1. Foundations of Communication Foundations of Communication

2. Communication The exchange of information, thoughts and feelings. The exchange of information, thoughts and feelings. This can be verbal (spoken words), written and non- verbal. This can be verbal (spoken words), written and non- verbal.

3. Elements of Communication Process Sender – creator of message Sender – creator of message Receiver – person who receives the message from sender Receiver – person who receives the message from sender Message – information, thought or idea Message – information, thought or idea

4. Elements of Communication Process Feedback – method used to determine if communication was successful. This occurs when receiver responds to the message – verbally or non-verbally The sender can then evaluate if message was correctly received.

5. Interference with the Process in Health Care Heavily medicated clients Heavily medicated clients Clients with hearing, visual, speech impairments Clients with hearing, visual, speech impairments Clients with limited English Clients with limited English Medical Terminology Medical Terminology Mental or physiological condition Mental or physiological condition

6. Effective Communication Verbal messages must be clear – in terms both sender and receiver can understand. Verbal messages must be clear – in terms both sender and receiver can understand. Medical terminology is often not understood by clients/families. Medical terminology is often not understood by clients/families. They often won’t admit they do not understand! They often won’t admit they do not understand! Speak in layman’s terms. Speak in layman’s terms. Have client/family restate to Have client/family restate to determine understanding. determine understanding.

7. Effective Communication Use good pronunciation and grammar Use good pronunciation and grammar Avoid slang and double meanings Avoid slang and double meanings Keep speech moderate, not monotone and do not speak too quickly Keep speech moderate, not monotone and do not speak too quickly

8. Effective Communication Interruptions and Interruptions and distractions can distractions can be a barrier. be a barrier.-noise -environment -environment -emotions, pain -emotions, pain

9. Attitude, Prejudice and Bias Health care professionals must be aware of their own bias and attitudes when sending and receiving communication in order to provide best quality care. Health care professionals must be aware of their own bias and attitudes when sending and receiving communication in order to provide best quality care. See each person as valuable individual and realize fear is most often cause for persons to be angry, critical. See each person as valuable individual and realize fear is most often cause for persons to be angry, critical.

10. Positive Attitude Receiver must have trust in the sender before they accept a message Receiver must have trust in the sender before they accept a message If a patient feels a health care professional does not know what they are talking about, they may not accept the information or treatment If a patient feels a health care professional does not know what they are talking about, they may not accept the information or treatment

11. Positive Attitude Be willing to say “I don’t know, but I will find that information for you” when asked a question for which you do not have knowledge. Be willing to say “I don’t know, but I will find that information for you” when asked a question for which you do not have knowledge.

12. Non-Verbal Communication Involves the use of facial expressions, body language, gestures, eye contact and touch. Involves the use of facial expressions, body language, gestures, eye contact and touch. You must watch both verbal and non-verbal communication You must watch both verbal and non-verbal communication

13. Non-Verbal Communication Make sure verbal and non-verbal communication agree!! Make sure verbal and non-verbal communication agree!! Differences in verbal vs. non-verbal communication can change message entirely. Differences in verbal vs. non-verbal communication can change message entirely.

14. Effective Listening Involves both hearing and interpreting messages Involves both hearing and interpreting messages Requires focusing on body language and the message being sent Requires focusing on body language and the message being sent May be passive or active May be passive or active Active listening is very important in the medical profession to gather information (for example, when interviewing a patient for their medical history. Active listening is very important in the medical profession to gather information (for example, when interviewing a patient for their medical history.

