Homework-communication skills

Please, read and study chapter 3. Then, answer the following questions on a document with word format. Do not use pages format from MacBook as blackboard does not recognize this format. Finally, submit the document using the submission area. Do not use the comment area.

1) Define: dysphasia, dysphonia, paraphrasing and stereotyping.

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2) Explain the elements of communication.

3) What is a close-ended question? Provide one example.

4) How can you communicate with an angry patient?

5) What is the importance of Elizabeth Kubler-Roos’ work?

health care

Chapter XX:
Chapter Title

Chapter 3:
Communication Skills

Learning Outcomes
Cognitive Domain
Note: AAMA/CAAHEP 2015 Standards are italicized.
1. Spell and define the key terms
2. List two major forms of communication
3. Identify styles and types of verbal communication
4. Identify types of nonverbal communication
5. Recognize barriers to communication
6. Identify techniques for overcoming communication barriers
7. Recognize the elements of oral communication using a sender-receiver process
8. Identify resources and adaptations that are required based on individual needs, that is, culture and environment, developmental life stage, language, and physical threats to communication

Learning Outcomes (cont’d)
9. Discuss examples of diversity:
Cultural
Social
Ethnic
10. Discuss the role of cultural, social, and ethnic diversity in ethical performance of medical assisting practice
11. Discuss the role of assertiveness in effective professional communication, and relate the following behaviors to professional communication:
Assertive
Aggressive
Passive

Learning Outcomes (cont’d)
12. Discuss the theories of:
A. Erik Erikson
B. Kübler-Ross
13. Explain how various components of communication can affect the meeting of verbal messages
14. Define active listening
15. List and describe the six interviewing techniques
16. Give an example of how cultural differences may affect communication
17. Discuss how to handle communication problems caused by language barriers
18. List two methods that you can use to promote communication among hearing-, sight-, and speech-impaired patients

Learning Outcomes (cont’d.)
19. Discuss how to handle an angry or distressed patient
20. List five actions that you can take to improve communication with a child
21. Discuss your role in communicating with a grieving patient or family member
22. Discuss the key elements of interdisciplinary communication
23. Explore issue of confidentiality as it applies to the medical assistant

Learning Outcomes (cont’d)
Psychomotor Domain
Note: AAMA/CAAHEP 2015 Standards are italicized.
1. Respond to nonverbal communication (Procedure 3-1)
2. Use feedback techniques to obtain patient information including the following:
A. Reflection (Procedure 3-1)
B. Restatement (Procedure 3-1)
C. Clarification (Procedure 3-1)
3. Coach patients appropriately considering the following:
A. Cultural diversity (Procedure 3-2)
B. Development life stage (Procedure 3-2)
C. Communication barriers (Procedure 3-2)

Learning Outcomes (cont’d)
Affective Domain
Note: AAMA/CAAHEP 2015 Standards are italicized.
1. Demonstrate
A. empathy
B. active listening
C. nonverbal communication
2. Demonstrate respect for individual diversity including:
Gender
Race
Religion
Age
Economic status
Appearance

Learning Outcomes (cont’d)
3. Use appropriate body language and other nonverbal skills in communicating with patients, family, and staff
4. Demonstrate awareness of the territorial boundaries of the person with whom one is communicating
5. Demonstrate sensitivity appropriate to the message being delivered
6. Demonstrate awareness of how an individual’s personal appearance affects anticipated responses
7. Demonstrate recognition of the patient’s level of understanding in communication
8. Analyze communication in providing appropriate responses/feedback
9. Demonstrate the principles of self-boundaries
10. Respond to issues of confidentiality

Learning Outcomes (cont’d)
ABHES Competencies
1. Identify and respond appropriately when working/caring for patients with special needs
2. Use empathy when treating terminally ill patients
3. Identify common stages that terminally ill patients go through and list organizations/support groups that can assist patients and family members of patients struggling with terminal illness
4. Advocate on behalf of family/patients, having ability to deal and communicate with family

Learning Outcomes (cont’d)
5. Analyze the effect of hereditary, cultural, and environmental influences
6. Locate resources and information for patients and employers
7. Be attentive, listen, and learn
8. Be impartial and show empathy when dealing with patients
9. Communicate on the recipient’s level of comprehension
10. Serve as liaison between physician and others
11. Recognize and respond to verbal and nonverbal communication

Communication is sending and receiving messages, verbally or otherwise. Until the message is received accurately, communication has not taken place.
The ability to communicate effectively is a crucial skill for medical assistants. The medical assistant is usually the first person the patient meets in the medical office. Thus, your positive attitude, pleasant presentation, and use of good communication skills will set the tone for future interactions.
message: words sent from one person to another; information
sent through spoken, written, or body language
Back to Learning Outcomes
Introduction
In your role, you must accurately and appropriately share information with physicians, other professional staff members, and patients.

