Professional Documents
Culture Documents
PUBH1382 Week 8 - MH3 2017
PUBH1382 Week 8 - MH3 2017
Learning Objectives
1. Understand different types of types of communication in healthcare practice
a. Therapeutic
b. Professional
2. Understand the reasons for the importance of effective communication as
healthcare practitioners
a. Benefits of good communication
b. Noise and Errors of communication
3. Components of effective verbal communication
a. Develop a list of do’s and don’ts for verbal communication
b. Identify areas of professional jargon and consider clearer ways to express
these ideas
4. Identify aspects of non-verbal communications and how these can affect:
a. Gesture and posture
b. Facial expressions
c. Gaze
d. Personal space and touch
e. Do’s and don’ts for non-verbal communication
5. Specific issues regarding clinical communication
a. Interpersonal skills
b. Active listening
c. Sensitive management of anger and anxiety.
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Notes
There are significant demands on the ability to effectively communicate to ensure the
highest quality of healthcare in Australia. These challenges will include the following
domains:
· Effectively communicating at all stages of the patient/client therapeutic contact
· Effectively interacting with the unique interrelationships with the families of patients
· Being an effective member on multidisciplinary or inter-disciplinary health care teams
There are two main forms of communication required of a Healthcare Professional [HCP]
1. Therapeutic communication
This is the communication between HCP and clients/patients and their families to ensure
quality health care that will improve or promote/maintain patients health well-being This
therapeutic communication has three main purposes
a. Collect profession-specific health care information about the patient (clinical
assessments including interviews)
b. Provide feedback to the patient/family in the form of diagnoses, prognoses and
suggested therapeutic interventions
c. In conjunction with the patient, formulate, implement and evaluate the agreed upon
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Communication can be defined as the successful transfer of information (including its total
meaning) from one person to another. The transfer of “meaning” is the key to this
definition. Effective communication only occurs when the sender of a message and the
receiver of that message totally agree on the meaning associated with that communication.
This will not only involve the verbal content of the message but also the non-verbal content
and the context of the sent message.
2. The sender encodes the idea into a (verbal plus non-verbal) message
3. The message travels from the sender to the receiver via the communication
channel/medium and within a specific context
4. The receiver [from their unique cultural perspective] decodes the [complete] message
to determine its meaning
5. The receiver sends enough feedback to the sender to confirm that both agree of the
meaning of the sent/received idea
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a) Communicate effectively in your first job interview and subsequent job or
promotion interviews
b) Communicate effectively with supervisors and (later) employees that have to be
managed
c) Communicate effectively in case conferences and national/international
conferences on research findings and professional practice
d) Communicate effectively with government and non-government organizations for
grants, etc
Noise is anything that disrupts effective communication and can interfere at every step of
the communication process. Some examples of noise:
1. Therapeutic communication – the patient/receiver may have a disability
(language/cognitive) that prevents them from understanding the communicated message
2. Professional communication – the HCP uses professional jargon that precludes
colleagues from other health professions from gaining a full understanding of the patients
presenting problem
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1. Miscommunication is one of the most common causes of patients complaints
2. Multidisciplinary teams have the potential to provide high quality patient care, but
research has found that communication errors within the team severely limits this
potential
3. Written communication error rates threatens patient safety
Top contributing factors to Medical errors in large health care settings
http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/longtermcare/
module1/igltcintro.html
1. Content and word choice
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a) Need a clear understanding of what needs to be conveyed – that is a level
understanding that allow you to teach these concept to someone who is naïve to
this concept
b) Need to choose words that are clear, unambiguous and unnecessarily technical –
c) Need to adjust communication (content and word choice) to match receiver’s level
of understanding – consider describing diagnoses to colleague versus patient
a) Poor grammar and mispronunciation creates a bad impression and confusion.
Correct grammar [and spelling] and pronunciation ensure clarity, maximizes
effective communication and inspires confidence and trust of the HCP by the
receiver
b) Good communicators focus on grammar, spelling and pronunciation at School, at
University and throughout the rest of their working lives – it is not something that is
incidental and needs only to be focussed on later in life
Note: modern media (eg text messaging) can create bad verbal/written
communication habits, future HCPs need to clearly discriminate between mediums.
