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Presented by:

APS HEALTHCARESouthwestern PA Health Care Quality Unit(HCQU)

Communication at the Bedside

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Disclaimer

“Information or education provided by the HCQU is not intended to replace medical advice from the consumer’s personal care physician, existing facility policy or federal, state and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented. ”

"Certificates for training hours will only be awarded to those who attend a training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies."

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Objectives

The participant will: 1. Recognize examples of people

first language within cited examples 2. Identify at least 3 techniques to

improve communication with people with developmental disabilities

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HELP WANTED

Need someone to assist in the care of a nonverbal female who drools frequently, is unable to feed herself, has no teeth, is incontinent of both urine and stool and wears diapers, sits up with assistance, and is unable to ambulate, requires total assistance.

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People First Language

Our words have the power to inspire people but they also have the power to hurt people

Write down at least 5-6 words to describe yourself

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People First Language

We are all people first:“The difference between the almost

right word & the right word is really a large matter--it's the difference between the lightning bug and

lightning.”- Mark Twain in a letter to George

Bainton, 10/15/1888

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Disabled

Dictionary: unable to operate; incapable of performing or functioning

People with disabilities are not broken!!!

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People First Language

SAY DO NOT SAYPerson with a disability

Disabled, handicapped

He has Down syndrome

He’s a Down’s boy or the Down’s boy

He uses a wheelchair Confined to wheelchair

Person with a physical disability

Crippled person, quadriplegic

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Scott

You just got your assignment for the day and you have Scott. Scott had an appendectomy and they decided to admit him overnight for observation. Scott is 22 years old, has Down syndrome and autism. He just got to the floor from the PACU and is screaming, trying to pull his IV out, trying to get out of bed.

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Nursing Intervention

What would you do first? What do you need to know? What other issues could be affecting

his behavior?

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Communication

Receptive communication – the ability to understand what someone is communicating to you

Expressive communication - the ability to communicate your needs, wants, feelings, and ideas to others

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Auditory Processing

Sometimes people do not respond initially to speech. They may need extra time processing.

Allow at least 15-20 seconds to be sure what you said was heard. Try and repeat what you have said slowly and simply to be sure the other person did hear and understand.

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Auditory Processing

There may be difficulty distinguishing words or sounds

A statement like, “Tell me how a chair and couch are alike” may sound like “Tell me how a hair and a cow are alike”

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Communication

Effective Non-EffectiveNurturing environment takes into consideration the needs, feelings, and contributions of others

Using a commanding or sarcastic tone

The individual has a sense of control over the environment

Giving orders to someone or pointing a finger at someone when you are addressing them

Speaking with respect Speaking to someone in a crowded place instead of a quiet place

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Respectful LanguageDoes Not Include:

Baby talk Honey or sweetie Sweetheart Baby doll Hon

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Human Rights

Treat others as you would like to be treated

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Modes of Communication

Body language Gestures and nods Facial expressions such as smiling

or frowning Sounds Eye contact Waving Language

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More Modes of Communication

Touching Proximity Movement Pictures or symbols Silence Melody, intensity, and volume of speech

or sounds Music Speech

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What’s Wrong Here?

Do you need anything?

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Jeff

Jeff has just been admitted to your unit with a urinary tract infection. The nurse walks into the room and goes over to Jeff and starts to get the BP cuff to put on his arm. Jeff flails his arms as she has not even spoken to him yet. She backs up like he is going to attack her. She touches him as if he is highly contagious

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Jeff

The nurse is trying to tell Jeff how to use the call bell. Jeff flails his arms again so the nurse begins to talk louder saying the same thing over again.

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Offensive Language

What things have been said to you that have been offensive?

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Offensive LanguageThat Has Been Used to Describe People

with Intellectual Disabilities

Retard or spaz The vegetable; feed and water the

vegetables Sped The blind leading the blind That is retarded or you’re so

retarded

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Right to Life

Quality of life is in the eye of the beholder

It is not for us to judge who deserves to live or die

People with disabilities deserve to live

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The Starfish

A person is walking along the beach and throwing starfish back in the ocean one by one

We may not save every single starfish, but for those that we do, it sure does make a difference

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Be Proactive

Know the individual Always talk with the person directly Treat the patient as you would want

to be treated Be proactive and not reactive Be respectful Smile and use a cheerful voice

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Helpful Hints from People with Disabilities or Their Family Members

Speech delay or auditory processing problems

They may need instructions more than once and may benefit from some visuals (pictures, models, diagrams)

Try listening to the radio and not quite getting the station in clearly. It may take a few times before a message gets through

Be patient and do not raise your voice

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Helpful Hints from People with Disabilities or Their Family Members

Be respectful of space issues Acknowledge their pain and feelings

“I know this seems scary” I know it hurts”

May need to use words like hurt or ouch to define pain

Look for the meaning in challenging behavior

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Jen

Jen has 3 sons. Her 6 year old has Down syndrome and smashed his toe. Jen took her son to the ER for evaluation. He had x-rays but was never offered anything for pain even though he was crying.

Jen asked the nurse for some Tylenol but he never got any. She finally carried her son out to her car, got her younger son’s infant Tylenol from the car, called her husband and had him Google the correct dose for her son and gave it to him while he was still waiting in the ER

What is wrong with this scenario?

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Visual Aids

Use of a calendar Clock Schedule of events 6 am see doctor 7 am breakfast 8 am bath 9am out of bed for a walk 1 0 am pain medicine 11 am rest 12 noon lunch

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HELP WANTED

Need someone to assist in the care of a quiet female who needs assistance with some of her personal needs including activities of daily living. Rewarding experience for a caring individual.

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Thank You for Being a Caring

and Compassionate

Nurse!

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References

www.thenthdegree.com www.disabilityisnatural.com www.nidcd.nih.gov/health/voice/auditory.

asp “Everyday Lives. Making It Happen” Pennsylvania

Department of Public Welfare Office of Mental Retardation

“How Can I Have the Life that I Want?”, 2000 OMR/CCI Published through the OMR Statewide Training and TA Initiative

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References

“How to Teach People with Profound Developmental Disabilities” YAI National Institute for People with Disabilities.

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For more information on this or any other physical or behavioral health topic, please visit our website @ www.hcqu.apshealthcare.com

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HCQU Websitewww.hcqu.apshealthcare.com