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SHE116 - Communication in the emergency care setting - Coggle Diagram
SHE116 - Communication in the emergency care setting
The Basics of Comunication
The imparting or exchanging of information by speaking, writing, or using some other medium. Oxford English dictionary. (2000).
Vermier et al. (2015: 1257) State, 'Effective communication is crucial to healthcare'.
Hayley (2014) argues that communication is one of the most important skills needed by a paramedic.
Due to the complexity and nature of communication, if the meaning intended is not clear and consistent it can often lead to misunderstandings.
7% of communication is attributed to words, 38% is derived from tone of voice and 55% owes to non-verbal cues. (Mehrabian, 1981)
Types of Communication
Active Listening
Involves comprehending, response, reflection and retention of information.
Written
Interactions that involve transcribed information.
Visual
Whereby visual resources are used to convey information or ideas.
Non-verbal
- Research has shown a relationship between non-verbal behaviour and patients' perceptions of clinicians' empathy. (Nursing Times, 2018)
Eye contact
It is an important way that people initiate and maintain communication. It is used by paramedics to show that they are interested and care for the patient (Bledsoe et al. 2014)
Facial Expression
Gamble and gamble 2017 states that the face is one of the most expressive parts of the human body.
According to the college of paramedics and American Acamdamy of orthopedic surgeons 2016, patients can recognise the emotions and moods displayed by the paramedic of which is caring for them.
Proximity
This may also be referred to as personal space (Hogg & Vaughan, 2013.)
Touch
Often times an engrained form of communication, but can just as easily be misinterpreted without direct or implied consent.
Gestures
Gamble and Gamble 2017 declares that gestures can assist in clarifying the meaning of a spoken message.
Posture
Open body language such as not having limbs crossed can convey a friendlier more approachable message whereas crossed limbs may appear to be confrontational.
Body language can enhance or detract from communication with patients. (Nursing Times, 2018)
Observing Patients' body language can provide important cues to how they are feeling (Nursing Times, 2017)
Verbal
Paralinguistic Features -
The meaning of the messages we communicate may change depending on the paralinguistic features used to convey them (Hogg and Vaughan 2013.)
Volume
The sender needs to communicate in a volume that the receiver can hear.
Rhythm
Pitch
Pitch can often be linked closely to volume. The pitch of the voice is higher when the volume is increased. These elements can create a sense of urgency or alternatively convey signs of panic and stress.
Pace
Intonation
Contributes to the emphasis of the voice which in turn creates a particular tone.
Tone
Intrapersonal Communication (communication takes place within the brain.)
Interpersonal Communication / Dyadic Communication (Takes place between two or more individuals)
Small Group Communication (takes place in a small group between three or more people)
Mass Communication (when a small group of people pass down information to a large number of varied populations)
Public communication (one speaker conveys information to a large group of people)
Benefits of effective communication
Patients may disclose more information
Enhances patient satisfaction
Builds rapport between patient and professional
Patient is more involved in the decision making of their care and treatment
Leads to more accurate diagnosis
Leads to more realistic patient expectations i.e be open and honest about hospital waiting times even on the back of an ambulance.
Better patient adherance to treatment
The patient may be more open to seeking further care and hold positive views of the ambulance service.
Barriers to effective communication
Time constraints.
Environmental issues i.e noise and privacy.
Pain and fatigue - symptoms can reduce concentration.
Embarrassment and anxiety. Many healthcare encounters are emotionally charged, involving fear and worry, pain and distress.
Use of medical jargon may become confusing.
Values, beliefs and culture may influence different perceptions.
Information overload.
PPE I.E FFP3 Masks creating a barrier to communicating with colleagues, patients and family.
Fear of past experience.
Ambulance wait times creating tension.
Presentation / appearance, uniform, first impressions etc.
Psychological / neurological barriers - intoxicated, decreased GCS, dementia.
Disabilities - hearing issues.
Hurried communication is never as effective as leisurely interaction (Ali M, 2017)
Gender.
Body language, arms crossed may create an aggressive impression.
Good communication is often one of the first things to be abandoned in a challenging situation.
Lacking adequate knowledge and expertise when breaking, or recommunicating, bad news to patients and families (Adebayo, Abayomi, Johnson, Oloyede, & Oyelekan, 2013).
Practical adaptations to overcome barriers to effective communication
(Ali, 2017)
If you think your patient has hearing problems, reduce background noise, find a quiet corner or step into a quiet side room. Check whether the patient uses physical aids.