In professional health care situations, they should always use standard English
grammar, spelling and pronunciation
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3. Tone – there are a number of basic expression tones, some used purposively to elicit
different responses and one that never should be used in professional settings
f. Incidental communication
a) Formal interview tone – first interviews should be formal occasions where the HCP
needs to create a competent, confident, professional impression [tone]. The design
and layout of the clinic and the behaviour of all clinic staff should be professional.
The interview should be scripted and include all the relevant professional/clinical
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e) Expressive tone. This should be avoided at all costs and involves an emotional
dimension and indicates the personal thoughts and/or feelings of the professional.
This tome should never be used in the clinic setting (either with patients or other
clinic or professional staff). This tone is spontaneous, emotional, uninhibited and
should be restricted to occasions such as home or socializing in non-work settings
f) Incidental communication
i. Small talk – this tone is used to build rapport with the patient and is typically
part of the initial communication (that is, when the HCP greets the patient in the
waiting room). The topics that are typically discussed include the weather; difficulty
finding the clinic, problems with parking, etc. This conversation is utilized to put the
patient (and the family) at ease but is limited to and ceases upon entry into the
professional suite.
ii. Commentary – the use of commentary occurs when there is a professional
task to be completed that does not involve the patient in answers or questions (for
instance the movement/preparation of test or other equipment. These tasks will
vary across HCP groups. The commentary should include what the HCP is currently
doing, what the subsequent procedure will involve and what the patient will
experience (in terms of personal sensations and thoughts). Again, this
communication is designed to reduce patient uncertainty, reduce patient anxiety,
and thus, put the patient at ease
2. Do use standard English and do not or minimize the use of slang
3. Do not use professional jargon, create simple everyday explanations
4. Do talk to the patient, do not talk directly to family members in the presence of the
patient
6. Do be a good listener, use paraphrasing and probes to check your understanding
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7. Do help the patient be a good listener, use probes to check their understanding of
your explanations
8. Do keep the patient talking, do explore all aspects of the problem and use techniques
to minimize non-disclosure
12. Do not give the patient unsought or unrelated advice
14. Do not tell patients you know how they feel or how they should feel
Professional Jargon
Every discipline has its own professional jargon. This might include words and phrases that
are unique to the discipline, and others that are ‘general’ but have a specific meaning
within the discipline. Some examples from psychology appear below. Jargon often
improves the efficiency of communication between colleagues but obscure communication
with a patient, or make them feel inferior. Think back to when you were first learning your
area of specialty. Was there any particular language you had to learn? What sorts of words
and phrases might you use between colleagues but not with patients? How about special
acronyms?
- Executive function
- Cognitive load
- Working memory
- Blunted affect
- Sydrome
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- ASD (autism spectrum disorder), GAD (generalised anxiety disorder), MDD (major
depressive disorder)
- Cerebellar signs
- …
http://bass-schuler.com/christopher-carter-2/
Some researchers estimate that over half of the message in a healthcare professional
interaction with a patient is via non-verbal communication. HCPs rely on non-verbal
communications to give effect and meaning to their important messages. Most humans are
unaware of the impact of this form of communication and this section is to bring this
aspect of communication to the conscious level of future HCPs. A simple demonstration is
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the number of communication errors that occur when communication varies. For instance,
demonstrations have shown that miscommunication increases as people shift from face to
face, to telephone to email/social media. As non-verbal communication decreases,
misunderstandings increase.
a) The patients state of mind and health will be communicated both verbally [what
they say] and non-verbally [how they present]. Typically patients who are ill and/or
depressed are likely to make fewer gestures and they will not be animated.
b) The HCP will communicate many health related procedures both verbally and via
gestures. Many procedures or therapeutic techniques are demonstrated using both
a verbal explanation and a series of gestures
c) HCP and patient conversations are regulated by non-verbal cues – this is typically
called turn-taking where both verbal and non-verbal cues determine when one
speaker is about to finish and there is an expectation that the other person will
immediately respond. This will involve body posture [leaning forward], nodding of
the head, and gaze [attending to the other person’s face].
