pt Communication; Motivational Interviewing

why is communicating w/ pt important?

-It allows the therapist and patient to establish a therapeutic alliance

-It allows the patient to present the reason why they are seeking physical therapy (or needing medical care)

-It allows for appropriate collaboration to arrive at a physical therapy diagnosis and mutually agreed upon treatment plan

-It decreases the chance for misunderstandings and harm to the patient and/or clinician

when do we communicate with our pts?

-Walking into the treatment room

-Talking to other providers in the room

-Talking to patient’s family members in the room

-Talking to the patient

-Whenever the patient can see, hear, or feel us

verbel vs non-verbel communication

-Verbal: the production of spoken language to send a message to the listener (*specific words in mouth, or electronic)

• In-Person

• Via Telephone

• Via Video Chat

-Non-Verbal: the act of conveying a message without the use of words (*how pt interpret)

• Tone of voice

• Volume of voice

• Body posture

• Physical touch

• Eye contact

• Appearance

positive non-verbel communication technqiues

-eye contact

-body position (open and receptive)

-physical touch (gentle and confident)

-volume/tone of voice (match pt energy level)

what do we communicate w/ our pts?

-intentions as healthcare provider

-what plan to do in session

-how understanding of their concerns (intentional/unintentional)

-how our day has been going: don’t bring your emotions into session

communicating w/ non-english speaking pts

simple and as straight-forward as possible; dif interpretations

-All patients have a right to utilize a qualified healthcare interpreter

• Can be in person, video, or phone

-Understand that even if the interpreter speaks the same language as the patient, they may be from very different cultures and words may not translate the exact same way as your intent as their healthcare provider

pt education: definition

“the process of influencing patient behavior and producing the changes in knowledge, attitudes and skills necessary to maintain or improve health”

*influence pt w/ knowledge and skills, and why that matters

Principles of Effective Patient Education

-Build rapport with the patient

-Set an agenda for change with the patient

-Evaluate the patient’s readiness to learn or intention for behavior change

-Customize your approach to the patient

-Use appropriate teaching resources (videos, written materials, active learning approaches, etc)

-Assess barriers to learning and problem solve with patients to generate solutions

health literacy

“Patient’s ability to read and understand all type of health-related materials”

-It's estimated that 90 million American’s have trouble understanding health-related information

-This means patients often have troubles understanding labels, appointment slips, and instructions for taking medications (or doing exercise!)

-Individuals with lower levels of health literacy report lower overall heath

*need base-level education than build-up

self-efficacy

-pt belief that they have control/can get better

-if low: pt feels passive in process

-should build up in pt

• “An individual’s sense that he or she can successfully carry out a particular health behavior needed to result in a desired outcome.

-Influenced by one’s past experiences, observations of the experiences of influential others, and valued support of others.

active vs passive approaches to learning (pro’s + con’s)

Active (*ideal, promotes higher level of learning; application base)

-Problem solving, feedback, peer support, discussions, experiments, role play, writing, interactive participation

-Pros: encourages learner to problem-solve, encourages innovation, transfer of knowledge to new situations

-Cons: more time consuming, more flexibility required, may make some uncomfortable

Passive

-Lectures, reading assignments, demonstrations, watching videos

-Pros: can present large amount of information, easier for teacher/learner, expectations are easier understood and met

-Cons: doesn’t prepare learner for novel situations, lower level processing of information less like to lead to innovation/new discoveries 

educating pt application: posterior THA

-WHAT are the precuations

-WHY are there precautions

-WHEN might they be broken

-CLARIFY understanding

-ENCOURAGE question-asking

what is motivational interviewing

-“Motivational Interviewing aims to explore and resolve ambivalence that people might have about health behavior in favor of change. It encourages people to say why and how they might change and pertains both to a style of relating to others and a set of skills to facilitate that process.”

*need motivation to participate; find what motivates them; avoid ambivalence!

MI Can

-Help reduce patient ambivalence about condition

-Help decrease resistance to change

-Increase confidence in making behavior changes

-Improve patient adherence to treatment programs

-Improve patient outcomes

MI: 4 overlapping processes

-Engaging in a working relationship

-Focusing on a problem to change

-Evoking the person’s desire to change

-Planning the change

-goal MI

-easy or hard?

-behavior change

-hard!

MI- OARS

-Open-ended questions

-Affirmations

-Reflective listening

-Summarive