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Communication

Core Interpersonal Skills for

Healthcare Professionals

4TH EDITION

Gjyn O’Toole, DipTEFL, DipOccThy,

BA, MEdStud
Senior Lecturer Occupational Therapy, School of Health Sciences, The
University of Newcastle, Newcastle, New South Wales, Australia
Table of Contents

Cover image

Title page

Copyright

How to use this book

Reviewers

Preface

Acknowledgements
Section 1. The significance of effective interpersonal
communication for the healthcare professional

1. Effective communication for healthcare professionals: A model to

guide communication

Why learn how to communicate? Everyone can communicate!

Factors to consider when defining effective communication

Possible factors that can impact on effective communication

 Chapter summary

References

2. The overarching goal of communication for healthcare

professionals: Person-centred care

An international WHO classification demonstrating the

importance of effective communication

A model to guide the overall purpose of communication for

healthcare professions

Mutual understanding

Family/Person-centred care and goals

Chapter summary

Useful websites

References

3. The specific goals of communication for healthcare professionals: 1

Introductions and providing information

Making verbal introductions

Providing information: A two-way process

Providing constructive feedback

Chapter summary

References
4. The specific goals of communication for healthcare professionals: 2
Questioning, comforting and confronting

Interviewing and questioning to gather information

Comforting: Encouraging versus discouraging

Confronting unhelpful attitudes or beliefs

Chapter summary

References

5. The specific goals of communication for healthcare professionals: 3

Effective conclusions of interactions and services: Negotiating
closure

The importance of effective conclusions

Features of effective conclusions or finalising

Preparing to conclude or finalise

Concluding initial meetings, single face-to-face or telephone

interactions

Concluding individual treatment sessions

Concluding provision of healthcare services after a period of

care

Concluding services due to a life-limiting illness

Chapter summary

References
Section 2. Achieving effective communication by
developing awareness within the healthcare professional

6. Awareness of and the need for reflective practice in healthcare

The ‘what’ of reflection: A definition

The ‘why’ of reflection: Reasons for reflecting

Reflection upon barriers to experiencing, accepting and

resolving negative emotions

The ‘how’ of reflection: Models of reflection

The result of reflection: Achieving self-awareness

Chapter summary

References

7. Awareness of self to enhance healthcare communication

Self-awareness: An essential requirement

The benefits of achieving self-awareness

Beginning the journey of self-awareness

Individual values

Is a healthcare profession an appropriate choice?

Values of a healthcare professional

Characteristics and abilities that enhance the practice of a

healthcare professional
 Conflict between values and needs

Perfectionism as a value

Self-awareness of personal communication skills

Self-awareness of skills for effective listening

Self-awareness of skills for effective speaking

Personality and resultant communicative behaviours

Chapter summary

References

8. Awareness of how personal assumptions affect healthcare

communication

Reasons to avoid stereotypical judgement when communicating

Stereotypical judgement relating to roles

Expectations of a healthcare professional

Developing attitudes to avoid stereotypical judgement

Overcoming the power imbalance: Ways to demonstrate

equality in a relationship

Chapter summary

References

9. Awareness of the ‘Person/s’ for healthcare communication

Who is the Person/s?

 Relevant information about the Person/s

Defining the whole ‘Person’

Cognitive aspects of the Person

Chapter summary

References

10. Awareness of the effects of non-verbal communication for the

healthcare professional

The significance of non-verbal communication

The benefits of non-verbal communication

The effects of non-verbal communication

The components of non-verbal communication

Communicating with the Person/s who has limited verbal

communication skills

Chapter summary

References

11. Awareness of listening to facilitate Person/s-centred

communication in healthcare

Defining effective listening

Requirements of effective listening

Results of effective listening

 Benefits of effective listening

Barriers to effective listening

Preparing to listen

Characteristics of effective listening

Disengagement

Chapter summary

References

12. Awareness of different environments affecting communication in

healthcare

The physical environment

The emotional environment

The cultural environment

Environments affecting sexuality

The social environment

The spiritual environment

Chapter summary

References

Section 3. Managing realities of communication as a

healthcare professional
13. Holistic communication resulting in holistic healthcare

Holistic communication

An essential criterion in holistic communication: Respect

Another essential criterion in holistic communication: Empathy

Holistic care

Chapter summary

References

14. Conflict and communication for the healthcare professional

Conflict during communication

Resolving negative attitudes and emotions towards another

Patterns of relating during conflict

Bullying

Communicating assertively

Chapter summary

References

15. Culturally effective communication in healthcare

Introduction

Defining culture

Cultural identity affecting culturally effective communication

 Defining culturally effective communication

Why consider cultural differences?