2. Facial expressions
Facial expressions are predominately about the emotional content of communication.
Researchers have reported that the facial expressions associated with basic emotions
[happiness, sadness, surprise, disgust, etc] are universal – and thus all humans use them
and need to understand their meaning. However, these same researchers noted that the
expression of some of these emotions [eg disgust] is culture-bound and thus some
patients will not display some of these basic emotions. In other cultures [including the
Australian indigenous community], it is the absence of non-verbal communication [no
facial expression, lethargy, averting the gaze] that represents a patient with serious illness
and severe pain.
3. Gaze
Gaze patterns vary, but are important in determining the patient’ health, the patient’s
attention and understanding of the therapeutic communication and the regulation of the
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HCP-patient conversation [direct gaze, initial eye contact, then averted gaze with
intermittent brief eye-contact].
4. Personal space and touch
Personal space
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http://www.gopixpic.com/1000/personal-space/http:||www*gadgethovel*com|comics|20
09-08-03_personalspace*jpg/
Personal space provides identity, security and control over the social environment.
HCP-patient interactions including consultations are regulated by room/furniture design
and should be arranged to ensure there is no invasion of personal space. In many health
care settings, patients are often required to give up personal space (medical procedures,
chiropractic manipulations, basic care in hospitals, etc). Patients need to be
informed/alerted when such procedures are about to commence (verbal statement plus
directive gesture) and the patient’s response [consent] should be clearly understood by the
HCP before any manual procedures commence.
While touch communicates much about personal/social relationships, HCP touch has to be
strictly within that particular professional practice (ethical) guidelines. The requirement to
touch should be clearly stated and before touching, patient consent needs to be explicit
Three rules to minimize discomfort, anxiety and/or stress
• Treat patients respectfully
• Allow patients as much control as practical
• Recognise patient’s rights to privacy
Finally, the HCP needs to consider the proper interpretation of all of their communication.
If the patient’s verbal and non-verbal messages are incongruent with each other, then the
HCP should explore and clarify such incongruity. Two examples that would need to be
explored:
1. A life threatening negative diagnosis is accompanied by a smile
2. A verbal “I understand” is accompanied by a confused facial expression
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3. Do meet and greet the patient professionally [consider whether a handshake is
appropriate and then be consistent with all patients – male and female, old and young]
4. Ensure appropriate location – must be private and must not lead to interruptions
5. Ensure appropriate seating arrangements, comfortable and considers the
professional status [impression of competence] and appropriate personal space for all
parties
6. Ensure there is a professional but relaxed atmosphere [re HCP posture and
non-verbal cues such as well-timed nods, conservative gestures and non-intrusive gaze]
7. Provide clear indications of attention and appropriate encouragement for the
patient to fully disclose relevant clinical information
8. Overall create a session that maintains professionalism, an assurance of
confidentiality and instils confidence in the patient
5. Clinical communication
All professionals require effective communication skills for successful interaction with
others, including: patients; colleagues; supervisors; and other [health] professionals, i.e.
clinical communication.
Essential interpersonal skills
1. Tactfulness and diplomacy – in the workplace, professionals will inevitably disagree
with how others behave and/or what they say. While the popular media portrays people
being critical, disparaging and putting the other person down, using tact and diplomacy get
the correct message across while maintaining the professional working relationship.
2. Courtesy and respect – showing courtesy or consideration of others (correctly
greeting someone, making room in crowded venues, including others in conversation
groups, opening doors, taking turns, checking with waiting patients that they are being
attended to, etc) will improve the ambiance and quality of the workplace. Showing respect
indicates that you value the person, that they are important to you and that you wish to
have a productive working relationship with them (be they colleagues or patients). Respect
is demonstrated by appropriate greetings (eg titles, names, etc) and providing undivided
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attention during all interactions (this includes appropriate posture, eye contact and
iterative, responsive conversations. Displaying courtesy and showing respect will always
achieve a positive outcome.