Basic Communication Flow
Communication requires three things
Message
Sender
Receiver
Two or more people act as sender and receiver as they seek feedback and clarification
Back to Learning Outcomes
feedback: in communication, the response to input from
another
clarification: explanation; removal of confusion or uncertainty

Basic Communication Flow (cont’d.)
Good communication entails:
Clarifying confusing messages
Validating patient’s perceptions
Adapting messages to patient’s understanding level
Asking for feedback to ensure that the messages you sent were received by the patient or other persons as intended
Back to Learning Outcomes

Figure 3-1 Flow of communication.

Checkpoint Question
What three elements must be present for communication to occur?
Back to Learning Outcomes

Checkpoint Answer
For communication to occur, these three elements must be present:
A message to be sent
A person to send the message
A person to receive the message
Back to Learning Outcomes

Forms of Communication
Verbal Communication
Verbal
Uses words or language
Most common form, so important to use clearly
Types
Oral
Written
Gear speech to patient’s educational level
Example—heart attack vs. myocardial infarction
Back to Learning Outcomes
You need good verbal communication skills when performing such tasks as making appointments, providing patient education, making referrals, and sharing information with the physician.

Forms of Communication (cont’d.)
Research indicates that primary message transmitted more by the way it is said than by the words that are used:
Paralanguage
Voice tone
Quality
Volume
Pitch
Range
Back to Learning Outcomes
paralanguage: factors connected with, but not essentially
part of, language, e.g., tone of voice, volume, pitch

Forms of Communication (cont’d.)
Nonlanguage
Laughing
Sobbing
Signing
Written
Should be clear and concise
Reinforces oral
Back to Learning Outcomes
The ability to write clearly, concisely, and accurately is important in the health care profession.
nonlanguage: not expressed in spoken language, e.g.,
laughing, sobbing, grunting, sighing

Forms of Communication (cont’d.)
Back to Learning Outcomes

Checkpoint Question

List five examples of paralanguage.
Back to Learning Outcomes

Checkpoint Answer
Examples of paralanguage are:
Voice tone
Quality
Volume
Pitch
Range
Back to Learning Outcomes

Forms of Communication (cont’d.)
Nonverbal Communication
Also called body language
Kinesics
Facial expressions
Body and eye movement
Gestures
Back to Learning Outcomes

Forms of Communication (cont’d.)
Proxemics
Physical proximity
Personal space — usually about 3 foot diameter
Varies among individuals and cultures
Medical care involves entering personal space
Some patients tolerate it better than others
Back to Learning Outcomes
culture: the way of life, including commonly held beliefs, of a group
of people

Forms of Communication (cont’d.)
Touch
Therapeutic — convey support and caring
Some patients find it uncomfortable
Seek cues from patient’s demeanor
Back to Learning Outcomes
therapeutic: having to do with treating or curing disease;
curative

Figure 3-2 Therapeutic touch conveys caring and concern.
demeanor: the way a person looks, behaves, and conducts himself or herself

Forms of Communication (cont’d.)
Defense Mechanisms
Can imped communication
The process in the brain that makes you forget or ignore painful or disturbing thoughts, situations, etc.
Be unaware exhibiting
Must be aware of various barriers and respond appropriately
Back to Learning Outcomes

Active Listening
Importance of active listening
Ensures that listener understands patient message
Ensures that patient understands information
Components of active listening
Give patient full attention
Minimize interruptions
Watch for nonverbal cues — especially where they conflict with verbal message
Back to Learning Outcomes
To listen actively, you must give your full attention to the patient with whom you
are speaking.

Interview Techniques
Main requirements for effective interview:
Listen actively
Ask appropriate questions — prepare ahead of time
Record answers
Conduct interview in private place — introduce yourself
Be organized
Back to Learning Outcomes
To conduct either type of interview, you must use effective techniques: listen actively, ask the appropriate questions, and record the answers.

Figure 3-3 Begin the interview by introducing yourself.

