HSC1101 – Patient Care and Safety – Communication
So this module started off pretty dry, with an important skill: Communication. This is important for a healthcare professional, and this topic is presented from a healthcare and patient-oriented perspective.
The learning objectives of this topic is to ensure that we understand the purpose of communication, explain the importance of health communication and evaluate key communication models. Also among the objectives, we should be able to identify the main types of communication, describe key elements of verbal and non-verbal communication and the importance of verbal communication in healthcare, as well as the key barriers to effective communication. We should also be able to identify the types of active listening skills, describe non-verbal and verbal attending skills, differentiate between therapeutic and normal communication, and understand main elements of patient interview.
The National Health Service defined communication as shown below in 2010:
Communication is a process that involves a meaningful exchange between at least 2 people to convey facts, needs, opinions, thoughts, feelings or other information through both verbal and non-verbal means, including face-to-face exchanges and the written word.
As such, there are many different forms and medium of communication. Road signs and warning signs, for example, are also a form of communication. Advertisement billboards, infographics, and even social media are often easily overlooked as types of communication.
There are many reasons to communicate. Here is a mindmap showing the main purposes of communication:
Health Communication is the study and application of communicating health information, providing health education, as well as communication between healthcare professionals and patients. This also includes public health campaigns, diagnoses and analyses of health condition.
Health communication is relevant to all aspects of health and well-being, including disease prevention, health promotion and the quality of life. The purpose of disseminating health information is to influence personal health choices by improving health knowledge. It ensures that the healthcare professional is providing the correct type and degree of care at the correct time to the correct person so that the best possible outcome can be achieved for the patient. It also prevents errors and adverse effects resulting from incorrect care provided to patients.
Good healthcare communication will result in:
Accurate and comprehensive diagnoses
Detection and management of emotional distress in patients
Increased patient satisfaction
Improved treatment adherence
Communication should be a two way traffic, and not just objective-centric. In other words, the healthcare professional should not just focus on giving accurate information bluntly, or ensuring that the patient follows the prescribed treatment accurately. Rather, professionals should also be open to opinions from the patient.
The birth of biopsychosocial approach in 1955 emphasised that biological, psychological and social factors all play a significant role in human disease, and brought about patient-centric communication, putting the needs of the patient at the center of the processes and priorities.
In the 21st century, healthcare has become much more complex due to the onset of multiple diseases within the same patient and increasing co-morbidities. Within the healthcare professionals alone, there may also be multiple options of assessment and treatment, as more professionals are involved in the diagnosis and treatment of a single patient. There is also a rise in the “informed consumer” who utilise internet resources and produce possibly conflicting self-diagnoses. There is also an increased diversity of patients due to migration, providing a plethora of different base conditions which can possibly complicate diagnosis or treatment. Lastly, healthcare professionals also have to be more conscious and “politically correct” when communicating as there is an increased number of healthcare stakeholders like the media, pharmaceutical companies, researches, consumer interest groups and policy makers.
There are 3 main types of communication models presented.
A linear communication model is one where there is simple one-way communication from the sender to the receiver. This is the old medical model style of communication, where the healthcare professional simply dumps information to the patient. This model is typically used in public speaking and mass communication, and is still used today in media like television, radio and newspapers.
The advantages of the linear communication model is that the script can be prepared beforehand and the delivery of information can be very seamless and efficient. It is also appropriate for intentional results.
The disadvantage is that there is no means for the receiver to provide any feedback as the receiver is not an active participant. Linear communication assumes the receiver has the ability to decrypt or otherwise decipher the information should it be conveyed in another form. For example, for a poster to be effective, the reader has to be able to read in the given language.
Another model is the Interactive Communication Model, where feedback is allowed after the message is received. The receiver and sender swap roles after every exchange, and the original receiver sends a response to the original sender (who is now the receiver). This is used in relatively new forms of communication, like e-mails, and posting a reply on an online forum. Another example is the walkie-talkie, where Push To Talk (PTT) is used. Both parties can act as either the sender or the receiver, but no two parties can have the same role at the same time.
The advantage to this model is that feedback is now possible even in mass communication. In a pool of receivers, any one of them can adopt the role of a sender in the next exchange. This is comparable to the “Reply All” function in e-mail.
The disadvantage is that feedback is not simultaneous and can take a long time to be responded to. In fact, this model defaults back to a linear model should the receiver choose not to respond. Communication is still not dynamic using the interactive model, and the delay in response can bring about a sense of unfamiliarity as both parties need not know each other.
The last model presented is the Transactional Communication Model. This is a dynamic means of communication, where the sender and receiver interchange roles simultaneously. As such, both (or more) parties are known as communicators. Messages exchanged are sent back and forth simultaneously, akin to a phone call, or in physical dialogue, where it is possible to interrupt and speak over the other party.
The advantages of this model is that it provides an opportunity for simultaneous and instant feedback. Both (or more) communicators can interchange roles. If this model is applied to a physical setting, it can even incorporate non-verbal communication. As such, physical, physiological and psychological factors can be considered.
