provincial violence prevention curriculum module 4 communication … · 2014-11-10 · occupational...

P r o v i n c i a l V i o l e n c e P r e v e n t i o n

C u r r i c u l u m

M o d u l e 4 – C o m m u n i c a t i o n B a s i c s

VE R S I O N 2.3

J A N U A R Y , 2011

V I O L E N C E P R E V E N T I O N

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T A B L E O F C O N T E N T S

Acknowledgements ............................................................................................................ iii

Course Overview ................................................................................................................. 1

Course introduction ............................................................................................................. 1

Course objectives ............................................................................................................... 2

Communication and Violence Prevention ............................................................................ 3

Introduction ....................................................................................................................... 3

What are the different communication types? ......................................................................... 3

Why is effective communication important? ............................................................................ 4

How does effective communication benefit patients? ............................................................... 4

How does effective communication benefit me? ...................................................................... 5

Non-verbal Communication ................................................................................................. 6

Personal Space .................................................................................................................... 7

Introduction ....................................................................................................................... 7

Why is important to maintain personal space? ........................................................................ 7

What are some guidelines for personal space? ........................................................................ 8

How does culture affect personal space? ................................................................................ 8

What do I need to do if entering someone’s personal space? .................................................... 9

How should I distance myself from someone who is not respecting my personal space? ............. 10

Body Language .................................................................................................................. 11

Introduction ..................................................................................................................... 11

Use a ready posture .......................................................................................................... 11

Eye contact ...................................................................................................................... 12

Be aware of your facial expressions ..................................................................................... 13

Negative body language .................................................................................................... 14

Touch ................................................................................................................................ 15

Introduction ..................................................................................................................... 15

Why shouldn’t I touch a patient? ......................................................................................... 15

When is it okay for me to touch a patient? ........................................................................... 15

Test Your Knowledge #1 ................................................................................................... 16

Recognizing Patient Cues for Violence............................................................................... 17

Introduction ..................................................................................................................... 17

Personal space ................................................................................................................. 17

Eye communications.......................................................................................................... 17

Gestures and postures ....................................................................................................... 18


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Facial expressions ............................................................................................................. 18

Vocal Communication ........................................................................................................ 19

What is vocal communication? ............................................................................................ 19

Speed of speech ............................................................................................................... 19

Pitch ............................................................................................................................... 20

Tone ............................................................................................................................... 20

Volume ............................................................................................................................ 21

Verbal Communication ...................................................................................................... 22

Introduction ..................................................................................................................... 22

What are the best words to use? ......................................................................................... 22

What words and phrases should I avoid? ............................................................................. 22

General Guidelines for Good Communication ..................................................................... 23

Test Your Knowledge #2 ................................................................................................... 24

What You’ve Learned ........................................................................................................ 25

Module 4 Quiz .................................................................................................................... 26

Test Your Knowledge - Answer Keys ................................................................................. 28

Test Your Knowledge #1 .................................................................................................... 28

Test Your Knowledge #2 .................................................................................................... 28

Module 4 Quiz Answer Key ................................................................................................ 29

Notes ................................................................................................................................. 30


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A C K N O W L E D G E M E N T S

This Violence Prevention Curriculum was developed as a project of the Provincial

Violence Prevention Steering Committee (PVPSC) to fill a need for effective, recommended and provincially-recognized violence prevention training for all British Columbia healthcare workers across a range of care settings, including affiliate organizations. The Curriculum includes eight online and five classroom modules.

The PVPSC wishes to acknowledge the generous support and commitment of the

management and the subject matter experts representing the following health authorities and healthcare unions. Without their expertise the development of this curriculum would not have been possible.

