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SHE116 Communication In the Emergency Care Setting - Coggle Diagram
SHE116 Communication In the Emergency Care Setting
An introduction to communication
(Pilbery & Lethbridge, 2019)
Communication is a fundamental aspect of all ambulance work.
You will have to communicate with: patients, friends and family members, as well as other healthcare professionals.
Effective communication, especially in a high-stress environment, is a skill that requires development and practice.
Poor communication has previously been responsible for disastrous medical and surgical errors. (WHO, 2009b)
Communication is regarded as the sending of a message from one person to another.
(Corcoran, 2013)
Be aware of the characteristics and consequences of verbal and non-verbal communication and how this can be affected by factors such as age, culture, ethnicity, gender, socio-economic status and spiritual or religious beliefs. (HCPC, 2014)
Who will you communicate with?
(Pilbery & Lethbridge, 2019)
Service users.
Other health and care professionals (Nurses, Doctors).
Colleagues (Paramedics, APPs, CCPs to name but a few).
Members of the public.
Staff in the Emergency Operations Centre.
Other professional services (Police, Fire etc.)
Methods of communication
(Pilbery & Lethbridge, 2019)
Verbal
Body language
Written
Electronic written (e-mail or electronic patient records)
Radio
Telephone
Types of Communication
(Pilbery & Lethbridge, 2019)
Verbal Communication
is a deliberate conscious process and can be divided into two broad areas (Blaber, 2008).
Language and Vocabulary
- You must be able to adjust your language and vocabulary so that it is suited to the person you are communicating with. (Pilbery & Lethbridge, 2019)
Do not try to say too much at one time.
Avoid using medical jargon and overly complex language.
Be concise and speak in a clear manner.
Frequent checks of the individuals understanding.
Language
- A system of sounds that convey meaning because of shared grammatical and semantic rules. (Hogg & Vaughan 2021)
Utterance
- A sound made by one person to another.
Locution
- Words placed in a sequence.
Illocution
- Words placed in a sequence and the context in which this is done.
Prepare what you want to say and consider the easiest way to communicate that message.
Paralinguistic Features
- Refers to the intentional or unintentional modification of the way in which we speak and place emphasis in communication. (Pilbery & Lethbridge, 2019) & (Blaber, 2008)
Volume
The volume used to send a message may vary depending on the situation. Ensuring an appropriate volume is important in terms of the effectiveness of the communication.
Rhythm
A disrupted rhythm could typify a lack of confidence or indicate nerves.
Pitch
Usually the louder the volume, the higher the pitch of voice. These linking in turn, could easily communicate a sense of urgency, stress or panic. The more the practitioner is under pressure, the more these features appear in the voice.
Pace
A fast pace could indicate urgency.
Tone
Can be described as the way in which someone speaks to someone. Your voice is just as important as your words. You can hear the difference in tone when someone is genuinely concerned for you. (College Of Paramedics and The American Academy Of Orthopaedic surgeons 2014).
Intonation
The emphasis placed on the voice to communicate a particular tone or mood. (Gault et al. 2016). For example, a rising intonation at the end of a statement transforms it into a question or can communicate uncertainty. (Hogg & Vaughan 2021).
Written Communication
- It is likely every patient contact you have will involve written communication, most commonly in the form of a Patient Clinical Record.
Avoid unnecessary abbreviations.
Writing must be neat, eligible, concise and follow a structure i.e the medical model.
Diagrams can be beneficial but must be clear and labelled.
Non-verbal Communication
can have a dramatic impact on the message you are sending and the way that it is then interpreted. Non-verbal cues can replace, supplement or even contradict the meaning of the message being sent. (Ellis et al., 2003).
Eye contact
(Blaber, 2018)
An important way people initiate and maintain communication. It is used by paramedics to demonstrate interest and care for the patient. (Bledsoe, et al 2014 as cited in Blaber 2018)
Not looking at the patient may come across as not interested or not paying attention.
It may be culturally insensitive or rude to maintain eye contact. (Pavord & Donelly 2015)
Position yourself at the same level as the patient to maintain eye contact on an equal level.
Facial expression
(Blaber 2018)
The face is one of the most expressive parts of the human body (Gamble and Gamble 2017)
According to the College Of Paramedics and The American Academy Of Orthopaedic surgeons 2014, patients can recognise the emotions and moods displayed by paramedics when caring for them. Inevitably as a paramedic you will encounter situations that you finding shocking, so it is important to be mindful of nonverbal cues such as displaying reactive facial expressions.
