exam 2 Flashcards
medical/traditional model
- disease/impairment focused
- top-down communication
- authoritarian
- clinician diagnoses
- clinician does something to clients
- clinician knows what’s best, sets treatment goals
- may be necessary for acute conditions or in an emergency situation
- curative
biopsychosoical model
- person focused
- horizontal communication
- interactive, facilitative
- identifies problems
- clinician does something with clients
- patient’s perceptions/needs determine goals, strategies
- for chronic conditions adherence and self-management (empowering, self-actualizing)
a patient journey circle
- pre-contemplation
- contemplation
- preparation
- action
- maintenance
- relapse
- permanent exit
- i don’t have a problem
- i might need hearing aids
- i think i need help with my hearing
- i am getting hearing aids
- i am using my hearing aids
- i don’t like using my hearing aids
- my hearing devices are here to stay
benefits of counseling
- enhanced understanding of hearing loss and its effects on communication
- better self-disclosure and self-acceptance
- greater knowledge about how to manage communication difficulties
- reduced stress and discouragement
- increased satisfaction with aural rehabilitation services
- increased motivation to minimize listening problems
- stronger adherence/compliance with the aural rehab plan, including use of amplification
undo brevit generates real struggle, minimizing adherence
what are thw two types of counseling we provide?
informational
personal adjustment
goal and desired outcome of informational counseling
goal: patient learns about hearing loss, listening device technology, & services
desired outcome: patient has an understanding of hearing loss and knows more about technology and available services
goal and desired outcome of personal adjustment counseling
goal: patient works through negative feelings about hearing loss and self-worth and learns to accept the permanency of the hearing loss
desired outcome: patient begins to regain positive self-image and becomes willing to engage in the AR intervention plan
behavioral approach to counseling
- skinnerian learning theory
- maladaptive behavior is learned (so we can unlearn it)
- desensitization (get better experiences witht he trigger so you associate good emotions with it)
- cognitive and emotional changes will follow behavioral changes
what are the factors that affect listening to speech with a hearing loss
- impaired frequency selectivity
- impaired temporal resolution
- increased perceptual effort
amplified hearing may help sound detection but not significantly impact understanding
- it makes it harder to differentiate between speech sounds and words when people are talking quickly
increased perceptual effort
- decreased working and long-term memory
(because they are working so hard to understand the speech itself)
neural plasticity
physiological changes in the central nervous system that occur because of sensory experiences
-the brain’s ability to change as a result of experience, behavior, environment, or changes reuslting from sensory deprivation or stimulation
changes in speech perception over time
the 6 steps of the listening process
- being mindful
- hearing
- selecting and organizing information
- interpreting communication
- effective responding
- remembering
beaming halos sorta illicit errant remembering
- active decision to be present and attentive in the moment (trying to understand their perspective w/o judgement)
- harder for our patients than us; make sure we talk clear and that they are understanding
- what are you listening for? and organizing the info (pleasure, info, meaning, tone etc, direction, order)
- person centered, dual perspective, imagine their pov
- communicate attention through eye contact etc; respond appropriatelly thoughout; invite them to elaborate
- use remembered info to develop action plans; monitor progress; and show the patinet that we really care about them
6 forms of non-listening
- pseudolistening
- monopolizing
- selective listening
- defensive listening
- ambushing
- literal listening
people make silver dollars a lot
pseudolistening
pretending to listen
monopolizing
focusing communication on ourselves instead of lsitening to the person who is talking
selective listening
focusing only on particular parts of communication
defensive listening
perceiving personal attacks, criticism, or hostility in communication that is not critical or mean-spirited
ambushing
listening carefully for the purpose of attacking a speaker
literal listening
listening only for content and ignoring the relationship level of meaning
visemes
group of speech sounds that look alike on the mouth