A model of culturally effective communication

Managing personal cultural assumptions and expectations

Strategies for achieving culturally effective communication

Using an interpreter

The culture of each healthcare profession

The culture of disease or ill-health

Chapter summary

References

16. Communicating with indigenous peoples as a healthcare

professional

Correct use of terms

The 4 Rs for reconciliation: Remember, reflect, recognise,

respond

The complexity of cultural identity

Principles of care for healthcare professionals when working

with indigenous peoples

Factors contributing to culturally effective communication with

indigenous peoples

Barriers to culturally responsive or effective communication

 Chapter summary

Websites and organisations

Further reading

References

17. Misunderstandings and communication for the healthcare

professional

Communication that produces misunderstandings

Factors affecting mutual understanding

Causes of misunderstandings

Strategies to avoid misunderstandings

Resolving misunderstandings

Chapter summary

References

18. Ethical communication in healthcare

Respect regardless of differences

Honesty

Clarification of expectations

Consent

Confidentiality
 Boundaries

Ethical codes of behaviour and conduct

Chapter summary

Further reading

Useful websites

References

19. Remote or long-distance healthcare communication: 1 The

unseen healthcare professional

Characteristics of remote forms of communication for the

healthcare professional

Principles governing professional remote communication

Electronic records

Telephones

Using video/teleconferencing or Skype or Zoom for professional

development and meetings

The internet

Chapter summary

References

20. Remote or long-distance healthcare communication: 2 The seen,

but not-in-theroom healthcare professional

Positive outcomes from using telecommunication

 Challenges relating to using telecommunication

Devices, trained personnel and secure internet connection

Requirements for effective communication

Websites for guidelines and/or policies

References

21. Documentation: ‘one-way’ professional healthcare

communication

Documentation: Information recording and provision

Quality, understandable documentation

Documentation requirements in healthcare

Characteristics of a professional writing style

Report or letter writing: Formatting and content

Points to remember

Chapter summary

Useful websites

References

22. Social media or ‘not present in person’ communication and the

healthcare professional

Social networking sites

Cyberbullying
 Other factors relating to the use of social media

Netiquette: A mnemonic to guide personal electronic

communication

Professional communication using social media

Chapter summary

Useful websites

References

Section 4. Scenarios to guide communication:

Opportunities for healthcare professionals to practise
communicating effectively with ‘the Person/s’

Introduction

Introduction

One possible session outline – role-plays

23. Person/s experiencing strong negative emotions

1. Person/s behaving aggressively

2. Person/s experiencing extreme distress

3. Person/s experiencing neurogenic or psychological shock

4. Person/s experiencing depression

5. Person/s reluctant to engage or be involved in communication

or intervention
24. Person/s in particular stages of the lifespan

A child

An adolescent

An adult

A Person/s who is older

25. Person/s fulfilling particular life roles

1. Person/s fulfilling the role of carer

2. Person/s fulfilling the role of a colleague

3. Person/s fulfilling the role of parent to a child requiring

assistance

4. Person/s fulfilling the role of single parent to a child requiring

assistance

5. A Person/s fulfilling the role of a grandparent

6. Person/s fulfilling the role of a student

7. Groups in the healthcare professions

References

26. Person/s experiencing particular conditions

1. Person/s experiencing post-traumatic stress disorder (PTSD)

and complex PTSD

2. Person/s with a spinal injury

 3. Person/s with decreased cognitive function

4. Person/s experiencing a life-limiting illness and their family

5. Person/s experiencing a mental illness

6. Person/s experiencing long-term (chronic) and/or multiple

physical conditions

7. Person/s experiencing a hearing impairment

8. Person/s experiencing a visual impairment

Useful websites

References

27. Person/s in particular contexts

1. A Person/s who experiences an emergency

2. A Person/s living in a residential aged care facility

4. A Person/s who speaks a different language to the healthcare

professional

Glossary

Index
Copyright

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ISBN: 978-0-7295-4325-5
Notice
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How to use this book

Each section includes opportunities to explore elements of

communication as individuals, in groups and from the perspective of
a particular scenario. Various types of activities encourage reflection
to promote deeper understanding of the requirements of
communication. They also encourage increased awareness of personal
tendencies during communicative events and skills development in
preparation for communicating as a healthcare professional.
The following icons indicate the type of activity:

Group work or activity for a group

Individual activity or opportunity for individual reflection

Scenario or case study
Reviewers
Adam Burston, RN, BNurs, GCertNurs, MHlthServMgmt, PhD,
MACN, Lecturer in Nursing; Course Coordinator Master Health
Administration; School of Nursing, Midwifery & Paramedicine,
Australian Catholic University, Brisbane, Queensland, Australia

Anne Churchill, GradCerthHlthMgmt, GradCertTertTeach,

MMH, Lecturer/Co-ordinator, School of Nursing, Midwifery and
Healthcare Professions; Faculty of Health, Federation University,
Berwick Campus, Berwick, Victoria, Australia

Thomas Crooks, BHlthSc, BA, GDipIntlStud, MCHAM, CMRB

Senior Lecturer in Social Sciences, National E-Learning Specialist,
Department of Social Sciences, Endeavour College of Natural
Health, Perth, WA, Australia
Registered Acupuncturist and Chinese Herbalist

Evita March, BA, GDipPsych, PhD, Senior Lecturer in

Psychology, School of Health and Life Sciences, Federation
University Australia, Berwick Campus, Berwick, Victoria, Australia

Krista Mathis, BA, MComm, MEPrac, Senior Teaching Fellow,

Faculty of Society & Design, Communication & Media, Bond
University, Gold Coast, Queensland, Australia

Christopher Mesagno, BSc, MSc(Exercise and Sport Science),

PhD, Senior Lecturer in Exercise & Sport Psychology, School of
Health and Life Sciences, Federation University, Ballarat, Victoria,
Australia

Charles Mpofu, MHSc(Hons), PhD, DCTD, Senior Lecturer,

School of Public Health and Interprofessional Health, Faculty of
Health, Auckland University of Technology, Auckland, New
Zealand

Evan Plowman, RN, GradCertCritCare, BN/BClinPrac(Para),

MNurs, Lecturer in Nursing, School of Nursing, Midwifery &
Indigenous Health, Charles Sturt University, Wagga Wagga, NSW,
Australia

David Reid, GradCertHSM, BSc (ParamedSci), DipHlthSci

(Paramed), MHM(Hons), GAICD
Senior Lecturer in Paramedicine, Director Paramedicine, School of
Medical and Health Sciences, Edith Cowan University, Perth, WA,
Australia
Paramedic, St John Ambulance (NT); Registered Paramedic
(AHPRA, Australia)

Arianne C. Reis, BSc(Sport Sci)/BTeach (PhysEd), MRes,

PhD, Senior Lecturer in Leisure and Recreation Studies, Director
of Academic Program – Master of Public Health/Master of Health
Science, School of Science and Health, Western Sydney University,
NSW, Australia

Narinder Verma, BSc(OccTher)(Hons), GradDipTertEd,

MProfPractice, NZROT
Fieldwork Team Leader/Senior lecturer in Occupational Therapy at
The School of Occupational Therapy, Otago Polytechnic, Dunedin,
New Zealand
Registered Occupational Therapist
Preface
Development of skills in communication is an ongoing journey for
each person. It requires awareness of personal biases and prejudice,
awareness of the power of non-verbal aspects of communication,
awareness of the needs of the ‘Person/s’, awareness of the effects of
environment and background, as well as reflection about
communicative practice. Even the best communicators have times
when they experience unsatisfactory communication, regre ing the
effects of an interaction. The journey for a healthcare professional in
developing communication skills is often eventful and sometimes
difficult. However, commitment to perseverance in overcoming the
barriers to effective communication is a beneficial and rewarding
process for any person, but essential for any healthcare professional.
This book contains four sections focusing on particular elements of
communication. Section 1 examines the significance and goals of
communication in the health professions. Section 2 highlights the
importance of reflection and increased awareness of various factors
when communicating as a healthcare professional. It indicates this
awareness must be of ‘self’; as well as the ‘Person’ and the
environment. Section 3 emphasises specific characteristics of and
skills required for effective communication in the health professions.
Section 4 presents 56 scenarios, representing typical situations and
people that a healthcare professional might encounter during their
working week. This section challenges readers through role-plays to
consider in depth the circumstances and needs of the Person/s in the
scenarios. Section 4 encourages readers to validate the information
found in the first three sections of the book, thus promoting
application of the information learnt and consolidation of the skills
developed in these sections.
All sections include presentation of information and opportunity
for reflection, practice and discussion. They provide opportunities to
communicate with both ‘self’ and ‘others’ in an a empt to promote
awareness of the major factors contributing to effective
communication.
Acknowledgements
I especially thank and acknowledge five people: Mitch, a wonderful
model of a communicator in many forms; Esther, author,
communicator and editor extraordinaire; Jasen, an interested and
invaluable communicator, designer and trainer; ever-developing
Zeke, who communicates in several languages with honesty, love
and empathy; and li le Eden Joan who, regardless of speaking skills,
continually communicates with acceptance and confidence. Your
encouragement, understanding, acceptance and support empower
and enable me, despite the challenges.
Thanks to Margie Freestone for assisting me in searching for
relevant and current evidence to support the content of this book.
Thanks also to James Charles, podiatrist from Charles Sturt
University, New South Wales, Australia, and Ailsa Haxell for their
invaluable evaluation of the details found in Chapter 15.
Thanks to the talented cartoonist Roger Harvey, who has used his
talent to expertly capture particular points from each chapter.
Thanks to the people who assisted with the compilation of Section
4. These include all the many Person/s I have had the privilege to
assist in practice and Esther Brooks (teacher extraordinaire), Ma
Peters (talented healthcare professional) and Nell Harrison (creative
and reliable healthcare professional) – all phenomenal people. To
say thanks is not enough.
I also have students, colleagues, friends and other family members
to thank for their commitment to both challenging and encouraging
me in my journey towards becoming an effective communicator.
I am, however, most in debt and thankful to the Creator and
Sustainer of the Universe, Yaweh.
SECTION 1
The significance of effective
interpersonal communication for
the healthcare professional
OUTLINE

