Communication Skills

1. 1 Communication Skills

2. 2 Learning Objectives By the end of the session, you should be able to: Identify what is required to facilitate effective communication Recognise communication theories and how they can be applied to patient care Identify difficult communication scenarios and possible interventions. Apply theory and practice through the use of case studies. QuizQuiz

3. 3 What makes a good communicator? Group Work & feedback Group Work & feedback

4. 4 Good Listening Skills Self aware Empathetical Respect Listening Fundamental to communication Self Aware of What? Reactions, Tone, Actions, How others see us. Empathy Respect even if don’t agree, can still respectListening Fundamental to communication Self Aware of What? Reactions, Tone, Actions, How others see us. Empathy Respect even if don’t agree, can still respect

5. 5 Interpersonal communication Who we are, what we do , what we know all influence how we send & receive messages. Me – Abolishing statistical maths or football or Cadbury’s A shows one way comm B shows two way comm A – Please pass me the sugar B – Pleasure here it is. Said that nurses/ hcp are bad at 2 way comm. Because we can control one way comm, but not two. We invite the unknown……… (Vatzlaviks) theory Watzlawicks - You can’t not communicate.Who we are, what we do , what we know all influence how we send & receive messages. Me – Abolishing statistical maths or football or Cadbury’s A shows one way comm B shows two way comm A – Please pass me the sugar B – Pleasure here it is. Said that nurses/ hcp are bad at 2 way comm. Because we can control one way comm, but not two. We invite the unknown……… (Vatzlaviks) theory Watzlawicks - You can’t not communicate.

6. 6 Verbal Communication Different Messages: Conscious, Preview, Disclaimer Surface, Jargon Phrases Paralinguistic Features Surface Messages Can you give me a lift? Does what it says. Conscious encoding. Painful messages often like this. Ie Nurse – It may be time to look at getting you more help around the house Ie Colleague – I don’t know how we will cope with staff of sick over the BH weekend. Preview Will preview the contents I’ll tell you all the gory details……….. You might not like this…………… Disclaimer Disclaiming the contents as not their views. Don’t think I’m a gossip but…….. Jargon Avoid it. Pseudonyms shadow, lump, problem. Phrases It’s probably for the best…. You’ll be back to normal in no time…… I know how you feel……..Surface Messages Can you give me a lift? Does what it says. Conscious encoding. Painful messages often like this. Ie Nurse – It may be time to look at getting you more help around the house Ie Colleague – I don’t know how we will cope with staff of sick over the BH weekend. Preview Will preview the contents I’ll tell you all the gory details……….. You might not like this…………… Disclaimer Disclaiming the contents as not their views. Don’t think I’m a gossip but…….. Jargon Avoid it. Pseudonyms shadow, lump, problem. Phrases It’s probably for the best…. You’ll be back to normal in no time…… I know how you feel……..

7. 7 Paralinguistics Brian sold his car

8. 8 Questions Open/Closed questions Leading Probing Reflective Multiple The why? Open/Closed Can you give me an example? Open asks for thoughts feelings, views and elaboration. Closed asks for facts and limit answers. Closed questions begin with who, what, where, which. Advantage of open Q’s Encourage own story Prevents stabs in the dark approach of closed Allows time for interviewer to think & listen. Leading Q’s You’re doing so much better today Mrs Smith, don’t you think? Probing What else has happened? Useful for getting and checking information. Not good for emotional sensitive issues. Reflective So you felt upset by what you heard? Good for establishing empathy and handling emotionally charged situations. Not good for checking factual info. Multiple Did you leave the room or did you stay with them? Avoid The why Q Can probe for answers which may not be there. Group exercise in pairs. Page 64 Why Questions How did it feel to be asked the why question? What where the good and bad points about using it? Page 65 Bombarding question exercise. What did it feel like not to answer the questions? Did any one answer the questions? Did you answer the Q’s non verbally? What was it like being bombarded?Open/Closed Can you give me an example? Open asks for thoughts feelings, views and elaboration. Closed asks for facts and limit answers. Closed questions begin with who, what, where, which. Advantage of open Q’s Encourage own story Prevents stabs in the dark approach of closed Allows time for interviewer to think & listen. Leading Q’s You’re doing so much better today Mrs Smith, don’t you think? Probing What else has happened? Useful for getting and checking information. Not good for emotional sensitive issues. Reflective So you felt upset by what you heard? Good for establishing empathy and handling emotionally charged situations. Not good for checking factual info. Multiple Did you leave the room or did you stay with them? Avoid The why Q Can probe for answers which may not be there. Group exercise in pairs. Page 64 Why Questions How did it feel to be asked the why question? What where the good and bad points about using it? Page 65 Bombarding question exercise. What did it feel like not to answer the questions? Did any one answer the questions? Did you answer the Q’s non verbally? What was it like being bombarded?

9. 9 Listening Active Passive Surface & depth listening Non Judgemental Listening

10. 10 Active Listening Shows that you’re listening Helps check how accurately you have understood what the speaker meant. Express acceptance of the speakers Prompt the speaker to explore their feelings and thoughts.

11. 11 Techniques of Active Listening Paraphrase speakers meaning. Express understanding of speakers feelings Ask questions Echoing words

12. 12 Listening Framework Experiences What is happening to the person. What are their experiences of what’s happening Behaviour How person acts What do they say or do? How are they with you? Feelings What emotions they experience. Can you reflect these. Thoughts What the person understands about themselves Experiences What is happening to the person. What are their experiences of what’s happening Behaviour How person acts What do they say or do? How are they with you? Feelings What emotions they experience. Can you reflect these. Thoughts What the person understands about themselves

13. 13 DVD Track 3 & 4DVD Track 3 & 4

14. 14 How do we communicate non verbally?

