The Gift of Gab

What people say about us•Most common complaints:1) Rude2) Heartless3) Impersonal

Isn’t it surprising how many things, if not said immediately, seem not worth saying ten minutes from

now?Arnot L. Sheppard, Jr.

Three components of communication

•Sending messages•Receiving messages•Barriers to effective communication

Sending messages•Verbal

▫What we say•Paraverbal

▫How we say it•Nonverbal

▫How we look when we say it

Verbal •Trust•Get them talking•Listen, Listen, Listen•Stay neutral•Choose words carefully•Reflection

Paraverbal •How we say it

◊“I didn’t say you were stupid”

◊“I didn’t say you were stupid”

◊“I didn’t say you were stupid”

Non-Verbal

Intentional or non-intentional messages that can be interpreted from somebody’s actions or decisions

Non-Verbal

Emotional impact of a message•Words = 7%•Voice tones = 38%•Facial expressions = 55%

Kinesics•The study of

communication that occurs through body movements, positions and facial expression

Appearance

Well groomedProper uniformProper equipment

Look the part!

PosturePositive (open)

ConfidentAt easeAttentiveProfessional

Negative (closed)

DiscomfortAngerDisgustFear

Facial expressions

•The most important conveyor of emotional information

Relative level •Eye contact•Above or over

▫Authority▫Intimidating

•Below▫Best for elderly and children▫Patient fells in control

•Even▫equality

Distance •Intimate zone – 0 to 1.5’

▫Visual distortion▫Assessing breath and body odors

•Personal distance – 1.5’ to 4’▫Perceived as extension of self▫Common assessment distance

•Social distance – 4’ to 12’▫Impersonal

The touch •Shows compassion•Concern•Support•Not accepted in all cultures

Receiving messages

•Requires concentration and energy•Involves a psychological connection•Includes a willingness to see their side•Requires that we suspend judgement

LISTEN

Physical attention

•Gently lean towards the speaker•Face the person squarely•Maintain open posture•Maintain appropriate distance•Appropriate facial expressions and

nodding

Reflective listening

•Paraphrasing▫A brief statement reflecting the speakers

message▫Use your own words

•Reflecting feeling▫A statement of the feeling that you heard▫“You’re worried that…….”

•Summarizing▫A statement of main ideas and feelings to

show understanding

Barriers

Verbal Barriers

•Attacking▫“You wouldn’t be sick if you would take

your medicine.”▫“Did you do what the doctor told you to

do?”▫If you stopped getting drunk everyday you

would probably feel better.”

Showing power▫“If you don’t go to the hospital with me, I’ll

have you arrested.”▫“Once you get in my ambulance, you follow

MY rules.”▫“You’re getting an IV if you ride with me.”

“You messages”▫“You don’t understand medicine, I do.”

▫“You don’t realize that if you don’t give your child the medicine on time, he’ll stay sick.”

▫“You have a mental problem.”

Nonverbal barriers

•Rolling your eyes•Yawning•Closed stance•Avoiding eye contact•Poor personal care•Slow movements•Slouching•Aggressive stance

The Angry Patient

•Usually a defense mechanism▫Fear of loss of control▫Fear of dying▫Fear of meaning of illness▫Fear of disability

Strategies

•Active listening▫Position▫Posture▫Eye contact ▫Silence

Listen and paraphrase what you’ve heard

Empathy

•Cognitive – enter patients’ perspective but don’t loose your own

•Affective – put yourself in patient’s place •Action – verify emotion so patient can

correct and/or feel listened to. Empathy is not the same as agreeing with

patient. Empathizing is expressing understanding of how the patient feels.

“I’m sorry”

• If you made a mistake that lead to anger, admit it and apologize.

•Do not try to excuse, explain or discuss specifics at first… the patient will need to have his or her

feelings validated first before they are willing to listen if they are angry. Trying to excuse the

problem may lead him or her to feel as if their feeling is not valid and lead to more anger.

Questioning techniques

•Leading questions▫Guides the patient’s answer▫“are you having chest pain?”

•Open-ended questions▫Spontaneous answers▫“what seem to be the problem?”

•Closed questions▫“did you eat lunch today?”

Questioning techniques

•Continue to ask open-ended questions▫Keeps them talking▫May reveal important facts

•Use closed questions when necessary▫May help control ‘talkative’ patients▫Useful when time is limited

•Ask only one question at a time

Questioning techniques

•Allow for complete response•Use language they can understand

▫Never tell a child you are going to “take” their blood pressure

▫Avoid medical terminology•Avoid terms of endearment

▫Honey, sweetheart, baby

Effective listening techniques

•Silence▫Give the patient time to answer

•Reflection▫Echo his/her message back in your own

words•Facilitation

▫Encourage the patient to provide more information

•Clarification▫Eliminate confusion

Effective listening techniques

•Confrontation▫Focus the patient on one particular factor

of the interview•Interpretation

▫State your interpretation of the information•Explanation

▫Share factual or objective information•Summarization

▫Briefly review the interview

Traps

•Providing false assurances▫“Everything will be alright”

•Giving advice▫Acceptable

“my opinion is that you should be evaluated at the hospital”

▫Not acceptable “I think you’re crazy not to be seen by a

doctor”

Traps

•Authority▫It’s not a power trip

•Avoidance language▫Changing the subject to avoid something

difficult•Distancing

▫Standing too close or too far•Using “why” questions

▫“why didn’t you call for help 3 hours ago?”

Children

•Three types▫Oblivious (infants)▫Uninformed (child)▫Invincible (teenager)

Elderly •Decreased hearing •Decreased vision•Slow to respond•Fear of hospitals•Do not use terms of endearment

Do’s and Don’ts•Maintain eye

contact•Show interest•Proper tone•Nod•Lean forward•Positive body

language

•Minimal or no eye contact

•Tense facial muscles

•Speaking too fast or too slow

•Yawning•Negative body

language

Blocks •Giving personal opinions•False reassurance•Defensive responses•Arguing•Asking for explanations•Changing the subject

Summary •Establish trust•Body language•Choose words carefully•Tone of voice•Be attentive•Look the part•LISTEN!! LISTEN!! LISTEN!!

Remember ……

It’s their emergency, not yours!

QUESTIONS??Julie Williams, NREMT-P, NCEETraining Coordinator Beaufort County EMSj_williams01@hargray.com