Professionalism/Communication book questions: Midterm

Describe some instances in which the use of gestures facilitates the communication between the HCP and their patient.

1) gesture where incision being made 2) Indicate how to position oneself for an X-ray

Suggest two ways a healthcare professional can enhance communication when explaining to a patient a complicated regimen for taking a medication.

1. Paraphrasing 2. Encode the message properly

Why is it important to not interrupt the patient in the middle of their history?

As an HCP you want to receive important information from the patient. When the patient begins to tell you their story, remember to let them finish. Interrupting a speaker indicates that the listener does not think the speaker's message is very important. An HCP who has effective communication skills will allow the patient to finish speaking Communication Skills for the Healthcare Professional, McCorry and Mason Answer Key - Chapter 3 without unnecessary interruption. To allow the patient to finish speaking is to reinforce the message that you are there to serve the patient's needs.

A 6 y.o. boy has fallen off his bicycle and sustained a deep cut on his arm that requires stitches. Discuss how the HCP should approach this patient to clean and treat the wound. Include appropriate forms of touch between the HCP and the boy. What other nonverbal behaviors will enhance the interaction and communication between the HCP and the boy?

Assume the boy is in pain and is afraid and upset because of his accident. Several forms of nonverbal communication may facilitate the interaction between the HCP and the young patient. A warm and friendly facial expression may help to ease the boy's anxiety. Clearly, the HCP will need to maintain an intimate distance in order to clean and treat the wound. However, this invasion of the boy's personal space may be partially offset by maintaining a body position that is eye level with the boy. Standing over him will likely make him feel even more powerless in this situation. Gestures, such as illustrators, will help the boy to position his arm properly. Finally, touch is an important factor in this interaction. Many patients, especially a frightened 6-year-old boy, may benefit from a gentle, caring touch that conveys empathy and reassurance. In addition, touch may enhance the rapport between the HCP and the patient as well as supplement verbal communication.

The quality you exhibit that tells others that it is the real you they perceive, and that you don't just go through the motions but show you really care about what you are doing is called _________________________.

Being genuine.

A hospitalized patient is in the radiology department for a computed tomography (CT) scan. The radiology technologist must position the patient in the machine. Discuss the best practices that should be employed by the HCP. What practices should be avoided?

Best practices: Tell your patient when, where, and how they will be touched when being positioned for the scan. This helps to put your patient at ease and will avoid startling them. Use a form of touch that is appropriate for the given situation which includes positioning the patient and perhaps putting them at ease if they are anxious. Use touch to supplement your verbal message. Observe and assess the recipient's response to the touch. Negative responses may include pulling away, a startled look or frightened appearance, a tense facial expression, or other anxious gestures or behaviors. You may safely assume that a patient has a positive Communication Skills for the Healthcare Professional, McCorry and Mason Answer Key - Chapter 2 response to touch if they appear to relax or seem more comfortable. The person who touches may be perceived as having enhanced status. Therefore, it is important that the HCP remain mindful of its possible effect on the power dynamic between them and the patient. In some instances, the patient may feel a reduced sense of independence or autonomy. Practices to avoid: Do not replace words with touch alone as this may be demeaning to the patient. Do not use a touch gesture that implies more intimacy with a patient than is desired. When a gesture suggests a degree of intimacy that is not shared, it will likely result in discomfort. When touching a patient of the opposite gender, it is advisable to have a colleague or a family member of the patient in the room in order to prevent any misunderstanding.

List three patient-generated roadblocks to therapeutic communication and explain why they are significant. Describe a clinical situation in which such roadblocks may occur and explain how to resolve them.

Compensation - When a patient does this, they compensate, or overemphasize, a certain trait or behavior in one area because they believe they must make up for what they perceive as a deficiency, or failure, in another. Denial - This occurs when the patient attempts, generally unconsciously, to reject or deny the existence of feelings, needs, thoughts, desires or even external facts. Displacement - This is when it is impossible to the patient to accept ownership of certain thoughts, feelings, needs or desires and attributes them, unconsciously, to a more acceptable substitute, someone or something outside of the self. Dissociation - When this happens, the patient is attempting to disconnect the emotional significance of certain ideas or events from those ideas or events. Identification - This occurs when the patient mimics the behavior of someone else in order to conceal their own natural behavior because they believe such behavior is inadequate. Projection - This is when the patient projects onto another person or object their own feelings as if the feelings originated in the other person or object. Rationalization - When a patient does this, they are using false reasoning to justify inappropriate or unacceptable behavior, hoping to make the behavior tolerable. Regression - A patient is regressing when they unconsciously return to immature, or even infantile, behaviors or thoughts. Repression - This is when the patient simply puts out of their mind painful or difficult thoughts, feelings, ideas or events.

