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- 1COMMUNICATION- The role of medical communication: who?Patients, nurses, relatives, carers, other profs eg interpreters, colleagues etc
- 2How?Verbal
Non verbal - 3What?Emails
Pagers
Phone
Fax
Written ie letters, signage, warnings - 4Why?Give info
Give instructions
Consent
Health and safety
Rapport
Patient care
Reassurance
Comfort - 5Listening"the ability to understand, elicit and assess how much info a patient wants"
"fulfil professional duties" - 6% of communication55% body movement
38% vocal (volume, pitch etc)
7% verbal - 7Effective communicationCompliance
Concerns
Empathy, understanding
Patient satisfaction
Medico-legal risks - 8Communication cycle1. SENDER: expresses
2. MEDIUM: transmits
3. RECIPIENT: interprets
4. FEEDBACK: returns - 9Steps to effective communication1. Sender expresses message, with purpose, goal or objective
- 102. Medium transmits the message (Benefits of written communication)Supplements oral communication
Enhance understanding and memory
Empower prior to an appt
Permanent record of the info - 11Written info to be effective needs to beNoticed
Read
Understood
Believed
Remembered - 123. Recipient interprets the messagea) construct and deliver the message with audience in mind: what do they need to know, want to know, already know
b) remove obstacles to clear understanding, eg noise, distractions, discomforts, prejudice - 134. Feedback returns the interpretation of the recipient to the senderEnables the sender to evaluate the effectiveness of the message and refine it if necessary
Can be in the form of: NVC (smile, nodding)
Oral (qs, comments)
Written (reply to letter, email, appt)
As recipient and sender roles are reversed, the communication loop is completed - 14Communication barriers: SENDERInappropriate language
Incorrect info
Wrong rceiver
Failure to send feedback
NVC does not = VC
Power imbalance
Preconceptions
Stress/anxiety - 15MEDIUMToo many links in the chain
Info not passed on/backed up
Mechanical probs
Poor interdepartmental relations
Noise/environmental distractions - 16RECEIVERCognitive probs
Forgetting
Language
Misinterpretation
Selective attention
Relationship w/ sender
Previous experience
Stress/anxiety - 17Communication needs to be:Accurate
Efficient
Supportive - 18COMMUNICATION STYLES: Passive:Ignoring own needs/rights
Avoiding conflict - 19AggressiveGetting own way at the expense of others
Creating conflict - 20Passive-aggressiveManipulative or blaming
Inappropriately getting own way
Unpredictable - 21PASSIVELISTENING: ok, whatever, silence
SPEAKING: sorry, don't mind, it's not imp
NVC: silence, shrug shoulders, wandering eyes, head down, slouching, low voice, mumbling, nodding
IMPRESSION: weakness, uncaring, submissive, helpless, indecisive - 22AGGRESSIVELISTENING: not listening, reacting defensively, responding from own perspective
SPEAKING: you are.. you always... can't you ever... swearing and abusive
NVC: Raised voice, abusive, threatening, arms crossed, invading personal space, pacing, tapping, pointing
IMPRESSION: rude, arrogant, overbearing, idiot, unapproachable - 23PASSIVE-AGGRESSIVELISTENING: appear to be actively listening
SPEAKING: you should have... it's your fault, why didn't you....
NVC: mixed signals, VC and NVC do not match
IMPRESSION: sarcastic, hard to read, untrustworthy, ambiguous, deceitful, manipulative - 24What is assertiveness?Ability to communicate thoughts, feelings and ideas, both positive and negative in an open and honest way which does not abuse our rights or those of others
-Leeds Mental Health Trust - 25ASSERTIVESaying what you want but not at the expense of others
Can negotiate and compromise - 263 principles of assertivenessHonesty
The bottom line
Communicate as equals - 273 steps to assertivenessSummarise them
Express yourself
Suggest action - 28Expressing yourself: assertive 'I' statements. 3 specific elements:Behaviour
Feeling
Tangible effect (consequence to you)
eg "I feel frustrated when you are late for meetings. I do not like having to repeat information" - 29Strategies for difficult situations: Broken record technique:Repeat, acknowledge, continue
- 30CALM modelClarify
Address
Listen
Manage - 31ASSERTIVENESSLISTENING: I can see you feel, you seem to be saying.. (feedback summarises and indicates listening)
SPEAKING: I think... I believe... My understanding is... I need...
