Transcript Slide 3 Connections: Communication TNEEL-NE

Stuart J. Farber, MD
TNEEL-NE
Connections: Communication
Healthcare Training
• Traditional Training
– Healthcare training stresses diagnosis and
treatment rather than communication.
• Patient-Centered Training
– Need to stress listening and
understanding patient experience.
– Gaining understanding
can help guide healthcare
diagnosis and treatments.
TNEEL-NE
Slide 2
Connections: Communication
Modern Training
• How to stress listening …
– Need to develop listening skills.
– Listen to words and subtle verbal and nonverbal
communication.
Mr. Smith and Nurse
1. Stress diagnosis and
treatment
2. Stress listening and
communication with
patient
TNEEL-NE
Slide 3
Connections: Communication
Listening
Conceptualize
Interpreted
by listener
May or may
not understand
Choose
words
May or
may not
accurately
transmit
Listen …
To every level of communication the patient and family provide
TNEEL-NE
Slide 4
Connections: Communication
Linguistic Elements
• Language content and
style
–
–
–
–
–
–
–
TNEEL-NE
Pause
Pitch
Speed rate
Intonation
Choice of words
Logic
Meaning
• Non-verbal
communication
–
–
–
–
–
Body position
Mood
Facial expression
Eye contact
Physical distance
Slide 5
Connections: Communication
Language Content & Style I
• Pause
– Patient
a. I want my pain pill.
b. I (pause) want my pain pill.
c. I want (pause) my pain pill.
– Nurse
a. You want your pain pill?
b. You want your (pause) pain pill?
c. You (pause) want your pain pill?
TNEEL-NE
Slide 6
Connections: Communication
Language Content & Style II
• Pitch and Intonation:
a. I get to go home today.
b. I get to go home today? (with rising pitch)
c. I get to go home today! (with rising and lowering
pitch.)
d. I get to go home today. (lowering pitch)
TNEEL-NE
Slide 7
Connections: Communication
Language Content & Style III
• Speed rate:
– Patient
a. Why can’t someone do something about this pain?
(even, slow rate)
b. Why can’t someone do something about this pain?
(Increasing rapid rate)
– Nurse
a. We’ve called the doctor. (even, slow rate)
b. We’ve called the doctor. (slowly increasing rate)
TNEEL-NE
Slide 8
Connections: Communication
Language Content & Style IV
• Word choice:
– Nurse
a. What did the doctor tell you about (the) illness?
b. What did your doctor tell you about your illness?
– Patient
a. The doctor said it doesn’t look good.
b. The doctor said the cancer doesn’t look good.
c. My doctor said my cancer doesn’t look good.
d. My doctor said it doesn’t look good.
TNEEL-NE
Slide 9
Connections: Communication
Language Content & Style V
• Logic:
– Nurse
a. Call your pain a number between 0 and 10?
(“0” allows for no pain in patient’s report.)
b. Call your pain a number between 1 and 10?
(“1” indicates patient will have some level of pain to
report)
– Patient
a. I don’t want to take strong pain medicine now,
because I want it to work when I really need it.
(Patients belief that strong pain medications will not
be effective if used over time.)
TNEEL-NE
Slide 10
Connections: Communication
Language Content & Style VI
• Meaning:
Nurse: How is your appetite?
Patient: I try to eat as much as I can.
Husband: She needs to eat more!
How might you interpret this conversation?
TNEEL-NE
Slide 11
Connections: Communication
Nonverbal Communication I
• Body position
TNEEL-NE
Slide 12
Connections: Communication
Nonverbal Communication II
• Mood
TNEEL-NE
Slide 13
Connections: Communication
Nonverbal Communication III
• Facial expression
TNEEL-NE
Slide 14
Connections: Communication
Nonverbal Communication IV
• Eye contact
TNEEL-NE
Slide 15
Connections: Communication
Nonverbal Communication V
• Physical distance
TNEEL-NE
Slide 16
Connections: Communication
Linguistic Elements
The following video illustrates Linguistic elements
Angry, distant son:
Dispirited son:
Nonverbal: Sits in a protective
position, avoiding initial eye
contact, sitting away from his
mother.
Verbal: No pause, high pitch, rapid
speed rate and angry intonation.
Nonverbal: Stares intently into
your eyes, sitting close to his
mother, etc.
Verbal: Several pauses, soft, low
pitch, slow rate with soft, sad,
bewildered intonation.
TNEEL-NE
Slide 17
Connections: Communication
Open-Ended Questions
• The most effective way of beginning to
gather information from patient and family
Mrs. Bell has end stage ischemic cardiomyopathy. She and
her daughter are in a hospital room. The daughter asks you
questions about her mother.
Nurse to daughter
“When you think about your mother getting very sick,
what worries you the most?”
TNEEL-NE
Slide 18
Connections: Communication
Reflective Statements
• A helpful tool to clarify everyone’s
understanding.
Statement
“What I heard you just say is, that you want more
information regarding pain management before you take
morphine. Is that right?”
TNEEL-NE
Slide 19
Connections: Communication
Intuitive Knowledge
• Definition: the power or faculty of attaining
direct knowledge or cognition without
evident rational thought and inference, a
“gut feeling.”
• When healthcare professionals pay attention
to intuitive knowledge, it can guide them in
their exploration of the patient and family
experience.
TNEEL-NE
Slide 20
Connections: Communication
Being Present
• Cultivating the ability to “be present” in the
moment is often all that is necessary to help
patients and families at the end of life.
In the hospital room
A patient’s son breaks into tears.
The nurse sits with them, touching
him, just being there without
attempting to stop him.
TNEEL-NE
Slide 21
Connections: Communication
Empathic Statements
• Empathy is the action of understanding,
being aware of, being sensitive to another
without having the feelings, thoughts and
experiences fully communicated in an
objectively explicit manner.
• It is the skill that helps demonstrate a
healthcare provider’s understanding of a
patient’s experience.
TNEEL-NE
Slide 22
Connections: Communication
Empathic Actions
Actions:
– Reflecting the
emotions expressed by
the patient and family.
– Sitting at patient level,
looking into the
patient’s eyes, a
concerned facial
expression, etc.
– Paying attention and
being present for the
patient’s experience.
TNEEL-NE
“This must be very frightening
news for you to hear.”
Slide 23
Connections: Communication
Issues Related to Dying Child I
For Children:
– Children are never too young to know that they or
someone close to them is dying. They need to know
they are not responsible for their illness.
– Dying children experience fear, loneliness, anxiety as
well as hope, love, and joy just like adults.
– Like adults, dying children may or may not choose to
discuss their concerns. Verbal language must be
adapted to a conceptual level and vocabulary that the
child can understand. They also can communicate in
ways other than through speech. (ex. drawing, etc.)
TNEEL-NE
Slide 24
Connections: Communication
Issues Related to Dying Child II
Continue For Children:
– Children may express their fears,
worries or concerns directly, indirectly
or symbolically. It is important that
parents and healthcare professionals
listen closely for them.
– Issues for the dying child apply equally
to siblings. The same issues, barriers,
and needs should be considered with
them.
TNEEL-NE
Slide 25
Connections: Communication
Issues Related to Dying Child III
For Parents & Family:
Nurses and other healthcare Providers need...
– To help prepare parents and other family members so
they can meet the emotional needs of the dying child.
– To recognize the pivotal role of
encouraging and supporting parents
in expressing their true feelings,
concerns and goals.
TNEEL-NE
Slide 26