Communications in Health Care Minnesota Healthcare Core Curriculum Created by: Dede Carr, BS, LDA.

Communications in Health Care

Minnesota Healthcare Core CurriculumCreated by: Dede Carr, BS, LDA

These materials are made available by the Minnesota State Colleges and Universities through a Creative Commons Attribution- ShareAlike 3.0 License.

Quotes

Ernest Hemingway: When people talk, listen completely. Most people never listen.

Franklin Delano Roosevelt: Be sincere; be brief; be seated.

George Eliot: It is very hard to say the exact truth, even about your own immediate feelings – much harder than to say something fine about them which is not the exact truth.

Hubert H. Humphrey: The right to be heard does not automatically include the right to be taken seriously.

Jonathan Swift: Argument is the worst sort of conversation.

Anne Morrow Lindbergh: Good communication is as stimulating as black coffee, and just as hard to sleep after.

Clarence Darrow: Even if you do learn to speak correct English, whom are you going to speak it to?

Edward R. Murrow: People say conversation is a lost art; how often I have wished it were.

Competency 11. Describe the components of verbal and non-verbal communication and situations in which these skills can be effectively used.

a. Name two types of communication and give examples of each.

b. Describe the components of communication.

c. List examples of barriers to effective communication.

Todays AbbreviationsMYOB OBO AWCSICS HAK ASAPTGIF GAL FITBSWL HOYEW LOLIOW JAM KITKMA L8R YGLTTSR TTYL TNTL

True or False1. Someone who is as cool as a cucumber, doesn’t

get worried or upset.2. If someone tells you to keep your hair on, they

want you to show more emotion.3. If you work like a dog, you work very hard.4. If something is down in the pan, it has failed.5. If you take to something like a duck takes to

water, you have a natural talent for it.

Verbal Communication Spoken word Written word Give and receive information Be aware of ability to understand words and

written communication Carefully choose words Check tone of voice Be aware of speed of speaking

Components of Effective Communication

1. Sender2. Message3. Receiver4. Feedback

All 4 steps are required for effective communication.

Steps must be in order.

Communication Methods

Composed of different methods Words Voice Tone Non-verbal clues

Words = 7% effective Tone = 38% effective Non-verbal clues = 55% effective

Verbal Communication

Care with: choice of words tone of speech speed of speech volume of speech

BE AWARE OF ABILITY TO UNDERSTAND

Verbal Communication Techniques

Slow/clear speech Receiver is attentive Focus on client’s feelings Repeat message Re-send if necessary

DON’T PRETEND

Non Verbal Communication Body language Facial expressions Use of touch Posture Gestures Silence Movement

Non – Verbal Communication Techniques

Face speaker Good posture Good facial expression Non-verbal supports verbal

WHAT you say is not nearly as important as HOW you say it…

A dull message delivered by a charismatic person filled with energy and enthusiasm will be accepted as brilliant.

An excellent message delivered by someone who is dull will lack enthusiasm of its audience.

The Communication Process – Six Steps

1. Set Communication Goals – Gather info Instruct Inform Report

2. Create the Message Receiver must be able to understand Organize messages Asking Questions –

Closed-ended Open-ended Probing Questions Leading Questions

3. Deliver the Message To whom is the message being delivered

to Understand family cultures and dynamics

4. Listen to Response Concentration Attention Observation

5. Offer Feedback & Seek Clarification Paraphrasing Reflecting Request clarification & additional

information Request examples

6. Evaluate the Encounter Were communication goals met? If goal was not met

Messages clearly stated? Appropriate level? Active listening? Which part was misunderstood?

Components of Communication Sender Message Receiver Feedback

Techniques for Effective Communication

Decrease background noise Listen Pace speech Allow time for response Show interest Eye contact – if appropriate Clear speech Volume as needed

Barriers

Decrease hearing Decrease vision Different language Belittle someone Negativity In a hurry False reassurance Inappropriate environment

Offensive Language vs.Acceptable Language Disabled person vs A person with a disability Blind person vs A person who is visually

impaired Deaf person vs A person who is hearing

impaired S/he is crippled vs S/he has a disability S/he is nuts vs S/he has an emotional illness Fit vs Seizure Retarded vs A person who is

developmentally disabled

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Competency 2 2. Explain how active listening skills can

improve client and team communication. a. List basic listening skills.

b. Describe active listening skills.

QuotesHistory repeats itself because no one listens the first time. —

Anonymous

Conversation: a vocal competition in which the one who is catching his breath is called the listener. — Anonymous

The most basic of all human needs is the need to understand and be understood. The best way to understand people is to listen to them. — Ralph Nichols

Active Listening = Effective Listening

We retain half of what we hear and forget about half of that within 48 hours.

