Communication and Critical Thinking Skills



Communication and Critical Thinking Skills



Objectives


Students who successfully complete this chapter will be able to do the following:


• Define communication and the components necessary for communication to occur.


• Compare and contrast verbal and nonverbal communication.


• Identify communication barriers.


• Explain how culture and religion can influence health and illness.


• Discuss various approaches used in communicating with patients who require special assistance.


• List the advantages and disadvantages of sonographer reports, including the creation of images (films and tapes) for patient use.



Key Terms



Communication is sharing information by sending and receiving messages. True communication, however, involves more, including the ability to receive, interpret, and respond appropriately and clearly to messages.



Basic survival needs


According to psychologist Abraham Maslow, the basic needs of humans for survival and functioning are as follows:



Maslow arranged these needs from the lowest to highest levels and postulated that lower-level needs must be met before higher-level needs could be achieved. Picturing these needs in the shape of a pyramid, with physical needs forming the base of the pyramid, is helpful (Figure 3-1).


image
Figure 3-1 Maslow’s basic needs pyramid concept is best demonstrated in the form of a pyramid constructed of basic needs ranging from the lowest (base) to the highest (apex) levels. Successful performance requires satisfying the lower needs before attempting to satisfy the higher needs.







Communication


Communication is a two-way process. Our minds constantly think in pictures and words. The words we speak affect our lives and those of others. Words have the power to create emotions and incite action. The words we choose have consequences for ourselves and others.


Good communication is the foundation of successful personal and professional relationships and is successful only when the sender and the receiver understand the message the same way. In effective communications senders and receivers often use verbal communication and nonverbal communication.


Nonverbal communication accounts for a large percent of our daily communications. Nonverbal communication consists of eye contact, facial expressions, body language, gestures, posture, tone of voice, and touch. In some instances the message a patient wishes to impart is contradicted by the accompanying nonverbal expressions. To be effective communicators, sonographers must develop communication skills and the ability to listen and convey interest,compassion, knowledge, and information. Getting feedback is the second most important factor in communication because it assures you that your message was properly conveyed to the receiver (Box 3-1).



Box 3-1   Effective Verbal Communication Guidelines





Types of communication


Social conversation is a type of communication that people use habitually. Usually consisting of polite or friendly exchanges of factual or social information (chitchat), such conversation is superficial and flows easily from one topic to another. Social conversation does not provide significant information, identify problems, or result in solutions. Nevertheless, social conversation is important in establishing a relationship with patients and creating a climate of supportive communication.


Supportive communication is more goal oriented and bears more information than social conversation. Important patient information is discussed—how patients feel—and any problems that concern them can be shared. The purpose of supportive communication is to help relieve patient anxiety, anger, or frustration and to learn about any unmet patient needs. By talking through such concerns, the sonographer often can help patients resolve their problems. However, only if sonographers really understand the patient can supportive communication be successful. This can be accomplished by means of the skills listed in Box 3-2.



Box 3-2   Effective Communication Skills




Listening. Listening carefully to the message, in addition to the words the patient is speaking, is important.


Observing. The most important facet of any nonverbal communication is the awareness of the true message that the patient may be sending. Sometimes this type of communication is more accurate than the verbal message. For example, when patients are eager to communicate, they maintain eye contact. Lack of eye contact often represents uncomfortable emotions such as anxiety, depression, and embarrassment. Body language in the form of yawning, drumming the fingers, shrugging the shoulders, or rolling the eyes sends the message, “I am uncomfortable,” “I would rather not be here,” or “Hurry up!” Sonographers must be sensitive to the feelings that patients express by words and actions.


Responding appropriately. When a listener exhibits attentiveness and interest, patients feel more at ease in talking about their problems and concerns. Anything a sonographer says to the patient should relate to what the patient has just told the sonographer, either verbally or nonverbally. Providing feedback encourages patients to keep talking about their concerns until they have talked them out or reached some decisions.


Maintaining silence. Sonographers should allow patients and themselves to be silent to give patients the chance to decide what to say or not to say. The sonographer should evaluate the silence. Is it heavy, sad, tense, or comfortable? Silence also can mean that a patient does not want to talk anymore. Sonographers must impress on their patients that this is all right, too.


Clarifying. Sonographers should check the statements they heard or the cues they observed to be sure they understand their patients. Patients need to know that their sonographer understands their communication. Sonographers should avoid ambiguity because it creates communication problems.


Repeating. Repeating ideas or statements the patient has communicated clarifies the message and allows patients to change their minds or reinforce their viewpoints.


Gathering information. The sonographer should attempt to obtain as much information about patients as possible by asking questions that are open ended and cannot be answered with a simple yes or no response.


Summarizing. By verbally listing or reviewing the ideas that patients express, the sonographer allows them to take a more objective look at their comments. This can be especially helpful with patients who have difficulty making decisions.


Accepting. Patients should be encouraged to express negative feelings or thoughts even if the sonographer disagrees. The sonographer must realize that he or she can appear judgmental.


Touching. A pat on the shoulder or touches on the hand are nonverbal gestures of support. The sonographer should be sure that the patient does not have any objections to being touched.



Communication factors


Barriers


Anything that interferes with the communication process constitutes a barrier. Verbal and nonverbal barriers exist, and they can be communicated by either senders or receivers. One common communication barrier is that of talking too fast. Using slang, medical vocabulary, or broad generalizations also can make it difficult for the receiver to know what the sender is trying to say.


