session 2 communication skills with practices in breast feeding

SESSION 2COMMUNICATION SKILLS

(LISTENING AND LEARNING)

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Breastfeeding Promotion and Support A Training Course for Health Professionals

Adapted from the Baby Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care (Section 3)

WHO/UNICEF 2009

Session Objectives:

At the end of this session, participants should be able to:

1.Use non-verbal and verbal techniques to encourage a mother to talk without asking too many questions

2.Respond to a mother's feelings with empathy

3.Avoid using words which suggest judgement of the mother and baby.

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COMMUNICATION SKILLS

• Health workers are trained to look for and fix problems BUT

• Good communication means respect for the women’s own thoughts, beliefs and culture

• NOT tell or advise a person what YOU think they should do

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COMMUNICATION SKILLS

Health workers should be able to do more than just offer infoHelp mothers to look at cause of any difficultiesSuggest courses of action to help fix problemSometimes just offer assurance she is doing well

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COMMUNICATION SKILLS IN BF

• Counselling :a way of working with people in which you try to understand how they feel and help them to decide what to do.

• BF is not the only situation in which counselling is useful.

• A BF mother may not talk about her feelings easily

• You need the skill to listen, and to make her feel that you are interested in her. This will encourage her to tell you more.

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Identify Communication Skills of Listening, Learning and Building

Confidence

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COMMUNICATION SKILLS IN BREAST FEEDING

• Communication involves :

A. Listening and learning

B. Building confidence and giving

support

• Not just giving information

C. Arrange suitable follow-up and support

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A. Skills to Listen and Learn

1. Use helpful non verbal communication

2. Ask open questions

3. Encourage the mother to talk

4. Empatise the mother

5. Avoid words which sound judging 8

A. Skills to Listen and Learn1 . Non-verbal Communication

•KEEP your head level

•Remove barriers- desk/folders

•Pay attention to mother -Avoid getting distracted

•Take time without hurrying – don’t look at your watch

•Only touch in appropriate way (hand/arm)

•Don’t touch her breasts/baby without permission

"Good morning, Pn Aniza. How is breastfeeding going for you and the baby?“

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A. Skills to Listen and Learn 2. Ask open questions

• Open questions usually start with "How? What? When? Where? Why?"

Eg. "How are you feeding your baby?“

• You need to assess the situation/difficulty• Ask questions that encourages the mother

to talk• Close questions do not give much info

– Start with “Are you? Did you? Has the baby?– Sometimes suggest the “correct” answer

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A.Skills to Listen and Learn

3. Use responses and gestures which show interest to Encourage mother to talk

• Show we are interested in what mother is saying

• Use responses such as – Nodding/smiling– Simple response eg “Uh “ “Hmm”, “Go on…”

• Reflect back what the mother is saying– Can help clarify the mother’s statement

• Mix reflecting back with other responses11


4.Emphatise

• Show you understand her feelings

• Looking at it from HER point of view

• Vs Sympathy

• Emphatise with her good feelings too, not just bad feelings

• Find out how she feels about the situation

• Ask for more facts 12


5. Avoid judging words

• Judging words include: right, wrong, well, bad, good, problem

• Can make a woman feel – like she is wrong– Something wrong with the baby

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B.Skills to Build Confidence and Give Support

• Good communication skills help mother to feel good and confident to carry out her decisions

• To help her build confidence:

Accept what a mother thinks and feels

Recognise and acknowledge what is right

Give practical help

Provide relevant information using suitable language

Make one or two suggestions.

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1.Accept what a mother thinks and feels

• Acceptance without disagreeing• Does not mean we agree she is right• Accept what she is saying, give correct info

later• Helps mother to trust you and encourages

her to continue the conversation

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2.Recognise and acknowledge what is right

• Recognise and praise what mother and baby are achieving

– Tell mother how well baby is attaching

– Point out how clever the baby is in detaching himself after feed

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3. Give practical help• Milk will flow better if mother is

comfortable– Offer another pillow– Offer to hold baby while she goes to

wash

• May need clear practical help e.g how to express milk

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4.Provide relevant information using suitable language

• Find out what she needs to know at this time

• Use suitable words that mother understands

• Do not overwhelm her with information

5. Make suggestions, not COMMANDS• Provide choices and let her decide• Do not tell her what she should do• Limit suggestions to 1 or 2

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C.Arrange follow-up and on-going support

• After a discussion, mother may

– still have questions but not time to discuss

– think of something else

– find it difficult to put practice into action

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C.Arrange follow-up and on-going support

• Important to arrange follow-up and on-going support

Learn what is available from family and friends

Offer a time to see or talk to her again

Encourage her to see you or another person for help

Refer to community support group if possible

Refer her for more specialised counselling if needed

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2. Practice Communication Skills

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Demo 1: CLOSE QUESTIONS

• HW: "Good morning, pn. I am SN/JM ….Is (baby) well?"

• Mother: "Yes, thank you."• HW: "Are you breastfeeding him?"• Mother: "Yes".• HW: "Are you having any difficulties?"• Mother: "No".• HW: "Is he breastfeeding very often?"• Mother: "Yes".

• Comment: The HW got "yes" and "no" for answers and didn't learn much. It can be difficult to know what to say next.".

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Demo 2: Open questions

• HW: "Good morning, pn. I am JM/SN. How is baby?"

• Mother: "He is well, and he is very hungry."• HW: "Tell me, how are you feeding him?"• Mother: "He is breastfeeding. I just have to

give him one bottle feed in the evening."• HW: "What made you decide to do that?"• Mother: "He wants to feed too much at that

time, so I thought that my milk is not enough".