/p, b, m/ ~ /f, v/ ~ /u, ð/ ~ /ʃ, ʒ/ ~ /w, ɹ/ ~ /n, d, t, s, z/ ~ /k, g/
homophenes
words that look the same on the mouth
- between 47–56% of words in the english language are homophenous
grices maxims of conversation
- quantity (information)
- quality (truth)
- relation (relevance)
- manner (clarity)
passive conversation style
bluffs, speaks softly, avoids interacrtions, and whithdraws from conversation
aggressive conversation style
acts demanding, hostile, and intemidating; shouting (soapbox) speech, excessive body gestures
passive-aggressive conversation style
expresses agression in passive ways, sarcasm, passive to your face but aggressive once gon
assertive conversation style
takes responsibility for difficulties, respects rights of communication partners, body language conveys openness, acknowledge partner’s efforts
-be respectful and clear about what you need
THIS IS WHAT WE WANT (OBV)
what are facilitative strategies
preventative strategies that modify apsects of speech reading to promote more successful communication interactions
- modifies: talker, message, environment, patient/listener
the facilitative strategies are:
- intructional
- message-tailoring
- constructive
- adaptive or anticipatory
instructional strategy
facilitative strategy
affects the talker
- could you not cover your mouth/ speak slower, etc
message-tailoring strategy
facilitative strategy
affects the message
- choose between two options instead of open ended quesitons
c
constructive strategy
facilitative strategy
affects the environment
- good lighting, closer distance, facing the person
adaptive strategy
facilitative strategy
affects the listener
- counteracts maladaptive strategies
- relaxation techniques (mindfulness, deep breaths, etc)
- reduces feelings of anxiousness
anticipatory strategy
facilitative strategy
affects the listener
- anticipate vocab; practice speech reading key words; pre-teach; know topic; learn names ahead of time
what are the goals of communication strategies training?
to improve conversational fluency and increase self-efficacy
self-efficacy
a person’s belief that they can succeed in performing a task
- belief in ones’ ability to do something
CONFIDENCE
self-efficacy in AR influences the patient’s…
- belief about their ability to manage difficult communication situations
- belief that they can plan and execute a course of action that will improve their interactions
- willingness to engage in activities and conversation
- effort and personal investment into completing AR program
agenda for the first session of a communication strategies training program
(in a group)
- introduce group
- review ground rules
- identify primary concerncs
- discuss communication strategies
- introduce curriculum
- review expectations
in revealed identities deep ideas reside
two short term training approaches
- materials approach
- short tutorial (1 hr) [like watch]
what is WATCH
for the listener, a short term communication strategies training
- Watch the talker’s mouth
- Ask specific questions
- Talk about your hearing loss
- Change the situation
- acquire Health care knowledge
if you do this, you often also do SPEECH for the talker
SPEECH: for the communication partner
- Spotlight your face & keep it visible
- Pause slightly between content portions fo sentences
- Empathize & be patient
- Ease their listening; be helpful
- control the circumstances & the listening conditions
- have a plan, anticipate difficult listening situations
4 habits of patient centered care
- invest in the beginning
- elicit the patient perspective
- demonstrate empathy
- invest in the end
IEDI
1.) invest in the beginning
habit of patient centered care
- create rapport quickly
- elicit patient concern(s)
- plan the visit with the patient
2.) elicit patient perspective
habit of patient centered care
- ask for patient perspective
- explore impact on patient’s life
3.) demonstrate empathy
habit of patient centered care
- be open to patient emotions
- discerns empathetic opportunities
- express empathy
4.) invest in end
habit of patient centered care
- deliver diagnostic info
- provide education and joint decision making
- complete the visit
2 maxims of the listener
- recognize genuinely (when our communication partner indicates comprehension, they genuinely perceive our message
- receive readily (our communication partners should not have to expend undue effort to express their message– ie pay attention to who is talking)
what are the 5 types of empthetic responses
(that we learned about)
- naming: i can see you are upset
- encourage: i’m glad you shared that with me. tell me how you are feeling about …?
- legitimation: that must be hard. i’m sorry this is happening to you
- support: what can i do help?
- respect: sounds like you are managing very well
what to do during the precontemplation stage
- review patient journey with patient and explore impact of hl on communication partners
- give info to review at home and suggest they book a new appointment when ready
what to do during contemplation stage
- listen to patient
- brief advice regarding possible options for improving hearing/communication
- acknowledge and support growing awareness of situation
- use the line to explore client’s experiences with hearing and communication
what to do during preparation stage
- advice on how to improve communication with others
- listen and answer question
- focus on benefits fo better hearing; don’t suggest that there is only one correct way forward
- use box tool if they are still expressing ambivalence
what to do during the action stage
- create a joint strategy for moving forward in line w/ their needs
- encourage/support patient by focusing on personal benefit of improved hearing and communication
what to do during the maintenance stage
- ask how they are managing their hl and answer questions
- provide support and info on communication strategies
- if patient is ambivalent use box (validate how HA are improving life)
what to do during the relapse stage
- focus on advantages of bette rhearing and communication (review reasons for takinga ction with line or box)
- emphasize manageable steps that previously enabled the client to implement new strategies
- stress past, positive experience, even if they were short
- try to agree with client on a new plan
what are the types of personal adjustment counseling
cognitive approach
behavioral approach
affective approach
what to do during the permanent exit stage
- provide option of returning for support
cognitive approach
to personal adjustment counseling
modifies thought process
A-B-C framework
- activating event
- belief
- consequence
we try to change the belief to a new belief by disputing the belief (what would happen if you didn’t believe that)
techniques—> questioning; interpreting; goal setting; creation of contracts; hw assignments; uses logic to direct and redirect -> thoughts, belief systems, values, ideas, opinions
affective approach
to personal adjustment counseling
focus on feelings and fostering emotional adjustment
- congruence with self (you don’t have to just have a professional facade)
- unconditional positive regard (believe they can make changes; don’t judge them)
- empathetic understanding (reflection)
what % of hearing aid users are sufficiently satisfied with the benefits of their HA
40–60%
- because HAs don’t fix the hearing loss all the way due to the fact that part of the problem is happening from the inner ear to the brain
goals of auditory training are to develop patient’s ability to…
- recognize speech using the auditory signal
- interpret auditory experiences
- exercise brain skills necessary for listening
auditory training is helpful to listeners because:
- it recalibrates the person’s brain for listening
- it’s evidence based (benefits HA and CI users)
hierarchy of listening skills
- awareness: hearing the sound
- discrimination: telling if sounds are different (telling them apart)
- identification: identify what the sound is that you are hearing
- comprehension: understand the meaing of the sound
who are the candidates for auditory training
- adults with recent hearing change (sudden HL, chemotherapy)
- CI users (all of them)
- new hearing aid users
- almost ALL children with hearing loss
- hearing aid users that try new tech (switching from analog to digital)
- patients with APD
- those with HL not ready for HAs
3 theoretical approaches for auditory training
- TAP (transfer appropriate processing theory): training task overlaps with the desired outcome (real life skill)
- meaning-based orientation: connecting the sounds and words to meaning
- affective filter hypothesis: fear, anxiety, hopelessness, low self esteen, stress (ie a big emotional response)-> can block the ability to hear
so overwhelmed with something that you put a wall up
top-down processing
in auditory training
- using context to make predicitions
- adults are usually much better at this
- synthetic: whole, overall meaning,general comprehension
bottom up processing
in auditory training
- the phonological code
- synthetic: whole, overal meaning, general comprehension
what will effective auditory training programs include?
- must be cost effective
- sufficiently engaging to sustain participation (not to easy or difficult)
- practical and easily accessible
- provide immediate feedback regarding responses
- incorporates elements of both bottom up and top down processing
- include active collaboration of a knowledgeable professional
external obstacles/barriers to mindful listening
communication situations
- message overload (ask how much they want to know)
- message complexity (don’t use jargon)
- noise (harder to hear with background noise)
internal obstacles/barriers to mindful listening
- preoccupation (hard to listen while thinking about something else)
- prejudgment (we might have underlying biases)
- reacting to emotionally loaded language (must get comfy with this)
- lack of effort (it takes a lot)
- failure to adapt listening styles (cultures or reasing we are listening)
audiovisual integration (mcgurk effect)
audio and visual signals combine to form a unified precept
- brain takes what it is seeing and what it is hearing and creates a unified precept
- don’t know exactly how or where it happens
mcgurk effect: it is the same sound but if you look at different mouth placements it sounds different
two categories of repair strategies
- Expressive
- less common
- used when the sender of the message (with hearing loss) creates a communication breakdown with an unintelligible utterance