Interview Techniques (cont’d.)
Do not answer phone calls or attend to other distractions
Let patients know what will happen next and approximate time
Six interviewing techniques:
Reflecting
Paraphrasing
Clarification
Asking open-ended questions
Summarizing
Allowing silences
Back to Learning Outcomes

Interview Techniques (cont’d.)
Reflecting
Repeat what you heard patient say
Leave sentence unfinished
Do not overuse
Paraphrasing or Restatement
Repeat what you heard in your own words
Allows patients to clarify and correct
Asking for Examples or Clarification
Clarifies and reinforces patient’s statements
Back to Learning Outcomes
reflecting: repeating what one heard using open-ended questions
paraphrasing: restating what you heard using your own words

Interview Techniques (cont’d.)
Asking Open-Ended Questions
What, when, or how questions
Patient can’t answer only yes or no
Avoid why questions
Avoid closed-end questions that allow only a “yes” or “no” answer
Back to Learning Outcomes
The best way to obtain specific information is to ask open-ended questions that require the patient to formulate an answer and elaborate on the response.

Interview Techniques (cont’d.)
Summarizing
Reiterate what has been discussed
Allowing Silences
Allows patient to add information or ask questions
Allows patient to formulate thoughts
Allows listener to organize thoughts and form questions
Back to Learning Outcomes
Briefly reviewing the information you have obtained, or summarizing, gives the patient another chance to clarify statements or correct misinformation.
summarizing: briefly reviewing the information discussed to determine the patient’s comprehension

Checkpoint Question

What are the six interviewing techniques?
Back to Learning Outcomes

Checkpoint Answer
When interviewing patients, you can use six different techniques:
Reflecting
Paraphrasing or restatement
Asking for examples or clarification
Asking open-ended questions
Summarizing
Allowing silences.
Back to Learning Outcomes

Factors Affecting Communication
Many factors can influence communication effectiveness
Use of cliché
Message unclear or inappropriate to the situation
Personal distractions (pain or anxiety)
Environmental distractions (noise)
Cultural differences
Stereotyping or biases
Language barriers
Hearing or sight impairment
Back to Learning Outcomes

Factors Affecting Communication (cont’d.)
Cultural differences
Perception is guided by cultural, social, religious beliefs
Avoid preconceived ideas about people from different cultures
Individuals vary within cultures
Back to Learning Outcomes
The way a person perceives situations and other people is greatly influenced by cultural, social, and religious beliefs or firmly held convictions.
To help avoid miscommunication and offending patients, you must be sensitive to these differences in all of your patient interactions.

Factors Affecting Communication (cont’d.)
Back to Learning Outcomes

Factors Affecting Communication (cont’d.)
Stereotyping and Biased Opinions
Should not let personal values or bias affect communications
Stereotyping and prejudice are deterrents to establishing therapeutic relationship
Example—patient who lives in homeless shelter
Back to Learning Outcomes
bias: formation of an opinion without foundation or reason;
prejudice
stereotyping: to place in a fixed mold, without consideration
of differences
As a health care professional, you are expected to treat all patients impartially, to guard against discriminatory practices, remain nonjudgmental, avoid stereotypes, and have a professional demeanor.
discrimination: making a difference in favor of or against someone

Factors Affecting Communication (cont’d.)
Language Barriers
Some patients don’t speak English well or at all — problem to convey and obtain accurate information
Use of interpreters
Staff or family member
Lacking interpreter, written references contain common medical questions and answers
If office serves speakers of particular language, obtain phrase book for that language
Back to Learning Outcomes

Factors Affecting Communication (cont’d.)
Try to use someone same sex as patient
Guidelines:
Do not shout
Demonstrate or pantomime as needed
Speak to patient, not interpreter
Speak slowly; use simple sentences that require simple answers
Avoid slang
Avoid distractions; find a relaxed, quiet environment
Learn basic phrases in appropriate language(s)
Back to Learning Outcomes

Special Communication Challenges
Sensory impairments
Motor (speech) impairments
Patients with limited understanding
Very ill or sedated patients
Very frightened or traumatized patients
Young children
Back to Learning Outcomes
Patients must feel that they are part of the process even if their condition
requires involvement by family members or other caregivers.

Special Communication Challenges (cont’d.)
Hearing-Impaired Patients
Impairments:
Conductive — interference with sound conduction
Sensorineural — lesions or problems with nerves or the cochlea
Anacusis
Sign language, interpreters or other tools
Presbycusis
Often in denial, hearing aids or other amplification devices
Back to Learning Outcomes
presbycusis: (also: presbyacusis) loss of hearing associated
with aging
anacusis: complete hearing loss

Special Communication Challenges (cont’d.)
Methods for communicating with hearing-impaired patients (use tact, diplomacy, and patience):
Touch patient gently to get his or her attention
Talk face to face
Ensure good lighting makes your face visible
Lower vocal pitch; speak distinctly and with force but do not shout
Use note pad and demonstrations
Use pictograms
Use short sentences, short words; enunciate clearly but do not exaggerate facial expressions
Eliminate distractions
Back to Learning Outcomes

Special Communication Challenges (cont’d.)
Back to Learning Outcomes

Figure 3-4 Pictogram for instructing a patient on medication routine.

