Communication

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Chapter 3 Communication

Gillian Springett, Karen Dunmall

CHAPTER CONTENTS

Introduction 23
Effective communication 24
Verbal communication 25
Non-verbal communication 25
The practical application of verbal and non-verbal communication in diagnostic imaging 31
Dealing with difficult or aggressive patients 37
Interprofessional working 38

KEY POINTS

image Communication has three key components – verbal communication, non-verbal communication and active listening.
image Effective communication is essential in the provision of quality patient care.
image Effective communication may be hindered by the environment, language barriers, physiological problems preventing the patient from communicating effectively and psychological issues.
image Interprofessional working involves communication between all individuals involved in the care of a patient.
image Interprofessional working encourages the care of patients from all aspects at all times, enhancing the patients’ perception of their care.

INTRODUCTION

Communication is an everyday word in contemporary society and yet it encompasses a variety of complex behaviours that are often difficult to categorise. A basic definition is the process of information transfer, which can be an indicator of:

• emotional state
• physical state
• knowledge and instructions.

Humans communicate by using language, which may be divided into two separate parts – verbal and non-verbal – performed consciously or unconsciously, each with its own function but often intrinsically bound to the other. Written communication in radiography is primarily the use of investigation request cards and case notes. With the advent of a computerised imaging system there is an increasing reliance on electronic forms of communication.

EFFECTIVE COMMUNICATION

Effective communication is at the heart of quality health care. In radiography a considerable part of the working day is spent relating to others. Given the technical nature of radiography it is possible that practitioners may misjudge the amount of time spent in face-to-face contact and seriously underestimate the effect their own behaviours may have on the way the service users respond to and perceive the care received.

Effective communication significantly improves health outcomes by:

• improving the satisfaction of both patient and practitioner
• improving patient concordance with treatment regimes
• decreasing the anxiety and distress felt by patients
• encouraging speedier recovery from invasive surgical procedures.

Department of Health policies and the National Institute for Health and Clinical Excellence (NICE) all stress the importance of empowering users and the need to achieve a ‘patient-centred focus’ in all aspects of the health service. Most patients will trust that imaging practitioners will have the correct knowledge and skills to operate the equipment and produce optimal images (unless their actions and behaviour signal otherwise!). It is often the practitioner’s interpersonal behaviours that the patient will consider when asked to assess the quality of the care received.

Learning to communicate effectively should be valued as a core clinical skill for all healthcare practitioners if service provision is to have a user orientation.

Much of the research over the past three decades suggests that when healthcare professionals use appropriate levels of eye contact, nods and gestures whilst maintaining an open posture they are regarded as more interested, empathetic and warm by their patients. Patient satisfaction, understanding and resultant concordance with the requirements of their healthcare interventions can improve when practitioners have displayed supportive, empathetic non-verbal behaviours.

Therefore, it is important that we are aware that non-verbal behaviours can serve to reinforce, regulate, qualify or replace verbal communication and show our patients and colleagues we are genuinely interested in them as individuals, however short our interactions may be.

Effective communication is essential in the interaction between staff and patients in order to maintain radiographic quality. By communicating effectively a patient’s voluntary and involuntary movements can be minimised, thus reducing the need for repeat imaging and thereby complying with the IRM(E)R regulations (2000).

Remember:

Imaging may be one of the first investigations patients undergo as part of their health care. The experience patients have whilst in the imaging department may influence their future perception of their care and healthcare practitioners overall.

BARRIERS TO EFFECTIVE COMMUNICATION

There are many barriers to effective communication and they can be categorised as environmental, language, physiological or psychological.

1 Environmental:

– privacy of room
– temperature
– light
– darkness of room (may inhibit non-verbal communication)
– equipment.

2 Language:

– not having a common language
– using colloquial phrases or professional, unfamiliar jargon
– inappropriate expressions
– patronising approach
– lack of clarity.

3 Physiological:

– ill health
– pain
– sensory impairment
– level of consciousness
– hunger
– need to use the toilet
– poor oral hygiene making speech uncomfortable or impossible.

4 Psychological:

– embarrassment over personal health issues
– mental health competency
– anger
– fear
– low self-esteem
– loss of dignity
– loss of privacy
– institutionalisation (loss of independence)
– invasion of personal space.

VERBAL COMMUNICATION

Verbal communication is the language of facts and information. It is likely to be used in the giving and receiving of knowledge and instructions but remains inseparable from non-verbal behaviours.