1. Effective communication for healthcare

professionals: A model to guide communication
2. The overarching goal of communication for
healthcare professionals: Person-centred care
3. The specific goals of communication for healthcare
professionals: 1 Introductions and providing
information
4. The specific goals of communication for healthcare
professionals: 2 Questioning, comforting and
confronting
5. The specific goals of communication for healthcare
professionals: 3 Effective conclusions of interactions
and services: Negotiating closure
CHAPTER 1
Effective communication for
healthcare professionals:
A model to guide communication

Chapter objectives

Upon completing this chapter, readers should be able to:

• explain the importance of effective communication for

healthcare professionals
• describe a model of interpersonal communication relevant to
healthcare professionals
• define effective communication
• demonstrate understanding of the importance of effective
communication
• identify factors contributing to effective communication
• demonstrate understanding of the importance of considering
the ‘audience’ to achieve effective communication.
Why learn how to communicate?
Everyone can communicate!
Communication occurs constantly throughout the world. Indeed,
most individuals from a young age participate daily in acts of
communication regardless of their nationality, age, personality or
interests. Communicative interactions are unavoidable and usually
essential for satisfactory daily life, with even those unable to
produce speech striving to effectively communicate. Well then, if
everyone communicates so effectively in daily life, why is it
necessary to learn how to communicate specifically in healthcare
se ings?
Ineffective communication in healthcare se ings may not only
result in complaints (Coad et al 2018; Hill 2015) or delayed diagnosis
(Rood & Elkin 2014); it can also cause fatalities (Paterson 2008).
Ineffective communication also has legal implications. These
implications may impact on the perceived competence of the
healthcare professional. It can therefore affect the reputation of the
particular healthcare professional. Interestingly, employers consider
skills in effective communication (both spoken and wri en) to be
the most important a ribute when considering prospective
employees (Graduate Careers Australia 2016). This indicates the
relevance of exploring effective communication in healthcare.
In reality, when providing healthcare, many situations challenge
the communication skills of communicating individuals. Effective
communication in a healthcare se ing is complex, requiring
particular understanding of oneself and others (Moss 2017; Tamparo
& Lindh 2017; Zimmerman et al 2007), along with developed skills in
face-to-face and non-face-to-face communication. Individuals do not
typically acquire such understanding or skill in everyday life. Thus,
it is beneficial if preparing to be a successful healthcare professional,
to learn how to achieve effective communication in healthcare
se ings (Henderson 2019).
Effective communication is an essential core skill for any healthcare
professional, producing positive outcomes for all (Arnold & Boggs
2019; Higgs et al 2012). It optimises development of the therapeutic
relationship and provision of effective healthcare (Conroy et al 2017;
Gilligan et al 2018). In contrast, ineffective communication produces
emotions and thoughts that could potentially negatively affect
health outcomes (Hill 2011a, 2011b; Rosen 2014). Certainly evidence
suggests the positive impact of effective communication when
experiencing a health condition. These include increased recovery
rates and decreased incidence of complications or further conditions
(co-morbidities), along with increased motivation and outcomes.
(Camerini & Schulz 2015; Henderson 2019; Pennebaker & Evans
2014; Rosen 2014; Stein-Parbury 2017). Generally, effective
communication reduces the cost of healthcare (Duman 2015; Rosen
2014), ensuring positive outcomes (Prasad et al 2013), thereby
increasing satisfaction for all people relating to healthcare
professionals (Chung et al 2018; Hall et al 2014; Hassan et al 2007;
Koponen et al 2010; Leve -Jones et al 2014; Levinson et al 2010;
Rosen 2014). Therefore, with skills in effective communication being
vital for successful outcomes in healthcare, it is crucial to understand
both communication and the components of effective
communication.
NOTE: In this book the word ‘Person/s’ typically means those
individuals and their families/carers and/or communities seeking the
services of a healthcare professional. On some occasions it may refer
to those individuals or colleagues working within or related to a
healthcare service.

