Transcript CHC-Communications-in-Health-Care

Communications in Health Care
Minnesota Healthcare Core Curriculum
Created by: Dede Carr, BS, LDA

These materials are made available by the
Minnesota State Colleges and Universities
through a Creative Commons AttributionShareAlike 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 1
1. Describe the components of verbal and nonverbal communication and situations in which
these skills can be effectively used.
a.
b.
c.
Name two types of communication and give
examples of each.
Describe the components of communication.
List examples of barriers to effective
communication.
Todays Abbreviations
MYOB
SICS
TGIF
SWL
IOW
KMA
TSR
OBO
HAK
GAL
HOYEW
JAM
L8R
TTYL
AWC
ASAP
FITB
LOL
KIT
YGLT
TNTL
True or False
1.
2.
3.
4.
5.
Someone who is as cool as a cucumber, doesn’t
get worried or upset.
If someone tells you to keep your hair on, they
want you to show more emotion.
If you work like a dog, you work very hard.
If something is down in the pan, it has failed.
If you take to something like a duck takes to
water, you have a natural talent for it.
Verbal Communication
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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.
2.
3.
4.
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
Sender
Message
Receiver
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
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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
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Slow/clear speech
Receiver is attentive
Focus on client’s feelings
Repeat message
Re-send if necessary
DON’T PRETEND
Non Verbal Communication
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Body language
Facial expressions
Use of touch
Posture
Gestures
Silence
Movement
Non – Verbal Communication
Techniques
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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 –
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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
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Sender
Message
Receiver
Feedback
Techniques for Effective
Communication
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Decrease background noise
Listen
Pace speech
Allow time for response
Show interest
Eye contact – if appropriate
Clear speech
Volume as needed
Barriers
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Decrease hearing
Decrease vision
Different language
Belittle someone
Negativity
In a hurry
False reassurance
Inappropriate environment
Offensive Language vs.
Acceptable Language
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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
YouTube Video
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Bucket Boyz
Competency 2
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2. Explain how active listening skills can
improve client and team communication.
a.
b.
List basic listening skills.
Describe active listening skills.
Quotes
History 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
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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
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2.
Information overload is rampant
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3.
Screen out things that SHOULD be important to us
We think faster than we speak
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4.
Active listening = high blood pressure, higher pulse rate, more
perspiration
Speak = 135-175 words/minute
Listen = 400-500 words/minute
Listening isn’t something that we teach
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Lack of training = poor listening skills & habits
FOCUS
www.frontlinelearning.com
Effective Listening Do’s
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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
www.karensusman.com
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

