Topic 7: Patient Centered Communication Skills

communication

Transmission of information that includes nonverbal behaviors, written communication, tone of voice, words are forms of communication; concept takes into consideration the values, words and ideas, emotions, and body language or sender, receiver, and context

collaborative communication

collegial conversations directed toward achieving maximal health outcomes for patients and help ensure continuity of care

patient and family communication

collaborative conversations between patients/families and their healthcare providers have a direct impact on the quality and safety of clinical care, the achievement of meaningful clinical outcomes, and patient satisfaction; exploring the patient’s illness experience, its impact on the family, and relevance to beliefs and expectations

empathy

being attuned to the patient’s perspective of their health situation and to their psychological state

respect

avoid being distracted and multitasking, respond fully and honestly, speak in a clam, even tone of voice to show this

boundaries

define interpersonal boundaries related to purpose and topic of conversation

sender, message, receiver, channels of communication, context

what does the lineal model of communication consist of

linear model of communication

model about the sending and receipt of messages

transactional model of communication

model about the reciprocal interaction process

human system, input, throughput, output, feedback

what does the transactional model of communication consist of

• active listening

• open ended questions

• focused questions

• closed ended questions

• clarification

• paraphrasing/restatement

• reflection

• summarizing

• silence

• providing or getting feedback

• validation

• using technology

what does the communication skill strategy include

active listening

intentional form of listening, where nurse hears a patient’s message, decodes its meaning, asks questions for clarification, and provides feedback to the patient; includes verbal and nonverbal components of the message

active listening

the goal is to understand what the client is trying to communicate and contributes to fewer incidents of misunderstanding, more accurate comprehensive data and stronger health relationships

open ended questions

questions that are open to interpretation and cannot be answered by “yes” or “no” or one word response; allow patients to express their problems or health needs in their own words and provide a broader context for each patient’s unique health concerns and are likely to yield more complete information

focused questions

require more than a yes or no answer, but they place limitations on the topic to be addressed; useful in emergencies and in other situations when immediate concise information is required

closed ended questions

narrowly focused questions, for which a single answer such as '“yes” or “no” or a simple phrase answer serves as a valid response; they are useful in emergency situations when the goal is to obtain information quickly

clarification

a brief question or request for validation that is used to better understand a client’s message

paraphrasing/restatement

used to check whether the nurse’s translation of the client’s words represents an accurate interpretation of the message; nurse taking the patient’s original message and transforming it into his or hew own words, without losing the meaning

reflection

a response that focuses on the emotional part of a message

summarizing

pulls several ideas and feeling together, either from one interaction or from a series of interactions, into a few brief sentences

silence

a brief pause, is a powerful listening response, intentional pauses can allow the patient to think, and a short pause lets the nurse step back momentarily and process what has been heard before responding

providing/getting feedback

a message a nurse gives to the patient in response to a question, verbal message, or observed behavior; should be specific and directed to the behavior and is clear, honest, and reflective

validation

form of feedback is used to ensure that both participants have the same basic understanding of messages; meaning of the same word can have cultural and contextual implications that can be different for each communicator

using technology

incorporating technology to communicate in digital encounters with patients and families

false reassure, giving advice, false inferences, moralizing, value judgement

what are negative listening responses

false reassurance

using pseudo-comforting phrases in an attempt to offer reassurance

giving advice

making a decision for a patient; offering personal opinions; tell a patient what to do like”ought to” or “should”

false inferences

making an unsubstantiated assumption about what a patient means; interrupting the patient’s behavior without asking for validation; jumping to conclusions

moralizing

expressing your own values about what is right and wrong, especially on a topic that concerns the patient

value judgements

conveying your approval or disapproval about the patient’s behavior or about what the patient has said using words such as “good” “bad” or “nice”

• tone of voice, facial expression, choice of words, body gestures

• feelings about the content of the message

• feelings about self and other

• culture

• timing

• previous experience environment

what factors affect professional communication

therapeutic communication

a dynamic interactive process between health care providers and patients the patient’s significant others in order to achieve health related goals

nurse self awareness

nurses have ethical and professional responsibilities to develop this about what may impede communication; allows you to maintain authenticity, neutrality, and enough understanding to sustain this nurse-patient interaction

environmental awareness

includes privacy, time, and cues

privacy

privacy and space affect conversation

time

important to choose time when the client is less stressed, not in pain, or distracted

cues

in face-to-face interactions, nurses have a ruch range of visual and vocal cues which provide additional data about the patient

in depth understanding from patient’s perspective, choice of words, checking for understanding

what factors affect professional communication of verbal responses in short encounters

personal factors

factors that influence communication and readiness and developing a common understanding

• preoccupied with pain, physical discomfort, worry, or contradictory personal beliefs

• inability to understand the nurse’s use of language, terminology, or frame of reference

• struggling with a personal emotionally laden topic

• feeling defensive, insecure, or judged

• confused by the complexity of the message (too many issues, tangential comments)

• Deprived of privacy (especially if topic is sensitive)

• have sensory or cognitive deficits that limit or compromise the receiving or accurate messages

when can barriers to effective communication can occur within patients

• preoccupation with personal agendas

• being in a hurry to coplete physical care

• making assumptions about patient motivations

• cultural stereotypes

• defensiveness or personal insecurity about being able to help the patient

• thinking ahead to the next question

• intense patient emotion or aggression

• weak language that does not add value to the conversation

• use of complex medical jargon

obstacles within the nurse may occur when the nurse is not fully engaged with the patient for which following reasons

authenticity, patience, neutrality, and understanding needed for therapeutic exploration of patient issues

what does self-awareness of personal vulnerabilities and prejudices allow nurses to maintain

proxemics

People require different amounts of personal space for conversational ease

touch to 18 inches

what distance to close intimate relationships range from

18 inches to 4 feet

what distance does personal distance range from

4 to 12 feet

what distance does social distance range from

12 to more than 25 feet

what distance public distance range from

3 to 4 feet, a social distance

what distance do therapeutic conversations typically take place within

• fostering healing relationships

• exchanging information

• responding to emotions

• managing uncertainty

• making decisions

• enabling patient self management

what are the functions of patient centered communication

first encounter of engaging the patient

the start of patient centered communication, full attention must be given to patient, mind must be free of personal biases, thoughts, etc; demeanor must be open, welcoming, and respectful

building rapport

being attentively present, providing relevant information, and actively listening to patient concerns help to build this

beginning questions

when building rapport these questions should be routine, open ended questions

• empathtic objectivity which allows you to experience patients as they are, not the way you would like them to be

• a “here and now” focus on the current issues and concerns important to the patient

• demonstration of respect and ask questions about cultural and social differences that can influence treatment

• authentic interest in the patient and a confident manner that communicates competence

• the capability to consider competing goals, and alternative ways to meet them

what does building a shared, workable partnership alliance require

patient’s explanation of problems, priorities, and treatment goals

what are areas where common ground can be found

• avoid overload

• focus

• present reality

• use metaphors

• use humor

other strategies that are important to communication