Communication skills therapeutic

Therapeutic Communication differs from normal communication in that it introduces an element of EMPATHY into what can be a traumatic experience for the patient.

It imparts a feeling of comfort in the face of even the most horrific news about the patient’s prognosis.

The patient is made to feel validated and respected.

Showing Empathy

Personal preferences, biases and prejudices will enter into many physician-patient relationship.

BIAS – a slant toward a particular belief.PREJUDICE – an opinion or judgment that is formed before the facts are known.

Common biases and prejudices in today’s society include:

1. A preference for Western style medicine

2. Choosing physicians according to gender

3. Prejudice related to a person’s sexual preference

4. Discrimination based on race or religion

5. Hostile attitudes toward people with different value system than one’s own

6. A belief that people who cannot afford healthcare should receive less care than someone who can pay for full services.

The SenderThe sender begins the communication cycle by encoding or creating the message to be sent.

Before creating the message, the sender must observe the receiver to determine the complexity of the words to be used within the message, the receiver’s ability to interpret the message, and the best channel by which to send the message.

The MessageThe message is the content being communicated. The message must be clearly understood by the receiver.

Four modes of communication:

•Speaking•Listening•Gestures or body language•Writing

These modes or channels are affected by our physical and mental development; our culture; our education and life experiences; our impressions from models and mentors, and in general by how we feel and accept ourselves as individuals.

The ReceiverThe receiver is the recipient of the sender’s message. The receiver must decode, or interpret, the meaning of the message.

The primary sensory skill used in verbal communication is listening.

The receiver must be aware that not only the spoken words, but the tone and pitch of the voice and the speed at which the words are spoken carry meaning and must be evaluated.

The FeedbackFeedback takes the place after the receiver has decoded the message sent by the sender.

Feedback is the receiver’s way of ensuring that the message that is understood is the same message that was sent.

Feedback also provides an opportunity for the receiver to clarify any misunderstanding regarding the original message and to ask for additional information.

Active Listening Active listening involves a “third ear,” that is, being aware of what the patient is not saying or picking up on hints to the real message by observing body language. The health care professional should have three 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 COMMUNICATION

Verbal communication takes place when the message is spoken.

One must keep in mind that unless the words have meaning, and unless the sender and the receiver apply the same meaning to the spoken words, verbal communication may be misunderstood.

To have any meaning, the spoken word must be understood by all parties of the communication.


The 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.



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.



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.


When 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 VERBAL COMMUNICATION

Non-verbal communication, often referred to as body language, includes the unconscious body movements, gestures and facial expressions that accompany speech.

The study of body language is known as kinesics.

Body language can communicate more than spoken words.


Facial Expression. This is considered as one of the most important and observed non-verbal communication. Each facet or aspect of anatomy of the face sends a non-verbal message.

Often expressions of joy and happiness or sorrow and grief are reflected through the eyes.

The anatomy of the eyes does not change, but the movement of the structures surrounding the eyes enhance or magnify the message being communicated.

Cultural influences affect customs and different forms of facial expressions.


Territoriality. This is the distance at which we comfortable with others while communicating.

Some examples of comfortable personal space for 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 feet

As with facial expression, territoriality or personal space is handled differently by various cultures.


Posture. Posture relates to the position of the body or parts of the body. It is the manner in which we carry ourselves, or pose in situations.

Those who study kinesics believe that a posture involves at least half the body, and that the position can last for nearly five minutes.


Position. The physical stance of two individuals, while communicating is a key factor while communicating with the patient.

When speaking with a patient, the physician or medical assistant will want to maintain a close but comfortable position, enabling observation of all clues being sent, bother verbal and non-verbal.

Positive posture and position encourage therapeutic communication.


Gestures and Mannerisms. Most of us use gestures and mannerisms when we “talk” with our hands.

This form of body language may be useful in enhancing the spoken word by emphasizing ideas, thus creating and holding the attention of others.


Touch. This is a powerful tool that communicates what cannot be expressed in words.

The touch that communicates caring, sincerity, understanding, and reassurance is usually welcomes and considered to be a therapeutic response.

However, not all patients are comfortable with touch. Whenever a patient is not comfortable with touch, ask permission and create as safe and reassuring an environment as possible.

Congruence is an abstract term that applies to similarity in objects.

When applied to therapeutic communication, congruence, or congruency in therapeutic communication, it simply means that there had to be agreement between verbal and non-verbal communication in order to the message to be successfully delivered to the patient.

Shaking your head NO while saying YES is an example of what congruency is NOT, and is sends a mixed message.

It is also important to remember that most non-verbal messages are sent in groups of various forms 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-CULTURAL COMMUNICATION

• 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.”

