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Starting the Conversation

• One of the biggest barriers to difficult conversations is how to
start them

• Health care professionals may avoid such conversations, not

wanting to frighten the patient/family or lead them to think
there is an ominous problem that they are not being open

• The topic of Advance Care Planning can be introduced as an

important and normal component of any relationship
between patients and their health care team
Initiating Conversations
1. Normalize
“Often people in circumstances similar to this have
concerns about __________”

2. Explore
“I’m wondering if that is something you had been thinking

3. Seek Permission
Would you like to talk about that?
Elements of Communication 1-3
Sender Receiver


Communication Model Questions
• What could
happen to block
any of the
elements of
• Is the message always verbal?
• Is the feedback always verbal?
• What interruptions or distractions could
interfere with communication?
Healthcare Communication
• Remember that in a
healthcare setting,
nonverbal cues are
important elements of the
communication model.
• Identify the elements of
communication in this
Feedback Methods 4-7
• Paraphrasing – reword the sender’s message and ask for
• Dr. Smith: “I think Mrs. Jones needs more aggressive treatment for
her anxiety.”
• Dr. Shevlin: “So you think we should order an antidepressant?”
Feedback Methods
• Reflecting – prompts the sender to add more detail to the original
• Dr. Smith: “I think Mrs. Jones needs more aggressive treatment for
her anxiety.”
• Dr. Shevlin: “So you think we should order her medication, such
Feedback Methods
• Asking Questions – request clarification or more additional
information. 8
• Dr. Smith: “I think Mrs. Jones needs more aggressive treatment for
her anxiety.”
• Dr. Shevlin: “Why? Is her current treatment not controlling her
Feedback Methods
• Requesting examples – examples can help explain or clarify meaning.
• Dr. Smith: “I think Mrs. Jones needs more aggressive treatment for
her anxiety.”
• Dr. Shevlin: “What kind of treatment are you thinking about?”
Obtaining Feedback
• Respond to this call to a I need to make an
veterinary office from a appointment for my
pet owner. dog. She’s not doing
• Paraphrasing very well.
• Reflecting
• Asking questions
• Requesting examples
Rules for Effective Communication 9-13
Message must be clear

Sender must deliver message clearly and concisely

Receiver must be able to hear and receive the


Receiver must be able to understand the message

Interruption or distractions must be avoided

Healthcare Information can be Subjective or
• Subjective 14
• Cannot be seen or felt
• Often called symptoms
• Usually statements or complaints from the patient
• Use the patient’s exact words
Healthcare Information can be Subjective or
• Objective 15
• Can be seen or measured
• Often called signs
• Information collected by the senses
Subjective Symptoms

I think I’m
gonna throw My tummy
up. hurts.

It’s really
sore on my I don’t feel
chest. very good.
Objective Signs of Illness
• Pulse rapid, irregular and thready
• Skin cold and clammy
• No respirations
• Lips cyanotic
Subjective or Objective?
1. Coughing • Objective
2. Fatigue • Subjective
3. Headache • Subjective
4. Foul smelling breath • Objective
5. Did not eat anything • Objective
6. Speech slurred • Objective
7. Joints ache • Subjective
8. Nervousness • Subjective
Speaking Skills
• Speak appropriately to the age or status of the receiver.
• Use appropriate terminology or words.
• Ask open-ended questions.
• Speak slowly and clearly.
• Try to be eye-level with the receiver.
• Make sure your non-verbal is consistent with your words.
Listening Skills
• Show interest and concern.
• Stay alert and maintain eye contact.
• Avoid interrupting.
• Pay attention to what the speaker is saying.
• Avoid planning your response while the speaker is
Listening Skills
• Try to see the other person’s point of view.
• Find a quiet or private location.
• Watch the speaker’s facial expressions for consistency
with words.
• Ask for clarification when needed.
• Maintain a positive attitude.
Nurse-Physician Communications
• Frequent occurrence
• Communication across a
hierarchy can be intimidating
• Gender or cultural issues may
complicate further
• Often named as cause of
nurse job dissatisfaction
• Critical for patient safety
Communication and Safe Care
• 60 % of medication errors are
caused by mistakes in interpersonal
• Poor coordination of care is the
most common cause of adverse
events triggering root cause

1Joint Commission Data

Steps to Excellent
Healthcare Communication

4 Assert concerns if needed

3 Actively listen to response
2 Concisely describe the problem

1 Clarify the problem & gather data

Communication with
Other Healthcare Workers
• Step 1 - Gather and clarify all of the information you
need to provide to the physician:
• Nature of the problem
• Supporting information or data
• Clarify in your mind what you would like for
the patient to do
Communication with
Other Healthcare Workers
• Step 2 – State concisely to the physician the problems
that the patient is experiencing.
• Nature of the problem
• Supporting information or data
• Question or issue on which you need
his/her input
Communication with
Other Healthcare Workers
• Step 3 – Actively listen to information communicated
by the physician/healthcare worker
• Listen to the plan of care
• Clarify areas which are unclear by asking
appropriate questions
Communication with
Other Healthcare Workers
• Step 4 – Know how to tactfully use assertive
communication when necessary
• State your concern
• State information that supports your
• Suggest a course of action
• Recap why you feel this action is best option
Assertive Communication
in Patient Care
• Is not:
• Yelling or bullying
• Accusatory
• Being disrespectful of authority
• Is: 16-18
• Focused on patient
• Noting your perceptions
• Persistently raising concerns, intended to move toward desired action
When Assertiveness Doesn’t Work
• Restate your concerns in another way
• Engage another healthcare worker (i.e. Respiratory
• Engage your supervisor
• Engage another physician on the team
Effective Communication
• Essential for real teamwork
• Essential for long term career satisfaction
• Essential for patient safety and quality