Adapting Communication to Patient's Ability to Understand PDF

Adapting Communication to a Patient’s Ability to Understand Lecture 7 Objectives: Explain how low health literacy may impact a patient’s health. Describe several strategies that will facilitate communication between a healthcare professional and a patient with low health li...

Adapting Communication to a Patient’s Ability to Understand Lecture 7 Objectives: Explain how low health literacy may impact a patient’s health. Describe several strategies that will facilitate communication between a healthcare professional and a patient with low health literacy. Explain how language barriers may impact communication between a healthcare professional and their patient. Describe several strategies that will facilitate communication between a healthcare professional and a patient who speaks a different language. Describe several strategies that will facilitate communication between a healthcare professional and a patient who is visually impaired. Describe several strategies that will facilitate communication between a healthcare professional and a patient who is deaf or hard of hearing. Describe several strategies that will facilitate communication between a healthcare professional and an elderly patient. Describe several strategies that will facilitate communication between a healthcare professional and a patient with impaired cognitive abilities. Health Literacy In its Healthy People 2010 report, the U.S. Department of Health and Human Services defines health literacy 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 includes the ability to understand instructions on over-the- counter and prescription drug labels, appointment slips, health education brochures, doctor’s instructions, and consent forms, as well as the ability to navigate complex healthcare systems. Health literacy also includes numeracy skills. For example, understanding probability and risk, calculating blood sugar levels, measuring medications, and understanding nutrition labels all require math skills. In addition to basic literacy skills, health literacy requires knowledge of health and medical issues. People with limited health literacy often lack the knowledge or even are misinformed about the human body as well as the nature and cause of disease. As such, they The HCP may employ a variety of strategies to communicate and interact most effectively with patients with low health literacy, including the following: 1. Evaluate the patient’s understanding before, during, and after the introduction of information or instruction. Ask the patient to explain the information back to you in their own words or to demonstrate the skills that you have taught them. 2. Limit the number of messages given to a patient at any one time. Less than half of the information provided to patients during each visit is retained. This method of “plain language” communication is characterized by the following: Information that is organized so that the most important points are delivered first. Information that is broken down into understandable chunks. Language that is simple with clearly defined medical terminology. The use of the active voice (subject is identified). 4. Supplement instructions with pictures. Simple line drawings may help patients understand complicated or abstract medical concepts. Images must be placed in context. In other words, when illustrating internal body parts, include an outline of the outside of the body. 5. Tailor medication schedules to fit a patient’s daily routine. Daily events (e.g., meals) or tasks (e.g., brushing teeth) that serve as reminders may improve patient compliance. 6. Prepare written forms of communication at a fifth- to sixth-grade reading level and in a format that appears easy to read. This reading level will reach the majority of patients and is recommended for all health education materials. 7. Provide or serve as a reader for forms or written information. A family member may also fill this role and will be available to continue to assist the patient at home.  Language Barriers When the patient and the HCP do not understand each other’s language, not only may the patient be less likely to effectively convey their complaints and concerns, but the HCP may also be less likely to effectively convey their diagnosis and recommendations. Therefore, it should be evident that the effective use of a qualified medical interpreter is of paramount importance. The use of nonprofessional interpreters should be avoided. nonprofessional interpreters are far more likely to incorrectly translate words and phrases from the HCP to the patient. A second disadvantage involves the loss of patient confidentiality. The HCP may employ a variety of strategies to work more effectively with a medical interpreter, including the following: 1. Look at and speak directly to the patient. 2. Use short sentences. 3. Avoid the use of informal and unprofessional vocabulary. 4. Remain patient and understanding. 5. Observe the patient’s nonverbal messages. 6. Repeat important information. 7. Ask the patient to repeat important instructions or information in their own words. 8. Avoid the use of ad hoc interpreters.  Visual Impairment Vision loss refers to difficulty seeing, even when wearing corrective lenses (glasses or contacts), as well as complete blindness. As with language barriers, visual impairment does not have to lead to impaired communication. The HCP may employ a variety of strategies to communicate and interact most effectively with patients who are visually impaired. These strategies, which are based primarily on courtesy, respect, and common sense. Summary of the strategies when communicating with a patient with visual impairment: 1. Greet the patient. As you approach the patient or enter the clinical area, greet the patient, clearly identify who you are, and speak in a normal tone of voice. Shake hands with the patient but only if they offer their hand. 2. Speak directly to the patient. During your conversation (i.e., face-to-face), speak directly to the patient and use their name so that they know that you are addressing them. Adopt a normal position (i.e., sitting or standing as appropriate). If there are other individuals involved in the conversation, such as family members or other HCPs, specify whom you are addressing. 