HAN 333 Communications Midterm

Therapeutic communication

Communication between the HCP and patient (and family) that takes place to advance the patient's well-being and care; characterized by support, clarity and empathy

3 purposes of therapeutic communication

1) Collect healthcare-related info about the patient 2) Provide feedback (info, education, training) 3) Assess the patient's behavior and modify it when appropriate

Definition of communication

The successful transfer of a message AND meaning from one person or group to another; both parties must agree on the meaning

5 steps of the communication process

1) Sender has an idea 2) Sender encodes the idea in a message 3) Message travels over a channel 4) Receiver decodes the message 5) Receiver understands and sends feedback

Encode

Put the idea into a form that can be communicated - spoken/written words, gestures, body movements, facial expressions

Decode

Receiver translates the message from its encoded form into a form they understand

Feedback

Receiver's verbal or nonverbal response saying 'I received and understand your message'

Channel

The means or medium used to send a message (phone, face-to-face, email, fax, writing, gestures)

Noise

Anything that inhibits effective communication - doesn't have to be actual sound (pain, fear, anxiety, language barrier, disinterest, hearing/vision impairment)

Channel noise

Anything that disrupts the channel's ability to carry the message clearly - static on a phone line, a badly printing fax, bad grammar in an email

Example: patient in severe pain can't absorb discharge instructions

Noise

Percent of communication that is nonverbal / tone / words

70% nonverbal, 23% tone of voice, 7% words

If verbal and nonverbal messages conflict…

The nonverbal message is usually believed

Functions of nonverbal communication

Reinforce, contradict, or enhance the verbal message; convey emotion; communicate attitudes; define the relationship; provide feedback; regulate the flow of communication

3 categories of nonverbal communication

Kinesics, Proxemics, Touch

Kinesics

Body movements: gestures, facial expressions, gaze patterns

Proxemics

Physical distance between people: personal space/territory, position, posture

Gestures

Movements of the head, hands, eyes and other body parts; the most obvious and common form of nonverbal communication; very culture-specific

Illustrators

Intentional gestures that emphasize, clarify or add to a verbal message (e.g., showing pill size with your fingers)

Leakage

Subconscious gestures or facial expressions that reveal true feelings (e.g., a 'calm' patient bouncing his leg)

Most effective form of nonverbal communication (Chapter Review)

Facial expressions

Facial expressions that are universal across cultures

Happiness, sadness, fear - biologically determined

Facial expression of pain - key points

Grimaces don't appear until the pain threshold is reached; HCPs tend to UNDERESTIMATE pain; exaggerating pain may be a message to receive care

3 functions of gaze

Monitoring, Regulating, Expressing

Staring

Can feel dehumanizing, discourteous or hostile, and like an invasion of privacy

Looking and liking

Patients who receive longer gazes from HCPs talk more freely and share more information

Personal space (territory)

Gives a sense of identity, security and control; invasion causes anxiety and loss of control

Intimate distance

Up to 1.5 ft - used to examine and care for the patient

Personal distance

1.5-4 ft (about an arm's length) - explaining a procedure or discussing personal matters

Social distance

4-12 ft - many HCPs use this during consultations

Public distance

More than 12 ft - inappropriate for discussing health issues

Proper HCP position

About an arm's length, eye level, face-to-face, leaning slightly forward

Posture: depression

Drooping head, sagging shoulders, low muscle tone

Posture: anxiety/fear

Increased muscle tone; rigid, upright body

Posture: avoidance/rejection

Closed posture - crossed arms/legs, leaning back, turning away

Posture: boredom

Lowered head, outstretched legs, leaning back

Posture: interest

Leaning forward with legs drawn back

Open body posture (HCP)

Arms and legs uncrossed, facing the patient, leaning slightly forward - appears confident, warm, inviting

Touch guidelines

Tell the patient when, where and how you'll touch them; touch supplements (not replaces) words; appropriate to the situation; don't imply intimacy; observe their response

Unclear nonverbal behavior - what should the HCP do?

Make a nonjudgmental observation, ask for clarification, offer an interpretation

Verbal communication

The use of spoken words and sounds to successfully transfer a message from sender to receiver

Paralanguage

Parts of verbal communication separate from the words' meaning: rate, rhythm, volume, pitch, inflection, tone (also sighing, throat-clearing)

Rate of speech

Fast = seen as confident; slow = less sure; rushed speech may mean anxiety or anger; talking too fast makes the HCP seem impatient

Rhythm of speech

Often set by a regional accent or second language; gives info about the speaker

Volume of speech

Can reflect culture, confidence or disability (hearing loss); too loud can break confidentiality

Inflection of speech

Emphasis on certain words changes the meaning ('I believe you will get better')

Expressive tone

Spontaneous, emotional, uninhibited; used to socialize, joke, complain - NOT appropriate with patients (puts focus on the HCP)

Directive tone

Authoritative, judgmental; gives orders and implies hierarchy - NOT appropriate with patients

Problem-solving tone

Rational, objective, unbiased, analytical - the tone HCPs should use MOST

Small talk

Light talk (weather, sports, traffic) before business to build rapport and relax a nervous patient; keep it limited

Commentary

Briefly narrating what you're doing during tasks (positioning, setting up equipment) to ease anxiety and avoid awkward silence

Medical jargon

Specialized professional language; avoid with patients - causes confusion, anxiety, fear and mistrust

Paraphrasing

Using your own words to repeat what someone said; perhaps the most important part of good listening

Reasons to paraphrase

Test the message for the HCP, test the message for the patient, build rapport, keep the focus on the patient, show empathy

Empathy

Feeling what another person feels - putting yourself in their shoes; BUILDS rapport

Sympathy

Awareness of someone's feelings plus sadness or pity - feeling sorry for them; can create DISTANCE

'Oh you poor thing, I feel so sorry for you' =

Sympathy

Open-ended questions

Lead to long, detailed, emotional answers; usually start with 'how' or 'what' (e.g., 'What brings you in today?')

