COMMUNICATION SKILLS IN PHYSIOTHERAPY with lecture notes.pdf

COMMUNICATION SKILLS IN HEALTH PROFESSIONALS Psychosocial Science Applied to Physiotherapy Degree of Physiotherapy CEU-San Pablo University 2023-2024 OUTLINE • INTRODUCTION AND IMPORTANCE • COMMUNICATION SKILLS • LISTENING SKILLS • ASSERTIVENESS SKILLS 2 COMMUNICATION WITH PATIENTS • Skills...

COMMUNICATION SKILLS IN HEALTH PROFESSIONALS Psychosocial Science Applied to Physiotherapy Degree of Physiotherapy CEU-San Pablo University 2023-2024 OUTLINE • INTRODUCTION AND IMPORTANCE • COMMUNICATION SKILLS • LISTENING SKILLS • ASSERTIVENESS SKILLS 2 COMMUNICATION WITH PATIENTS • Skills: “The set of verbal and non-verbal techniques and behaviours that make up the relational competence of health professionals through which they express, in an interpersonal context (patient-centred) and in a specific situation, their needs, feelings, preferences, opinions, desires and rights, providing a series of consequences in the relationship that affect the patient, the professionals, the relationship between the two and the health system. 3 SKILLS IN HEALTH PROFESSIONALS • INFORMATIVE COMMUNICATION • ACTIVE LISTENING • EMPATHY • RESPECT • AUTHENTICITY OR CONGRUENCE • ASSERTIVITY OR SOCIALLY SKILLFULL BEHAVIOUR 4 INFORMATIVE COMMUNICATION • Ability of health professionals to: • Provide information by ensuring that patients have understood • Obtain comprehensive information about patients • Emphasise the message 5 ACTIVE LISTENING • Ability of health professionals to: • to listen carefully to the totality of the message being delivered, trying to interpret the correct meaning of the message, through the patient's verbal and non-verbal communication, and indicating through feedback what we think we are understanding". 6 ACTIVE LISTENING • TALK LESS, LISTEN MORE !!!!! • PATIENTS WANT TO BE LISTENED!!! • PATIENTS WANT TO EXPRESS FEELINGS, NEED SOMEONE TO LISTEN TO THEM!!!! • DO NOT INTERRUPT YOUR PATIENTS!!! 7 EMPATHY • Ability of health professionals to: • observe things that the patient experiences from his/her internal frame. • Readiness to grasp the other's inner frame of reference, feelings and meanings. • behavioural dimension of the empathic attitude is active listening and empathic response. • Empathic responding is the ability to communicate verbally and non-verbally what is understood through different ways of responding. 8 RESPECT • Ability of health professionals to: • to receive, accept and understand what the patient conveys in the relationship, without moralising judgement, 9 AUTHENTICITY OR CONGRUENCE • Ability of health professionals to: • be him/herself in the relationship as he/she is. • coherence between internal life and the way he/she communicates it in his/her verbal and non-verbal language. 10 ASSERTIVITY • Ability of health professionals to: • express feelings, attitudes, desires, opinions or rights in a way that is appropriate to the situation, respecting those behaviours to others, and that generally solves the immediate problems of the situation while minimising the probability of future problems. 11 COMMUNICATION SKILLS IN HEALTH PROFESSIONALS • COMMUNICATION SKILLS: TEACH BACK • LISTENING SKILLS: ACTIVE LISTENING • ASSERTIVE SKILLS 12 COMMUNICATION: TEACH-BACK • Evidence-based approach to asking patients to repeat in their own words what they need to know or do. • It is an opportunity to check understanding, and to re-teach the information. • The goal is to provide effective teaching to the patient or primary learner. • Patient should be able to explain in their own words. • Simple language, speak slowly and clear, encourage questions, short sentences, use illustrations, 2-3 key concepts. 