Transcript 2a2b05e1255d95e

Verbal and nonverbal
communication
Family Planning Fellowship
Outline
Verbal communication: definition, types, how to
improve
Nonverbal communication: definition, types,
how to improve
Verbal Communication
• Verbal communication is the use of words to
exchange thoughts, feelings, and information
• denotative meanings (standard dictionary
definitions) (‫(يا باشا‬
• connotative meanings (all of the associations,
implications, and suggested meanings) (‫(يا باشا‬
classes of verbal behavior
1. Provider gathers information from clients
(asks questions)
2. The Provider listens to the client
2. Provider responds to the patient’s experience
Questioning skills
The health care provider asks questions that encourage the
client to talk about herself/himself.
Types of Questions:
Closed-ended question (Yes –No), (Who-Whom-When-where-How oftenHow many-Does.)
Open-ended questions (What-Describe-How-Why-explain-Discuss)
Open-ended questions cannot be answered by ''Yes'' or ''No'' or a one word
response. Such questions are therefore richer and more informative than
close-ended questions, because they give the opportunity for a full
answer.
Examples:
How do you feel about that?
How do you feel about having chemotherapy?
Tell me how this accident happened?
Types of questions
Probing questions to Clarify and to understand
Examples:
Do you mean (repeat the counselee message)
Am I understanding you correctly, you do not see any purpose in
taking your medication? Are you saying that ( repeating the
counseled message)
Justify: what makes you think of that.
Check accuracy: you definitely took three tablets/day
Confirmatory questions: Please tell me what you understood.
Unacceptable is Leading questions
How TO IMPROVE Your QUESTIONING
SKILLS:
1- Conduct the interview in a private place.
2- Help the client feel at ease.
3- Do not ask interrogative questions e.g. did you try to induce
abortion?
4- Use a tone of voice that shows interest, concern and
friendliness.
5- Ask only one question at a time, and then wait for an answer.
6- Ask the same question in different ways if you think the client
has not understood.
Continued
7- Start with open ended questions to get story from the client's perspective
e.g. '' tell me, how did the bleeding start?''
8- Follow with closed- ended questions to get more specific information e.g.
was the bleeding light, heavy or moderate?
9- Avoid leading questions e.g. of course you will have the delivery at the
hospital, right?
10- Use facilitations to encourage the client to talk e.g. nodding, uhmm,
yes….etc.
11- Ask the patient his/her interests: health, needs, and fears
12- Respect and deal with feelings: shyness, worry, fear.
Listening skills
Listening is an active process.
Conscious effort to listen to the words to be
aware of the feeling shown and of the
attempts to hide feelings.
Observation of the nonverbal messages
Nonverbal gestures during listening
(ROLES)
R: Relax (avoid nervous movements).
O: Be Opened Flexible.
L: Lean Forward Towards The Clients.
E: Maintain Eye Contact
S: Show you are listening (head nodding…)
ELEMENTS HELPING GOOD LISTENING:
Choosing private and comfortable place.
Giving the client a chance to think.
Observing her voice tone and body
movements.
Speaking in a moderate speed.
Repeating what the client has said from time
to time.
Effective responding skills
• Empathy
• Validation
• Restating
• Reflecting
• Clarifying
• Summarizing
Empathy
Empathy is the ability to perceive accurately the feelings of
another person and to communicate this understanding to
the person.
• Sample empathic response:
Patient: “I was terribly disappointed when I was told that I had to
have the operation and stay in the hospital. I was hoping I
could have had outpatient surgery.”
Provider: “You became disappointed when you heard you would
need surgery? And were you also frightened? Was it
important to you to recover at home with your family?”
begin with phrases such as “You sound,” “You look,” and “You
seem”
Validation
Validation is the act of obtaining feedback from a patient to
discover whether the empathic response is an accurate
perception.
• Sample validating response:
Patient: “I really can’t afford a babysitter for the 5 days I will be in
the hospital....”
Physician: “I know how important it is for you to be at home with
your family and that it will require child care. Let’s try to think
of some solutions.”
The validation affirmed the patient’s wishing to be at home with
her/his children and elicited her/his concern about the
expense of childcare.
Restating
Restating is repeating to the patient, almost verbatim, what the provider
believes is the main thought, idea, or feeling being expressed.57
Tells the patient that the provider is listening. In addition, restating can serve
to validate interpretation of the message.58
• Sample restating response:
Patient: “I have a yellow discharge after I urinate. It must have been about 2
weeks ago when I first noticed it, just after I started using a diaphragm
instead of condoms. It feels uncomfortable and bothers me.
” Physician: “You noticed the discharge after you started using the
diaphragm?”
Patient: “Yeah and I started to feel itchy.”
By restating the patient’s message, the provider indicates that she/he is
attentive, verifies that she/he understood what was being said, and
encouraged the patient to contribute additional information.
Reflecting
Reflecting is the process of directing back to patients their ideas, feelings, and
questions.