Checkpoint Question

How does the TDD system work?
Back to Learning Outcomes

Checkpoint Answer

The caller types a message, and the patient reads the message and types a response.
TDD: Telecommunication device for the deaf
Back to Learning Outcomes

Special Communication Challenges (cont’d.)
Sight-Impaired Patients
Range from blurred vision to total blindness
Different conditions can result in impairment
Cataracts
Glaucoma
Macular degeneration
Retinal detachment
Hyperopia
Myopia
Nyctalgsia
Retinopathy
Strabismus
Presbyopia
Back to Learning Outcomes
Patients who cannot see lose valuable information from nonverbal communication.

Special Communication Challenges (cont’d.)
Methods for communicating with sight-impaired patients:
Identify yourself by name at each visit
Do not raise your voice
Explain fully exactly what you’re about to do; alert patient when you will touch him or her
Orient patient spatially by having him or her touch furniture or walls
Offer to escort patient while he or she holds your arm
Tell patient when you leave room; knock when entering room
Explain sounds of equipment used and what each machine will do
Back to Learning Outcomes

Special Communication Challenges (cont’d.)
Speech Impairments
Dysphasia
Dysphonia
Stuttering
Methods for communicating with speech-impaired patients:
Allow patient time to gather thoughts
Allow ample time for patient to communicate
Do not rush conversation
Do not appear impatient
Offer note pad for writing questions
Discuss with physician the possibility of speech therapist
Back to Learning Outcomes
dysphasia: difficulty speaking
dysphonia: impairment of voice; hoarseness

Checkpoint Question
What is the difference between dysphasia and dysphonia?
Back to Learning Outcomes

Checkpoint Answer

Dysphasia is difficulty with speech, usually the result of nerve problem.
Dysphonia is a voice impairment, usually caused by a physical condition.
Back to Learning Outcomes

Special Communication Challenges (cont’d.)
Mental Health Illnesses
Create broad range of communication challenges:
Uncontrollable outburst
Mute conditions
Hear voices
See objects that do not exist
Communicating with patients with moderate to severe disorders required indepth training
Back to Learning Outcomes

Special Communication Challenges (cont’d.)
Methods for communicating with patients with mild mental illnesses:
Tell patient what to expect
Keep conversations focused and professional
Do not force or demand answers
If you feel unsafe, speak to your supervisor or the physician
Do not confirm hearing voices or seeing nonexistent objects
Orient the patient to reality as appropriate
Back to Learning Outcomes
Your communication should be professional, nonjudgmental, and encouraging when appropriate.

Special Communication Challenges (cont’d.)
Angry or Distressed Patients
Contributing factors:
Frustration
Long wait times—keep patients informed of long wait times
Illness
Financial strain
Billing or insurance problems
Bad health news
Back to Learning Outcomes

Special Communication Challenges (cont’d.)
To improve communication:
Be supportive
Take to private area
Stay calm
Be open and honest
Do not provide false reassurance
Do not belittle problem or concern
Ensure own safety if angry patient becomes aggressive or threatening
Back to Learning Outcomes
The key to communicating with upset patients is to prevent an escalation of the problem.

Special Communication Challenges (cont’d.)
Developmental
Need to understand stages of development
Erik Erikson, developed theory of 8 stages of development
Each stage has different accommodations to be made when interacting with patients
Back to Learning Outcomes

Special Communication Challenges (cont’d.)
Children
To facilitate communication:
Place child at your eye level or lower yourself to child’s eye level
Keep voice gentle and low-pitched
Make movements slow and visible
Rephrase question until sure child understands
Tell child when you will touch him or her
Expect that a child will return to an earlier developmental phase when ill
Use play and toys to phrase questions
Allow child to express feelings
Back to Learning Outcomes

Special Communication Challenges (cont’d.)
Adolescents:
May wish to be seen without parent
Do not show shock or disapproval — will stop communicating
Back to Learning Outcomes

Special Communication Challenges (cont’d.)
Back to Learning Outcomes

Figure 3-5 The medical assistant communicates at the child’s eye level.