13 TEACH-BACK BENEFITS • Minimises the risk of patients misunderstanding critical information. • Promotes knowledge • Promotes adherence to treatment. • Improves self-efficacy • Improves patient-centred communication • Improves satisfaction, safety and quality of care. 14 HOW TO TEACH-BACK? 1. Assess patients' basic knowledge before providing extensive information. 2. Explain things clearly using simple language. 3. Highlight 1 to 3 key points and repeat them during the visit. 4. Effectively encourage patients to ask questions. Use an open-ended approach. 15 HOW TO TEACH-BACK? 5. Use teaching to confirm patient understanding: ASK QUESTIONS AND BEHAVIOURS. 6. Write down important instructions 7. Provide useful educational materials accesible to family members 16 TO SUMMARIZE ….. 17 TEACH-BACK EXAMPLE 18 TEACH-BACK EXAMPLES 19 STRATEGIES FOR EFFECTIVE HEALTH COMMUNICATION • SIT DOWN AND BE HUMBLE • ASK QUESTIONS: BATHE technique ▪ BACK GROUND ▪ AFFECT ▪ TROUBLE ▪ HANDLING ▪ EMPATHY • SPEAK IN PLAIN LANGUAGE • KEEP COMMUNICATION CONFIDENTIAL 20 STRATEGIES FOR EFFECTIVE HEALTH COMMUNICATION • GET TO KNOW YOUR PATIENT (TRUST) • PROBE, FOLLOW UP AND CONFIRM • RAPPORT • CREATE MEANINGFULL CONVERSATIONS • BE HONEST • DO NOT GIVE FALSE HOPES • MAKE A REFERRAL 21 TO LEARN MORE...... • http://teachback.org/learn-about-teach-back/ 22 Process of Communication Mehrabian rule: From the information received Language 7% Corporal language Emotions 38% 55% 23 What is language for? TO INFORM OTHERS ABOUT SOMETHING TO COMMUNICATE TO EXPRESS OUR FEELINGS AND SHOW HOW WE FEEL MOST OF TIMES TO BE PERSUASIVE AND CONVINCE OTHERS!!!!! 24 ACTIVE LISTENING EFFECTIVE LISTENING CHARACTERISTICS • EMPATHY • UNCONDITIONAL ACCEPTANCE OF THE OTHER • AUTHENTICITY 26 ACTIVE LISTENING • Attending to the total message. • Integrating into a message through different channels. • Using feedback • Allows the communication process to be completed. 27 ACTIVE LISTENING ADVANTAGES • Provides greater knowledge of patient • Improves the patient’s predisposition • Reduces the patient’s anxiety • More time to respond • Makes easier to reach agreements 28 ACTIVE LISTENING REQUIREMENTS • Focus on the patient. • Understand the message. • Summarise • Confirm. 29 ACTIVE LISTENING REQUIREMENTS • Pleasant physical environment • No interruptions. • Positive attitude • Not to be in a hurry/interrupt/anticipate • Focus on the message: summarize • Maintain eye contact • Nod your head. • Control your posture. 30 ACTIVE LISTENING, LISTEN WITH THE HEART Be present • Do not interrupt or judge • Eye contact and light smile Escucha Activaslightly forward leaning body type • Receptive, y Empatía • Paraphrase and ask relevant questions if appropriate • Empathising is not sympathising • LISTENING-RECAPITULATING (UNDERSTANDING)-EXPRESSING • IN THE PROCESS OF COMMUNICATION EMPATHY? ASERTIVITY? Escucha Activa yUNDERSTAND Empatía EACH OTHER'S POSITION: YOU MAY OR MAY NOT SHARE IT. ASSERTIVENESS IS COMMUNICATING EFFECTIVELY WHAT YOU FEEL, WHAT YOU THINK AND RESPECTING YOUR INTERLOCUTOR. “OUR WORST COMMUNICATION PROBLEM IS THAT WE DO NOT LISTEN TO UNDERSTAND BUT LISTEN TO ANSWER" 33 LISTENING LEVELS Hearing the • verbal message • • Superficial and discontinuous listening Interested in oneself and one's own interventions With conventional and commonplace answers Understand the • verbal message • • Listening focused on the formal meaning of words Ignoring the emotional aspects and intention of the sender Responding with limited scope and no impact on the sender Active listening: understand • the verbal and • non verbal message Interpreting their emotions, feelings and intention Adopting a dialogic and facilitative attitude about the issue 34 PLEASE DO NOT FORGET THAT....... •"We have two ears and one tongue so that we would listen more and talk less." •-Diogenes ASSERTIVENESS • Expression of personal rights, thoughts, opinions with respect and responsible attitude. • Allows to defend us against criticism or excessive requests. 