1. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 16 The Communication Process

2. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Communication Exchanging messages between sender and receiver Types: –Verbal –Nonverbal –Written –Electronic

3. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Communication in Health Care Excellence in communication essential in health care –Increase in size of delivery systems Need for intercommunication –More complex payment systems –Decrease in time spent in hospitals Importance of patient education

4. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Communication in Health Care Shift in causes of death to heart disease, cancer, and stroke –Patient information regarding wellness and healthy lifestyles

5. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Communication and Patient Well-Being Need for respect and understanding of individual patients and their needs Impact on speed of patient recovery

6. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Communication and Patient Well-Being Stressors for patients: –Intimidation of health care setting –Fear and anxiety Poor communication can lead to fatal errors

7. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Communication Process Communication –More than talking and listening Therapeutic communication = effective health care communication –Aimed at meeting needs of patients –Requires developing and applying communication skills

8. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Communication Process 1.Set communication goals 2.Create message 3.Deliver message 4.Listen to response 5.Offer feedback and seek clarification 6.Evaluate encounter –And revise message, if necessary

9. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 1. Set Communication Goals Decide what is to be accomplished Therapeutic communication usually at deeper level than everyday conversation –Must be clear and accurate

10. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 1. Set Communication Goals Examples of goals: –Gather information from patient –Give instructions to patients –Report information to coworker

11. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 1. Set Communication Goals Goals to include in every patient interaction: –Show sincere concern for patient’s welfare –Establish trust –Enhance patient’s self-esteem

12. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question True or False: –Today’s health care services are so technologically advanced that there is little point in allowing patients to participate in making decisions about their health.

13. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer False Patients should be involved in decision- making whenever possible

14. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 1. Set Communication Goals Factors to consider when setting goal: –Patient’s level of understanding –Emotional factors –Physical factors –Urgency of communication

15. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 2. Create Message Create message based on information gathered and communication goal Avoid medical terminology with patients –Use general language Rather than slang

16. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 2. Create Message Organize long messages –Rank items in order of importance –Give overview and then details –Break information into chunks Messages can be in form of question

17. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 2. Create Message Types of questions: –Closed-ended Can be answered with one word or phrase –Open-ended Requires more than one-word answer

18. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 2. Create Message Types of questions: –Probing Asks for more information –Leading Question includes possible answer

19. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question “What is your date of birth?” is an example of a _____ question. A.Probing B.Open-ended C.Closed-ended

20. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer C. Closed-ended Response to question is short phrase –Therefore closed-ended

21. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question True or False: –An appropriate use of a leading question is with patients who are unable to offer complete answers on their own.

22. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer True Leading question offers part or all of answer –Can be helpful when patients cannot create answer themselves

23. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 2. Create Message When asking questions: –Allow time for response –Take care with leading questions Because patient may simply agree with you –Reword questions when necessary

24. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 2. Create Message Humor appropriate when used carefully –Helps relieve tension –Can promote open discussion of sensitive issues Patient jokes to mask fear –Listen carefully –Patient may need help dealing with fear

25. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 3. Deliver Message Address patients directly whenever possible –Young and elderly patients Use titles to show respect –Ask patients how they wish to be addressed

26. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 3. Deliver Message Take care not to breach confidentiality Maintain communication with patients who cannot speak to respond

27. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question True or False: –Using casual words such as “like” and “you know” in your messages to patients can help them feel more at ease.

28. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer False Filler words should be avoided –Can be distracting to your message and/or irritating for some listeners

29. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 3. Deliver Message: Nonverbal Communication Delivers up to 70 percent of meaning of oral message Nonverbal communication includes the following: –Tone of voice –Touch Can be reassuring, but use with care

30. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 3. Deliver Message: Nonverbal Communication Nonverbal communication includes the following: –Body language Gestures can be positive or negative –Smiling –Crossing arms –Rolling eyes

31. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 3. Deliver Message: Nonverbal Communication Nonverbal communication includes the following: –Facial expressions Avoid showing negative reactions –E.g., impatience, disgust –Physical appearance Sign of health care professional competence and regard for patients

32. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question Leaning toward the speaker when you are listening is usually a sign of: A.Aggression B.Interest C.Difficulty understanding

33. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer B. Interest Leaning toward speaker –Sign of interest in what speaker is saying

34. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 3. Deliver Message: Physical Environment Can affect delivery of message Factors to consider: –Light source –Sound distractions –Privacy –Focus on patient –Patient comfort

35. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 4. Listen to Response Listening –Active process Concentration Attention Observation

36. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question The best definition of active listening is _____. A.Taking notes while listening B.Maintaining eye contact with the speaker C.Focusing fully on what the speaker is saying

37. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer C. Focusing fully on what the speaker is saying Active listening may involve other actions, but focusing fully on speaker is underlying definition

38. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 4. Listen to Response: Empathy Empathy –Effort to understand other peoples’ thoughts, feelings, and behaviors –“Walk a mile in my shoes” Communicate awareness of patient’s feelings

39. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 5. Offer Feedback and Seek Clarification Feedback –Method for receiver to check understanding of what sender says Types of feedback: –Paraphrasing Rewording of sender’s message in receiver’s own words

40. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 5. Offer Feedback and Seek Clarification Types of feedback: –Reflecting Prompting receiver to complete or add to original message –Asking questions Requesting clarification and additional information –Requesting examples Asking for examples to clarify and fill in meaning

41. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question “I hear you saying you feel better after you’ve done the exercises I taught you last week” is an example of: A.Paraphrasing B.Reflecting C.Asking a leading question

42. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer A. Paraphrasing Paraphrasing –Stating in own words what you think sender said

43. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 6. Evaluate Encounter Determine if communication goal met If not met, identify difficulty Continually evaluate communication throughout encounter

44. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 6. Evaluate Encounter: Communication Barriers Barriers can block effective communication Examples of barriers: –Cultural differences –Language differences –Defense mechanisms –Physical distractions –Pain

45. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Patients with Special Needs Terminally ill –May experience loneliness –May want to share fears and concerns –Health care professionals need to come to terms with death as patient outcome

46. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Patients with Special Needs Those with pain, medication, or disorientation –Identify self and say patient’s name –Speak slowly and maintain eye contact –Use simple, short messages –Repeat as necessary and review content –Use touch, if appropriate –Try to schedule best time for patient

47. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Patients with Special Needs Hearing impaired –Observe behavior and check for understanding –Ensure face and mouth of speaker are visible –Speak slowly and clearly –Turn off sources of noise –Do not shout –Announce change of subject

48. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question When a listener leans forward and turns his head, this is most likely to be a sign of a/an _____. A.Hearing impairment B.Visual impairment C.Inability to understand English

49. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer A. Hearing impairment Two of several signs that listener is hearing impaired: –Leaning toward speaker –Turning head

50. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Patients with Special Needs Visually impaired –Announce presence and identify self –Explain procedures, sounds, and what patient can expect –Give detailed instructions about what patient is to do

51. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Patients with Special Needs Visually impaired –Tell patient when leaving –Give information about doorways, obstacles, etc., if patient is leaving area alone

52. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Patients with Special Needs Speech impaired –Use pantomime and gestures –Use drawings and pictures –Write –Use communication boards

53. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Patients with Special Needs Anger –Emotional response to perceived wrong –Loss of personal control –Worries and fears –Health care professional should not take personally

54. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Patients with Special Needs Anger –Dealing with angry patients Remain calm Do not respond in anger Do not argue Listen carefully and express concern Answer patient’s questions Ask for help, if necessary

55. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Patients with Special Needs Patients who do not speak English –Empathize with situation –Smile, if appropriate –Determine if someone can interpret –Speak slowly and clearly –Repeat message in different words –Use pantomime and gestures –Write message

56. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Special Applications of Communication Skills Telephone communication –Often first means of contact with health care facility –Person answering represents facility –Guidelines: Speak clearly Speak at moderate rate

57. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Special Applications of Communication Skills Telephone communication –Guidelines: Project warmth and caring “Smile” in voice, if appropriate Avoid speaking in monotone Give caller chance to speak Never chew gum or eat

58. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Special Applications of Communication Skills Patient education –Patients want information –More self-care required today

59. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Special Applications of Communication Skills Patient education –Process for delivering patient education 1.Set educational goals 2.Create instructional message 3.Deliver instruction 4.Listen to patient questions 5.Check for patient understanding 6.Evaluate instruction

60. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Special Applications of Communication Skills Group presentations –E.g., patient’s family, professional meeting, coworkers at staff meeting

61. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Special Applications of Communication Skills Group presentations –Strategies for success: Clarify purpose and important points Determine needs of audience Organize material and prepare notes Speak at moderate rate Look at audience

62. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Gossip Unnecessary, negative conversation Avoid at workplace Strategies for handling: –Explain unfairness –State belief in inappropriateness –Change subject

63. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Patient Privacy Avoid speaking in public about patients Do not discuss patients in social conversations Do not discuss patients in front of them if not included in conversation