British Columbia Nurses’ Union Union of Psychiatric Nurses of BC Hospital Employees’ Union Health Sciences Association of BC

Fraser Health Authority Interior Health Authority Vancouver Coastal Health Authority Northern Health Authority Vancouver Island Health Authority Providence Health Care Provincial Health Services Authority

WorkSafeBC Occupational Health and Safety Agency for Healthcare (OHSAH) in BC

The PVPSC would also like to acknowledge the British Columbia Ministry of Health funding received through the Joint Quality Worklife Committee and the financial support provided by OHSAH for the Provincial Violence Prevention Curriculum Project.

The copying, reproduction and distribution of this guide to promote effective Violence Prevention activities in the Healthcare Industry is encouraged; however, the current owner, the Provincial Health Services Authority (PHSA), should be acknowledged. Written permission must be received from PHSA if any part of this curriculum is used for any other publication. This curriculum, whether in whole or in part, must not be used or reproduced for profit.

This course has been developed by Andrea Lam, Ana Rahmat, Chris Back, Charles

Ballantyne, Dailaan Shaffer, Deb Niemi, Helen Coleman, Joe Divitt, Kathryn Wellington, Lara Acheson, Larry Bryan, Leslie Gamble, Lynn Vincent, Marg Dhillon, Marty Lovick, Michael Sagar, Peter Dunkley, Phil Goodis, Rob Senghera, Sheile Mercado-Mallari, Sherry Moller and Tara McDonnell. The information on the fight/flight/freeze response and self settling strategies was contributed by Shayna Hornstein.

Bringing a group of subject matter experts to the table to develop a curriculum

such as this takes vision, passion and a diversity of experience and practice. The creators of this curriculum drew on their skill in and knowledge of the following disciplines:


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o Mental Health and Addictions o Occupational Health and Safety o Social work

o Healthcare Violence Prevention programs o Geriatric care o Nursing o Psychiatry o Physical strategies and team response training

Course Materials Designed by Tanya Schecter and Brad Eastman.

Photographic contributions by fotografica studio ltd.

This curriculum was developed during 2010 by the Provincial Violence Prevention Curriculum Team at Vancouver, British Columbia, Canada.


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C O U R S E O V E R V I E W

C O U R S E I N T R O D U C T I O N

Effective communication is an important element of any successful relationship.

When dealing with patients and visitors in the healthcare system effective communication becomes even more important. It is one of the main ways in which you can help to influence a situation's outcome. Communication involves both verbal and physical aspects. Violence may occur

when someone:

Is unable to express themselves in other ways

Feels frustrated that they are not being "heard"

Feels disrespected

A significant stressor that may lead to a violent expression is the perception of being treated unfairly or disrespectfully. In terms of violence prevention, using effective communication techniques helps you to minimize or eliminate this risk.


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C O U R S E O B J E C T I V E S

By the end of this course, you will be able to:

Identify how effective communication can help prevent violence

Identify the different ways of communicating non-verbally

Identify non-verbal cues for violence

Identify how to effectively communicate with your voice

Identify how to effectively communicate with words

Identify general guidelines for effective communication

In order to complete this course, you need the following materials:

This participant guide

Optional: a computer with internet access to look up additional resources (e.g., glossary, references)


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C O M M U N I C A T I O N A N D V I O L E N C E P R E V E N T I O N

I N T R O D U C T I O N

Using effective communication can help to prevent violence in health care.

However, ineffective communications can have a negative impact on both patients and staff.

W H A T A R E T H E D I F F E R E N T C O M M U N I C A T I O N T Y P E S ?

There are three types of communication:

Non-verbal (body language, gestures, etc.)

Vocal (tone, rate/speed, pitch/volume)

Verbal (words)

Typically, two or three types are used at the same time. For example, when a neutral question is asked in a condescending tone (vocal), the listener will often hear and react to the negative tone instead of answering the neutral question. Likewise, when having a conversation with someone who is fidgeting (non-verbal), the speaker may conclude that the fidgeting person is not

interested in what he or she has to say.


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W H Y I S E F F E C T I V E C O M M U N I C A T I O N I M P O R T A N T ?

