Strengthening Communication and Problem Solving for CNAs

This curriculum consists of six one-hour in-service training sessions for facility-based Certified Nursing Assistants (CNAs) in California. The goal is to help CNAs provide better care for residents in long-term care facilities, by achieving the following objectives:

  • To develop core competencies of communications and problem-solving skills for CNAs, and provide them with concrete tools to respond to resident’s needs and preferences.
  • To assist CNAs and their employers to comply with 2009 state surveyor interpretive guidelines from the Center for Medicare and Medicaid Services (CMS) for “resident-centered” practices.
  • To help to address key areas of residents’ concern, as suggested by resident complaint surveys and further refined by resident and staff interviews.

Introduction for Instructors

The "Introduction for Instructors" is a guide for delivering the curricula and should be used by instructors in preparing for the training.  Each unit includes two files (1) curriculum (2) handouts. 

Introduction for Instructors

Unit 1. Introduction to Resident-Centered Care and Active Listening

This unit provides an overview of resident-centered care. Participants consider what resident-centered care would mean to them if they were residents.  Participants are then introduced to guidelines for resident-centered care from the Centers for Medicare and Medicaid Services (CMS) and the Minimum Data Set (MDS) 3.0 revisions. Unit 1 also introduces the use of communication skills to support resident-centered care, focusing on active listening.  Role playing activities are presented to demonstrate the use of body language to support active listening.

Unit 1 - Introduction to Resident-Centered Care and Active Listening
Handout 1A - Overview of Workshop Series

Unit 2. Active Listening: Paraphrasing

Unit 2 continues building active listening skills, with a focus on paraphrasing. Through a role playing activity, participants learn what paraphrasing is and how it can be used to support resident-centered care—by letting residents know that they are listening and by checking for understanding of what the resident has said. Participants also practice paraphrasing sample statements.

Unit 2 - Active Listening: Paraphrasing
Handout 2A - Overview of Paraphrasing

Unit 3. Active Listening: Asking Open-Ended Questions 

In Unit 3, participants learn about a third active listening skill—asking open-ended questions. They explore the differences between closed and open-ended questions, both in terms of how the questions are asked and the impact they can have on the conversation. Participants then practice creating open-ended questions to see how it can enhance resident-centered care, by encouraging residents to express their needs and preferences.

Unit 3 - Active Listening: Asking Open-Ended Questions
Handout 3A - Open-Ended Questions

Unit 4. Managing Emotions: Pulling Back

In Unit 4, participants learn about the skill of pulling back. They explore how responding emotionally in stressful situations can make it harder to listen well and how pulling back can lead to more respectful communications and more effective problem-solving.  Participants identify strategies for pulling back and situations in which they can use those strategies to enhance resident-centered care.

Unit 4 - Managing Emotions: Pulling Back
Handout 4A - Reacting Emotionally vs. Pulling Back - You Choose

Unit 5. The Exploring Options Approach to Problem-Solving

Unit 5 introduces a person-centered model for problem-solving—“The Exploring Options Approach.” This approach involves:

  • Clarifying what the problem is from the point of view of the resident, the CNA, and the organization.
  • Identifying important issues that need to be addressed from each point of view.
  • Brainstorming possible solutions to address the important issues.
  • Considering which option (or combination of options) would work best to solve the problem from all three points of view.

This approach to problem-solving is particularly appropriate for resident-centered care because it emphasizes the perspective of the resident in all the steps.

Unit 5 - Exploring Options Approach to Problem-Solving
Handout 5A - Exploring Options Sample Scenario

Unit 6. Giving Constructive Feedback 

In Unit 6, participants consider the importance of teamwork in resident-centered care, through a small-group activity.  They then learn about constructive feedback and guidelines for giving constructive feedback. Participants practice giving constructive feedback through case scenarios and consider its impact on teamwork and resident-centered care.

Unit 6 - Giving Constructive Feedback
Handout 6A - Giving Constructive Feedback