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    Why not? List A therapeutic relationship requires independence ways of demonstrating them in your not dependence. It demands a focus on the needs of chosen profession. A therapeutic relationship desires neither to manipulate nor to be manipulated. In a therapeutic relationship the health professional desires to share their knowledge, skill and, where required, comfort and support to facilitate function and participation in life. Such a relationship empowers an individual to continue to face and overcome challenges that restrict participation and function.

    The support characteristic of a therapeutic relationship empowers the individual to overcome seemingly overwhelming situations. A therapeutic relationship encourages a collaborative partnership. A collaborative partnership is one in which the contribution of each person is essential to achieve a satisfactory and appropriate outcome. It facilitates involvement from an individual who is intimately aware of their own needs.

    It also requires input from the health professional who has the knowledge, understanding and skill to assist. This collaboration enables the individual to face and overcome the relevant challenges. It gives them strength to achieve their own goals. It provides the mutual knowledge and understanding that is required to consider all relevant factors and resolve any areas of dysfunction. Collaboration allows people opportunity to be agents of change in their own circumstances, ultimately empowering them to increase their levels of function and participation in everyday life.

    While each step has particular characteristics, one skill necessary for successful completion of each step, and the overall purpose of interpersonal communication in the health professions, is effective listening see Ch 9. The health professional must invest the time to listen, validate and confirm understanding in every situation. Instead, these steps require investigation of the abilities, feelings, needs and desires of the person, in order to establish and prioritise their personal goals for participation in their life Unsworth Such efforts will potentially provide the individual with feelings of control and thus increase positive emotional responses.

    They will maintain levels of motivation, effort and satisfaction in the person Gilkeson These communication events contribute to and increase positive outcomes. While the ultimate purpose of communication in the health professions may be to deliver a service or intervention, this model can create an experience that facilitates function and empowers a person to participate thereby positively affecting their health and wellbeing.

    It potentially makes the delivery of any health service a positive experience for all. Figure 2. These are also built upon mutual understanding, which requires respect, expressions of empathy and development of trust when practising as a health professional. The model presented in this chapter can guide such practice. The health professional can directly contribute to the establishment of each component, and thus can achieve effective communication and positive experiences that facilitate participation and function in activities that have meaning and produce satisfaction.

    Positive emotions from feelings of control Positive outcomes Effective listening Therapeutic relationships Collaborationagent of change Empoweringto overcome barriers Rapportconnection Mutual understanding Respectacceptance and value Empathyskill, time, commitment Trustpredictable and reliable. Butterworth-Heinemann, London Davis C M Patient practitioner interaction: an experiential manual for developing the art of healthcare, 5th edn. Davis, Philadelphia Harms L Working with people: communication skills for reflective practice.

    Communication Research Reports 27 4 Communication Quarterly 59 1 Doi Seminars in Speech and Language 28 4 Ley P Communicating with patients: improving communication satisfaction and compliance. Communication Research Reports 27 4 Doi WHO, Geneva. There are, however, specific goals that also guide communication for health professionals. These specific goals may vary from one interaction to another. This chapter examines the two major aims of: making verbal introductions providing information.

    Making introductions and providing information are two specific aims of communicating in the health professions. Many other goals for communicating fall within these two areas. The second piece of the discussion relating to the specific goals of communication in the health professions examines the skills of: gathering information by interviewing and using the related skill of questioning comforting confronting.

    These skills require specific management to ensure appropriate outcomes for all individuals involved in an interaction, and thus are considered separately in Chapter 4. Introductions are a form of giving information, and many overlook their significance and potential impact. Introductions also practice. Gilleylen Introductions should reassure the lis What constitutes a good. They should produce a sense new environment and do not know of confidence that means the listening person will willanyone? This may to feel less vulnerable if you were in also be the situation for new colleagues including coltheir place.

    Introductions generally provide information that allows the speaker and listener to achieve mutual understanding and establish whether they share a common intent or experience Holmes et al The vulnerable person listening to a health professional is certainly listening for answers. What do they want? What can they do to help me? Do they really want to help me? Can I trust them?

    Will they listen to me? Will they understand me and therefore help me? Will they really want the best for me? Will they want what I want? Are they worth listening to? Do I want to keep listening? The verbal message or actual words used may contribute to the answers of only two or three of the questions in the mind of each listener. Hi, Im is easy to say many times a day. However it can be challenging to introduce the role of a health profession. A well-known and well-understood health profession in the public mind may seem easy to introduce.

    It may even be tempting to not introduce such a health profession. However, possible preconceptions may cause confusion. If the role is not clearly understood in the particular context or setting, this confusion requires clarification using questions or a verbal or written explanation. Some health professions are unknown or commonly misconstrued in the public mind.

