c1-COMMUNICATION.docx

COMMUNICATION ============= Communication cycle ------------------- Armed with the understanding of the cardiovascular system, the next step is using effective communication with patients. It begins with the communication cycle or loop, which consists of sequential steps to transfer a message and...

COMMUNICATION ============= Communication cycle ------------------- Armed with the understanding of the cardiovascular system, the next step is using effective communication with patients. It begins with the communication cycle or loop, which consists of sequential steps to transfer a message and receive feedback. This process starts with the sender\'s idea or message and ends with a response from the receiver. The sender develops the subject matter to communicate, then puts it into a translatable format. The sender considers both the receiver and the urgency of the message. Having developed the message, the sender chooses the route of delivery (spoken, written, symbolic, nonverbal). Once the message is transmitted, the receiver begins to decode it into understandable thoughts. Effective communication occurs only when both the sender and the receiver assign similar meanings to the message. The final step of the communication process is feedback. This is the part of the cycle when the receiver provides a response. This final step determines whether the receiver has understood the message the way the sender intended it. Communication styles -------------------- To be an effective communicator, it is important to recognize that people communicate in different ways. There are several communication styles, as well as tools to determine which style an individual prefers. Identifying a communication style can help determine how to interact with patients. Learning how to relate to and understand various styles can improve communication with diverse populations. - **Analytical communicators** prefer to work with real numbers, facts, and data. They place very little emphasis on feelings or emotions. - **Intuitive communicators** prefer to look at the big picture. While this can be an efficient style, it can result in more questions than answers when using too broad an approach. - **Functional communicators** prefer an organized approach with timelines and detailed plans, using a step-by-step method to solve problems and communicate information. This can be an effective style of communication as long as the patient does not become overwhelmed with details. - **Personal communicators** use emotional language and connections. They care about what people think and feel in response to the information. People who use this style are often good, active listeners and resolve conflict easily. A vital component of communication with patients is active listening. Listening is the most fundamental component of communication. Active listening is mindfully hearing and attempting to comprehend the meaning of words. It can involve making sounds or gestures that indicate attentiveness, as well as giving feedback in the form of a paraphrased version of what the speaker said. Signs of active listening include a smile, eye contact, erect posture, and attention to what the speaker is conveying. Never just pretend to listen while focusing on the task at hand. Make eye contact repeatedly, smile, and respect patients\' personal space at all times. Convey genuine interest, warmth, empathy, sincerity, openness, and consideration to facilitate communication with the patient. Verbal vs. nonverbal communication ---------------------------------- Verbal communication is the sharing of information using recognizable spoken words. Nonverbal communication is behavior that complements, negates, or substitutes for spoken words. It includes gestures, mannerisms, facial expressions, body posture, stance, eye contact, movements, touch, personal space, and overall appearance. Both verbal and nonverbal communication elements are important when providing high-quality customer service and patient care. Therapeutic communication ------------------------- Therapeutic communication is an interaction that aims to enhance the comfort, safety, trust, health, and well-being of the patient. A phlebotomist can focus on patients and help them gain a better understanding of a procedure or interaction. The objective is to communicate using terminology the patient understands. Therapeutic communication uses specific strategies that convey understanding and respect. This encourages patients to express their feelings and ideas. Patients seeking health care are often anxious and apprehensive. They might fear that test results will bring terrible news, and some have had difficult experiences with phlebotomy in the past. When collecting specimens, be sensitive about patients\' feelings and respect their individual rights. It is not necessary to study psychology in depth to learn how to ease patients\' apprehension and communicate therapeutically, but it does help to understand some of the basic therapeutic communication techniques, as well as techniques not to use. In most cases, interactions with patients are very brief. However, sometimes phlebotomists see patients repeatedly, such as in acute care. The following chart highlights therapeutic techniques to use. Therapeutic communication skills -------------------------------- **accepting** Hear what patients say and follow the thoughts they express. \"I get what you\'re saying.\" **clarifying** Ask for a clearer explanation when what patients say is vague. \"I\'m not sure I\'m following that.\" **Encouraging communication** Ask patients to share what they are feeling. \"Tell me when you are getting more anxious.\" **exploring** Gently persuade patients to express their thoughts in a little more detail but avoid probing or prying. \"Would you tell me a little more about that?\" **focusing** Keep patients\' attention on the information they need to understand. \"I\'m enjoying hearing your thoughts about your upcoming vacation, but let\'s get back to what to do if this keeps bleeding after you leave.\" **giving a broad opening** Allow patients to direct the discussion. \"What do you need to know about what we\'re doing today?\" **giving recognition** Show patients recognition as individuals, including addressing them by name. \"Let\'s get started as soon as you\'re ready, Mr. Ellis.\" **making observations** Share your perceptions with patients. \"You seem a bit nervous today.