COMMUNICATION IN PHYSICAL THERAPY 23-24 Class 1 and 2.pdf

COMMUNICATION IN PHYSIOTHERAPY Psychosocial Science Applied to Physiotherapy Degree of Physiotherapy CEU-San Pablo University 2023-2024 OUTLINE • INTRODUCTION AND IMPORTANCE • DEFINITION, PRINCIPLES AND ELEMENTS • BEHAVIOURAL COMPONENTS 2 COMMUNICATION • Necessity for people/society. • Socio...

COMMUNICATION IN PHYSIOTHERAPY Psychosocial Science Applied to Physiotherapy Degree of Physiotherapy CEU-San Pablo University 2023-2024 OUTLINE • INTRODUCTION AND IMPORTANCE • DEFINITION, PRINCIPLES AND ELEMENTS • BEHAVIOURAL COMPONENTS 2 COMMUNICATION • Necessity for people/society. • Socio-cultural fact • to ensure existence. • Solve problems and influence others. • Intrapersonal communication. 3 IMPORTANCE OF COMMUNICATION IN HEALTH SCIENCES • Fundamental for the good development of clinical practice: Relation PT-Patient and Team. • INTERACTION HEALTHCARE PROVIDER-PATIENT: o Paternalistic (provider-centred model). o Patient-centred model • Essential for healthcare professionals: o Identify model required o Have necessary skills for communication 4 IMPORTANCE OF COMMUNICATION IN HEALTH SCIENCES • EVIDENCE QUALITY COMMUNICATION PHYSICAL THERAPIST (PT)-PATIENT: o Compliance o Adherence o Patient's self-confidence o Feeling of control regarding the experience of their problem and their ability to overcome it. • POSITIVE VARIABLES RELATION (PT)-PATIENT: o affectionate behaviour o understanding the patient's perceptions and cognitions, o taking into account the patient's expectations, o giving information in an understandable way, o generating hope o generating confidence : satisfaction and compliance. 5 DEFINITION OF COMMUNICATION • “Process of transmitting and receiving signals by means of a code (a system of signs and rules) that is common to both the sender and the receiver“ • “Process by which one person contacts another with a message, and expects the latter to give a response (opinion, attitude or behaviour)“ (Feedback) • “An interpersonal process in which participants express something of themselves through verbal and non-verbal signs with the intention of influencing each other in some way. 7 COMMUNICATION BASIC PRINCIPLES "BULLET THROWING" APPROACH. "FRISBEE" OR "SAUCER THROWING" APPROACH. 8 "BULLET THROWING" APPROACH. • Communication conceived and that emphasises well-delivered the well- message, originating in classical Greece. • Someone put out a good message and delivered it, someone else received it, and that was the end of the communication picture. • The notion of "feedback" was not present. 9 "FRISBEE" OR "SAUCER THROWING" APPROACH. • 1940s focus moved to interpersonal communication with 2 central components relevant to health science communication: o Confirmation: recognise, notice, support o mutual understanding on common ground/ “reciprocal identification”: trust and accuracy. o Important during interview!!!! o Discomfort, tension, threat 10 "FRISBEE” APPROACH • “Effective communication” based on 5 principles: o Interaction vs transmission of information(exchange and feedback) o Reduce unnecessary uncertainty (accuracy and efficiency) o Requires planning: outcomes to be achieved. o Dynamism: flexibility, skills. o Helical vs linear model: repetition, reiteration, feedback 11 COMMUNICATION APPOACHES EVOLUTION "BULLET THROWING" APPROACH. Message "FRISBEE" OR "SAUCER THROWING" APPROACH. Interaction Feedback Collaboration 12 COMMUNICATION ELEMENTS • SENDER • RECEIVER • CHANNEL • CODE • CONTEXT • NOISE • FILTERS • FEEDBACK 13 COMMUNICATION ELEMENTS • SENDER o Emits a message/takes initiative/communicates the first o Influence depends on: o Personal characteristics o cultural peculiarities o social system o level of education o attitudes 14 COMMUNICATION ELEMENTS • RECEIVER o Receives a message being necessary to have the ability to listen and pay attention. o Reception depends on: o psychosocial characteristics o personality, o socio-cultural environment, o level of education o communication skills. 