NVC: Reinforces verbal, smiling, maintaining eye contact, maintaining personal space, steady voice
IMPRESSION: in contrast, honest, confident, cooperative, PROFESSIONAL - 32COMMUNICATION AND THE GLOBAL HOSPITAL Ethnocentrism:Tendency to view own cultural group as centre of everything, the standard against which others are judged (Randall-David, 1989)
Using own set of standards and customs to judge all ppl (Bennett, 1998) - 33Culture:what is it made up of?Mannerisms
Dress
Language
Religion
Arts
Food
Custom
Lifestyles
Ways of living together
Values - 34CulturePrejudice may exist that cause us to make wrong assumptions
- 35StereotypesA widely held but fixed and oversimplified image or idea of a particular type of person
- 36Non verbal communicaionIntentional and unintentional signals that convey mood communication
Imp in terms of patient satisfaction
Believed more readily than the verbal
Imp in both health profs and patient - 371. ImmediacyDegree of closeness
Frequency of touching
Eye contact
Leaning forward
Body orientation
Physical proximity - 382. RelaxationHand and neck
Sideways or backward leaning - 393. ResponsivenessFacial activity
Vocal activity
Speech rate
Speech volume - 404. Active listeningFace the speaker
Eye contact
Minimise external and internal distractions
Respond appropriately-encouraging
Focus on words being spoken
Keep open mind
Wait till they finish to respond
Clarify situation - 41Potential probsNVC not matching VC
Gender
Class/status
Sensitive topic/fear of hurting feelings
Strong emotions
Bullying
Trying to please
Sarcasm - 42Positive NVCSmiling
Nodding
Eye contact
Relaxed posture
Facing directly
Unbuttoned jacket
Legs and arms uncrossed
Open hands
Leaning forward - 43Negative NVCTight lips
Frowning
Avoiding eye contact
Too much eye contact
Raising eyes
Dead expression
Squirming
Fidgeting, doodling
Pointing
Turning away
Clenched hands
Stiff posture
Standing over
Crossed legs and arms
Standing too close - 44CHALLENGING PATIENTS: ConsiderationsNHS Constitution (2013) eg 'duty of care'
SoR code of professional conduct (2013) eg 'best compassionate of care'
HCPC Standards of proficiency (2013) eg 'understanding emotions, behaviours and needs of our patients' - 45Patient FactorsPsychiatric disorders
Alcoholism
Personality disorder
Previous experience
Well founded need for info
Inbuilt critical approach to probs
Egotistic elements
Excessively demanding attitude - 46Practitioner factorsStrong assumptions how patients should behave
Narcissism
Arrogant personality
Poor communication
Poor psychosocial skills
Cultural gaps
Lack of experience
Stress or work overload - 47Healthcare system factorsGrowing multicultural societies causing communication probs or unrealistic expectations
Increase of patient mistrust
Pressures of department impacting care
Lack of continuity of care
Easy access to wide range and confusing info via technology - 484 types of patientsDependent clingers: attention seeking, constant reassurance, urgent demands and explanations
Entitled demanders: use intimidation, devaluation and guilt
Manipulative help rejecters: pessimism 'nothing is working'
Self destructive deniers: trying to defeat HCPs in attempting to preserve life - 49Them vs us: cycle of conflictRude
Obnoxious
Defensive
Arrogant
Demanding
Crazy
Judgemental
Frustrated
Loud
Withdrawn
Superior - 50General strategiesDetermine agenda: patient and own
Identify emotional reaction to patient
Establish common goal
Negotiate plan
Refer to colleague
