1. Communication Skills: Enhancing Direct Practice
Dr. BC Farnham & Elizabeth Pugh, LBSW, CM

2. Important Information
This education program for healthcare professionals was developed by The Consortium for Advancements in Health and Human Services, Inc. (CAHHS) and is facilitated by Kindred at Home via a community education partnership agreement. CAHHS is a private corporation and is solely responsible for the development, implementation and evaluation of its educational programs. There is no fee associated with receiving contact hours for participating in this program titled, Communication Skills: Enhancing Direct Practice. However, participants wishing to receive contact hours must offer a signature on the sign-in sheet, attend the entire program and complete a program evaluation form.
The Consortium for Advancements in Health and Human Services, Inc. is an approved provider of continuing nursing education by the Alabama State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. The Consortium for Advancements in Health & Human Services, Inc., is approved as a provider of continuing education in Social Work by the Alabama Board of Social Work Examiners, #0356, Expiration Date: 10/31/2018.
This program is Approved by the National Association of Social Workers (Approval # ) for 1- Social Work continuing education contact hour.
In most states, boards providing oversight for nursing and social work recognize contact hours awarded by organizations who are approved by another state's board as a provider of continuing education.  If you have questions about acceptance of contact hours awarded by our organization, please contact your specific state board to determine its requirements. Provider status will be listed on your certificate.
CAHHS does not offer free replacement certificates to participants. In the event that CAHHS elects to provide a replacement certificate, there will be a $20.00 administrative fee charged to the individual who requests it.

3. Learning Objectives
To increase understanding of deliberate listening as it relates to direct practice
Evaluate individual communication style by utilizing the communication style inventory
To explore the elements of active listening skills to enhance direct practice

4. Communication – a Review
Communication is the process of transferring information from one source to another.
Communication is a process by which we assign and convey meaning in an attempt to create shared understanding

5. A learned skill Communication is a learned skill.
Speaking, listening and our ability to understand verbal and nonverbal meanings are skills we develop in various ways.
We learn basic communication skills by observing other people and modeling our behaviors based on what we see.

6. Learned skill….continued
For many of us, we were taught communication skills directly through education and by practicing those skills and having them evaluated.

7. Three major parts
There are three major parts in human face-to- face communication –
Body language
Tone of voice
Content/words used in communication process
The power of nonverbal communication and body language
Nonverbal communication, or body language, is a vital form of communication. When we interact with others, we continuously give and receive countless wordless signals. All of our nonverbal behaviors—the gestures we make, the way we sit, how fast or how loud we talk, how close we stand, how much eye contact we make—send strong messages.
The way you listen, look, move, and react tell the other person whether or not you care and how well you’re listening. The nonverbal signals you send either produce a sense of interest, trust, and desire for connection—or they generate disinterest, distrust, and confusion.
Nonverbal communication cues can play five roles:
Repetition: they can repeat the message the person is making verbally
Contradiction: they can contradict a message the individual is trying to convey
Substitution: they can substitute for a verbal message. For example, a person's eyes can often convey a far more vivid message than words and often do
Complementing: they may add to or complement a verbal message. A boss who pats a person on the back in addition to giving praise can increase the impact of the message
Accenting: they may accent or underline a verbal message. Pounding the table, for example, can underline a message.
Source: The Importance of Effective Communication, Edward G. Wertheim, Ph.D.
Nonverbal communication and body language in relationships
It takes more than words to create fulfilling, strong relationships. Nonverbal communication has a huge impact on the quality of our relationships. Nonverbal communication skills improve relationships by helping you:
Accurately read other people, including the emotions they’re feeling and the unspoken messages they’re sending.
Create trust and transparency in relationships by sending nonverbal signals that match up with your words.
Respond with nonverbal cues that show others that you understand, notice, and care.
Types of nonverbal communication and body language
There are many different types of nonverbal communication. Together, the following nonverbal signals and cues communicate your interest and investment in others.
Facial expressions
The human face is extremely expressive, able to express countless emotions without saying a word. And unlike some forms of nonverbal communication, facial expressions are universal. The facial expressions for happiness, sadness, anger, surprise, fear, and disgust are the same across cultures.
Body movements and posture
Consider how your perceptions of people are affected by the way they sit, walk, stand up, or hold their head. The way you move and carry yourself communicates a wealth of information to the world. This type of nonverbal communication includes your posture, bearing, stance, and subtle movements.
Gestures
Gestures are woven into the fabric of our daily lives. We wave, point, beckon, and use our hands when we’re arguing or speaking animatedly—expressing ourselves with gestures often without thinking. However, the meaning of gestures can be very different across cultures and regions, so it’s important to be careful to avoid misinterpretation.
Eye contact
Since the visual sense is dominant for most people, eye contact is an especially important type of nonverbal communication. The way you look at someone can communicate many things, including interest, affection, hostility, or attraction. Eye contact is also important in maintaining the flow of conversation and for gauging the other person’s response.
Touch
We communicate a great deal through touch. Think about the messages given by the following: a firm handshake, a timid tap on the shoulder, a warm bear hug, a reassuring pat on the back, a patronizing pat on the head, or a controlling grip on your arm.
Space
Have you ever felt uncomfortable during a conversation because the other person was standing too close and invading your space? We all have a need for physical space, although that need differs depending on the culture, the situation, and the closeness of the relationship. You can use physical space to communicate many different nonverbal messages, including signals of intimacy, aggression, dominance, or affection.
Voice
We communicate with our voices, even when we are not using words. Nonverbal speech sounds such as tone, pitch, volume, inflection, rhythm, and rate are important communication elements. When we speak, other people “read” our voices in addition to listening to our words. These nonverbal speech sounds provide subtle but powerful clues into our true feelings and what we really mean. Think about how tone of voice, for example, can indicate sarcasm, anger, affection, or confidence.
For help with tone of voice please go to:

