Chapter 4

1. Chapter 4 Therapeutic Communication Skills

2. Importance of Communication • Foundation for all patient care • Therapeutic communication skills create feelings of comfort for patients

3. The Communication Cycle • Involves two or more individuals exchanging information • Involves sending and receiving messages

4. The Communication Cycle ^^ The communication cycle and channels of communication.

5. Four Elements ofthe Communication Cycle • The sender begins cycle by encoding message • The message delivered via a channel or mode of communication • Speaking • Listening • Gestures or body language • Writing

6. Four Elements ofthe Communication Cycle • The receiver must decode the meaning of the message • Feedback takes place after receiver has decoded message sent by sender

7. The Communication Cycle • Listening skills • Active listening involves verifying message from sender • Received message is sent back to sender worded slightly differently

8. Verbal Communication • Takes place when message is spoken • Sender and receiver must apply same meaning to spoken words

9. Verbal Communication • The five Cs of communication • Complete • Clear • Eye contact enhances clarity • Articulate and enunciate • Time to process message • Message must be heard • Concise • Cohesive • Courteous

10. Verbal Communication • Good communication skills help establish rapport with patients • Call patients by full name • Encourage patients to verbalize feelings • Give technical information to patients clearly • Allow patients to make practical application to their health needs

11. Nonverbal Communication • Body language • Unconscious body movements, gestures, and facial expressions Body language can communicate more than spoken words >>

12. Nonverbal Communication • Body Language • Expressions that accompany speech • Kinesics is study of body language • Body language learned first • Body language influenced by primary caregivers and culture

13. Nonverbal Communication • Feelings and emotions are communicated through nonverbal means • 70% of language is nonverbal • Tone of voice communicates 23% of message • Spoken word communicates 7% of message

14. Nonverbal Communication • Facial expression • Eyes reflect feelings • Staring is invasion of privacy • Cultural influences affect facial expressions • Personal space • Comfortable personal space • Handled differently by various cultures • Explain procedures that will be invasive

15. Nonverbal Communication • Posture • Relates to position of body or parts of body • Involves at least half the body • Position • Face-to-face communication • Should enable observation of verbal and nonverbal cues

16. Nonverbal Communication Positive posture and position encourage therapeutic communication >>

17. Nonverbal Communication • Gestures and mannerisms • “Talk” with hands • Enhances spoken word • Touch • Appropriate touch is therapeutic • Not all patients are comfortable with touch

18. Congruency in Communication • Click to play the video

19. Congruency in Communication • Verbal and nonverbal messages must agree • The meaning of mixed messages • Clustering groups of nonverbal messages • Masking conceals true feeling or message

20. Congruency in Communication • Perception • Conscious awareness of one’s own feelings and the feelings of others • Sense another’s attitudes, moods, and feelings • Follow perceived assessments with verbal validation • Easily misinterpreted

21. Barriers to Therapeutic Communication • Age and gender barriers • Economic barriers • Education and life experience barriers

22. Barriers to Therapeutic Communication • Bias and prejudice barriers • Verbal roadblocks to therapeutic communication

23. Regression Denial Repression Projection Sublimation Displacement Compensation Rationalization Undoing Defense Mechanisms as Barriers

24. Barriers to Therapeutic Communication • Barriers caused by cultural and religious diversity • Caregiving expectations • Time focus

25. Barriers to Therapeutic Communication • Human needs as barriers to communication Maslow’s hierarchy of needs >>

26. Establishing Multicultural Communication • The patient must trust the professional • Steps to building trust include: • Risk/trust • Conveying empathy • Showing respect • Being genuine • Active listening

27. Working with Multicultural and Diverse Patient Populations • Click to play the video

28. Cultural Brokering • Cultural broker serves as a go-between • One who advocates on behalf of another individual or group within the health care community

29. Cultural Brokering • Goal of cultural brokering • Increase the capacity of health care and mental health programs to design, implement, and evaluate culturally and linguistically competent service delivery systems • Cultural brokers may assume the role of medical interpreter

30. Working with Interpreters • Interpreters do not provide word-for-word equivalence, rather focus on the accurate expression of equivalent meaning • Remember to speak directly to the patient, not to the interpreter

31. Working with Interpreters • A family member may serve as the interpreter • Disadvantage of a family member serving as interpreter • They may not understand medical terminology • It would be very difficult for a family member to share a poor prognosis or a life-threatening diagnosis

32. Interview Techniques • Closed questions • “Are you taking your medications?” • Open-ended questions • “How are you coming along with your diet?” • Indirect statements • “Tell me what you’ve been doing since your retirement.”

33. Point of Care Techniques • Location where the patient and provider or patient and office personnel physically interact

34. Community Resources • Need to refer patient to a community resource • Developing a community resource document