3. Empathy – is the ability to understand how others feel (both colleagues and
patients). The technical term for this ability comes from theory of mind. This skill develops
by imagining yourself in their situation and is demonstrated to them by listening
[understanding] and communicating to them that you understand [caring behaviour, tact
and respect]. Just directly telling them you understand is not enough
4. Genuineness – the impression developed by consistently acting in a professional
manner [both to your colleagues and to patients]
5. Appropriate self-disclosure – occurs when you reveal some past experience and
should be restricted to occasions where you wish to demonstrate you have experience in
this situation. This experience should illustrate your knowledge and competence and will
also indicate that you have empathy for their situation/current reality.
6. Assertiveness [not aggressiveness] – healthcare professionals need to comfortably
and confidently express their ideas while respecting the ideas/perceptions of others.
Assertive communication sends clear, direct messages to others while remaining relaxed
and respectful. Generally assertive skills are used when others are using emotional,
aggressive communication styles. Note, HCPs should reply to such outbursts in an even
and assertive manner (rather than escalating the communication interchange to match the
other person’s aggressive tone). The ultimate use of the assertive tone is to present your
views in an even, non-confrontational manner so that information and not emotion holds
sway.
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http://www.blurrent.com/article/18-underrated-ways-your-mom-is-active-listening-
Active listening is aided by the following behaviours
1. Encourage patient communication
2. Paraphrasing to check/demonstrate your professional understanding
3. Offering expertise and a willingness to be involved
4. Leading and exploring themes to promote patient self-disclosure
5. Being open to allow patients to introduce related [previously undisclosed] issues
6. Remaining silent with the patient – provide opportunity/time for them to present
their thoughts/perspectives
7. Showing acceptance of the patients current [ill] state and their struggles/challenges
to re-gain health
8. Remaining non-judgmental and respecting the rights of others to have alternate
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ideas/opinions
9. Giving recognition to positive health changes
Barriers to effective communication as a HCP
1. Provide reassurance via unrealistic prognosis [outcomes]
2. Minimizing/trivializing/ignoring patient’s feelings
3. Approving/disapproving of the person [patient or colleague] and their
thoughts/feelings
4. Giving personal advice in a professional role
5. Becoming defensive and emotional about decisions or even proposals
6. Demanding that a patient explain or disclose something they do not wish to
7. Making sweeping generalizations (especially involving stereotypes = eg a typical
patient does…..]
● Compensation – focus on one [minor, positive] aspect but not the whole problem
● Denial – that a professional error has been made regarding a life-threatening
diagnosis
● Displacement – attribute problem to others or to some uncontrollable event (eg, an
addiction)
Rationalization – providing an incorrect explanation to justify inappropriate or
unacceptable behaviour
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2. Anger
http://www.inmagazine.net/dia-de-la-madre-diez-cosas-que-tu-mama-probablemente-odia-
de-ti/
Anger - patients become angry/frustrated for many reasons and while such patient-HCP
interchanges are not acceptable, they occur and the HCP needs to manage such situations
in an appropriate manner. Some guidelines include:
• Learn to recognize anger or settings that create anger/frustration
• Stay calm, respectful, genuine
• Be assertive – see above
• Do not match the patient’s emotions by becoming aggressive/angry
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• Calmly and firmly present health care guidelines (re clinic procedures, professional
behaviour, or treatment protocols, etc)
• Only make realistic promises/assurances and then keep them
• Given angry patients time and space to calm down
• Exit any situation that has the possibility of aggression and harm [while statistically
rare, assaults on HCP do happen and you need to have safety protocols for you and clinic
staff]
3. Anxiety
http://blueheronhealthnews.com/site/2012/04/16/white-coat-symptoms-proven-in-studies/
Anxiety – patients become anxious for many reasons (including white coat syndrome,
uncertainties associated with diagnosis, treatment, prognosis, etc). The HCP needs to
manage such situations and in an appropriate manner. Some general guidelines include:
• Learn to identify the signs of excessive anxiety
• Acknowledge situations [places, diagnosis, procedures, etc] that increase
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