Communication and Communication Skills (Dr. Akpe) PDF

# Communication and Communication Skills Many people and situations define communication as it suites them. In any form defined, communication implies that there is a message to be transmitted, that the message is received and understood. Hopefully, the message is to be accepted and, where action...

# Communication and Communication Skills Many people and situations define communication as it suites them. In any form defined, communication implies that there is a message to be transmitted, that the message is received and understood. Hopefully, the message is to be accepted and, where action is indicated to be taken, the desired action is taken at the appropriate time and by the right people. Communication is the process by which information is exchanged and understood by two or more people, usually with the intent to motivate or influence behavior. ## The Process of Communication The communication process consists of a complex interaction of items: - **Sender (Encoder)**: The sender (encoder) is the one who wishes to convey an idea or concept to others. This may be: - to seek information - to give information - to express a thought or emotion - **Channel**: The sender encodes the idea and sends the message through: - Face to face - Telephone - Sign language / gesticulations - Writing etc - **Receiver (Decoder)**: The receiver decodes the message to interpret the meaning of the message and reacts as a feedback. ## Reasons for Communicating - To instruct, teach, or educate - To issue orders - Exchange thoughts / ideas - Attempt to influence / persuade others - To inquire - Express feelings or ideas - Conduct social activities (music) - To entertain ## Forms of Communication - **Verbal Communication**: One-on-one speaking. - **Indirect Communication**: No response, as in TV, Radio, Newspaper etc. - **Non-Verbal Communication**: Signs; Mode of dressing; Emotional signs (crying, smiling, laughing etc) ## Directions of Communication - **Downward Communication**: Flows from top to bottom to give directions primarily. - **Upward Communication**: Flows from bottom to top, primarily as suggestions or requests or as a feedback to downward communication. - **Horizontal Communication**: This is a communication that is at the same level of the hierarchy, between heads of departments. - **Lateral / Diagonal Communication**: Flows from a higher position in a department to a lower level in another department. - **Grapevine**: Exists in the organization but not formally. ## Guide to Health Communication - Make the care of your patient in any form of communication your focus or concern primarily. - Treat all patients politely and considerately. - Respect the patient's dignity and privacy. - Listen to patients and respect their views. - Give patients information in a way they can understand. - Respect the rights of the patients to be fully involved in decisions concerning their care. - Keep your professional knowledge and skills up to date. - Recognize the limits of your professional competence and actions. - Be honest and trustworthy. - Make sure that your personal beliefs do not prejudice your patients' care. - Act quickly to protect patients from risks. - Avoid abusive words and do not abuse your position. - Work with colleagues in ways that best serve patient's interest. # Communication Skills Good communication is the single most important component of good nursing practice because it identifies problems quickly and clearly, it defines expectations, and help to establish trust and rapport between the nurse and patient. ## Failure in Communication Leads To: - Poor health outcomes - Strained working relationships - Widespread dissatisfaction among the patient, families, and health professionals - Anger on both the nurse and patient - Litigations Sadly, poor communication is common in most healthcare systems and has become the root cause of most complaints. ## Remember That Patients Are Ill Remember that patients are ill and apprehensive, hence their distress will be enhanced and effective communication will be impossible if the nurse appears difficult, unempathetic, and short of time. Always... ## **Break the Ice** First impressions are critical and it is essential that patients be put at ease by appropriate introductions and a friendly greeting - get up, shake hands or say Namaste, or whatever is culturally appropriate - and look at the patients not the notes. The nurse must ensure that the patient feels that he/she is the center of interest and should begin by outlining the likely course of events. Most patients will be reluctant to discuss potentially important issues if they feel that the nurse is not interested or is likely to dismiss their contributions as either irrational or trivial. Listen with rapt attention, and talking to the patient with care and skill will usually lead to a problem identification and a way of solving it. ## Allow the Patient to Talk Without Overbearing Questioning Allow the patient to talk without overbearing questioning but should try to facilitate the process with appropriate questions. ## Forms of Questions to Ask - **Open-ended questions**: Allow the patient to express their own thoughts and feelings, e.g. - How have you been since you came to our facility? - Is there anything else you would want us to know? - **Close-ended questions**: Are requests for factual information, e.g. - When did the pain start? - **Leading questions**: Invite specific responses and suggestions or options, e.g. - You want your spouse to be part of your care? - **Reflecting questions**: Help to develop or expand topics, e.g. - Can you explain to me your social life and relationships? ## Non-Verbal Cues Are Also Equally Important Non-verbal ques are also equally important. The patient's facial expressions, gesticulations and body language may betray hidden fears which the nurse may explore. The nurse may be encouraging the patient talk more freely by smiling or nodding appropriately or juxtaposing short responses ""Is it so?" "Okay" or "Tell me more!" Or the nurse may show concern where necessary - "Ayaa, I am so sorry!" ## Some Barriers to Good Communication in Health Care In **respect of the nurse**: - **Authoritarian or dismissive attitudes:** Hurried approach - hasting, looking at the watch often. - **Use of jargons:** Medical terms, language limitations. - **No experience of pts cultural background**. - **Prejudice**. In **prospect of the patient:** - **Anxiety due to illness exacerbation.** - **Reluctance to discuss sensitive or seemingly trivial issues.** - **Misconceptions.** - **Conflicting sources of information.** - **Cognitive / reasoning impairment.** - **Hearing / Speech / Visual impairment.** - **Forgetfulness / Dementia.** **Important to Remember** Health care professionals' ability to explain, listen and empathize with the client can have a profound effect on biological and functional health outcomes as well as patients' satisfaction and experience of care. ## Strategies Patients Note For Nurses - Distancing Themselves From Communication - **Selective attention:** Choosing only health-related topics and avoiding/dodging psycho-social topics. - **Normalizing:** Dumping individuality of the patient and generalizing - "It happens to all people!" - **Premature reassurance:** "Everything will be ok". - **False reassurance**. - **Switching topics:** Have fever? Have you eaten? - **Passing the buck.