CommunicationCommunicationHealth Science Health Science

InternshipInternshipby: Cindy Quisenberryby: Cindy Quisenberry

Employment in healthcare

requires knowledge of the

process of communication.

Communication is vital in the

field of healthcare, since

miscommunication can lead to

serious physical and legal

consequences. Healthcare

professionals must be good

communicators to be successful.

(p. 359)

All people need to feel they are

being heard. Moving into a long-

term facility often makes patients

feel isolated and lonely. They are

surrounded by strangers whom

they depend on to help them with

their most basic needs. Talking to

someone helps reduce their

feelings of loneliness and isolation.

When you show a patient you

understand their feelings, they

begin to trust you. Patients

who feel you understand them

are more likely to share their

feelings and needs. A trusting

relationship can develop when

they feel cared for and know

what to expect.

Effective

communication is

the key to creating a

trusting

relationship.

Trust Firm belief in the reliability, truth,

ability, or strength of someone or something. The basis for any relationship. Ways to develop trust.

• Make the person feel safe. (answer call lights, etc.)• Listen to what they say.• Be clear about what you can and can’t

do.• Be courteous at all times.

Trust • Be honest and open. (Do what you say

you are going to do. (ie: I will be back in 10 minutes, arrive to work on time, take a pt’s VS’s, etc.)

• Be consistent. (Keep patients aware of what you are going to do, before you do it.)

• Be respectful.• Dress professionally.• Be reliable.• Maintain confidentiality.

Effective communication is important because:• It helps you understand each patient’s needs.

• It promotes a trusting relationship.

• It makes your job easier and more enjoyable.

• It improves the patient’s “quality of life”.

• It helps you gain the patient’s cooperation.

• It adds to the patient’s satisfaction, the family’s and your own.

• It helps staff know what changes you have observed.

• It helps the healthcare team plan individualized care.

Communication

• Sending and receiving messages verbally and nonverbally

Context

• The whole situation, background, or environment that gives meaning to someone’s words

Ways We Communicate

• Verbal - Words (talking)

• Nonverbal - Symbols (ie: traffic lights, road signs, etc.)

• Nonverbal - Body language (smiling, handshake, how you stand or sit, how you move, tone of your voice, touch, etc.)

Do’s & Don’ts of Communication

• Do use words they can understand

• Do speak clearly and slowly

• Do look directly at the person you are talking to

• Do try to be at the person’s eye level

• Do use a pleasant tone

Do’s & Don’ts of Communication

• Do reduce or eliminate other sounds

• Don’t use medical terms or slang

• Don’t put your hands near your mouth while you are talking

• Don’t talk with food or chewing gum in your mouth

Smirking

• Smiling in a way that gives the impression you are superior to another person

Condolences

• Expressions of sympathy or sorrow

Clarify

• Make sure something is clearly understood

Good Listening Skills

• Stop what you are doing.

• Make eye contact.

• Sit down and stay at the person’s eye level.

• Prevent distractions such as personal pagers and cell phones.

• Keep your body language positive.

• Validate what you hear the other person saying.

Validating Communication

• Prove to be valid, sound, or effective

• Check out to see whether the other person understands your intended message (ie: ask the other person to repeat what you said or to do the activity)

Promoting Effective Communication• Show respect for patients by calling

them by their title and surname (Mrs. Jones) unless they request otherwise.

• Do NOT use nicknames such as “sugar” or “honey”.

• Always ask patients if it is okay to do something. Explain new procedures.

• Always keep your word.

Nickname

• A familiar name that family and friends use

Surname

• Last name or family name

Promoting Effective Communication• If you cannot do something you promised,

explain why.

• Respect a patient’s feelings.

• Do not disrespect their feelings by saying things such as “Things are not all that bad.”

• Use open ended questions, “Tell me about . . . . or How do you feel about . . . ”

Promoting Effective Communication• Give hope, but not false reassurances.

– Instead of saying, “You’ll feel better tomorrow, “ say “I know you’re having a tough time. But I think you’ll be more comfortable if we . . .”

• Offer patients choices in their daily activities, whenever possible.

• Respect residents’ privacy by not sharing personal information about them except on a need to know basis with the staff.

How To End A Conversation

• Try to end the conversation so that the patient fells good.

– “I’ve really enjoyed talking to you.”

– “Can we continue this conversation after dinner.”

– “I have to check on some other patients now.”

– “I have about 10 minutes before I have to do something else. Could we talk for a few minutes?”

• Never make a promise you cannot keep.

Communicating with the Hearing Impaired

• Eliminate or reduce background noise.

• Face the patient.

• Speak clearly, using your lips to emphasize sounds.

• Use gestures or point to objects as you speak.

• You may touch a patient to get their attention.

Communicating with the Hearing Impaired

• Encourage the patient to use their hands to point to things they want.

• If a resident with a hearing impairment neglects to use their hearing aid, encourage its use. Be sure the hearing aid is clean and working properly.

• Repeat what you said if a patient asks you to. (May need to change the wording.)

• Be sure you have the person’s attention, and maintain eye contact.

Communicating with the Hearing Impaired

• In some cases you may need to write down on paper what you are saying.

• Always be patient.

Communicating with Depressed Patients• Most important be patient, understanding,

and consistent.

• Spend extra time just sitting with the patient, even if they are not talking to you.

• Invite them to participate in their own care as well as social activities in the facility.

• Set goals for the patient. Make suggestions, “Today we’ll walk just to the nurses station and back. Tomorrow I’d like you to walk with me to the dining room.”

Communicating with Depressed Patients

• Ask family members and friends about the patient’s interests in the past. Then try to engage them in conversation about these interest.

• In all your efforts, keep trying.

Cognitive Impairment

• Condition in which memory, thinking, or problem-solving skills have changed or been damaged

Communicating with the Cognitive Impaired Patient• Keep your questions and your directions short

and simple. Repeat information if needed.

• Try to understand the patient’s feelings and their perceptions of the world, and use words appropriate for them.

• Use helpful visual reminders, such as referring to calendars and clocks throughout the facility. A wall chart in the room can help a patient remember daily routines, such as the steps in getting dressed or the times that meals are served.

Communicating with the Cognitive Impaired Patient

• Because of their memory loss, some things a patient says may not make sense to you, even though they are trying hard to fill in gaps in their memory.

• Never laugh or make fun of anything they say.

Aphasia

• Condition in which a person has difficulty putting thoughts into words

• Absence or impairment of the ability to communicate through speech, writing, or signs because of brain dysfunction

Communicating with the Speech Impaired Patient• Encourage the patient to use their hands

to point to things out or touch thing to help communicate their message.

• Ask questions they can answer with a “yes” or “no”.

• Since it is frustrating for these patients to make themselves understood, let them express their anger and frustration. If needed, sit quietly and let them cry.

Communicating with the Speech Impaired Patient

• When you understand what a patient’s particular sound or symbol means, tell other staff, so they can communicate better with the patient. You can put a chart or common phrases they might use on the wall, so they can point to what they need.

Responding to Sexual Advances

• Without being negative about the person, you might say;

– “That makes me very uncomfortable. Please do not do it again.”

• If patient’s cannot control their behavior, the best thing you can do is distract them with another topic or activity.

Responding to Sexual Advances• A patient who is not mentally competent

must be protected from unwanted sexual advances.

– Watch vulnerable patients closely.

• You must also protect others from unwanted sexual advances by a mentally incompetent patient.

– Move to a different area

– Spend time alone with them

– Look for activities

Responding to Abuse

• Verbal Abuse

– “You must feel very angry – can I help?”

• Physical Abuse

–Must act to prevent harm to others.

• May have to step between two residents or take away an object a resident may try to use to hurt another.

• May have to move a patient for cooling-off.

• May have to support or reassure residents who get upset by the conflict.

Responding to Abuse• The best way to prevent aggression and

possible injury is to know residents well – what they are feeling and thinking.– Monitor moods, facial expressions, etc.

– Try to understand what they are feeling and fit your actions and words to meet their needs.

– Never surprise the resident or let them surprise you.

– Never walk up behind them and touch or startle them.

– Never give a resident orders, as if you are their boss.

Responding to Aggressive Patient• Talk in a soft, friendly voice.

• Use short sentences and ask simple “yes” or “no” questions.

• When appropriate and when it will not surprise the resident, gently touch them.

• Don’t rush. Give plenty of time for the resident to hear and understand you. Give simple instructions. May need to give the resident a hug and change the subject.

Responding to Aggressive Patient• If the conversation becomes very

tense, may need to leave the room.

• Do not take the resident’s actions personally or consider yourself the cause.

• Never argue with any resident, no matter what they say to upset you.

• ALWAYS stay calm and patient.

Conflict Resolution

• Use of effective communication to resolve problems

What is conflict?

• Situation in which one side or person tries to gain something at the expense of another.

• Situation in which people have incompatible or seemingly incompatible ideas, interests, or values.

• Disagreement.

• Situation in which people are trying to meet a goal in different ways.

• Things that clash or are in opposition, competing or opposing actions, and opposing desires or tensions.

Conflict Resolution

• Think about how you respond to the following:

– Someone raises their voice when speaking to you.

– Someone questions your ideas or your words?

– Someone ignores you.

Conflict Resolution

• Understanding Yourself

– Recognize the energy that arises from an emotional reaction to a conflict.

– Channel this energy and step back to observe the situation and yourself.

– Consider how effective communication can help.

Conflict Resolution

• Reactions to Conflict– Avoidance – conflict not dealt with and

usually continues

– Competition – “beat” that person; the action may not have anything to do with the original conflict

– Accommodation – “give in”; you are doing what the other person wants you to do against your better judgment.