A guiding principle
Before defining communication, it is important to establish an
underlying principle to guide communication for healthcare
professionals. Critical self-awareness and self-knowledge (see Chs 6
–8) are necessary requirements for successful adherence to this
principle. This guiding principle simply states:
Do not say or do anything to another person that you would not want
said or done to you.

Adapted from Hillel around 15BC

Consistent consideration of and adherence to this principle is not

always easy. However, consideration of the ‘audience’ (the receiver
of the message in health – usually the Person receiving care) and
their response, generally produces effective communication and
satisfying outcomes in both healthcare and life (Duman 2015).
Cooper et al (2015) suggest that effective communication should
become a required component of guidelines for best practice in
quality healthcare improvement recommendations.
Factors to consider when defining
effective communication
Increasingly in the world today communication is one-way or linear.
Text messages, emails, blogs and social media generally require a
sender to ‘send’ a message, with no immediate response and only
some expectation of a response, and not necessarily from a specific
individual. However, many dictionaries and communication
theorists indicate that communication involves several interacting
individuals simultaneously sending and receiving messages during
an interaction. This understanding of communication appears to
resemble aspects of a game of tennis. In the same way that tennis
players hit a ball to each other, communicators send and receive
messages in various forms. Initially this metaphor seems
appropriate, however, tennis players generally focus on the ball and
the rules governing the game, typically avoiding personal
interactions with each other. In addition, the tennis ball remains
constant throughout the process, unlike messages, which tend to
change and develop because of responses during interactions. These
realities suggest effective communication involves more than
exchanging messages between communicators. Indeed, effective
communication typically requires processing and understanding the
messages, not merely sending and receiving them. Communication
occurs in many forms or channels: auditory, verbal, visual and non-
verbal. It includes vocalising without words (e.g. laughing or
crying); non-verbal cues (e.g. eye contact, facial expressions,
gestures and signing) and material forms (e.g. pictures,
photographs, picture symbols, logos and wri en words) (Crystal
2008). Thus, it requires consideration of various forms and multiple
factors from the perspective of all communicating individuals.

A communication model to guide

interactions in healthcare: Negotiating
mutual understanding
Various communication models identify factors relevant to effective
communication. Some models suggest a linear or one-way process
(Shannon & Weaver 1949), some a circular process (Schramm 1954),
and others a transactional process requiring ongoing processing of
messages throughout an interaction, and a relationship (Berlo 1960).
Thus transactional models require a connection between individuals
and message-processing to achieve mutual understanding. This
involves simultaneously sending and receiving messages, with the
messages affecting the responses of every interacting individual.
Transactional models appear to be most appropriate and
applicable to healthcare se ings. During transactional interactions,
the communicating individuals assign meaning to each message,
hopefully the intended meaning of the sender. Each interaction is
unique, with unique realities common to each communicating
individual, along with particular requirements and constraints.
These realities, requirements and constraints may be internal or
external to the communicators. Regardless of their origin, they
influence the effectiveness of the interaction at the time. This
indicates the need to explore the effect of these factors upon meaning
and responses and to achieve mutual understanding and effective
communication (Fig 1.1). Mutual understanding requires a shared
focus or mutual a ention upon the messages during the interaction.
Therefore, every communication act requires active involvement of
all communicators to connect with and understand all responses,
and to understand the factors affecting those responses (Brill &
Levine 2005; Hassan et al 2007; Levine 2012). This facilitates
understanding of all verbal and non-verbal messages between the
sender and receiver. This resultant understanding enables
individuals to overcome any barriers to effective communication; to
be able to consider reactions (including feedback) and to provide
appropriate responses. This encourages successful interactions and
achievement of mutual understanding, thereby encouraging those
communicating to trust their ability to effectively communicate
(Stein-Parbury 2017). This strengthens the interaction, encouraging
the sender and receiver to continue communicating. Therefore,
understanding the internal and external realities, requirements and
 g q
constraints relevant to each Person/s empowers the communicators
to achieve effective communication in healthcare.