Reflecting is done by paraphrasing stated or implied feelings and values and
examining the reason for the feelings.
Reflecting helps to clarify the patient’s message and helps the patient to
recognize and get in touch with her/his ideas, feelings
• Sample reflecting response:
Patient: “I’ve been able to go back to work now, but right after the
miscarriage I felt really tired all the time, and now when I go home I just
want to sleep. I just can’t seem to get anything done, and I’ve been getting
headaches often lately. Maybe I’m just not eating right.” Provider: “You
seem to feel emotionally and physically upset by the loss of your baby.”
Patient: “Yes. I guess I am.”
Clarification
Clarification is the attempt to understand what a patient is reporting by
asking for additional information.61
Clarification indicates to the patient that the provider is trying to understand
her/him.
Gives the provider an opportunity to make sure she/he understands the
patient
Builds common expectations between patient and provider
• Sample clarification response:
Patient: “I’ve been taking these pills for 1 week, and I still don’t feel well.”
Provider: “Have you been taking 1 tablet after each meal for the past week?”
Patient: “No, 1 each day.”
Phrases that can be used include “I’m not sure I understand; would you
explain it to me again?” and “Maybe I didn’t make this clear; let me go
over it again.”
Summarizing
Summarizing means going over the main points of a discussion
to organize the focus and content of the information being
conveyed.
• Sample summarizing response:
Patient: “So, I really think the pill would be the best way for me
to keep from getting pregnant. My husband doesn’t always
want to wear a condom.”
Physician: “So a birth control method you have control over is a
better choice for you. Have you thought about how you will
protect yourself from sexually transmitted diseases?
This summarizing response sums up what the patient has said
and elicits additional pertinent information.
Factors Impairing the verbal
communication
• Discipline-specific jargon ( ‫(الكتاوت و البوبينة‬
‫حمل غير مخطط فعالية آثار جانبية‬
• Use “Job Aids”
• Volume of information presented in an encounter with a
physician must be suitable (THREE MAIN POINTS IS YOUR LIMIT)
• Give written information in addition to the verbal information
Impairing verbal communications
Do NOT
Give Orders
Attack
Be Aggressive
Advise
Ridicule
NON VERBAL COMMUNICATION
DEFINITION
Nonverbal communication includes all of the
conscious or unconscious unspoken gestures,
behaviors, and actions that express thoughts,
feelings, and information.
How important????
Body Language 55%
Tone of Voice 38%
Actual Words 7%
Functions
• Express emotions
• Express attitudes
• Establish, develop, and maintain social
relationships
• Support verbal communication
CATEGORIES OF NON-VERBAL
COMMUNICATION
Body movements, way of walking, posture.
Facial expressions and eye contact.
Gesture; movements of hands, legs, arms and feet
Head nodding.
Space and distances: (at same level)
o -Intimate (45 cm).
o -Personal (45-120 cm).
o -Social (120-360 cm).
o -Public (>360 cm).
Touch.
Personal appearance and effective utilization of Time
Para Language:
-Vocal characteristics.
-Vocal interferences.
Ways of Improving Non-verbal
Communication
Sit facing the client.
Look directly to the client but not continuously.
Use encouraging movements as nodding and leaning
forward.
Speak in voice tone showing care.
Observe the non verbal expressions shown by the
patient.
Avoid the movements that cause distraction as
looking at the watch or papers or around the room.
Observing Nonverbal Communication
Assess nonverbal communication
A client whose words and actions do not align
may indicate distress and the need to explore
feelings that are not being expressed directly.
A patient who says “I appreciate your assistance”
with eyes averted and a tense facial
expression
Analyzing and Interpreting
Communication
• Observe
• Interpret.
• Validate
Sight
•
•
•
•
Facial expressions
Gestures
body postures
physical appearance
Meanings
• Averted eyes may convey humility, avoidance,
or fear.
• Erect posture and leaning toward the speaker
• leaning away from the speaker
• Muscle tension or rapid breathing
Sound.
Sighs
Cries
voice inflections
voice pitch
Hesitations
Silence
Touch.
Caring
Intrusive
Threatening
Be aware of the patient’s response and reaction
to touch.
.
• Anger:
Aggressive speech patterns
Loud voice tone
Short answers
Increased muscle tension
Increased heart rate
• Anxiety:
Rapid speech
Restlessness
Inattention
Irritability
increased muscle tension
increased heart rate
Diaphoresis
Dry mouth
Depression:
poor eye contact
lack of spontaneity
slowed speech and movement
difficulty concentrating
Manipulation:
Lying
excessive flattery
Helplessness
Intimidation
suicide threats
BOTTOM LINE
Maintain the comfort level while providing care
to your patients
‫أسئلة‬
‫طيب أسأل أنا‬
• What are the classes of verbal communication
• What are the components of nonverbal
communication
• What are the nonverbal communication
components of an efficient provider
• What are the manifestations of a problem
during counseling????