communication 2e - o'toole - 9780729541008

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Contents

Preface xAcknowledgements xiReviewers xii

SECTION ONE – THE SIGNIFICANCE OF INTERPERSONAL COMMUNICATION IN THE HEALTH PROFESSIONS 1

1 Definingeffectivecommunicationforhealthprofessionals 3Whylearnhowtocommunicate?–Everyonecancommunicate! 4Factorstoconsiderwhendefiningeffectivecommunication 4Chaptersummary 8References 9

2 Theoverallgoalofcommunicationforhealthprofessionals 11Amodeldemonstratingtheimportanceofcommunication 12Amodeltoguidethegeneralpurposeofcommunicationforthehealthprofessions 13Chaptersummary 17References 18

3 Thespecificgoalsofcommunicationforhealthprofessionals:1 20Makingverbalintroductions 21Providinginformation:atwo-wayprocess 24Reviewquestions 26Chaptersummary 28References 28

4 Thespecificgoalsofcommunicationforhealthprofessionals:2 30Interviewingandquestioningtogatherinformation 31Comforting:encouragingversusdiscouraging 35Confrontingunhelpfulattitudesorbeliefs 37Reviewquestions 39Chaptersummary 42References 42

SECTIONTWO – DEVELOPINGAWARENESSTOACHIEVEEFFECTIVECOMMUNICATIONINTHEHEALTHPROFESSIONS 45

5 Awarenessofandneedforreflectivepractice 47The‘what’ofreflection:adefinition 48Theresultofreflection:achievingself-awareness 49The‘why’ofreflection:reasonsforreflecting 50The‘how’ofreflection:modelsofreflection 52Reflectionuponbarrierstoexperiencing,acceptingandresolvingemotions 56Reviewquestions 59

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Chaptersummary 61References 61

6 Awarenessofself 65Self-awareness:anessentialrequirement 66Beginningthejourneyofself-awareness 67Individualvalues 69Isahealthprofessionanappropriatechoice? 69Valuesofahealthprofessional 70Characteristicsandabilitiesthatenhancethepracticeofahealthprofessional 71Personalunconsciousneeds 71Conflictbetweenvaluesandneeds 73Perfectionismasavalue 74Self-awarenessofpersonalcommunicationskills 75Self-awarenessofskillsforeffectivelistening 76Self-awarenessaboutskillsforeffectivespeaking 78Preferencesformanaginginformationandresultantcommunicativebehaviours 79Personalityandresultantcommunicativebehaviours 80Reviewquestions 81Chaptersummary 85References 85

7 Awarenessofhowpersonalassumptionsaffectcommunication 88Reasonstoavoidstereotypicaljudgementwhencommunicating 89Stereotypicaljudgementthatrelatestoroles 90Developingattitudesthatavoidstereotypicaljudgement 92Overcomingthepowerimbalance:waystodemonstrateequalityinarelationship 93Reviewquestions 94Chaptersummary 98References 98

8 Awarenessofthe‘Person/s’ 100WhoisthePerson/s? 101Thepurposeandbenefitofanessentialcriterion:respect 101Definingrespect 101Demonstratingrespect 103WhatinformationwillassistthehealthprofessionalwhenrelatingtothePerson/s? 104Reviewquestions 118Chaptersummary 121References 121

9 Awarenessoflisteningtofacilitateperson/s-centredcommunication 124Definingeffectivelistening 125Therequirementsofeffectivelistening 125



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Resultsofeffectivelistening 126Barrierstoeffectivelistening 127Preparingtolisten 127Disengagement 129Reviewquestions 131Chaptersummary 134References 134

10 Awarenessofdifferentenvironmentsthatcanaffectcommunication 136Thephysicalenvironment 137Theemotionalenvironment 143Theculturalenvironment 144Environmentsrelatingtosexuality 147Thesocialenvironment 148Thespiritualenvironment 149Reviewquestions 149Chaptersummary 152References 152

SECTIONTHREE – UNDERSTANDINGANDMANAGINGREALITIESOFCOMMUNICATIONINTHEHEALTHPROFESSIONS 155

11 CommunicationwiththewholePerson/s 157DefiningthewholePerson 158Holisticcare 159Holisticcommunication 162Reviewquestions 163Chaptersummary 165References 165

