Dynamics of Care in Society Communication

Objectives: Identify & define the concepts & elements of communication theory Recognize a communication dilemma Identify nonverbal aspects of communication Utilize sensitivities & problem solvng skills to achieve interpersonal communication that occurs in the health delivery process

Formulate appropriate communication strategies to detect & avert breakdowns in communication Differentiate between open & closed ended questions Develop skills to design open-ended questions Determine the appropriate questions to ask patients Be familiar with appropriate, caring responses Know how to obtain help if there is a language barrier

Communication defined: a sharing of information or ideas, including content as well as the feelings or emotions Verbal & nonverbal behavior within a social context Listen…Talk to your doctor Health reporter John Hammarley summarizes communication tips

Methods of COMMUNICATION One on one Small group Large audience Mass communication TV, radio, film, newspapers, internet

FORMS OF COMMUNICATION: 1 FORMS OF COMMUNICATION: 1. VERBAL: spoken words, manner, tone, non-language sounds (sighs or sobs) 2. NON-VERBAL: touch, eye contact, kinesics (body movement), proxemics (personal space) 3. WRITTEN: letters, memos, chart documentation, agendas, reports…

COMMUNICATION PROCESS Channel: medium Copy in Notes

Communication Process Flow of communication between a medical assistant and a patient

THE SENDER… The one who initiates the message or communication. Puts the thought, idea, experience or act into a form that can be transmitted.

THE MESSAGE… The thought, idea or expression from the sender. Often a dual message, verbal and nonverbal simultaneously.

THE RECEIVER… The one to whom the message is sent. The receiver is prompted (by the message), to analyze, interpret and respond.

THE FEEDBACK…

Observations Health care workers use their senses to: See Color of skin, swelling or edema Presence of rash or sore Color of urine or stool Amount of food eaten Touch Pulse Dryness or temperature of skin Perspiration Swelling Smell Body odor Unusual odors of breath, wounds, urine or stool (feces) Hearing Respirations Abnormal body sounds Coughs Speech

Video: “Drew” AGT Communication Challenges

COMMUNICATION BARRIERS/CHALLENGES: Educational/intellectual level: ex. medical terminology unfamiliar to patient Psychological/Emotional: grief, anger, anxiety, perceptions, pride, financial concerns Physiological: Impairments in cognition or hearing, age, sex , developmental stage Environmental: noise, lighting…

Person cannot see, hear or receive the message Visual disability; Hearing disability; Environmental problems: poor lighting Noise speaking from too far away

Person cannot make sense of the message Different languages are being used, including sign language; People using different terms, such as slang, internet or text jargon; One of the speakers has a physical or intellectual disability, such as memory loss or a learning dysfunction. Non-verbal signals not clear ex:crying tears of joy

Please answer the question below…. صبح لڑکوں اور لڑکیوں کو ہے. براہ کرم اور کڑیو خاموش ہے. اج ہم کام شروع یونٹ 1 3 ہے. مجھے بتا سکتے ہیں کہ کیا یہ کسی ہے؟ What is preventing you from reading the instructions on the board?

Communicating with the Hearing Impaired Use body language such as gestures and signs. Speak clearly in short sentences. Face the individual to facilitate lip reading. Write messages if necessary. Make sure hearing aids are working properly

Person misunderstands the message Cultural differences: different cultures interpret non-verbal and verbal, and humour, in different ways; Assumptions about people: assumptions about race, gender, disability etc. can lead to stereotyping and misunderstanding; Emotional differences: very angry or very happy people may misinterpret what is said; think about sarcasm… Social context: conversations and non-verbal messages understood by close friends may not be understood by strangers.

Communicating with the Visually Impaired Use a soft tone of voice. Describe events that are occurring. Announce your presence as you enter a room. Explain sounds or noises. Use touch when appropriate.

Communicating with Patients with Aphasia or Speech Impediments These patients may have difficulty remembering the correct words, may not be able to pronounce certain words, and may have slurred speech. The health care worker must be patient Allow them to try and speak Encourage them to take their time Repeat the message to assure accuracy Encourage them to use gestures or point to objects Provide pen and paper if they can write Use pictures with key messages communicate Communication App 6min 2013

Culture/language barriers: See: the Language Line Eye contact – in some cultures, it’s not acceptable, and looking down is a sign of respect Terminal illness – in some cultures, the patient is NOT told his/her prognosis, and family members are responsible for making care decisions Touch – in some cultures, it is wrong to touch someone on the head. Others may limit touch between male and female Personal care – in some cultures, only family members provide personal care

Attention, Environment, Hunger, Pain Stereotyping, prejudice, bias Stereotypes such as “dumb blonde” or “fat slob” cause us to make snap judgments about others that affect the communication process. Health care workers must learn to put prejudice aside and show respect for all individuals. Distractions: Attention, Environment, Hunger, Pain

(Texting…where does it fit?)