FIGURE 1.1 A model to guide communication in the healthcare

professions.
Note: Person/s is used to describe all those relating to the healthcare
professional during practice, including other employees and
colleagues.

The model presented here (Fig 1.1) acknowledges the effects of

various internal and external factors upon the interacting
individuals. It highlights the importance of achieving mutual
understanding, despite barriers and consideration of the various
factors affecting the outcome of every interaction (Table 1.1). Despite
many of these factors being obvious, they are often overlooked or
assumed and thus require consideration/exploration.
TABLE 1.1
Possible factors affecting communicating individuals

Factors common to all Possible Possible external factors

communicators internal factors
Understanding the Positive and Context: including surroundings,
purpose of the negative noise, temperature, light, phone
interaction emotions
Age Knowledge and Background and life experiences
understanding
Gender Particular Existing relationship
disorders and
pain
Personality Language and Privacy and confidentiality
meaning
Value, beliefs and Ability – Time pressures
culture hearing and
cognition
Possible factors that can impact on
effective communication
Possible factors common to both the sender
and receiver
The realities common to each individual communicating may
require accommodation to achieve shared understanding. Firstly, it
is essential that all communicators understand the purpose of the
interaction. A failure to understand the reason for the interaction may
produce inappropriate expectations of the interaction and inaccurate
assumptions about meaning, thereby producing
misunderstandings. Such misunderstandings can produce negative
and undesired results. This highlights the need to achieve a common
understanding about the purpose of each unique interaction. Other
realities relevant to each communicator are age, gender and
personality. These can affect the type of communication and
relevance of particular information. For example, when
communicating with a young child they may not understand
particular words or be able to fulfil particular expectations, such as
completing particular required documentation. Therefore, when
talking to a young child it is appropriate to adjust the
communication style by using less complex words or sentences. This
adjustment of communication style facilitates mutual understanding
for both the healthcare professional and the child. However, using
the same simplistic language when interacting with an adolescent or
adult may cause offence. The age of the Person/s seeking assistance
may affect their range of life experiences, while the age of the
healthcare professional may also affect their experience with life and
the healthcare process.
Gender can also affect the focus and content of an interaction. For
example, communicating with an adolescent female about personal
hygiene requires particular details, not all of which would be
appropriate for a male the same age. A female Person seeking
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 DISEASES AND INJURIES.

With ordinary care in cleanliness, freedom from cold damp drafts,

and a well-regulated food supply, canaries are subject to few ills. In
fact, most of their troubles may be traced to some untoward
circumstance in handling them. Their diseases are very little
understood and correct diagnosis is difficult, and though much has
been written regarding them this has served mainly to reveal general
ignorance on the subject. Present knowledge does not warrant an
exhaustive account of diseases, but in the following notes
information is given on the more usual complaints of canaries.
When canaries become sick the first care should be to see that the
diet is proper and to examine into the general sanitary conditions
under which the birds are living. If canaries are confined in company
with others, sick birds must be removed at once to a separate cage,
since their companions will continually peck and worry them. Where
numbers of canaries are kept, as a precaution to prevent spread of
contagious or infectious diseases ailing birds should be removed
from the bird room. It is always well to move a sick bird to a warm
place. Heat and protection from drafts work wonders with ailing
canaries and often are sufficient alone to restore them to health.
When medicine is necessary it is best to administer it in the
drinking water. If this can not be done it may be given directly in the
bill by means of a quill or a medicine dropper. In administering
medicines it must be remembered that a canary is small and that a
single drop in most cases is a large dose. Indiscriminate dosing of
birds with various remedies is to be avoided.
The few instructions that follow are not to be regarded as infallible,
but they may be of assistance in simple ailments. When a bird is
seriously ill there is usually little chance of its recovery.

BROKEN LIMBS.
 In case of bad fractures or injuries it is perhaps best for all
concerned to end the trouble by killing the bird. If a valuable bird
breaks a leg, a slender splint of wood wrapped in a slight wisp of
cotton and held by a bandage may be applied with care. This
support must not be touched for two or three weeks, but then it may
be removed entirely. When the break occurs in the lower leg (tarsus)
a small quill makes a simple support. The quill is split and cut down
until it fits snugly around the part affected. It is then padded inside
with a few shreds of cotton and tied carefully in place with silk
thread.
Broken wings should be allowed to heal without outside
interference. All high perches should be removed from the cage, and
food and water made easily accessible. A bird with a broken wing
must be kept as quiet as possible in order that the fracture may heal.

