Key Takeaways
- Active listening requires full concentration, not just hearing sounds
- Use SOLER: Sit facing patient, Open posture, Lean forward, Eye contact, Relax
- Reflect emotions and paraphrase content to show understanding
- Barriers include multitasking, prejudging, distractions, and time pressure
- Validate difficult emotions instead of dismissing or minimizing them
Active Listening
Active listening is a communication technique that requires full concentration, understanding, responding, and remembering what the patient says. It's one of the most important skills a CNA can develop.
Hearing vs. Listening
| Hearing | Active Listening |
|---|---|
| Passive, automatic | Active, intentional |
| Sound enters ears | Mind processes meaning |
| Can occur without attention | Requires full focus |
| Simply perceiving sounds | Understanding and responding |
The SOLER Technique
Use SOLER to demonstrate active listening:
| Letter | Meaning | How to Apply |
|---|---|---|
| S | Sit facing the patient | Position yourself squarely |
| O | Open posture | Uncross arms and legs |
| L | Lean forward slightly | Shows interest and attention |
| E | Eye contact | Maintain appropriate gaze |
| R | Relax | Be natural, not stiff |
Active Listening Skills
Attending Behaviors:
- Give undivided attention
- Put down other tasks
- Minimize distractions
- Turn off or silence devices
- Position yourself at patient's level
Verbal Acknowledgment:
- "I see..."
- "Tell me more..."
- "Go on..."
- "I understand..."
- "That sounds difficult..."
Reflecting and Clarifying:
- Paraphrase what you heard
- Ask clarifying questions
- Summarize key points
- Check your understanding
Barriers to Active Listening
| Barrier | Description | Solution |
|---|---|---|
| Multitasking | Doing other things while "listening" | Stop and focus completely |
| Prejudging | Deciding what they'll say before they finish | Keep an open mind |
| Distractions | Environmental or mental interruptions | Minimize and refocus |
| Formulating responses | Planning what to say instead of listening | Listen first, respond second |
| Emotional reactions | Getting upset by what's said | Stay calm and professional |
| Time pressure | Rushing to finish | Make time or return later |
Reflecting and Paraphrasing
Reflecting restates the emotional content:
Patient: "I'm so frustrated that I can't do things for myself anymore." CNA: "It sounds like you're feeling frustrated about needing help."
Paraphrasing restates the content:
Patient: "Every time I try to walk, I'm afraid I'll fall." CNA: "So you're worried about falling when you walk?"
Clarifying and Summarizing
Clarifying seeks more information:
CNA: "When you say you feel 'bad,' can you describe what that means?" CNA: "Are you talking about pain, or something else?"
Summarizing reviews key points:
CNA: "Let me make sure I understand. You're having pain in your lower back that started this morning and gets worse when you move. Is that right?"
Responding to Difficult Emotions
Patients may share difficult feelings:
| Patient Expression | Appropriate Response |
|---|---|
| Anger | "I can see you're upset. Tell me what's bothering you." |
| Sadness | "It sounds like you're feeling sad. I'm here to listen." |
| Fear | "It's okay to feel scared. What concerns you most?" |
| Frustration | "That does sound frustrating. How can I help?" |
| Grief | "I'm sorry for your loss. Would you like to talk about it?" |
Active Listening DO's and DON'Ts
| DO | DON'T |
|---|---|
| Give full attention | Interrupt or finish sentences |
| Show interest with body language | Look at your watch or phone |
| Ask open-ended questions | Change the subject |
| Allow silence for thinking | Fill every pause with talk |
| Validate feelings | Dismiss or minimize feelings |
| Summarize to confirm understanding | Assume you understood |
| Be patient | Rush the conversation |
Practice Exercise
Try this scenario to practice active listening:
Patient says: "I've been so worried. My son hasn't called in two weeks, and I keep thinking something terrible has happened. Nobody tells me anything."
Good active listening response:
"It sounds like you're really worried about your son because you haven't heard from him in a while. That must be stressful. Would you like me to ask the social worker if there's a way to contact him?"
What does the "S" in SOLER stand for?
What is the difference between hearing and active listening?
A patient expresses fear about an upcoming procedure. What is the BEST response?