Barriers to
Communication
Communication barrier –
Anything that gets in the way of
clear communication.
Three Common Barriers
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Physical disabilities
Psychological attitudes
and prejudice
Cultural diversity
Physical Disabilities may include:
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Deafness or hearing
loss
Blindness or impaired
vision
Aphasia or speech
disabilities
To improve communication with the
hearing impaired…..
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Use body language
such as gestures and
signs.
Speak clearly in short
sentences.
Face the individual to
facilitate lip reading.
Write messages if
necessary.
Make sure hearing aids
are working properly.
To improve communication with the
visually impaired…….
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Use a soft tone of voice.
Describe events that are occurring.
Announce your presence as you enter a
room.
Explain sounds or noises.
Use touch when appropriate.
What about someone with aphasia or
speech impairments…..
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They have difficulty remembering the correct words,
may not be able to pronounce certain words, and
may have slurred speech.
The health care worker must be patient.
Allow them to try and speak.
Encourage them to take their time.
Repeat message to assure accuracy.
Encourage them to use gestures or point to objects.
Provide pen and paper if they can write.
Use pictures with key messages to communicate.
Psychological barriers are often caused
by:
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Prejudice
Attitudes
Personality
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Stereotypes such as “dumb
blondes” or “fat slob” cause
us to make snap
judgements about others
that affect the
communication process.
Health care workers must
learn to put prejudice aside
and show respect for all
individuals. Is that possible?
Do all patients have the
right to quality health care?
Health Care workers should:
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Allow patients to
express their fears or
anger.
Encourage them to talk
about their feelings.
Avoid arguing.
Remain calm.
Talk in a nonthreatening tone of
voice.
Provide quality care.
Cultural Barriers
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Each cultural group has beliefs and practices
regarding health and illness.
Some cultures believe the body needs balance-if the
body is cold, they eat hot foods.
Some cultures believe illness is due to demons and
evil.
Some cultures believe health is a reward from God,
and illness is punishment from God.
Cultural beliefs must be respected
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Patients may practice
their cultural remedies
in addition to modern
healthcare techniques.
Cultural diversity may interfere with
communication in other ways:
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Language differences-people who don’t
speak English may have a difficult time
communicating. You should:
a.
Speak slowly.
b.
Use nonverbal communication
(smile).
c.
Avoid tendency to speak louder.
d.
Find an interpreter.
Cultural Barriers Cont.
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Eye contact- in some cultures, it’s not acceptable ,
and looking down is a sign of respect.
Terminal illness- in some cultures, the patient is
NOT told his/her prognosis, and family members are
responsible for making care decisions.
Touch- in some cultures, it is wrong to touch
someone on the head.
Personal care-in some cultures, only family
members provide personal care.
Respect and acceptance of cultural diversity is
essential for any health care worker.
Recording and Reporting…
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Health care workers must listen
carefully AND make observations.
They use their senses to:
See
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Color of skin, swelling or
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edema
Presence of rash or sore
Color of urine or stool
Amount of food eaten
They use their senses to:
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Smell
∆ Body odor
∆ Unusual odors of:
breath, wounds,
urine and stool
Touch
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Pulse
Dryness and temperature
of skin
Perspiration
Swelling
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Hearing
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Respirations
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Abnormal
body sounds
∆
Coughs
∆
Speech
Observations:
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Observations should be reported accuratelyuse facts and report what you saw, not the
reasons.
NOT-”Mr. Ruiz is in pain.”
INSTEAD- “Mr. Ruiz is moaning and holding
his side.”
Observations on a patient’s health record
(chart) should be accurate, concise, and
complete.
Observations:
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Objective observations – what was seen.
DO NOT record what you feel or think.
If a patient’s statement is recorded, use the
patient’s words and use quotation marks.
Sign entries with name and title of the person
recording the information.
Cross out errors neatly with a straight line,
write error, and initial error.
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Subjective
Objective
Assessment
Plan
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SUBJECTIVE — . These
are symptoms the patient
verbally expresses or as
stated by a significant other.
These subjective
observations include:
the patient's descriptions of
pain or discomfort,
the presence of nausea or
dizziness,
when the problem
first started, and
a multitude of other
descriptions of dysfunction,
discomfort, or illness the
patient describes.