15. 15 Non Verbal Communication Body language Illustrators Regulators Facial expression Posture Touch Eye contact Clothes Body space Illustrators Hand movement accompanying speech Regulators Facial expressions which indicate keep going. Make eye contact when ready to stop talking Hmm, Yeah, more frequently when want to talk. Facial Expression Be conscious of facial expression. Sensitive nerve ending in the nose react when under stressed. Nose rubbing, twitching often interpreted as a person lying. Posture Open/ closed. What is open posture? Eye Contact Average length of eye contact 2.95 seconds. If longer or shorter uncomfortable When listening time spent gazing is 62-75% When talking 38-41% Body Space Distances Intimate distance for intimate people Social distance 4-12 feet Public 12-25 feet Buffer zone – where we feel safe. Equilibrium theory – Greater the intimacy the closer the distance. Lower the intimacy more distance. Therefore when forced into close distance with some one we will make some kind of adjustment, turn face away, turn body away, avoid eye contact. Illustrators Hand movement accompanying speech Regulators Facial expressions which indicate keep going. Make eye contact when ready to stop talking Hmm, Yeah, more frequently when want to talk. Facial Expression Be conscious of facial expression. Sensitive nerve ending in the nose react when under stressed. Nose rubbing, twitching often interpreted as a person lying. Posture Open/ closed. What is open posture? Eye Contact Average length of eye contact 2.95 seconds. If longer or shorter uncomfortable When listening time spent gazing is 62-75% When talking 38-41% Body Space Distances Intimate distance for intimate people Social distance 4-12 feet Public 12-25 feet Buffer zone – where we feel safe. Equilibrium theory – Greater the intimacy the closer the distance. Lower the intimacy more distance. Therefore when forced into close distance with some one we will make some kind of adjustment, turn face away, turn body away, avoid eye contact.

16. 16 Awareness Open Suspected Mutual Closed Open When the person/patient and the other people involved know what is wrong and acknowledge it. Suspected When the person/patient suspects what is wrong but does not mention or acknowledge the suspicion. Mutual Mutual pretence – when both know that the other knows but neither say so. Closed When the person/patient does not know what is wrong. People can move from one to the other. They can indicate different levels of awareness to different people. Group work Q - Do you use these awareness contexts? Q - How is how we communicate affected by what you think patients know? 3 groups Answer all Q’s Open When the person/patient and the other people involved know what is wrong and acknowledge it. Suspected When the person/patient suspects what is wrong but does not mention or acknowledge the suspicion. Mutual Mutual pretence – when both know that the other knows but neither say so. Closed When the person/patient does not know what is wrong. People can move from one to the other. They can indicate different levels of awareness to different people. Group work Q - Do you use these awareness contexts? Q - How is how we communicate affected by what you think patients know? 3 groups Answer all Q’s

17. 17

18. 18 Communication/Counselling Theories There are 4 main approaches to communication & counselling they are Psychodynamic Behaviourist Humanistic Transactional Analysis There are 4 main approaches to communication & counselling they are Psychodynamic Behaviourist Humanistic Transactional Analysis

19. 19 Transactional Analysis Eric Berne (1966) A framework for the analysis of interaction Ego state: Parent, Adult, Child. All 3 needed for balanced personality. TA is described a s a framework for the analysis of interaction. The a main concept is ego state. 3 Ego states Parent When you behave/think/feel in ways copied by parental figures. Eg….Fire alarm I would be parental role. Child Behaviours replayed from childhood. Adult Behaviours which are direct and appropriate responses to the here and now. A balanced personality needs all 3 states. TA is described a s a framework for the analysis of interaction. The a main concept is ego state. 3 Ego states Parent When you behave/think/feel in ways copied by parental figures. Eg….Fire alarm I would be parental role. Child Behaviours replayed from childhood. Adult Behaviours which are direct and appropriate responses to the here and now. A balanced personality needs all 3 states.

20. 20 Complimentary Transaction Complimentary transaction Parallel arrows - where ego state that is addressed is the one that responds. Adult to adult Would you like to go shopping today? Yes, that sounds like a good idea. Complimentary transaction Parallel arrows - where ego state that is addressed is the one that responds. Adult to adult Would you like to go shopping today? Yes, that sounds like a good idea.

21. 21 Complimentary Transaction Parent – Child Now Mr Smith get out of bed that a good boy. Oh yes Ok nurse. Parent – Child Now Mr Smith get out of bed that a good boy. Oh yes Ok nurse.

22. 22 Crossed Transaction Problems occur when we get a crossed transaction. Eg Shall we sit here? No come and sit over here, quickly. The stimulus may be adult to adult, but response comes from the parent Think about how we talk to our patients and clients, do we talk in the parent role? Come into hospital and put their pyjamas on. Talcott & Parsons talk about the sick role Problems occur when we get a crossed transaction. Eg Shall we sit here? No come and sit over here, quickly. The stimulus may be adult to adult, but response comes from the parent Think about how we talk to our patients and clients, do we talk in the parent role? Come into hospital and put their pyjamas on. Talcott & Parsons talk about the sick role

23. 23 Resources Berne E (1964) Games People Play: the psychology of Human Relations. London, Grove Press. Burnanrd P (2005) Counselling Skills for Health Care Professionals. Slovenia, Nelson Thornes. Ellis R B, Gates B, Kenworthy N (2003) Interpersonal communication in nursing. 2nd Ed. Churchill Livingstone. London.

24. 24 Heron J (2001) Helping the Client: a creative practical guide 5th ed. London, Sage. Morris P, Burnanrd P (1997) Caring & Communication Houndsmill, Macmillan.