LOSS OF FEATHERS ABOUT HEAD.

Baldness is sometimes occasioned by mites or bird lice and may

be treated best by removing the cause. Loss of feathers about the
head, however, may indicate old age or general debility. At the
natural time of molt the growth of feathers on the bare spots may be
aided by warmth and a well-regulated diet. In addition to the usual
food, twice a week give a little bread moistened with milk which has
been dusted with a mixture of two parts of sulphur to one of
potassium chlorate. At the same intervals rub a little carbolized
petrolatum on the bare places. Baldness is said to arise at times,
particularly in spring, through failure to provide the canary with
lettuce, apple, or other green food. In such cases improvement may
be made by supplying this need.

RESPIRATORY TROUBLES.

The fact that canaries are injured by cold drafts can not be too
strongly emphasized, and it may be said that a large proportion of
their common ailments come from such exposure. In many cases
exposure is followed by congestion in the intestinal region, and death
ensues in a very short time. In ordinary colds there is difficulty in
breathing and some liquid discharge from the nose. Frequently this
is accompanied by coughing. A bird thus affected should be kept in a
warm room free from all drafts and protected from irritating dust,
vapor, or tobacco smoke. The symptoms are increased as the cold
progresses and becomes acute, and the bird sits with feathers
puffed out, seeming really ill. Breathing is difficult and rapid. If there
is enough catarrhal secretion partly to block the respiratory passages
a slight bluish tint is noticed beneath the transparent sheath of the
bill. As a remedy, place in the drinking cup 1 ounce of water to which
have been added 20 drops of sirup of tolu, 10 of sweet spirits of
niter, and 10 of glycerin.
Pneumonia in cage birds often follows exposure and is nearly
always fatal. The symptoms, rapid and difficult breathing with little
catarrhal discharge, appear suddenly. The bird becomes very weak
at once and usually dies in from two to seven days. Little can be
done beyond sheltering the bird, as noted above, and providing an
easily assimilated food, as egg food and bread moistened in milk.
Asthma is a chronic affection, in which there is difficulty in
expiration of air in breathing. In severe cases a contraction of the
abdominal muscles is evident in forcing the air from the lungs.
Asthma is more in evidence at night, and often birds apparently free
from it during the day will wheeze when at rest. There is practically
nothing that can be done for it. Sometimes a semblance of asthma is
caused by indigestion from overeating. Fanciers consider asthma
hereditary and do not recommend birds so affected for breeding
purposes.

INTESTINAL COMPLAINTS.

Intestinal troubles in canaries arise in most cases from the food or

water supply and are avoided by cleanliness and proper care. Dirty
water cups with foul water, decayed or soured fresh or soft foods, or
a poor seed supply lead inevitably to trouble. Should the canary
contract diarrhea, remove all green and soft foods from the cage for
a time and give only the normal seed supply. As a remedy, add a
small quantity of Epsom salts to the drinking water for a day. If there
is no improvement, feed the bird a bit of moist bread, with the
surface covered lightly with bismuth (subnitrate), or place an ounce
of water in the drinking cup, to which have been added three or four
drops of tincture of opium. For constipation, the addition of lettuce,
apple, chickweed, or other green food to the regular menu is usually
sufficient; if not, a pinch of Epsom salts may be added to the drinking
water. The quantity of the purgative should be enough to impart a
faintly saline taste to the solution. Castor oil is not a good corrective
remedy for small birds.
Occasionally birds in confinement “go light,” or waste away until
they are far below their normal standard of plumpness, without
marked symptoms of disease. In such cases change the seed
supply, making sure that the seed is fresh and wholesome, and vary
the diet with green foods, and with bread softened with milk. It is also
beneficial to change the location of the cage; if possible, place the
cage where it will receive the sun for a few hours each day, except in
the heat of midsummer. Make sure that the canary is not infested
with mites.
When worms are present, as sometimes happens, small
fragments of these internal parasites may be seen in the droppings
when the cage is cleaned. As a remedy, place in the drinking cup 8
or 10 drops of tincture of gentian in an ounce of water. This may be
given for two days, and, in addition, two drops of olive oil may be
administered in the bill by means of a medicine dropper.
For more serious complaints than those enumerated it will be well,
if possible, for the amateur to seek the advice of some person with
experience in handling cage birds.
 BIBLIOGRAPHY.

For the benefit of those who may wish further information on the
care of canaries a short list of standard works on the subject is
appended. (None of these is available for free distribution by the
United States Department of Agriculture.)[4]

BOOKS.