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OBJECTIVE —These
objective observations
include symptoms;
that can actually be
measured seen, heard,
touched, felt, or
smelled.
Included in objective
observations are vital
signs such as
temperature, pulse,
respiration, skin color,
swelling and the results
of diagnostic tests.
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ASSESSMENT — is
the diagnosis of the
patient's condition. In
some cases the
diagnosis may be clear,
such as:
a contusion. However,
an assessment may not
be clear and could
include several
diagnosis possibilities.
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PLAN — The plan may include:
laboratory and/or radiological
tests ordered for the patient,
medications ordered, treatments
performed (e.g., minor surgery
procedure),
patient referrals (sending patient
to a specialist), patient disposition
(e.g., home care, bed rest, shortterm, long-term disability, days
excused from work, admission to
hospital), patient directions (e.g.
elevate foot, RTO 1 week), and
follow-up directions for the
patient.
SOAP Note Example
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Patient Name: Robert Kryle DOB: 12/31/1961
Record No. K-6112r809
Date: 09/09/1999
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S—Pt. states that she has always been overweight. She is very
frustrated with trying to diet. Her 20 year class reunion is next year and
she would like to begin working toward a weight loss goal that is
realistic. NKDA, NKA.
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O—WT = 210 lbs HT = 60, Chol = 255 BP = 120/75
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A—Obese at 183% Ideal Body Weight (IBW), hypercholesterolemia
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P—Long Term Goal: Change lifestyle habits to lose at least 70 pounds
over a 12 month period. Short Term Goal: Client to begin a 1500
Calorie diet with walking 20 minutes per day. Instructed Pt on lower fat
food choices and smaller food portions. Client will keep a daily food and
mood record to review next session. Follow-up in one week.
Soap Note Two example….
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Patient Name: Paul Kessler DOB: 11/03/1961
Record No. K-470pk624
Date: 21/8/2008
S—Mild burning with frequent urination, a thin discharge that is
worse in the A.M., irritation at the urinary opening at tip of penis,
NKA.
O—Discharge with gram stain negative for gonorrhea, showing
large numbers of WBCs. Chlamydia test is positive.
A—Non-Gonorrheal Urethritis
P—Doxycycline 100mg BID for 10 days or Erythromycin 500mg
QID for 10 days or Tetracycline 500mg QID for 10 days. Increase
fluid intake, avoid alcoholic beverages. Pt education on safe sex
practices.
Test your gray matter….
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What is the best way for a nurse to assess a patient’s concerns
about her scheduled mastectomy? -Ask the pt. husband how the pt.
feels,- The nurse should bring up the subject while taking the pts.
VS and making the bed,- The nurse should close the door, sit down,
and ask the pt. how she is feeling about the surgery,- Observe the
pt, for signs of fear and anxiety.
If you are talking to a person who has a speech impairment who has
difficulty completing a sentence you should: -Offer the person an
opportunity to write the word or words you are unsure of – Smile,
nod your head, and pretend you understand – Ask the person to
start over and try to speak more slowly and clearly – Anticipate what
the person is trying to say and complete the sentence.
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A medical office assistant asks a pt. if she has net her deductible.
The pt. doesn’t answer. What should the medical office assistant do
next? –Ask “Why are you so embarrassed?” – Charge the full
amount of the bill – Ask “Do you understand what I’m asking?”Make a note on the chart that the pt. is uncooperative.
A Latino pt. comes to the ER and expresses concern about being
treated by a Caucasian physician. The health care worker should:
Allow the pt, to express his/her fears without being judgmental – Tell
the pt. that the physician is a good one and he/she had nothing to
worry about – Say nothing to the pt. but inform the doctor of the pts.
Hostility – Find a Latino healthcare worker in the hospital who can
verify the doctor’s credentials to the pt.
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A medical assistant believes a child needs stitches. How should he
report this to the doctor? – “We have a child who is going to need
stitches.” – “Your next pt. is a child.” – “We have a child with a 2 inch
laceration under her chin.” – “Your next pt. is going to be a handful.
It’s a child who popped her chin.”
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What is the correct way to signify that an entry on a medical record
was made in error? – Circle the error and write “EE” (entry error)
beside it- Erase the error completely – Use “white-out” to paint over
the error, writing the correct information over the top of the dryed
“white out.” – Cross out the error with a straight line, write “error” and
initial it.