Lecture 5: Communication with Healthcare Team Members

Lecture 5  Communication with other members of the Healthcare Team (Colleagues, Supervisor)  Roadblocks to Therapeutic Communication  Introduction: The quality of your work experience will have a lot to do with how well you communicate with the other people at work. You and your colleague...

Lecture 5  Communication with other members of the Healthcare Team (Colleagues, Supervisor)  Roadblocks to Therapeutic Communication  Introduction: The quality of your work experience will have a lot to do with how well you communicate with the other people at work. You and your colleagues are all members of the healthcare team whose shared purpose is to provide patients with the highest level of care possible. In fulfilling that purpose, you want to use the same good communication practices with your colleagues that you would use with patients— courtesy, respect, empathy, genuineness, appropriate self- disclosure, and assertiveness. 1. Always Use an Appropriate Means of Communication with Co-Workers: - There may come times when you need to resolve a dispute with a coworker. - The dispute may be purely work-related or it may have a more personal aspect. - If the matter is of a serious nature (e.g., quality of patient care concerns) that a supervisor should be immediately involved, do not hesitate to involve the supervisor. - If the problem is less serious, you should generally first try to reach a solution with the other party rather than involving a supervisor. 2. The Appropriate Attitude is Assertive, not Aggressive: Maintaining an assertive yet friendly manner of communication lets others in the workplace know that you are there to do your job as effectively as possible. Understanding what you believe is right and feeling comfortable and confident in asserting that will send a signal to your coworkers that you are someone who can be counted on to work hard in the service of patient care. 3. Always Choose an Appropriate Time and Place for Important Communication: Remember to always be considerate of your co-workers’ time. If you have an important matter to discuss with a co-worker and you believe it will take some time, show respect by asking if that co-worker has time available to make an appointment to talk.  Communication with Other Members of the Healthcare Team—Your Supervisor Keep Supervisors Informed: 1. You must recognize early on that it is very important to keep your supervisor informed when anything goes wrong. Of greatest importance is the patient, and if you ever have a concern about the quality of patient care in your practice, you must let your supervisor know—immediately. 2. If the concern is something less serious—such as disorderly conditions in some of the examination rooms’ cabinets; or even something purely office related, such as the breakdown of the copy or fax machine—you should let your supervisor know at an appropriate time. Ask Questions: ‫اسال عندما ال تعرف و ال تفعل اذا لم تكن تعرف‬ If you are ever unsure about the right thing to do, be sure to ask. It is always better to ask a question before acting than to act without asking and make a mistake. You might fear that by asking the question you will annoy your supervisor, However, the risk of annoying a supervisor by asking a question is, in most cases, smaller than the risk of annoying a supervisor by making a mistake that could have been avoided by simply asking. Finally, where patient care is concerned, you should not take any risk: If Minimize Interruptions of Your Supervisor’s Time: You should show the same consideration to your supervisor that you show to your co-workers. If you have a matter you want to discuss with them, make the effort to make sure they have time. Ask them, “Is there a time I can talk to you? I have a couple of questions I want to ask.” Finally, it is a good practice to save questions until you have a few you can ask at once, rather than repeatedly interrupting your supervisor during the course of a busy day. Behaving in this manner will indicate to your supervisor that you are thinking about Show Initiative: Keep your eyes and ears open at work. If you believe you have found a more effective or efficient way of completing some task, make it known to your