Sonographers must avoid “talking down” to patients or speaking in hostile or insulting tones. Such behavior makes patients defensive and unable to understand messages. Strong feelings such as anger or prejudice toward the speaker also can cause misunderstanding of what is being said. Listeners often miss parts, or all, of a message when they are distracted by their concern about their problems. Labeling patients as “complainers” or “disoriented” only encourages listeners to ignore or misunderstand what these patients are saying.


Language and cultural barriers can impede communication if the sender and receiver speak different languages. Sonographers should remember that smiling is a universal language technique and use hand signals whenever possible. Trying to speak a few words in the other person’s language will be appreciated and will gain patient cooperation.



Cutting Off Communication


Whenever a listener prevents a conversation from starting or continuing, the communication is cut off. Common reasons why listeners do this are embarrassment, feeling threatened, or distrust of the sender. Such tactics may be conscious or subconscious. Box 3-3 lists responses that stop or cut off communication. Sonographers always should show respect for patients by a willingness to listen—without judgment—to their concerns and feelings. Give accurate information. If you do not know the facts, or if you are not free to discuss them, find someone who is authorized to give that information. Patients must be able to trust your honesty.



Box 3-3   Negative Communication Traits




Judgmental responses. Telling patients they should not feel angry or afraid or that some people are in worse situations only leaves patients feeling guilty or ashamed for complaining.


Arguing. Debating with patients instead of learning what they are thinking is counterproductive.


Solving. Sonographers should avoid offering advice or answers before patients have the chance to think of their own solutions.


Interrupting. Cutting off patients before they have a chance to finish speaking puts the sonographer at risk of receiving only part of the message, giving an inappropriate response, and alienating patients.


Changing the subject. Patients feel that a sonographer does not want to listen to them when the sonographer deliberately changes the subject before a topic is completed.


Distractions. Sonographers must guard against showing that they are uninterested by body language or behavior.


False assurances. Kidding or falsely cheering patients out of a situation only makes the sonographer feel more comfortable. It deprives the patient of working through a problem and possibly finding solutions or making decisions.


Untruthfulness. The sonographer should never fabricate or construct excuses to avoid confronting patients with unpleasant news.


Evasion. The sonographer should not focus patients’ attention on their signs or symptoms simply to reassure them or to avoid being questioned about whether they are going to die.


Avoidance. The sonographer should not redirect every patient question to someone else. This signals to the patient that the sonographer cannot or will not answer.


False reassurance. Sonographers should avoid telling patients not to worry—that everything will be all right—just to prevent them from talking about their fears. The sonographer really does not know that everything will be fine. By saying these things, he or she may prevent patients from working through their fears or working out solutions to their problems. Instead, sonographers should show respect for patients by a willingness to listen—without judgment—to their concerns and feelings. Correct information that is as true and as factual as possible should be given. If the sonographer does not know the facts or is not free to discuss them, he or she should find someone who is authorized to give that information. Honesty builds trust with patients.



Exploring Attitudes and Feelings


Patients’ physical states (tired, cold, in pain) or emotional states (sad, happy, confident) can affect greatly their ability to carry on with supportive communication. Sonographers and patients can be affected. A sonographer who does not feel well may become irritated by the patient’s behavior and not really listen to—or may even avoid— the patient. When patients do not feel well, they often become angry or stubborn. Strong negative emotions such as anger and crying are particularly difficult to handle in such circumstances, it may not be the right time to work out a problem. When these situations become difficult to handle, sonographers should be careful about what is said, take a break, or seek help.


These same situations also can occur with coworkers, family, or friends. When problems cannot be resolved, and you sense hard feelings or anger among coworkers, or when you cannot seem to communicate with a supervisor, step back and evaluate the situation. Examine what happens when you talk to others and how you feel about yourself and the other person. The same techniques of developing supportive communication with patients are useful to communicate effectively with coworkers, family, and friends.



Patients with special communication problems


The ability to communicate relies heavily on the five senses, especially hearing, seeing, and touching. Patients who cannot hear or see have difficulty communicating and may become confused. When working with patients with any sensory losses, sonographers should plan to use the patient’s remaining senses to their fullest.


In working with elderly or hospitalized patients, the sonographer may encounter confusion. The causes of the patient’s confusion may range from too little stimulation of the patient’s five senses to physical causes such as too little oxygen, poor nutrition or fluid intake, medications, or infections. The following sections offer suggestions for working with patients who have experienced a loss of hearing or eyesight, who have speech disorders, or who are confused or disoriented.



Patients with Hearing Impairments


Frequently elderly persons’ hearing fails so gradually that they may not realize that they are becoming deaf. They may even refuse to accept their condition. If the institution has a sign language interpreter, arrange for that person to be present to speak directly to the patient with a hearing impairment. If not, or if the patient does not know sign language, certain strategies will help you communicate with patients who are hearing impaired. First determine if the patient is using any hearing aids. When speaking, face the patient directly and on the same level if possible. The use of facial expression, body gestures, and touch enhance communication. Often, when people try to communicate with patients with hearing impairments, they shout. Instead learn to use a lower tone of voice, because the people who are hearing impaired are more able to hear these frequencies. If the patient reads lips, make sure that the light is not shining in his or her eyes. Reduce background noise. Be sure to get the patient’s attention before speaking and never talk from another room. If the patient has difficulty understanding something, find another way of saying the same thing rather than repeating the original words. Use a pad and pencil whenever necessary.

Related posts:

Legal and Ethical Aspects of Sonography Professional Development and Leadership The Sonographer as Student Sonographer Safety Issues The Origins and Evolution of Diagnostic Medical Sonography Medical Techniques and Patient Care

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Aug 20, 2016 | Posted by in ULTRASONOGRAPHY | Comments Off on Communication and Critical Thinking Skills

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