communicationskills.pptx

1. Communication Skills by Dr. Mona M Aboserea Professor of Public Health & Community Medicine

2. Contents ■ ■ ■ ■ ■ Communication skills Consultation Counselling Breaking bad news Quizzes

3. Concepts ■ What is communication? The process in which feelings or ideas are expressed as messages sent , received and comprehended . It should be dynamic , continuous and reciprocal . ❑ Once you send it, it is irreversible (non erasable).

4. Why is Communication Important?

5. The Communication Process Model

7. Principles of communication 1. Listening 2. Probing 3. Observing 4. Informing

8. Listening ➢ Focus your attention: Avoid barriers ➢ Show that you are listening ➢ ➢ ➢ Understand ideas and pick words Retain information (memory, notes) Give your feedback

9. Probing ➢ What clients think ➢ Encourage clients to talk: tell them that you are really listening and want to hear more ➢ Ask open questions ➢ Keep privacy

10. Observing Non verbal communication: ➢ Facial expression ➢ Voice tone ➢ Body language

11. Informing ➢ In a clear, correct, concise and complete ➢ the needs, language and way Consider obstacles ➢ summing ➢ Check back with the speaker to ensure that the statement is accurate

12. Means of communication ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1. Verbal: written or spoken 2. Non verbal: any thing except words: Body movement Posture: way of setting, standing Gesture: movement of hands, legs, arms Facial expression, eye contact Space Touch Paralanguage: mmm

13. Means of communication

14. Barriers to communication Receiver Sender Distortion Feedback

15. )Sender (Speaker ➢ Personal appearance ➢ ➢ ➢ ➢ Gender Differences Language differences Psychological barriers: stress, frustration, anger, tiredness Cannot communicate the message

16. Receiver (Listener) ➢ Personal ➢ Physiological ➢ Psychological ➢ language

17. ➢ Unclear, confusing ➢ ➢ Difficult words Not interesting to the receiver Message

18. Channel ➢ Noise ➢ Not accessible to the receptor

19. Effective communication Avoid Barriers to Communication. ■ ■ Messages: ■ ■ ■ Send Understandable Effective communication. Actively Listen. Utilize Non-verbal Signals. Try multiple channels

20. ■ How do you know that your communication was effective? ➢ Feedback ➢ Your message affect other people: ➢ start to change behavior Had effect on the whole community

21. Consultation and counseling ■ Consultation: a process of a dialogue that leads to a decision ■ Counseling: helping a person or a group of people to develop self help

22. Consultation Models Bad consultations result from ❑ having insufficient clinical knowledge, ❑ failing to relate to patients or ❑ failing to understand the patient's behaviour, his perception of his illness or its context

23. Consultation ■ ■ A process in which the counselor works with (parent, teacher, administrator) with the goal of positive change in the child Voluntary problem-solving process with goals of enhanced services and improved functioning

24. Individual Consultation

25. Individual Consultation

26. Group Consultation

27. Triad of Consultation Consultee Client System Consultant The triadic relationship in consultation

28. Consultation After each consultation session five things must be established: 1. Discover the reasons of patient attendance 2. Define clinical problem (HPT, DM) 3. Address the patient’s problem (details) 4. Explain the problem to the patient 5. Make effective use of the consultation

29. The Consulting Process 1. Pre-entry Look at oneself to see if you are right for the task and services to be provided 2. Entry, problem exploration and contracting learn about needs, presenting problem, people involved, previous interventions, and expectations of seeker

30. .)The Consulting Process (Cont 3. Diagnosis stage Information gathering, problem confirmation, goal setting, and potential interventions 4. Solution searching and intervention selection avoid favorite paradigm consider human and structural factors

31. .)The Consulting Process (Cont 5. Evaluation ■ ■ ■ Ensures professional effectiveness Were goals achieved? Did interventions work? 6. Termination ■ ■ Describe what was and was not successful Look for areas of improvement

32. Initiating the Session Gathering Information Explanation and Planning Closing the Session Building the Relationship Attending to Task Expanded Framework

33. Providing Structure InitiatingtheSession Closingthe Session • preparation • establishinginitial rapport • identifying thereason(s) for the consultation • providingthecorrectamountandtype of information • aidingaccurate recallandunderstanding • achievinga shared understanding: incorporatingthe patient’s illness framework • planning: shared decisionmaking • • Gathering information Physical examination Explanation and planning • exploration of the patient’s problems to discover the: biomedical perspective the patient’s perspective background information - context • ensuring appropriate pointof closure • forward planning Buildingthe relationship • using appropriate non-verbal behaviour developing rapport involving the patient • making organisation overt • attending to flow