    In such cases, preconceptions can be equally challenging. It is also important to avoid professional jargon and potentially confusing descriptions in this explanation Bevan et al It may be useful to include specific examples of the role of the particular health profession in the spe Write down the role of your health cific setting or context.

    It may be important when profession. When working with adults, a profession. Do they understand written explanation may address any misconceptions you? Do they agree? Discuss Failure to introduce a particular role, or at least their perception of your health to question and clarify understanding of the role, profession.

    New environments create questions about a number of things the physical layout of the environment, the people in the environment, the emotional safety and predictability of the environment, the possible events and routines that occur within the environment and, for some, survival within the new environment. These questions and the overall goal of a health professional determine the order of an environmental introduction. Thus, the first part of an environmental introduction is usually introducing the physical environment.

    Essential information for all newcomers to an unfamiliar environment includes the location of the toilet! In an inpatient setting information relating to ward routines, including how to order meals, meal times, visiting hours and particular relevant events, can assist in reducing anxiety. Further information required for an environmental Have a group member explain a introduction will depend on the needs of the newtime when feeling vulnerable, comer.

    If they indicate a need to know more about the anxious or in an unfamiliar situation events they can expect in the environment, then a verbal affected their understanding and memory. Consider the importance of or written description of the typical events should the information at the time. It may be more Discuss why such feelings might. A verbal or written introduction of the other people or professionals in the environment should follow the initial environmental introduction.

    It is important to find a suitable time to introduce these people or at least arrange a time for such an introduction. It may be beneficial to provide a written description of the people they might encounter and their respective roles. Allowing a person to read such a document at their leisure facilitates understanding and may stimulate questions for future interactions. If the newcomer exhibits anxiety of any kind, it may be necessary to demonstrate particular interest in their emotional safety. This demonstrates empathy Davis and respect. Emotional safety is achieved by answering their questions or indicating interest in and care about their concerns.

    This behaviour indicates to the person that the health professional is willing to consider and address their concerns. Physical concerns are often easy to address, for example, a cup of something or a blanket. Emotional concerns take more thought and time to address. It is important at this early stage to spend time acknowledging their concerns and fears, and reassuring them with relevant information to allay them Stein-Parbury Statements such as Youll be all right and You dont need to Person 1 age 24 has pain in the lower back.

    They have been to various health services and do not have much confidence in this one to care about their needs or assist with their particular difficulties. Person 2 age 72 has never accessed any healthcare services they have always been very healthy and active. They have had a fall while walking to their car after doing some grocery shopping and are experiencing extreme pain in their left hip. Suddenly finding themself at your health service they are worried about everything they have no idea what is wrong, the pain is terrible, they are worried about their future, afraid they may not be able to return home, have no idea what happened to their shopping or the car or the cat food, and what about the cat?

    This is the first time you have met the person described in each scenario. Decide how best to demonstrate empathy, respect and behaviour worthy of trust using introductions. Understanding information Consider a specific time when you received new information e. What made it easy to understand? What limited your understanding? Was your understanding related to words only or were there other factors? It is sometimes helpful to introduce a concerned and fearful person to another person with similar difficulties who has positive experiences associated with assistance from the particular health profession or service.

    Consideration of emotional concerns during an initial introduction is important because it establishes the new, unfamiliar environment as a safe and caring environment for future interactions. It is essential to consider the factors that affect both providing and gathering information. The order chosen in this book reflects the reality that introductions provide information.

    It is not intended to suggest that one has greater significance than the other or that one should occur before the other. In reality, when attempting to understand the perspective of the vulnerable individual, the health professional simultaneously provides and gathers information. Providing information: a two-way process A health professional provides information to various people throughout the working day. This information takes two main forms, verbal or written, and generally has the purpose of informing, instructing or explaining.

    When a health professional informs, they provide information about people, possible events or situations usually about what to expect. This information may empower the person to act and react appropriately Egan Instructions are directions about ways to successfully complete tasks or required procedures. If the information creates questions, then the health professional responds with more information in the form of answers that inform, instruct or explain.

    The provision of information is a two-way process requiring mutual understanding. Regardless of the reason for providing information, it is important to consider the factors that facilitate understanding. These factors fall into three main. Chapter Divide a page into two, top to 10 describes the environmental factors affecting bottom. On one side list the factors understanding.

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    Preparing the listener involves limited your understanding. It requires a clear statement of the purpose and create a list of ways to effectively organise and present information to significance of the information. This simple, respectful ensure understanding. It is important to establish if they know anything about the particular topic, event or procedure. Establishing their existing knowledge can be an appropriate point at which to begin presenting the information. This not only demonstrates respect and can develop trust, but also provides an opportunity to establish the accuracy of their previous knowledge.