Name two instances when commentary might be useful during a patient encounter.

During the patient visit, moments of "downtime" can become awkward for the patient if they pass in utter silence. It is therefore helpful to the process if the HCP briefly comments on what they are doing, just to keep the interaction alive and allow the patient to remain engaged in the active role they take in their own care. Such commenting, moreover, can ease fear and reduce anxiety for the patient. Two such instances when commentary could reduce anxiety would be while changing a urinary catheter and changing an IV bag on a patient's pump.

Define the word encode and provide two examples of its use.

Encode: put the idea into some form that can be communicated. hand gestures, body movements

What approaches help to ease the anxiety in a patient created by intrusions and the loss of personal space when hospitalized?

Explain to PT what procedures will be happening when, where and how they will be touch during exam/procedure Maintain relaxed and open body posture Use touch to support verbal message

There are two types of tone in addition to the directive tone; the other two types are the _____________________ and the ___________________.

Expressive Problem-solving

Most forms of nonverbal communication are cross-cultural and are interpreted similarly between people of different ethnic backgrounds (T/F)

False

True/False A nurse's pager that goes off, displaying a phone number, is not a channel for communication

False

An HCP whose mother had the very same complaint as the patient should tell the patient about their mother because that will help the patient feel more comfortable. (T/F)

False.

It is always a good idea for the allied health professional to assert authority and use the directive tone when speaking to patients. (T/F)

False.

Repeating back to the patient what they have told you wastes valuable clinical time (T/F)

False.

Using slang is an effective way of connecting with a patient you have never met but who belongs to an ethnic group you think you understand. (T/F)

False.

In order to put the patient at ease, it is important that the HCP maintain direct eye contact with the patient during the entire course of the conversation (T/F)

False. Establish amount of eye contact where both you/Pt feel comfortable

True/False Sign language is not a channel for communication.

False. Any medium which sender chooses to communicate is a channel. i.e.: phone, face to face, body language, hand gestures, drawing

Patients complain more about dirty examination rooms than anything else in health care. (T/F)

False. Complain of lack of effective communication

True/False When a doctor tries to examine a patient with abdominal pain, they ask the patient to rate the pain on a scale of 1 to 10, with 10 being the worst pain imaginable. The patient screams and says, "It's a 10?" That scream is an example of noise.

False. It is providing feedback to sender

When verbal messages and nonverbal messages are not congruent, the verbal message tends to be believed. (T/F)

False. Non-verbal message tends to be believed

True/False In order to encode a message, the sender must have a computer or fax machine.

False. To encode an idea means to put idea into some form that can be communicated, i.e.: spoken, written, symbols, gestures

True/False When a nurse asks a patient a question, the patient simply stares back blankly. This is not a form of feedback.

False: Even this seeming non-response is a response that provides feedback to the HCP. The HCP can follow up with questions about the patient's understanding or emotional state.

Appropriate self-disclosure means to tell the patient everything about your experience that reminds you of their condition. (T/F)

False: As an HCP, you will have the opportunity to self-disclose to patients, but you should be thoughtful and cautious about when and how you do this.

A celebrity, such as a famous pop singer, has been admitted to one of the internal medicine wards down the hall in the hospital where you work. A good friend of yours is a big fan of this singer. You try to find out what the pop singer's medical details are on the hospital's computer system so that you can have something good to talk about when you see your friend. This is okay as long as your friend promises not to tell anyone else. (T/F)

False: Aside from the purposes of treatment, payment, and healthcare operations (TPO - described in Chapter 4), you must work to ensure that the privacy of patient information is always protected. This information includes everything pertaining to treatment in the patient's medical record, as well as all other protected health information.

If an angry patient accuses all of the staff in your practice of giving poor patient care, it is your responsibility to stand up for your co-workers and let the patient know how wrong they are. (T/F)

False: Never become defensive. The HCP who becomes defensive inappropriately changes the terms of the relationship from patient/provider to attacker/defender, and in such instances the therapeutic communication process, which is built on trust and understanding, completely breaks down.

Showing that you personally disapprove of a patient's relapse into smoking because you find smoking to be a dirty and dangerous habit is an effective form of therapeutic communication. (T/F)

False: The HCP who shows disapproval of a patient's actions can cause the patient to feel as if the HCP is passing some sort of moral judgment on the patient. This is also inappropriate.

