Communication
Communication in Health Care
•Process of exchanging messages
◦health care workers
◦patients
◦patients’ families
◦students and visitors
◦administrators and business contacts.
Verbal Communication
•Use of language and words
Most effective form
•Goals:
▫Establish rapport
▫Obtain information from patients
▫Confirm understanding
▫Relay information to other health care workers
▫Give instructions to patients
Tone of Voice
•Expresses speaker’s feelings
•Patients can pick up on fear, agitation, calmness, and confidence
•Adjust tone of voice appropriately to the situation
Language Choice
•Translate medical terminology into laymen terms
•At the same time, health care workers must avoid talking down to patients by over-simplifying their language.
•They should also be careful to enunciate words and avoid mumbling.
Therapeutic Communication
•Therapeutic communication – patient-centered communication in which the patient is looked at as a person.
•Improves patient satisfaction and improves health outcomes
•Develop a rapport.
•Speak clearly and slowly.
•Introduce yourself.
•Use language the patient can understand, and avoid medical jargon, codes, and abbreviations.
•Show leadership but do not be imposing or give advice.
•Be honest with the patient.
Use open-ended questions.
•Use closed questions only when specific information is needed.
•Ask one question at a time.
•Do not interrupt.
•Allow the patient enough time to answer a question before asking the next question.
•Listen carefully to what the patient says.
Allow the patient to ask questions.
•Allow the patient to discuss his or her concerns and feelings.
•Be empathetic.
•Ask the patient for permission before performing a procedure.
•Tell the patient what you are going to do.
•Apologize for any necessary discomfort and pain.
•Be aware of your non-verbal communication.
Written Communication
•Form of verbal communication
•Allows writer time to research and to organize thoughts
•Must:
▫Be accurate and clear
▫Be brief with logical organization
▫Be free of grammar, spelling, and punctuation errors
▫Use appropriate vocabulary
Selecting the Correct Form
•Would message be better delivered orally?
•Does the message require a written record?
•What format?
Writing Memos
•Often used in the health care industry
•Standard parts:
▫TO:
▫FROM:
▫DATE:
▫SUBJECT:
▫Body
The Five W’s
•Who is the audience?
•What is the purpose of the message?
Why is the message important?
When did or will the event occur?
•Where did or will the event take place
Nonverbal Communication
•Used in addition to or as a substitute for language
•Includes:
▫Eye contact and facial expressions
▫Gestures and body language
▫Physical appearance
▫Touch
▫Proximity
Eye Contact and Facial Expressions
•Direct eye contact sends a powerful and positive message
•Smiles and other facial expressions
•Be conscious of interpretation and own expression
Gestures and Body Language
•People use their bodies instead of words
•Posture also conveys a message.
•Read and use gestures and body language
Physical Appearance
•Uniforms send the message that they belong to the health care field
•Physical appearance is also expressed by grooming
Touch
•Touch can communicate many things.
•Touch can also be misinterpreted
•Be conscientious to touch patients with only kindness and respect.
Proximity
•Physical space between people
•Includes:
▫Distance between people
▫Height
▫Odor
•Sensitivity and professionalism are required when patient proximity is an issue
Communication Process
•Communication is a process.
•The sender-receiver model is a way to break down the process into steps.
•Use with active listening
Sender-Receiver Model
•The sender is the person who encodes, or gives, information.
•The receiver is the person who decodes, or accepts, the information.
•The message is the information that is being communicated.
•Other elements include frame of reference and feedback.
Active Listening Skills
•Show interest.
•Be alert.
•Maintain eye contact.
•Avoid interrupting.
•Pay attention.
•Avoid thinking ahead for a response.
•Try to ignore personal prejudices.
•Ignore distractions by moving to a quiet place.
•Watch the speaker closely for nonverbal contradictions.
•Maintain a positive attitude.
Restatement, Reflection, and Clarification•Restatement
involves repeating the message back to the sender in the receiver’s own words.
•Reflection involves responding with empathy.
•Clarification occurs when the receiver asks questions to get a more concise explanation or to clear up any confusion about the message.
Other Effective Communication Skills
•Be conscious of your own body language, including posture and eye contact.
•Avoid any display of anger.
•Speak slowly, softly, and clearly.
Attitudes and Behaviors
•Adopt acceptable attitudes and behaviors
◦Courtesy
◦Respect
◦Sensitivity to boundaries
◦Empathy
Courtesy
•Involves being polite, gracious, helpful, and considerate
•Overcome personal and other issues unrelated to the job
Respect
•Approach another person with a feeling of esteem or regard
•Theme in any study of communication in health care
•Without proper respect, communication can quickly veer towards failure.
