ihc chapter 16 4th edition

Chapter 16The Communication Process

Communication

• Exchanging messages between sender and receiver

• Types:– Oral– Nonverbal– Written– Electronic

Communication in Health Care

• Excellence in communication essential in health care– Increase in size of delivery systems

• Need for intercommunication– More complex payment systems– Decrease in time spent in hospitals

• Importance of patient education

Communication in Health Care

• Shift in causes of death to heart disease, cancer, COPD, and stroke– Patient information regarding wellness and

healthy lifestyles

Communication and PatientWell-Being

• Need for respect and understanding of individual patients and their needs

• Impact on speed of patient recovery

Communication and PatientWell-Being

• Stressors for patients:– Intimidation of health care setting– Fear and anxiety

• Poor communication can lead to fatal errors

Communication Process

• Communication– More than talking and listening

• Therapeutic communication = effective health care communication– Aimed at meeting needs of patients– Requires developing and applying

communication skills

Communication Process

1. Set communication goals2. Create message3. Deliver message4. Listen to response5. Offer feedback and seek clarification6. Evaluate encounter

– And revise message, if necessary

1. Set Communication Goals

• Decide what is to be accomplished• Therapeutic communication usually at

deeper level than everyday conversation– Must be clear and accurate

1. Set Communication Goals

• Examples of goals:– Gather information from patient– Give instructions to patients– Report information to coworker

1. Set Communication Goals

• Goals to include in every patient interaction:– Show sincere concern for patient’s welfare– Establish trust– Enhance patient’s self-esteem

Question

• True or False:– Today’s health care services are so

technologically advanced that there is little point in allowing patients to participate in making decisions about their health.

Answer

• False• Patients should be involved in decision

making whenever possible

1. Set Communication Goals

• Factors to consider when setting goal:– Patient’s level of understanding– Emotional factors– Physical factors– Urgency of communication

2. Create Message

• Create message based on information gathered and communication goal

• Avoid medical terminology with patients– Use general language

• Rather than slang

2. Create Message

• Must be clear and accurate• Organize long messages

– Rank items in order of importance– Give overview and then details– Break information into chunks

• Messages can be in form of question

2. Create Message

• Types of questions:– Closed-ended

• Can be answered with one word or phrase– Open-ended

• Requires more than one-word answer

2. Create Message

• Types of questions:– Probing

• Asks for more information– Leading

• Question includes possible answer

Question

• “What is your date of birth?” is an example of a/an _____ question.A. ProbingB. Open-endedC. Closed-ended

Answer

• C. Closed-ended• Response to question is one word or short

phrase that functions like one word– Therefore closed-ended

Question

• True or False:– An appropriate use of a leading question is with

patients who are unable to offer complete answers on their own.

Answer

• True• Leading question offers part or all of

answer– Can be helpful when patients cannot create

answer themselves

2. Create Message

• When asking questions:– Allow time for response– Take care with leading questions

• Because patient may simply agree with you– Reword questions when necessary

2. Create Message

• Humor appropriate when used carefully– Helps relieve tension– Can promote open discussion of sensitive

issues• Patient jokes to mask fear

– Listen carefully– Patient may need help dealing with fear

3. Deliver Message

• Address patients directly whenever possible– Young and elderly patients

• Use titles to show respect– Ask patients how they wish to be addressed

3. Deliver Message

• Take care not to breach confidentiality• Maintain communication with patients who

cannot speak to respond

Question

• True or False:– Using casual words such as “like” and “you

know” in your messages to patients can help them feel more at ease.

Answer

• False• Filler words should be avoided

– Can be distracting to your message and/or irritating for some listeners

3. Deliver Message: Nonverbal Communication

• Delivers up to 70% of meaning of oral message

• Nonverbal communication includes the following:– Tone of voice– Touch

• Can be reassuring, but use with care

3. Deliver Message: Nonverbal Communication

• Nonverbal communication includes the following:– Body language

• Gestures can be positive or negative– Smiling– Crossing arms– Rolling eyes

3. Deliver Message: Nonverbal Communication

• Nonverbal communication includes the following:– Facial expressions

• Avoid showing negative reactions– E.g., impatience, disgust

– Physical appearance• Sign of health care professional competence and

regard for patients

Question

• Leaning toward the speaker when you are listening is usually a sign of:A. AggressionB. InterestC. Difficulty understanding

Answer

• B. Interest• Leaning toward speaker

– Sign of interest in what speaker is saying

3. Deliver Message: Physical Environment

• Can affect delivery of message• Factors to consider:

– Light source– Sound distractions– Privacy– Focus on patient– Patient comfort

4. Listen to Response

• Listening– Active process

• Concentration• Attention• Observation

Question

• Which is the most important characteristic of active listening?A. Taking notes while listeningB. Maintaining eye contact with the speakerC. Focusing fully on what the speaker is saying

Answer

• C. Focusing fully on what the speaker is saying

• Active listening may involve other actions, but focusing fully on speaker is the underlying characteristic

