Communication Skills for the Healthcare Professional

Communication Skills for the Healthcare Professional Chapter 6 Adapting Communication to a Patient’s Ability to Understand

Chapter 6 Outline • Factors That May Impair Communication with a Patient • Health Literacy • Language Barriers • Visual Impairment • Deafness and Hearing Loss • Advanced Age • Delirium and Dementia

Factors That May Impair Communication with a Patient • Communication with any patient may be negatively impacted by: pain, fear, or anxiety

Factors That May Impair Communication with a Patient, cont. • Communication may also be impaired in some patients by: • Low health literacy • Language differences • Visual impairment • Loss of hearing • Advanced age • Confusion

Health Literacy • Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”

Health Literacy, cont. • Health literacy includes: the ability to understand instructions on over-the-counter and prescription drug labels, appointment slips, medical education brochures, doctor’s instructions, and consent forms, as well as the ability to navigate complex healthcare systems

Health Literacy, cont. • Most medical literature is written at a high school reading level or higher. • However, over time many individuals with a high school diploma may end up reading at only a seventh or eighth grade level. • Health literacy also includes numeracy skills (e.g., understanding probability and risk, calculating blood sugar levels, measuring medications, and understanding nutrition labels.)

Health Literacy, cont. • Approximately 12% of adults have proficient health literacy. • Populations that may experience low health literacy include: older people, racial and ethnic minorities, people without a high school diploma or GED, individuals with low incomes, non-native speakers of English, and people with chronic disease.

Health Literacy, cont. • Individuals with low health literacy are more likely to: • Overlook important preventive measures. • Have a chronic disease, be less able to manage their care effectively, and be less likely to get the health care they need. • Enter the healthcare system when they are sicker. • Go to the emergency room and be hospitalized.

Health Literacy, cont. • Individuals with low health literacy are more likely to, cont.: • Lack health insurance. • Have a sense of shame regarding their lack of skills and may hide their difficulties to maintain their dignity. • Be noncompliant with doctor’s instructions and make medication errors. • Have poorer health outcomes and higher healthcare costs.

Health Literacy, cont. • Strategies to communicate and interact most effectively with patients with low health literacy include: • Evaluate the patient’s understanding before, during, and after the introduction of information or instruction. • Limit the number of messages given to a patient at any one time. • Use “plain language” (communication that the patient can understand the first time they hear it or read it.)

Health Literacy, cont. • Plain language is characterized by: • Information organized so that the most important points are delivered first • Information broken down into understandable chunks • Language that is simple with clearly defined medical terminology • The use of the active voice

Health Literacy, cont. • Strategies to communicate and interact most effectively with patients with low health literacy, cont.: • Supplement instructions with pictures. • Tailor medication schedules to fit a patient’s daily routine. • Prepare written forms of communication at a fifth- to sixth-grade reading level and in a format that appears easy to read. • Provide or serve as a reader for forms or written information.

Language Barriers • Disadvantages that may be present when the patient and the HCP do not speak the same language include: • The opportunity to develop rapport is reduced. • The use of “small talk” to obtain relevant clinical information from the patient and to emotionally engage with the patient is limited. • The patient and the HCP must rely on a medical interpreter to deliver their messages. • The patient may be less likely to effectively convey their complaints and concerns.

Language Barriers, cont. • Disadvantages that may be present when the patient and the HCP do not speak the same language, cont.: • The HCP may be less likely to effectively convey their diagnosis and recommendations. • Pediatric patients may experience an increased use of diagnostic tests in an emergency department as well as increased rates of hospitalizations. • Adverse medical events in hospitalized patients are more common.

Language Barriers, cont. • Only qualified medical interpreters should be used. • The use of nonprofessional interpreters, such as family or friends, may be disadvantageous: • They are often unfamiliar with complex medical information and may incorrectly translate words and phrases from the HCP to the patient. • The loss of patient confidentiality may make the patient uncomfortable being candid and they may withhold potentially important details of their condition.

Language Barriers, cont. • Strategies the HCP may employ to work more effectively with a medical interpreter include: • Look at and speak directly to the patient. • Use short sentences. • Avoid the use of informal and unprofessional vocabulary. • Remain patient and understanding.

Language Barriers, cont. • Strategies the HCP may employ to work more effectively with a medical interpreter, cont.: • Observe the patient’s nonverbal messages. • Repeat important information. • Employ “teach back.” (Ask the patient to repeat important instructions or information in their own words.)

Visual Impairment • Vision loss refers to difficulty seeing, even when wearing corrective lenses, as well as complete blindness. • Well over 25 million Americans report experiencing significant vision loss.

Visual Impairment, cont. • Strategies for communicating and interacting most effectively with patients who are visually impaired are based primarily on courtesy, respect, and common sense and include: • Greet the patient. • Speak directly to the patient. • Tell the patient that you will be touching them before you do so.

Visual Impairment, cont. • Strategies for communicating and interacting most effectively with patients who are visually impaired, cont.: • Be verbally descriptive. • Use the words “look” and “see” normally. • Tell the patient when you are leaving the area.