The verbal use of words, phrases and sentences includes the prosodic (intonation, rhythm, pausing) and also paralinguistic systems (the vocal utterance of sounds, e.g. ‘mmm’, ‘uh-huh’).1

Within radiography there are many technical terms which patients may not understand; however, it is important for practitioners to be able to convey the information and instructions in a suitable manner. The effectiveness of a practitioner’s communication will depend on the ability to use jargon-free and familiar language with patients.2

NON-VERBAL COMMUNICATION

Non-verbal communication displays our feelings and emotions and may demonstrate aspects of our personality and attitudes. It is often the unconscious expression of the ‘truly human’ part of us. Non-verbal signals have little or no meaning in themselves but they can acquire significance in particular contexts.

If effective communication is to occur, the non-verbal contribution to the interaction plays a critical role in the way messages are received and interpreted.

Consider the occasions you may have said something like: ‘It’s not what he said but the way he said it!’ This implies a conflict between verbal and non-verbal communications and confusion in the interpretation. This may lead to an inappropriate response and/or behaviour. On the whole, non-verbal signals tend to be spontaneous, although of course if premeditated thought is given some behaviours can be ‘stage-managed’. Non-verbal signals are often sent out and interpreted without conscious knowledge but the so-called ‘body language’ is often more representative of what the sender is trying to communicate than the spoken or written word.

EXAMPLES OF NON-VERBAL BEHAVIOURS

Facial expressions

The face can communicate:

• the degree of interest or liking of a person or a situation
• the degree of understanding of the signals (verbal and non-verbal) being received
• a range of emotional states ranging from happiness to despair
• an individual’s feelings, whether the person wishes to display or try to conceal them
• a physiological response, e.g. sweating, flushing or pallor.

Facial expressions and eye contact can be used to start and sustain communication by showing interest in the individual and the conversation, but they can also be responsible for causing the cessation of an interaction.

The face can respond instantaneously, providing immediate feedback to others. This may be useful in certain situations where demonstrating empathy, concern and understanding to your patients is important. However, consider the messages that may be perceived if practitioners display uncontrolled, inappropriate facial expressions when faced with offensive body odours or unexpected, unpleasant visual information in the course of their work.

Emotional expression is under voluntary control and can be artificially manipulated, with the face demonstrating intensification or reduction of the emotion. In reality, trying to distinguish people’s emotions from their facial expressions is often more difficult than we imagine because some people are capable of masking their true emotions. Social and cultural norms may distort expression of emotion (Fig. 3.1).

image

Figure 3.1 Non-verbal cues.

It is possible people may not actually know what their facial expressions are displaying but by showing you have ‘listened to their non-verbal cues’ you have given the patient, in a supportive way, an opportunity to confirm or deny any concerns.

However, it is important to remember that it is relatively easy to lie with the face – most people can fake anger or surprise with relative ease and patients are often astute enough to sense a false, frozen smile that is not genuine in nature!

Eye contact

Eye contact can signal a desire to engage and communicate with another person. Others perceive gaze as a signal that they are liked.

The start of an interaction usually commences with a period of good eye contact but gaze may become averted. The speaker may look to see if the listener is being attentive or how the message is being received. If there is evidence that the listener is distracted, this may result in the speaker feeling uncomfortable and the interaction may falter.

Gaze can also be used to support the face in expressing emotions and attitudes. A strong gaze may indicate dominance or aggression but, alternatively, a person who avoids making eye contact may be viewed as submissive, ashamed, embarrassed, preoccupied or lacking in confidence and shy.

Having to interact with people who are partially hidden by facial garments, dark glasses and masks, or obscured by screens, may cause considerable discomfort.

People tend to avoid making eye contact when they do not wish to become involved or viewed as a ‘volunteer’. This may be appropriate in some situations but can be a problem if practitioners use gaze aversion deliberately to dissuade interactions when they are busy, as this may signal a lack of interest. However, it is also important to remember there are some cultures and some contexts for which sustained eye contact may be inappropriate.

Gestures

Gestures may be used to:

• reinforce verbal communication by repeating, complementing or stressing the content of the message
• replace speech when verbal communication is not appropriate or when they may be the only way to communicate with an individual (e.g. where there is no shared common language or where someone has a severe hearing loss)
• act as regulators of the interaction, by demonstrating encouragement to continue, giving approval and showing understanding of what has been said (e.g. head nods)
• give useful indications of an individual’s emotional state; for example clenched fists can indicate aggression.

Unintentional gestures are those which signal a personal reaction to what is going on. These include:

• face stroking
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