Download Chapter 5 - Medical Assistant Program

Chapter 5
Therapeutic Communication Skills
© 2014 Cengage©Learning.
2014 Cengage
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Importance of Communication
• Therapeutic communication
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Introduces element of empathy
Specific and well-defined professional skills
Foundation of all patient care
Nontechnical language
Technically accurate
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
The Communication Cycle
• Two or more individuals exchanging
information
• Sending and receiving messages
• Four basic elements
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Sender
Message and channel or mode of communication
Receiver
Feedback
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
The Communication Cycle
The communication cycle and
channels of communication >>
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
The Communication Cycle
• The sender
– Encoding or creating message to be sent
• The message
– Content being communicated
– Must be understood clearly by receiver
– Four modes of communication
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Speaking
Listening
Gestures or body language
Writing
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
The Communication Cycle
• The receiver
– Recipient of sender’s message
– Must decode (interpret) meaning of message
– Sensory skill in verbal communication is listening
• Feedback
– After receiver has decoded message sent by
sender
– Receiver’s way of ensuring message that is
understood is same as message sent
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
The Communication Cycle
• Listening skills
– Active listening: received message sent back to
sender, worded a little differently, for verification
from sender
– Listening with a “third ear”
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
The Communication Cycle
• Listening skills
– Listening goals
• Improve listening skills so patients are heard accurately
• Listen either for what is not being said or for information
transmitted only by hints
• Determine how accurately message has been received
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Types of Communication
• Verbal communication
– Takes place when message is spoken
– Sender and receiver must apply same meaning to
spoken words
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Types of Communication
• Verbal communication
– The Five Cs of communication
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Complete
Clear
Concise
Cohesive
Courteous
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Types of Communication
• Verbal communication
– Good communication skills necessary in
establishing rapport with patients
– Patients feel respected and validated when called
by full name
– Patients should be encouraged to verbalize their
feelings and concerns
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Types of Communication
• Verbal communication
– Patients should be given technical information in
manner that they can understand
– Patients should be allowed to make practical
application to their personal health needs
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Types of Communication
• Nonverbal
communication
– Body language
• Unconscious body
movements,
gestures, facial
expressions
Body language can
communicate more than
spoken words >>
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Types of Communication
• Nonverbal communication
– Body language
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Expressions that accompany speech
Kinesics is study of body language
Body language learned first
Body language influenced by primary caregivers and
culture
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Types of Communication
• Nonverbal communication
– Feelings and emotions communicated through
nonverbal means
• 70% of language is nonverbal
• Tone of voice communicates 23% of message
• Spoken word communicates 7% of message
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Types of Communication
• Nonverbal communication
– Facial expression
• Eyes reflect feelings
• Staring is invasion of privacy
• Cultural influences affect facial expressions
– Personal space
• Comfortable with others while communicating
• Handled differently by various cultures
• Beneficial to explain procedures that invade another’s
space
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Types of Communication
• Nonverbal communication
– Posture
• Relates to position of body or parts of body
• Involves at least half the body
– Position
• Physical stance of two individuals while communicating
• Face-to-face communication
• Should enable observation of verbal and nonverbal cues
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Types of Communication
Nonverbal
communication
Positive posture and
position encourage
therapeutic
communication >>
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Types of Communication
• Nonverbal communication
– Gestures and mannerisms
• “Talk” with hands
• Enhances spoken word
– Touch
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Communicates what cannot be expressed in words
Requires use of good judgment on part of professional
Linked closely to personal space
Not all patients are comfortable with touch
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Congruency in Communication
• Please refer to the video “Interpreting
Communication” through the instructor
companion site.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Congruency in Communication
• Verbal and nonverbal messages must
agree
• Meaning of mixed messages
• Clustering: grouping of nonverbal
messages into statements or
conclusions
• Masking: attempt to conceal or repress
true feeling or message
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Congruency in Communication
• Perception
– Conscious awareness of one’s own feelings and
the feelings of others
– Sense another’s attitudes, moods, feelings
– Follow perceived assessments with verbal
validation
– Easily misinterpreted
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Factors Affecting Therapeutic
Communication
• Barriers
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Age
Economic
Education and life experience
Bias and prejudice
Verbal roadblocks
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Factors Affecting Therapeutic
Communication
• Defense mechanisms
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Regression
Denial
Repression
Projection
Sublimation
Displacement
Compensation
Rationalization
Undoing
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Factors Affecting Therapeutic
Communication
• Barriers caused by cultural and religious
diversity
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Communication context
Caregiving expectations
Time focus
Attitude toward Western medicine
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Factors Affecting Therapeutic
Communication
• Human needs
as barriers to
therapeutic
communication
Maslow’s hierarchy of
needs >>
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Factors Affecting Therapeutic
Communication
• Patient with special needs
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English as a second language
Audio challenged
Visually challenged
Mental cognition
• Environmental and time factors
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Establishing Multicultural
Communication
• The patient must trust the professional
• Steps to building trust:
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Risk/trust
Conveying empathy
Showing respect
Being genuine
Active listening
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Establishing Multicultural
Communication
• Cultural brokering
– Bridging, linking, mediating between groups or
persons through process of reducing conflict or
producing change
– Cultural broker serves as go-between
– One who advocates on behalf of another
individual or group within health care community
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Establishing Multicultural
Communication
• Cultural brokering
– Increase capacity of health care and mental health
programs to design, implement, and evaluate
culturally and linguistically competent service
delivery systems
– Cultural broker may assume role of medical
interpreter
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Establishing Multicultural
Communication
• Cultural brokering
– Interpreters do not provide word-for-word
equivalence, but rather focus on accurate
expression of equivalent meaning
– Remember to speak directly to patient, not to
interpreter
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Establishing Multicultural
Communication
• Cultural brokering
– Family member may serve as interpreter
– Family member may not understand medical
terminology
– Difficult for family member to share a lifethreatening diagnosis or a poor prognosis
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Therapeutic Communication in Action
• Interview techniques
– Closed questions: answered with simple yes or no
– Open-ended questions: patient required to
verbalize more information
– Indirect statements: elicit response from patient
without patient feeling questioned
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Therapeutic Communication in Action
• Interview techniques
– Silence: gives patient time to put their feelings and
thoughts into words
– Feedback: words and nonverbal cues important;
offer encouragement to patient to continue
– Give recognition
– Offer comfort
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Therapeutic Communication in Action
• Point of care techniques
– Location where patient and provider or patient and
office personnel physically interact
– Barrier to communication is emotional tension
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Community Resources
• Need to refer patient to community
resource
• List of community resources readily
available
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.