Therapeutic Communication differs fromnormal communication in that it introducesan element of EMPATHY into what can bea traumatic experience for the patient.It imparts a feeling of comfort in theface of even the most horrific newsabout the patient’s prognosis.The patient is made to feel validatedand respected. Showing Empathy
Personal preferences, biases and prejudices will enter into manyphysician-patient relationship.BIAS – a slant toward a particular belief.PREJUDICE – an opinion or judgment that is formed before the facts areknown.Common biases and prejudices in today’s society include:1. A preference for Western style medicine2. Choosing physicians according to gender3. Prejudice related to a person’s sexual preference4. Discrimination based on race or religion5. Hostile attitudes toward people with different value system than one’s own6. A belief that people who cannot afford healthcare should receive less care than someone who can pay for full services.
The SenderThe sender begins thecommunication cycle by encodingor creating the message to be sent.Before creating the message, thesender must observe the receiverto determine the complexity of thewords to be used within themessage, the receiver’s ability tointerpret the message, and the bestchannel by which to send themessage.
The MessageThe message is the content beingcommunicated. The message mustbe clearly understood by thereceiver.Four modes of communication:•Speaking•Listening•Gestures or body language•WritingThese modes or channels are affected by our physicaland mental development; our culture; our education andlife experiences; our impressions from models andmentors, and in general by how we feel and acceptourselves as individuals.
The ReceiverThe receiver is the recipient of thesender’s message. The receivermust decode, or interpret, themeaning of the message.The primary sensory skill used inverbal communication is listening.The receiver must be aware thatnot only the spoken words, but thetone and pitch of the voice and thespeed at which the words arespoken carry meaning and must beevaluated.
The FeedbackFeedback takes the place after thereceiver has decoded the message sentby the sender.Feedback is the receiver’s way ofensuring that the message that isunderstood is the same message thatwas sent.Feedback also provides an opportunityfor the receiver to clarify anymisunderstanding regarding the originalmessage and to ask for additionalinformation.
Active ListeningActive listening involves a “third ear,” that is, beingaware of what the patient is not saying or picking upon hints to the real message by observing bodylanguage. The health care professional should havethree listening goals:1. To improve listening skills sufficiently so that patients are heard accurately.2. To listen to either what is not being said or for information transmitted only by hints.3. To determine how accurately the message has been received.
VERBAL COMMUNICATIONVerbal communication takes place when themessage is spoken.One must keep in mind that unless the wordshave meaning, and unless the sender and thereceiver apply the same meaning to the spokenwords, verbal communication may bemisunderstood.To have any meaning, the spoken word mustbe understood by all parties of thecommunication.
VERBAL COMMUNICATIONThe Five Cs of Communication Complete. The message must be complete, with all the necessary information given. The medical assistant cannot expect the patient to be compliant if the instructions are not given and understood. Clear. The information given in the message must also be clear.
VERBAL COMMUNICATIONThe Five Cs of Communication Concise. A concise message is one that does not include unnecessary information. It should be brief and to the point. Avoid technical terms that may not be understood by the patient. Courteous. Courtesy is important in all aspects of communication. It only takes a moment to acknowledge a patient with a smile or by name. Likewise, be courteous to colleagues in the office.
VERBAL COMMUNICATIONThe Five Cs of Communication Cohesive. A cohesive message is organized and logical in its progression. It doesn’t rumble nor jump from one subject to another. The patient should be able to follow the message easily. The medical assistant should always allow time to summarize detailed messages and use responding skills to verify that the patient fully understands the message.
VERBAL COMMUNICATIONWhen communicating within health professions,keep in mind the following:1. Good communication skills are necessary in establishing rapport with patients.2. Patients feel respected and validated when called by their full name.3. Patients should be encouraged to verbalize their feelings.4. Patients should b given technical information in a manner that they can understand.5. Patients should be allowed to make practical application to their personal health needs.
NON VERBALCOMMUNICATIONNon-verbal communication, often referred toas body language, includes the unconsciousbody movements, gestures and facialexpressions that accompany speech.The study of body language is known askinesics.Body language can communicate more than spoken words.
NON VERBALCOMMUNICATIONFacial Expression. This is considered as oneof the most important and observed non-verbalcommunication. Each facet or aspect ofanatomy of the face sends a non-verbalmessage.Often expressions of joy and happiness orsorrow and grief are reflected through the eyes.The anatomy of the eyes does not change, butthe movement of the structures surrounding theeyes enhance or magnify the message beingcommunicated.Cultural influences affect customs and differentforms of facial expressions.