12 Non-verbalcommunication 167Thesignificanceofnon-verbalcommunication 168Theeffectsofnon-verbalcommunication 168Thecomponentsofnon-verbalcommunication 169Suprasegmentals:prosodicfeaturesofthevoice 171Suprasegmentals:paralinguisticfeaturesofthevoice 172CommunicatingwiththePerson/swhohaslimitedverbalcommunicationskills 174Reviewquestions 176Chaptersummary 179References 179

13 Conflictandcommunication 181Conflictduringcommunication 182Resolvingnegativeattitudesandemotionstowardsanother 184Patternsofrelatingduringconflict 184Howtocommunicateassertively 187Reviewquestions 189



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Chaptersummary 191References 191

14 Culturallycompetentcommunication 193Definingculture 194Culturalidentityaffectingculturallycompetentcommunication 195Definingculturallycompetentcommunication 195Whyconsiderculturaldifferences? 197Amodelofculturallycompetentcommunication 197Managingpersonalculturalassumptionsandexpectations 202Strategiesfordemonstratingculturallycompetentcommunication 204Usinganinterpreter 206Thecultureofeachhealthprofession 208Thecultureofdiseaseorill-health 208Reviewquestions 209Chaptersummary 211References 211

15 CommunicatingwithIndigenousPeoples 214Correctuseofterms 215The4Rsforreconciliation:Remember,Reflect,Recognise,Respond 215Thecomplexityofculturalidentity 217PrinciplesofpracticeforhealthprofessionalswhenworkingwithIndigenousPeoples 218FactorscontributingtoculturallysafecommunicationwithIndigenousPeoples 224Barrierstoculturallysafecommunication 227Reviewquestions 228Chaptersummary 231References 231Furtherreading 232Websitesand/ororganisations 233

16 Misunderstandingsandcommunication 234Communicationthatproducesmisunderstanding 235Factorsaffectingmutualunderstanding 235Causesofmisunderstandings 237Strategiestoavoidmisunderstandings 239Resolvingmisunderstandings 241Reviewquestions 242Chaptersummary 244References 244

17 Ethicalcommunication 246Respectregardlessofdifferences 247Honesty 248Clarificationofexpectations 249Consent 249Confidentiality 250



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Boundaries 252Ethicalcodesofbehaviourandconduct 254Reviewquestions 254Chaptersummary 257References 257Furtherreading 259Usefulwebsites 259Informedconsent 260

18 Remotecommunication 262Characteristicsofremoteformsofcommunicationforthehealthprofessional 263Principlesthatgovernprofessionalremotecommunication 265Reviewquestions 273Chaptersummary 276References 276

SECTIONFOUR – THEFOCUSOFCOMMUNICATIONINTHEHEALTHPROFESSIONS:PERSON/S 279

Person/sexperiencingstrongemotions 283Stagesoflife 291Particularliferoles 302Long-termconditions 319Particularcontexts 341References 350Furtherreading 350

Glossary 352Index 359



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1The Significance of Interpersonal Communication in the Health Professions

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Chapter 1

Defining effective communication for health professionals

Chapter objeCtives

Upon completing this chapter, readers should be able to:• Explain why it is essential to learn about effective communication• State an underlying principle for effective communication• Describe a model of interpersonal communication relevant to the health professions• Define effective communication• Demonstrate understanding of the importance of effective communication• Identify factors contributing to effective communication• Demonstrate understanding of the importance of considering the ‘audience’ to achieve

effective communication.

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Why learn how to communicate? – Everyone can communicate!Communication occurs constantly throughout the world and most individuals participate in acts of communication every day regardless of their nationality, age or interests. Most people would agree that communicative interactions are unavoidable and usually essential for satisfactory daily life. Even those who are unable to produce speech seek to effectively communicate every day. If everyone already communicates in daily life, then why is it necessary to learn how to communicate in healthcare settings? Simply, in most healthcare settings there are specific required characteristics of communication and particular situ-ations that challenge the communication skills of any communicating person. Effective communication in a healthcare setting requires particular understanding of people and oneself (Zimmerman et al 2007), as well as highly developed communication skills. Individuals do not usually acquire such awareness or skill in everyday life, thus it is ben-eficial if preparing to be an effective health professional to learn about communication. Higgs et al (2005, 2010) indicate that effective communication is an essential core skill of any health professional. In addition, competent communication skills are a requirement to practise in many health professions. Ineffective communication negatively affects health outcomes, thus in New Zealand particularly, failure in communication is repeatedly the cause of complaints made to the Health and Disability Commissioner (Hill 2011a, 2011b). Certainly there is evidence to suggest that communicating after experiencing a health condition increases recovery rates and decreases the incident of further conditions (Davison et al 2000, Pennebaker 1995, 1997). Generally, effective communication ensures positive outcomes for all people relating to health professionals (Hassan et al 2007, Koponen et al 2010). Thus if effective communication skills are vital for successful outcomes of practice in the health professions, it is crucial to understand both communication and what constitutes effective communication.

