The Communication Process

1. Chapter 16
The Communication Process

2. Communication
• Exchanging messages between sender
and receiver
• Types:
– Oral
– Nonverbal
– Written
– Electronic

3. Communication in Health Care
• Excellence in communication essential in
health care
– Increase in size of delivery systems
• Need for intercommunication
– More complex payment systems
– Decrease in time spent in hospitals
• Importance of patient education

4. Communication in Health Care
• Shift in causes of death to heart disease,
cancer, COPD, and stroke
– Patient information regarding wellness and
healthy lifestyles

5. Communication and Patient
Well-Being
• Need for respect and understanding of
individual patients and their needs
• Impact on speed of patient recovery

6. Communication and Patient
Well-Being
• Stressors for patients:
– Intimidation of health care setting
– Fear and anxiety
• Poor communication can lead to fatal
errors

7. Communication Process
• Communication
– More than talking and listening
• Therapeutic communication = effective
health care communication
– Aimed at meeting needs of patients
– Requires developing and applying
communication skills

8. Communication Process
1. Set communication goals
2. Create message
3. Deliver message
4. Listen to response
5. Offer feedback and seek clarification
6. Evaluate encounter
– And revise message, if necessary

9. 1. Set Communication Goals
• Decide what is to be accomplished
• Therapeutic communication usually at
deeper level than everyday conversation
– Must be clear and accurate

10. 1. Set Communication Goals
• Examples of goals:
– Gather information from patient
– Give instructions to patients
– Report information to coworker

11. 1. Set Communication Goals
• Goals to include in every patient
interaction:
– Show sincere concern for patient’s welfare
– Establish trust
– Enhance patient’s self-esteem

12. Question
• True or False:
– Today’s health care services are so
technologically advanced that there is little
point in allowing patients to participate in
making decisions about their health.

13. Answer
• False
• Patients should be involved in decision
making whenever possible

14. 1. Set Communication Goals
• Factors to consider when setting goal:
– Patient’s level of understanding
– Emotional factors
– Physical factors
– Urgency of communication

15. 2. Create Message
• Create message based on information
gathered and communication goal
• Avoid medical terminology with patients
– Use general language
• Rather than slang

16. 2. Create Message
• Must be clear and accurate
• Organize long messages
– Rank items in order of importance
– Give overview and then details
– Break information into chunks
• Messages can be in form of question

17. 2. Create Message
• Types of questions:
– Closed-ended
• Can be answered with one word or phrase
– Open-ended
• Requires more than one-word answer

18. 2. Create Message
• Types of questions:
– Probing
• Asks for more information
– Leading
• Question includes possible answer

19. Question
• “What is your date of birth?” is an example
of a/an _____ question.
A. Probing
B. Open-ended
C. Closed-ended

20. Answer
• C. Closed-ended
• Response to question is one word or short
phrase that functions like one word
– Therefore closed-ended

21. Question
• True or False:
– An appropriate use of a leading question is with
patients who are unable to offer complete
answers on their own.

22. Answer
• True
• Leading question offers part or all of
answer
– Can be helpful when patients cannot create
answer themselves

23. 2. Create Message
• When asking questions:
– Allow time for response
– Take care with leading questions
• Because patient may simply agree with you
– Reword questions when necessary

24. 2. Create Message
• Humor appropriate when used carefully
– Helps relieve tension
– Can promote open discussion of sensitive
issues
• Patient jokes to mask fear
– Listen carefully
– Patient may need help dealing with fear

25. 3. Deliver Message
• Address patients directly whenever
possible
– Young and elderly patients
• Use titles to show respect
– Ask patients how they wish to be addressed

26. 3. Deliver Message
• Take care not to breach confidentiality
• Maintain communication with patients who
cannot speak to respond

27. Question
• True or False:
– Using casual words such as “like” and “you
know” in your messages to patients can help
them feel more at ease.

28. Answer
• False
• Filler words should be avoided
– Can be distracting to your message and/or
irritating for some listeners

29. 3. Deliver Message: Nonverbal
Communication
• Delivers up to 70% of meaning of oral
message
• Nonverbal communication includes the
following:
– Tone of voice
– Touch
• Can be reassuring, but use with care

30. 3. Deliver Message: Nonverbal
Communication
• Nonverbal communication includes the
following:
– Body language
• Gestures can be positive or negative
– Smiling
– Crossing arms
– Rolling eyes

31. 3. Deliver Message: Nonverbal
Communication
• Nonverbal communication includes the
following:
– Facial expressions
• Avoid showing negative reactions
– E.g., impatience, disgust
– Physical appearance
• Sign of health care professional competence and
regard for patients

32. Question
• Leaning toward the speaker when you are
listening is usually a sign of:
A. Aggression
B. Interest
C. Difficulty understanding

33. Answer
• B. Interest
• Leaning toward speaker
– Sign of interest in what speaker is saying

34. 3. Deliver Message: Physical
Environment
• Can affect delivery of message
• Factors to consider:
– Light source
– Sound distractions
– Privacy
– Focus on patient
– Patient comfort

35. 4. Listen to Response
• Listening
– Active process
• Concentration
• Attention
• Observation

36. Question
• Which is the most important characteristic
of active listening?
A. Taking notes while listening
B. Maintaining eye contact with the speaker
C. Focusing fully on what the speaker is saying

37. Answer
• C. Focusing fully on what the speaker is
saying
• Active listening may involve other actions,
but focusing fully on speaker is the
underlying characteristic