** - **Jollying along:** "Worse things than this have happened to other people". - **Physical avoidance.** When information is given skillfully, patients are able to understand, remember and find it more useful. **Important to Remember** Patients are likely to adhere to such communications if they get comprehensive information, it makes sense and if they can get easy access to more information if need be. The main aim of giving information is to allow patients to understand their problems and use the information appropriately to help them. # Approaches to Health Communication (Therapeutic Communication) The approach includes the following: - **Information must be related to the health condition and patient's ideas.** - **Patients may be voracious for information but they refrain from sensitive and threatening information.** Most patients will remember 70-80% of even the most unfamiliar, complex or alarming information if presented thus: - Using a logical sequence of explanation of the cause and effects in the patient's context. - Talk about one thing at a time and check patient's understanding before moving on to another area. - Use simple words/language - Make your information and instructions direct, detailed and concrete - Give prepared handouts, pamphlets / books - Provide web sites and do not be exasparated by patient's knowledge. # Guidance and Counseling Guidance and counseling is a complex phenomenon comprising of so many services and programs in different specific areas including health. These concepts are always together but performs different but complementary roles and responsibility. Guidance is generally the umbrella that houses counseling and its the developmental process by which an individual is helped to understand himself, his ability, interests, aptitude, attitudinal construct in relation to his aspirations. Guidance and counseling is therefore a helping service found within all places and locations where human beings exist, since problems are human oriented. Specifically, counseling is a relationship between a counsellor and counsellee aimed at facilitating the counsellee to understand him/her in making him capable of taking visionary and informed decision on any problem which prior to the relationship, he/she was not able and so constituted a hindrance to the solution. ## Guidance Can Also Be Seen As... Guidance can also be seen as a comprehensive system of functions, services and programs designed to facilitate the personal development and psychological competencies of the recipient of the guiding principles. ## Guidance Is a Process... Guidance is a process, developmental in nature by which individuals are assisted to understand, accept and utilize their abilities, aptitude and interests. It is a continuous process of helping every individual through his own efforts and interests to discover, release, and help his potentials thereby gaining personal satisfaction and contributing to society. ## Counselling is a Relationship... Counseling is a relationship between a client with a psychological problem and a counsellor who is trained to help the client with the problem. While guidance essentially deals with facts, counselling goes beyond mere facts to providing individual attention, personalized directives and explanations. ## Counselling Therefore Is... Counselling, therefore is an intervention process that facilitates meaningful understanding of self and environment and results in the establishment of values for future behaviour. ## Guidance and Counselling Services Include: - Information - Placement - Appraisal - Vocational Guidance - Counselling Referral - Evaluation - Follow-up - Consultancy - Research - Community Problem-Solving Process ## Types of Counselling - **Individual Counseling:** This is a way of offering an opportunity to the client to experience a one on one interaction which is accepting and tolerant yet free from mobilizing, directing, advising and judging. In this way the hope is that the client will have enough understanding of themselves so that they can stand on their own feet without support. The goal of this type of counselling is to improve adjustment, functioning, and self-direction, self-supporting and self-sufficiency. - **Group Counseling:** is a process whereby a counsellor is involved in an interaction with numerous clients for their adjustment and development. This type of counselling focuses on experiences and feelings of its members. The counsellor assists members to explore and express themselves and clarify their attitudes and views. Four criteria are employed in group counselling, these are: - Group interaction is the process used in achieving goals. - Members deal with developmental tasks. - Feelings are revealed and explored. - Desired outcome are self-acceptance and self-understanding. The main advantage of group counselling is that it provides an avenue for the individuals to share their thoughts and experiences in solving their problems. # Group Dynamics A group is those persons with shared goals who communicate with one another often over a span of time and are enough so that each person may communicate with all the others face-to-face. Three conditions must be met for a group to exist, thus: - The members are able to see and hear each other. - Each member engages in personal communication with every other member. - The individuals see themselves as members of the group with shared goals. ## A Health Group/Team Is... A health group/team is an organized group of individuals, practitioners, and consumers who identify themselves with a problem, commit themselves to joint effort to solve or ameliorate problem across the entire spectrum or care plan, action and evaluate outcome. ## There Are 5 Stages of Group Development: - **Forming phase:** Members focus on defining goals and developing procedures for performing their task and it involves getting acquainted and understanding each other. - **Storming phase:** Conflicts emerge over task, behaviours - who is to be responsible for what and competition over leadership role and conflict over goals are dominant. - **Norming phase:** Sharing of information, acceptance of different opinions and positive attempts to reach mutually agreeable, in compromise, decisions on the group's goals. Ground rules are set and a sense of shared responsibility for the group develops. - **Performing phase:** Teamwork is achieved, roles are flexible, solutions are formed and implemented. The group shows how effectively and efficiently it can perform its task. The members usually understand when they should work independently and when they should help each other. - **Adjourning phase:** This is the termination of task behaviour and disengagement from the relationship-oriented behaviours. Some groups have specific terminal points while others are of continuous performance. **Group Dynamics Is Very Important In...** Group dynamics is very important in the health care delivery system because of the tremendous advantage it has to the professional and the community. For health education using this group approach it has the advantages of: - **Save time** - Instead of the health educator going from one individual to another, the group is used. - **It provides support and encouragement to the health educators and community members.** - **It reduces work load.** - **It enhances and facilitates interaction of members as well as learning.** - **Permits sharing of experiences and skills** - hence members will learn from each other.