9.2 Core Workflows and Decision Points
Key Takeaways
- Therapeutic techniques include open-ended questions, active listening, silence, restating, and clarifying.
- Blocks to communication include closed questions, false reassurance, changing the subject, giving advice, and 'why' questions.
- SBAR (Situation, Background, Assessment, Recommendation) structures reports to the nurse, but the STNA recommends within scope.
- Documentation must be objective, timely, legible, signed, and corrected with a single line and initials—never erased.
9.2 Core Workflows and Decision Points
Therapeutic communication techniques
Therapeutic communication is purposeful interaction that builds trust and gathers information. The exam rewards techniques that keep the resident talking and feeling heard.
| Technique | What it does | Example |
|---|---|---|
| Open-ended question | Invites a full answer | "Tell me how you slept." |
| Active listening | Shows attention | Facing resident, nodding, not interrupting |
| Silence | Gives time to respond | Pausing after a hard question |
| Restating / paraphrasing | Confirms understanding | "So you felt dizzy when you stood up?" |
| Clarifying | Resolves confusion | "What do you mean by 'a little' pain?" |
Communication blocks (what NOT to do)
These answer choices are usually wrong on the exam:
- Closed (yes/no) questions when you need detail
- False reassurance ("Don't worry, you'll be fine")
- Giving advice or your personal opinion
- Changing the subject or minimizing feelings
- Asking "why" (sounds accusatory and pressures the resident)
- Using medical jargon the resident cannot understand
Reporting with SBAR
SBAR stands for Situation, Background, Assessment, Recommendation. It is the standard hand-off structure used to report a change to the nurse clearly and quickly.
- Situation: "Mrs. Lee in 214 has a new reddened area on her left heel."
- Background: "She is on bed rest and was repositioned two hours ago."
- Assessment: "The skin is intact but does not blanch." (objective only)
- Recommendation: "Can you come assess the heel?"
The STNA gives observations and asks for nurse assessment; the aide does not order treatment.
Documentation workflow
Charting is legal communication. The medical record can be used in court, surveys, and investigations. Rules the exam tests:
- Chart objective facts as soon as care is given (timely).
- Write legibly, in ink, and sign with name and title.
- Use only approved abbreviations.
- To correct an error, draw a single line through it, write "error," and initial—never erase, scribble out, or use correction fluid.
- Never chart in advance or chart care you did not give (this is falsification and grounds for losing certification).
Decision point: report now or chart only?
A change in condition (new pain, fall, bleeding, confusion, shortness of breath, refusal of care) is reported immediately, then documented. Routine completed care (bath given, 50% of meal eaten, ambulated in hall) is simply documented on the flow sheet. Knowing which findings demand an immediate verbal report is a recurring decision the test checks.
Verbal vs. written reports
A verbal report is fast and used for anything urgent or anything the nurse needs in real time; it relies on the listener confirming receipt. A written report (charting) is permanent and is the legal record of care. The two are not interchangeable: telling the nurse about a fall does not satisfy the charting requirement, and charting a fall does not satisfy the duty to report it now. The exam frequently presents both as options and expects you to recognize that urgent findings need both, in that order.
The end-of-shift hand-off
At change of shift the outgoing aide gives a hand-off report so the incoming aide knows each resident's status. A good hand-off is organized (often SBAR-style), objective, and covers anything that changed: new orders affecting daily care, refusals, skin changes, intake and output concerns, falls, and behavioral changes. Leaving out a change in condition during hand-off is a classic communication failure that the exam frames as a safety risk.
Listening as part of the loop
Reporting is only half of the loop—receiving is the other half. When a nurse delegates a task, repeat it back to confirm (closed-loop). When a resident gives you information, restate it ("So you haven't had a bowel movement in three days?") so you record it correctly and the resident can correct you. Confirming understanding before acting prevents the wrong-resident and wrong-task errors that the test treats as serious.
Decision point: what is in scope to say?
When a resident asks "What's wrong with me?" or "Will I get better?", the aide does not answer with a diagnosis, prognosis, or test result, even to be kind. The defensible move is to acknowledge the worry, say you will let the nurse know they have questions, and offer presence and support. Stepping outside scope to reassure with clinical claims is a trap baked into many items.
Pulling the workflows together
Think of every communication task as a short pipeline: observe, confirm, decide urgency, report, document, and protect privacy throughout. If you observe a change, confirm it (look again, ask the resident), decide it is a change in condition, report it verbally to the nurse using SBAR, then chart the objective findings, and never discuss it outside the care team. If the task is routine, you skip the urgent report and simply document. If a resident asks a clinical question, you stay in scope and refer it.
Drilling this pipeline until it is automatic means you can answer most workflow questions in well under a minute, which matters because the written test averages roughly 68 seconds per item and a single hesitation on a long stem can cost you a later question. The exam rarely rewards the fastest physical action; it rewards the controlled, documented, in-scope action that leaves the cleanest record and keeps the resident safe.
A resident says, "I'm scared about my surgery tomorrow." Which is the most therapeutic response?
While charting, the nurse aide writes the wrong room number. What is the correct way to fix the entry?