38. 4. Listen to Response: Empathy
• Empathy
– Effort to understand other peoples’ thoughts,
feelings, and behaviors
– “Walk a mile in my shoes”
• Communicate awareness of patient’s
feelings

39. 5. Offer Feedback and Seek
Clarification
• Feedback
– Method for receiver to check understanding of
what sender says
• Types of feedback:
– Paraphrasing
• Rewording of sender’s message in receiver’s own
words

40. 5. Offer Feedback and Seek
Clarification
• Types of feedback:
– Reflecting
• Prompting receiver to complete or add to original
message
– Asking questions
• Requesting clarification and additional information
– Requesting examples
• Asking for examples to clarify and fill in meaning

41. Question
• “I hear you saying you feel better after
you’ve done the exercises I taught you last
week” is an example of:
A. Paraphrasing
B. Reflecting
C. Asking a leading question

42. Answer
• A. Paraphrasing
• Paraphrasing
– Stating in own words what you think sender
said

43. 6. Evaluate Encounter
• Determine if communication goal met
• If not met, identify difficulty
• Continually evaluate communication
throughout encounter

44. 6. Evaluate Encounter:
Communication Barriers
• Barriers can block effective communication
• Examples of barriers:
– Cultural differences
– Language differences
– Defense mechanisms
– Physical distractions
– Pain

45. Patients with Special Needs
• Terminally ill
– May experience loneliness
– May want to share fears and concerns
– Health care professionals need to come to
terms with death as patient outcome

46. Patients with Special Needs
• Those with pain, medication, or
disorientation
– Identify self and say patient’s name
– Speak slowly and maintain eye contact
– Use simple, short messages
– Repeat as necessary and review content
– Use touch, if appropriate
– Try to schedule best time for patient

47. Patients with Special Needs
• Those with Alzheimer’s disease and other
forms of dementia
– Do not confront
– Use short sentences
– Agree or distract when patient doesn’t make
sense
– Respond to patient’s feelings
– Offer suggestions, not corrections

48. Patients with Special Needs
• Those who are depressed
– Invite patients to discuss their feelings
– Offer hope
But do not tell to cheer up
– Allow for silence

49. Patients with Special Needs
• Those who are anxious
– Maintain calm
– Monitor anxiety level
– Keep message simple
– Stick to one topic
– Use feedback to check understanding

50. Patients with Special Needs
• Hearing impaired
– Observe behavior and check for understanding
– Ensure face and mouth of speaker are visible
– Speak slowly and clearly
– Turn off sources of noise
– Do not shout
– Announce change of subject

51. Question
• When a listener leans forward and turns his
head, this is may be a sign of a/an _____ .
A. Hearing impairment
B. Visual impairment
C. Inability to understand English

52. Answer
• A. Hearing impairment
• Two of several signs that listener is hearing
impaired:
– Leaning toward speaker
– Turning head

53. Patients with Special Needs
• Visually impaired
– Announce presence and identify self
– Explain procedures, sounds, and what patient
can expect
– Give detailed instructions about what patient is
to do

54. Patients with Special Needs
• Visually impaired
– Tell patient when leaving
– Give information about doorways, obstacles,
etc., if patient is leaving area alone

55. Patients with Special Needs
• Speech impaired
– Use pantomime and gestures
– Use drawings and pictures
– Write
– Use communication boards

56. Patients with Special Needs
• Anger
– Emotional response to perceived wrong
– Loss of personal control
– Worries and fears
– Health care professional should not take
personally

57. Patients with Special Needs
• Anger
– Dealing with angry patients
• Remain calm
• Do not respond in anger
• Do not argue
• Listen carefully and express concern
• Answer patient’s questions
• Ask for help, if necessary

58. Patients with Special Needs
• Patients who do not speak English
– Empathize with situation
– Smile, if appropriate
– Determine if someone can interpret
– Speak slowly and clearly
– Repeat message in different words
– Use pantomime and gestures
– Write message

59. Special Applications of
Communication Skills
• Telephone communication
– Often first means of contact with health care
facility
– Person answering represents facility
– Guidelines:
• Speak clearly
• Speak at moderate rate

60. Special Applications of
Communication Skills
• Telephone communication
– Guidelines:
• Project warmth and caring
• “Smile” in voice, if appropriate
• Avoid speaking in monotone
• Give caller chance to speak
• Never chew gum or eat

61. Special Applications of
Communication Skills
• Patient education
– Patients want information
– More self-care required today

62. Special Applications of
Communication Skills
• Patient education
– Process for delivering patient education
1. Set educational goals
2. Create instructional message
3. Deliver instruction
4. Listen to patient questions
5. Check for patient understanding
6. Evaluate instruction

63. Special Applications of
Communication Skills
• Group presentations
– E.g., patient’s family, professional meeting,
coworkers at staff meeting

64. Special Applications of
Communication Skills
• Group presentations
– Strategies for success:
• Clarify purpose and important points
• Determine needs of audience
• Organize material and prepare notes
• Speak at moderate rate
• Look at audience

65. Gossip
• Unnecessary, negative conversation
• Avoid at workplace
• Strategies for handling:
– Explain unfairness
– State belief in inappropriateness
– Change subject

66. Patient Privacy
• Avoid speaking in public about patients
• Do not discuss patients in social
conversations
• Do not discuss patients in front of them if
they are not included in conversation