We listen at 125-250 words per minute but think at 1,000-3,000 words per minute.

Active Listening

1. Effective listening isn’t easy Active listening = high blood pressure, higher pulse rate, more

perspiration

2. Information overload is rampant Screen out things that SHOULD be important to us

3. We think faster than we speak Speak = 135-175 words/minute Listen = 400-500 words/minute

4. Listening isn’t something that we teach Lack of training = poor listening skills & habits FOCUS

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Effective Listening Do’s

Build atmosphere of trust Lean forward, make eye contact Have enough time & energy to listen Restate, clarify & sum up what you’ve heard Practice Get feedback

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3 or more of the following

Culprit of non-active listening if: Finish others thoughts Tolerate or create distractions Fake paying attention Create early assumptions without keeping an

open mind Call the subject uninteresting Criticize the speaker or the topic being discussed

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Steroids

Competency 33. Use a variety of communication techniques to achieve effective interpersonal and team communication.

a. Select effective verbal communication techniques.

b. Recognize effective non-verbal communication skills and skills to promote communication with clients/individuals who have difficulty hearing, seeing, speaking or have language barriers.

c. List basic telephone usage.

d. Demonstrate telephone message taking skills.

Effective Verbal Communication Techniques

Speak slowly and clearly Have the attention of the receiver Focus on the client’s/individual’s feelings Repeat the message in your own words to

make sure you understand If you don’t understand the message ask the

sender to re-state the message and do not pretend that you understand

Seek information from the client/individual

Effective Non-verbal Communication

Face the speaker Non-verbal message supports the verbal

message. Appropriate posture Appropriate use of gestures Pleasant facial expression Utilize appropriate listening skills

Communication with Elderly Clients

If hearing is decreased: Face them Be clear Hands not at mouth Stand near Assist with hearing aid Decrease background noise Do not chew gum

If vision is decreased Identify self, give name Knock Reduce glare Assist with glasses Do not move furniture or articles Explain Assist in walking – offer arm Understand potential anger of client

Techniques for Communicating with Language or Speaking Difficulties.

Recognize that a person who cannot speak usually understands what is being said

Recognize that the individual may express anger or frustration when attempting to communicate.

Special Needs Clients

Words to avoid:Abnormal Defect NormalAfflicted Defective PalsiedBurden Deformity PoorDiseased Stricken with GimpCourageous Invalid Suffers withCrippled Unfortunate Victim

TACTFULT = Think before you speakA = Apologize quicklyC = Converse, don’t competeT = Time your commentsF = Focus on behaviorU = Uncover hidden feelingsL = Listen for feedback

Is Technology Killing the Art of Conversation? I am one of those people who still puts pen to

paper. Talking to more people from different countries,

cultures, backgrounds Next time you are in a café, watch how many

people are on their phones instead of talking to the person opposite them.

Many people live away from their friends and would prefer to have instant conversation with them.

Conversation vs. Communication

Basic Phone Usage

Name of facility Your name Soft/friendly voice Clear Moderate speed No gum chewing No personal calls

Message Taking

Date – 01/25/11 Time – 24 hour clock Who for Who from Phone number Reason for call

Competency 44. Describe communication skills that are important when managing conflict.

a. Define conflict.

b. List causes of conflict.

c. List groups in which conflict occurs

d. List communication skills that are important when managing conflict

Conflict Management

Conflict ……………….. is natural and normal part of everyday

life. can be handled in positive or negative

ways. can have either constructive & creative

or destructive results. can be a positive force for personal

growth & socail change

5 Dimensions of Conflict

1. Who or how many parties are involved? Internal Interpersonal Intragroup Intergroup Global

2. What are the sources of conflict? What is it over?

Resources Values Psychological Needs

3. Relationship between/among conflicting parties. Climate Power Balance or Imbalance Degree of Interdependence Know one another

4. What is the history of the conflict? Duration Frequency Intensity Perception

5. The Process: How do we choose to deal with the conflict? Avoidance Diffuse Engage

Communication & Conflict Needs

1. To be listened to2. To be understood3. To be loved & accepted4. To be taken seriously5. To move toward resolution6. Respect

Causes of Conflict

Gender Issues Increased work Threat to safety Threat to security (job) Invasion of personal space

Communication Skills when Managing Conflict Describe the problem as specifically. Avoid describing solutions when identifying the

problem. Consider the problem to be mutual, not one-sided Identify the differences between each party before

solving See the problem from the other side’s point view.

