Interpersonal Communication

Day Two – Communication Skills Interpersonal Communication

Goals for Communication • There are four goals for communication in a care relationship: • Making verbal introductions • Gathering information • Providing information • Comforting

Making Verbal Introductions • Clients coming to a health professional for care are often vulnerable • They ask themselves questions such as: • Who is this person? • What can they do to help me? • Can I trust them? • Will they listen to me? • Do they really want what’s best for me?

Making Verbal Introductions • In person-centered care, it is important that a health professional first introduce: • Themselves • Their role • Their workplace environment • Why? • Establishes a precedent for future interactions • Produces a sense of confidence in the health professional and the facility • Demonstrates an understanding of the client’s need for information and a sense of control

Introducing Yourself • Hi, I’m ... • Name and explain your role • If the client is unfamiliar with the role, it might be useful to include specific examples of what your responsibilities are • Avoid professional jargon • If this is not done, it can lead to misunderstandings that can be difficult to correct

Introducing the Unfamiliar Environment • Introduce the physical environment • ie location of waiting area, restroom, etc • Introduce any important procedures • Ex “If you’d like to have a seat, we’ll call you when the physician is ready for you / when your prescription is ready” • Take a moment to answer any questions or concerns that the client may have • Indicates interest and an intention to provide care

Gathering Information • Before a health professional can provide care, they must first understand the needs of the client • Most common method of gathering information is the Interview • Can be formal or informal • Uses various forms of questioning

The Interview • Step One: Explain the purpose of the interview • Clients who understand the reason for questions are more likely to answer them honestly • Step Two: Ask for permission to ask questions • Demonstrates respect for the client

The Interview • Step Three: Ask questions • The right questions: • Assist in developing rapport and trust • Display interest in the client • Cause the client to relax and develop confidence • Encourage the person to communicate • Establish mutual understanding • Gather the appropriate information

Question Types • Closed Questions • Elicit specific information that is short and definite • Ex “Is the pain sharp?” or “Have you taken this medication before?” • Often have a yes or no answer • Also includes questions in which the client is given a choice of several answers • Very useful if the patient has trouble expressing themselves or if an interview is tending to get off topic

Question Types • Limitations of Closed Questions • Are not generally useful for building rapport • If not worded carefully, can lead the client to a particular answer that may not be correct • Ex: ``It doesn`t hurt, does it?” • Don’t always trust head movements as an indication of yes or no – different cultures use nodding or shaking of the head to mean different things

Question Types • Open Questions • Generally have no right or wrong answer • Require more than a yes or no answer • Give the client control and allow the questioner to listen, observe and learn • Ex “How...?” “What ...?” “Tell me about...”

Open Question Types • Questions that probe • Seek more information about a particular topic • Lead to a greater understanding of the situation • Questions that clarify • Seek understanding rather than information • Important to avoid misunderstanding

Listening • Not only is it important to ask the right questions, but also to listen carefully to the answers • Keeps the client at the center of the communication

Effective Listening • Sit if possible to facilitate ease of sight and interaction • Maintain an open posture and facial expressions that communicate alert interest • Avoid crossed arms • Lean slightly towards the speaker • Use appropriate eye contact • Relax • Maintain focus on the individual • Distraction is interpreted as lack of interest • Paraphrase or ask questions to clarify • Demonstrates that you were listening

Providing Information • Health professionals provide information to various individuals in a variety of forms (verbal and written) • Clients • Other health professionals • Providing information is a two-way communication • Must ensure the listener understands by allowing them to ask questions

Providing Information • Prepare the listener • Ask their permission to provide the information • Clearly state the purpose and significance of the information • Allows the listener to focus on understanding the message • Establish if the listener has any existing knowledge of the topic • Demonstrates respect • Allows the professional to establish the accuracy of current information

Providing Information • Organize the information • Make sure the information is presented in the clearest way possible • Make sure each point is clearly understood before moving on to the next point • Summarize when finished • Allow the listener to ask clarifying questions • Present the information verbally as well as in written form to enhance understanding

Providing Information • Things to avoid: • Overlaying the information with opinion, bias or uncertainty • Long, overly wordy explanations • Ignoring non-verbal responses from the listener that might indicate confusion or distraction

Providing Information • Be aware that many factors may influence the listener’s ability to understand the message • Context • Background and experiences • Age • Previous knowledge • Use of professional jargon • Particular disorder

Comforting • People seeking care are often vulnerable • They have anxieties and negative emotions that they will share with the health professional • Health professionals may have difficulty understanding these concerns because they have a greater understanding of the conditions and probable outcomes than the client

Comforting • Key to appropriate comforting behaviour: Encouragement instead of Discouragement

Comforting

Non-Verbal Communication • Communication without words • Includes behaviours, body language, facial expressions, tone of voice, etc • Essential to effective communication • The words you choose to say provide the basic content of your message, which are then further influenced by non-verbal cues • The effect of non-verbal cues on a message are often more important that the words of the message itself

Effects of Non-Verbal Communication • Confirm or reiterate the meaning of words • Smiling when saying “Have a nice day” • Contradict or complicate the meaning of words • Saying “I’m fine” with a faltering voice • Reinforce or accentuate the meaning of words • Shaking head while saying “No” • Influence the response of the ‘other’ without words • Holding up a hand to tell someone to stop

Components of Non-Verbal Communication • Environment • Body Language • Facial Expression • Eye Contact • Gesture • Space • Voice • Volume • Pitch • Rate • Emphasis • Pauses • Tone

Environment • Design of the facility • Placement of seating • Demonstrates care for the needs of the client • Appearance of health professionals • Noise and distractions

Body Language • Can vary from culture to culture • Facial Expression • Health professionals should consciously use and control facial expression to express respect, empathy, and attention • Eye Contact • Signals interest and attention • Be aware of differing comfort levels with continued eye contact

Body Language • Gesture • Body movement • Head, arm, hand, leg, etc • Convey attitudes, feelings and ideas – often without the use of words • Must be very careful about cultural differences • Space / Proxemics • Can indicate interest and/or the intimacy of the relationship • Must be aware of differing comfort levels with proximity

Feature of the Voice • Volume • A loud voice can carry and potentially violate confidentiality • A soft voice can indicate nervousness or uncertainty • Volume must be adjusted to be appropriate for the situation and environmental noise levels

Features of the Voice • Pitch • Frequency of voice • Low or high • Variations in pitch may give greater force or intensity of feeling to different words • Can also indicate meaning • Ex: raising voice at the end of a statement often indicates a question

Features of the Voice • Rate • Speed of speaking • Can affect the listener’s ability to comprehend • Ex: speaking more slowly might be necessary for someone who has limited English skills

Features of the Voice • Emphasis • Stress placed on certain words within a phrase or sentence to change meaning • Example: • You’re so smart! • You’re so smart! – can be interpreted negatively as sarcasm • Must be careful that the emphasis enhances the message and is positive

Features of the Voice • Pauses • Breaks when speaking • Provide opportunity to take a breath or look up from notes • Important to give time for the listener to process the message and the speaker to process the listener’s non-verbal cues • Vocalization during pauses can communicate uncertainty • Ex. “Um...”

Features of the Voice • Tone • The qualities of a voice that indicate feelings, attitudes or thoughts about a particular topic • Similar to emphasis, but reflected throughout the entire thought, not just one or two words • Examples of tones: happy, sarcastic, negative, monotone

Interpersonal Communication