chapter 9

Question 1

Models of communication

Answer 1

• Culture, experience, health status, mental
  status, age, education and other factors all
  play a part
• Environmental context also has a significant
  impact
• Words and nonverbal behaviors are essential
  variables in communication
• To explain what is wrong, or seek comfort

Question 2

Patient-Centered Care (PCC)

Answer 2

Key Components of PCC:

• Respect and Dignity: Healthcare professionals honor patients’ perspectives and choices, integrating their cultural backgrounds and personal values into care plans.
• Information Sharing: Providers communicate complete and unbiased information, enabling patients to make informed decisions about their care.
• Participation: Patients are encouraged to actively engage in their care, collaborating with healthcare teams in decision-making processes.
• Collaboration: Care involves partnerships among patients, families, and healthcare providers, fostering a supportive environment.

Question 3

PCC and communication

Answer 3

The focus in PCC is on mutual understanding between health professional and patient about the patient’s values and needs plus the sharing of responsibility.

Question 4

Improvisation skills

Answer 4

effective tools in health professional and patient communication by “improving active listening, clear information delivery, and collaborative narrative building.” **“yes and” ** questions

Question 5

Meeting with a Patient in Person

Health professional should introduce or reintroduce
himself or herself as appropriate

Answer 5

Wear name badge

Explain role in understandable language

Question 6

Meeting with a Patient in Person

Use patient’s full name as a sign of respect

Answer 6

Ask preferred name—then remember how to pronounce!

Question 7

Meeting with a Patient in Person

Value of direct contact

Answer 7

• Engaging all possible ways of communicating
  * Richer exchange
• What about future communications? Emails? Holographs?

Question 8

Meeting with a Patient in Person

Setting differences

Answer 8

• Home health—more deferential, asking before doing
• ICU—often foreign, threatening

Question 9

Vocabulary and Jargon

Answer 9

highly technical professional jargon is almost never appropriate in direct conversation with patients because it cuts off communication.

Question 10

Health Literacy

Answer 10

Translate jargon into understandable terms
* Don’t assume patients who are HCPs understand
information-examples

Health professionals have a duty to teach patients effectively and evaluate their understanding and ability to use health information.

Question 11

Language Barriers

Answer 11

• Seek the support and assistance of an trained
  interpreter when there is a potential language barrier

1.Untrained interpreters are more likely to make errors, violate confidentiality, increase the risk of patient dissatisfaction and poor outcomes.20

2.Family interpreters often speak as themselves rather than merely providing accurate information between parties.21

3.Untrained interpreters often lack knowledge of medical terms, which can lead to miscommunication and misdiagnosis.

4.Untrained interpreters may be emotionally harmed because of the stress of performing an essential activity for which they are not prepared

Question 12

Cognitive issues

Answer 12

yes/no or forced choice

Question 13

Talk to patients as equals

Answer 13

While remaining flexible

Question 14

problem that can result from using technical language

Answer 14

person to whom you are speaking will not be convinced you really want to know how they feel.

Doubt arises about health professional’s
interest—need to become “bilingual”!

Question 15

Meanings are confused

Answer 15

Example: complaint

Question 16

Desired results are lost

Answer 16

• When explanation is vague/confusing
• Easy to turn to lab/tests for treatment plan
  * Without trying to understand pt narrative
• Pt is frustrated/anxious/noncompliant

Question 17

Clarity

Answer 17

involves speaking at a moderate pace
using simple, direct terms.
* May become stuck on 1 thing that you said
* Patient may be ”awed” by medical person
* Afraid to ask them to repeat
* Life is in their hands

Question 18

organization

Answer 18

involves the presentation of
ideas and concepts in a logical order.

Question 19

organization

Complicated information

Answer 19

should be broken
into manageable chunks.
* Summarize—or ask patient to do it!

Question 20

When information is shared verbally

Answer 20

there should also be written information for the patient.

Written notes or instructions, diagrams, videotapes, and nonverbal demonstrations are highly desirable adjuncts to the spoken word because they may help the person organize the ideas and information more fully and can be used for future reference.

Question 21

Tone of voice

Answer 21

an change the meaning of
spoken words.