Communication Skills when Managing Conflict…cont…

Use brainstorming to find solutions. Select the solution that meets all parties needs and

all possible consequences Reach an agreement about how the conflict is to end

and not recur. Evaluate the solution

Roadblocks to Communication

Threatening, Warning

You better or else… If you don’t

Preaching You should….. You ought…..

Ordering You must….. You will…. have to…

Lecturing You always…. You never…. Do you realize…

Communication in Conflict

4 Different ways to Communicate when in conflict1. Passive/Nonassertive2. Aggressive3. Passive-Aggressive4. Assertive

Passive/Nonassertive Behavior

is when someone gives up their own rights and (directly or indirectly) defers to the rights of another person. Passive behavior results in an "I lose; you win" outcome. Passive behavior includes violating your own rights through inaction or by failing to express your thoughts, feelings or desires.

"We can do whatever you want. Your ideas are probably better."

Aggressive Behavior

is when someone stands up for their own rights without regard for others. Aggressive behavior results in an "I win; you lose" outcome. Aggression is self-expression which demands, attacks or humiliates other people, generally in a way which shows lack of respect for others.

"Hey, I'm in a hurry. Get out of my way."

Passive-Aggressive Behavior

is when someone acts out aggressive impulses in an indirect way. When people act passive-aggressively, they attempt to get what they need or want indirectly or manipulatively. Passive-aggressive behavior is an indirect attempt to control or punish others.

"I’m sorry I'm so late. I didn’t realize this was such a big deal."

"Oh, don’t bother, I'll just have to do it myself."

Assertive Behavior

includes standing up for your rights without infringing on the rights of others. Assertive behavior results in an "I win; you win" outcome. Assertion involves expressing beliefs, feelings and preferences in a way which is direct, honest, appropriate and shows a high degree of respect for yourself and for others.

"When you talk, I can't hear the movie. Please keep it down."

"I really like it when you wear that shirt. You look great!"

Assertiveness Script: "When you __(behavior)__ , I feel / think ___________ ; So, I would like __(new behavior)__ ."

Turning “You” into “I” You really don’t understand because if you did

you’d let me go to the party. We always have to do what you want to do. I

never get to suggest anything. You are the one who bought the Wii, now how

are we going to pay for it? You wanted me to take the job and now I hate it. You never listen to me.

Situation

You typically get off from work at 4:30. One day your boss comes up to you in at 3:30 and says, “Oh, by the way, you need to stay at work today until 6:00.” You have other things you planned to do after work, so staying late is an imposition. What would be different ways you could respond?

Passive

Example- Stay until 6:00 and say nothing even though you need to cancel other plans.

Aggressive

Example: Yell at your boss, “I hate this! You don’t tell me until 3:30 that I need to stay until 6:00. You are always doing things like this. You don’t care about me or any of the other employees. You’re a dictator, not a boss! You are mean and inconsiderate.” - AGG

Passive/Aggressive

Example - You say, “Oh, OK, I’ll stay. I need to change a lot of plans and people will probably be really mad at me, but that’s OK - don’t worry about me. I guess what I had planned isn’t that important. I don’t mind - really (deep sigh). I hope my friends will still talk with me after canceling at the last minute.”

Assertive

Example - You say, "When you tell me I need to stay until 6:00 at 3:30 in the afternoon, I feel frustrated because I have already made plans; So, I would like us to talk about this situation so we both can get what we need.”

For each of the following situations write a 1) passive, 2) aggressive, 3) passive-aggressive, and 4) assertive response.

Situation #1 You are working and one of your clients/patients

comes in an hour late to an appointment. The client/patient insists that he be able to keep the appointment immediately because he was stuck in traffic, and it wasn’t his fault. You are not able to accommodate his request because there are already 5 people waiting for appointments.

Situation #2 You have set an important meeting for first thing in

the morning with a co-worker to discuss a project that needed to be done that day. You only have an hour for the meeting, and the project needs to be done that day. An hour should be enough time to discuss the project if you and your co-worker work fast. Your co-worker comes in 35 minutes late, and says, “I’m running late - sorry about that. I stayed up really late last night, and I just couldn’t get out of bed this morning. Are you ready to start?”

Competency 5 5. Explain the components of accurate and appropriate documentation and

reporting including common medical abbreviations.a. Describe the components of accurate and appropriate documentation including common medical abbreviations

b. Describe the components of accurate and appropriate reporting.

c. Recognize and report abnormal physical changes to supervisor or appropriate person

d. Recognize and report objective information (signs) to the charge nurse:

e. Recognize and report what the resident may tell you (subjective information or symptoms):

f. Identify common roots, prefixes, and suffixes to communicate information.

g. Identify medical abbreviations to communicate information.

