communication skills Flashcards
What is dental anxiety?
General state of apprehension, prepared for something negative to happen
What is dental phobia?
Severe anxiety which results in avoidance or endurance of a situation w significant discomfort
What are dental anxiety stats?
36%- moderate anxiety
12%- extreme anxiety
45%- fear of dentist is barrier to care
30%- tooth drill= v anxious
28%- LA= v anxious
What is the dental anxiety scale?
Extreme- freq cancels, shows up late, resist tx, no referrals (30-50Hz)
Moderate- not proactive, needs more time, talks through tx, resists, low referrals (20-30Hz)
Low- easier, proactive, open to plan, tongue battle, gagging, tense jaw, fair referral (13-20Hz)
Cognitively aware- relaxed, quiet, proactive, trusting, excellent referral (8-12Hz)
How does anxiety affect society/NHS?
1. Cost of sedation and GA
2. missed appts
How does anxiety affect the dental team?
1. Higher levels of stress
2. Dentist absorbs pts anxiety
3. Dissatisfied about Q of tx
4. Missed appts
What are causes of dental anxiety?
1. LEARNING (classical conditioning/observational/vicarious)
2. UNCERTAINTY (fear of unknown/lack of control)
3. PERSONALITY (neuroticism, negative attributes of dentist)
What is the social learning theory (Bandura 1986)?
Behaviour learned from environmental through observational learning
Eg. Witness parents, remember, reproduce
What are dental pain stats?
77%- some pain
11.6%- LA fails
What are the 3 As of anxiety?
ASK how anxious
ACKNOWLEDGE what you heard
ADDRESS the fears by offering solutions
What are main skills from the Calgary Cambridge framework?
1. Establish supportive environment and initial rapport
2. Demonstrate respect and interest
3. Listen attentively and use silence effectively
4. Actively encourage (supportive words, non verbal)
5. Open exploratory questions
6. Actively determine pts perspective
7. Adjust language as appropriate
8. Explore tx options and negotiate mutually acceptable plan
What is CBT?
Focuses on present not past
Helps identify problems
Positive management strategies
Thoughts, feelings, physical sensations and actions interconnected
Break cycle
What is the evidence base for CBT?
2018 systematic review
More effective than other techniques in reducing anxiety
Low quality evidence
What are behavioural management techniques?
1. REDUCE UNCERTAINTY (provide info)
2. ENHANCE CONTROL (stop signals)
3. DISTRACT (music, game, eye mask)
Can you use IS and GA as a technique?
Doesn’t reduce anxiety
Higher cost to NHS
What are key features of the children’s CBT guide?
1. CHALLENGE UNHELPFUL THOUGHTS
2. ENHANCE CONTROL
3. REFLECT AND PLAN REWARD
What is bad news?
Any news that drastically and negatively alters the patients view of their future
Why is it difficult to give bad news?
1. Not knowing how to
2. Fear of upsetting pts life
3. Not knowing or
4. Fear of implications for pt
5. Fear of pts reaction
6. Uncertainty of what next (answering Qs)
7. Feeling responsible and fearing blame
How should you give bad news?
1. PREPARE (info, setting, time) is pt expecting? Should anyone be there? What do they know?
2. DISCUSS NEWS (give info, check understanding, identify main concerns, elicit pts resources and decide on way forward)
3. REVIEW SITUATION
How should you deliver bad news according to Calgary?
1. Find out what they know
2. Find out what they want to know (active listening, understand perspective)
3. Give information (minimum jargon, introduce incrementally, pay close attention to response)
What is empathy?
Experience of understanding another persons condition from their perspective, place yourself in their shoes
What is shared decision making?
1. Share own thinking as appropriate
2. Involve pt
3. Explore management options
4. Ascertain lvl of involvement pt wishes
5. Negotiate mutually acceptable plan
6. Check w pt
What are stats for uncooperative behaviour?
20-25% children disruptive
Correlated w age and type of procedure
What are different signs of distress?
VERBAL- crying, moaning, complaining, screaming
BEHAVIOURAL- flinching, blocking, thrashing, turning away
What is behavioural management?
Means by which the dental team effectively and efficiently perform dental tx and thereby instils a positive dental attitude
What are babies able to do at 6 months?