Since communication is a complex mix of verbal, non-verbal and vocal messages that takes place between two (or more) people, it is important to learn about communication components.

When communicating, you need to be aware of both:

What you are communicating

How the person is responding to you

H O W D O E S E F F E C T I V E C O M M U N I C A T I O N B E N E F I T P A T I E N T S ?

As a healthcare worker, you have the additional responsibility of bringing effective communication skills into a situation, since patients and families in healthcare settings are often under stress. This can influence how they:

Hear what you are saying

Interact with you and other health care workers

Effective communications can impact on patients by decreasing:

Their confusion, resulting from mixed messages (i.e., patients and families get the wrong information or perceive information

differently from the way in which the communication was intended)

Their anxiety levels

The likelihood that they become verbally or physically violent


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H O W D O E S E F F E C T I V E C O M M U N I C A T I O N B E N E F I T M E ?

Effective communication can benefit you in the following ways:

Increased opportunities for proactively solving problems (prevent

escalation)

Increased staff morale

Increased ability to effectively engage with families and patients

Decreased stress

Decreased risk of violence

Decreased chance of being misunderstood


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N O N - V E R B A L C O M M U N I C A T I O N

Non-verbal communication is defined as communication that takes place through:

Use of personal space

Body language (e.g., posture or gestures)

Touch

Eye contact

Non-verbal communication is often the most important part of any

communication, since 55% of your message is expressed by your body language, rather than the words you use. Using supportive body language may help prevent a situation from escalating.


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P E R S O N A L S P A C E


You are often in a patient's personal space when providing care and interacting

with them. For many people, this is very stressful. Maintaining personal space (yours and the patient's) is an important component of violence prevention.

W H Y I S I M P O R T A N T T O M A I N T A I N P E R S O N A L S P A C E ?

Perceived invasion of personal space is a major stressor for everyone.

Respecting someone's personal space by not getting too close helps:

Reduce the stress that they are experiencing

Keep you and others safe


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W H A T A R E S O M E G U I D E L I N E S F O R P E R S O N A L S P A C E ?

Most people have expectations around personal space. As a health care worker, you need to be aware of these. Generally, these are:

Intimate zone (approximately 1.5 feet) - this zone is for family and friends

Personal zone - space where casual acquaintances are not expected

to enter:

Front (approximately 3 feet)

Rear (approximately 5 feet)

Side (approximately 1.5 feet)

H O W D O E S C U L T U R E A F F E C T P E R S O N A L S P A C E ?

Different cultures have different ideas as to what constitutes personal space. For example, North Americans tend to require more personal space than other cultures.


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W H A T D O I N E E D T O D O I F E N T E R I N G S O M E O N E ’ S P E R S O N A L

S P A C E ?

As a health care worker, you must often enter into someone's personal and

intimate space. This unique aspect of health care can increase your risk of violence.

In these cases, doing the following will help to protect you:

Keep a leg's length distance away until you are sure that it is safe to approach

Be respectful when entering someone's personal space

Make sure that the patient sees or hears you before making any physical contact

Explain what you are going to do

Watch for signs that the patient may be upset

Move slowly


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H O W S H O U L D I D I S T A N C E M Y S E L F F R O M S O M E O N E W H O I S N O T

R E S P E C T I N G M Y P E R S O N A L S P A C E ?

If someone is distressed or in some way invading your personal space:

Keep at least a leg's distance away from the person

Take a step back

Place your hands in front of you to maintain some space between

you and the other person

Leave the situation and get someone to help you if you feel threatened

Never turn your back on the person

Don't let the person get between you and the exit


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B O D Y L A N G U A G E


Using appropriate and supportive body language can help prevent violence.

U S E A R E A D Y P O S T U R E

Avoid standing face-to-face with the person. Instead, stand at a 45 degree angle.

Do not keep your hands:

Hidden

In your pockets

Clenched

Instead, keep your hands open, visible, and above your waist. This appears non-threatening and allows you to defend yourself more quickly if the situation escalates.