    Discussion of their existing knowledge may also develop interest and enhance concentration. It is important to ensure the person is feeling well enough to concentrate, because if unwell or tired they will understand and retain less. In such circumstances, making another time to provide the information will be beneficial for all and is more likely to achieve effective communication.

    To ensure effective communication it is important to avoid overlaying the information with opinion, bias or uncertainty Mohan et al , For example, I think you should , It is obvious you must , Have you thought about doing? While presenting information it is important to avoid distractions.

    Present and explain one point at a time. State each point clearly and succinctly using precise language, and avoid using words such as here, there, thing etc. A long, complicated and wordy presentation of each point is time-consuming and often results in the listener losing concentration Devito It is often helpful to provide examples to illustrate or explain each point because examples can facilitate comprehension.

    If instructing, it may be beneficial to demonstrate the task while explaining each point. Repeating the important points can be appropriate and may enhance understanding. Take care, however, because repeating information may not be necessary and may negatively affect the reception of and response to the information. Seeking an indication of their understanding may be more beneficial than repetition, and the use of specific questions will confirm their actual understanding. Organising the information is equally important. Compiling the information into well-ordered points assists in achieving understanding.

    It may be appropriate to begin with the points that generally stimulate the most interest and then move to related but less motivating points Holli et al Initially it is helpful to introduce the main point of the information and then to present the detail of each connected point. When each point has been explained it is important to finish with either a summary of the main point s or questions that establish understanding of each point.

    This repetition provides an opportunity to further process the information and to ask questions that clarify meaning. Organising the information includes consideration of the timing of providing particular information. Providing detailed information about something that is four weeks away has limited relevance and meaning. Providing information about something that is immediate, however, will be both meaningful and relevant.

    Providing information in both verbal and written forms allows processing, answering of relevant questions and thus understanding. The written form of any information must consider the above factors. Choose a procedure or routine typically used in your health profession. Compile a clear and easy-to-understand written form about the procedure or routine with all the relevant information. Verbally present this information to someone who knows nothing about the procedure or routine.

    Respond to any questions or comments until they demonstrate clear understanding. If necessary, adjust your verbal or written information to make it easier to understand. Present your written explanation to people from your health profession. Discuss ways of refining and improving it. Chapter summary Introductions are crucial in establishing the quality and thus success of future interactions.

    Introductory information about a health profession may be in verbal or written form. It must consider the needs of the people hearing or reading the information. Effective introductions should demonstrate respect and empathy, establish trust and the reliability of the health professional; achieve mutual understanding and result in positive interventions. The manner of presenting, organising and sequencing the relevant information whether informing, instructing or explaining has equal significance for positive health outcomes. Introductions establish the quality of future interventions and include introducing: i.

    Providing information about a health profession can take two main forms: i.

    The Art of Communicating

    Providing information requires mutual understanding and may inform, instruct or explain. The manner of providing information should result in: i. When providing information there are important principles to follow, including consideration of at least seven points. List the points below.

    Achieving mutual understanding when providing information requires: i. Communication Research Reports 28 2 Doi Pearson, Boston Egan G The skilled helper, 10th edn. Technical Communication Quarterly 20 2 Doi Communication Research Reports 27 4 Householder B J, Wong N C H Mood state or relational closeness: explaining the impacts of mood on the ability to detect deception in friends and strangers. Communication Teacher 25 3 Doi Communication Teacher 25 2 Doi Communication Reports 23 1 Doi The ultimate goal of health professions is: The ultimate goal of health professions is Family-person centred practice.

    Oneself ii. The role of the particular health professional iii. The particular service environment, both personnel and physical 3. Verbal ii. Written 4. The development of trust and a therapeutic relationship ii. Appropriate interventions and positive outcomes 5. Prepare the listener or person ii. Establish the current knowledge of the listener or person iii. Consider the needs of the person, including their emotional needs iv.

    Avoid giving personal opinion or showing bias v. Be clear, succinct, exact, well organised, well-time and relevant vi. Should avoid placating comments and generalisations vii. Commitment and time to establish mutual understanding 6. Time and commitment OToole 2e. The specific purpose of communication for health professionals is outlined in this book in two parts.

    The first part of the discussion see Ch 3 describes introductions and providing information. The second part occurs in this chapter and examines the specific purposes of: interviewing and questioning to gather information comforting encouraging versus discouraging confronting unhelpful attitudes and beliefs. Ask the person next to you: their name their health profession where they were born how they travelled today if they have a tattoo. If so, where is it? A health professional gathers various types of information from many sources throughout the working day.

    Studies have identified particular instruments for measuring skills in gathering information in the health professional Derkx et al , Srinivasan et al , Zabar et al Such skills develop with practice and reflection, however there are particular How easy was it to obtain the important considerations when gathering informainformation about the person next tion.

