Communication Skills Communication Skills

Breege Smithers Breege Smithers Practice Educator Practice Educator

Aim of Session Aim of Session

n n To develop an understanding of the processes To develop an understanding of the processes and skills that are involved in effective and skills that are involved in effective communication with patients and clients. communication with patients and clients.

Objectives Objectives

n n Identify methods of communication Identify methods of communication n n Demonstrate a basic understanding of skills needed Demonstrate a basic understanding of skills needed

for effective listening for effective listening n n Demonstrate how these skills can be used to Demonstrate how these skills can be used to

improve the communication process improve the communication process n n List the barriers to communication List the barriers to communication n n Identify professional boundaries in effective Identify professional boundaries in effective

communication. communication.

Why Communicate? Why Communicate?

n n To develop relationships To develop relationships n n To increase our knowledge To increase our knowledge n n To make our feelings and thoughts known To make our feelings and thoughts known n n To find out about people To find out about people n n To find out information To find out information

Communication in Nursing Communication in Nursing

n n Essential to be able to develop therapeutic Essential to be able to develop therapeutic relationships with patients relationships with patients

n n To be able to identify problems accurately from To be able to identify problems accurately from the patients perspective the patients perspective

n n To be able to plan and deliver appropriate care To be able to plan and deliver appropriate care n n To develop professional relationships with To develop professional relationships with

colleagues within the team colleagues within the team

Effective Communication Effective Communication

n n Increases patient satisfaction and health Increases patient satisfaction and health outcomes outcomes (Barlett, Grayson et al., 1984) (Barlett, Grayson et al., 1984)

n n Reduces the risk of complaint and litigation Reduces the risk of complaint and litigation (Beckmam 1994) (Beckmam 1994)

n n Higher levels of job satisfaction Higher levels of job satisfaction (Kramer et al., Suchman et al., 1993) (Kramer et al., Suchman et al., 1993)

Goal of Effective Communication Goal of Effective Communication

n n Shared Meaning Shared Meaning

n n Accuracy Accuracy

n n Efficiency Efficiency

n n Supportiveness Supportiveness

Can Communication skills be Can Communication skills be taught? taught?

n n Communication is a clinical skill Communication is a clinical skill n n Experience is a poor teacher Experience is a poor teacher n n There is conclusive evidence that There is conclusive evidence that

communication skills can be taught communication skills can be taught n n That communication skills teaching is retained That communication skills teaching is retained

How do we communicate? How do we communicate?

By using By using Mechanical methods Mechanical methods

Verbal methods Verbal methods

Non verbal methods Non verbal methods

Verbal Methods (spoken word) Verbal Methods (spoken word)

n n Questioning Questioning n n Facilitation Facilitation n n Empathic statements Empathic statements n n Clarification Clarification n n Summarising Summarising

Types of Questions Types of Questions

n n Open (broad) Open (broad) – – gives control to respondent, allows gives control to respondent, allows disclosure disclosure

n n Open (focused) Open (focused) – – gives control to respondent within a gives control to respondent within a given area, encourages disclosure of feelings given area, encourages disclosure of feelings

n n Closed Closed – – control is with interviewer, checks control is with interviewer, checks information information

n n Leading Leading – – control with interviewer, suggests desired control with interviewer, suggests desired response response

Facilitation Facilitation

The ability to overcome obstacles and make it The ability to overcome obstacles and make it easier for the patient to verbalise their concerns easier for the patient to verbalise their concerns by : by :- -

n n Acknowledging and legitimising the problem Acknowledging and legitimising the problem n n Showing a willingness to share the patients Showing a willingness to share the patients

feelings feelings

Empathy Empathy

n n The ability to see things from the person The ability to see things from the person’ ’s s perspective and sharing that understanding with perspective and sharing that understanding with the person the person

Clarification Clarification

n n Clarification is required when the patient uses an Clarification is required when the patient uses an ambiguous word. ambiguous word.

n n Other words which need clarification are those Other words which need clarification are those which have a social and a professional meaning which have a social and a professional meaning e.g. e.g. “ “depressed depressed ” ”

Summarising Summarising

n n Involves sorting out the information you have Involves sorting out the information you have been given and demonstrated that you have been given and demonstrated that you have been listening been listening

n n By sharing this with the respondent any By sharing this with the respondent any misconceptions or misunderstanding can be misconceptions or misunderstanding can be cleared up. cleared up.