Record as an incident - 51Dynamic listeningTune in
Ignore distractions
Do not interrupt
Empathy
Tame own emotions
Avoid hasty judgements
Acknowledge their perspective - 52Taking controlSelf awareness; you only have control over your own behaviour, you influence how patients respond to you
Communication: engage, empathise, educate, enlist
Open ended qs
Listening: active listening, looking @ them. Reflective listening, repeating back. Empathetic listening "that must be difficult for you" - 53The angry patientListen to their grievance
Remain composed
Communicate in private
Recognise and acknowledge anger
Verify their anger
Accept the anger by listening, acknowledge the feeling not the behaviour
Explore reasons
Discuss in neutral fashion
Reflect
Reach agreement about the resolution
Help recognise ways to deal with the situation
Make clear their say will be listened to
Validate experience
Paraphrase
Empathise
Offer to help find solution
State what is needed
Use name
Change of scenery, change of face - 54LEAPSListen
Empathise
Ask them
Problem solve
Speak without judgement or blame - 55KEEP CALMKnowledge
Expel prejudice
Express concern
Position appropriately
Confront with care
Avoid touch
Listen
Manage - 56The dramatic patientAka seductive/manipulative
- 57Contributing factors: the way a patient may feelweak
unattractive
unsuccessful
illness is personal defect
vulnerable
rejected - 58How to deal with a dramatic patientestablish control
remain calm
be gentle and firm
chaperone
guidelines in dept
make clear rules are for everyone
maintain prof boundaries
respond to personal or uncomfortable qs by reminding patient of your role - 59strategiesmaintain control
eye contact
sit or stand at the same level
calm void
nod head
minimal physical contact
empathise, acknowledge feelings do not condone behaviour
do not use technical jargon
let them know your limitations (guidelines, protocols, the law)
repeat your position and limitations
chaperone (ie witness)
refer to another radiographer - 60COUNSELLING SKILLS Impact of counselling skillsImprove job satisfaction
Improved coping with treatment
Positive impact on patient experience and coping - 61SkillsListening
Not reacting
Reading in between the lines
Thinking
Self awareness and understanding
Tuning in - 62Core conditions of helping Carl Rogers (1958)Unconditional positive regard
Empathy
Genuineness - 63EmpathyUnderstanding someone as if you were them and communicating this to them
- 64Conveying empathyListening, identifying core message, attention to non verbal cues, not interrupting, respond to tone and speak in a similar way
- 65Passive listeninginvoluntary, perceiving sound
- 66Active listeningAsk questions, paraphrase, summarise, reflect meanings and feelings, pay attention to non verbal cues
- 67Use of questions: Open endedenable free speaking, can give any response, elicit examples
- 68Closed ended questionsclose down conversation, limit over talking, elicit specific information, predict a factual and focused response
- 69minimal encouraging behaviourallowing silence, eye contact, open body posture, nod head occasionally, neutral facilitative responses that do not interrupt, no distracting nervous movements
- 70Paraphraseput what they have said into different words
- 71SummariseFocus on the essential part of what was said, condense and clarify
- 72Reflection of feelings and meaningsRepeat the last few words they have said and use tentative phrases like "it sounds like you are feeling..."