8. Our focus….
Today we will focus on one of the more difficult skills of communication…LISTENING
As a direct practice worker, you must constantly sharpen your tool of listening to ensure you are listening for meaning

9. Why listen?
How well you listen has a major impact on how effective you are in your role as a professional helper.
How well you listen has an impact on the quality of your relationships with others

10. Purpose of listening
Think about your purpose of listening to others – Why do you listen to others?
To obtain information
To understand
For enjoyment
To learn

11. Did you know…. We only remember 25-50% of what we hear
When you talk with your clients, boss or colleagues for 10 minutes, they only really hear 2 ½ - 5 minutes of the conversation!
Turn it around when you are receiving directions or being presented with information, you aren’t hearing the whole message either.

12. Wing and a prayer….
You hope the important parts are captured in your %, BUT, what if they’re not?
Share a story/experience where this has happened to you or someone you know.

13. Benefits
By becoming a better listener, you will improve productivity, as well as your ability to:
Influence
Persuade
Negotiate
What’s more, you’ll avoid conflict and misunderstandings – all necessary for success in direct practice!

14. Self-awareness
Good communication skills require a high level of self-awareness. By understanding your personal style of communicating, you will go a long way towards creating good and lasting impressions with others

15. Communication Inventory
Let’s take a few moments to conduct an individual communications style inventory
What kind of communicator are you?
Controller/Director
Promoter/Socializer
Supporter/Relater
Analyzer/Thinker
Have participants complete the survey.

16. Active Listening
The way to become a better listener is to practice “active listening”.
Active listening requires a conscious effort to hear not only the words that another person is saying, but more importantly, to try and understand the total message being sent.

17. Barriers
Caution! The following barriers contribute to a lack of listening and understanding
Don’t allow yourself to become distracted by things going on around you
Don’t form counter arguments that you will make when the other person stops speaking
Don’t allow yourself to lose focus on what the other person is saying

18. Helpful tip
If you find it particularly difficult to concentrate on what someone is saying, try repeating their words mentally as they say it
This will reinforce their message and help you control mind drift
Provide an example.

19. Acknowledge
Using body language and other signs to acknowledge your involvement in a conversation reminds you to pay attention and not let your mind wander
Acknowledgement can be something as simple as a nod of the head, or a simple “uh huh” – this does not necessarily mean that you are agreeing with the person, but that you are listening

20. Hear what people are saying
There are five basic elements to increase your skills of being able to truly hear what people are saying

21. Pay attention
Give the person speaking your undivided attention; acknowledge the message; recognize what is NOT said is also part of the message.
Look directly at the person speaking
Put aside distracting thoughts – don’t mentally prepare a rebuttal!
Avoid being distracted by environmental factors
“listen” to the speakers body language
Refrain from side conversations in a group setting

22. Show that you are listening
Use your own body language and gestures to convey your attention
Nod occasionally
Smile and use other appropriate facial expressions
Note your posture and make sure it is open and inviting
Encourage the speaker to continue with small verbal comments like “yes” and “uh huh”

23. Give feedback
We all have personal filters that lend to our assumptions, judgments and beliefs – and these personal filters may distort what we hear.
As a direct practice worker, your role is to understand what is being said. This may require you to reflect what is being said and ask questions

24. Feedback questions
Use paraphrasing – reflect what has been said by paraphrasing. “What I’m hearing is….” and “Sounds like you are saying…”
Ask questions to clarify certain points. “What do you mean when you say…..”
Summarize the speaker’s comments periodically
Express how important this is when speaking with a patient. You always want to make sure that the patient and family understand what you are saying. It is even more important that YOU understand what they are saying.

25. Helpful tip
If you find yourself responding emotionally to what someone said, say so, and ask for more information: “What I thought you just said is ….., is that what you meant?”

26. Defer judgment
Interrupting is a waste of time. It frustrates the speaker and limits full understanding of the message.
Allow the speaker to finish
Don’t interrupt with counterarguments

27. Respond
When you listen to someone it is a model of respect and understanding.
You are gaining information and perspective
Respond appropriately – you gain nothing by attacking a speaker or otherwise putting him/her down
Be candid, open and honest in your response
Assert your opinions respectfully
Treat the other person as you would like to be treated

28. The Bottom Line
By improving your listening and communication skills, you will improve your workplace productivity and relationships

29. References
Robertson, K., (2005). Active listening – more than just paying attention. Australian Family Physician. Vol. 34 (12), pp
Mind Tools, (n.d.). Active listening: Hear what people are really saying. Retrieved April 15, 2009 from istening.htm

30. Questions & Answers:

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