35. Consultation Styles ■ doctor-centred ■ ■ ■ ■ dominates the consultation asks direct, closed questions rejects the patient's ideas evades the patient's questions ■ patient-centred ■ ■ ■ asks open questions actively listens challenges and reflects the patients' words and behaviour to allow them to express themselves in their own way

36. Counseling Preparing a counseling session Physical setting Timing Interpersonal space

37. 1. Physical setting ■ Privacy: in a quiet, calm and no interruption ■Proper lightening and temperature. 2. Timing ■ 45-60 minutes

38. 3. Interpersonal space ➢ 4-9 feet (1 feet=30.4cm) D ➢ D P D P P (×) (√) (√)

39. Counseling, Consultation, communication process ■ Initiating the session ■ Gathering Information ■ Building Relationship ■ Explanation and Planning

40. Initiating the session a) Establishing Initial Rapport‫ةةةةة‬: -Greets the patient and obtains name. -Introduce self, role and nature of interview. -Demonstrate respect and interest. b) Identifying reasons for the consultation: -Identifies patient’s problems using opening question. -Listens attentively to patient’s opening statement without interrupting. -Confirms lists and screens for further problems. -Negotiates agenda taking and doctor’s needs into account.

41. Gathering Information : Exploration of patient’s problem -Encourages patient to tell the story. -Uses open and closed questioning technique. -Listen attentively. -Facilitates patient’s responses. -Clarifies patient’s statements. -Periodically summarizes. -Uses concise, easily understood questions. -Establishes dates and sequence of events.

42. Building Relationship a) Using appropriate non-verbal behavior: -Demonstrate appropriate non-verbal behavior (eye contact, posture, vocal cues). -Demonstrate confidence. b) Developing rapport: -Accepts patient’s views and feelings. -Provides support. -Deals sensitively with embarrassing and disturbing topics. c) Involving the patient: -Shares thinking. -Explains rationale. -Asks permission and Explains process during physical examination.

43. Explanation and Planning a) Providing the correct amount and type of information: -Assesses patient’s starting point (prior knowledge). -Asks patients what other information does he needs and would be helpful. -Give explanation at appropriate time. b) Aiding recall and understanding: -Organizes explanation. -Uses explicit categorization. -Uses easily understood language. -Uses visual methods of conveying information. -Checks patient’s understanding. c) Achieving a shared understanding: incorporating the patient’s perspective: -Relates explanations to patient’s illness framework. -Provides opportunities and encourages patients to contribute. -Picks up verbal and non-verbal cues. -Elicits patient’s beliefs, reactions and feelings.

44. : d) Planning: shared decision making . Shares thinking- . Involves patient- Encourage patient to contribute his- . thoughts . Negotiate acceptable plan- . Offers choices- Checks with patients if he accepts plans- .and if his concerns have been addressed

45. Closing the sessions a) Forward planning: -Contracts with patients next steps. -Explain possible unexpected outcomes. b) Ensuring appropriate point of closure: -Summarizes session briefly and clarifies plan of care. -Final check that patient is satisfied, comfortable with plan.

46. Breaking Bad News ■ A difficult but fundamentally important task for all health care professionals ■ Physicians feel uncertain & uncomfortable while breaking bad news, leading to being distant & disengaged from their patients.

47. Delivering Bad News Rabow & Mcphee (West J. Med 1999) synthesized a simple model of ABCDE: ■ ■ ■ ■ ■ Advance Preparation Build a therapeutic environment/relationship Communicate well Deal with patient & family reactions Encourage and validate emotions

48. Advance Preparation ■ Familiarize yourself with the relevant clinical information (investigations, hospital report) ■ Arrange for adequate time in private, comfortable environment ■ Instruct staff not to interrupt ■ Be prepared to provide at least basic information about prognosis and treatment options (so do read it

49. Advance Preparation ■ Mentally rehearse how you will deliver the news. You may wish to practice out loud ■ Script specific words & phrases to use or to avoid ■ Be prepared emotionally

50. Build a therapeutic environment/relationship ■ Introduce yourself to everyone present ■ Summarise where things have got to date, check with patient/relative Discover what has happened since last seen Judge how the patient is feeling/thinking Determine the patient’s preferences for what and how much he/she wants to know