Sensitivity to Boundaries
•Sensitivity is ability to see and appreciate the personal traits of others
•Sensitivity to boundaries is ability to recognize and observe the emotional and physical limits of others
Empathy
•Ability to share in someone else’s feelings or emotions
•Patients who are lonely or facing serious surgeries or terminal illnesses are in special need of empathy
Diversity
•Put aside all personal and cultural bias
•Treat all people fairly, equally, and with sensitivity
•Be aware that others have cultural and personal biases
Diversity includes the following:
▫Race
▫Gender
▫Age
▫Ethnicity
▫Socioeconomic status
▫Occupation
▫Health status
▫Religion
▫Sexual orientation
Criticism
•Constructive criticism can build people up and inspire them to do better.
•Non-constructive criticism serves only to tear people down and discourage them.
•Be prepared to accept and give constructive criticism
Accepting Constructive Criticism
•When people receive constructive criticism, they should appreciate it.
•People who receive criticism should avoid making excuses, getting angry, and blaming others.
Giving Constructive Criticism
•When giving criticism, people should put themselves in the other’s place.
•Choose words carefully and speak kindly and considerately
•Allow the other person a moment to accept what is said
Group Communication
•Health care workers must effectively communicate with their colleagues.
•Health care workers must put aside all personal prejudice and treat team members fairly and equally and so that they can communicate effectively in group situations.
•Successful group situations also involve an understanding of communication patterns, interaction, and participation.
Communication Patterns
•Chain-of-communication pattern
•Wheel-of-communication pattern
•All-channel communication pattern
Group Interaction
•Conformity occurs when individuals change their opinions or beliefs to match that of the group.
•In some instances, conformity can be bad, as it may cause people to go against their beliefs and values.
•In the professional world, conformity can be good. It is good when people conform to behave appropriately in the professional atmosphere.
Group Participation
•Understand the group goals and own roles within the group
•In meeting situations, group members must:
▫Be prepared.
▫Use active listening skills.
▫Focus on the discussion.
▫Share relevant ideas.
▫Respect others.
▫Follow through with assignments.
Directions
•In the health care field, it is critical that directions are carried out correctly.
•In order for this to occur, directions must both be given and taken accurately.
Giving Directions
•When giving directions:
▫Keep instructions simple and brief
▫Give directions in a logical, chronological order
▫Adjust language and complexity to the patient’s ability
▫Have the patient restate
▫Correct any misunderstanding
Following Directions
•When following directions:
▫Be diligent
▫Ask questions
▫Take notes
▫Follow through
•Many types of barriers
•A communication barrier:
◦make it difficult to send a clear message
◦understand message being sent
◦provide appropriate feedback.
Personal Communication Barriers
•Can occur within either participant in communication
•Can result from emotions and attitudes, resistance to change, preconceptions, and self-absorption
•Can form out of prejudice and personality, including traits such as closed-mindedness, judging, belief in stereotypes, and preaching or moralizing
Emotions and Attitudes
•Extreme emotions interfere with ability to concentrate
•Attitudes can create barriers. These attitudes may include:
▫Prejudice
▫Selective comprehension
▫Complacency
Preconceptions
•Preconceptions are similar to prejudice.
•Typically directed toward to a single person, rather than a group
•Create barriers when people disregard what another is saying simply because they disagree or they do not care for the other person
Resistance to Change
•Health care workers may have resistance themselves, or they may have to deal with a patient’s resistance.
•Be flexible and open-minded
•Communicate the benefits of change in a positive way to patients
Self-Absorption
•When people are preoccupied, they can miss much of the message coming from another person
•Put own issues aside and focus 100% on their patients
Overcoming Personal and Psychological Communication Barriers
•Poor attitudes alienate patients
•Patients will attach little value to what is said
•Learn to overcome or put aside personal and psychological barriers
Cultural Communication Barriers
•Values, beliefs, and customs that are common among a group of people
•Barriers include:
◦language
◦health practices and beliefs
◦eye contact
◦religion
Language
•Most obvious communication barrier
•Speak slowly and use simple words and gestures or pictures.
•Find an interpreter, if possible.
Health Beliefs
•Beliefs about health practices and treatments may conflict
•Patient has the right to refuse treatment
•Be sensitive to these cultural conflicts
•Work with patients to make sure that they are getting the required care and treatment
Eye Contact
•Differing cultural views on what is or is not appropriate eye contact can inhibit good communication.
•In some cultures direct eye contact is viewed as disrespectful.
•Respect and adjust to the patient’s cultural differences
Religion
•Organized belief in a higher power
•Influence many aspects of people’s lives including birth, life, diet, illness, and death
•Be aware of common religious influences
Physical Communication Barriers
•Patients who are physically or mentally impaired provide challenges when trying to communicate important health information.
•Physical challenges that can effect communication include:
▫Problems with hearing, vision, and speech
▫Mental challenges
▫Current physical and mental state
Hearing Challenges
•Deaf patients:
▫Use sign language if possible.