Visual Impairment, cont. • Strategies for communicating and interacting most effectively with patients who are visually impaired, cont.: • Do not attempt to guide the patient without first asking. • Never touch or distract the patient’s service dog. • Walk with the patient between you and the service dog. • Provide reasonable accommodations.

Deafness and Hearing Loss • The term “deaf” refers to those patients who are unable to hear well enough to rely on their hearing and use it as a means of processing information. • The lower case deaf is used when referring to the audiologic condition. • The uppercase Deaf is used when referring to a particular group of deaf individuals who share a language, American Sign Language, and a culture.

Deafness and Hearing Loss, cont. • The term “hard of hearing” refers to those patients who have some hearing and are able to use it for communication purposes. These patients are described as having mild to moderate hearing loss. • More than 28 million Americans are deaf or hard of hearing.

Deafness and Hearing Loss, cont. • Because the majority of these individuals are 65 years of age or older, the number of deaf and hard of hearing patients is expected to increase substantially in the coming years as the population ages. • Ineffective communication between the HCP and the deaf or hard of hearing may lead to misdiagnosis and medication errors, as well as potential embarrassment, anxiety or fear.

Deafness and Hearing Loss, cont. • Interpreters of American Sign Language may be needed in the clinical setting. • The HCP must remember to be patient and considerate. Everyone, especially hard of hearing patients, will hear and understand less well when they are tired, ill, or in pain. It can be a marked strain for these patients to remain attentive for long periods of time.

Deafness and Hearing Loss, cont. • Strategies for communicating and interacting most effectively with patients who are deaf or hard of hearing are based primarily on courtesy, respect, and common sense and include: • Be sure that the patient sees you approach. • Interact directly with the patient. • Record and respect the patient’s preferred method of communication.

Deafness and Hearing Loss, cont. • Strategies for communicating and interacting most effectively with patients who are deaf or hard of hearing, cont.: • If your patient hears better in one ear that the other, make note of this in the patient’s medical record and position yourself accordingly. • Gain the patient’s attention before you speak. • Speak clearly, in a normal tone of voice, a little more loudly, and at a moderate pace. Pause between phrases.

Deafness and Hearing Loss, cont. • Strategies for communicating and interacting most effectively with patients who are deaf or hard of hearing, cont.: • Optimize conditions for speech reading. • Minimize the use of medical terminology. • Maintain eye contact with the patient. • Include the use and observation of nonverbal communication.

Deafness and Hearing Loss, cont. • Strategies for communicating and interacting most effectively with patients who are deaf or hard of hearing, cont.: • Rephrase or write the message. • Indicate a change in topic. • Supplement the conversation with visual aids. • Employ teach back.

Advanced Age • The size of the elderly population in the United States is increasing markedly. • “Baby Boomers” are individuals who were born between 1946 and 1964. • In 2010, there were an estimated 76 million Baby Boomers. • By 2030, more than 58 millions Americans will be age 65 or older.

Advanced Age, cont. • Declining health and complex disease management in the elderly result in multiple visits to doctors and other healthcare providers each year.

Advanced Age, cont. • Communication may be impaired between these older patients and their HCPs by several factors including: • Sensory loss (vision loss and hearing loss) • Decline in memory • Slower processing of information • HCPs must adapt their communication with older patients accordingly.

Advanced Age, cont. • Strategies to communicate and interact with patients of advanced age include: • Schedule older patients earlier in the day. • Speak slowly, clearly, and loudly. • Repeat important information and write down instructions.

Advanced Age, cont. • Strategies to communicate and interact with patients of advanced age, cont.: • Focus on one topic at a time and minimize distractions. • Face the patient and maintain eye contact. • Use visual aids.

Delirium and Dementia • Delirium is acute confusion; a temporary or reversible period of disorientation, hallucinations, or delusions • Episodes have an abrupt onset, which is associated with a specific risk factor or cause. • Episodes may last for hours or days. • Patients will find it difficult to focus attention and to rest or sleep.

Delirium and Dementia, cont. • Dementia is chronic confusion; a progressive, irreversible decline in mental function • Characterized by: memory impairment and deficits in reasoning, judgment, abstract thought, comprehension, learning, task execution, and use of language • May involve degenerative processes • Typically has an insidious onset that occurs over months and years

Delirium and Dementia, cont. • Strategies for communicating and interacting effectively with cognitively impaired patients include: • Expect an increase in confusion from the patient upon waking as well as “sundowning.” • Approach the patient from the front and call the patient by name. • Respect the patient’s personal space and observe their reaction as you move closer.

Delirium and Dementia, cont. • Strategies for communicating and interacting effectively with cognitively impaired patients, cont.: • Avoid sudden movements that may startle or irritate the patient. • Speak slowly and distinctly in a low-pitched voice. • Ask one question at a time.

Delirium and Dementia, cont. • Strategies for communicating and interacting effectively with cognitively impaired patients, cont.: • Give one-step directions and instructions. • Remain mindful of your nonverbal messages. • Do not disagree or argue with the patient.

Communication Skills for the Healthcare Professional