    These include considering the possible responses to you? If so,. What caused the ronment upon these responses see Ch 10 and the difficulties? Murray et al The most common method of gathering information through personal interaction is either a formal or informal interview Mohan et al , The interviewing process in the health professions usually begins although not always with a more formal setting the initial interview.

    Therefore, taking the time to explain the reason for each interview is a way of demonstrating respect and care for the interviewee s. Regardless of the particular health profession or the purpose of the interview, the major tool used in any interview is the question. The skill of asking questions that gather the maximum amount of desired information in the required time is valuable in all resourcestretched health professions.

    This knowledge assists health professionals in deciding what question types to avoid or use when gathering information. Why use questions? In the health professions using questions does more than gather information. Initially, questions assist the health professional to develop trust and rapport Mohan et al , , Tyler et al Questions can facilitate exploration of and elaboration about particular areas and thus provide additional relevant information Davis Finally, regardless of the type of question, the ultimate goal of questioning is to gather information.

    They are often recognised as questions that have a yes or no answer. For example, Is the pain sharp? Did you use the splint? Have you kept to your diet? Is your workstation comfortable? Are you taking your medication? For example, Is it all right if I ask you some questions? After asking this initial question it is best to use open questions until there is trust and adequate levels of rapport.

    When communicating with people who do not have English as their native language, it is important to remember that there are different ways of answering particular kinds of closed questions that can cause confusion. In English, the question It doesnt hurt, does it? In some languages such a question requires the opposite answer yes indicates it does not hurt, while no indicates it does hurt.

    This difference in responses provides a warning for health professionals; it indicates that the use of particular types of closed questions with individuals from non-Englishspeaking backgrounds requires careful clarification and negotiation to establish mutual understanding. It may be tempting to use closed questions with such people because they require minimal spoken language, however in such circumstances it may be more productive to use simply worded questions.

    When communicating with people from a non-English-speaking background it may also be tempting to rely on movements of the head to indicate yes or no. This can also create confusion, as different cultures use shaking and nodding the head to mean different things. Thus it is important for health professionals, when attempting to establish mutual understanding, to be aware of the possible confusion potentially related to this type of non-verbal communication. Some closed questions require specific and discreet information rather than yes or no Mohan et al , For example, Where is the pain most severe?

    For how long did you wear the splint? How many days did you keep to your diet? What about your workstation e. What time do you usually take your medication? Another form of closed questioning that requires Think of an issue specific to your discreet or specific information is the multiple-choice health profession and create a question.

    Multiple-choice questions can be useful if multiple-choice question about this people are unable to provide specific answers. Instead, issue. If relevant you may use the questions above re pain, splinting, the health professional uses their knowledge of the diet, workstation or medication; if specific situation to provide possible answers. Stein-Parbury Would you describe the pain as its clarity and effect. Explain any burning, sharp, dull, gripping, pressing, in a particular place or terms specific to your profession if moving?

    However avoid including too many options! In all closed questions there is only one answer, which is short, definite and clear. The question does not require elaboration or descriptive detail. Closed questions can be useful when the health professional requires particular types of information. They are sometimes the most appropriate questions to ask in particular situations, for example, in Emergency or if a Person is in extreme pain or is short of breath.

    Such questions demand little of the Person; they can save time and provide the exact answer without the complications of too much thought or too many words. Open questions Open questions are the other main type of question. There is no wrong or right answer to an open question. Open questions are useful when the required information is not discreet and may need thoughtful use of memory, elaboration, opinion, detail and sometimes sharing of experiences and feelings.

    Open questions Change the following closed some are can be less threatening because they allow the leading questions into open ones. Did you keep to your diet this week? Open questions are useful when there Did you follow your exercise regimen is a need to explore or elaborate on a particular carefully? They are also useful when Is your workstation comfortable?

    Open quesyou feel ill? Questions that probe usually seek more information about a particular topic SteinParbury The subject of a probing question usually What happened before? What were you thinking when happened? How did you feel about? The answers to probing questions provide specific detail about situations, people, events, thoughts and feelings. Probing questions can also change the focus or return the focus to an earlier point in the conversation Stein-Parbury A probing question is useful if the health professional requires information about something different to the current focus, or if the health professional remembers something more they need to know about a previous point.

    Questions that clarify usually seek understanding rather than information Stein-Parbury Can you explain what happened? Do you mean? Any lack of understanding or incomplete meaning may result in assumptions that limit the possible outcomes of the interventions. Overuse of questions that clarify meaning may have a negative effect on the interaction.

    It is important in such situations to listen effectively and to demonstrate respect and empathy rather than frustration while attempting to establish mutual understanding. Leading questions direct the response of the listener. A vulnerable person will answer a leading question according to the cues in the question that indicate the desired answer. For example, