Chapter 7
Professional
Communication
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Review Tip
Take this time to evaluate your review process and progress. Is your
environment comfortable and conducive to studying? Are you
spending the time as you initially planned? Are you staying focused
and motivated (especially after the “killer” A&P chapter)? Is your
study group (if you have one) productive? Are you asking family,
friends, and employers for assistance and encouragement?
Revise your plan if necessary, but DO NOT PROCRASTINATE. Remember
why you are taking the exam!
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Overview
Communication is the process of forming and transmitting a message
(encoding) to a receiver who interprets that message (decoding) and,
in most cases, transmits a message back to the original sender,
repeating the process.
■ Every phase of health care requires communication, whether it
involves patients, their families and friends, physicians, coworkers,
other members of the health care team, vendors, attorneys,
governmental agencies, or other entities
■ Many of the serious errors that result in patient harm are
associated with faulty communication
■ Other consequences of miscommunication include malpractice
suits, anger, distrust, and stress
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Overview, cont’d.
■ Communicating in a professional, culturally sensitive manner helps
ensure that messages are properly sent and correctly perceived by
the recipient, and that the recipient responds appropriately to the
sender
■ A leading principle of communication in health care is confidentiality
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Overview, cont’d.
Figure 7-1. The communication process.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Communication Goals
All communication has goals, either conscious or subconscious, that
a person must understand to correctly formulate a message.
Sometimes there is more than one goal per message. Some
examples of communication goals are to:
■ Obtain information
■ Provide information
■ Develop trust
■ Demonstrate caring
■ Relieve stress
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Stages of Development
There are distinct processes that normally should occur in each of
these stages of development. When communicating with people of
various ages, keep in mind the behavior pertinent to each group.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Stages of Development,
cont’d.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Communication
Formal—a style associated with decorum, etiquette, and a person’s
recognized role
■ Informal—a style associated with an easygoing, open role and
relationship
■ Verbal—word-of-mouth communication; may be formal or informal
• Face-to-face
• Telephone
• Television
• Audio technology (compact discs, tapes)
■ Written—communication using the printed word; may be formal or
informal
• Medical records
• Letters
• Memorandums
■
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Communication,
cont’d.
• E-mail
• Books
• Reports
• Posters
• Faxes
• Bulletin boards
■ Nonverbal—communication using body language and other
nonwritten or nonoral methods
• Open—receptive, positive appearance (e.g., the recipient
leaning forward to listen)
• Closed—nonreceptive, negative appearance (e.g., the recipient
standing with frown on face and folded arms)
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Communication,
cont’d.
• Indicators—signs that imply open or closed communication
- Facial expressions, such as a smile or frown
- Voice tone (e.g., soft or shrill)
- Gestures, including sign language (e.g., extending hand for
handshake or shaking a finger at a person, indicating anger or
disapproval)
- Body stance and posture, such as standing straight with arms at
side or slouching with arms folded
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Communication Barriers
Noise
■ Inadequate listening
■ Withdrawal or lack of attention
■ Lack of privacy
■ Embarrassment
■ Cultural differences
• Concepts of health and illness (e.g., only visiting the physician in
the case of illness; not seeking preventive care)
• Folk beliefs and practices (e.g., the belief that burying the
umbilical cord when it falls off will help the child develop
normally)
• Childrearing traditions (e.g., “a fat baby is a healthy baby”)
• Religion (e.g., Jehovah’s Witnesses prohibit blood transfusions)
• Politeness (e.g., in some Native American cultures, it is taboo to
make eye contact with another person)
■
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Communication Barriers,
cont’d.
• Who speaks for whom (e.g., in some cultures, the husband
speaks for his wife at the health care facility
• Family ties (e.g., all members of family and extended family
expected to stay with ill person)
• Death and dying traditions (e.g., required rites, blessings, or
ceremonies)
■ Educational differences
■ Language barriers
■ Physical and developmental impairments
■ Pain or discomfort
■ Prejudice (holding a negative or positive opinion or bias concerning
an individual because of his or her affiliation with a specific group;
this includes gender bias)
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Communication Barriers,
cont’d.
Stereotyping (believing that all members of a culture, subculture, or
group are the same)
■ Emotions
■ Criticizing, lecturing
■ Substance abuse
■
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Defense Mechanisms
People commonly react to injury and illness with anxiety and, often,
defensive behavior.