Gesture and posture
(Gamble and Gamble 2017)
Can emphasise and clarify the meaning of a spoken message.
Posture includes the way you stand, sit and position your body.
When talking to patients, paramedics should use an open posture. Standing with crossed arms may appear as confrontational and uncaring.
Proximity
(Blaber 2018)
People communicate by how closely they stand or sit next to another person. This distance is often reduced when the people know each other. However being too close can cause discomfort and be perceived as threatening, even if touch is not involved.
Touch
Much of the care a paramedic gives involved touch (such as placing a blood pressure cuff), although it is instinctive it can be misinterpreted and become problematic, consent must be obtained to undertake any procedure.
Active listening
(Pilbery & Lethbridge, 2019)
Acknowledging communication using small verbal cues, such as 'OK' and 'yes' as an individual speaks. Doing this increases the likelihood of communication continuing and more information being revealed as the sender feels you are paying close attention.
Sender > Message > Receiver (
Basic Model of communication) (Corcoran, 2013)
Sender > Message > Receiver > Understanding > Feedback
- A Cyclic Process (Modified Model of Communication) (Corcoran, 2013)
Social Context
(Pilbery & Lethbridge, 2019)
Communication relies heavily on the social context in which it takes place.
Ensure you encode the message, using both verbal and non-verbal features of communication, in such a way that it is likely it will be decoded in the manner you intended.
Every day, paramedics meet people from a wide range of social and cultural background and must be mindful of modifying communication to suit the needs of the individual.
Barriers to communication
- include anything that influences your ability to effectively pass on and receive back the message you need.
Sensory Problems
- Many patients will have impairments to their hearing, sight or speech.
Language
- Paramedics inevitably will treat patients with whom they cannot communicate with in their native language.
Emotions
- Paramedics frequently encounter patients and situations where those involved are experiencing extreme emotions.
Age
- Young patients in particular need to be communicated with in a way that they can understand, i.e, use pictures and drawings.
Time constraints
- Hurried communication is never as effective as leisurely interaction.
Environment issues
- such as noise, privacy and a lack of seating.
Pain and fatigue
- which can reduce concentration.
Embarrassment and anxiety
- can result in awkward encounters which may hamper communication
Use of medical jargon
may confuse or even worry patients who do not understand medical terms.
Religion, Values and Beliefs
- hands on hips is a sign of hostility in Mexico, hands in pockets is a sign of disrespect in turkey and showing the bottom of feet is considered offensive in muslim nations.
Information overload
- relaying too much information at one time can be overwhelming.
Presentation and appearance - How we look can be a powerful transmitter of intentional and unintentional messages.
Gender
- In some cultures it may not be appropriate for an individual to be treated by someone of the opposite gender.
Education
Geography
Economic Status
Long Waiting Times
- Create tension prior to the arrival of an ambulance.
Psychological barriers
- such as people under the influence of alcohol or drugs.
Assumptions
- A patient might genuinely believe that female staff must be junior for example.
(Ali 2017, Ali 2018a, Ali 2018b, Ali 2018c, Ali 2018d)
(College Of Paramedics and The American Academy Of Orthopaedic surgeons 2014)
(Pilbery & Lethbridge, 2019)
Practical adaptations to overcome barriers to effective communication
Language
Simple issues can be communicated through imitating and actions.
For more complex messages, using a family member as a translator can be helpful
Phrase books or access Language Line (a translator service)
Google translate.
Age
- Use pictures, drawing and props if available.
Sensory Problems
Speak slowly, listen carefully, pronounce your words clearly and make sure the person can see your lips
Use communication aids such as hearing aids and think of alternative methods, such as writing things down.
Reduce background noise, find a quiet area or step into a quiet side room.
It is important to acknowledge
pain and discomfort
. E.g "I know that it is painful...". Showing Empathy can build rapport with patients.
If you are concerned about
information overload
, ask the patient to repeat it back to you and check it has been understood.
Consider suggesting for the patient to involve a relative or friend in complex conversations.
Suggest patients take notes if they wish.
Give written information leaflets.
Arrange another meeting if necessary, though not really possible as a paramedic you can suggest guidance of whom to contact in proceeding steps.
Flag up particularly important bits of information.
Avoid using
Medical Jargon
and clinical acronyms. Use appropriate vocabulary for the audience and age-appropriate terms.
To avoid
assumptions
, explain your role at the outset i.e "Hello, My name is Madison, I'm a Student Paramedic"
An appropriate
appearance
for your professional role will help you establish credibility and avoid unintended negative messages (Anderson 2010).