– Compromise – both people give up something that they want in order to resolve the issue; no one is happy

Conflict Resolution

• Reactions to Conflict

– Collaboration – best reaction to conflict; both sides collaborate to resolve an issue. They work together to come up with a reasonable solution. Each party must understand the other’s position and work together on the solution.

Conflict Resolution

• Defensive Reactions – When they feel another person is attacking their integrity.

– Taking things personally. – realize if someone disagrees they are not attacking the person personally

– Running for cover – hiding behind a policy

– Creating a diversion – bringing up something that has nothing to do with the conflict (ie: past events)

Conflict Resolution

• Defensive Reactions – When they feel another person is attacking their integrity.

– Attacking the other person through words

Conflict Resolution

• Guidelines to help you communicate openly and avoid acting defensively.– Remove your from the situation. – Ask

yourself “What is the issue here?”

– Put yourself in the other person’s place.

– Ask the other person questions that help clarify the issues.

– Communicate directly and honestly. – Use “I” statements instead of “you” statements.

– Try not to take the situation personally. – It is not about you.

Conflict Resolution

• Effective Communication

– Understand your role in the conflict and the barriers to communication.

– Consider the timing of your communication.

– Always address the issue, not the person.

– Use “I” statements, not “you” statements.

–Watch your nonverbal.

– Be understanding, open, and honest.

Conflict Resolution

• Effective Communication

– Consider where you will talk about the conflict. (talk in a private place)

– Be sure the other person understands your point and that you understand theirs.

Steps for Conflict Resolution1. Try to understand the other person’s

position and feelings.

2. Explain what you mean.

3. Collaborate

• Agree that you both understand each other’s position

• Agree to work together on a solution

• List all possible solutions

• Together, choose the best solution you can both agree to

Communicating About Yourself• As you talk to patients about their

personal lives and families, you can share things from your own life. This sharing often promotes communication. However, stay focused on the patient and do not make the conversation all about you.

• Be careful about sharing your problems, do not ever make them feel like they cannot tell you their problems b/c you have problems.

Telephone Courtesy• Answering the phone:• State the facility’s name, the unit, and your

name.

• Find out why the caller is phoning by asking how you help.

• Try to meet the caller’s request. Never yell or call out for someone, go get them.

• Never put a caller on hold for more than 2-3 minutes.

• If you cannot meet the caller’s request, take their telephone number and say you will give the message to the right person.

• Thank the caller for calling.

Dealing with Behavior Issues - Foundations

• Recognize frustrating and frightening situations. – How would you feel in the person’s

situation?– How do you want to be treated?

• Treat the person with dignity and respect.

• Answer questions clearly and thoroughly. Refer if you cannot answer or tell them you will find out for them.

Dealing with Behavior Issues• Keep the person informed.– Tell the person what you are going to do

and when.

• Do not keep the person waiting.– Answer signal (call lights).– If you say you are going to do

something, do it promptly.

• Explain the reason for long waits.– Ask how you can increase their comfort.

Dealing with Behavior Issues• Stay calm and professional,

especially if the person is angry or hostile.

• DO NOT argue with the person.• Listen and use silence.• Protect yourself from violent

behaviors.• Report the person’s behavior to your

supervisor. Discuss how to deal with the person.

Communicating With Persons From Other Cultures• Learn as much as you can about the

person’s culture.• DO NOT judge the person by your

own attitudes, values, beliefs, and ideas.

• Incorporate their cultural beliefs and customs into their patient care.

Communicating With Persons From Other Cultures• Do the following for foreign speaking

individuals:– Convey comfort by your tone and body

language.– Do not speak loudly or shout.– Speak slowly and distinctly.– Keep messages short and simple.– Be alert for words the person seems to

understand.– Use gestures and pictures.– Repeat the message in other ways.– Avoid using medical terms and abbreviations.– Be alert for signs the person is pretending to

understand.

Disability Etiquette• Extend the same courtesies to the person as

you would to anyone else.• Allow the person privacy.• DO NOT hang on or lean on a person’s

wheelchair.• Treat adults as adults. (Do not use the

person’s first name.)• DO NOT pat a person on the head.• Speak directly to the person. (not the

companion)• Do not be embarrassed if you use words that

relate to a disability.• Sit or squat to talk to a person in a W/C or

chair.

Disability Etiquette• Ask the person if he or she needs

help before acting. – If the answer is no, respect their wishes.– If they need help, ask the person what

to do and how to do it.

• Think before giving directions to a person in a W/C.

• Allow the person extra time to say or do things. Let the person set the pace in walking, talking, or other activities

Comatose Patient• Knock before entering the person’s room.• Tell the person your name, the time, and

the place every time you enter the room.• Give care on the same schedule every day.• Explain what you are going to do. (step-by-

step)• Tell the person when you are finishing

care.• Use touch to communicate care, concern,

and comfort.• Tell the person what time you will be back

to check on them.• Tell the person when you are leaving the

room.