3. Tell the patient that you will be touching them before you do so. Never surprise a visually impaired patient with needles, a cold stethoscope, or other medical objects and devices. As with all patients, explain what you are doing as you are doing it. 4. Be verbally descriptive. When providing instructions, be descriptive when conveying information that would be visually obvious to patients with normal vision. Do not point or gesture as this is of little or no value to these patients. 5. Use the words “look” and “see” normally. Visually impaired patients have the same vocabulary as sighted people and these 6. Tell the patient when you are leaving the area. Let the patient know if other individuals will remain in the area or if the patient will be alone. Similarly, inform the patient when you return. 7. Do not attempt to guide the patient without first asking. If assistance is welcome, allow the patient to take your arm above the elbow or to place their hand on your shoulder in order to control their own movements. 8. Provide reasonable accommodations. Patients who are essentially or totally blind may require medical information that is prepared in audiotape, or Braille formats. Patients who have low vision may require written materials that are printed with 14-, 16- or 18-point font, with margins that are at least one inch on all sides, with at least 1.5 spaces between the lines. 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 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. Ineffective communication between the HCP and deaf or hard of hearing patients can lead to misdiagnosis and medication errors, as well as potential patient embarrassment, anxiety or fear. The HCP must remember to be patient and considerate. Remain mindful that 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 when they have to remain attentive for long periods of time. The HCP may employ a variety of strategies to communicate and interact most effectively with patients who are deaf or hard of hearing. As with those suggested for patients with visual impairment, these strategies are based on courtesy, respect, and common sense. Summary of Strategies for Communicating with Patients Who A Deaf or Hard of Hearing 1. Interact directly with the patient. Focus on your patient as opposed to friends or family members who may have accompanied them. This patient has lost their ability to hear, not their individuality, dignity, or intellectual competence. 2. Record and respect the patient’s preferred method of communication. 3. If your patient hears better in one ear than the other, make note of this in the patient’s medical record and position yourself accordingly. 4. Gain the patient’s attention before you speak. Say the patient’s name or make a small gesture such as raising your hand or touching the patient’s arm. This will enable the patient to focus their attention and avoid missing words at the beginning of the 5. Speak clearly, in a normal tone of voice, a little more loudly, and at a moderate pace. Pause between phrases. Do not shout or exaggerate your mouth movements. Shouting will distort the sounds of speech and may make speech reading more difficult. 6. Optimize conditions for speech reading. Many deaf and hard of hearing patients will be good speech readers. Ensure that the light is behind the patient and does not shine in their eyes. With the light behind them, they will see your face and lips clearly. Avoid having obstacles in front of your face such as your hands 7. Minimize the use of medical terminology. 8. Maintain eye contact with the patient. 9. Use short, simple sentences 10. Include the use of nonverbal communication. 11. Observe the patient’s nonverbal behavior. 12. Rephrase or write the message. If the patient has difficulty understanding your message, find a different way of saying the same thing. Do not repeat the same words over and over. 13. Indicate a change in topic. When changing the subject during a conversation, be sure that the patient is aware of what the new subject is. Sudden shifts in topic can be very confusing and may lead to a breakdown in effective communication. 14. Supplement the conversation with visual aids. The use of visual aids may significantly enhance the effectiveness of the communication. Any visual aids should be in an upright position and as close to you as possible without blocking your face. This will allow the patient to observe you and the visual aid simultaneously and avoid having to look back and forth between you and the object. 15. Employ teach back. As with the patient who speaks another language, ask the patient to repeat the information. Summary of Strategies for Communicating with Patients of Advanced Age  Schedule older patients earlier in the day and allot extra time for them  Speak slowly, clearly and loudly  Use simple words and short sentences  Repeat important information  Write down the instructions  Focus on one topic at a time  Minimize distractions  Face the patient and maintain eye contact  Use visual aids such as charts, models and figures  Provide an opportunity for patients to ask questions Delirium and Dementia In addition to a decline in their physical health, some elderly patients also have a decline in their cognitive abilities. In other words, they are more likely to experience confusion. There are two types of confusion: Acute confusion, also referred to as delirium, occurs when a patient undergoes a temporary or reversible period of disorientation, hallucinations, or delusions. During these episodes, the patient will find it difficult to focus attention and to rest or sleep. Chronic confusion, also referred to as dementia, occurs when a patient undergoes a progressive, irreversible decline in mental function, characterized by memory impairment, deficits in reasoning, judgment, abstract thought, comprehension, learning, task execution, and use of language.  Summary of Strategies for Communicating with Patients with Delirium or Dementia Expect an increase in confusion when the patient wakes up as well as when “sundowning”. Approach the patient from the front and call the patient by their name. Respect the patient’s personal space and observe their reaction as you move closer. Avoid sudden movements that may startle or irritate the patient. Speak slowly and distinctly in a low-pitched voice. Use simple words. Ask one question at a time. Give one step directions and instructions & allow adequate time for the patient to perform the activity. The end of the Lecture