51. Build a therapeutic environment/relationship ■ ■ ■ ■ (contd) Warning shot “I’m afraid it looks more serious than we had hoped” Use touch where appropriate Pay attention to verbal & non verbal cues Avoid inappropriate humour Assure patient that you will be available

52. Communicate well ■ ■ ■ ■ ■ ■ Speak frankly but compassionately Avoid medical jargon Allow silence & tears; proceed at patient’s pace Have the patient describe his/her understanding of the information given Encourage questions Write things down & provide written information ■ Conclude each visit with a summary & follow up plan

53. Deal with patient and family reactions ■ ■ ■ ■ ■ Assess & respond to emotional reactions Be aware of cognitive coping (denial, blame, guilt, disbelief, acceptance, intellectualization) Allow for “shut down”, when patient turns off & stops listening Be empathetic; it is appropriate to say “I’m sorry or I don’t know. Crying may be appropriate Don’t argue or criticize colleagues

54. Encourage and validate emotions ■ Offer realistic hope ■ Give adequate information to facilitate decision making ■ Explore what the news means to the patient & inquire about spiritual needs ■ Inquire about the support systems in place

55. Encourage and validate emotions ■ Attend to your own needs during and following the delivery of bad news (counter-transference can be harmful) ■ ■ Use multidisciplinary services to enhance patient care ( hospice) Formal or informal debriefing session with concerned team members may be appropriate

56. ?What to do ■ ■ ■ ■ ■ ■ ■ ■ ■ Introduce yourself Look to comfort and privacy Determine what the patient already knows Warn the patient that bad news is coming Break the Bad News Identify the patient’s main concern Summarize and check understanding Offer realistic hope Arrange follow up and make sure that some one

57. ?How to do it ■ ■ ■ ■ ■ ■ ■ ■ ■ Be sensitive Be empathic and consider appropriate touching Maintain eye contact Give information in small chunks Repeat and clarify Regularly check understanding Do not be afraid of silence or tears Explore patient’s emotions and give him time to respond Be honest if you are unsure about something

58. ?What not to do Hurry ■ ■ ■ ■ ■ ■ ■ Give all the information in one go Give too much information Use medical jargon or unclear language/words Lie or be economical with the truth Be blunt. Words can be like loaded pistols/guns Guess the prognosis (She has got 6 months, may be 7)

59. Quotation ■ The greatest revolution of our generation is the discovery that human beings, by changing the inner attitudes of their minds , can change the outer aspects of their lives. William James American Psychologist & Philosopher

60. Angry Patient WHAT TO DO? ■ ■ ■ ■ ■ ■ Introduce yourself Acknowledge the person’s anger Try to find out the reason for his anger, e.g. frustration, fear or guilt Validate his feelings Let him ventilate his anger or any feelings that led to his anger Offer to do something or for him to do something

61. Angry Patient HOW TO DO IT? ■ ■ ■ ■ ■ ■ Sit at the same level as the patient, not too close and not too far, with eye contact Speak calmly without raising your voice Avoid dismissive or threatening body language Encourage the person to speak with open ended questions Empathize as much as you can with verbal and non verbal cues Be aware of your own safety

62. Angry patient WHAT NOT TO DO? ■ ■ ■ ■ ■ ■ ■ Glare at the person Confront him or interrupt him Patronize him or touch him Put the blame on others/seek to exonerate yourself Make unreasonable promises Block his exit If the person is a patient’s relative, be mindful about confidentiality

63. Quizzes ■ ■ ■ Explain two other models of breaking bad news? With illustration by examples? How to use communication skills in taking history from anxious patient? Differentiate between counselling & consultation?

64. SCENARIO 1 Sameh, a 55-year-old chain smoker taxi driver with persistent cough for 3 months, attends your clinic to find out the biopsy report of a lesion shown on a chest x-ray and CT scan. He is rather anxious, that he has a serious condition. His biopsy report confirms that he has a Bronchogenic Carcinoma of right lung. You are required to proceed with this consultation.

65. Scenario2 ■ ■ A 44-year-old woman attends your clinic to find out the result of an MRI of her spine. She has had constant pain all over her spine for the last 2 months. She also has a history of Breast cancer, which was treated 5 years ago. Her report shows that she has secondaries all over her spine Proceed with this consultation. (Examination not required)

66. Summary

67. A FORMULA FOR SUCCESS FLUENCY SKILLS + COUNSELING + TEACHING RESPONSIBILITY = EFFECTIVE THERAPY

communicationskills.pptx

communicationskills.pptx

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