Defense mechanisms = psychological behaviors that protect a
person from guilt and shame:
Compensation—overemphasizing certain behaviors to
accommodate for real or imagined weaknesses (e.g., giving a
child expensive gifts to make up for not spending time with him
or her)
■ Denial—refusal to accept unwanted information or unpleasant
circumstances (e.g., the parent who will not consider that his or
her child is using drugs despite very clear indications to the
contrary)
■
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Defense Mechanisms, cont’d.
■ Displacement—transferring negative feelings, sometimes hostility, to
something or someone unrelated to a negative situation (e.g., being rude
to the medical office receptionist because your insurance company does
not have you listed on the physician’s roster)
■ Introjection—identifying and assuming characteristics or feelings of another
(e.g., the expectant father who has food cravings similar to his pregnant
partner)
■ Projection—placing blame or accusing another for actions or feelings
committed by the person himself or herself (e.g., the patient blaming the
health care provider for continued illness when the patient was
noncompliant with the care plan)
■ Rationalization—justifying thoughts or actions whether right or wrong (e.g.,
spending money on a luxury item because you’ve had a bad day)
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Defense Mechanisms,
cont’d.
Regression—escaping an unpleasantness by returning to an earlier
stage or behavior in life (e.g., a child who reverts to baby talk when
scolded to distract the parent’s anger)
■ Repression—dealing with a difficult situation by true temporary
amnesia (e.g., a witness to a crime who cannot remember the
crime or who he or she is)
■ Sublimation—redirecting unacceptable thoughts or behaviors to
acceptable ones (e.g., the alcoholic who goes from drinking every
night to attending Alcoholics Anonymous meetings every night)
■ Suppression—purposefully forgetting an unpleasant situation or
avoiding it (e.g., victims of childhood sexual abuse who do not
remember the molestation until, perhaps, an incident in adulthood
triggers the memory)
■
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Health Care Implications
Every communication within the health care setting has the potential for
affecting a patient’s outcome, physically and emotionally, positively or
negatively. The relationship, good or bad, between the patient and
the health care provider is predominately the result of their
interactions. Other considerations when communicating with patients
are as follows:
■ Real or unrealistic expectations of patient or health care providers
■ Feelings
■ Challenges
• Obtaining knowledge
• Interpreting and understanding each other
• Accurately exchanging information
• Accepting differences
• Making reasonable accommodations
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Health Care Implications,
cont’d.
Therapeutic Communication
The health care team should strive to make every interaction with the
patient an understanding and caring one. The encounter should
promote healing or acknowledgment in cases of serious disease or
disability and provide some level of comfort. Therapeutic
communication is:
■ Confidential
■ Respectful
■ Professional (friendly and capable but not too informal)
■ Empathetic (sympathetic but not enabling)
■ Nonjudgmental
■ Tolerant and supportive
■ Accepting
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Health Care Implications,
cont’d.
Reassuring
■ Mindful of the patient’s individuality
■ Honest and open
■ Sensitive and tactful
■ Positive in attitude and body language
■
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Enhancing Communication
The health care provider should continually strive to develop and practice
better communication techniques. To promote positive and effective
communication, especially in the health care setting:
Provide a quiet, private, safe, and comfortable environment
■ Listen carefully with no interruptions
■ Provide feedback (paraphrasing, mirroring, repeating, restating to
ensure understanding)
■ Ask open-ended questions (such as “Tell me about your pain”), not
questions that can be answered with yes or no or one word
■ Seek clarification (who, what, how, how much)
■ Use silence to allow patients to add more information
■ Demonstrate open body language
■
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Enhancing Communication,
cont’d.
Exhibit a confident demeanor
■ Focus (stay on important topics)
■ Observe boundaries (e.g., remaining at a friendly but professional
distance, not discussing intimate parts of patient’s life or health care
provider’s life that do not pertain to the pertinent health care issue; not
allowing rambling; not giving advice)
■
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Enhancing Communication,
cont’d.
Special Communication Needs and Strategies
■
Sight-impaired patients
• Speak in a normal tone of voice
• Describe surroundings and locations of structures
• Explain what you are going to do and what you are doing
• Alert patient before touching him or her
• Explain unusual noises associated with a procedure
• Notify patient of anyone who is entering the room or if you are leaving
the room
• Allow touching of instruments and use models when appropriate
• Facilitate return demonstrations as needed
• Obtain feedback
• Encourage questions
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Enhancing Communication,
cont’d.
