Communicating With Patients Families, and Caregivers

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Communicating With Patients Families, and
Caregivers
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Overview

• Active Listening
• Patients needs
• Setting your needs aside
• Responding
• Conflict management
• Assertive, not aggressive, communications
• Communicating across cultures

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Patients Can Teach Lessons of Life

• What lesson or lessons did you learn from reading
  the article Patients can teach lessons of life?
• What interferes with listening to the patient?

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Barriers to Good Communication

• Listening
• Our own problems stress levels
• Personality conflicts who we like and dont like
• Responding
• How we manage conflict
• Not knowing how to be assertive rather than
  passive or aggressive

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Barrier to Listening Your Stress Level

• 0 15
• 16 40
• 41 117

• Relatively low level of stress
• Mild to moderate level of stress
• High level of stress

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Coping with Stress

• Monitor your stress level
• Engage in relaxation techniques
• Identify the source
• See stressful situations as a challenge
• Positive attitude I can
• Support systems
• Positive lifestyle exercise, nutrition, rest and
  relaxation (Mens sana in corpore sano Homer)
• Seek professional help

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Barrier to Listening Personality Conflicts
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Who Do We Like? Who Dont We Like?

• Personal Characteristics

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The Case of Ralph and Mark
Ralph Jones and Mark Harris were both
17-year-old seniors in high school. Ralph was
shot in the back by a drug dealer he was trying
to rip off, and Mark was in a car accident after
being out partying and drinking one night with
friends (he was not driving). Both were left
paralyzed from the waist down.  After a
couple of years, Ralph is depressed, antisocial
and not taking good care of himself. He is
frequently rehospitalized for bedsores and
ulcers. He still abuses drugs and drinks heavily.
In contrast, Mark has gotten involved in National
Handicapped Sports Association activities, has a
girlfriend and travels to high schools talking to
kids about drinking and driving. He has a part
time job with a telephone marketing company and
is planning to return to school to get his GED. 
You have received referrals for both of
these clients. You have capacity to add one new
client to your service right now. The other
person will have to wait for at least one month
to receive your services. Who do you add Ralph
or Mark?
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Develop Listening Habits and Techniques

• Let the speaker finish
• Let the speaker know youre listening
• Concentrate
• Be an active listener (attentive)

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Barrier to Responding Conflict Management Style

• Know your own style
• Learn how to deal with conflict

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Common Styles

• The Competitor
• The Harmonizer
• The Side-Stepper
• The Deal-Maker
• The Team Player

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The Competitor

• Quick, decisive action especially if perceives
  action will be resisted
• Aggressive
• Uncooperative
• You should You must
• Power oriented to support position
• rank, quote authorities, economic sanctions

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Harmonizer

• Opposite of competitor
• Non-assertive
• Cooperative to please others even if neglect own
  concerns
• Self-sacrificing behavior to please others
• Obeying others even when rather not
• Speak softly and use qualifiers
• Reluctant to rock the boat fear of what others
  think

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Side Stepper

• Avoids conflict by not expressing own needs
• Changes the subject, tone of interaction, focus
  on distraction
• Useful when damage associated with confronting
  issue exceeds benefit of resolution
• Style reduces tension helps to gain perspective
  and composure

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Deal Maker

• Can we make a deal?
• Spirit of compromise and negotiation
• Each party gives in a bit and concedes a bit
• Acknowledges others and self beliefs and values
  but bargains are without underlying trust as
  values are just surface issues
• Useful under time pressure get it done

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Team Player

• Collaborator
• Finds solution to integrate concerns, beliefs,
  and values of each party
• Works through these feelings to reach mutual
  decision
• Requires trust and openness
• Listens, generates options from learning about
  and understanding the other persons perspective

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How To Handle Conflict

• Identify the problem.
• Determine importance of the problem.
• Focus on behaviors causing conflict.
• Determine specific change strategy.
• Begin behavior change strategy.
• Follow-up.

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Conflict Management

• Remember
• The important thing is to resolve conflict and go
  on to channel your energy and resources into more
  positive and productive uses.

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Barrier to Responding Being Non-Assertive or
Aggressive

• Non-assertive
• Aggressive
• Assertive

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Non-assertive

• Quiet or passive
• Fails to get your point across
• Giving in
• Message I dont count, I am not as important as
  you.
• Problem You end up feeling bad about yourself.

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Aggressive

• Hostile, angry, offensive, sarcastic or
  humiliating, belittling
• Message conveyed You are stupid.
• Problem Others wont cooperate or work with you.

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Assertive

• Direct, congruent expression of your thoughts,
  feelings, beliefs and opinions
• Message This is how I view the situation. This
  is what I think or feel.
• Advantage Non-offensive and youll feel good
  about yourself.

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Assertive Responses

• Saying no
• Making requests
• Initiating conversations
• Disclosing self
• Expressing affection
• Expressing opinions and being confrontational
  (I messages)

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Owning the Problem I Messages

• I feel the emotion
• I own the problem
• I want to get the problem solved
• NO blaming

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DESCFormat for Assertive Communication

• D Describe the situation When
• E Express your feelings I feel
• S Specify change Id like
• C Consequences of changing In that way
  x,y, z, will happen.

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DISC

• If person does not care how you feel
• eliminate the E (express feelings) and
  substitute I
• I indicate the problem the behavior is causing

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Assertive Behavior

• More difficult in new situations, i.e. clinicals
• Learned by practice
• No guarantee you will get what you want -
  preserves dignity, honesty and regard for others
• Words alone not enough- look to your body
  postures
• Sometimes best assertive response is to walk
  away- How important is this and what
  consequences?

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Cases

• Use I statements to respond assertively, not
  aggressively, to the patient, family member or
  caregivers remarks in the following cases

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• 1. You are getting ready to teach a 28-year-old
  college football player to use crutches NWB one
  day s/p an ACL repair. He says, I dont need you
  to show me what to do. I can figure it out
  myself.

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• 2. You have spent an hour teaching a mother a
  complicated and lengthy home program for her
  child with cerebral palsy. As the mother and her
  child are leaving, you notice that she has left
  her written instructions on the treatment table.
  You run after her to give her the instructions,
  and when you catch up with her she says, I dont
  need that. I remember everything you showed me.

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• 3. You are treating an 82-year-old former
  school teacher after a THR. As you start
  reviewing her THR precautions, she disdainfully
  says, I can get this information from my doctor.
  Youre too young to know what youre doing.

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• 4. You call the referring physician to discuss
  the fact that he has requested e-stim for your
  patient. You believe the treatment is
  contraindicated because the patient has a
  demand-type pacemaker, but as you start to
  discuss this with the physician, he says, Young
  lady or young man I dont need you to tell me
  this. I have many more years of experience than
  you, and theres no reason why you cant do this
  treatment on this patient.

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• 5. Mrs. Whiner always come to PT almost an hour
  early and expects to be seen as soon as she
  arrives, rather than wait for her scheduled
  appointment time. One day she screams at you, I
  am tired of waiting! I should have been seen
  before her! I was here first!

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• 6. You offer PT services in a gym that also has
  scheduled hours for the public. However, at the
  time the public is supposed to leave and the PT
  patients take over using the equipment, there are
  some people who wont leave. They argue with you
  that its their turn to use the equipment, not
  theirs (meaning your patients).

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Benefits of Assertive Behavior

• Ethical and healing responsibility
• Increases our self respect
• Increases our self control
• Improves self confidence
• Helps develop more emotionally satisfying
  relationships
• Increases likelihood that everyones needs be met
• Exercise our rights without denying rights of
  others

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Video Communicating Across Cultures