4. Listen to Response: Empathy

• Empathy– Effort to understand other peoples’ thoughts,

feelings, and behaviors– “Walk a mile in my shoes”

• Communicate awareness of patient’s feelings

5. Offer Feedback and Seek Clarification

• Feedback– Method for receiver to check understanding of

what sender says• Types of feedback:

– Paraphrasing• Rewording of sender’s message in receiver’s own

words

5. Offer Feedback and Seek Clarification

• Types of feedback:– Reflecting

• Prompting receiver to complete or add to original message

– Asking questions• Requesting clarification and additional information

– Requesting examples• Asking for examples to clarify and fill in meaning

Question

• “I hear you saying you feel better after you’ve done the exercises I taught you last week” is an example of:A. ParaphrasingB. ReflectingC. Asking a leading question

Answer

• A. Paraphrasing• Paraphrasing

– Stating in own words what you think sender said

6. Evaluate Encounter

• Determine if communication goal met• If not met, identify difficulty• Continually evaluate communication

throughout encounter

6. Evaluate Encounter: Communication Barriers

• Barriers can block effective communication• Examples of barriers:

– Cultural differences– Language differences– Defense mechanisms– Physical distractions– Pain

Patients with Special Needs

• Terminally ill– May experience loneliness– May want to share fears and concerns– Health care professionals need to come to

terms with death as patient outcome

Patients with Special Needs

• Those with pain, medication, or disorientation– Identify self and say patient’s name– Speak slowly and maintain eye contact– Use simple, short messages– Repeat as necessary and review content– Use touch, if appropriate– Try to schedule best time for patient

Patients with Special Needs

• Those with Alzheimer’s disease and other forms of dementia– Do not confront– Use short sentences– Agree or distract when patient doesn’t make

sense– Respond to patient’s feelings– Offer suggestions, not corrections

Patients with Special Needs

• Those who are depressed– Invite patients to discuss their feelings– Offer hope

But do not tell to cheer up– Allow for silence

Patients with Special Needs

• Those who are anxious– Maintain calm– Monitor anxiety level– Keep message simple– Stick to one topic– Use feedback to check understanding

Patients with Special Needs

• Hearing impaired– Observe behavior and check for understanding– Ensure face and mouth of speaker are visible– Speak slowly and clearly– Turn off sources of noise– Do not shout– Announce change of subject

Question

• When a listener leans forward and turns his head, this is may be a sign of a/an _____ .A. Hearing impairmentB. Visual impairmentC. Inability to understand English

Answer

• A. Hearing impairment• Two of several signs that listener is hearing

impaired:– Leaning toward speaker– Turning head

Patients with Special Needs

• Visually impaired– Announce presence and identify self– Explain procedures, sounds, and what patient

can expect– Give detailed instructions about what patient is

to do

Patients with Special Needs

• Visually impaired– Tell patient when leaving– Give information about doorways, obstacles,

etc., if patient is leaving area alone

Patients with Special Needs

• Speech impaired– Use pantomime and gestures– Use drawings and pictures– Write– Use communication boards

Patients with Special Needs

• Anger– Emotional response to perceived wrong– Loss of personal control– Worries and fears– Health care professional should not take

personally

Patients with Special Needs

• Anger– Dealing with angry patients

• Remain calm• Do not respond in anger• Do not argue• Listen carefully and express concern• Answer patient’s questions• Ask for help, if necessary

Patients with Special Needs

• Patients who do not speak English– Empathize with situation– Smile, if appropriate– Determine if someone can interpret– Speak slowly and clearly– Repeat message in different words– Use pantomime and gestures– Write message

Special Applications of Communication Skills

• Telephone communication– Often first means of contact with health care

facility– Person answering represents facility– Guidelines:

• Speak clearly• Speak at moderate rate

Special Applications of Communication Skills

• Telephone communication– Guidelines:

• Project warmth and caring• “Smile” in voice, if appropriate• Avoid speaking in monotone• Give caller chance to speak• Never chew gum or eat

Special Applications of Communication Skills

• Patient education– Patients want information– More self-care required today

Special Applications of Communication Skills

• Patient education– Process for delivering patient education

1. Set educational goals2. Create instructional message3. Deliver instruction4. Listen to patient questions5. Check for patient understanding6. Evaluate instruction

Special Applications of Communication Skills

• Group presentations– E.g., patient’s family, professional meeting,

coworkers at staff meeting

Special Applications of Communication Skills

• Group presentations– Strategies for success:

• Clarify purpose and important points• Determine needs of audience• Organize material and prepare notes• Speak at moderate rate• Look at audience

Gossip

• Unnecessary, negative conversation• Avoid at workplace• Strategies for handling:

– Explain unfairness– State belief in inappropriateness– Change subject

Patient Privacy

• Avoid speaking in public about patients• Do not discuss patients in social

conversations• Do not discuss patients in front of them if

they are not included in conversation