15 COMMUNICATION ELEMENTS • MESSAGE o Set of ideas/information transmited by codes/clues/images whose meaning will be interpreted by the receiver (personal experience/socio-cultural context) • CHANNEL o Medium through which the message is sent. o oral-auditory o graphic-visual 16 COMMUNICATION ELEMENTS • CODE o Keys, images, languages and rules used to send a message. o Shared by the sender and receiver • CONTEXT o Specific situation in which communication takes place. o Roles of sender/receiver depend on it. o It will determine the image/interpretation given to the message. 17 COMMUNICATION ELEMENTS • NOISE o Disturbances during the message transmission not always related to sound. • FILTERS o Mental barriers from values, experiences, expectations, prejudices of sender and receiver • FEEDBACK o Information the receiver gives back to the sender about his own communication (content and its interpretation). 18 19 COMMUNICATION ELEMENTS • SENDER • RECEIVER • CHANNEL • CODE • CONTEXT • NOISE • FILTERS • FEEDBACK 20 COMMUNICATION ELEMENTS • SENDER: • Define objectives: What is it that I want to say? • Encode the message • Activation of filters • Transmission (Channel) 21 COMMUNICATION ELEMENTS • RECEPTION: • Noise and filters (mental barriers, prejudices, preconceived ideas) • Stress of the patient reduces ability to listen, pay attention…. • DECODING: • Internal process (experiences, knowledge) to interpret the message • Filters, problems (receiver knowledge and proper use of code). • How to listen essential in decoding!!! 22 COMMUNICATION ELEMENTS • RECEIVER (What did he want to tell me?): • Intention of the sender will be in line with receiver’s interpretation and sender’s objectives. • Interpretation of message (subjective, biased, lost information). • Difficult to be certain that receiver interprets what we communicate exactly as we wish. • "Interactive Communication Circle“ technique: • Assess the extent understood • Improve communication • Emphasise message 23 INFORMATION LOSS DURING COMMUNICATION What is meant • What is said • • • What is Heard What is listened to What is interpreted Loss of information 24 KEY POINTS TO KNOW IF I AM A GOOD COMMUNICATOR If I am able to communicate in a way that the other person likes to talk to me, if I make my interlocutor feel listened to, if I communicate what I want without attacking anyone and if I manage to convey an attitude that favours dialogue and the exchange of opinions, as well as communicating I will probably be relating appropriately with others. MAYBE I CAN BE A SOCIAL BUTTERFLY …...... 25 BEHAVIOURAL COMPONENTS OF COMMUNICATION • NON-VERBAL • PARAVERBAL • VERBAL 26 NON-VERBAL COMMUNICATION • Word is not involved. • Powerful in conveying emotions • Glance, gesture reveals more than a speech. • Serves to define the relationship established between interlocutors, and helps to confirm or not verbal messages, • Gaze, tone of voice, posture, facial expression, movements, physical contact, volume, etc. 27 NON-VERBAL COMMUNICATION • FACIAL EXPRESSION • GAZE • SMILE • ORIENTATION & POSTURE • PHYSICAL CONTACT • GESTURES & PERSONAL APPEARANCE • SELF-MANIPULATIONS & NERVOUS MOMENTS 28 NON VERBAL COMMUNICATION • FACIAL EXPRESSION o EMOTIONS: joy, surprise, sadness, fear, disgust o Expression of emotions by gestures combinations. o Combination of emotions. o Important to pay attention to the facial expression of patients!!!!! “THE FACE IS THE MIRROR OF THE SOUL” 29 NON VERBAL COMMUNICATION • GAZE o One of the most important non-verbal elements o 4 functions: o Regulation of the Flow of communication o Feedback by monitoring the interlocutor reactions o Expression of emotions o Communication of the nature of personal relationship “LISTEN WITH YOUR EYES, NOT WITH YOUR EARS” 30 NON VERBAL COMMUNICATION • SMILE o Basic element in welcoming, acceptance, friendliness, liking o For the patient to have a favourable impresión of us. o Not appropiate: bad news, anger 31 NON VERBAL COMMUNICATION • ORIENTATION AND POSTURE o Orientation: Relative position of person in relation to his interlocutor: facing forward or inclined. o Posture: • approach-withdrawal: body inclination. • expansion-contraction. 