Active listening is a skill How do your employees measure up?
Alabama agency teaches aides the art of communication
Misunderstandings between home care professionals can lead to a rash of "he said, she said" accusations, creating an environment of recrimination that severely weakens the bond of trust between team members or between patients and home care workers.
An Alabama home care agency was prompted to address this issue after an incident at a patient’s home in which home care aides and a field nurse gave very different interpretations of what occurred.
"There was a communication problem either in what they actually heard or in how they interpreted what they heard, and so we decided to give aides an inservice on communication," says Nora Serian, RN, home health aide supervisor for Woodland Community Hospital Home Health Services in Cullman, AL. The hospital-based, full-service agency serves Cullman County in northern Alabama, not far from Birmingham.
The inservice covered the basics on how to communicate better and why people perceive and say things in different ways, says Margie Riddle, RN, Woodland patient care coordinator and nursing supervisor.
"It was a lot of fun," Riddle recalls. "We called it Basic Needs Communication because communications is a basic need for all of us."
The inservice covered "active listening," which is when someone tries to uncover the speaker’s true meaning, says Lynne Graham, LBSW, Woodland social worker.
"A patient may say something, and we take it superficially instead of picking up on the underlying meaning," Graham says.
Patients know their own bodies
Graham knows the importance of active listening from personal experience. She had been sick for a long time and knew that she was dying, although no physicians could find anything wrong with her. Finally, she found a doctor who actively listened when she told him she was very sick. Since he listened to her and believed that her illness was serious, he ran a special test and discovered a congenital hole in her heart.
Her life was saved because "my doctor actively listened to me," Graham says.
"Patients know what’s going on with their own bodies," she adds. "A lot of times our patients know things within themselves that they can share, so active listening is very important."
Although Woodland Community Hospital Home Health Services still has had some misunderstandings among staff, these have been more easily resolved since the inservice, Serian says. "They understood why it was perceived one way by one person and this way by another, so it wasn’t nearly as traumatic to them."
Here’s how the agency conducted the inservice and how others can do the same:
1. Develop an outline.
The inservice covered this basic outline:
I. What is communication?
A. verbal
B. tone
C. clarity
D. non-verbal
E. hand motions
F. facial expressions
G. eye contact
II. Touch therapy
A. appropriateness
B. purpose
III. Exercise: Describer/Interpreter
IV. Criticism and your response
A. complaints
B. formal
C. informal
V. Conclusion
2. Give aides examples of active listening.
Sometimes patients are preparing themselves to die, or perhaps they have become very depressed, and no one picks up on their verbal cues, Graham explains. "We may say, We’ll see you next week, and the patient says, You may not,’ " she says. The easy and common retort is to reassure the patient with a comment of "Oh sure, we will see you."
But this type of response ignores the patient’s deeper meaning.
Instead, Graham says, aides should put down their clipboard and ask the patient, "Why do you feel like you may not see me next week?"
This response shows that the listener wants to know how the patient is truly feeling.
"I’d prefer the home care aides open that door and allow the patient to discuss problems," Graham says. "If they can’t handle it, then they can get a social worker or nurse to see the patient."
Then, they need to actively listen to the patient’s answer. It’s possible that the patient is depressed about being chronically ill and wants to die. An aide who actively listens could alert the nurse and get the patient help.
Or it could be the patient senses that something is going wrong with his or her body.
"Some of these patients come to a point where they know that treatment is not working anymore, and they don’t know how to advocate for themselves with the physician," Graham explains. "We could intervene."
The educators used some group exercises to bring home the point that communication is a learned skill that can be difficult at times. (See communication exercises, p. 19.)
The agency’s home care aides found the inservice helpful, and they gained a greater understanding about why they might interpret an incident one way and the nurse interpret it another way, Serian notes.
"They began to understand that a lot of times the way we interpret things is based on the way we were taught to interpret things when we were children," Serian adds. "Our perception is not the same as someone else’s."
3. Show aides how to facilitate family communication.
Aides may see and hear more about patients’ true wishes than other members of the medical staff, so they’re in a good position to work with families where communication is a problem.
For example, Graham says, what if an 80-year-old woman has high blood pressure but is mostly independent. The woman’s family members may plan to have her move into their home because they fear she might hurt herself while living alone.
But suppose the woman doesn’t want to leave her own home, which is where she is comfortable and has some control over her life.
Aides may serve as a liaison between the patients and families because they are the home care workers who are most involved in the home, Graham says.
"The aide can try to help the family understand what the patient’s needs are and get other disciplines involved at that point," Graham says.
"Sometimes we overlook the fact that older people may thrive and do much better in their own environment," she adds.
4. Stress honesty.
"The main thing we really stress is honesty," Graham states. "If patients ask you a question, you answer to the best of your knowledge. But if you don’t know the answer, you say you don’t know the answer, but you’ll find out."
Honesty is essential because once a patient loses trust of the aide, it will be difficult for the aide to help him or her, she adds.
Another situation in which honesty and clear communication can prevent a conflict is when a patient tries to stir up trouble between two or more aides.
"A lot of these patients are very lonely," Graham explains. The patient might have a weekday aide and a weekend aide, and because there is no one else around, the patient might try to triangulate the two aides.
"The patient might say, She didn’t dry me this way,’ and then go back to the other aide, and say, The weekend aide says you shouldn’t do it that way,’" Graham says.
The best way to stop this type of conversation is for the aide to tell the patient, "We’re both individuals, and we do it a little bit differently," Graham suggests.
Or if the patient continues to complain, the aide can say, "I really can’t discuss this with you, but if you’d like to make a formal complaint, then I’ll pass this on to my supervisor."
Graham says the aides have to understand that the patients start these types of conflicts not so much because they are mean but because they are bored. "They have nothing else to do all day, and our home care aides are the only people they see all week, and in order to start a conversation, they end up being negative."
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