Checkpoint Question
What is the stage of development in which trust versus mistrust is developed?
Back to Learning Outcomes

Checkpoint Answer

The developmental stage where trust versus mistrust is developed is the infant stage, ages 0 to 1 years.
Back to Learning Outcomes

Communicating with a Grieving Patient or Family Member
Loss of loved one
Death
Loss of relationship
Loss of body part
Loss of health
Dr. Elisabeth Kübler-Ross’ five distinct stages of grief in On Death and Dying— mourning can occur over months or years:
Denial: Patient does not believe diagnosis
Anger: Toward doctor or facility
Bargaining: Attempt to trade diagnosis
Depression: Quiet, withdrawn, uncaring
Acceptance: Acknowledgment of situation
Back to Learning Outcomes
grief: great sadness caused by loss
mourning: to demonstrate signs of grief: grieving

Communicating with a Grieving Patient or Family Member (cont’d.)
Back to Learning Outcomes

Communicating with a Grieving Patient or Family Member (cont’d.)
Grief when a patient dies:
Normal to feel sad
Focus on empathy, not sympathy
Empathy = feeling with
Sympathy = feeling for
Back to Learning Outcomes
Empathy can help you recognize a patient’s fear and discomfort so you can do everything possible to provide support and reassurance.

Checkpoint Question

What are the five stages of grieving?
Back to Learning Outcomes

Checkpoint Answer

The five stages of grieving are:
Denial
Anger
Bargaining
Depression
Acceptance
Back to Learning Outcomes

Establishing Positive Patient Relationships
Proper Form of Address
Use proper form of address to show respect and set a professional tone
Use last name unless otherwise instructed by patient
Calling patients by pet names, such as sweetie, granny, gramps, or honey, can offend the person
Avoid referring to patient by his or her medical condition
Back to Learning Outcomes
Pet names denigrate the individual’s dignity and put the interaction on a personal, not professional, level.

Establishing Positive Patient Relationships
Professional Distance
Avoid revealing intimate information about yourself
Choose general topics and keep the conversation light
Back to Learning Outcomes
You should not become too personally involved with patients because doing so may jeopardize your ability to be objective.

Establishing Positive Patient Relationships (cont’d.)
Teaching Patients
Be knowledgeable about current medical issues, discoveries, and trends.
Be aware of special services available in your area.
Have pertinent handouts or information sheets available.
Allow enough teaching time so that you are not interrupted or rushed.
Find a quiet room away from the main office flow if at all possible.
Back to Learning Outcomes

Establishing Positive Patient Relationships (cont’d.)
Give information in a clear, concise, sequential manner; provide written instructions as a follow-up.
Allow the patient time to process this new information.
Encourage the patient to ask questions.
Ask open-ended questions in a way that will allow you to know whether the patient understands the material.
Invite the patient to call the office with additional questions that may arise.
Back to Learning Outcomes

Professional Communication
Assertiveness in Professional Communication
An assertive person:
Sets clear boundaries for himself or herself and others
Knows how to set limits
Clearly and politely communicates his or her wants and needs
Can say “no” without offending another person
Understands the appropriate time for assertiveness versus passive compliance
Back to Learning Outcomes

Professional Communication (cont’d.)
Refuses to be inappropriately dominated or “handled”
Considers the feelings and roles of others
Voices differences of opinion without being rude or overbearing
Stands up for what he or she believes when appropriate
Holds himself or herself with confidence and maintains eye contact
Looks for compromise, not conflict
Speaks firmly but pleasantly
Respects others
Understands when he or she is about to “step over a line” and pulls back
Is honest and fair
Back to Learning Outcomes

Professional Communication (cont’d.)
An aggressive person, conversely, is:
Hostile
Threatening
Demanding
Loud
Annoying
Sarcastic
Angry
Mean
Back to Learning Outcomes

Professional Communication (cont’d.)
Communicating with Peers
Must remain professional
Minimize discussion of non-work-related topics
Minimize loud talking, laughter, whispering
Remain honest
Become active in local professional organization
Back to Learning Outcomes
Involvement in local community organizations and support groups is also beneficial to promoting you and your profession.

Professional Communication (cont’d.)
Communicating with Physicians
Address with professional title
Use correct medical terminology
Do not use slang
Display confidence
Communicate clearly
Be honest if you do not know something
Back to Learning Outcomes

Professional Communication (cont’d.)
Communicating with Other Facilities
Maintain patient confidentiality
Observe legal requirements for dispensing patient data
Use caution with fax machines, e-mail, and other electronic devices
Provide only facts
Always be nonjudgmental
Confirm receipt of message
Back to Learning Outcomes

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