32 NON VERBAL COMMUNICATION • PHYSICAL CONTACT o Proximity: Type of relationship/degree of acceptance. o Contact regulation: body movement, gaze, closeness o Touch: welcome/understanding PHYSICAL CONTACT AND GAZE ARE THE MOST IMPORTANT ELEMENTS FOR A THERAPEUTIC BOND WITH A PATIENT!!!! 33 NON VERBAL COMMUNICATION • GESTURES & PERSONAL APPEARANCE o Gestures : Hand movements. o Personal Appearance: Personal grooming, clothing, adornment to generate impressions o Judgements by apperance/impression on us 34 NON VERBAL COMMUNICATION • SELF MANIPULATIONS & NERVOUS MOMENTS o Self manipulations : Touch of our own body. o Nervous moments: Hand and feet o Repetitive o Rhythmic o Normaly involuntary 35 PARAVERBAL COMPONENTS • Its use not alter the content of words but the meaning. • HOW THINGS ARE SAID. • Volume, tone, speed, fluency and clarity, speaking time, pauses and silences, response latency. • Help people to form judgements about the people they interact with 36 PARAVERBAL COMMUNICATION • VOICE VOLUME o make our message audible. o average overall level of volume at which we convey a message o To emphasise and capture the patient's attention we use a higher voice volume. o the louder a person speaks, the more nervous is considered to be. o Important in the impression that others make of us. 37 PARAVERBAL COMMUNICATION • TONE & SPEED o Tone: reflects the quality of the voice. It also varies the meaning of the message and expresses self-confidence. o Speed: Time very important in healthcare but increasing the speech speed (no understanding) and too slow (boring) 38 PARAVERBAL COMMUNICATION • FLUENCY & CLARITY o Words not understood because they are choppy, strong accent, emotional state. o Open our mouths when speaking 39 PARAVERBAL COMMUNICATION • SPEAKING TIME o Duration of interlocutors’ interventions. o Correct time if no monopolisation & equal participation 40 PARAVERBAL COMMUNICATION • PAUSES & SILENCES o Emphasise o emotional factors o intellectual factors o interaction SILENCE IS AN ESSENTIAL PART OF COMMUNICATION!!!! 41 PARAVERBAL COMMUNICATION • RESPONSE LATENCY • Time it takes us to start speaking once our interlocutor has finished. • Warm/friendly demeanour with appropriate facial expression/smile/repeated eye contact • A forward posture, with open gestures and affirmative head movements • A low, tempered voice volume, with satisfactory vocalisation and the use of silence 42 VERBAL COMPONENTS Speech used for communicating ideas, describing feelings, reasoning and arguing. Words used depend on the situation, the roles to be played and the objectives to be achieved. Any professional must have knowledge (language/ profession) to be able to deal successfully with the speech in the context in which it is used ("what they have to say“) 43 VERBAL COMMUNICATION • CONTENT • Idea or information transmitted by the sender • PERSONAL ATTENTION • concrete signs of interest in the other person or in his or her ideas, feelings, activity, etc. • asking questions, looking when we are spoken to, letting the words finish, not interrupting while speaking. 44 VERBAL COMMUNICATION • QUESTIONS & ANSWERS TO QUESTIONS o Open questions: o allow for a broader response from our interlocutor. o Closed questions: o Mark a limited possibility of reponse. • ANSWERS TO QUESTIONS o our answers should be adjusted to the type of questions asked: open or closed. 45 VERBAL COMPONENTS IN PT DISCUSSING ASKING ENCOURAGING EXPLAINING • DISCUSSING POSSIBLE OPTIONS TOGETHER • ASKING THE PATIENT'S OPINION • ENCOURAGING CLEAR QUESTIONS AND ANSWERS • EXPLAINING WHAT THE PATIENT NEEDS TO KNOW USING SIMPLE LANGUAGE ADAPTED TO HIS OR HER KNOWLEDGE. 46 BIBLIOGRAPHY • Kripalani S, Weiss B.D. Teaching About Health Literacy and Clear Communication. J GEN INTERN MED 2006; 21:888–890 • Winifred Tamura-Li. Teach-Back for Quality Education And Patient Safety UROLOGIC NURSING / November-December 2013; 33: 6 • Cristian A, Batmangelich S. Physical Medicine and Rehabilitation PatientCentered Care: Mastering the Competencies (English Edition) 10 edition, Kindle version, 2015. 47