2-7 COMMUNICATION SKILLS

LEARNING OBJECTIVE: Recognize communication techniques used in a healthcare setting.

Communication is a highly complicated inter­personal process of people relating to each other through conversation, writing, gestures, appearance, behavior, and, at times, even silence. Such communications not only occur among healthcare providers and patients, but also among healthcare providers and support personnel. Support personnel may include housekeeping, maintenance, security, supply, and food service staff. Another critical communication interaction occurs among healthcare providers and visitors. Because of the critical nature of communication in healthcare delivery, it is important that you understand the communication process and the techniques used to promote open, honest, and effective interactions.

THE COMMUNICATION PROCESS

The human communication process consists of four basic parts: the sender of the message, the message, the receiver of the message, and feedback.

The sender of the message starts the process. The message is the body of information the sender wishes to transmit to the receiver. The receiver is the individual intended to receive the message. Feedback is the response given by the receiver to the message. Feedback, at times, is used to validate whether effective communication has taken place.

Verbal and Nonverbal Communication

The two basic modes of communication are verbal and nonverbal. Verbal communication is either spoken or written. Verbal communication involves the use of words. Nonverbal communication, on the other hand, does not involve the use of words. Dress, gestures, touching, body language, face and eye behavior, and even silence are forms of nonverbal communication. Remember that even though there are two forms of communication, both the verbal and the nonverbal are inseparable in the total communication process. Conscious awareness of this fact is extremely important because your professional effectiveness is highly dependent upon successful communication.

Barriers to Effective Communication

Ineffective communication occurs when obstacles or barriers are present. These barriers are classified as physiological, physical, or psychosocial. Physiological barriers result from some kind of sensory dysfunction on the part of either the sender or the receiver. Such things as hearing impairments, speech defects, and even vision problems influence the effectiveness of communication. Physical barriers consist of elements in the environment (such as noise) that contribute to the development of physiological barriers (such as the inability to hear). Psychosocial barriers are usually the result of one’s inaccurate perception of self or others; the presence of some defense mechanism employed to cope with some form of threatening anxiety; or the existence of factors such as age, education, culture, language, nationality, or a multitude of other socioeconomic factors. Psychological barriers are the most difficult to identify and the most common cause of communication failure or breakdown. A person’s true feelings are often communicated more accurately through nonverbal communication than through verbal communication.

Listening

Listening, a critical element of the communication process, becomes the primary activity for the healthcare provider, who must use communication as a tool for collecting or giving information. When one is engaged in listening, it is important to direct attention to both the verbal and nonverbal cues provided by the other person. Like many other skills necessary for providing a healthcare service, listening requires conscious effort and constant practice. Your listening skills can be improved and enhanced by developing the following attitudes and skills:

As a healthcare provider, you will be using the communication process to service a patient’s needs, both short and long-term. To simplify this discussion, short-term needs will be discussed under the heading of “patient contact point.” Long-term needs will be discussed under the heading of “therapeutic communications.”

PATIENT CONTACT POINT

To give you a frame of reference for the following discussion, the following definitions will clarify and standardize some critical terms:

The contact point person has certain criteria to meet in establishing a good relationship with the patient. Helping the patient through trying experiences is partially the responsibility of all contact point personnel. Such healthcare providers must not only have skills related to their professional assignment, but they must also have the ability to interact in a positive, meaningful way to communicate concern and the desire to provide a service.

Consumers of healthcare services expect to be treated promptly, courteously, and correctly. They expect their care to be personalized and communicated to them in terms they understand.

No matter how excellent and expert the care in the facility may be, an early impression of nonchalance, disregard, rudeness, or neglect of the needs of patients reflects poorly on its efforts and achievements. Our personnel must be constantly on their guard to refrain from off-hand remarks or jokes in the presence of patients or their families. We must insist that our personnel in all patient areas are professional in their attitudes. What may be commonplace to us may be to a patient frightening or subject to misinterpretation.

By example and precept, we must insist that, in dealing with our beneficiaries, no complaint is ever too trivial not to deserve the best response of which we are capable.

THERAPEUTIC COMMUNICATION

A distinguishing aspect of therapeutic communication is its application to long-term communi­cation interactions. Therapeutic communication is defined as the face-to-face process of interacting that focuses on advancing the physical and emotional well-being of a patient. This kind of communication has three general purposes: collecting information to determine illness, assessing and modifying behavior, and providing health education. By using therapeutic communication, we attempt to learn as much as we can about the patient in relation to his illness. To accomplish this learning, both the sender and the receiver must be consciously aware of the con­fidentiality of the information disclosed and received during the communication process. You must always have a therapeutic reason for invading a patient’s privacy.

When used to collect information, therapeutic communication requires a great deal of sensitivity as well as expertise in using interviewing skills. To ensure the identification and clarification of the patient’s thoughts and feelings, you, as the interviewer, must observe his behavior. Listen to the patient and watch how he listens to you. Observe how he gives and receives both verbal and nonverbal responses. Finally, interpret and record the data you have observed.

As mentioned earlier, listening is one of the most difficult skills to master. It requires you to maintain an open mind, eliminate both internal and external noise and distractions, and channel attention to all verbal and nonverbal messages. Listening involves the ability to recognize pitch and tone of voice, evaluate vocabulary and choice of words, and recognize hesitancy or intensity of speech as part of the total communication attempt. The patient crying aloud for help after a fall is communicating a need for assistance. This cry for help sounds very different from the call for assistance you might make when requesting help in transcribing a physician’s order.

The ability to recognize and interpret nonverbal responses depends upon consistent development of observation skills. As you continue to mature in your role and responsibilities as a member of the healthcare team, both your clinical knowledge and understanding ofhuman behavior will also grow. Your growth in both knowledge and understanding will contribute to your ability to recognize and interpret many kinds of nonverbal communication. Your sensitivity inlistening with your eyes will become as refined as—if not better than—listening with your ears.

The effectiveness of an interview is influenced by both the amount of information and the degree of motivation possessed by the patient (interviewee). Factors that enhance the quality of an interview consist of the participant’s knowledge of the subject under consideration; his patience, temperament, and listening skills; and your attention to both verbal and nonverbal cues. Courtesy, understanding, and nonjudgmental attitudes must be mutual goals of both the interviewee and the interviewer.

Finally, to function effectively in the therapeutic communication process, you must be an informed and skilled practitioner. Your development of the required knowledge and skills is dependent upon your commitment to seeking out and participating in continuing education learning experiences across the entire spectrum of healthcare services.