supervisor in the appropriate manner. Your supervisor will appreciate your conscientiousness and will recognize in you someone who is working hard to  Roadblocks to Therapeutic Communication Part I —The Healthcare Professional’s Behavior  Providing Easy (False) Reassurance: For example, a HCP may want to comfort a patient who is about to hear results on an important test, such as a biopsy to rule out a cancer diagnosis. It is inappropriate to provide easy reassurance by saying something like, “Don’t worry about anything. I know it’s all going to turn out just fine.” the reassurance the HCP wants to provide may give the patient false hope in the face of a negative outcome. A more appropriate response to the patient would be to say, “You know that whatever the result, you have us here and all of the staff on our  Approving/Disapproving: Approving or disapproving of the patient can falsely give the patient the impression that a power relationship exists between them and their HCP. A HCP who approves of (as distinct from giving recognition for) a patient’s actions can lead the patient to believe that certain behaviors will be rewarded with praise from the HCP. This is inappropriate. Conversely, an HCP who shows disapproval of a patient’s actions can cause the patient to feel as if the HCP is passing some sort of moral judgment on the patient. This is also inappropriate. The patient’s  Agreeing/Disagreeing: Either agreeing or disagreeing with the ideas, feelings, and thoughts of the patient is an ineffective communication behavior because it turns the discussion of the patient’s health into a matter of the patient’s being right or wrong. The healthcare process should never become about the patient being right or wrong, but should be about helping the patient manage their healthcare needs.  Giving Your Own Advice You should never give a patient personal advice. You are there to serve as part of a healthcare team assisting the patient with the management of their care, but you are not there to provide the patient with your personal insights about their condition or behavior. You may have a personal opinion about something concerning the patient, but it would not be appropriate to share that opinion with the patient the way it might be appropriate to share opinions with your friends.  Prying: Sometimes a patient may indicate that they do not want to discuss a certain topic. This is the patient’s decision, and they have a right to that decision. It is inappropriate and even antagonistic for the HCP to pry into that topic once the patient has made clear that they do not want to talk about it. However, remember that prying is distinct from encouraging discussion.  Becoming Defensive: Patients may at times express unhappiness or dissatisfaction with the care received, the HCP, or even the hospital. The HCP should never become defensive in such cases. The HCP who becomes defensive at such times inappropriately changes the terms of the relationship from patient/provider to defender, and in such instances the therapeutic communication process, which is built on trust and understanding, completely breaks down. When a patient expresses unhappiness, the HCP should make every effort to show that they are listening carefully and empathically, and that they will attempt to address the issue  Roadblocks to Therapeutic Communication Part II—The Patient’s Behavior Ineffective Coping Behaviors: Denial—Avoid talking down to the patient or appearing to be condescending as this is likely to make the situation worse. The cancer patient whose diagnosis has been confirmed by blood tests, x-rays, computed tomography (CT) scans, still thinks the doctors might have gotten it wrong. Perhaps, this patient thinks, the medical staff has mistakenly confused their tests with those of another patient.  Displacement—‫اسقاط الغضب على طرف اضعف‬This occurs when it is impossible for the patient to accept ownership of certain thoughts, feelings, needs, or desires and attributes them, unconsciously, to a more acceptable substitute— someone or something outside of the self. ‫مثال‬The father who is deep in grief after his child receives a cancer diagnosis would naturally feel anger as part of that grief; however, he does not understand what to do with this anger and so whenever he sees his child’s doctor during an  Dissociation—‫ار عكس‬oo‫ارجي أفك‬oo‫لوك الخ‬oo‫ع الس‬oo‫ار م‬oo‫ط األفك‬oo‫دم تراب‬oo‫ع‬ ‫لوك‬o‫الس‬When this happens, the patient is attempting to disconnect the emotional significance of certain ideas or events from those ideas or events.