36 ASSERTIVENESS • Right to protect ourselves, to reject what bothers us and to ask what we need. • Respect our personal rights as well as others. • Learn to define and identify human rights 37 ASSERTIVE SKILLS • to freely give information • to make self-revelations • to empathise • to formulate criticism • to request changes • to express opinions or criteria, • to express agreement or disagreement • to summarise • to ask questions • • to issue "I-messages" to praise. VERBAL + PARAVERBAL + NON VERBAL PRACTICE IN DIFFERENT CONTEXTS 38 ASSERTIVE SKILLS GIVE FREE INFORMATION • Provide additional information: personal opinions, ideas, thoughts • Facilitates a topic and stimulates to talk about themselves. • Different ways of providing information 39 ASSERTIVE SKILLS MAKE SELF-REVELATIONS • Reveal personal information • Two-way communication • “I think, I would like” • Self-disclosure should be symmetrical. 40 ASSERTIVE SKILLS FORMULATE A CRITIC • Choose the time and place. • Person is not upset and available. • Avoid in a tension/anger state • Not to wait to long. • Describe behaviour without judging and generalising. 41 ASSERTIVE SKILLS FORMULATE A CRITIC • Describe the situation • Express the feelings. • Changes needed or consequences. 42 DESC MODEL FORMULATE A CRITIC: FEEDBACK 43 DESC MODEL: DESCRIBE • OBSERVE: Describe the situation, the event, what was observed: What happened, where, when? • Be specific and limit yourself to what happened. • Use neutral phrases without judging or evaluating, actions that are concrete. • Simply say what the person did, avoid using harmful words, watch your tone. 44 DESC MODEL: EXPRESS • FEELINGS: Explain the impact of the event on you and how you felt when observing the event, analyse emotions. • Describe how it made us feel: hurt, angry, disappointed. • This helps others to be compassionate and change behaviours. 45 DESC MODEL: SPECIFY • NEEDS: suggesting your needs or wants to the other person, usually should be a collaborative process. • These are needs related to feelings. • But if the person does not respond a more direct approach may be needed such as: next time this happens I hope you will ....... 46 DESC MODEL: CONSEQUENCES • Explain the consequences, requests or actions to be taken in the present in a clear way. • Consequences should be framed positively around the benefits of making changes in our behaviour. "If this does not change I will have to or the results will be ....". 47 KILLER PHRASES • There is no dialogue with you. • You do nothing but repeat and repeat. • You are a ghost • You always do the same thing! • You understand absolutely nothing about this issue. • Look, don't make a fuss. • You say it, you know everything. • Sometimes, you care more about others than about your family. • You're crazy; do it yourself if you want to. 48 I- MESSAGES • Respectful communication • Without reproaching • Describe the situation or behaviour. versus You-MESSAGES • No judgements • Describe the consequences on you • Express the feelings on you • Attribute the causes of your behaviour and opinions to the other person. • Expressed in commands and imperatives • The others feel evaluated, controlled, blamed and unfairly treated. 49 ASSERTIVE SKILLS CHANGE A BEHAVIOUR/COMPLETE A TASK • Sandwhich model • DESC model 50 ASSERTIVE SKILLS EXPRESS A DIFFERENT OPPINION • Right to maintain own opinions, to change them and to have people respect • "It is true what you say .... but I still wish ….! 