"So you're feeling...." - 73Active listeningReflecting rather than evaluating
Clarifying rather than confronting
Supportive rather than problem solving
Sharing silence rather than filling the gaps
Summarising rather than interpreting - 74Barriers to good communicationBeing too task orientated
Time constraints
Distractions
Cultural differences
Prejudice/stereotyping
Willingness of the patient
Internal barriers to listening - 75Internal barriers to listeningFear of the patient's feelings
Too close to home
Fear of getting it wrong
Stress
Tiredness
Transference issues
Burnout - 76Egan's Helping ModelPutting it all together
SOLER
3 stage model of a helping interaction - 77SOLERS - sitting at a comfortable angle and distance
O - open posture. Arms and legs uncrossed
L - Leaning forward. Looking interested
E - Effective eye contact without staring
R - Remaining relatively relaxed - 78The helping process - 3 stage model1. Exploring; active listening, paraphrasing, reflecting meanings and feelings and clarifying
2. Understanding; stage I skills, immediacy, challenging, summarising, new perspectives, linking themes, establish aims
3. Action; goal setting, resources, evaluation - 79Patient centred communicationFriendly introductions
Smiles, warm tones, appropriate touch
Explaining
Asking permission
Open communication
Maintain patient's dignity - 80Counselling skillsEmpathy
Active listening
Cultural sensitivity
Self awareness - 81Why do HCPs need to study ethics?To protect the vulnerable in society
Medical advancements present ethical dilemmas
Using an ethical framework to guide difficult clinical decisions - 82What is ethics?the study of moral behaviour (Hawley, 2007)
- 83Day to day ethics:Respecting people
Treating people with dignity
Treating people fairly
Supporting patient's choices - 84Why do radiographers need to be aware of ethicsHCPC (Health care and professions council) requirement
Under HCPC standards of proficiency: "be able to practice within legal and ethical boundaries of their profession"
"Understand the legislative, policy, ethical and research frameworks that underpin, influence and inform the practice of radiography" - 85Why do we need an ethical debate?Advancements in technology
Increasing public awareness
Increasing public expectations
Improvements in general standards of health/nutrition
Diminishing resources in health care
These all present ethical dilemmas - 86Normative ethicsPrescriptive
Modern approach
Attempts to address a situation through the evaluation of right or good standards/actions
Theory based on a set of criteria
Practical or applied ethics
Investigates qs that arise when considering how to act morally
Examines standards for the rightness and wrongness of actions - 87Descriptive ethicsDescribing how people behave
What sorts of moral standards they claim to follow
Anthropology, sociology, psychology and history as part of process of understanding what people do or have believed about moral norms
Study of people's beliefs about morality
Empirical research into attitudes
Uncover beliefs about values, which actions are right and wrong - 88Medical ethicsApplied branch of ethics or moral philosophy where an attempt is made to evaluate actions or nonactions in a health care setting
System of moral principles that apply values and judgements to the practice of medicine - 89Doctrine of double effectAn action will have 2 consequences
The ethicality of that action depends on which of the effects was intended
Commonly referred to in cases of euthanasia
Used to justify the case where a Dr gives drugs to a patient to relieve distressing symptoms although knowing this could shorten their life - 90Ordinary means"must always be used"
any treatment which provides some benefit to the patient without excessive burden or hardship - 91Extraordinary means"optional"
Measures which do not present an excessive burden - 92Consequentialism / utilitarian approachtaking the consequences of our actions into consideration
actions are right or wrong according to the balance of their good and bad consequences
the right act is the one with the best overall result
utilitarianism-which action has the greatest utility-use/benefit/positive outcome
actions ought to produce the maximal balance of positive value eg happiness over disvalue or harm - 93ConsequencesConsequences of an action are the ultimate basis for any judgement about the rightness or wrongness of that conduct
A morally right act produces a good consequence
the ends justify the means - 94DeontologyDuty based theory
Assess situation as right or wrong
Does not look at the best outcomes
An act is right if it conforms to an overriding moral duty
Perceived as rigid and formal
Judges morality of an action based on the action's adherence to rules
Rule based theory, rules bind you to your duty
HCPC/SCoR code of conduct is a product of deontological ethics - guides actions based on principles/duties - 954 principles approachPrinciple of autonomy-right to be self governing
Principle of non maleficence - avoiding harm
Principle of beneficence - promote wellbeing and best interests
Principle of justice - consider as equals - 96AutonomyCapacity to think, decide and act freely
Self governance, liberty, rights and privacy
Respect for autonomy-moral requirement
Recognises the rights of individuals to self determination
Make informed decisions about personal matters - 97BeneficenceTo do good and maximise good
Patients interests come first
Promoting health and wellbeing - 98Non maleficenceAn absolute moral duty
Never knowingly do harm to patient
Obligation to avoid harm
"Do no harm"
Primary consideration;it's more important to avoid harm than do your patient good - 99JusticeEqual access to healthcare, social, welfare rights and entitlement
Offer same standard of care to all human beings regardless of financial status, ethnic origins, political views, religious affiliations, gender/sexuality
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- OSCE Karteikarten am OSCE, erstellt von nabeelajhetam am 27/04/2015.
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