\" **mirroring** Restate patients\' statements to show understanding. Patient: \"I can\'t always understand what the doctor is telling me.\" Phlebotomist: \"You\'re having difficulty understanding the doctor?\" **offering self** Convey your availability to listen and help. \"I\'m here for you. Tell me what you need.\" **offering general leads** Encourage patients to keep expressing their thoughts. \"Please continue.\" **reflecting** Repeat patients\' statements or questions back to them to encourage them to value or accept their own opinions. Patient: \"I don\'t think this test is going to tell me anything I don\'t already know.\" Phlebotomist: \"What do you already know about your cholesterol levels?\" **remaining silent** Convey that patients can continue formulating the thoughts they want to express without any pressure to converse. **summarizing** Demonstrate understanding of the important parts of the conversation. \"So, you know to contact the office if you have any pain, or the site keeps bleeding even after you apply some pressure with the gauze pads I gave you.\" Nontherapeutic communication ---------------------------- **advising** Tell patients what to do about matters outside the scope of phlebotomy practice. \"If I were you, I wouldn\'t take that medication. Just try to avoid salt in your diet.\" **agreeing/disagreeing** Imply that the phlebotomist\'s opinion is validating or overriding that of the patient\'s. This also exceeds the scope of phlebotomy practice. \"I agree. Chemotherapy is your best option.\" \"Don\'t have that ultrasound. It\'s not going to help, and you\'ll wind up having that surgery anyway.\" **defending** Attempt to protect the facility or provider, while blocking further communication about the issue from the patients. \"Dr. Lopez has been doing this for a long time. She knows what\'s best for you.\" **disapproving** Pass judgment on patients\' thoughts or plans. \"You really should have given that medication a chance to work before you stopped taking it.\" **giving approval** Tell patients they are doing the right thing. This is judgmental and could result in them continuing to seek approval rather than focusing on progress. \"Good job. I\'m proud of you for taking the initiative to check your thyroid levels.\" **making stereotypical comments** Use cliches and meaningless phrases that show no original or patient-specific thoughts. \"Things are always darkest right before the dawn.\" **minimizing feelings** Make light of patients\' anxieties. \"Everybody hates needles.\" **probing** Pursue topics patients do not want to discuss or that invade their privacy. \"So why didn\'t your daughter want to drive you here today?\" **reassuring** Give false hope or devalue patients\' feelings. \"Everything is going to be all right. You\'ll see.\" Respect personal boundaries in all patient encounters. Discussing personal issues with a patient is inappropriate. It changes the role of the phlebotomist from a health care provider to a person in need of support from the patient. The key to therapeutic communication in this field is this: The encounter is all about the patient, not the phlebotomist. When working in a professional capacity, things are not always what they seem. Many patients are experiencing much stress as they deal with various acute and chronic conditions. It is human nature to use defense mechanisms, which can be helpful or harmful. Be familiar with these shields that patients often use-consciously or unconsciously-to protect their emotions. Defense mechanisms are coping strategies people use to protect themselves from negative emotions (guilt, anxiety, fear, shame). People are usually unaware that they are using these responses. Some patients use them adaptively (in a positive way) and have the ability to adjust. Others use them nonadaptively (in a negative way) and lack the ability to change. Learning to recognize these defense mechanisms and the emotions behind them can help phlebotomists understand patients and meet their needs. Here are some common defense mechanisms. Defense mechanisms ------------------ **apathy** indifference/a lack of interest, feeling, concern, or emotion \"I don\'t even care what the doctor says about my weight because I know I stick to my diet.\" **compensation** balancing a failure or inadequacy with an accomplishment \"I ate a lot of candy yesterday, but I also ate a big green salad.\" **denial** avoiding unpleasant or anxiety-provoking situations or ideas by rejecting them or ignoring their existence \"I am healthy and fit. There is no way I have cancer. So I don\'t need all these tests.\" **displacement** redirection of emotions away from the original subject onto another less threatening subject \"I had enough trouble dealing with my aging parents. I shouldn\'t have to wait this long to get a routine blood test.\" **dissociation** disconnecting emotional importance from ideas or events and compartmentalizing those emotions in different parts of awareness \"I\'m always getting into fights with my neighbors, which is odd because I teach an online course in conflict resolution.\" **identification** attributing characteristics of someone else to oneself \"I\'m just as healthy as my sister is, and I don\'t even work out at the gym like she does.\" **introjection** adopting the thoughts or feelings of others \"My dad says I should stand up for myself, so I am going to be more assertive.\" **physical avoidance** keeping away from any person, place, or object that evokes memories of something unpleasant \"I can\'t go back to that hospital because that\'s where my father died.\" **projection** transferring a person\'s unpleasant ideas and emotions onto someone or something else \"My wife eats way more junk food than I do, so why is the doctor warning me about my cholesterol?\" **rationalization** an explanation that makes something negative or unacceptable seem justifiable or acceptable \"My partner drinks every night to make himself less anxious about work.\" **regression** reverting to an earlier, more childlike, developmental behavior \"I can\'t come back every month for these tests, and you can\'t make me.\" **repression** eliminating unpleasant emotions, desires, or problems from the conscious mind \"They tell me I was hurt in that robbery, but I can\'t remember anything about it.\" **sarcasm** using words that have the opposite meaning, especially to be funny, insulting, or irritating \"You have a nice office if you don\'t like fresh air and natural light.