Patient centered communication

patient centered communications also known as person centered

communication or client center communication is defined as process that invites
and encourages patients and their families to actively participate and negotiate
in decision making about their care needs.

• BENEFITS OF PATIENTS CENTERED COMMUNICATION are

followings:

• Better patient outcomes-improved quality.

• Increased patient and physicians satisfaction.
• Increased loyalty ;less tests and referrals.
• More appropriate medical decisions.
• Better management of chronic condition.
• Fewer medical errors- malpractice claims.
• Decreasing chance of law suits by avoiding

 perceived problem in patient- physicians relationship.

 poor delivery of information- even bad news.
 ineffective or absent apology.
 feeling of neglect.
 devaluing patient view/concern.
 falling to understand patient/family perspective.

• Patients centered communication skills are as

following:
1. Initiating session: identify the reason for visit.
2. Gathering information
3. Providing structure
4. Building relationship
5. Explanation and planning
6. Closing the session

1.Initiating session
• Preparation
• Establish initial rapport:
 greet patient by name,
 Introduce self and clarifies the role
 Demonstrate interest and respect attends to patients physical
comfort.
 • Identifying the reasons for visit/consultation
 Identify the patients problems or the issues that the patient wishes to
address with an appropriate opening question
e.g. what problem brought you to the hospital?
What would like to discuss today?
What questions did you hope to get answered today?
 Listen attentively to the patients opening statement, without
interrupting or directing patients response
 Confirms list and screens for further problem e.g. so that’s
headaches and tiredness; anything else?

2. Gathering information's
• Make observation to the patients facial expressions or other non verbal
clues related to patients sharing.
• Encourages patient to express feelings.
• Nurse should look at the patient while listening ;notes should be
written during pauses in the conversations.
• After finishing the conversation, gather more information by reviewing
information from patients chart , investigation reports, and by
interviewing family/ guardian if necessary.

3.Providing structure

• Making organization overt

 summarizes at the end of a specific line of inquiry to confirm
understanding before moving on the next section.
 progress from one section to another using transitional statements;
includes the rational for the next session
• Attending to flow
 structures interview in a logical sequence

4.Building relationship

• Using appropriate non- verbal behavior

 demonstrate appropriate non verbal behavior for example eye
contact, posture, positions, and movement.
 if reads writes notes or uses a computer, does in a manner that not
interfere with dialogue or rapport.
 demonstrate appropriate confidence
• Developing rapport
 accepts legitimacy of patients views and feelings; is not
judgmental.
  Uses empathy to communicate understanding and appreciation of
the patients feeling or predicament; overtly acknowledges the
patients views and feeling
 Provide support : expresses concern ,understanding, willingness to
help ;acknowledges coping efforts and appropriate self-care; offer
partnership
 Deals sensitively with embarrassing and disturbing topics and
physical pain; including when associated with a physical
examination
• Involving the patient
 Shares thinking with the patient to encourage patients
involvement [ e.g. what I'm thinking now is…..]
 Explains the rationale for questions or parts of physical
examination
 During the physical examination, explains the process, asks the
permission

5.Explanation and planning

• Acknowledging the patients emotions and values demonstrate that
nurse recognize their individuality. That must have
been[painful/frightening/frustrating] are crucial to establish rapport.
• Ask the patients what other information would be helpful e.g. etiology
prognosis
• Gives explanation at appropriate times: avoids giving advice,
information.
• Uses repetition and summarizing to reinforce information.
• Language : uses concise , easily understood statements; avoids or
explain jargon
• Uses visual methods of conveying information: diagrams , models,
written information and instructions
• Provide opportunities and encourage the patient to contribute: to ask
questions, seek clarification or express doubts ; respond appropriately

Planning: shared decision making

 Shares own thinking as appropriate: ideas, thought processes,

dilemmas
• Involves patient by making suggestions rather than directives
• Encourages patient to contribute their thoughts : ideas, suggestions and
preferences
• Negotiate a mutually acceptable plan
 • Offers choices :encourages patient to make choices and decisions to the
level that they wish
• Checks with the patient: if plans accepted; if concern have been
addressed

6.Closing the session

• Forward planning
 contracts with patient in next steps for patient and physician
 Safety nets, explaining possible unexpected outcome, what to do if the plan is
not working, when and how to seek help.
• Ensuring appropriate point of closure
 Summarizes session briefly and clarifies plan of care
 The final check that patient agree and is comfortable, questions or other items
to discuss

History taking process

• History taking is a mechanism for obtaining the health history of client. This
process allows the nurse to observe the client and any interaction between the
client and family.

Purposes of history taking

• To eliminate confusion about the patients identify and obtain information
required for contacting the patient if the need arises.
• to initiate a relationship based on recognition of the importance of informants
role in sharing in the care of the patient.
• To find out the patients condition [present and past]
• To support for nursing care.
• To support for diagnosis, treatment and management.

Summary
Patients center communication is defined as process that invites and encourages
patients and their families to actively participate and negotiate in decision making
about their care needs. Patients centered skills are initiating the session, gathering
information, providing structure, building the relationships, explanation and planning,
closing the session etc.
References

• Ghimire, B & Khadka, S. (2021). A textbook of Community Health

Nursing - I. , (2nd edition), pp: 183-210. Kathmandu, Nepal. Vidhyarthi
Pustak Bhandar.
• Tuitui, R & Dr. Suwal S.N. (2070). A textbook of Community Health
Nursing – I. (3rd edition), pp: 167-180. Kathmandu, Nepal: Vidhyarthi
Prakashan (P.) Ltd.
• Rai, L. (2019). Nursing Concept, Theories & principles. (4th edition).
Pp157-180.kathmandu, Nepal:Akshav.
 • Acharya D.K& K. D. Nursing Concepts & Principles. (2nd edition).
Pp 207-262. Kathmandu, Nepal:Jupiter Publishers & Distributor Pvt. Ltd.
• Kurtz SM., Silverman JD& Draper J. (1998).Teaching and Learning
Communication Skills in Medicine.Radcliffe Medical Press (Oxford)
Home assignment
Explain the steps of patient centered communication.
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