Documentation

1. Accurate & Appropriate Documentation Accurate Legible Date Time Full signature Title Correct spelling Only the fact

2. Accurate & Appropriate Reporting Facts not opinions Clear Specific Follow chain of command

Patient’s Chart/Medical Record Legal Document Can be subpoenaed Patient’s true condition “If it’s not charted, it was not done.” Must be objective – chart the facts. Know the meaning and spelling of the words you

use.

NEVER chart in advance Use permanent ink not pencil Chart exact time Do not leave blank lines or spaces Mistake? Cross out with single line, write “error” Sign first initial, last name and title.

Sign – Observation about the patient that can be observed by others.

Symptom – Something the patient reports about his/her condition.

Objective Observation – Factual observations that you make by seeing, hearing, touching, smelling.

Subjective Observation – Observations based on what you think or what the patient tells you; may or may not be factual.

Abnormal Physical Changes to Report (Objective)

Shortness of breath Rapid respirations Fever Cough Vomiting Cyanosis Excessive drowsiness Excessive sweating Swelling of extremities

Watery or hard stool Blood in stool (black or

tarry consistency) Blood in urine Strong urine odor Persistent skin redness,

breaks, tears, or bruises Increase in confusion

or memory loss

Subjective Symptoms/Informationto Report

Chest pain Abdominal pain Pain anywhere or upon

movement Nausea Difficulty or painful

urination Change in appetite

Trouble swallowing or chewing

Feelings of sadness (change of mood).

Medical Terminology Roots Prefixes Suffixes Abbreviations

Usage of Medical Terminology

Use only approved terms for appropriate healthcare area

Each area has specific terms Medical terms may not be understood by care

recipients

Competency 6

6. Explain the roles and responsibilities of team members.

a. Recognize characteristics of effective teams.

b. Discuss methods for building positive team relationships.

c. Describe attributes and attitudes of an effective leader

d. Describe the roles workers have in healthcare teams across a variety of healthcare settings.

e. Examine the impact healthcare teamwork and partnerships have in meeting client healthcare needs.

Characteristics of Effective Teams

Respectful Purpose driven Patient/resident centered Open-minded Displays patience Inclusive

Building Team Relationships

Provide positive feedback Listen to all suggestions Recognize contributions of team members Discuss rather than dictate Bring client/family in where and when needed

Effective Leaders Patience displayed Encouraging Respectful Kind Assertive not aggressive Knowledgeable Organized Respects confidentiality Understanding

Roles of Team Members

Basic role is dependent upon the focus of the team All teams share a similar goal: to better the

care/situation of a client The job description of the team member will also

determine the role played by each member when an action is determined etc. Ex; a NA/R will reinforce teaching rather than initiate teaching to the client

Impact of Team on Meeting Needs of Client

Care will be consistent Attitude of care giver positive Client feels included in cares Family feels included in cares Confidence of client, family and caregiver increases Care giver feels valued Quality of care improves

Competency 77. Describe the use of information technology in healthcare settings.

a. Identify a variety of electronic communication devices used in healthcare facilities.

b. Identify different types and content of health records (patient, pharmacy, and laboratory

c. Describe the importance of policies and procedures related to electronic communication required by national, state, local and organizational levels.

d. Explain procedures for accurate documentation and use of electronic and print health records.

e. Discuss validity of web based resources.

Electronic Communication Computer Fax Distance diagnosing/assessment Telephone Pager IPad IPod

Content of Health Records

Diagnosis (dx) Insurance information Medications Personal home address Telephone numbers Diagnostic test results History (hx) of health issues Symptoms (sx) of illnesses presented Financial information

Electronic Communication Policy/Procedures

Must indicate personnel responsible for usage of data

Importance of confidentially Maintenance of devices Proper usage of devices

Accurate Documentation

Records are legal documents Data permissible in court Documents must be destroyed properly (shredded)

Use of Web Sites

Care to use only substantiated sites Do not place personal information on non-secure

web sites

“The inability to share….to communicate – that’s the biggest

problem in the world…that’s how people get themselves in

all these troubles.”

V. Satir

Competency 88. Using a problem solving process applied to healthcare situations, describe how healthcare workers can effectively communicate with their clients and team members.

Describe the steps in problem identification and solution utilizing a team approach.

Describe workplace situations in which problem-solving processes are utilized.

Problem Solving

Identify the problem Analyze the problem Generate solutions/brainstorm Implement best solution Evaluate solution

Workplace situations Within the team Within the facility With a client With a visitor Electronic (computer, Fax) Phone

Questions?