Battye, H. W.
Yorkshire Canaries, How to Breed, Manage, and Exhibit.
80 pp., ill. F. Carl, 154 Fleet St., London, E. C.
Boaler, G. H.
Seeds, Foods, and Wild Plants for Cage Birds. 97 pp., ill.
F. Carl, 154 Fleet St., London, E. C.
Brunskill, E.
Canary Culture for Amateurs. F. Carl, 154 Fleet St.,
London, E. C.
Church, T. A.
The Roller; Concerning Its Health, Habits, Feeding, etc.
223 pp., ill. Stuyvesant Press, New York, N. Y.
Crandall, L. S.
Pets; Their History and Care. Ill. H. Holt & Co., New York,
N. Y.
——
Pets and How to Care for Them. Ill. Pub. by New York
Zoological Park, New York, N. Y.
Creswell, W. G.
 The Hygiene of Bird Keeping. F. Carl, 154 Fleet St.,
London, E. C.
House, C. A.
Canary Manual. 130 pp., ill. F. Carl, 154 Fleet St., London,
E. C.
——
Norwich Canaries. 48 pp., ill. F. Carl, 154 Fleet St,
London, E. C.
Lewer, S. H.
Canaries, Hybrids, and British Birds in Cage and Aviary.
424 pp., 26 pls. (color), and other ills. Waverly Book
Co., 7 and 8 Old Bailey, London, E. C.
Norman, H.
Aviaries, Bird Rooms, and Cages. F. Carl, 154 Fleet St.,
London, E. C.
Page, W. T.
Foreign Birds for Beginners. 60 pp., ill. F. Carl, 154 Fleet
St., London, E. C.
Ramsden, J. W.
The Colour Feeding of Canaries and Other Birds. F. Carl,
154 Fleet St., London, E. C.
St. John, C.
Our Canaries: A Thoroughly Practical and Comprehensive
Guide to the Successful Keeping, Breeding, and
Exhibiting of Every Known Variety of the
Domesticated Canary. 32 pls. (color) and many ills.
Pub. in 16 parts, 1910-11. F. Carl, 154 Fleet St.,
London, E. C.
Verrill, A. H.
Pets for Pleasure and Profit. 359 pp., 152 ills. 1915.
Charles Scribners’ Sons, New York, N. Y.

PERIODICALS.

Avicultural Magazine. Pub. for the Avicultural Society,

by Stephen Austin & Sons, 5 Fore St., Hertford,
England.
Cage Birds and Bird World. Pub. weekly by F. Carl,
154 Fleet St., London, E. C.
Roller Canary. Pub. monthly at 2144 Sacramento St.,
San Francisco, Calif.

FOOTNOTES:

[4] Addresses of dealers in cage birds and cage-bird supplies

may be obtained on application to the Biological Survey, U. S.
Department of Agriculture.
ORGANIZATION OF THE UNITED STATES DEPARTMENT OF
AGRICULTURE.
Secretary of Agriculture
Assistant Secretary
Director of Scientific Work
Director of Regulatory Work
Weather Bureau
Bureau of Agricultural Economics
Bureau of Animal Industry
Bureau of Plant Industry
Forest Service
Bureau of Chemistry
Bureau of Soils
Bureau of Entomology
Bureau of Biological Survey
Bureau of Public Roads
Fixed Nitrogen Research
Laboratory
Division of Accounts and
Disbursements
Division of Publications
Library
States Relations Service
Federal Horticultural Board
Insecticide and Fungicide Board
Packers and Stockyards
Administration
Grain Future Trading Act
Administration
Office of the Solicitor
This bulletin is a contribution from the—
Bureau of Biological Survey
Henry C. Wallace.
C. W. Pugsley.
E. D. Ball.
——.
Charles F. Marvin, Chief.
Henry C. Taylor, Chief.
John R. Mohler, Chief.
William A. Taylor, Chief.
W. B. Greeley, Chief.
Walter G. Campbell, Acting Chief.
Milton Whitney, Chief.
L. O. Howard, Chief.
E. W. Nelson, Chief.
Thomas H. MacDonald, Chief.
F. G. Cottrell, Director.
A. Zappone, Chief.
Edwin C. Powell, Acting Chief.
Claribel R. Barnett, Librarian.
A. C. True, Director.
C. L. Marlatt, Chairman.
J. K. Haywood, Chairman.
Chester Morrill, Assistant to the
Secretary.
R. W. Williams, Solicitor.
E. W. Nelson, Chief.
 Division of Food Habits Research W. L. McAtee, in Charge.

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