A thoughtfully designed
environment
can have a positive impact on patients' wellbeing.
Position yourself where the patient can see your face and facial expressions clearly, getting down to a patients level is a much more pleasant experience.
Clear instructions can ease
stress and embarrassment
when delivered with confidence. Encourage questions.
Try to connect with patients, get to know them by asking a few questions, learn about their views and preferences.
Adopt a model for breaking bad news to appear more confident.
Use open
body language
to display an approachable and gentle demeanour, include a therapeutic smile.
(Ali 2017, Ali 2018a, Ali 2018b, Ali 2018c, Ali 2018d)
(Pilbery & Lethbridge, 2019)
(College Of Paramedics and The American Academy Of Orthopaedic surgeons 2014)
Theories and Models of communication
The 7 C's of effective communication
Completeness
- refers to giving full information.
Correctness
- the legitimacy of the factual information.
Conciseness
- brief and precise.
Courtesy
- communicating with politeness, genuineness and respect
Consideration
- to acknowledge the situational factors of the audience that you address.
Concreteness
- your message being specific, meaningful and focused.
Clarity
- transfer accurate and easily comprehendible messages to the receiver
The
SPIKES
Model can help you prepare for breaking bad news. (Baile, 2000, as cited in Pilbery & Lethbridge, 2019)
S
etting Up - Prepare what you are going to say.
P
erception - try to gain an insight as to what the individual already knows.
I
nvitation - Find out how much the person wants to know.
K
nowledge - Avoid using complex medical language. Match their level of communication.
E
motions and empathy - Do not provide reassurance that you cannot be sure will happen.
S
trategy and Summarise - Recap the situation and come up with concrete next steps for what the person needs to do.
The
PEWTER
model also provides a framework to communicate bad news effectively. (Bumb et al., 2017)
P
repare - Knowing what information will be presented and understanding how to present it in a clear, everyday language.
E
valuate - Assessment of what the patient and family members already know or suspect, you should consider the cognitive and psychological status of the patient.
W
arning - Giving the patient an indication that serious news will be presented.
T
elling - [resenting the information in a straightforward and nonapologetic and calm manner.
E
motional response - Assess the patients reaction to the bad news.
R
egrouping preparation - Patient-clinician collaboration to respond to the bad news.
Aristotle’s Model of Communication
Aristotle argues that we should look at five elements of a communication event to analyze how best to communicate: speaker, speech, occasion, target audience and effect.
Shannon-Weaver Model
The Shannon-Weaver model is the first to highlight the role of ‘noise’ in communication, which can disrupt or alter a message between sender and receiver.
Berlo’s S-M-C-R Model
Berlo’s S-M-C-R model explains communication in four steps: Source, Message, Channel, and Receiver.
Osgood-Schramm Model
The Osgood-Schramm model looks at reciprocal communication, showing how we have to encode, decode, and interpret information in real-time during a conversation.
Westley and Maclean Model
The Westley and Maclean model shows that our communication is influenced by environmental, cultural and personal factors.
Since 300BC, theorists have developed communication models in attempts to explain and understand how to improve communication and rhetoric.
Barnlund’s Transactional Model
Barnlund’s Transactional Model of Communication highlights the role of private and public cues that impact our messages.
Dance’s Helical Model
Dance’s Helical Model sees communication as a circular process that gets more and more complex as communication occurs, which can be represented by a helical spiral.
(Drew, 2022)
Medical Handover
- A handover is passing on the care of your patient to another healthcare provider(s). (Pilbery & Lethbridge, 2019)
SBAR
(Pilbery & Lethbridge, 2019)
S
ituation
B
ackground
A
ssessment
R
ecommendations
SBAR is the professional handover.
ASHICE
(Clinical Support Officer, 2010)
A
ge
S
ex
H
istory
I
njuries sustained
C
ondition
E
stimated time of arrival
ASHICE is used as a pre-alert to the hospital.
ATMIST
(Pilbery & Lethbridge, 2019)
A
ge
T
ime
M
echanism of injury
I
njury
S
igns
T
reatment
SOCRATES
(Furst 2016)
S
ite
O
nset
C
haracter
R
adiates
A
ssociated Symptoms
T
ime
Ex
acerbating Factors
S
everity
METHANE
(Ferris, 2021)
M
ajor incident
E
xact location
T
ype of incident
H
azards presented or suspected
A
ccess (and eggress)
N
umber of casualties
E
mergency services