Patient trust must first be established before any cross-cultural communication can begin. The following are some steps to building trust:


• 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.


• 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 of Needs

Abraham Maslow is considered the founder of humanistic psychology and is most well known for his hierarchy of needs.

Abraham Maslow Maslow’s Hierarchy of Needs


First Level: PHYSIOLOGIC OR SURVIVAL NEEDS.

These needs include food, water, and air to breath- homeostasis for the body.



Second Level: SAFETY AND STABILITY

These needs include safety, security (stability) and protection. Everyone has a desire to be free from fear and anxiety. Safety needs also include the need for structure, law and order, and limits.



Third Level: SOCIAL DESIRE (Belonging and love needs).

This third level involves both giving and receiving affection.



Fourth Level: SELF ESTEEM (Prestige and esteem needs.

These needs come from a basic need for a stable, healthy self-respect for ourselves and others.



Fifth Level: SELF REALIZATION (Actualization)

In this level, we at our peak, doing what truly fits us. It is an achievement of potential.


At times a patient may need to be referred to a community resource. This could be as simple as arranging with Meals on Wheels to deliver daily hot meals, or as complex as arranging for skilled nursing facilities or hospice care.

Technology-mediated communication and a greater reliance on cyberspace technology will greatly affect communication in the twenty-first century.

Examples of new technologies in medical offices:

• Interactive videoconferencing• Clinical e-mail• Automated routing units• Instant messaging• Paging systems• Physician digital assistants

Roadblocks close communication and prevent quality care of the total person. The following are examples:

• Reassuring clichés• Moralizing/ lecturing• Requiring explanations• Ridiculing/shaming• Defending/contradicting• Shifting Subjects• Criticizing• Threatening

Being sensitive to patients’ unique personalities and needs enable the health care professional to avoid these roadblocks to communication.

Defense mechanisms are defined as behavior that is used to protect the ego from guilt, anxiety, or loss of esteem.

It is the body’s way of seeking relief from uncomfortable or painful reality.

Defense mechanisms are difficult to analyze without knowledge of the motive behind the behavior.

Regression – An attempt to withdraw from an unpleasant circumstance by retreating to an earlier, more secure stage of life.

Use of a security blanket by an adult or child when faced with something that disrupts his or her life is an example of regression.

Denial – Refusal to accept painful information that is readily apparent to others. It is often the first stage of an emotional response after a traumatic event.

Repression - Similar to denial, but it is a totally unconscious reaction, in which case the person seems to experience temporary amnesia.

It is the mind’s way of defending itself from mental trauma by forgetting or wiping things out of the conscious memory.

Projection – Attributing unacceptable desires, impulse and thoughts falsely to others to avoid acknowledging they are actually the person’s own experiences.

Sublimation – The channeling of a socially unacceptable behavior into a socially acceptable behavior.

An overly aggressive person directed to play football to relieve his aggression is an example o sublimation.

Displacement – The unconscious transfer of unacceptable emotions, thoughts, or feelings from one’s self to a more acceptable external substitute.

Compensation – A conscious or unconscious overemphasizing of a characteristic to offset a real or imagined deficiency.

Rationalization – The mind’s way of making unacceptable behavior or events acceptable by devising a rational reason.

The purpose of rationalization is to avoid embarrassment or guilt, or to avoid obeying a directive.

Undoing – An action designed to make amends or to cancel out inappropriate behavior.

Showering the abused with gifts to compensate for unacceptable actions that took place in the past is an example.

Interview Techniques. All health professionals must be adept at interview techniques – knowing how to encourage the best communication between them and the patient.

Early in the interview, the patient must feel comfortable enough to risk being honest with the health professional. The health professional must build an atmosphere of trust by showing concern for the patient.

Always be honest and genuine in your responses to the patient. Be sympathetic and empathic and create an environment that is devoid of hypocrisy.

It is important to listen with a “third” ear. Listen to what the patient is not saying but is apt to exhibit through non-verbal communication.

Closed Questions – those that can be answered by “yes” or “no.”

Open-Ended Questions – Probing questions that encourage therapeutic communication because the patient is required to verbalize more information.

Indirect Statements – Statements that will elicit a response from a patient without the patient feeling being questioned.

Telephone Techniques. Communication over the telephone requires understanding on the part of each communicator.

When communicating over the telephone, listen with full attention to make certain that t he message se and received is correct.

Observe all the techniques for effective face-to face communication even when the communication is over the telephone because you cannot see the person with whom you are speaking.

Consider the following, for example, when closing 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.

Communication skills therapeutic

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