The disadvantage of this model is that communicators can still choose not to respond, and in the case of a phone call, without verbal response, the sender cannot be sure if the information was established to the receiver as intended. There may also be more noise as more communicators may now deliver at the same time.
It is largely understood that communication is more than just words. The way in which we deliver the content is also important. A study found that non-verbal communication has a stronger impact than verbal communication.
Non-verbal communication are messages sent to express ideas and opinions without talking or vocalisation.
It is a primal level of communication, used even by infants before learning language, and it cannot be “turned off”, as even silence has a meaning. Non-verbal communication may not be intentional, can be very ambiguous, and is largely impacted by gender, ethnicity and culture.
Eye contact is an important part of non-verbal communication as it expresses emotion. We tend to maintain longer eye contact for people we like, or are close to, and intense eye contact when emotional. Good eye contact indicates interest and attention to message, while avoiding eye contact indicates lack of interest or inattention. Direct eye contact sends a powerful and positive message.
Most non-verbal communication is conveyed by the face. The look on a person’s face is often the first thing we see, and it can express countless emotions and attitudes without the need to vocalise. It is also worth mentioning that most facial expressions are universal.
The positioning of one’s body, how one walks, sits, stands or holds their head, signifies status, current mood and personality. A closed posture, with crossed arms, legs, leaning backwards, can prevent communication. Conversely, an option posture with unfolded arms, uncrossed legs facilitates communication.
The physical space between people also conveys a non-verbal message. Being an appropriate distance away conveys sensitivity and professionalism. Standing over someone, however, creates an authoritarian vibe.
Touch can communicate many things. In healthcare, touch can be diagnostic, assisting or healing. Generally, a touch of the hand, a pat on the back, arm around shoulder etc, is interpreted as caring. Health professionals need to be conscientious to touch patients with only kindness and respect.
The 7 C’s for effective oral communication by Bergin are as follows:
Candidness: Honest, open and unbiased
Clarity: Get correct meaning of the message
Completeness: Include all necessary information
Conciseness: Express message with fewest possible words
Correctness: Message should not contain incorrect information
Concreteness: Be specific, definite and clear.
Courtesy: Be tactful, thoughtful and appreciative.
Effective oral communication is also dependent on choice of language. Medical terminology should be explained in a way where the patient can easily understand. However, we should also note that we should not oversimplify, often interpreted as “talking down” to the patient. Colloquialisms and slang should generally be avoided.
As healthcare professionals, our choice of words is important for the understanding of the patient or receiver.
Tone and volume is also important, as it indicates the speaker’s feelings. The tons of voice needs to be adjusted to the situation. Patients can pick up on agitation, calmness and confidence. If your tone is weak, distant or too soft, it can be interpreted as non-assertive. If you’re too loud, tense or demanding, it can come off as aggressive, and only when you’re well-modulated, firm, warm and confident, you’re seen as assertive.
Written communication on the other hand, is an entirely different language all together. Documentation is vital in healthcare communication, especially with other healthcare professionals. Documentation must incorporate patient’s report as well as healthcare professional’s own observations. It should be accurate, clear and readable (if handwritten), brief with local organisation, correct spelling and grammar with dates and timestamps, and quotation marks for direct quotes from the patient’s statements.
Some common barriers of communication for the patient are shown below:
Common barrier for healthcare professionals are as follows:
There may even be environmental factors to consider as barriers to communication. These include privacy, comfortable surroundings and an appropriate seating arrangement.
Avoidable barriers that are totally within our control:
Cliched statements “I won’t beat around the bush”
Contradicting “It couldn’t have happened like that”
Criticising “You are unable to follow instructions”
Ridiculing “That was a stupid thing to do”
Sarcasm “It could be far worse”
Indifference “Whatever, this doesn’t matter”
Lecturing “You know you shouldn’t be eating that”
Commanding “Take your medicine right now”
Threatening “If you don’t follow instructions, we won’t treat you”
Baseless reassurance “It will all be okay”
In summary, effective communication can be achieved by the following:
Active listening is the most important communication skill. It is important to receive the entire message as communication is not complete without effective listening. It requires attention, and being an attentive listener can stimulate the speaker as well.
Some non-verbal skills to facilitate active listening are as follows:
One can also use SOLER as an abbreviation to remember the following:
S - Sit at a comfortable angle and distance facing the patient
O - Open posture, with arms and legs uncrossed
L - Lean towards the patient, looking genuinely interested
E - Establish and maintain effective eye contact
R - Relax and be natural
Questions that allow the respondent to answer and elaborate with their own words are called open questions. These cannot be answered with a simple "Yes" or "No", or concluded with a specific piece of information. It allows for sharing of a large amount of information, encouraging the patient to tell their own story.
Examples include:
"What happened?"
"How do you feel?"
"What do you mean?"
"What would you like to achieve?"
This has been a really long and wordy article about communication.
Yes, the mindmaps are there because this topic was really too dry and had no pictures that I could easily include.
Stay tuned for more next week! Thanks for reading my Messy Workings~ :)
