Healthcare Core Curriculum
Competency #3: The Communication Process
Dede Carr, BS, LDA
Karen Neu, MSN, CNE, CNP
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2
Objectives
 Use a variety of communication techniques to
achieve effective interpersonal communication &
team communication
◦ Identify barriers and influencing factors impacting
effective communication
◦ Identify and describe steps of the communication
process
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Provide a comfortable environment (lighting,
temperature, furnishings).
Establish a relaxed, unhurried setting.
Sit down when speaking to the patient.
◦ Although you probably have dozens of things you need to be
doing at that moment, try to relax.
◦ Don't stand at the doorway or sit on the edge of your seat, as if
you are preparing to jump & run as soon as you can get away.
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Face the speaker & maintain eye contact.
Provide for privacy.
Avoid interruptions & other distracting influences
(Medical Education Division)
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Set Goals
Create the Message
Delivery of the Message
Listen for a Response
Offer Feedback & Seek Clarification
Evaluate the Encounter
A goal can be defined as something that a person
plans to achieve, to aim for.
In communication, setting a goal is achieved by
deciding what type of message needs to be sent.
Is the message to be one of:
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Gathering information
Instructing
Informing
Reporting
Step 1 Set Goals: #1 Gathering Information
A person can gather information by asking
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Who?
What?
Where?
How?
When?
Why?
Step 1 Set Goals: #2: Instructing
The goal of this form of communication is detail,
such as a step-by-step process to complete the
procedure.
For example: When teaching a student the proper
way to prepare a syringe for the administration of
medication.
Step 1: Set Goals: #3 Informing
If informing the receiver is the goal, the message may
be short and to the point. The message may be
communicated using words and/or symbols.
A stop sign, for example, informs the driver to stop.
A voice message informs the caller that no one is
available.
Example of “No Smoking”
Step 1: Set Goals: #4 Reporting
Reporting should be clear & accurate facts &
timeframes; not opinions or judgments.
Reporting in used in many different situations and
might consist of using graphs, images, tables, charts,
etc.
 Situation: Giving test results to a patient
 During an investigation of malpractice
 At the end of shift, team members may report to
team leader who reports to on-coming team leader
When creating the message to be delivered, goal is to
make it so that the receiver can understand it.
Consider the organization of the message
Follow a step-by-step process in order to give concise,
accurate information
Message may consist of asking questions of the
receiver
Types of questions that may be asked of the receiver
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Open-ended questions
Closed-ended questions
Neutral questions
Probing questions
Leading questions
(Ramont, Niedringhaus, pp. 234-235)
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Used in short directive interviews
Generally, requires a “yes” or “no” or short factual
response giving specific information
Often begin with “when,” “where,” “who,” “what,” “do
(did, does),” “is (are, was, were),” and sometimes “how”
Examples:
◦ “What medicine did you take?”
◦ “Are you having pain now? Show me where it is.”
◦ “How old are you?”
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Highly stressed, people with difficulty communicating
will find close-ended questions easier to answer
(Ramont, Niedringhaus, pp. 234-235)
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Used in non-directive interview
Invites clients to discover & explore thoughts,
feelings & allows freedom to talk about client’s
wishes
Specifies only broad topic to discuss
Invites longer answers than one or two words
Useful at beginning of interview, to change topics, or
to elicit attitudes
Choice of this type depending on situation & many
times used in combination with close-ended
questions
(Ramont, Niedringhaus, p. 235)
Client can answer without direction or pressure
Examples:
 “How do you feel about that?”
 “Why do you think you had a bad operation?”
(Ramont, Niedringhaus, p. 235)
Contrast to neutral questions
 Phrasing of question suggests what answer is expected
 Gives client less opportunity to decide whether the
answer is true or not
 Creates problems if client gives inaccurate responses
in order to please the healthcare worker
Examples:
 “You’re stressed about surgery tomorrow, aren’t you?”
 “You will take your medicine, won’t you?”
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(Ramont, Niedringhaus, p. 236)
Guided by & chosen based on what the OTHER person
has said
 Shows that you are paying attention
 Indicate interest and a desire to understand.
 Probing questions can be non-directive
Examples:
 "Go on", or “& specific as below:
 Person A: “I live in New York.”
 Person B: “Ah. Do you live in Brooklyn, or The Bronx?”
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(Bascal & Associates)
Requesting Clarification
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“Can you share an example of that with me?”
Encouraging Elaboration
“How are you dealing with that situation now?”
Verifying Information & Responses
 “So, if I understand you correctly… Is that right?”
Evaluative Questions
Use open- ended & closed-end question formats to gain
confirmation & to uncover attitudes, opinions, &
preferences of client.
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◦ “How do you feel about…?”
◦ “Do you se the merits of…?”
◦ “What do you think…?”
(Bascal & Associates)
Question Type
Examples
Closed-ended
What is your date of birth?
Are you taking any medication?
Open-ended
How did you fall?
Why do you think you are feeling sad?
Probing
You said that you have been experiencing pain in
your chest. Where, exactly, in your chest do you
feel the pain?
When is it most severe?
Leading
Would you describe the pain as sharp, dull,
throbbing or aching?
Do you feel the pain more in the morning or at
night?
(Changing Minds Organization)
Usage
Example
As opening questions in a conversation,
as it makes it easy for the other person to
answer, and doesn't force them to reveal
too much about themselves.
It's great weather, isn't it? Where do
you live?
What time is it?
For testing their understanding (asking yes/no
questions). This is also a great way
to break into a long ramble.
So, you want to move into our
apartment, with your own bedroom
and bathroom?
For setting up a desired positive or negative
frame of mind in them (asking successive
questions with obvious answers
either yes or no ).
Are you happy with your current
supplier? Do they give you all that you
need?
Would you like to find a better
supplier?
For achieving closure of a persuasion
(seeking yes to the big question).
If I can deliver this tomorrow, will you
sign for it now?
(Changing Minds Organization)
Usage
Example
As a follow-on from closed questions,
to develop a conversation and open up
someone who is rather quiet.
What did you do on you
holidays? How do you keep focused
on your work?
To find out more about a person, their
wants, needs, problems, and so on.
What's keeping you awake these
days? Why is that so important to
you?
I wonder what would happen if your
customers complained even more?
Rob Jones used to go out late. What
happened to him?
To get people to realize the extend of
their problems (to which, of course,
you have the solution).
To get them to feel good about you by
asking after their health or otherwise
demonstrating human concern about
them.
How have you been after your
operation? You're looking down.
What's up?
(Changing Minds)
A = Assessment
D = Discovery
A = Activation Questions
P = Projection
T = Transition Questions
This is a sequence of questions with a specific purpose that
begins with assessment of a problem leading to a transition of
helping client find solutions to problem
(University of Mississippi Business Faculty)
See next slides for the five steps of the ADAPT
questioning sequence and an explanation of
sequence pattern
Assessment Questions
• Broad bases and general facts describing situation
• Non-threatening as no interpretation is requested
• Open-end questions for maximum information
Discovery Questions
• Questions probing information gained in assessment
• Seeking to uncover problems or dissatisfactions that
could lead to suggested client’s needs
• Open-ended questions for maximum information
Activation Questions
• Show the negative impact of a problem discovered
in the discovery sequence
• Designed to activate client’s interest in and
desire to solve the problem.
Projection Questions
• Projects what life would be like without the problems
• Client establishes the value of finding and
implementing a solution
Transition Questions
• Confirms interest in solving the problem
• Transitions to presentation of solution
Who is your audience?
◦ A patient
◦ A family member
◦ A co-worker
What are the family dynamics and how does the
family operate as a family unit?
◦ Are the family members getting along or arguing?
◦ Is one member in charge of making the medical
decisions or is the entire family making the decisions?
(Ramont, Niedringhaus)
The type of audience will determine the type of
language you use and how your message is
delivered so know your audience, and know it
well.
Consider the different methods of delivery used
when speaking to one or two individuals, a group
of people, or a large population.
Concentrate & Attention
◦ Is the sender focused on the feedback that the
receiver is providing or thinking of the next
thing to say?