Lift head and chest
Sit when held
Reach and grab
Prefer moving objects
Focus eyes
Distress by sudden noise
Laugh and vocalise
Cry loudly
Smile to speech
Wary of strangers
Pleasure to loving attention
How should you interact w a 6 month old?
Respond to baby’s needs
Allow baby to touch objects
Allow baby to hold/play
Face to face communication
Make sure no negative associations
Introduce slowly objects that make noise
What can babies do at 12 months?
Rise to sit up
Crawl
Point to objects of interest
See we’ll
V good visual memory
Know and respond to own name
Speak 2-6 words
Understand simple instructions
Fluctuating moods
How should you interact a 12 month old baby?
Provide interesting varied environment
Use baby’s name
Talk to baby about everyday
Provide simple instructions
Encourage role play
Plenty of reassurance
Use familiar comforting items
How can you give a good first impression?
Acknowledge child
Meet w in waiting room
Toys, bricks, balls
Introduce by first name
Position on same level
Be encouraging
Ask about favourites
What is a 2 year old able to do?
Run, throw, push, pull
Listen to conversation
Speak over 200 words
Express how feel
Curious
How should you interact w a 2 year old?
Provide simple instructions
Explain using toys, picture books, glove puppets
Play let’s pretend
Encourage child to express feelings
What is a 5 year old able to do?
Good balance/coordination
Brush own teeth
Increased attention
Fluent speech
Enjoy jokes
Can give full name, age etc
Likes and dislikes
Independent
How should you interact with a 5 year old?
Encourage to do simple tasks
Involve them
Explain everything
Ask if any Qs
Engage through humour
Praise and reward
What is the role of the parent?
1. Gain child’s attention, improve compliance
2. Avert escape or avoidant behaviour
3. Enhance effective communication
4. Minimise anxiety and achieve positive dental experience
What are positive approaches to behaviour management?
1. Effective communication skills
2. Tell-show-do
3. Distraction
4. Behaviour shaping and positive reinforcement
5. Hand signs (stop signals)
6. Written information
7. Pain control methods
What is behaviour shaping?
Reinforce- strengthen pattern of behaviour- increase probability of future behaviour
What are positive reinforcers?
1. Verbal praise
2. Facial expression
3. Positive voice modulation
4. Parental approval
5. Rewards and treat
What are pharmacological pain control methods?
1. Topical
2. LA
3. Conscious sedation
4. GA
When might you have language barriers?
Children
Elderly
Disabilities
Non native English
What is cultural competence?
Acknowledgement of the importance of culture in peoples lives
Respect for cultural differences
IDEALLY- treat pts as individuals but maintain constant awareness of potential impact of culture (avoid stereotyping)
What Calgary skills can be applied to pts w language barriers?
Initiation- check pronunciation/how to greet, check wish for family/interpreter to be present
Gathering info- explore beliefs about tx and perspective to healthcare
Building relationship- aware of differences in non verbal, avoid assuming, show sensitivity to differences
Explanation and planning- work w interpreter, check understanding of info, address concerns freq, give real choices based on situation
What makes the perfect dentist?
Confident
Empathetic
Humane
Personal
Frenal
Respectful
Through
How should you deal w a difficult pt?
1. Don’t downplay complaint, listen w/o interrupting
2. Express empathy
3. Express that you will do whatever it takes to solve their problem
4. Don’t go on defensive
5. Take control of situation
6. Ask pt what they want
7. Establish plan and sell it
8. Carry out plan and make sure pt is happy w result
What is the Calgary Framework?
INITIATE SESSION- greet pt, obtain name, introduce self, role and nature of interview, obtain consent, demonstrate respect and interest
GATHER INFO- encourage pt to tell story, open and closed Qs, leave space for pt to think, verbal/nonverbal, clarify pts statements, periodically summarise, don’t use jargon, establish dates/sequence of events
PHYSICAL EXAM
EXPLAIN/PLAN- give info in chunks and check understanding, find out previous knowledge, ask what else would be helpful, avoid giving advice or premature reassurance
CLOSE SESSION
PROVIDING STRUCTURE* - summarise at end of enquiry, progress to next session w sign posting/transitional statements, logical sequence, attend to timing, keep on task
BUILDING RELATIONSHIP* - non verbal, if multitasking don’t interfere w rapport, appropriate confidence, non judgemental, use empathy, provide support, deal sensitively, involve pt