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E Y E C O N T A C T

Eye contact and facial expressions provide important emotional information. Appropriate eye contact is different in different cultures. For example, in some cultures it is considered disrespectful to look a person in the eye.

Direct eye contact with someone who is anxious or distressed may result in a negative response. When interacting with a patient:

Make eye contact without glaring or staring

Don't force eye contact

Don't roll your eyes

This can reduce or eliminate the likelihood that violence will occur.


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B E A W A R E O F Y O U R F A C I A L E X P R E S S I O N S

When talking to a patient:

Relax your facial muscles

Maintain a calm facial expression

Show interest and/or concern


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N E G A T I V E B O D Y L A N G U A G E

The following examples of body language may be interpreted as condescending or disrespectful and may prevent you from reacting quickly if the situation escalates:

Pointing or shaking your finger

Crossing your arms

Putting your arms behind your back

Keeping your hands hidden, clenched, or in your pockets


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T O U C H


Touch can either soothe and relax or increase stress levels. When responding to a

patient, you must be very careful not to touch them in a way that may increase their stress levels.

W H Y S H O U L D N ’ T I T O U C H A P A T I E N T ?

You should not touch a patient when they are anxious or stressed because

they may misinterpret physical contact or touch as hostile, threatening, or provocative. Touching a distressed patient may increase the chance that they

respond negatively.

W H E N I S I T O K A Y F O R M E T O T O U C H A P A T I E N T ?

You must always touch with caution. This is even more important if a patient

is distressed. In this situation, err on the side of caution and don't touch the patient.

If you need to touch the patient in order to provide care:

If possible, ask the patient for permission and get it before touching them

Back off and try again later if the patient is responding negatively to you

Ask someone to help you provide care


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T E S T Y O U R K N O W L E D G E # 1

Select all statements that are TRUE. Once you’ve completed the quiz, you can go to the end of this guide to check your answers.

1. Verbal communication (words) is the most important part of any communication.

2. Respecting someone's personal space reduces their stress levels and helps keep you and others safe.

3. If you are nervous, you can keep your hands hidden, clenched, or in your pockets.

4. When responding to a patient, you must be very careful not to touch them in a way that may increase their stress levels.

5. Standing at a 45 degree angle with your hands open, visible and above your waist is non-threatening and allows you to protect yourself if a situation escalates.


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R E C O G N I Z I N G P A T I E N T C U E S F O R V I O L E N C E


Since effective communication requires two or more people, it is important to pay

attention to the other person's non-verbal cues as well as your own.

P E R S O N A L S P A C E

Pay attention to a patient who is moving in or advancing into your personal space. In this case, take a step backwards or exit the situation.

Alternatively, if a patient is backing away in order to increase their own personal space, respect their need to do so.

E Y E C O M M U N I C A T I O N S

A distressed person may look at you intently before acting out. The following non-verbal cues can let you know that they are about to become violent:

Target glance (e.g., briefly looking at a person, object, or body part that the person plans on striking)

Narrowed eyes

Intense gaze

Looking through you

Sizing you up

Glazed and/or watery eyes


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G E S T U R E S A N D P O S T U R E S

The following gestures and postures are indications that a person is distressed and may become violent:

Finger pointing

Crossed arms

Clenched fists

Leaning forward

Rapid hand movements

Fidgeting

Pacing

F A C I A L E X P R E S S I O N S

The following facial expressions, when expressed with other body language cues, may be a warning that the person may become violent:

A change in facial colour (e.g., pale or flushed face)

A pinched look


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V O C A L C O M M U N I C A T I O N

W H A T I S V O C A L C O M M U N I C A T I O N ?

Vocal communication includes:

The speed of your speech

The pitch of your voice

The tone of your voice

The volume of your voice

Vocal cues add meaning to verbal messages. These can influence the listener as much, if not more, than the words themselves. Vocal cues can significantly add to

or take away from the listener's understanding of the message.

S P E E D O F S P E E C H

How quickly you talk may affect how well your message is received. Pay attention to how quickly you are talking. You may speak more quickly when you are feeling nervous.

When speaking with someone that is distressed, speak at a slower rate without being condescending. This will help you to get your message across

and reduce the likelihood of a violent incident.


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P I T C H

Pitch is defined as varying your voice (higher or lower) to convey meaning. A common sign of anxiety or stress is a rise in a person’s vocal pitch. When you are speaking with a patient, it is important that you keep your pitch steady and firm, even if you are nervous or stressed. This will help you sound calm and credible, and communicate more effectively.

To help keep your vocal pitch even, take a moment to take a deep breath and settle yourself before speaking.

T O N E

The tone you use when you speak and how you emphasize different words or syllables can express different feelings. For example, the words, “Can I help you?” may express care, but if your general tone is expressing irritation and impatience, your message will be lost.

The sentences below are the same, but have a different emphasis on specific words. The meaning of each

sentence will change dramatically

depending on the tone you use.

Examples:

Excuse me.

Excuuuse me.

Excuse me?

EXCUSE ME!!!

Before speaking with a patient, settle yourself and think about using a soft and respectful tone.


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V O L U M E

People often speak more loudly when they become anxious or upset. This may also happen when someone starts raising their voice at you: you may

automatically respond by raising your voice. This may escalate the situation quite quickly.

No matter how you are feeling, never yell at the patient. Try not to speak too loudly or quietly.


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V E R B A L C O M M U N I C A T I O N


Verbal communication refers to the actual words that you use.

W H A T A R E T H E B E S T W O R D S T O U S E ?

Clear communication works best with words that are:

Short

Simple

Straight-forward

For example, "Yes I can help you."

W H A T W O R D S A N D P H R A S E S S H O U L D I A V O I D ?

Try to avoid the following words or phrases since they can appear condescending:

Calm down

Relax

Chill out

Whatever

Never mind


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G E N E R A L G U I D E L I N E S F O R G O O D

C O M M U N I C A T I O N

The following are general guidelines for effective and respectful communication:

Listen with care (i.e., focus on what is being said instead of thinking

about what you're going to say next)

Remove the audience

Keep it simple

Be aware of your body language

Don't interrupt and don't start to talk until the person stops talking

Allow silence to exist

Respect differences

Don’t make false promises

Pay attention to how the person is receiving the information and adjust your actions accordingly


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Select all statements that are TRUE. Once you’ve completed the quiz, you can go to the end of this guide to check your answers.

1. If a patient is moving into your personal space, take a step backwards or exit the situation.

2. Vocal cues do not change the listener's understanding of the message.

3. Clear communication works best with words that are short, simple, and straight-forward.

4. When listening, you should be thinking about what you're going to say next.

5. It is important that you keep your pitch and volume steady, even if you

are nervous or anxious.


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W H A T Y O U ’ V E L E A R N E D

In this module, you have learned the following key points:

Communication involves non-verbal, vocal, and verbal communication. Two or

more forms of communication are often used at the same time. 55% of the message comes from body language.

Effective communications can help patients by decreasing confusion and anxiety levels, and the likelihood that they become verbally or physically violent.

Respecting someone's personal space helps reduce the stress that they are

experiencing and keeps you and others safe. When entering someone's personal space: 1) keep at least a leg's length away, 2) make sure that the patient sees or hears you before making any physical contact, 3) explain what you are going to do, 4) watch for signs that the patient may be distressed, and 5) move slowly.

Using appropriate body language means: 1) standing at a 45 degree angle, keeping your hands visible and making eye contact without glaring or staring,

2) focusing your attention on the person when talking to them, and 3) avoiding negative body language.

If a patient is distressed, err on the side of caution and do not touch the patient.