Steroids
Competency 3
3. 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
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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
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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.
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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
Afflicted
Burden
Diseased
Courageous
Crippled
Defect
Defective
Deformity
Stricken with
Invalid
Unfortunate
Normal
Palsied
Poor
Gimp
Suffers with
Victim
TACTFUL
T = Think before you speak
A = Apologize quickly
C = Converse, don’t compete
T = Time your comments
F = Focus on behavior
U = Uncover hidden feelings
L = Listen for feedback
Is Technology Killing the Art of
Conversation?
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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
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Name of facility
Your name
Soft/friendly voice
Clear
Moderate speed
No gum chewing
No personal calls
Message Taking
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Date – 01/25/11
Time – 24 hour clock
Who for
Who from
Phone number
Reason for call
Competency 4
4. Describe communication skills that are
important when managing conflict.
a.
b.
c.
d.
Define conflict.
List causes of conflict.
List groups in which conflict occurs
List communication skills that are important when
managing conflict
Conflict Management
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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?
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2.
Internal
Interpersonal
Intragroup
Intergroup
Global
What are the sources of conflict? What is it over?
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Resources
Values
Psychological Needs
3.
Relationship between/among conflicting parties.
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4.
Climate
Power Balance or Imbalance
Degree of Interdependence
Know one another
What is the history of the conflict?
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Duration
Frequency
Intensity
Perception
5.
The Process: How do we choose to deal with the
conflict?
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Avoidance
Diffuse
Engage
Communication & Conflict Needs
1.
2.
3.
4.
5.
6.
To be listened to
To be understood
To be loved & accepted
To be taken seriously
To move toward resolution
Respect
Causes of Conflict
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Gender Issues
Increased work
Threat to safety
Threat to security (job)
Invasion of personal space
Communication Skills when Managing
Conflict
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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…
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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…
You always…. You never….
Do you realize…
Lecturing
Communication in Conflict
4 Different ways to Communicate when in
conflict
1. Passive/Nonassertive
2. Aggressive
3. Passive-Aggressive
4. Assertive
Passive/Nonassertive Behavior
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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
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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.
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"Hey, I'm in a hurry. Get out of my way."
Passive-Aggressive Behavior
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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
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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”
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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
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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
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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
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5. Explain the components of accurate and appropriate documentation and
reporting including common medical abbreviations.
f.
Describe the components of accurate and appropriate documentation including common medical abbreviations
Describe the components of accurate and appropriate reporting.
Recognize and report abnormal physical changes to supervisor or appropriate person
Recognize and report objective information (signs) to the charge nurse:
Recognize and report what the resident may tell you (subjective information or symptoms):
Identify common roots, prefixes, and suffixes to communicate information.
g.
Identify medical
a.
b.
c.
d.
e.
abbreviations to communicate information.
Documentation
1. Accurate & Appropriate Documentation
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Accurate
Legible
Date
Time
Full signature
Title
Correct spelling
Only the fact
2. Accurate & Appropriate Reporting
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Facts not opinions
Clear
Specific
Follow chain of command
Patient’s Chart/Medical Record
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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.
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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.
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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)
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Shortness of breath
Rapid respirations
Fever
Cough
Vomiting
Cyanosis
Excessive drowsiness
Excessive sweating
Swelling of extremities
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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/Information
to Report
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Chest pain
Abdominal pain
Pain anywhere or upon
movement
Nausea
Difficulty or painful
urination
Change in appetite
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Trouble swallowing or
chewing
Feelings of sadness
(change of mood).
Medical Terminology
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Roots
Prefixes
Suffixes
Abbreviations
Usage of Medical Terminology
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Use only approved terms for appropriate
healthcare area
Each area has specific terms
Medical terms may not be understood by care
recipients
Do NOT use Abbreviations
The Joint Commission has identified
abbreviations that should not be used by
healthcare providers.
View the following URL for the official
“Do Not Use List”
Competency 6
6. Explain the roles and responsibilities of team members.
a.
b.
c.
d.
e.
Recognize characteristics of effective teams.
Discuss methods for building positive team relationships.
Describe attributes and attitudes of an effective leader
Describe the roles workers have in healthcare teams
across a variety of healthcare settings.
Examine the impact healthcare teamwork and
partnerships have in meeting client healthcare needs.
Characteristics of Effective Teams
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Respectful
Purpose driven
Patient/resident centered
Open-minded
Displays patience
Inclusive
Building Team Relationships
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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
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Patience displayed
Encouraging
Respectful
Kind
Assertive not aggressive
Knowledgeable
Organized
Respects confidentiality
Understanding
Roles of Team Members
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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
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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 7
7. Describe the use of information technology in
healthcare settings.
a.
b.
c.
d.
e.
Identify a variety of electronic communication devices used
in healthcare facilities.
Identify different types and content of health records
(patient, pharmacy, and laboratory
Describe the importance of policies and procedures related
to electronic communication required by national, state,
local and organizational levels.
Explain procedures for accurate documentation and use of
electronic and print health records.
Discuss validity of web based resources.
Electronic Communication
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Computer
Fax
Distance diagnosing/assessment
Telephone
Pager
IPad
IPod
Content of Health Records
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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
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Must indicate personnel responsible for usage of
data
Importance of confidentiality
Maintenance of devices
Proper usage of devices
Accurate Documentation
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Records are legal documents
Data permissible in court
Documents must be destroyed properly (shredded)
Use of Web Sites
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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 8
8. Using a problem solving process applied to
healthcare situations, describe how healthcare
workers can effectively communicate with their
clients and team members.
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Describe the steps in problem identification and
solution utilizing a team approach.
Describe workplace situations in which problemsolving processes are utilized.
Problem Solving
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Identify the problem
Analyze the problem
Generate solutions/brainstorm
Implement best solution
Evaluate solution
Workplace situations
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Within the team
Within the facility
With a client
With a visitor
Electronic (computer, Fax)
Phone
Questions?