■
Hearing-impaired patients
• Touch the patient gently on an arm or shoulder to get his or her
attention
• Address the patient directly
• Determine level of hearing loss and what assistive devices are used
by patient
• Increase voice volume, if appropriate, but do not shout
• Speak distinctly and more slowly, using short sentences with slight
pauses
• Eliminate as much background noise as possible
• Offer notepads or other non–hearing communication devices
• Use pictures and captioned videos as appropriate
• Facilitate return demonstrations as appropriate
• Obtain feedback
• Encourage questions
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Enhancing Communication,
cont’d.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Enhancing Communication,
cont’d.
■
Non–English-speaking or limited English-speaking patients
• Attempt to acquire some knowledge of culture to avoid negative
communication
• Provide an interpreter if possible (some insurance companies will
arrange or cover the cost; some social agencies dealing with
refugees and immigrants provide help)
- Research culture to determine if there are any restrictions
regarding who may act as an interpreter (e.g., in some cultures,
interpreter must be of the same sex as patient)
- Determine whether patient is bringing an interpreter (children and
young adolescents should not be used)
- Speak directly to the patient even when using an interpreter
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Enhancing Communication,
cont’d.
• Speak in a normal tone but at a slightly slower pace
• Use simple, short sentences
• Avoid slang or idioms
• Observe patient’s body language as questions are asked and
answered
• Use visual aids, such as pictures, hand gestures, or demonstrations
• Provide forms, educational materials, and office signs in various
languages, if possible
• Use dual dictionaries of English and the patient’s language
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Enhancing Communication,
cont’d.
■
Pediatric patients
• Always state the truth
• Position yourself at the same height as the child
• Use vocabulary appropriate to the child’s developmental age
• Incorporate dolls, pictures, and other toys to enhance communication
or obtain cooperation
• Allow children to handle safe medical equipment
• Expect child to regress emotionally during illness
• Maintain a calm voice and demeanor, even if the child is “acting out”
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Enhancing Communication,
cont’d.
■ Adolescent
patients
• Treat the adolescent with respect
• Avoid being judgmental
• Always state the truth
• Expect adolescents to demonstrate resentment in illness, especially in
chronic illness
• Allow privacy from parents during assessment and treatment, if
desired by the patient
• Maintain a calm voice and demeanor even if he or she is “acting out”
• Do not assume that he or she possesses the correct terminology and
knowledge related to body functions (especially reproductive)
• Consider typical teenage preferences and behaviors when providing
self-care instructions
• Obtain feedback
• Encourage questions
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Enhancing Communication,
cont’d.
■
Geriatric patients
• Accommodate for hearing, sight, or other impairments
• Ensure patient’s comfort and privacy
• Maintain an unrushed environment
• Use feedback strategies often
• Facilitate staying focused on pertinent topics
• Include the patient in the conversation even if a caregiver is providing
the information
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Maslow’s Hierarchy
Abraham Maslow, an American psychiatrist, theorized that people are
motivated by their needs and that those needs are a progression
from basic survival to reaching one’s pinnacle, or self-actualization.
Dr. Maslow ordered these needs in a hierarchy and listed them in
a pyramid formation. Generally, a person cannot progress from
one level to the next until all needs are met in the lower levels.
The implications of Maslow’s hierarchy for health care providers are
substantial. Your communication with the patient will be more
effective if you determine where that person is on Maslow’s
hierarchy. Effective therapeutic communication recognizes the
stage on the Maslow hierarchy pyramid, provides empathy and
understanding, and then strives to discover a motivating factor
within that level.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Maslow’s Hierarchy, cont’d.
Figure 7-2. Maslow’s hierarchy of human needs.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Stages of Death and Dying
Another progression in human life involves the stages of death and
dying. Elizabeth Kübler-Ross is credited as being the first to
formally outline these stages. The patient and the patient’s family
and close friends all experience the continuum. Communication is
more effective when the stage is recognized and appropriate
accommodations are made.
■ Denial—refusing to accept that death will soon occur or has
occurred
■ Anger—lashing out at a deity, family and friends, and health
care providers
■ Bargaining—attempting to gain time through negotiating,
pleading with a deity, with health care providers to do more,
and with self
■ Depression—withdrawing, feeling low in spirits
■ Acceptance—resigning to the situation, preparing (if time
permits), and feeling tranquil
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins