Module 2.1 AETCOM CLASS MARCH22 (2)-1.pptx

AETCOM

1. Module 2.1 : The foundations of communications-2

2. Skill : Skill is the ability to perform a task leading to a specific predefined outcome. Skill may be: a ) Intellectual or cognitive which includes clinical reasoning and decision making skills, e.g. ability to interpret haematological tests of a patient with anemia b ) Procedural or psychomotor skills that require manual dexterity and include laboratory and clinical skills, e.g. ability to obtain a blood sample by venepuncture

3. c ) Communication skills, is defined as the ability to communicate with others in a given situation. e.g. ability to motivate volunteers for blood donation d ) Team skills including leadership skills . Team Skill is defined as the ability to work together in a team. e.g. Ability to work towards implementing a project/operating on a patient with the team.

4. The effective communication is one of the important skill in healthcare. In couple of decades ago, patients,s expectations from the treating doctor were just to diagnose and treat. The doctor-patient relationship enjoyed the cushion of trust and care. As a result, no body cared about communication.

5. Over time, Patients ’ expectations have changed Patients wish to know Their illness Discuss treatment option with doctor and actively select the treatment modality So communication with patient and the family has become the center stage of all patient care interactions.

6. Indian Medical Graduate (IMG) must be able to function in the following roles appropriately and effectively. Clinician Leader and member of the health care team and system Communicator with patients, families, colleagues and community Lifelong learner Professional

7. Communication is a Latin word derived from the word Commune, which means ‘to share’. Communication is an exchange of information between individuals through a standard system of symbols, signs or behavior. It is exchange of information through speaking, writing or using some other medium including body language.

8. There are six major elements of communication which include the following Sender Channel Message Feedback Channel Receiver Encoding Decoding Noise

9. Sender : some one who wishes to communicate a message Encoding : to put the idea into some form that can communicate the message Message : content of the communication

10. Channel : the method or means of communication Receiver : for whom the message was intended Decoding : to translates the original message from its encoded form into a form that the receiver understands.

11. Feedback : the signals from the receiver to the sender about how the message was received. Noise : anything that interferes with effective communication is noise.

12. Types of communication We communicate both verbally and nonverbally. Nonverbal communication makes a significant chunk of communication.

13. Verbal communication: Verbal communication is the use of sounds and words to express oneself. It involves both spoken and written words To communicate effectively, one must use simple and easy to understand language.

14. Vocalics /Paralanguage is the non-lexical component of communication including voice modulation, tone of voice, pitch, speed of speaking etc. Paralanguage shares more information than verbal communication and usually believed over verbal communication.

15. Paralanguage play a significant role in changing the impact of communication. A soft polite and firm tone is useful to keep the communication professional and to the point. One can use pauses and silence during the interaction to encourage patients to ask questions and speak up.

16. Nonverbal communication: Nonverbal communication includes body language, such as facial expression, eye contact, gesture, posture and hand movement. 55% of communication happens through body language and is trusted more than words.

17. One may consciously or unconsciously integrate nonverbals with verbal communication to enhance the impact of verbal communication. Nonverbal communication is present in most interpersonal conversations. Emotions are usually better expressed and understood through nonverbal communication.

18. Clinical communication Clinical communication is between two individuals purely for professional and therapeutic purposes. The communication has to be meticulously planned and practised . The art of communication between doctor and a patient is ever changing and ever-evolving

19. Literature shows that these skills need to be acquired through training and practice. Inadequate doctor patient communication leads to Communication gaps Mistrust Frustation Patient dissatisfaction Aggressive reactions

20. Studies indicate a need to shift from viewing patients as passive recipient of care and treating them as active partner. Emergence of ‘ patient – centered care ’ In patient centered care, the patient is considered an equal partner and involved in the care plan.

21. Essential skills in clinical communication Form the basis of all doctor-patient communication Useful to enhance workplace efficiency Develop therapeutic alliance with the patient and fosters patient satisfaction. Improves coordination, reduces medical errors and improves health outcomes.

22. Essential skills in clinical communication BUILDING QUICK RAPPORT : helps earn patient’s trust and facilitate cooperation. It makes the patients feel accepted, welcomed and valued as equal human beings. Some good ways to build initial rapport with the patient are: 1. Making eye contact as soon as a patient enters. Looking at a person for 2-3 seconds and then shifting the focus for a second promotes conversation and continuation of communication

23. 2. Greeting the patient /responding to the patient’s greetings 3. Attending to patient’s comfort by showing the place to sit 4. Obtaining /confirming the patient’s name and attendant 5. Introducing self (if meeting for the first time) 6. Starting with small talk before the big talk (for example, Who is this with you? Or Where are you from?)

24. 7. Demonstrate attention and interest in attending to the patient by limiting interruptions and distractions 8. Accepting the legitimacy of a patient’s views and feelings without being judgemental 9. Expressing concern, understanding and willingness to help the patient 10. Respecting patient’s privacy and confidentiality

25. Greeting the patient Greeting the patient or responding to the patients’ greeting is a useful initial gesture before starting the interaction. Greeting the patient helps create comfort and familiarity and expresses the willingness to attend . Similarly, thanking the patient for allowing us to learn and serve are some of the realization that remind us of the importance of patients in practising our profession.