◦ Is the sender actively listening to the receiver’s
feedback?
Observation
◦ What type of nonverbal cues is the receiver
sending? Is the receiver frowning, rolling
his/her eyes?
Paraphrasing is a reflection of meaning but not content.
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It is a way for the sender to summarize the message and
resend it if necessary. The receiver also paraphrases the
message when providing feedback to the sender. Repeat
what the other person has said, but in your own words.
Then ask, “Is that right?”
Paraphrasing demonstrates that you have listened and
have taken the time to understand what the other person
has said
(Ramont, Niedringhaus, p. 235)
Examples of Paraphrasing
Sender: We are going to leave town tonight and will
be back in a week’s time after we have visited
relatives.
Receiver: “So you will be gone for a week starting
tonight. Will you be back on the Thursday or the
Friday?”
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Were the communication goals met?
Did the sender deliver a clear message?
Did the receiver ask for clarification, for examples?
Was feedback given and how was it received?
[See communication guidelines on the following
slides.]
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Convey to the patient & family that they are
important to you & that you want to help them.
◦ Do what is comfortable & natural for you.
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Convey honesty & trustworthiness.
Try not to overwhelm the patient with embarrassing
or personal questions.
When it is necessary to ask personal questions,
explain why & keep it short & matter-of-fact.
(Medical Education Division)
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Don't make promises you can't keep. If you say you are going
to do something, make every effort to do it or see that it gets
done.
Try to be there when you say you will. If you are late, explain
why.
Accept & respect patient despite symptoms of his illness.
Communicate with each patient as an individual.
Especially important in a hospital setting, where patients
often experience a loss of identity by
◦ Getting to know the patient
◦ Listen to the patient
◦ Put yourself in his place (Medical Education Division)
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Be able to decipher the patient's message.
Get to know the patient well enough to discover the
underlying meaning (intent) of his/her
communication.
Be alert & perceptive enough to pick up the correct
message.
Many people feel uncomfortable talking about their
feelings, especially if they are trying to be "good
patients."
Learn to "read between the lines.“
(Medical Education Division)
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Be realistic in your relationships with people; avoid
making assumptions or judgments about your patients'
behavior.
If you have negative thoughts about something a
patient says or does, try to keep in mind that he is an
adult, responsible for making his own decisions.
You do not want him to feel he must conceal anything
from you.
You want him to see that you will accept him for what
he is; you will allow him his own identity
(Medical Education Division)
Bascal & Associates. (2008-2010). What are probing questions?
Probing questions ask for more information or clarification.
Retrieved from http://work911.com/communication/skillsprobing.htm
Berman, A., Snyder, S.J., Kozier, B., & Erb, G. (2008). Health care
delivery systems. In A. Berman, S.J. Snyder, B. Kozier, & G. Erb
(Eds.). Kozier & Erb’s Fundamentals of nursing: Concepts,
process, and practice (8th ed.) (pp. 101-116). Upper Saddle
River, NJ: Prentice Hall
Changing Minds Organization.(2002-2011).Open and closed
questions. Retrieved from
http://changingminds.org/techniques/questioning/open_closed_question
s.htm
Industrial Engineering. (n.d.) Communication & Consumer Behavior.
Retrieved from
http://industrialeducation.blogspot.com/2009/07/communicationconsumer-behavior.html
Medical Education Division of Brookside Associates. (2007).
Patient relations. Nursing fundamentals I. Retrieved from
http://www.brooksidepress.org/Products/Nursing_Fundame
ntals_1/lesson_1_Section_2.htm
McGill, I. & Beaty, L. (1994). Action learning: A guide for
professional management and educational development (2nd
ed.). Sterling: VA: Stylus Publishing Inc.
Ramon, P.R. & Niedringhaus, D. M. (2008). Client
communication. Fundamental nursing care (2nd ed.) (pp. 226242). Upper Saddle River, NJ: Person Prentice Hall
University of Mississippi Business Faculty. (2004). Module 4:
Communication Skills. Retrieved from
faculty.bus.olemiss.edu/dvorhies/.../Module%2004%203E.ppt