Health Communications
1) Discuss the differences between verbal and non-verbal communication.
2) Give at least 3 examples of each (be specific and provide details as appropriate). Use examples from your readings, “Communicating with Patients in Crisis” and “Communicating Effectively with Patients Displaying Significant Negative or Resistive Coping Responses”.
Discussion Board Requirements: 250 word count One original post and two reply posts, APA Format, please include references
Communication
Skills
for the
Health Care
Professional
Concepts, Practice, and Evidence
Gwen van Servellen
CHAPTER 15
© 2009 Jones and Bartlett Publishers
Chapter 15
Communicating with Patients in Crisis
© 2009 Jones and Bartlett Publishers
Objectives
Define crisis response
Individuals and groups in crisis
Dysfunctional communication in times of crisis
Relevance of stress and adaptation in periods of crisis
Adaptive and maladaptive coping responses
© 2009 Jones and Bartlett Publishers
Objectives Continued
Stressors, coping resources, and stress resistance resources
Differentiate between situational and developmental crisis
Stages of crisis resolution
Interventions to manage highly anxious patients
Interventions to manage agitated and/or confused patients
© 2009 Jones and Bartlett Publishers
Definition of Crisis and Crisis Responses
More change is required of an individual than capable to deal with at the time
Assumptions
Not all crises are incapacitating
Persons experience crisis in isolation of others
Persons can worsen each others responses through further excitation
Crisis is not the same as the stressor itself
© 2009 Jones and Bartlett Publishers
Dysfunctional Aspects of Crisis Communication
Difficulty in perceiving accurately
Abilities of processing information may be impaired
Ability to express ideas, thoughts, and emotions may be limited
Perceived state of disorganization can increase these deficits
© 2009 Jones and Bartlett Publishers
Impact: Over Stimulation and Under Stimulation
Over stimulation
Rapid bombardment or excessive stimuli
Not too much but stimuli are noxious
Exceed tolerance level
Inability to hear, speak, and if they do hear, unable to move
© 2009 Jones and Bartlett Publishers
Stress Theories and Understanding Crisis
Levels of anxiety and effects on patients; mild to severe and panic
Stress and adaptation
Lazarus and Folkman (1984) coping always discussed when stress effects are analyzed
Studies of stress of different kinds; and stress of the same kind across several groups of individuals
© 2009 Jones and Bartlett Publishers
Adaptive Coping Responses
Seek information
Seek comfort/support from friends or family
Search for solutions to the problem(s)
Self-talk that will help them feel better
Seek professional counseling or advice
© 2009 Jones and Bartlett Publishers
Types of Crisis
Developmental Crises: interruption or unsatisfactory passing from one psychosocial task and developmental phase that correspond also to physical developmental growth
Situational: Crisis emanates from precipitating events that occur and are typically out of the person’s realm of expectancy.
© 2009 Jones and Bartlett Publishers
Caring for Patients in Crisis
Do not re-victimize in the process of helping
Establish an emotional or psychological connection with the patient and family
Do not challenge the validity of the crisis situation or underestimate its effect
Practice active listening skills, direct straightforward approach, become aware of personal responses and their impact
© 2009 Jones and Bartlett Publishers
Summary
Crisis is unavoidable; many illness or injury events can be perceived as a crisis to the patient and family. More needs to be known about the unique expression of crisis across individuals and communities.
Communication
Skills
for the
Health Care
Professional
Concepts, Practice, and Evidence
Gwen van Servellen
CHAPTER 16
© 2009 Jones and Bartlett Publishers
Chapter 16
Communicating Effectively with Patients Displaying Significant Negative or Resistive Coping Responses
© 2009 Jones and Bartlett Publishers
Objectives
Multidimensional situations: patients, tasks, and care contexts
Types of difficult patient behaviors and underlying communications
Ways provider can monitor and apply specific guidelines
Difficult patient encounters and corresponding therapeutic responses
© 2009 Jones and Bartlett Publishers
Difficult Patients, Tasks, and Care Contexts
Difficult patients: behaviors evoke distress in the provider exceeding that expected or accepted
Up to 15% of provider-patient encounters are “difficult”
10%-20% of consultations are with patients of this type
© 2009 Jones and Bartlett Publishers
Difficult Patients, Tasks, and Care Contexts Continued
Care contexts, e.g. dying patient, newly diagnosed terminally ill patient
Care situations, e.g. poorly staffed, little patient continuity, lack of transfer of important medical data
© 2009 Jones and Bartlett Publishers
Difficult Behaviors
Dependent or manipulative
Aggressive
Condescending
Self-pitying
Complaining
Demanding
© 2009 Jones and Bartlett Publishers
Behaviors and Underlying Meanings
The non-adherent patient
Patient barriers
Treatment and disease burden
Patient-provider relationship and system barriers
© 2009 Jones and Bartlett Publishers
Manipulative-Dependent
Found among all genders, ages, ethnicities, income classes
Exaggerated expressions of powerlessness and hopelessness and may be fabricated
Reinforces the authority-subordinate relationship between provider and patient
© 2009 Jones and Bartlett Publishers
Responses to Manipulative Dependent Patient
Thorough assessment of behaviors
Set limits on demands and requests, especially if fabricated
Establish the goals of treatment and engage patient actively as a partner
Avoid honoring special privileges or patient bargaining
Avoid accepting flattery
© 2009 Jones and Bartlett Publishers
Aggressive Patient
Expressed aggression toward provider is troublesome and can occur for many reasons
Patient may or may not be aware of underlying hostility
Assault is rare but can occur
© 2009 Jones and Bartlett Publishers
Responses to Aggression
Fully assess the foundations for the aggression, including health status
Lower the stimuli in the immediate environment
Avoid direct contact if possible or approach with a colleague
Evaluate for medication needs, e.g. pain medications and mild sedative
© 2009 Jones and Bartlett Publishers
Discuss Underlying Meanings and Therapeutic Responses
Complaining and demanding patient
Patient in denial of illness or prognosis
Depressed or anxious patient
© 2009 Jones and Bartlett Publishers
Monitoring Own Reactions
Become aware of your reactions and reflect
Enhance awareness and observation skills
Show patient respect
Practice unconditional positive regard
Show concern and interest
Practice objectivity
Conduct analyses with input from colleagues
© 2009 Jones and Bartlett Publishers
Summary
Dealing with difficult patients, difficult tasks, and difficult care contexts is omnipresent in health care. Providers’ abilities rely on awareness, observation, and well placed responses.
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