Assertiveness is an important quality to have only when dealing with patients, not co-workers (T/F).

False: When dealing with a co-worker, an assertive communicator will use clear and direct language while remaining relaxed and respectful. When you use an assertive style, you tell listeners that while you may disagree you remain honest and courteous with them. Their response, in turn, is likely to feel respected and valued by you. They will trust you more easily.

If a blood pressure monitor stops working while you are using it, you should just put it back in the drawer you took it from and not tell anyone because you will be suspected of having broken it. (T/F)

False: You must recognize early on that it is very important to keep your supervisor informed when anything goes wrong. Of greatest importance is the patient, and if you ever have a concern about the quality of patient care in your practice, you must let your supervisor know - immediately. If the concern is something less serious - such as disorderly conditions in some of the examination rooms' cabinets; or even something purely office-related, such as the breakdown of the copy or fax machine - you should let your supervisor know at an appropriate time.

List three possible forms of noise that might impair communication in a hospital emergency department waiting room.

Fear/anxiety language barrier Pt. has physical pain that prevents from "effective listening"

Two types of nonverbal communication that help to regulate the flow of conversation include:____________ and __________________

Gestures Facial Expressions

Provide three examples of open-ended questions and explain why each is an open-ended question.

Open-ended questions lead to the kinds of answers that the HCP will want to paraphrase, that is, longer answers with more detail and emotion. We use open-ended questions when we want to hear the whole story. Open-ended questions most frequently begin with the words "how" or "what." Open-ended questions encourage the patient to further discuss issues of concern, and they can be very helpful in coming to a complete understanding of the patient's needs.

Discuss the characteristics of "good eye contact" between the HCP and their patient

Patients who receive longer gazes from practitioner tend to talk more freely about health concerns, and provide more info on psychosocial issues. Looking into Pt eyes but not 100% of time.

Describe the ways in which paraphrasing can enhance the patient-HCP relationship

Perhaps the most important part of good listening is paraphrasing. To paraphrase is to use your own words to repeat what someone else has said. Good paraphrasing skills are essential to effective communication. An HCP should use paraphrasing for several important reasons. A) Paraphrasing provides a test of the message for the HCP. Paraphrasing back to the patient what the patient has said provides the HCP with an opportunity to verify that they have understood what the patient has said. By paraphrasing, the HCP is allowing the patient to either confirm that the HCP has the correct information or to point out inconsistencies or gaps in the information. Under optimal circumstances, this is simply to verify that the HCP has received the same message that the patient has intended to send. However, circumstances are not always optimal. A patient may be angry, confused, in pain, speech impaired, or in some other condition that makes it more difficult for them to get their message across to the HCP. It is important that the HCP try to understand exactly what the patient is trying to communicate. B) Paraphrasing allows for a test of the message for the patient. The patient can listen to their HCP's paraphrase, checking to see that the paraphrase is what the patient intended to say and that the HCP understands. C) Paraphrasing allows for a building of rapport and trust between the patient and the HCP. The HCP shows engagement with the patient's case, validating the patient's concerns. The patient understands from this interaction that the HCP is focused on the patient and cares about them. The patient is then more likely to slow down and listen carefully to the HCP. D) Paraphrasing keeps the focus on the patient and keeps the patient talking. Paraphrasing what the patient says reinforces the point that the healthcare encounter is occurring for the purpose of helping the patient. The patient is made to understand that everything they and the HCP say has to do exclusively with the patient. When the patient clearly understands this, they are at greater ease in the therapeutic relationship, becoming better able to play a role in their own care. The patient typically has a lot to say about their own case, even if they do not seem to at first. However, once the HCP has helped the patient understand that a complete focus on the patient's case is entirely appropriate, the patient will feel more comfortable and open up.

When discussing a sensitive topic or describing a clinical procedure, it is appropriate for the HCP to maintain a __________ distance between themselves and the patient.

Personal (1.5-4 feet apart)

List three HCP-generated roadblocks to therapeutic communication and explain why they are significant. Describe a clinical situation in which such roadblocks may occur and explain how to resolve them.