\ The patient, for example, may relay an incident of childhood abuse that the HCP knows must have been painful, and yet, in the telling of the incident, the patient does not acknowledge the pain that must have been a part of the experience.  Projection— ‫رين‬o‫وم على االخ‬o‫قاط الل‬o‫اس‬This happens when the patient projects onto another person or object their own feelings, as if the feelings originated in the other person or object. A patient who feels anger over some perceived inadequacy in their care may not be able to own that anger but will instead accuse the HCP of being angry. o‫في‬o‫ظ‬o‫و‬o‫لح‬o‫الم‬o‫ض النقص‬ o ‫ع‬o ‫ب‬o‫بب‬o‫ب بس‬o‫ بالغض‬o‫عر‬o‫ش‬o‫ذي ي‬o‫ريض ال‬o‫م‬o‫ل‬o‫ون ا‬o‫ك‬o‫د ال ي‬o‫ق‬ ‫ة‬o‫دم الرعاي‬o‫يتهم مق‬o‫ك س‬o‫دًال من ذل‬o‫ه ب‬o‫ ولكن‬، ‫ب‬o‫ذا الغض‬o‫ل ه‬o‫ادًر ا على تحم‬o‫ه ق‬o‫رعايت‬ ‫الصحية بأنه غاضب‬.  Rationalization—‫برير‬o‫ الت‬When a patient does this, they are using false reasoning to justify inappropriate or unacceptable behavior, hoping to make the behavior tolerable.  The patient who does not comply with the physician’s orders to show up for Tuesday’s colonoscopy appointment may not admit that their failure to appear was because of fear but rather will change the subject and say that the HCP did not bother to ask whether the patient was free on that Tuesday. ‫ال‬o‫ذي‬o‫ال‬o ‫ض‬o‫ري‬o‫لم‬o‫ا‬o‫ترف‬o‫ع‬o‫د ال ي‬ o o‫ق‬ ‫ل‬o‫ب‬o‫وف‬o‫الخ‬o‫ب‬o‫ب‬o‫بس‬o ‫ان‬o‫ه ك‬ o ‫ور‬o‫ض‬o‫ح‬o‫م‬o‫د‬o‫ن ع‬ o ‫أ‬o‫ء‬o ‫ا‬o‫الث‬o‫لث‬o‫ا‬o‫م‬o‫و‬o‫ن ي‬ o o‫و‬o‫القول‬o‫ر‬o‫ا‬o‫نظ‬o‫د م‬o‫وع‬o‫لم‬o ‫ور‬o‫حض‬ o ‫ب بال‬o‫ي‬o‫ب‬o‫ر الط‬ o o‫م‬o‫وا‬o ‫ أل‬o‫ل‬o‫يمتث‬ ‫ير‬o‫ريض غ‬o‫ان الم‬o‫ا إذا ك‬o‫ عم‬o‫ؤال‬o‫الس‬o‫اء‬o‫ه عن‬o‫نفس‬o‫ف‬o‫ل‬o‫م يك‬o‫حي ل‬o‫لص‬o‫ارس ا‬o‫ن المم‬ o ‫ول إ‬o‫وع ويق‬o‫ض‬o‫يغير المو‬o‫س‬ ‫مشغول في ذلك الثالثاء‬.  Regression—‫لوك‬oo‫ع في الس‬oo‫تراج‬A patient is regressing when they unconsciously return to immature, or even infantile, behaviors or thoughts. A patient may behave in this way when confronted with especially painful or difficult circumstances. Repression—‫د‬o‫ل مثال بع‬o‫كل ال ارادي مث‬o‫داث بش‬o‫يان لالح‬o‫دث نس‬o‫يح‬ ‫ديد‬o‫ادث ش‬o‫ح‬This is when the patient simply puts out of their mind painful or difficult thoughts, feelings, ideas, or events. A patient who is confronted with a decision whether to undergo a difficult brain biopsy and then goes  Angry Patients Patients can become angry for many reasons. They may believe they have received inadequate care, been the subject of unfair treatment, or receiving of personal insult. They may be angry as a result of loss of control in the face of serious illness …..etc Role of health care providers 1- Early recognized of patient signs of anger as speaks in a tense voice, who acts in a difficult or stubborn manner ‫د‬o‫ عني‬, or who rejects or ignores your attempts to communicate. 2-Stay calm, stay respectful, stay genuine. Your calm demeanor and  Angry Patient cont.’’ 3-Remember to stay focused on the patient’s physical and medical needs. 4- Use appropriate nonverbal communication 5-Resist the urge to defend yourself in the face of accusations from the patient. 5- ‫قاوم الرغبة في الدفاع عن نفسك في وجه اتهامات المريض‬ 6. Encourage the patient to be specific when describing the reasons for their anger and what they think about those reasons 7-firmly present your point of view to the patient to help them understand what has happened. 8-Be sure complete on any promises you make in addressing the Anxious Patients Patients can be anxious for just as many reasons Quickly identify the signs of anxiety in the patient. Acknowledge the patient’s anxiety to the patient Use appropriate nonverbal communication Identify possible sources of the patient’s anxiety Make sure that the patient is as comfortable as possible physically. Determine what types of support the patient has Work to create a climate of warmth, acceptance, and trust. Never minimize of the patient’s anxiety, feelings, or thoughts. End of the Lecture