51 ASSERTIVE SKILLS ASK OTHERS TO CONFIRM OR EXPRESS DISAGREEMENT • Encourage the expression of agreement/disagreement • To find out individual’s position • Quetions needed: • Is it correct to asume that…? • Am I right about what you are saying? 52 ASSERTIVE SKILLS ABILITY TO ASK QUESTIONS • To gather information, to maintain a conversation, to generate doubts, to invite to reflect. • Open-ended questions – How do you feel? – What do you think? • Closed questions 53 ASSERTIVE SKILLS ABILITY TO GIVE PRAISE • Compliments highlight what we consider positive characteristics of a person. • Praise must be: • Justified and sincere • Personalised and adapted • Specific: describe the behaviour. 54 ASSERTIVE TECHNIQUES • Behavioural options used to assert our rights and defend ourselves from any possible "attack" from others who try to impose their criteria and will in personal relationships. • Behavioural options to put into practice in the face of possible reactions from the people we interact when defending our assertive rights. 55 ASSERTIVE TECHNIQUES • RECORD SCRATCHING • FOG BANKING • VIABLE COMPROMISE • ASSERTIVE AGREEMENT • ASSERTIVE QUESTIONING • SIMULATED CLAUDICATION 56 ASSERTIVE TECHNIQUES RECORD SCRATCHING • To make requests or to reject requests. • Being persistent without getting upset and always finishing the sentence with the aim! • No long explanations or excuses. • Calm voice! 57 ASSERTIVE TECHNIQUES FOG BANKING • To accept the interlocutor opinions, wishes, feelings though we do not share them. • Deal with: • criticisms not based on real facts but opinionated facts • Statements to manipulate us by appealing to logic or to arouse feelings of anger, guilt or anxiety. 58 ASSERTIVE TECHNIQUES FOG BANKING • Agree with the truth • Agree with the possibility • Agree in principle Forces you to listen to the critic but not to respond with other critic Respond only to what is said but not its implications!!! 59 ASSERTIVE TECHNIQUES VIABLE COMPROMISE • Alternative to broken record technique when interlocutor is assertive and both give up without damage. • Commit to something we can achieve. 60 ASSERTIVE TECHNIQUES ASSERTIVE AGREEMENT/NEGATIVE ASSERTION • To face with criticism of our competence, habits or physical appearance. • Respond to criticism by admitting part of the content but separating it from being a good/bad person. • Calm actitude, no anger! 61 ASSERTIVE TECHNIQUES ASSERTIVE/NEGATIVE QUESTIONING • To deal with criticism by eliciting in a relaxed way new criticism from the interlocutor or more info about the behaviour. • It does not imply any criticism of the interlocutor and invites to make further critical statements and to examine their values. 62 ASSERTIVE TECHNIQUES SIMULATED CLAUDICATION • Similar to fog banking but the object is different. • Agree with the person arguments but do not agree to change your position. • “You may be right, I could be more generous” 63 ASSERTIVE TECHNIQUES • ASSERTIVE IRONY: Respond positively to hostile criticism. • BREAKING THE PROCESS: Respond with a word or laconic phrases. • IGNORING: Postpone the discussion till the person calms down • PROCESSING CHANGE: Shift the focus to the relation between people leaving the subject aside • ASSERTIVE POSTPONEMENT: Put off responding till you feel calmer. 64 TIPS TO REMEMBER • Important to recognise the communication style. • Important to work on assertiveness • Important to train active listening, empathy, clear communication • Practice feedback and teach-back 65 Peggy H. Yen, FNP-BC, DNP and A. Renee Leasure, PhD, RN, CCRN, CNS 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. • Peggy H. Yen. Use and Effectiveness of the Teach-Back Method in Patient Education and Health Outcomes. Fed Pract. 2019 Jun; 36(6): 284–289. 66