A guiDing principleBefore defining communication it is important to establish an underlying principle to guide communication for health professionals. Self-awareness and self-knowledge are necessary requirements for successful adherence to this principle. The principle simply states:

Do not say or do anything to another person that you would not want said or done to you.

Adapted from Hillel around 15 BC

Consistent consideration of and adherence to this principle is not always easy, but it will generally produce effective communication in health care practice and in life.

Factors to consider when defining effective communicationMany dictionaries indicate that communication involves the sending and receiving of messages. They state that communication occurs in auditory/verbal, visual and non-verbal forms. This understanding of communication suggests that the act of communicating resembles a game of tennis. In the same way that tennis players hit a ball to each other,



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communicators send and receive messages in various forms. Initially this metaphor seems appropriate, but tennis players only interact with the ball; they nor-mally do not interact with each other. In addition the tennis ball remains constant, unlike messages, which change and develop when communicating. These realities suggest defining communication requires more than a comparison with playing tennis.

Effective communication involves more than simply sending and receiving words by producing and receiving sound. As effective communication occurs in many forms, including vocalising without words (e.g. laughing or crying), non-verbal cues (e.g. eye contact, facial expressions, gestures and signing) and material forms (e.g. pictures, pho-tographs, picture symbols, logos and written words) (Crystal 2007), it requires consid-eration of multiple factors.

MutuAl unDerstAnDingEach communicative act or interaction is unique, with unique requirements and con-straints. These requirements and constraints influence the effectiveness of the interaction at the time. The combination of these factors along with ongoing discussion determines whether the interaction produces mutual understanding. Successfully negotiating mutual understanding will encourage those communicating to trust their ability to communicate effectively (Stein-Parbury 2009) and thus they will continue to communicate. Every com-munication act requires all communicators to be actively involved, to connect with and understand each other, and to understand the factors affecting the communication act (Brill & Levine 2005, Hassan et al 2007). Effective communication requires the commu-nicating parties to have some basic knowledge about each other and their individual goals (Devito 2009).

FIGURE 1.1 A model to guide communication in the health professions. Note: Person/s is used to describe those relating to the health professional during practice.

negotiating mutual understanding

Send

Receive

Send

Receive

HealthProfessional

Person/s

VulnerableSelf/Person aware

• Does communicating in the health professions require more than speech, hearing and sight? If so, what does it require?



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Communication is ineffective, without mutual understanding. Therefore, the sending and receiving of a message achieves nothing unless there is shared meaning and meaning-ful exchange of information. The specific purpose of communication among health pro-fessionals (see Chs 3 & 4) is to share information and fulfil needs. If mutual understanding is not negotiated through words and non-verbal messages (Gietzelt & Jones 2002), there is no appropriate information to guide an intervention and potentially limited fulfillment of needs. For example, if there is no connection (Hassan et al 2007, Horan et al 2011) and exchange of information with mutual understanding when there is a need for a toilet or something in which to vomit, the results can be messy and, more importantly, time consuming.

Effective communication in the health professions occurs when the sender and receiver connect with each other for the common purpose of exchanging information and achiev-ing mutual understanding. It is essential for health professionals to negotiate or continue discussion during their interactions until achieving mutual understanding, thereby ensur-ing appropriate interventions and meaningful results.

A coMMon unDerstAnDing of worDsMutual understanding is essential for effective com-munication. However, different factors influence the comprehension of a message. These factors may either facilitate or restrict communication.

