Domain 4: Communication Flashcards
Relationships and Boundaries
Communication is the foundation of successful relationships, both personal and professional. A relationship is a connection between two people or between groups of people. You have many different relationships. You have relationships with your family, friends, and acquaintances, and likely with people in your neighbourhood or religious organization. These types of relationships are social. Social relationships are based on emotions such as love and liking, and may form because you take part in activities together. People in social relationships tend to influence each other and share thoughts and feelings (Government of Alberta, 2013).
Professional relationships are different from social relationships. You have a professional relationship with your clients and with the members of your health-care team. This relationship is established and maintained by you through your interactions with the client. The purpose of this relationship is to take care of the client’s needs. The needs of the client always come first in this type of relationship.
The following are examples of differences between social and professional relationships:
· A social relationship may last a lifetime. A professional relationship is limited.
· The power in a social relationship is shared. In a professional relationship the client may perceive you have the power because he or she is relying on you for care and, in addition, you have access to his or her private information.
· A social relationship is often spontaneous and unstructured. A professional relationship is defined by the length of time that care is needed.
Boundaries
Boundaries help to create limits to a relationship. The purpose of having boundaries is to protect and take care of you. You need to be able to tell other people when they are acting in ways that are not acceptable to you. Boundaries give you a sense of control in a relationship.
The following are examples of setting boundaries in a social relationship:
· You tell your spouse or sibling that you do not want him or her to open your mail.
· You tell the salesperson that you do not want him to touch you.
· You move away when a friend gets too close when speaking to you.
Boundaries in a professional relationship make it safe for the client. These boundaries set the limits in which care is provided. Professional boundaries are intended to clearly define a safe connection between you and your client. Professional boundaries guide your behaviour. Boundaries keep your relationship safe so that you and the client respect one another. You respect the client as a person who needs care. The client respects you as a person providing the care (College and Association of Registered Nurses of Alberta, 2011).
A boundary in a professional relationship is crossed or violated when you behave inappropriately.
The following are examples of violating a professional boundary:
· Physical abuse – e.g., hitting a client, being rough when providing physical care, touching a client who does not like to be touched
· Sexual relations or romantic encounters – e.g., inappropriate touching
· Verbal abuse – e.g., sarcasm, intimidation, teasing, or taunting, swearing, cultural slurs, or inappropriate tone of voice that expresses impatience or exasperation
Sometimes the client may violate the professional boundary. If this occurs, you must tell the client that his or her behaviour is unacceptable. If this behaviour persists, report what has happened to your supervisor or other health-care professional (College and Association of Registered Nurses of Alberta, 2011).
Sharing personal information is another way of violating the boundary in a professional relationship. Although you share information about yourself with your clients, be careful about what you share. Information that you share with your client is for the purpose of developing a professional relationship. It is information that helps the client to get to know you. You will share your name and, as you get to know the client, you may share information such as whether you are married and have children or where you received your training.
You would not share information with your client that you share with a family member or spouse. You would not share that your spouse has asked you for a divorce, that you are upset with a friend because of a rude remark or that you are concerned with your son’s behaviour. (College of Physical Therapists of British Columbia, 2009). You do not burden the client with your problems or ask for advice (Government of Alberta, 2013).
Team Communication
The purpose of communication in your relationship with the health-care team is to share information about your client’s health. The team plans what needs to be done; shares how clients respond to treatment, and supports its members in providing quality client care.
The following are examples of the purpose of communication with team members:
· To inform a team member about work completed
· To educate a team member about a new treatment
· To correct misunderstandings about a client assignment
· To negotiate time off
· To support a team member when a client dies
· To counsel a team member who is upset with a client’s family member
· To give feedback on work well done
· To confront a team member who is not doing her assigned work
· To promote teamwork
· To create and maintain social bonds
· To share information and observations about the client
To communicate effectively on a team, you must be open-minded, an active listener, and able to focus. Keeping your mind open to new information is the most basic requirement for working creatively and effectively with others. As a team member, you should be aware that you are working with people who will have different ideas and different ways of looking at things.
Active listening means that you will not miss vital information about a client. As well, you will understand how your assignment relates to others. If you are talking in a team setting, be mindful of the purpose of the meeting, stay focused, and limit personal stories. Communicate as a team member about your individual assignment progress, problems that arise, and when and where help is needed.
Teamwork is essential in the health-care setting. Each person on the team brings different skills and knowledge. Effective communication with team members ensures quality, safe, and competent client care (Government of Alberta, 2013).
Communication Between Two People
Effective communication is about sending your messages to other people clearly. It is also about receiving information that others are sending to you. Doing this involves effort from both the sender of the message and the receiver. Communication is successful only when both the sender and the receiver understand the same information.