Question 22

Voice volume controls interaction in subtle
ways.

Answer 22

Controls distance between people—whisper/shout

Question 23

Test if patients hear what you say

Answer 23

by asking
them to repeat instructions.

Question 24

Attitudes and emotions have an impact
on communication: (both patient and
HCP)

Answer 24

• Fear—reassure patient
• Grief—comfort, authentic care
• Sense of Humor—use wisely

Question 25

Anger or Frustration

Answer 25

Health professionals may try to manage underlying negative emotions by pulling away from genuine warmth

making itself known to patients largely through nonverbal signs

Question 26

Facial expression

Answer 26

smile! Eye contact

Your own facial expression can stimulate good feelings. For example, a genuine smile indicates that you are approachable, cooperative, and trustworthy

Question 27

Physical appearance

Answer 27

First impressions
* Attire and grooming—what does a white coat
convey?

Question 28

Touch

Answer 28

(battery=unconsented touching—ALWAYS
explain first!)

Positive effects of touching…caring touch

Question 29

Proxemics

Answer 29

study of how space is used in human
interactions—sit down to be on patient’s level

Question 30

Sense of time and physical space

Answer 30

culture difference

Question 31

Communicating Across Distances

Written communication

Answer 31

requires a high degree of accuracy
* All written communication should define and
state the purpose
* Clarity and brevity are hallmarks of good
written communication
* Vocabulary—fitting for recipient

Question 32

Consent forms

Answer 32

• If too lengthy—patient less likely to understand
• Both spoken and written=problems prevented

Question 33

Gestures and Body Language

Answer 33

Understanding subtle and obvious gestures is an important component of learning respectful communication. Patients can also read the health professional’s body language.

When you are stressed, it is a good habit to take a moment to assume a relaxed posture, take a deep breath and shake off tension to ready oneself for effective communication.

Question 34

Phone, text messages, e-mail, patient portals,
and social media

Answer 34

can all have a place in
communication with patients

Question 34

Although there are clear benefits of using social media

Answer 34

Some of the consequences of misuse of social media include breached patient confidentiality, possible exposure to lawsuits by patients or others who are entitled to confidentiality, boundary issues in professional relationships and for students and faculty, and impairment of program integrity

Question 35

Electronic forms of communication:

Answer 35

• Offer speed and convenience
• Require savvy users and access to technology to
  be effective
• Carry special responsibilities for health
  professionals including awareness of boundaries
  and privacy issues
• Written record of exchange

Question 36

Telehealth Encounters

Answer 36

(WHO) views telemedicine as one of the most promising methods of health delivery to areas where the need for high-quality health care vastly outstrips the ability to deliver it.

Question 37

patient portals and secure messaging (SM)

Answer 37

Patient portals are “secure online websites that require username and password and are linked to a patient’s personal health record providing 24-hour access from anywhere with an Internet connection.

SM, where patients can send nonurgent health-related messages to providers, upload photos, ask follow-up questions about a treatment, view test results, and make appointments

Question 38

Effective Listening

Answer 38

(1) to improve listening acuity so you hear the patient accurately and
(2) to ascertain how accurately a patient has heard you.

Question 39

frame of mind

Answer 39

may distort meaning

Question 40

Active listening

Answer 40

requires undivided attention

Question 41

Choosing the Right Words
and Means

Answer 41

• Ascertain the level of literacy and health
  literacy
• Consider factors that affect health literacy
  such as context, the teaching method used,
  etc.
• Provide educational information in simple,
  plain language using “universal precautions”
  in literacy to communicate with all patients.

Question 42

universal literacy precautions

Answer 42

health professionals should strive to communicate with all patients in simple, plain language, using lay language whenever possible to minimize the risk for any patient misunderstanding of the information provided. Additionally, there are communications tools like Ask3 that empower patients to ask three basic questions at the end of every clinical encounter The questions are: What is my main problem? What do I need to do? Why is it important for me to do it?

Question 43

Effective Listening

Answer 43

• Be selective in listening.
• Concentrate on central themes.
• Judge content rather than style.
• Listen with an open mind.
• Summarize what you hear before speaking
  again.
• Clarify before proceeding.