Communication Skills for the Healthcare Professional

1. Communication Skills for the Healthcare Professional Chapter 2 Nonverbal Communication

2. Revesion Chapter 1 outline: • Therapeutic Communication • A Definition of Communication • The Five Steps of the Communication Process • The Sender has an Idea to Communicate • The Sender Encodes the Idea in a Message • The Message Travels Over a Channel • The Receiver Decodes the Message • The Receiver Understands the Message and Sends Feedback to the Sender • Noise

3. Chapter 2 Outline • Importance of Nonverbal Communication in Health Care • Categories of Nonverbal Communication: Kinesics, Proxemics, Touch • Types of Nonverbal Communication: Gestures, Facial Expressions, Gaze Patterns, Personal Space, Position, Posture, Touch • Proper Interpretation of Nonverbal Communication: Congruency with Verbal Messages • Proper Nonverbal Communication Skills for the Healthcare Professional

4. Importance of Nonverbal Communication in Health Care • Nonverbal communication, which may be unintentional, includes body movements, gestures and facial expressions. • These behaviors convey information that words alone often do not. • It is generally accepted that 70% of communication is nonverbal, 23% involves the tone of voice, and only 7% of communication occurs by the chosen words. • Nonverbal communication provides a clue to a person’s inner thoughts and feelings and may be particularly important in stressful situations such as illness.

5. Importance of Nonverbal Communication in Health Care, cont. • Certain behaviors may have more than one potential interpretation. • Is the patient sitting with crossed arms angry, anxious, self-conscious, or simply cold? • Many aspects of nonverbal communication, especially eye contact, are culturally informed and need to be interpreted according to the sender’s cultural background. • If there is a conflict between verbal and nonverbal messages, the nonverbal messages tend to be believed.

6. Categories of Nonverbal Communication • Kinesics: involving body movement –gestures, facial expressions, gaze patterns • Proxemics: involving the physical distance between people when they communicate—territoriality and personal space, position, and posture • Touch

7. Types of Nonverbal Communication, cont. • Gestures • Gestures include movements of the head, hands, eyes, and other body parts. • Gestures are one of the most obvious and common forms of nonverbal communication. • Examples?

8. Types of Nonverbal Communication, cont. • Gestures, cont. • Illustrators are intentional gestures that serve to emphasize, clarify, or add to the verbal content of a message. • Examples? • Gestures may be involuntary or subconscious. • Leakage occurs when subconscious gestures reveal true feelings or attitudes.

9. Types of Nonverbal Communication, cont. • Gestures, cont. • Many gestures have common interpretations. • “Positive” vs. “Negative” gestures • Examples? • Gestures are one of the most culture-specific forms of nonverbal communication. Care must be taken not to unintentionally offend a patient.

10. Types of Nonverbal Communication, cont. • Facial Expressions • Facial expressions may be used to punctuate a message or to regulate the flow of conversation. • Examples? • Facial expressions of many emotions—happiness, sadness, and fear—are biologically determined, universal, and learned similarly across cultures. • Examples?

11. Types of Nonverbal Communication, cont. • Facial Expressions, cont. • Leakage may also occur with facial expressions. • Examples? • The HCP must learn to control their facial expressions to prevent conveying potentially hurtful feelings to their patient.

12. Types of Nonverbal Communication, cont. • Facial Expressions, cont. • The facial expression of pain is of importance to the HCP. • Grimaces of pain are not observed until the threshold of pain has been reached. • HCPs have a tendency to underestimate pain when performing clinical assessments. A patient’s voluntary exaggeration of pain in the presence of others may not be meant to be disingenuous, but rather may be a message to elicit care.

13. Types of Nonverbal Communication, cont. • Gaze Patterns • Gaze serves three primary functions: • Monitoring—assessing how others appear or how a listener is responding to the speaker • Regulating—using gaze to regulate the conversation such as indicating when it is the other person’s turn to speak • Expressing—communicating feelings and emotion

14. Types of Nonverbal Communication, cont. • Gaze Patterns, cont. • Eye contact—shows that the HCP is interested in giving and receiving messages and acknowledges the patient’s worth. • Lack of eye contact—may be interpreted as avoidance or disinterest in the patient. • Staring—may be dehumanizing, discourteous, or hostile, and may be interpreted as an invasion of privacy.

15. Types of Nonverbal Communication, cont. • Gaze Patterns, cont. • Gaze patterns are affected by changes in mood: • Sad or depressed people tend to make less eye contact. • Patients with mental health problems tend to avert their gaze.

16. Types of Nonverbal Communication, cont. • Gaze Patterns, cont. • Strong correlation between looking and liking: • Patients who receive longer gazes from HCPs tend to talk more freely about health concerns, present more health problems, and provide more information about psychosocial issues.

17. Types of Nonverbal Communication, cont. • Personal Space • Personal space, or territory is the distance a person prefer in interaction with others • provides an individual with a sense of identity, security, and control. • People often feel threatened or uncomfortable when that space has been invaded. It may create anxiety or feelings of loss of control. • In a healthcare setting, patients are often required to give up this personal space so that they may be properly examined and treated. Examples?

18. Types of Nonverbal Communication, cont. • Personal Space, cont. • Approaches to help lessen a patient’s anxiety created by intrusions and the loss of personal space: • Treat the patient respectfully—recognize their territory, belongings, and right to privacy • Allow the patient to exercise as much control over their surroundings as possible. • Recognize the patient’s need for privacy—be discrete both verbally and physically

19. Types of Nonverbal Communication, cont. • Personal Space, cont. • Four generally accepted distance zones: • Intimate distance = up to 1.5 feet a(round 30 cm to 45 cm). Clinicians often need to enter this zone to examine and care for the patient.

