1. Dynamics of Care in Society
Communication

2. 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

3. 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

5. 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

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

7. 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…

8. COMMUNICATION PROCESS
Channel: medium
Copy in
Notes

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

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

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

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

13. THE FEEDBACK…

14. 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

15. Video: “Drew” AGT Communication Challenges

16. 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…

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

18. 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

19. 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?

20. 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

21. 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.

22. 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.

23. 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

24. 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

25. 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

26. (Texting…where does it fit?)

27. 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,,,

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

29. 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”.

30. 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

31. 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."

32. 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

33. 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?”

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

35. 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.

36. 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.

37. NON-VERBAL COMMUNICATION

38. What is the message for each?

39. 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

40. 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

41. NON-VERBAL COMMUNICATION
may vary with culture

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

44. 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)

45. 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

46. 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

47. 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

48. 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

51. HAZARDOUS SUBSTANCE SYMBOLS

52. Visuals
For
Communication
Project