15. Effective Listening Techniques Show interest Show interest Eye contact Eye contact Do not interrupt Do not interrupt Think about what other person is saying Think about what other person is saying Control your temper and try to eliminate prejudice Control your temper and try to eliminate prejudice Reflect and clarify Reflect and clarify

16. Overcoming Barriers: Hearing Impairment Suggestions: Suggestions: Face person when speak for lip reading Face person when speak for lip reading Speak short, clear sentences Speak short, clear sentences Make sure if have hearing aid that it is properly inserted, turned on and has good batteries Make sure if have hearing aid that it is properly inserted, turned on and has good batteries Hearing Aid Styles

17. Overcoming Barriers: Hearing Impairment Suggestions: Suggestions: Use gestures Use gestures Use written or picture communication Use written or picture communication Sign language Sign language Allow assistive animals Allow assistive animals

18. Overcoming Barriers: Visual Impairment Suggestions: Suggestions: Remember: They are not deaf! However… Remember: They are not deaf! However… They cannot see body language, facial expression or gestures – you must explain everything to them in detail - verbally and use touch when appropriate. They cannot see body language, facial expression or gestures – you must explain everything to them in detail - verbally and use touch when appropriate. Explain noises Explain noises Allow guide animals Allow guide animals

19. Overcoming Barriers: Visual Impairment Suggestions: Suggestions: Announce yourself when you come in the room and tell before you touch! Announce yourself when you come in the room and tell before you touch! Give Braille materials or audio materials for education Give Braille materials or audio materials for education Explain details of environment – tell when you change surrounding environment Explain details of environment – tell when you change surrounding environment

20. Overcoming Barriers: Aphasia Persons with CVA (stroke) or other brain injury may experience aphasia. May affect the ability to send or receive communication. Persons with CVA (stroke) or other brain injury may experience aphasia. May affect the ability to send or receive communication.

21. Overcoming Barriers: Aphasia Suggestions: Suggestions: Patience! Patience! Encourage them to try. Encourage them to try. Speak slowly, clearly and repeat messages back to clarify. Speak slowly, clearly and repeat messages back to clarify. Use written or picture tools. Use written or picture tools. Use gestures, touch. Use gestures, touch.

22. Barriers to Communication: Aphasia and Speech Impairment Use communication boards and devices Use communication boards and devices Communicate through caregivers who normally work with and understand the person Communicate through caregivers who normally work with and understand the person

23. Barriers to Communication: Non-English Speaker Translator – either professional or from client’s family Translator – either professional or from client’s family Be careful that family understands correctly and will accurately translate for you! Be careful that family understands correctly and will accurately translate for you! Translating devices – such as translator phones, video translators or handhelds Translating devices – such as translator phones, video translators or handhelds Gestures, pictures Gestures, pictures These patients DO NOT have hearing problems. Screaming at them does not make them understand better.

24. Written Communication in Health Care Accurate and descriptive Accurate and descriptive Clear and concise Clear and concise Legible and spelled correctly Legible and spelled correctly Use only approved abbreviations * Use only approved abbreviations * If quoting client, physician, etc – record in quotations and identify as their statement If quoting client, physician, etc – record in quotations and identify as their statement

25. Written Communication in Health Care Errors should be crossed out neatly with a straight line, have “error” recorded by them and the initials of person making the entry. Errors should be crossed out neatly with a straight line, have “error” recorded by them and the initials of person making the entry. All medical records must be recorded in ink (blue/black) and have signature, title and date/time for each entry. All medical records must be recorded in ink (blue/black) and have signature, title and date/time for each entry. If you didn’t write it, it didn’t happen If you didn’t write it, it didn’t happen

26. Written Communication in Health Care Subjective Data Cannot be measured by health care provider such as patient’s stated level of pain or description of symptom. These are best recorded as “quotes” from patient.

27. Written Communication in Health Care Objective Data Observable, measurable information about patient such as vital signs, assessment findings. Observable, measurable information about patient such as vital signs, assessment findings. Be descriptive and detailed in your documentation. Be descriptive and detailed in your documentation.

28. Electronic Health/Medical Records EHR, EMR The US Government has mandated health care facilities begin making the move to computer based records - requiring them to have beginning use in place by 2015 or suffer penalties in Medicare payments.

29. Actual Medication Error Orders for Prednisone and Toprol XL were interpreted and transcribed into the patient care system as "QID" (four times daily) while the prescriber intended the drugs to be given "QD" (daily). Orders for Prednisone and Toprol XL were interpreted and transcribed into the patient care system as "QID" (four times daily) while the prescriber intended the drugs to be given "QD" (daily).

31. Examples of Illegible Handwriting