Sender, Receiver, Message, and Feedback
The components of the communication process between two people involve the sender, the receiver, the message, and feedback. The sender is the person who has information to share. The receiver is the person who receives the information. The message is the information told by the sender. Feedback is information that the receiver provides to let the sender know that the message was received and understood.
As the sender of the message, you need to be clear about why you are communicating and what you want to communicate. When speaking to clients, speak clearly and use words that you know they will understand.
The message is the information that you want to communicate. Make sure that your message is organized and presented in a logical manner. If your message is too lengthy, disorganized, or contains errors, it may be misunderstood and misinterpreted.
As a receiver, your role is to actively listen so that you understand what is being said. This means you must focus on what the sender is saying. Observe the non-verbal communication of the sender. Let the other person know that you are listening to what he or she is saying. Use body language and other signs to acknowledge that you are listening. This can be something as simple as a nod of the head or saying “uh-huh.” Focus your attention on the sender and do not interrupt. Ask questions and repeat information back to the sender if you do not understand (Burgess, 2013).
Feedback is either the verbal or non-verbal reactions to the message. Feedback lets the sender know that the message is understood. If the message was not understood, the sender has an opportunity to send the message a second time.
Misunderstanding the Message
A communication misunderstanding occurs when the receiver fails to understand or interpret the message correctly. Misunderstandings can occur in a number of ways.
Although the message contains factual information, it may also include emotions. Emotions are communicated through words or body language. Body language is important when the receiver is interpreting your message. Is your posture open and friendly or closed and cold? Is your facial expression friendly or tense and irritated? These factors influence how your words will be received and understood.
The tone of your voice can influence how your message is interpreted. You could say to a client “You are taking a long time to get dressed this morning.” If your tone of voice is disapproving, the client could think you are criticizing, and might become upset. If your tone of voice is questioning, the client could think you are asking about how he is feeling. He might tell you that his arthritis is bothering him.
Your past experiences with a person or situation can influence how you interpret the message. You may be assigned to care for a client who is often angry. When you enter her room, you expect to be yelled at, so whatever the client says you may interpret as an insult.
Whether or not the person is in a position of authority can influence how you interpret the message. Your supervisor or other health-care professional may say to you “Are you finished with morning care?” You might interpret this as criticism that you are slow, when the supervisor was actually planning to send you for an early coffee break.
Your mood or attitude can also influence how you interpret the message. Your supervisor or other health-care professional may ask you to do a certain task. Depending on your mood, you may be resentful and not want to do the task, or you may be happy to do it.
Stress or different personalities and cultures increase the possibility of misunderstandings. It is very easy to misunderstand the message. Our tendency is to hear what we expect to hear and this makes it easy to misunderstand one another.
Understanding the Message
Active listening is a skill that will help you to avoid misunderstandings. Pay close attention to what the other person is saying. You may need to ask the other person to clarify or repeat anything that is unclear. Or you may want to repeat back the message in your own words.
When speaking, stand in front of the other person. Consider what you want to communicate, why you want to communicate it, and how you can do it in the clearest possible way. Avoid being distracted by other, or by other things going on in the same room.
Treat the other person with respect. No matter what you think of another person, if you treat that person with respect, communication will be much more successful. The more effort you make to understand the person sending the message, the more likely you will be to interpret the message correctly (Government of Alberta, 2013).
Perception
Perception is the process of becoming aware or of understanding objects or events in the external world. Perception is important when communicating, since we all see the world differently. We communicate information according to how we view it.
Physical, environmental, or learned factors influence our perception. Physically, our perceptions are influenced by the information our eyes and ears take in and how our brain processes this information.
Age is another physical factor that influences perception. As people age, they perceive things differently because of life experiences. A life experience such as a death in the family will influence how you perceive death. This experience will affect how you communicate with others who have had a similar loss.
Physical health includes fatigue, stress, and physical ability, all of which affect perception. Remember a time when you were stressed or tired. How would you have responded if asked to do one more task at work? If stressed, are you more likely to view this request differently?
Environmental factors influence perception. Today we have access to television, cellphones, and the Internet. These technologies provide us with up-to-date information on what is happening in the world or our own neighbourhood. These technologies impact how we see the world and how we communicate with others.
Learned factors influence our perception of the world. We learn how to organize and interpret information. People of different cultures or people who live in different countries perceive the world differently because of learned factors. If you live in a country where war and violence are common occurrences, you will view the world differently from a person who lives in Canada. Males and females learn different behaviours and perceive the world differently.