20. Personal distance = 1.5 to 4 feet (around 45cm to 122 cm about an arm’s length.) In the healthcare setting, this distance may be used when explaining a clinical procedure or discussing a personal matter.

21. Types of Nonverbal Communication, cont. • Personal Space, cont. • Four generally accepted distance zones, cont.: • Social distance = 4 to 12 feet (122 cm to 300 cm). Many HCPs maintain this distance during a consultation. • Public distance = more than 12 feet (400 cm and more).

22. Types of Nonverbal Communication, cont. • Personal Space, cont. • The far side of the social distance and the public distance are inappropriate when dealing directly with patients and discussing their health issues. Both intimacy and privacy may be lost at these distances.

23. Types of Nonverbal Communication, cont. • Personal Space, cont. • The HCP should be sensitive to the distance norms for different situations and allow the patient to participate in establishing these distances whenever possible. • It is important to explain any procedure that requires entering the patient’s personal space before beginning the procedure.

24. Types of Nonverbal Communication, cont. • Position • Maintain a close but comfortable position about an arm’s length from the patient. • Maintain an eye-level conversation whenever possible.

25. Types of Nonverbal Communication, cont. • Position, cont. • Communicate with the patient in a face-to-face manner. • Maintain a position leaning slightly forward so as to express warmth, caring, interest, acceptance, and trust.

26. Types of Nonverbal Communication, cont. • Posture • Posture refers to the position of the body and limbs as well as muscular tone. • The posture of a patient may reveal their emotional status: • Depression or discouragement is characterized by a drooping head, sagging shoulders, low muscle tone, and the appearance of sadness or fatigue.

27. Types of Nonverbal Communication, cont. • Posture, cont. • The posture of a patient may reveal their emotional status, cont.: • Anxiety and fear may be characterized by increased muscle tone where the body is held in a rigid and upright manner. • Interest is conveyed by leaning forward with the legs drawn back.

28. Types of Nonverbal Communication, cont. • Posture, cont. • The posture of a patient may reveal their emotional status, cont.: • Boredom may be conveyed with a lowered head, outstretched legs, and a backward leaning position. • Avoidance and rejection are displayed by a closed body posture where the patient may cross their arms and legs, lean back as if to create distance, and may even turn their body away from the HCP.

29. Types of Nonverbal Communication, cont. • Posture, cont. • The HCP who maintains an open body posture (arms and legs uncrossed, facing the patient, leaning slightly forward) will appear confident, friendly, warm, and inviting.

30. Types of Nonverbal Communication, cont. • Touch • Touch serves as a critical tool for examining, diagnosing, treating, or simply caring for a patient. • Touch may also serve to: • Ease a patient’s sense of isolation • Decrease patient anxiety

31. Types of Nonverbal Communication, cont. • Touch, cont. • Touch may also serve to, cont.: • Demonstrate caring, empathy, and sincerity • Offer reassurance, warmth, or comfort • Enhance the rapport between the HCP and the patient • Supplement verbal communication

32. Types of Nonverbal Communication, cont. • Touch, cont. • Touch may evoke negative reactions in some patients. • Not everyone likes to be touched as it may make them feel embarrassed, uncomfortable, or threatened. • Cultural differences are important factors in determining a patient’s receptivity to touch.

33. Types of Nonverbal Communication, cont. • Touch, cont. • General guidelines that may enhance the likelihood that touch will be perceived positively in a clinical setting: • Tell your patient when, where, and how they will be touched during an examination or clinical procedure.

34. Types of Nonverbal Communication, cont. • Touch, cont. • General guidelines, cont.: • Use touch to supplement your verbal message. • Do not use touch to replace your verbal message.

35. Types of Nonverbal Communication, cont. • Touch, cont. • General guidelines, cont.: • Use a form of touch that is appropriate for the given situation. • Do not use a touch gesture that implies more intimacy with a patient than is desired. • Observe and assess the recipient’s response to touch.

36. Proper Interpretation of Nonverbal Communication: Congruency with Verbal Messages • Verbal and nonverbal messages must be in agreement, or consistent, with each other for communication to be successful. • When the messages are mixed, or conflicting, the nonverbal message is usually accepted as the intended message. • If the patient is made aware of the conflict, then they may be encouraged to revise their response.

37. Proper Interpretation of Nonverbal Communication: Congruency with Verbal Messages, cont. • Misinterpretation of a patient’s nonverbal behavior can lead to more misunderstanding than simply ignoring it. • If the meaning of a patient’s nonverbal behavior is unclear, the HCP must make this known: • Make a nonjudgmental observation of the behavior. • Ask for clarification. • Offer an explanation or interpretation of the patient’s nonverbal behavior.

38. Proper Nonverbal Communication Skills for the Healthcare Professional • Wear professional attire and maintain good hygiene. • Offer the patient a firm handshake and a warm greeting. • Sit down when speaking with the patient. • Ensure privacy when speaking with the patient.

39. Proper Nonverbal Communication Skills for the Healthcare Professional, cont. • Assume a position of about one arm’s length from the patient. • Maintain a posture that is relaxed but attentive. When seated, lean slightly forward and be still but not motionless. Keep your hands visible. • Eliminate barriers between you and the patient. • Maintain a demeanor that is warm and friendly.

40. Proper Nonverbal Communication Skills for the Healthcare Professional, cont. • Maintain an attitude of confidence and professionalism. • Maintain eye contact with the patient. • Encourage the patient with affirmative head nods. • Recognize the different forms of nonverbal communication that may be conveyed by the patient. • Observe the patient’s reactions toward you.