26. 2. EMPATHY : Empathy is the ability to see things from the other person’s perspective. Listening attentively to patients and responding with concern and compassion is an expression of empathy.

27. 3. SKILLS TO BUILD TRUST : Earning patient’s trust is fundamental to doctor-patient functioning. It saves the time you need to explain the treatment and get consent for the same. Treating patients with respect as equal human beings, listening to them, accepting the legitimacy of the patient’s views and feelings are ways to build trust.

28. 4. QUESTIONING SKILLS: Asking questions is an art and a skill as the answers and information a doctor can get from the patients are dependent on the questions they ask. It is good to start with an open ended question It allow respondents to include more information, including feelings, attitudes and understanding and report all problems. The doctor can facilitate and encourage patients by using appropriate verbal and nonverbal cues.

29. 5. ACTIVE LISTENING SKILLS: Active listening is a dynamic process that includes processing and interpreting spoken words to understand the complete message . Active listening requires one to be fully present – physically, mentally and emotionally.

30. Active listening includes picking the verbal and nonverbal cues to understand and interpret the complete message. Active listening is one of the most effective ways to build rapport and establish trust with the patients. It is challenging to stay focused without getting distracted by internal and external triggers.

31. Tips of active listening Face the person Lean forward Make eye contact Nod and smile, whenever appropriate Ask open-ended question Facilitate conversation

32. Avoid interruptions Avoid verbal or nonverbal communication of judging or disapproval Avoid distractions like a phone call or cross talk Avoid nonverbal distractions like staring, closing eyes, posture indicating hurry or disinterest. Do not pretend to be listening, as patient can make out.

33. Skills to facilitate conversation Encouraging - to convey interest and to keep the person talking Restating/paraphrasing -expressing others’ basic ideas using your own words.

34. Reflecting – acknowledgment of an observed feeling. Reflecting helps to communicate empathy and makes patients feel that their feelings and thoughts are well understood. Legitimizing – acceptance of the patients’ emotional experience and respect for it explicitly.

35. 6. ASSERTION SKILLS: There are multiple ways we communicate with people around us. The outcome of any interaction majorily depends on the style we pick . Assertive communication is an useful and healthy communication style where one expresses positive and negative thoughts, feelings and wishes in an open, honest and direct manner without being aggressive.

36. 7. COLLABORATIVE SKILL: Collaboration in healthcare is to work together, share responsibility for problem-solving and make decisions to formulate and carry out plans for better patient care. 8. NEGOTIATION SKILLS: Negotiation is a communication strategy used to discuss an issue and reach a common consensus.

37. 9. DOCUMENTATION SKILLS: Documentation of essential clinical information about each patient’s diagnosis, treatment and outcome for communication between doctors, other team members and referrals by different stakeholders is one of the significant tasks in clinical practice.

38. GATHERING INFORMATION The attending doctor needs to investigate the problem in detail . Exploring the patient’s problems Getting the details of the patient’s problem by establishing the starting point and the dates in the patients own words is a good way to start.

39. Funnel method : asking general and open ended question followed by closed-ended questions is a valuable way to start exploring. When the patient narrates her/his problem, listen attentively and allow the patient to complete statement without interrupting. Use verbal and nonverbal responses to facilitate the patient’s narration.

40. The use of pauses and silence Picking up and acknowledging cue Use of reflection and paraphrasing Clarify patient’s statements that are unclear or need further amplification by asking clarification question.

41. Signposting: during the conversation, when a doctor moves on from one topic to another, inform the patient. Inform before asking questions about social background, job, work-life, family, social support, caretakers and related aspects.

42. While asking sensitive questions signpost by saying :”I need to ask some sensitive questions that may make you uncomfortable, but need to ask them for the shake of treatment. Are you ok with it.” Periodically summarize to clarify and verify the details shared by the patient and ask the patient to correct in case there is any discrepancy or add anything that is not covered. Establish dates and sequence of events to understand the problem accurately.

43. Exploring the patient’s perspective It is useful to explore and understand the patient’s view of the illness. Patient’s understanding of illness: Explore the patient’s perspective by asking question like: “Why do you think this is happening?” “What do you think is the cause of this problem or feelings of pain?” “How is this illness affecting your life?” These questions are useful to elicit the patient’s perception of the illness.

44. Patient’s concerns : patient and her/his family have concerns about the illness, treatment, recovery, cost of treatment and prognosis. These concerns of the patient should be addressed and answered during the conversation. Patient’s expectations Patient has a set of expectations from the doctor and treatment. It is useful to know her/his expectations to suitably plan the treatment.

45. Patient’s past experience The patient’s past experience with the illness would have a definite impact on the present problem and recovery. Patient’s emotion: Diseases impact individuals differently. To explore the emotional makeup of a patient helps to understand the impact of the illness on the patient, the patient’s resilience to disease and the patient’s coping ability.

46. References Fundamentals of clinical communication by Dr. Indu Arneja and Dr. Pawanindra Lal AETCOM MANUAL by Nitin Ashok John Module – 5 SKILLS TRAINING BY NMC(MCI)

47. THANK YOU