Effective communication requires two or more people to have a topic of mutual interest, a mutual desire, intent or need to communicate about the topic, the opportunity to communicate and the means of communicating. Thus, if there is no common under-standing of language or way of communicating there will be no mutual understanding and thus no exchange of information or effective communication (Nunan 2007). This potentially will restrict health outcomes.

factors external to the sender and receiverThe words in the box above (file, stand etc) have meanings that might vary within the context of the situation or environment (Nunan 2007). Thus, if asked for a ‘file’ (e.g. Pass that file please) when there is no obvious folder with pieces of paper inside, the receiver of the request might search for other meanings of the word. They might see an implement used to file nails in the environment and assume that is the required file. In this case, the receiver of the message assumes the meaning because of features of the environment.

There are other external factors that affect the meaning an individual might assign to a word. Someone who comes from a particular background (Purtilo & Haddad 2007) or who has particular life experiences might assign a particular meaning to one word. For example, someone with a scientific or nursing background might assume that the word ‘stand’ means a structure used to hold or support something, while someone with a political background might assume it means to run for election. Someone with a military background might assume it means to resist an onslaught without being harmed, while someone with another background or experience might assume it means to position themselves on both legs with a straight back and stay in that position without moving. In this case it is the background and experience of the communicating individuals that affect the understanding of the particular word. The background or experience might be

• Consider the different meanings of the following words: file, stand, form, compress, bracing, crutch and ‘a simple case’.

• Can you think of other words or combinations of words that might cause miscommunication?

• What factors might change the meaning an individual assigns to a word or combination of words?



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particular to a family, socioeconomic group or culture; all of these factors and more can affect and vary the meaning of messages. It is important when communicating in the health professions, therefore, to consider related factors that might influence the achievement of mutual understanding, effective com-munication and thus positive health outcomes.

factors specific to the senderSenders of messages often express their messages according to their own thoughts, agenda, needs or feelings at a given time. For example, senders often communicate their intended meaning through emphasis or stress on a particular word, rather than the actual words they use (Crystal 2007).

factors specific to the receivers or ‘audience’In every communicative event someone receives a message or information. The audience is the person or group of people who receive the message or infor-mation. In the health professions there are many people who constitute the audience including col-leagues, Person/s and family members.

There are many factors that influence the effec-tiveness of communication and some of these factors are specific to the receiver/audience. When commu-nicating as a health professional, the potential impact of these audience factors upon communication man-dates their consideration.

Every person has particular knowledge and asso-ciated levels of understanding that affect their ability to comprehend particular messages (Milliken & Honeycutt 2004). Thus, when practising as a health professional it is important to communicate in ways that acknowledge the level of understanding and/or knowledge of the audience.

The age of the person is one factor that can influ-ence the knowledge or level of understanding. There-fore, when talking to a young child it is appropriate to adjust the communication style by using less complex words or sentences. This adjustment of communication style assists the mutual understanding of both the speaker and the child. Using the same simplistic language when talking to an adolescent or adult, however, may cause offence. An additional factor that requires adjustment of language is the cultural/language background of the audience (Fageeh 2011) (see Chs 7 & 14 and Section 4).

A further factor that requires consideration is whether or not to use professional jargon. The decision of how and when to use professional jargon requires the health professional to consider the experience and background of the person (Purtilo & Haddad

Consider:• It is time we had those ATOs in the

store means: Can you put the ATOs in the store now?

• Have you seen that splinting material? means: I have asked everyone else – do you know?

It is often the emphasis on particular words that changes the intended meaning of a sentence.Compare:• I want a drink of water.• I want a drink of water.• I want a drink of water.The emphasis changes the meaning of each statement. The first is a statement of a desire to have a drink of water. The second suggests a focus upon the speaker; thereby implying the irrelevance of the desires of others. The third indicates that the desired drink is water and nothing else. In each case the emphasis indicates the particular desire of the person sending the message. If the receiver fails to note the emphasis in the last sentence, for example, the sender of the message may not receive the desired drink.

• List all the people with whom a health professional might communicate.

• For each person or group of people list factors specific to that person or group that might affect their ability to understand a sent message.



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2007). The use of medical terminology may be appropriate if the person has a medical background and understanding of that particular field of medicine. It may also be appro-priate if they have previous experience with such terminology, but may cause confusion if they do not have the knowledge, understanding or experience of such terminology. When communicating with health professional colleagues about medically related topics, use of non-medical terminology may cause confusion! In order to avoid confusion it is important to consider and sometimes request information about the knowledge and experience of the audience when communicating as a health professional. It is certainly beneficial to ensure there is understanding of all relevant terms.