A distressed person may look at you intently before acting out. Look for non-

verbal cues to help determine if someone may become violent.

Use words that are short, simple, and straightforward to communicate

effectively. Avoid using words or phrases that can escalate the situation (e.g., calm down, relax, chill out, whatever, and never mind).


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M O D U L E 4 Q U I Z

Please complete the following quiz once you have finished this module. Circle the correct answer(s) for each question.

1) Which of the following statements are true?

A. Communication involves two or more of the following types of communication: verbal, vocal and non-verbal

B. 55% of your message is expressed by your body language C. Verbal communication (i.e., the words you use) is the most important part of any

communication D. All of the above

2) Effective communication is important because:

A. It can help decrease a patient’s confusion or anxiety B. It can help decrease the likelihood that a patient may become verbally or physically violent C. It can increase your ability to engage effectively with patients and their families D. All of the above

3) Respecting a patient’s personal space reduces their stress levels and helps keep you and others safe.

o True

o False

4) All patients, regardless of their cultural background, require the same amount of personal space. o True o False

5) When entering a patient’s intimate space, you should: A. Keep at least a leg’s length away until you are sure that it is safe to approach

B. Explain what you are going to do C. Move quickly and quietly D. Make sure the person sees or hears you before making any physical contact

6) Standing at a 45 degree angle with your hands open, visible and above your waist is non-threatening and allows you to protect yourself if a situation escalates. o True

o False

7) If someone is invading your personal space or you feel threatened, you should not leave the situation and get help. o True o False


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8) Which of the following are examples of supportive body language? A. Making eye contact without glaring or staring B. Crossing your arms

C. Showing interest and/or concern with your facial expression D. Putting your hands behind your back

9) If you need to touch a patient to provide care, you should: A. Ask for and get permission from the patient before touching them B. Continue to provide care if you notice that they are becoming more anxious and stressed C. Back off and try again later if the patient is responding negatively to you

D. All of the above

10) A person’s non-verbal cues (e.g., invasion of your personal space, pacing, glaring, flushed face) can help you determine if they may become violent. o True o False

11) It is important that you keep your pitch and volume steady even if you are nervous or anxious. o True o False

12) What you say (i.e., verbal communication) is sometimes more important than how you say it (i.e., vocal and non-verbal communication).

o True o False

13) You should avoid using words or phrases (e.g., calm down, whatever, never mind) that may be perceived as condescending. o True o False

14) Listening without _________ is one of the best ways of making someone feel heard and respected. A. Frowning B. Judging C. Distractions

15) Effective and respectful communication involves which of the following?

A. Thinking about what you’re going to say next while listening to someone speak B. Paying attention to how the other person is responding to you C. Not paying attention to your body language D. Making false promises (e.g., Saying, “I’ll be with you in 15 minutes” when it will likely take

a lot longer for you to help someone.)


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T E S T Y O U R K N O W L E D G E - A N S W E R K E Y S


1. False - Non-verbal communication is often the most important part of any communication - 55% of what a person hears comes from your body language.

2. True - Respecting someone’s personal space reduces their stress levels and helps keep you and others safe.

3. False - Never keep your hands hidden, clenched or in your pocket since it may prevent you from reacting quickly if the situation escalates.

4. True - When responding to a patient, you must be very careful not to touch them in a way that may increase their stress levels.

5. True - Standing at a 45 degree angle with your hands open, visible and above your waist is non-threatening and allows you to protect yourself if a situation escalates.


1. True - If a patient is moving into your personal space, take a step backwards or exit the situation.

2. False - Vocal cues can significantly add to or take away from the listener's

understanding of the message.

3. True - Clear communication works best with words that are short, simple, and straight-forward.

4. False - When listening, you should focus on what is being said instead of thinking about what you're going to say next.

5. True - It is important that you keep your pitch and volume steady, even if you are nervous or anxious.


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provincial violence prevention curriculum module 4 communication … · 2014-11-10 · occupational...

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