Symptoms such as pain can reduce concentration. It is important to acknowledge how the patient is feeling.
Showing empathy can build rapport and make patients more receptive
If you want to check the patients understanding based on neurological concerns, ask the patient to repeat the information back to you to gage their understanding
Avoid using medical jargon and clinical acronyms with patients
Everyone makes assumptions based on their social or cultural beliefs, values etc. To avoid misinterpretation of status perhaps consider explaining your role from the outset. For example, "Hello, My name is Madison I'm a student paramedic"
For language barriers, consider using an NHS interperator, or simply google translate.
When dealing with paediatric cases, children may often feel fearful, use a better more simplified choice of words.
Use open body language, do not cross limbs etc.
According to Nursing Times 2018, getting to know patients, learning about their views and preferences can prevent problems from escalating
Feeling prepared, educated, and well-rehearsed can enhance confidence when delivering bad news (Mishelmovich et al., 2016)
Choosing an appropriate, quiet, and private area that is free of interruptions conveys respect and maintains a patient's dignity during a difficult time (Fujimori et al., 2005; Kaplan, 2010).
Adopting a model for breaking bad news can inspire the confidence required for effective discourse.
Theories of Communication
The 7 C's of Effective Communication
Rosliza Md Zani et al. (2011)
Completeness
Providing all the information necessary
Correctness
Being specific, definite and vivid rather than general
Conciseness
A message that is complete without too much explanation or repetition of material.
Courtesy
Demonstrating good manners and being polite.
Clarity
Stating of facts and of consequences to particular actions.
Consideration
Preparing the message with the receiver in mind i.e their values, feelings etc.
Concreteness
The accuracy of the information you are providing
Importance of communication
To begin an action
To manage tasks
To influence people
To be empathetic
To realise self-potential
In an extreme case, not delivering bad news effectively was directly linked to a patient's suicide (Dias et al., 2003).
Standardised handover
promotes effective and comprehensive transfer of key clinical information which reduces the risk of miscommunication. (Rosenberg et al. 2009: Murray et al. 2012: Flynn et al. 2017)
SBAR
B
ackground
A
ssessment
S
ituation
R
ecommendation
ATMIST
M
echanism of injury
I
njury
T
ime
S
igns
A
ge
T
reatment
ASHICE
H
istory
I
njuries sustained
S
ex
C
ondition
A
ge
E
stimated time of arrival
METHANE
H
azards present or suspected
A
ccess (and eggress)
T
ype of incident
N
umber
E
xact location
E
mergency
M
ajor incident
SOCRATES
Radiates
Associations
Time
Character
Onset
Exacerbating factors
Site
Severity
NHS Institute for innovation and improvement (2008)
Models of Communication
The SPIKES Model
- was initially designed for oncology care, specifically for difficult discussions. (Baile et al., 2000; Kaplan, 2010)
I
nvitation / information
Determine how much and what kind of information would be helpful for the patient and family based on their needs and reactions.
K
nowledge
Consider the point in which the bad news is shared. Information about the extent of disease and plan of care should be provided directly and honestly in small segments.
P
erception
Determine the understanding.
E
mpathy
Acknowledging emotions and reactions of the patient and family during the discussion.
S
elect
A private area.
S
ummarize or strategize
Requires the nurse to explain the information presented in an understandable language, avoiding the use of medical Jargon.
The PEWTER Model
- was originally created as a tool for school counselors but has been effectively used in clinical settings when delivering life-changing news to patients (Keefe-Cooperman & BradyAmoon, 2013; Nardi & Keefe-Cooperman, 2006)
E
valuate
Assessment of what the patient and family members already know or suspect, this should include consideration of the cognitive and psychological status of the patient.
P
repare
Knowing what information will be presented and understanding how to present it in clear, everyday language
W
arning
Giving the patient an indication that serious news will be presented.
T
elling
The presentation of information in a straightforward and nonapologetic and calm manner.
E
motional response
Assess the patient's reaction to the bad news.
R
egrouping preparation
Patient-clinician collaboration to respond to the bad news.
Shannons Model of Communication
-Structuralist reduction of communication to a set of basic constituents that not only explain how communication happens, but why communication sometimes fails. (Shannon, C. E. A (1948).
An information source
The message, which is both sent by the information source and received by the destination
A transmitter.
The signal, which flows through a channel
A carrier or channel
Noise
A receiver
A destination. Presumably a person who consumes and processes the message.
Aristotle Model Communication
Occasion
Audience
Speach
Effect
Speaker