NON VERBALCOMMUNICATIONTerritoriality. This is the distance at which wecomfortable with others while communicating.Some examples of comfortable personal spacefor U.S. culture are as follows:• Intimate: touching to 6 inches• Personal: 1 ½ to 4 feet• Social: 4 to 12 feet• Public: 12 to 15 feetAs with facial expression, territoriality orpersonal space is handled differently by variouscultures.
NON VERBALCOMMUNICATIONPosture. Posture relates to the position of thebody or parts of the body. It is the manner inwhich we carry ourselves, or pose in situations.Those who study kinesics believe that a postureinvolves at least half the body, and that theposition can last for nearly five minutes.
NON VERBALCOMMUNICATIONPosition. The physical stance of twoindividuals, while communicating is a key factorwhile communicating with the patient.When speaking with a patient, the physician ormedical assistant will want to maintain a closebut comfortable position, enabling observationof all clues being sent, bother verbal and non-verbal. Positive posture and position encourage therapeutic communication.
NON VERBALCOMMUNICATIONGestures and Mannerisms. Most of us usegestures and mannerisms when we “talk” withour hands.This form of body language may be useful inenhancing the spoken word by emphasizingideas, thus creating and holding the attention ofothers.
NON VERBALCOMMUNICATIONTouch. This is a powerful tool thatcommunicates what cannot be expressed inwords.The touch that communicates caring, sincerity,understanding, and reassurance is usuallywelcomes and considered to be a therapeuticresponse.However, not all patients are comfortable withtouch. Whenever a patient is not comfortablewith touch, ask permission and create as safeand reassuring an environment as possible.
Congruence is an abstract term that applies tosimilarity in objects.When applied to therapeutic communication,congruence, or congruency in therapeuticcommunication, it simply means that there hadto be agreement between verbal and non-verbalcommunication in order to the message to besuccessfully delivered to the patient.Shaking your head NO while saying YES is anexample of what congruency is NOT, and issends a mixed message.
It is also important to remember that most non-verbal messages are sent in groups of variousforms of body languages:• Clustering – the grouping of non-verbal messages into statements or conclusions.• Masking – an attempt to conceal or repress the true feeling or message.• Perception – the conscious awareness of one’s own feelings and the feelings of others.
ESTABLISHING CROSS-CULTURALCOMMUNICATIONPatient trust must first be established beforeany cross-cultural communication can begin.The following are some steps to buildingtrust:• Risk/Trust: Promise no more than you can deliver. Be honest, and carefully and thoroughly explain procedures and policies. Answer all questions truthfully and honestly.• Empathy: The ability to accept another’s private world as f it were yours. IT communicates identification with and understanding of another’s situation. It states, “I’m available to walk this road with you.”
ESTABLISHING CROSS-CULTURALCOMMUNICATION• Respect: Respect values another person and considers her or him as a special individual. It is important to respect a patient’s personal space, to provide privacy, and to use his or her full name and title when appropriate.• Genuineness: This means being real and honest with others. The health care professional must be able to communicate honestly with others, while being careful not to blame or condemn.
ESTABLISHING CROSS-CULTURALCOMMUNICATION• Active Listening. Active listening involves verbal and non-verbal clues that send the message you are completely involved in the communication. Maintain an open, relaxed posture to establish an non-threatening environment for the patient. Listen carefully to the words the patient uses to describe problems, and use those terms rather than medical terminology when discussing symptoms.
Cultural Brokering Cultural brokering is “the act of bridging linking, or mediating between groups or persons through the process of reducing conflict or producing change.” A cultural broker serves as a go-between, or one who advocates on behalf of another individual or group within he health care community.
Maslow’s Hierarchy ofNeeds Maslow is considered the founder ofAbrahamhumanistic psychology and is most well knownfor his hierarchy of needs. Abraham Maslow Maslow’s Hierarchy of Needs
Maslow’s Hierarchy ofNeeds PHYSIOLOGIC OR SURVIVAL NEEDS.First Level:These needs include food, water, and air to breath-homeostasis for the body. Maslow’s Hierarchy of Needs
Maslow’s Hierarchy ofNeedsSecond Level: SAFETY AND STABILITYThese needs include safety, security (stability) andprotection. Everyone has a desire to be free fromfear and anxiety. Safety needs also include the needfor structure, law and order, and limits. Maslow’s Hierarchy of Needs
Maslow’s Hierarchy ofNeeds SOCIAL DESIRE (Belonging and loveThird Level:needs).This third level involves both giving and receivingaffection. Maslow’s Hierarchy of Needs
Maslow’s Hierarchy ofNeedsFourth Level: SELF ESTEEM (Prestige andesteem needs.These needs come from a basic need for a stable,healthy self-respect for ourselves and others. Maslow’s Hierarchy of Needs
Maslow’s Hierarchy ofNeeds SELF REALIZATION (Actualization)Fifth Level:In this level, we at our peak, doing what truly fits us.It is an achievement of potential. Maslow’s Hierarchy of Needs
At times a patient may need to be referredto a community resource. This could be assimple as arranging with Meals on Wheelsto deliver daily hot meals, or as complexas arranging for skilled nursing facilities orhospice care.