▫Utilize body language and gestures.
▫Face the patient when speaking.
•Hard-of-hearing patients:
▫Face the patient when speaking.
▫Speak clearly at a moderate pace.
▫Keep sentences short and uncomplicated.
Vision Challenges
•Blind patients:
▫Speak softly to them.
▫Announce your presence.
▫Describe procedures as they are happening.
▫Explain unusual noises.
•Low-vision patients:
▫Volunteer to turn on more lights.
▫Use bigger body gestures.
Speech Challenges
•Aphasia
▫Speech problems that originate with damage to the brain
▫Patients may struggle both with speaking and with writing
▫Health care workers must be patient and considerate by speaking clearly and simply.
•Dysarthria
▫Trouble with particular sounds and slurring words
▫Health care workers should be patient and encourage these patients to speak slowly and to use hand gestures.
Physically or Mentally Challenged
•When interacting with a patient in a wheelchair, it is respectful for the health care worker to also be seated.
•Health care workers must also be sensitive to patients who are mentally or emotionally challenged. They must be prepared for anything and treat these patients with calmness, respect, and courtesy.
Current Physical or Mental State
•Patients may not be able to communicate clearly if they are:
▫Very ill or in physical pain
▫On strong medication
▫Upset or confused
▫Experiencing a great deal of stress
•Understand the context of the situation when interacting with patients.
Environmental Communication Barriers
•Environmental barriers include:
▫Noise and activity levels
▫Physical arrangement and comfort
▫Time
Noise and Activity Levels
•Control the noise and activity levels in common areas where patient-health care worker conversations might take place
Physical Arrangement and Comfort
•Partitions and dividers
•Room temperature
•Make the physical arrangement welcoming and comfortable
Time
•Communication barrier if not enough of it is devoted to interacting with a patient
Patient Interaction
•Feeling confident, comfortable, and competent during patient interaction takes practice and experience.
•Patient interaction involves several stages:
▫Preparation
▫Introduction
▫Assessment
▫Treating and monitoring
▫Feedback and follow-up
Preparation
•Take a moment to prepare
•Review the patient’s chart:
▫Patient’s name
▫Health history
▫Chief complaint
▫Special needs or precautions
Introduction
•Enter the room calmly and formally introduce yourself.
▫Name
▫Position
▫Purpose for being there
•Be positive and genuine
Assessment
•Make observations and evaluate a patient’s condition
•Assessment includes the patient’s:
▫Appearance
▫Personality
▫Attitude
▫Reaction to the health care worker
▫Vital signs
Treating and Monitoring
•Treating a patient involves reading and following a doctor’s orders.
•Describe the procedure in lay terms
•Monitor the patient, looking for any signs of change, good or bad
Feedback and Follow-Up
•Assess the patient again.
▫Ask patients how they are feeling.
▫Take vital signs.
•Give patients feedback about the treatments.
▫Let patients know how well they performed.
▫Give pointers or tips about getting better results the next time.
Patient Education
•One-on-one conversation or as a presentation to a group
•Patient education literature
Patient Questions
•Patient questions often create patient education situations.
•Be prepared to answer these questions:
▫How did I get it?
▫How long will it last?
▫Am I going to die?
▫Is it curable?
▫Will I need medication? Will I need surgery?
▫Will I be the same after I have recovered?
One-on-One Conversation
•In one-on-one situations, health care workers must teach patients about treatments, procedures, therapy, and equipment.
•Make sure patients fully understand what is expected of them
Group Presentation
•Health care workers may be required to deliver presentations for patient education purposes.
•To prepare, health care workers should ask the following questions:
▫Who is the audience?
▫What is the audience’s interest in the topic?
▫Should the presentation be formal or informal?
▫Are supporting materials necessary?
▫What type of audiovisual will be most effective?
Types of Documentation
•Many types of documentation and they vary from one agency to another
•Some standard documentation includes:
▫Health histories
▫Notes
▫Initial evaluations
▫Progress reports
▫Discharge reports
Health Histories
•Provides the doctor with important information about the patient
•Health histories generally include:
▫General Statistical Data
▫Chief Complaint
▫Present Illness
▫Review of Systems
▫Past History
▫Family History
▫Personal/Sociocultural History
SOAP Notes
SOAP is an acronym for:
▫Subjective
▫Objective
▫Assessment
▫Plan
•All employees know where to look for information and in what format they will find it
•Eliminate some excess writing and reading for health care workers
Narrative Notes
•Tells the patient’s story
•Chronological order
•Can describe how a patient’s status, treatment, etc. has changed
•More time-consuming than the SOAP method.
Initial Evaluation
•Groundwork for a patient’s file
•An initial evaluation includes:
▫Patient identification information
▫Referral information: reason, referral history, referral diagnosis, requested treatment, complicating factors
▫Evaluation
▫Diagnosis with rationale for treatment
▫Treatment plan: prescriptions, follow-up appointments, frequency and duration, goals
Progress Report
•Contains information regarding a patient’s on-going care, treatment, and progress
•Occur over a specified length of time, which can be days, weeks, months, etc.
•Support and give evidence of the need for the patient’s continued medical care
•Progress reports should contain the following information:
▫Patient information
▫Current evaluation
▫Diagnosis
▫Treatment
▫Assessment
▫Complications
▫Recommendations, changes, goals
Discharge Report
•A discharge report has two functions:
▫It releases the patient back to their regular lifestyle, sometimes with some restrictions.
▫It gives a record of the interactivity among health care providers, as it documents the patient’s success from the initial evaluation to release.
•Discharge reports should contain the following information:
▫Patient information
▫Final evaluation
▫Diagnosis
▫Treatment
▫Assessment
▫Complications
▫Recommendations and goals
Documentation Guidelines
•Use a black ink pen.
•Write neatly and concisely
•Always include signature
•Correct errors appropriately.
•Do not leave empty spaces
•Record items in chronological order.
•Only use abbreviations that are approved by the agency.
•Do not record information performed or observed by another health care worker.
•Destroy documents properly
•Double-check for the correct patient, chart, and form
Fact versus Opinion
•Be careful to only include facts and to conceal own opinions
•Subjective and objective observations
Subjective and Objective Observations
•Subjective observations are often called symptoms. They are not seen or felt. Instead, they are comments or complaints made by the patient.
•Objective observations are typically called signs. They can be measured or seen.
Making Objective Observations
•Observe:
▫Sight - Unusual skin color, swelling, rashes, sores
▫Smell - Body odor or unusual odors from the breath, urine, stools, or wounds
▫Touch - Pulse and the condition of the skin, including temperature, swelling, and dryness or perspiration
▫Sound - Respirations, coughing, and impaired or slurred speech
Documenting Observations
•Both subjective and objective observations have a place in patient documentation.
•Objective observations should make up most of the report.
•Subjective statements made by the patient may also be included. However, they should be recorded in the patient’s exact words and quotation marks should surround them.
Eliciting Information
•Know how to ask the right questions in order to get the information
•Ask broad questions that encourage patients to reply with more than “yes” or “no” answers.
Confidentiality
•The information that goes into a patient’s file is confidential.
•Be sensitive to confidentiality:
▫Ask patients for personal information in a private environment.
▫Be careful to close file folders before setting them down.
Telephone Communication
•May be the first communication patients have with a health care agency
•Creates an impression
Telephone Etiquette: Greeting
•Good telephone etiquette includes a proper greeting.
•Identify yourself, the agency, and possibly the department
Telephone Etiquette: Voice
•Use a clear voice with a normal volume.
•Vary tone, pitch, and volume for emphasis
•Hold the phone’s mouthpiece about one inch from the mouth
Telephone Etiquette: Courtesy
•Be polite, gracious, helpful, and considerate
•Use the other person’s name and say “please” and “thank you.”
•Be careful not to interrupt the other person
Telephone Etiquette: Attention
•Atmosphere around the telephone can be very busy and noisy
•Focus on the caller
Taking Telephone Messages
•Phone messages should include:
▫The full name of the caller with the correct spelling
▫The caller’s telephone number with the area code and extension number, if applicable
▫The best time of day to return the call
▫A brief message about the nature or purpose of the call
▫The date and time the call was received
▫A brief note of any action that was taken
▫Their own initials in case there are any questions about the message
Test Results and Triage
•The telephone should not be used to communicate bad news or complex information.
•The telephone is often used for triage.
Answering Machines and Services
•Used to deliver a message to callers and record calls from patients.
•Answering services are more efficient in that the caller will be connected to an operator.
Electronic Communication
•Automatic routing telephone systems (ARU)
•Paging systems
•Cellular phones
•Facsimile, or fax, machines
•Electronic mail.
Automatic Routing Units
•Many telephone calls can be answered simultaneously
•Directions instruct the caller to press a number on the telephone key pad to reach a person or a department.
Paging Systems
•Pagers beep and display either a telephone number or a digital text message.
•Pagers cannot be used for two-way communication.
Cellular Phones
•Two-way communication tools
•Private patient information should never be discussed using cellular phones
Fax Machines
•Used to quickly transmit data over telephone lines
•When using a fax machine:
▫Get patient permission before faxing records.
▫Never fax financial information.
▫Contact the receiver before and after sending a fax.
▫Attach a cover sheet that contains a confidentiality statement.
Electronic Mail
•Communication among health care workers, agencies, and insurance companies
•Often takes the place of printed interoffice communication
•Should never be used to communicate confidential patient information because e-mails can be intercepted