Your self-concept influences your perception of the world. If you perceive yourself as being unattractive and shy, you will view and interact with your world differently than if you perceive yourself as being attractive and confident. What factors influence how you perceive the world? (Government of Alberta, 2013).
Misinterpreting Telephone Messages
You may be required to answer the telephone where you work. Be aware of your facility’s policy regarding what information you can provide over the telephone. Confidentiality is a concern when providing information over the telephone. Your supervisor or other health-care professional is probably the person who should provide information about a client.
Good Telephone Etiquette
The person answering the telephone must be efficient, confident, and capable of inspiring confidence in the caller.
The following are features of good telephone etiquette:
· Answer the telephone promptly and use a pleasant greeting (e.g., “Good morning”).
· Answer the telephone according to your facility’s policy (e.g., “Unit 43; Mary, health care aide speaking”).
· Offer assistance, because the caller needs something. (“How may I help you?”)
· If you must put the caller on hold, ask permission first. (“May I put you on hold for a minute?”)
· Don’t put the caller on hold too long. After a few minutes, ask the caller whether he or she wants to continue to hold or call back. (“Do you want to continue to hold or can I take a message?”) Keep in mind that the universal telephone irritation is a silent line. One minute can seem like a long time to the caller.
· If you need to take a message, be sure to include the date and time of call, name of caller, telephone number where caller can be reached, and your name. Remember to deliver the message to the appropriate person.
It is not appropriate to use the telephone at your place of work for personal calls. Use a pay telephone or your personal cellphone. Tell your family to call your cellphone if it is important that they talk to you. If you do not have a cellphone, instruct the family to call you at work only if there is an emergency (Government of Alberta, 2013).
How to Avoid Misinterpreting Telephone Messages
The speed, clarity, and tone of your voice affect how the caller interprets your message. Speaking too fast creates barriers and confusion. The caller may find it difficult to understand what you are saying. Slow down and think about how you are going to answer any questions. Avoid mumbling, speak clearly and loudly, but do not shout. Your tone should be pleasant, friendly, and interested. If your voice is high-pitched, heavily accented, or grating, lower your tone and speak slowly.
When making telephone calls, be prepared to tell the person who answers the reason for your call. Remember that the person who answers was not expecting your call and may be busy with another task. Speak on the telephone as you wish to be spoken to.
Listening is very important during telephone conversations. Since you are unable to view non-verbal communication such as posture, gestures, and eye contact, interpretation of the caller’s message is more challenging. Your mind should be focused on what the caller is saying. Listen to the tone of the caller’s voice. Does the caller sound frustrated or angry? If you don’t understand what the caller is saying, ask questions. Remember to use the strategies previously discussed about how to communicate effectively, such as clarification and paraphrasing (Government of Alberta, 2013).
The ‘Hearback’ Method
Hearing a message correctly from a team member or a client is critical, especially in emergency situations. The “hearback” method is one way of ensuring that the message was heard correctly. This method requires the receiver to read back the message. An example of the hearback method being used is during a plane’s takeoff and landing. The readback/hearback process is used between controllers and pilots during this time. A controller’s hearback of the pilot’s readback is intended to ensure that the pilot got the message right. It also offers help to ensure that the controller gave the message right.
Another method of making sure the receiver got the message correctly is by organizing the message to ensure that the important information is provided. In health care, the Situation-Background-Assessment-Recommendation (SBAR) format for communication uses this approach.
The SBAR technique provides a framework for communication between members of the health-care team about a client’s condition.
S
–
Situation – What’s going on (5-10 seconds)
B
–
Background – Brief, pertinent history; relevant context
A
–
Assessment – What I think; conclusion
R
–
Recommendation – What I need and in what time frame
Here is an example of how you would use this approach.
For the past four days, you have been assigned to apply ointment to Mrs. Knott’s rash. You notice when you apply the ointment that the rash has spread since yesterday, and there are scratch marks and spots of blood. You report these findings to your supervisor or other health-care professional using the SBAR technique.
S
–
Situation – I am concerned about Mrs. Knott’s rash.
B
–
Background – Mrs. Knott has a rash on her abdomen. I have been applying ointment for the past four days. The rash has spread since yesterday and there are scratch marks and spots of blood.
A
–
Assessment – Mrs. Knott says the rash is itchy and she has been scratching her abdomen, causing the rash to bleed.
R
–
Recommendation – I need you to look at the rash sometime this morning.
The SBAR format helps to ensure that information about the client is complete and reduces the possibility of missed data. It provides an easy and focused framework for what information will be communicated and how it will be communicated. This format standardizes communication between health-care providers (Government of Alberta, 2013).
