communcation ppt

Chapter 3: The Interview

Interview Purpose

  • Understanding Patient's Perspective:

    • Key opportunity to comprehend a patient's beliefs, concerns, and self-perception related to their health state.

  • Data Compilation:

    • Integrates subjective data (personal feelings, thoughts) with objective observations (physical appearance, posture, conversational ability, demeanor).

Successful Interview Characteristics

  • Data Accuracy:

    • Collect complete and accurate health information, including symptom description and chronology.

  • Trust Establishment:

    • Foster trust to facilitate acceptance and openness in the data-sharing process.

  • Patient Education:

    • Teach the patient about their health status.

  • Therapeutic Relationship:

    • Build rapport to nurture a continuous therapeutic relationship.

  • Health Promotion Discussion:

    • Discuss topics related to health promotion and disease prevention.

The Interview Contract Terms

  1. Location:

    • Determine the time and place for the interview, which will lead to a physical examination.

  2. Explanation:

    • Introduce oneself and clarify roles during the interaction.

  3. Purpose:

    • Align objectives with the mutual goal of achieving optimal health.

  4. Time Frame:

    • Discuss the duration of the interview process.

  5. Participation:

    • Indicate expected participation from the patient and if others will be present.

  6. Confidentiality:

    • Ensure reasonable confidentiality aligned with legal and ethical standards.

  7. Cost:

    • Disclose any potential financial costs involved.

Process of Communication: Sending

  • Verbal Communication:

    • Words spoken through vocalization and tone of voice.

  • Nonverbal Communication:

    • Body language provides critical cues that may reflect genuine feelings and thoughts.

    • Emphasize recognizing the importance of unconscious messages in communication.

Process of Communication: Internal Factors

  • Personal Internal Factors:

    • Factors specific to the health care team member that can enhance communication skills, including:

    1. Liking Others:

    • Use an authentic and genuine approach.

    1. Empathy:

    • Develop sensitivity and understanding for feelings expressed by others.

    1. Listening Ability:

    • Practice active listening techniques.

    1. Self-Awareness:

    • Be cognizant of implicit biases that may affect interactions.

Process of Communication: External Factors

  • Environment Setup:

    • Define external factors that encourage effective communication, which include:

    1. Privacy Assurance:

    • Ensure both geographic and psychological privacy.

    1. Minimize Interruptions:

    • Actively avoid interruptions during the communication process.

    1. Physical Environment:

    • Create an environment promoting equal status seating.

    1. Dress Code:

    • Be mindful of appearance and comfort.

    1. Note-Taking:

    • Keep note-taking minimal to maintain focused attention on the patient.

Electronic Health Record (EHR)

  • Government Mandates:

    • Federal regulations aimed at enhancing quality and safety in health care.

  • Communication Effects:

    • The technology interface can influence provider-patient communication dynamics.

  • Information Capture:

    • Biomedical, psychological, and emotional information may not be fully captured via EHRs, hence:

    • Barrier Awareness:

    • Avoid allowing computer use to hinder effective communication.

Techniques of Communication

  1. Interview Introduction:

    • Keep it concise and formal.

  2. Working Phase:

    • Engage in data-gathering.

  3. Verbal Skills:

    • Utilize two primary types of questions:

      • Open-ended Questions:

      • Encourage narrative responses from the patient.

      • Closed Questions:

      • Seek specific responses that yield dichotomous answers (e.g., yes or no).

    • Each question type serves different roles in the interviewing process.

Verbal Responses: Assisting the Narrative (1 of 2)

  • Nine Types of Verbal Responses (divided by patient perspective and interviewer perspective):

    1. Facilitation:

    • Encourages patients to elaborate on their responses.

    1. Silence:

    • Engages directed attentiveness to patient’s narrative.

    1. Reflection:

    • Helps by echoing content to clarify meaning.

    1. Empathy:

    • Names and validates emotional expressions of patients.

    1. Clarification:

    • Seeks confirmation for understanding.

Verbal Responses: Assisting the Narrative (2 of 2)

  • Interviewer perspectives on verbal responses:

    1. Confrontation:

    • Clarifies inconsistencies in the patient’s information.

    1. Interpretation:

    • Makes links to identify causes or draw conclusions.

    1. Explanation:

    • Shares factual and objective information with the patient.

    1. Summary:

    • Concludes interview by summarizing verified information and indicating the end of the interview process.

Ten Traps of Interviewing

  1. Providing False Assurance or Reassurance:

  2. Giving Unwanted Advice:

  3. Using Authority:

  4. Using Avoidance Language:

  5. Engaging in Distancing:

  6. Using Professional Jargon:

  7. Using Leading or Biased Questions:

  8. Talking Too Much:

  9. Interrupting:

  10. Disrespecting Patient’s Emotional State (e.g., humor):

Nonverbal Skills—Congruency

  • Congruent Messages:

    • When verbal and nonverbal messages align, the communication is reinforced.

  • Incongruent Messages:

    • If they do not align, the nonverbal message is often considered more genuine as it is governed by unconscious cues.

  • Self-Awareness Importance:

    • Self-awareness is critical to ensure that nonverbal communication promotes effective interaction.

Nonverbal Modes of Communication (1 of 2)

  1. Physical Appearance:

    • The initial perception based on appearance.

  2. Posture:

    • Body language interpretations that affect engagement.

  3. Gestures:

    • Sending implicit messages through body movement; awareness is essential.

  4. Facial Expressions:

    • Reflect emotions and cultural implications.

Nonverbal Modes of Communication (2 of 2)

  1. Eye Contact:

    • Maintain appropriate contact during discussions while considering cultural diversity.

  2. Voice:

    • Be attentive to tone, intensity, and speech rate.

  3. Touch:

    • Interpretations of touch vary based on demographic factors: age, gender, cultural background, prior experiences, and situational context.

Closing the Interview

  • Gradual Ending:

    • The interview should conclude slowly to allow for final expressions of thoughts.

  • Avoid New Topics:

    • Do not introduce new subject matter at the closing phase.

  • Summary Provision:

    • Offer a summary as the final statement to encapsulate the discussion.

Developmental Competence

  • Interviews with Minors:

    • Engage with both parent and child to promote participation.

    • Collect relevant data while addressing each individual by name to foster engagement.

    • Maintain awareness of physical relationships to enhance self-perception.

  • Nonverbal Behavior Awareness:

    • Be mindful of nonverbal cues to sustain engagement.

Communicating with Different Ages

  • Guidelines based on Cognitive Development Stages:

    • Tailor communication methods according to the maturity level of children amidst health crises.

Stages of Cognitive Development

  1. Infants (Birth to 12 months):

    • Use gentle handling and a soft voice.

  2. Toddlers (12 to 36 months):

    • Provide one direction at a time with simple explanations.

  3. Preschoolers (3 to 6 years):

    • Give short, concrete instructions, and ask open-ended questions.

  4. School-Age (7 to 12 years):

    • Engage with direct, respectful questions.

  5. Adolescents (Post-puberty):

    • Maintain a respectful, honest approach and focus on individual concerns.

The Older Adult

  • Developmental Tasks:

    • Assisting with the search for meaning and evaluation of existence.

  • Respectful Address:

    • Communicate respectfully with older adults as they may require a longer interview process.

  • Pacing Consideration:

    • Adjust pacing to accommodate potential physical limitations, allowing for increased response time and encouraging therapeutic touch for empathy.

Interviewing People with Special Needs

  • Considerations for Vulnerable Populations:

    • Address specific needs of individuals who may be acutely ill, dealing with substance abuse, experiencing aggression, or emotional distress.

  • Resource Utilization:

    • Leverage appropriate resources based on situational context.

  • Awareness of Personal Questions:

    • Be cautious with queries to avoid indicating ulterior motives, and respond through personal ethics.

Culture and Genetics

  • Cultural Sensitivity:

    • Acknowledge gender norms and maintain confidentiality during interviews and examinations.

  • LGBTQ Awareness:

    • Employ neutrality regarding sexual orientation and respect communication patterns while acknowledging one’s biases.

Working with (and without) an Interpreter

  • Language Barriers:

    • Understand that language challenges can hinder effective health care communication.

  • Communication Patterns:

    • Be attentive to both verbal and nonverbal cues within cross-cultural contexts.

  • Gender Considerations with Interpreters:

    • Prefer trained medical interpreters or bilingual team members of matching gender to ensure comfort.

Health Literacy

  • Definition Flexibility:

    • Health literacy encompasses more than mere reading skills, including the ability to comprehend and follow health-related instructions, bridging effective communication between patient and health care professional.

  • Distinction Between Literacy and Health Literacy:

    • A patient can be literate but still lack proper health literacy skills.

  • Quantitative Measurement and Memory:

    • Involves aspects that measure comprehension and retention of information.

  • Assessment Tools:

    • Tools available vary in reliability, validity, and time required for assessment.

Techniques to Improve Health Literacy

  1. Oral Teaching:

    • Deliver instructions in simple language, avoiding jargon.

  2. Written Materials:

    • Ensure documents are designed according to standard educational levels, utilizing clear formats (e.g., 12-point font, bullet points).

  3. Teach Back Method:

    • Verify understanding by asking patients to explain back the information given, allowing for clarification if needed.

Communicating with Other Professionals

  • Interdisciplinary Communication:

    • Engage in effective conversations between members of the health care team to foster mutual respect and enhance collaborative efforts.

  • Consequences of Ineffective Communication:

    • Poor communication can lead to negative outcomes including treatment delays, medication errors, misdiagnoses, patient injuries, and fatalities.

  • Maintaining Open Communication:

    • Regularly provide timely updates to ensure a clear, organized exchange of information within the team.

Standardized Communication—SBAR

  • Components of SBAR Communication:

    1. Situation:

    • Briefly describe essential patient variables, clinical diagnosis, and location.

    1. Background:

    • Provide relevant history that connects to the current health status.

    1. Assessment:

    • State important findings from assessments with data interpretations.

    1. Recommendation/Request:

    • Clearly indicate needs for the patient regarding medical treatment or assistance.