Non Verbal Methods Non Verbal Methods

n n Listening (active and passive) Listening (active and passive) n n Silence Silence n n Touch Touch n n Hand gestures Hand gestures n n Eye contact Eye contact n n Posture Posture n n Facial expression Facial expression

Active Listening Active Listening

Giving your full attention to Giving your full attention to q q The verbal message The verbal message q q The tone of voice The tone of voice q q The persons posture The persons posture q q The persons gestures The persons gestures q q Understand thoughts,feelings and behaviour Understand thoughts,feelings and behaviour Focus is on Focus is on ‘ ‘being with being with’ ’ rather than rather than ‘ ‘doing doing’ ’

S O L E R S O L E R

n n S = sit S = sit S Squarely in relation to the patient quarely in relation to the patient n n O = O = O Open position pen position n n L = L = L Lean slightly towards patient ean slightly towards patient n n E = E = E Eye contact ye contact n n R = R = R Relax elax

Egan (1986) Egan (1986)

Effective Communication Effective Communication

n n Your verbal and non verbal cues need to convey Your verbal and non verbal cues need to convey the same message the same message

e.g. a verbal empathic response needs to be linked e.g. a verbal empathic response needs to be linked with empathic behaviour if the message is to be with empathic behaviour if the message is to be believed. Otherwise the non verbal cues will be believed. Otherwise the non verbal cues will be believed believed

n n Verbal and non verbal cues of others need to be Verbal and non verbal cues of others need to be considered considered

Barriers to Communication Barriers to Communication

n n Language Language n n Technical terms Technical terms n n Sensory impairment Sensory impairment n n Mental disability/Physical disability Mental disability/Physical disability n n Capacity to understand Capacity to understand

Barriers to Communication Barriers to Communication

n n Practical considerations Practical considerations n n Lack of knowledge Lack of knowledge n n Being too busy /not enough time Being too busy /not enough time n n Cannot deal with the emotion of the patient or Cannot deal with the emotion of the patient or

themselves themselves n n Not being able to do anything about it so why Not being able to do anything about it so why

ask ask

Barriers to Communication Barriers to Communication

n n Being frightened of upsetting the patient Being frightened of upsetting the patient n n Causing more harm than good Causing more harm than good n n Being frightened of difficult questions Being frightened of difficult questions n n Saying the wrong thing/getting into trouble Saying the wrong thing/getting into trouble

Barriers to Communication Barriers to Communication

n n Being seen as too busy Being seen as too busy n n Belief that health care professionals are only Belief that health care professionals are only

concerned about physical care. concerned about physical care. n n Not wanting to burden anyone else with their Not wanting to burden anyone else with their

problems problems n n Concerns about the future Concerns about the future

Barriers to Communication Barriers to Communication

n n Feelings that their concerns may be trivial Feelings that their concerns may be trivial n n Fear of admitting that they are not coping Fear of admitting that they are not coping n n Fear of losing control Fear of losing control n n Not being able to express how they feel Not being able to express how they feel n n Anxiety about having worst fears confirmed Anxiety about having worst fears confirmed

(Maguire 1985) (Maguire 1985)

Barriers to Telephone Barriers to Telephone Communication Communication

n n Not being able to see each other Not being able to see each other n n Surrounding Noise Surrounding Noise n n Being interrupted Being interrupted n n Time Pressure Time Pressure n n Emotional Barriers Emotional Barriers n n Language/Accent/Dialect Language/Accent/Dialect

Answering Incoming Calls Answering Incoming Calls

n n Smile as you answer the telephone Smile as you answer the telephone n n Introduce yourself confidently and clearly. Introduce yourself confidently and clearly. n n Listen Listen - - give your full attention to the caller give your full attention to the caller n n Find out who is calling Find out who is calling - - ask, spell, repeat ask, spell, repeat n n Use the persons name in the conversation Use the persons name in the conversation n n Message Message - - write down clearly, repeat back write down clearly, repeat back n n Information Information – – give clearly and confidently give clearly and confidently n n Don Don’ ’t forget to say goodbye! t forget to say goodbye!

Professional Boundaries and Professional Boundaries and Communication Communication

n n Reporting Reporting n n Documentation Documentation n n Confidentiality Confidentiality n n Privacy Privacy n n Data Protection Data Protection

Further Reading Further Reading

n n Burnard P (1990) Burnard P (1990) Learning Human Skills Learning Human Skills – – an an experiential guide for nurses experiential guide for nurses. 2nd Ed. . 2nd Ed.

Heineman Nursing: Oxford Heineman Nursing: Oxford n n Faulkner, A (2001) Faulkner, A (2001) Effective Interaction with Patients, Effective Interaction with Patients,

2 2 nd nd Ed. Churchill Livingstone, London Ed. Churchill Livingstone, London