A particular disorder affecting an individual may also influence the success of the communicative event. In some circumstances it may be essential to communicate only one idea or step at a time. For example, individuals with limited cognitive ability and reduced affect require adjustments in the communication style of the health professional and their manner of constructing and delivering a message.

It is not only the age, background and experiences of the receiver that can affect their levels of understanding. Receivers of messages often interpret messages according to their own thoughts, ideas, needs or emotions at that given time, which may assist or adversely affect their understanding of the messages (see Chs 5 & 6 and Section 4). Effective com-

munication between a health professional and the people seeking their assistance should be an exchange of thoughts, ideas, needs and emotions that has a therapeutic outcome (Paré & Lysack 2004, Seikkula & Trimble 2005). A health professional who consid-ers and appropriately adjusts to the thoughts, ideas, needs and emotions of the receiver will usually promote mutual understanding and thus achieve effective communication.

Chapter summaryEffective communication occurs when people send, receive and understand messages. Such communication produces mutual understanding and is essential for health

FIGURE 1.2 Mutual understanding is essential!

• List at least six factors that facilitate effective communication.

• State whether these factors are external or internal to the sender or receiver.



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professionals. There are both external and internal factors that influence information exchange through mutual understanding. These factors occur in the environment, in the sender and the receiver. A sound understanding and consideration of these factors con-tributes to effective communication and positive health outcomes.

RefeRencesBrill N I, Levine J 2005 Working with people: the helping process, 8th edn. Pearson,

BostonCrystal D 2007 How language works. Penguin Books, LondonDavison K P, Pennebaker J W, Dickerson S S 2000 Who talks? The social psychology of

illness support groups. American Psychologist 55(2):205–217Devito J A 2009 The interpersonal communication book, 12th edn. Pearson, BostonFageeh A A 2011 At crossroads of EFL learning and culture. Cross-cultural

Communication 7(1):62–72Gietzelt D, Jones G 2002 Importance of language – single words don’t communicate all

that is necessary. In: Bergland C, Saltman D (eds) Communication for healthcare. Oxford University Press, Melbourne, p 18–32

Hassen I, McCabe R, Priebe S 2007 Professional–patient communication in the treatment of mental illness: a review. Communication & Medicine 4(2):141–152 Doi:10.1515/CAM.2007.018

Higgs J, Ajjawi R, McAllister L et al 2010 Communicating in the health sciences. Oxford University Press, Melbourne

Higgs J, Sefton A, Street A et al 2005 Communicating in the health and social sciences. Oxford University Press, Melbourne

Hill A 2011a Consumer-centred care: seamless service needed. New Zealand Health & Disability Commission, August. Online. Available: http://www.hdc.org.nz/ 10 Jan 2012

Hill A 2011b Recurring themes. Society of Anaesthetists Newsletter, FebHoran S M, Houser M L, Goodboy A K et al 2011 Students’ early impressions

of instructors: understanding the role of relational skills and messages. Communication Research Reports 28(1):74–85 Doi:10.1080/08824096.2011. 541362

Koponen J, Pyööräälää E, Isotalus P 2010 Teaching interpersonal communication competence to medical students through theatre in education. Communication Teacher 24(4):211–214 Doi:10.1080/17404622.2010.514275

Milliken M A, Honeycutt A 2004 Understanding human behavior: a guide for healthcare providers, 7th edn. Thomson Delmar, New York

Nunan D 2007 What is this thing called language? Palgrave Macmillan, BasingstokeParé D, Lysack M 2004 The willow and the oak: from monologue to dialogue

in the scaffolding of therapeutic conversations. Journal of Systemic Therapies 23:6–20

Pennebaker J W 1995 Emotions, disclosure & health. American Psychological Association, Washington, DC

Pennebaker J W 1997 Opening up: the healing power of expressing emotions. Guildford Press, New York

Purtilo R B, Haddad A 2007 Health professional and patient interaction, 7th edn. Saunders, Philadelphia



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Seikkula J, Trimble D 2005 Healing elements of therapeutic conversations: dialogue as an embodiment of love. Family Process 44:461–473

Stein-Parbury J 2009 Patient and person: interpersonal skills in nursing, 4th edn. Churchill Livingstone Elsevier, Sydney

Zimmerman S S et al 2007 Using the power of student reflection to enhance professional development. Internet Journal of Allied Health Sciences and Practices 5(2):1–7



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