Providing Easy Reassurance When confronted by a patient's unease or distress, an HCP's first impulse as a fellow human being may be to provide reassurance with the intention of soothing the patient's unease. The HCP should resist this impulse as such an attempt to make the patient feel better may be inappropriate for two reasons. First, the patient has the right to feel any way they may feel and such reassurance diminishes the patient's feelings. Minimizing the Patient's Feelings - The HCP should be also careful to avoid saying anything that diminishes or makes light of the way a patient may be feeling. The HCP's job is to listen attentively and show empathy for the patient, thereby opening up the channel to effective therapeutic communication. A patient who feels that the HCP does not take the patient's feelings seriously will not trust the HCP.Approving/Disapproving - Approving or disapproving of the patient can falsely give the patient the impression that a power relationship exists between them and their HCP.Agreeing/disagreeing - Either agreeing or disagreeing with the ideas, feelings and thoughts of the patient is an ineffective communication behavior because it turns the discussion of the patient's health into a matter of the patient's being right or wrong. Giving Your Own Advice - You should never give a patient personal advice. You are there to serve as part of a healthcare team assisting the patient with the management of their care, but you are not there to provide the patient with your personal insights about their condition or behavior. Becoming Defensive - Patients may at times express unhappiness or dissatisfaction with the care received, the HCP, or even the hospital or practice. Prying - Sometimes a patient may indicate that they do not want to discuss a certain topic. Asking the Patient to Explain their Behavior Making Commonplace, or Clichéd, Comments

Why is it important to use a patient's name?

Since first impressions are important, using the patient's name in greeting them at the initial meeting is a way to make a good first impression. It shows respect. As an HCP who has effective communication skills, you understand the importance of establishing Communication Skills for the Healthcare Professional, McCorry and Mason Answer Key - Chapter 3 rapport with the patient. Using the patient's name at the initial meeting and at the beginning of each subsequent meeting is crucial to that rapport.

HIPAA stands for ______________________

The Heath Insurance Portability and Accountability Act

A closed question will generally prompt a one-word answer (T/F)

True

As much as 70% of communication is in the form of nonverbal communication, which is particularly important in stressful situations such as illness or medical emergencies. (T/F)

True

To show a patient empathy means to show the patient you understand how they are feeling (T/F)

True

If you know that a patient is receiving poor care, you should let your supervisor know immediately, regardless of the consequences to another employee (T/F).

True.

Repeating the expression, "Let me tell you what I think you're going through" is a not good way to show empathy to the patient. (T/F)

True.

Saying "Get over it. Everyone has to do this stuff!" is not an effective way of managing a patient with anxiety (T/F)

True.

True/False: A patient's deafness can be a form of noise

True. Anything that disrupts communication process is considered noise. Hearing/Sight impaired included.

The HCP who leans slightly forward during the conversation has a better rapport with their patients. (T/F)

True. It expresses warmth, caring, interest, acceptance and trust.

Briefly explain the difference between an assertive and an aggressive style of communication.

When disagreeing, an assertive communicator will use clear and direct language while remaining relaxed and respectful, whereas an aggressive communicator can tend to use confrontational and even sarcastic language, while maintaining a tense and often superior attitude

Why is it essential to properly interpret the nonverbal communication displayed by a patient?

behavioral observation may be only means to derive info from patient, i.e pt speech impaired, too ill to talk or unwilling to talk

Another term for nonverbal communication is: __________________

body language

Why is the problem-solving tone more effective than the expressive tone when discussing a patient's skin rash?

he problem-solving tone is the tone the HCP uses most frequently when serving patients' needs. A significant part of the allied health professional's job consists of verbally collecting important information from the patient and providing explanations and solutions to the patient. The problem-solving tone is what the patient rightfully expects from the HCP. In the case of a skin rash, the problem-solving tone allows the HCP and the patient to focus on the cause of the rash and treatment without allowing the discussion to become embarrassing.

Suggest three ways in which cultural differences can inhibit the communication process

language barrier cultural differences in eye contact cultural differences in hand gestures

Briefly explain why providing easy reassurance to the patient may not be a good communication practice.

patient has the right to feel any way they may feel and such reassurance diminishes the patient's feelings. Second, the reassurance the HCP wants to provide may give the patient false hope in the face of a negative outcome.

Discuss the differences between the following statements: Don't eat that rich ice cream if it always gives you a stomach" The lactose in ice cream and other dairy products may contribute to the stomach pain you often experience."

problem-solving tone, than to Statement A, which uses a directive tone that sounds almost accusatory. In virtually every case the patient would be more receptive to what the HCP is saying when a problem-solving tone is used to convey information.

List three channels a doctor might use to communicate with a patient.

telephone face to face writing on paper