- write it down; use gestures/hand signals; spell out topic words
- Receptive
- used when the recipient of the message doesn’t recognize the sender’s message (what the rest of the examples are)
cross-modal enhancement
when we add one sense to another sense we will be more successful (we do better with multiple modalities)
- occurs when the response to a stimulus presented through one modality (hearing) is augmented or modulated by another stimulus presented thorugh a different modality (sight)
implicit conversational rules
- tacitly agree to share one another’s interests
- ensure that no single person does all the talking
- participate in choosing and developing the topic
- take turns in an organized fashion
- try to be relevant to the topic of conversation
- provide just enough info to convey a message
specific repair strategies (types)
- repeat entire message
- repeat part of the message
- feedback (i didn’t get that)
- confirm the message
- choose between two candidates
- simplify the message
- indicate topic of conversation
- answer a question
- elaborate the message (least effective)
- key word
- spell
nonspecific repair strategies
most commonly used and least effective, it will usually result in the message being repeated verbatim (& you are less likely to understand a message if it is simply repeated verbatim)
- huh, what, pardon
words and phrases to use when being assertive
- please, thank you, it would help me if…, i would appreciate it if…
- ex: “let’s get a seat away from the stereo speaker, then you won’t have to repeat every you say”———”i’m gonna turn down the car radio so that i can hear you better and so you won’t have to repeat so much”
high vs low conversational fluency
- high conversational fluency:
- minimal communication breakdowns
- ideas exchanged easily between speakers
- no dominance amongst one speaker
- minimal silence
- low conversational fluency:
- numerous communication breakdowns
- minimal exchange of ideas between speakers
- one speaker dominates
- awkward silence
how to measure conversational breakdown
- time spent repairing breakdowns
- exchange of information and ideas
- sharing of speaking time
- time spent in silence
3 measures of conversational fluency
- interviews (specific to patient, what situation they find difficult)-> remarks can’t be quantified
- questionnaires (quick & easy, open or close ended, qualit/quantitative)
- living well tool (specific to patient, incorporates comm strategies, current tech)
why is conversational fluency hard to measure
- conversational fluency and success in managing communication difficulties depend on the setting, situation, communication partner, and topic
- communication difficulties do not always arise during a conversation (if they are speaking to an aud who knows how to talk to a hearing impaired person, in a quiet environment, with their families)
mlt
mean length of turn: average words spoken during a set number of conversational turns
how does it influence the patient
- belief about their ability to manage difficult communication situation
- belief that they can plan and execute a course of action that will improve their interactions
- effort and personal investment into completing AR program
- willingness to engage in activities and conversation
4 ways to systematically increase self-efficacy
- mastery experience
- vicarious experience
- verbal persuasion
- emotional arousal
mastery experience
increasing self-efficacy systematically
- direct experience; most powerful
- successful practice in authentic situation (working on repair strategies with them)
vicarious experience
increasing self-efficacy systematically
- direct observation of others
- supports perspective that if others can do this, i can too
verbal persuasion
increasing self-efficacy systematically
- shared confidence and positive belief from others; counseling approach
- logical explanation that communication can be improved
emotional arousal
increasing self-efficacy systematically
decreased perceived stress associated with behavior
- teach mindfulness, relaxation, and breathing techniques
formal instruction
communication strategy training
(with verbal persuasioin)
- direct teaching
- introduced to optimal communication strategies, listening and speaking behaviors
- engaged participation is better tan a lecture style lesson
- analyze/evaluate potential benefits, drawbacks, feasibility, acceptablity through group discussion
guided learning
communication strategies training
(vicarious experiences)
- modeling: a lot with children but also good in a class→ clinician will point out what was appropriate or not and the clients will see 2 things
- info about behavior or struggles
- the outcome of what using the right strategy does
- role playing: what was wrong and could be improved, what went well with the good situation; vicarious experience
- attention: show/point out what members of the class are doing that is working well (so people recognize that certain things are working)
- video taped analysis: watch vid and pick out what could’ve happened to be better, or what was good
real world practice
communication strategies training
(with mastery experience)
- practice a new skill or behavior in an everyday environment (do it in the world—pick one thing)
- can report back to group how successful they were (if they weren’t the group can come up with new ideas)
benefits of communication strategies training
- better hearing aid (& ci) use and fewer returns
- positive change in use of communication strategies
- positive change in perceived hearing-related disability
- increased benefit if both the client and their frequent communication partner received training
-communication strategies training can empower patients and their frequent communication partners leading to increased self efficacy
