9.1 Communication Overview
Key Takeaways
- Communication and interpersonal skills is a graded domain on the Ohio STNA knowledge test (79 questions, 90 minutes, 70% to pass).
- Therapeutic communication uses open-ended questions, active listening, and silence; it avoids false reassurance and 'why' questions.
- The STNA observes and reports objective data and reports subjective complaints to the nurse; the STNA never diagnoses.
- Confidentiality is protected by HIPAA and Ohio rules; discuss resident information only with the care team on a need-to-know basis.
9.1 Communication Overview
Communication is the exchange of information through verbal, nonverbal, and written channels. On the Ohio State Tested Nurse Aide (STNA) exam, communication is one of the graded content areas, and the questions are practical: who you tell, what you say, what you write, and what you keep private. The written knowledge test has 79 multiple-choice questions with a 90-minute limit, and you must score 70% (at least 56 of 79) to pass. The exam is administered by D&S Diversified Technologies (Headmaster). Communication appears throughout the test because nearly every resident interaction involves it.
The communication loop
Every message has a sender, a message, a receiver, and feedback. Breakdown at any point causes errors. As an aide you confirm the message was received correctly: ask the resident to repeat instructions, or repeat back what a nurse delegated to you (this is called a read-back or closed-loop confirmation).
Verbal vs. nonverbal
Researchers estimate that the majority of meaning in face-to-face contact comes from nonverbal cues (facial expression, posture, tone, eye contact, touch). When words and body language conflict, people believe the body language. A resident who says "I'm fine" while grimacing and guarding the abdomen is reporting pain nonverbally.
| Channel | Examples | Aide application |
|---|---|---|
| Verbal | Spoken words, tone, volume, pace | Speak slowly, face the resident, use simple terms |
| Nonverbal | Eye contact, posture, gestures, touch | Sit at eye level; do not cross arms; use gentle touch |
| Written | Care plan, flow sheets, ADL charting | Chart objective facts, sign, never erase |
Objective vs. subjective
The STNA must separate objective data (what you see, hear, measure, or smell, such as a blood pressure of 150/92 or a reddened heel) from subjective data (what the resident tells you, such as "my chest hurts"). You observe and report; you do not diagnose or interpret. Report subjective complaints to the licensed nurse promptly and document objective findings on the assigned flow sheet.
Scope and the chain of command
The STNA works under the direction of a licensed nurse (LPN or RN). When you observe a change in condition, you report up the chain of command: aide to nurse, nurse to physician or charge nurse. You never act outside your scope, never give medical advice, and never tell a resident a diagnosis. Knowing exactly what to report and to whom is heavily tested.
Privacy as a communication rule
Under the Health Insurance Portability and Accountability Act (HIPAA) and Ohio nurse-aide rules, resident information is confidential. You may share it only with care-team members who need it to provide care. Do not discuss residents in hallways, elevators, the break room, or on social media. Verifying identity before disclosure, closing doors, and lowering your voice are all communication-privacy behaviors the exam expects.
Why communication is so heavily tested
The STNA spends more time at the bedside than any licensed staff member, so the aide is the facility's early-warning system. A licensed nurse cannot act on a change she never hears about. Many questions are written so that the resident's safety depends on the aide noticing something, reporting it accurately, and recording it. Because the written test allots only about 68 seconds per question (90 minutes for 79 items), you must recognize the communication pattern quickly and pick the answer that is therapeutic, in scope, and protective of privacy.
Common communication terms to know
Few vocabulary words appear as bare definitions, but they anchor the scenarios. Therapeutic communication is purposeful interaction that helps the resident; active listening is full attention with verbal and nonverbal feedback; empathy is recognizing and respecting another's feelings (different from sympathy, which is feeling sorry for someone). Receptive aphasia is difficulty understanding language, while expressive aphasia is difficulty producing it. Dysarthria is slurred speech from weak muscles.
Defense mechanisms such as denial, anger, and projection are normal reactions to illness; the aide responds with patience, not correction.
Putting it together
A strong test-taker reads each stem for four things: the resident (any sensory, language, or cognitive barrier), the finding (objective or subjective), the urgency (routine or a change in condition), and the privacy context (who is allowed to hear this). The right answer almost always keeps the resident talking, stays inside the aide's scope, reports changes promptly, documents objectively, and shares information only on a need-to-know basis. Memorize that pattern now and the rest of this chapter becomes pattern recognition.
A note on tone and pacing
Good communication is as much about how you speak as what you say. Use a calm, warm, unhurried tone; rushing a resident is itself a barrier, especially with the elderly, the hard of hearing, and those with cognitive decline. Introduce yourself at every encounter, explain what you are about to do before you touch the resident, and ask permission. Give one instruction at a time and allow the resident to respond before moving on. Maintaining eye contact, sitting rather than standing over the resident, and keeping your hands still all signal that you are present and attentive.
These habits convert routine tasks into therapeutic interactions and reflect the resident-centered approach that the Ohio STNA exam expects in nearly every scenario item. They also reduce agitation, refusals, and falls, which is why surveyors and the test treat respectful communication as a safety measure, not a courtesy.
A resident tells the nurse aide, "My stomach has been hurting all morning." How should the aide classify and handle this information?
When a resident's spoken words and body language conflict, which principle guides the nurse aide's response?