\" **substitution** replacing an unacceptable desire or goal with a more constructive or acceptable one \"When I was a kid, I used to like to pull wings and legs off insects I\'d catch. Now I am a biology teacher.\" **suppression** voluntarily blocking an unpleasant experience from one\'s awareness \"The doctor said I need more tests, but I\'m going to take my vacation first.\" Communication challenges ------------------------ Effective communication is critical for patients\' safety and quality of care. Barriers to communication include differences in language, culture, cognitive level, developmental stage, sensory issues, and physical challenges. When patients and health professionals have different language proficiencies, it is not always immediately evident. Both the patient and provider can underestimate the barrier. Cultural differences also significantly influence communication. Culture affects an understanding of a word or sentence, and even perception of the world. Patients have the right to fully understand information regarding their care. Poor health literacy results in inability to understand medical jargon or complex instructions. Medical terminology can seem like a foreign language, making it difficult for patients to understand. Patients also might not know how to communicate their concerns using this terminology, which can lead to consequences and misunderstandings. Make sure the patient understands the terminology used and offer explanations as needed. Personal experiences and values shape the way people see the world. All health care professionals must be aware of viewpoints and personal biases, paying close attention to words and actions that could cause miscommunication. If possible, avoid figurative or colloquial language. In addition, nonverbal communication is extremely important and can keep the conversation straightforward and brief. It takes practice and patience to accomplish all of this while remaining compassionate and caring. Interpersonal skills (friendliness, empathy, genuineness, openness, sensitivity) can help tremendously in serving diverse populations. If a patient is not fluent in the language used, ensure that each party understands what the other is conveying. For brief and routine encounters, patients might communicate well nonverbally. But when there is important information to exchange, seek the assistance of an interpreter. Incorporate written instructions when possible. It is also important to respect any cultural or personal preferences that arise. Cultural competence is a key part of health care delivery; phlebotomists should be familiar with the cultural nuances of populations served in their community. Phlebotomists will encounter patients who have vision and hearing loss. These issues are not always obvious. Many patients will let the phlebotomist know they need assistance, but it is important to always be alert and recognize challenges patients might be experiencing. For patients with vision loss, verbally explain everything that is taking place. Escort patients when necessary to ensure their safety and prevent injury. However, never tell the patient to ((sit over there\"; instead, offer an arm to lead the patient to the chair. Unless patients wish to converse about their vision loss, do not ask questions about it or make stereotypical comments (such as how their other senses must be sharp). Instead of focusing on the patient\'s vision, it is more important to make sure communication of the procedure is thorough. For patients who have service animals, keep in mind that these animals are not pets. Intervene as needed to remind anyone in the area who wants to speak to, touch, or remark about these animals that they are on duty, and distractions are inappropriate. For patients who have hearing loss, face them directly when speaking so that they can lip-read and see facial expressions and gestures. For example, facing a computer screen or turning away to gather supplies while talking could lead to hearing challenges. Do not speak louder than usual but be sure to enunciate clearly. It also helps to modulate vocal pitch. For many patients who have hearing loss, low-pitched tones are easier to hear than high-pitched tones. If possible, reduce all extraneous noises to assist the patient who has hearing loss. When a patient does not understand, it can help to rephrase the message. For patients who are deaf, written communication of essential messages is crucial. If a patient requests a sign language interpreter, the facility must provide this service based on the Americans with Disabilities Act. When communicating with older adults, remember that hearing difficulties are often part of the aging process. Older adults can also need more time to process information, formulate questions, and understand answers. As with all patients, treat older adults with respect, kindness, and compassion, and preserve their dignity at all times. Use these same principles for interactions with patients who have other specific needs (developmental delays, speech impediments, physical challenges). Tips for working with people who have hearing loss - Face the person directly. - Keep your face lit (no backlighting). - Avoid background noise. - Get the person\'s attention before speaking. - Ask how you can assist with communication. - Speak clearly and distinctly. - Do not shout or overenunciate. - Keep your mouth visible. - Offer a sign language interpreter if needed. Tips for working with patients who have vision loss: - Be mindful of safety, comfort, and dignity. - Promote independence. - Use bright colors, which are easiest to see. - Use solid colors as backgrounds, avoiding patterns. - Avoid clear glass obstructions and objects. - Offer print materials in Braille, large print, or audio formats. - Recognize that less than 10% of people who are blind read Braille. Customer service ---------------- Effective communication and great customer service go hand in hand. Customer service means ensuring the customer\'s satisfaction during a workplace transaction. Open communication and high-quality customer service are important for developing and maintaining positive relationships with patients. Encouraging patients to communicate their feelings, listening to their viewpoints, and helping to solve problems can increase customer satisfaction and provide a better experience. The health care staff, office culture, and patient population all benefit from superior customer service.