Be an active & critical listener Encourage Sound open and positive. Be attentive. Fact Find Ask Questions(Who, What, Why, When, Where, & How). Avoid distractions Use eye contact MD interviews Computer 1min Take notes Use strategies,,,

Big Bang Bad Listening 4min Ray Romano Learns Active Listening 4min Ray Romano demonstrates active listening 4min

Strategies Use reflections open ended questions statements to repeat back what you heard ex. “Mr. Wellness, you were saying that the new medication is making you vomit.” Use paraphrasing use your own words to restate what you heard ex. “it sounds as if you are saying you do not want to take the medication anymore”.

Use open ended questions to gain further information (activity…open vs closed ended questions) Ex. “Can you describe the type of pain?” Closed ended questions are necessary for times when specific information is required. Ex. “Are you in pain right now?” Summarize organize the information they have communicated and check back for accuracy

Listen with an accepting attitude. Use encouraging words that will invite them to continue on. "Mmm, hmm" "I see." "Right." “ Uh, huh." "Tell me more." "Sounds like you have some ideas on this." "I'm interested in what you have to say." "Let's talk about it."

Use nonverbal actions to show you are listening. relaxed posture head-nodding facial expression relaxed body expression eye contact Use Silence is natural and sometimes appropriate in conversations

Conversation Starters Always make sure you have time to listen and talk before you start. If you want to encourage talk, avoid questions with ‘yes’, ‘no’, or just one word. Start with “Tell me about…” or “What do you think about…” You might start a conversation by mentioning a television show: “What do you think about the boys in that ad? Do you know anyone who is like that?” Show your interest in his or her life: “I hear prom is coming up. What do you think about it?”

NEGATIVE IMPACTs ON COMMUNICATION Giving an opinion Offering false reassurances Being defensive Showing approval or disapproval Stereotyping Asking why Changing the subject inappropriately

Things to avoid while being an active listener Do not interrupt. Do not interrogate. Limit the number of questions you ask so that you are "drilling" them. Do not try to think of your response in your own head while you are listening. Do not change the subject.

Avoid phrases like: "Are you sure." "You shouldn't feel that way." "Its not that bad." “You're making something out of nothing." "Sleep on it. You'll feel better tomorrow." Do not be judgmental … allow speaker to feel that they can communicate questions and ideas.

NON-VERBAL COMMUNICATION

What is the message for each?

NON-VERBAL COMMUNICATION Includes: Appearance Kinesics or body movement Facial expressions Gestures Eye movement Posture & gait Tone of voice Touch Can create positive or negative feelings, Watch for nonverbal cues that show how the patient feels about being touched, Maintain proper personal space, position, & posture

8. Proxemics (personal space) 7. Eye contact 8. Proxemics (personal space) Larger when talking to a stranger Becomes smaller the better you know someone Typically larger between two men than between two women Differs from culture to culture How are these a reflection of professionalism ????? Give an example of how non-verbal clues create misperceptions ????? Watch power posture … 8.5 min 21min

NON-VERBAL COMMUNICATION may vary with culture

What is the message for each? Friends (Summary)Non-verbal Comm.

1. Look for patients who need help: TIPS FOR MAKING SURE PATIENTS WITH LOW HEALTH LITERACY (patients' ability to understand their disease and how to manage their care) …GET THE APPROPRIATE MEDICAL INFO 1. Look for patients who need help: A patient can read and write with average skill and still not understand the language you use. 2. Avoid jargon: many well-intentioned physicians make the mistake of using technical terms, then trying to define them. (also remember most Americans read at an 8th grade level)

3. Use the “teach back” method: Avoid asking patients, "Do you understand?" most will say they do even when they are confused. "I want to make sure I did a good job teaching you. Tell me how you are going to do this when you get home.“ Ask them to repeat your instructions in their own words . Watch this method 5min

4. Avoid unnecessary details: …yet be specific when necessary. Address one problem or issue at a time, or on separate meetings 5. Use pictures: Illustrations often convey instructions better than words. (Sample pictogram s on next slide) 6. Enlist the aid of a family member or friend or translator The 4 E’s: Engagement /Enlistment /Empathy /Education watch empathy – 4min

Patient Interviews General guidelines Listen actively Ask appropriate questions Record information accurately Protect patient’s privacy Be organized Avoid attending to distractions Let patient know who will see her next and when Basic interview techniques Reflecting: using open-ended statements to repeat back what you have heard Paraphrasing: using your own words to repeat what you have heard Clarification: asking for an example or further details Open-ended questioning: what, when, how? Summarizing: reviewing what you have heard in a condensed form Silences: allowing time to formulate thoughts

New patient interviews Patient’s medical & family history Brief review of body systems Patient’s social history Patient’s medications Established patient interviews Review patient’s chart for health problems Ask questions about current medical problems & changes in health Ask about known allergies Record patient information Patient Education Assess Plan Implement Evaluate Document

HAZARDOUS SUBSTANCE SYMBOLS

Visuals For Communication Project