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Demo 3: Starting and continuing a conversation.

HW: "Good morning, (name). How are you and baby getting on?" Mother: "Oh, we are both doing well thank you.“( ????) HW: "How old is baby now?" Mother: "He is 2 days old today." HW: "What are you giving him to drink?" Mother: "He is breastfeeding, and having drinks of water." HW: "What made you decide to give the water?“ (Open) Mother: "There is no milk in my breasts, and he doesn't want to suck.“

Comment: open, specific, specific, open Sometimes you might need to ask a closed question, eg: "Are you giving him any other food or drink?" or "Are you giving the other feeds by bottle?”

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Demo 4: Using responses and gestures which show interest

• HW: "Good morning, pn. How is breastfeeding going for you these days?"

• Mother: "Good morning. It is going quite well, I think."

• HW: "Mmm." (nods, smiles)• Mother: "Well, I was a bit worried the other day,

because he vomited."• HW: "Oh dear!" (raises eyebrows, looks interested)• Mother: "I wondered if it was something that I ate,

so that my milk did not suit him."• HW: "Aha!" (nods sympathetically).

• Comment:

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Demo 5: Continuing to ask questions

• HW: "Good morning, pn. How are you and baby today?"

• Mother: "He wants to feed too much - he is taking my breast all the time!"

• HW: "About how often would you say?"• Mother: "About every half an hour."• HW: "Does he want to suck at night too?"• Mother: "Yes".

• Comment: The HW asks factual questions, and the mother gives less and less information.

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DEMO 6: REFLECTING BACK

• HW: "Good morning pn. How are you and baby today?"• Mother: "He wants to feed too much - he is taking my breast

all the time!"• HW: “ Baby is feeding very often?"• Mother: "Yes. This week he is so hungry. I think that my milk

is drying up."• HW: "He seems more hungry just for about a week?"• Mother: "Yes, and my sister is telling me that I should give

him some bottle feeds as well."• HW: "Your sister says that he needs something more?"• Mother: "Yes. Which formula is best?“

• Comment: The HW reflects back what the mother says, so the mother gives more information.

• But do not reflect ev. time……..27

Demo7: Mixing reflecting back with other responses

• HW: "Good morning. How are you and baby today?"• Mo: "He wants to feed too much - he is taking my breast all the

time."• HW: “Baby is feeding very often?"• Mo: "Yes. This week he is so hungry. I think that my milk is

drying up."• HW: "Oh dear!"• Mo: "Yes, it is exhausting. My sister tells me that I should give

some bottle feeds and get some rest."• HW: "Your sister wants you to give some bottle feeds?"• Mo: "Yes - she says that I am foolish to struggle on like this."• HW: "How do you feel about that?"• Mo: "Well, I don't want to give bottle feeds.“• Comment: conversation more natural,hw is learning more

about how the mother feels.28

Demo 8: Empathizing

HW: "Good morning, pn. How are you and baby today?"Mother: “Baby is refusing to breastfeed - he doesn't seem to like my milk now!"HW: "You feel that he doesn't like you now?"Mother: "Yes, it's as if he doesn't love me - it just started suddenly this week, after his grandmother came to live with us. She likes so much to give him a bottle feed!"HW: "You feel that she wants to be the one to feed him?"Mother: "Yes - she wants to take him over from me!“

Comment: The HW empathizes with the mother's feelings and learns some very important things - without asking direct questions.

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Demo 9: Empathizing with a mother's good feelings

HW: "Good morning, pn. How is breastfeeding going for you and baby ?"Mother: "He is suckling well and he seems quite contented after feeds now."HW: "You must feel pleased that it is going so well".Mother: "Yes, I am so happy that I don't have to give bottle feeds."HW: "You really enjoy breastfeeding. That's wonderful.“

Comment: It is important to make a mother feel that you are interested in her, even if she does not have a problem.

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Demo 10: Using judging words• HW: "Good morning, pn. Is baby breastfeeding

normally?"• Mother: "Well - I think so."• HW: "Do you think that you have enough breastmilk for

him?"• Mother: "I don't know.......I hope so, but maybe not ..."

(She looks worried.)• HW: "Has he gained weight well this month? May I see

his growth chart?"• Mother: "I don't know........“

• Comment: The HCW is not learning anything useful, but she is making the mother very worried.

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Demo11: AVOID JUDGING WORDS

• HW: "Good morning, pn. How is breastfeeding going for you and baby?"

• Mother: "It's going very well. We both enjoy it!"• HW: "How is his weight? Can I see his growth chart?"• Mother: "Nurse said that he gained more than half a kilo

this month. I was pleased."• HW: "He is obviously getting all the breastmilk that he

needs.“

• Comment: The HW learnt what she needed to know without making the mother worried.

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SUMMARY: COMMUNICATION SKILLS

• Communication involves listening and building confidence, and not just giving information

• 1.Listening and learningUse helpful non verbal communication

Show interest, reflect back and emphatise

Avoid judging words

• 2.Building confidence and giving supportAccept what a mother thinks and feels

Recognise and acknowlege what is right

Give practical help and relevant information

• 3. Arrange suitable follow-up and support 33

REVISION :Skills to Listen and Learn

1. Use helpful non verbal communication

2. Ask open questions3. Encourage mother to talk4. Emphatise the mother5. Avoid words which sound

judging

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REVISION : Non-verbal Communication

•KEEP your head level

•Remove barriers- desk/folders

•Pay attention to mother -Avoid getting distracted

•Take time without hurrying – don’t look at your watch

•Only touch in appropriate way (hand/arm)

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THANK YOU

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session 2 communication skills with practices in breast feeding

Health & Medicine