, observable facts collected using the CNA's direct senses (sight, hearing, touch, and smell) or physical measurement instruments. Objective data is factual and unbiased.
  • Examples: Blood pressure reading of 138/84 mmHg, temperature of 101.2°F, a 2 cm red skin lesion on the right heel, foul-smelling cloudy urine, coughing up yellow sputum, or a pulse of 88 beats per minute.
• Subjective Data (Symptoms): Information that cannot be seen, felt, or measured directly by the CNA; it consists of statements, feelings, or complaints reported by the resident.
  • Examples: Resident states, "I have a sharp headache behind my eyes," "I feel extremely dizzy when I stand up," "My stomach feels nauseous," or "I feel very lonely today."

When charting or reporting subjective data, the CNA must record the resident's exact words in quotation marks (e.g., Resident reports, "My lower back hurts when I bend over").

Reporting Condition Changes: The SBAR Framework

When a CNA observes a sudden change in a resident's physical or mental condition, the information must be communicated to the charge nurse immediately, clearly, and structured. Healthcare facilities widely utilize the SBAR framework for standardized clinical communication:

• S — Situation: State your name, the resident's name, room number, and the immediate problem. ("Nurse Jane, this is CNA Mark. Mr. Robert in Room 112 is experiencing sudden shortness of breath.")
• B — Background: State brief relevant clinical context. ("He returned from physical therapy 10 minutes ago and has a history of asthma.")
• A — Assessment: Report objective vital signs and physical observations. ("His respiratory rate is 28 breaths per minute, he is using accessory neck muscles to breathe, and his pulse rate is 104.")
• R — Recommendation / Request: Request immediate nurse evaluation or assistance. ("I need you to come evaluate Mr. Robert immediately.")

By utilizing therapeutic communication skills, overcoming sensory barriers, accurately recording objective and subjective observations, and utilizing SBAR, CNAs ensure resident safety and seamless care delivery.