Closed questions

Short, focused answers - often yes/no; good for filling gaps and the medical record (e.g., 'Are you allergic to penicillin?')

Multiple choice questions

Give options to choose from; help withdrawn, depressed or anxious patients; downside: can feel complicated or confusing

Verbal communication don'ts

Don't interrupt, don't give unsought advice, don't talk about yourself, don't say you know how they feel

Essential interpersonal skills for the HCP

Tactfulness & diplomacy, courtesy & respect, empathy, genuineness, appropriate self-disclosure, assertiveness (vs. aggressiveness)

Tactfulness and diplomacy

Disagreeing or showing displeasure without putting the other person down

Courtesy and respect

Being considerate of feelings and needs, and showing you value the person (e.g., title + last name: 'Mrs. Lopez')

Genuineness

Being the real you - not putting on an act; engaging fully instead of going through the motions

Appropriate self-disclosure

Sharing a parallel experience only to show understanding (like a paraphrase); avoid one-upping or taking focus off the patient

Assertive vs aggressive

Assertive = clear, direct, relaxed, respectful. Aggressive = confrontational, sarcastic, tense, superior

Remaining silent

Letting the patient gather their thoughts without filling the pause

Remaining nonjudgmental

Your job is to help manage their care, not approve or disapprove of their beliefs

Showing acceptance

Indicating you're listening carefully (nodding, 'Mm-hm, go on')

Giving recognition

Recognizing positive changes ('You walked twice as far as last week!') - different from approving

Offering of yourself

Making clear you're professionally available to the patient with compassion and empathy

Giving the patient the opening

Letting the patient start a topic using open-ended questions ('What would you like to talk about today?')

Leading the discussion

Gently prodding when the patient stops short because of fear or embarrassment

Making observations

Sharing your perceptions without judgment ('You seem tense when we talk about surgery')

Encouraging communication

Asking the patient to spell out what they feel - don't assume you know

HCP roadblocks (list)

Easy reassurance, minimizing feelings, approving/disapproving, agreeing/disagreeing, giving your own advice, prying, becoming defensive, demanding the patient explain their behavior, clichéd comments

Providing easy reassurance

Roadblock: 'Don't worry, I'm sure it's nothing' - diminishes the patient's feelings and gives false hope

Minimizing the patient's feelings

Roadblock: making light of how they feel ('It's just a little needle')

Approving/disapproving

Roadblock: implies a power relationship of rewards and penalties

Agreeing/disagreeing

Roadblock: turns the patient's health into being right or wrong

Giving your own advice

Roadblock: 'If I were you, I'd…' - never give personal advice

Prying

Roadblock: pushing into a topic the patient said they don't want to discuss

Becoming defensive

Roadblock: turns the relationship into attacker/defender

Demanding the patient explain their behavior

Roadblock: 'Why didn't you take your medicine?!' - makes the patient defensive

Commonplace/clichéd comments

Roadblock: 'Everything happens for a reason' - shows lack of attention and caring

Compensation

Coping: overemphasizing one area to make up for a deficiency in another (obese patient brags about never missing his cholesterol pill)

Denial

Coping: unconsciously rejecting feelings or facts (cancer patient insists the lab mixed up her scans)

Displacement

Coping: shifting feelings onto a safer target (grieving father is hostile to his child's doctor)

Dissociation

Coping: disconnecting emotion from an event (calmly describing childhood abuse with no feeling)

Identification

Coping: mimicking someone else's behavior to hide one's own (teen athlete copies her stoic parent's reaction)

Projection

Coping: putting your own feelings onto someone else (angry patient accuses the HCP of being angry)

Rationalization

Coping: false reasoning to justify behavior (skipped colonoscopy from fear, blames the scheduler)

Regression

Coping: returning to immature or childlike behavior under stress

Repression

Coping: putting painful thoughts out of mind (avoids even thinking about a brain biopsy decision)

Dealing with an angry patient

Recognize anger; stay calm, respectful, genuine; don't get defensive; have them be specific; calmly give your view; keep promises; offer time alone; if threatened, leave and get help

Dealing with an anxious patient

Identify and acknowledge anxiety; good nonverbals; find the source; make them comfortable; check support system; never minimize; give truthful info; notify the physician

White-coat syndrome

Anxiety simply from being in a medical setting

HIPAA year

1996

HIPAA Title I vs Title II

Title I = Health Insurance Reform (portability). Title II = Administrative Simplification (privacy and protection of patient data)