Technology-mediated communication anda greater reliance on cyberspacetechnology will greatly affectcommunication in the twenty-first century.Examples of new technologies in medicaloffices:• Interactive videoconferencing• Clinical e-mail• Automated routing units• Instant messaging• Paging systems• Physician digital assistants
Roadblocks close communication andprevent quality care of the total person.The following are examples:• Reassuring clichés• Moralizing/ lecturing• Requiring explanations• Ridiculing/shaming• Defending/contradicting• Shifting Subjects• Criticizing• ThreateningBeing sensitive to patients’ uniquepersonalities and needs enable thehealth care professional to avoid theseroadblocks to communication.
Defense mechanisms are defined asbehavior that is used to protect the egofrom guilt, anxiety, or loss of esteem.It is the body’s way of seeking relieffrom uncomfortable or painful reality.Defense mechanisms are difficult toanalyze without knowledge of the motivebehind the behavior.
Regression – An attempt to withdrawfrom an unpleasant circumstance byretreating to an earlier, more securestage of life.Use of a security blanket by an adult orchild when faced with something thatdisrupts his or her life is an example ofregression.Denial – Refusal to accept painfulinformation that is readily apparent toothers. It is often the first stage of anemotional response after a traumaticevent.
Repression - Similar to denial, but it isa totally unconscious reaction, in whichcase the person seems to experiencetemporary amnesia.It is the mind’s way of defending itselffrom mental trauma by forgetting orwiping things out of the consciousmemory.Projection – Attributing unacceptabledesires, impulse and thoughts falsely toothers to avoid acknowledging they areactually the person’s own experiences.
Sublimation – The channeling of asocially unacceptable behavior into asocially acceptable behavior.An overly aggressive person directed toplay football to relieve his aggression isan example o sublimation.Displacement – The unconscioustransfer of unacceptable emotions,thoughts, or feelings from one’s self to amore acceptable external substitute.Compensation – A conscious orunconscious overemphasizing of acharacteristic to offset a real orimagined deficiency.
Rationalization – The mind’s way ofmaking unacceptable behavior orevents acceptable by devising a rationalreason.The purpose of rationalization is toavoid embarrassment or guilt, or toavoid obeying a directive.Undoing – An action designed to makeamends or to cancel out inappropriatebehavior.Showering the abused with gifts tocompensate for unacceptable actionsthat took place in the past is anexample.
Interview Techniques. All healthprofessionals must be adept at interviewtechniques – knowing how to encourage thebest communication between them and thepatient.Early in the interview, the patient must feelcomfortable enough to risk being honest withthe health professional. The healthprofessional must build an atmosphere of trustby showing concern for the patient.Always be honest and genuine in yourresponses to the patient. Be sympathetic andempathic and create an environment that isdevoid of hypocrisy.
It is important to listen with a “third” ear. Listento what the patient is not saying but is apt toexhibit through non-verbal communication.Closed Questions – those that can beanswered by “yes” or “no.”Open-Ended Questions – Probing questionsthat encourage therapeutic communicationbecause the patient is required to verbalizemore information.Indirect Statements – Statements that willelicit a response from a patient without thepatient feeling being questioned.
Telephone Techniques. Communication overthe telephone requires understanding on thepart of each communicator.When communicating over the telephone,listen with full attention to make certain that the message se and received is correct.Observe all the techniques for effective face-toface communication even when thecommunication is over the telephone becauseyou cannot see the person with whom you arespeaking.
Consider the following, for example, whenclosing an appointment over the telephone:1. Use the patient’s name if it can be done without announcing the name to persons in the reception area.2. Confirm the date and time of the appointment.3. Identify the physician if there is more than one physician in the office.4. Give any specific instructions that may be necessary.5. Say good-bye.
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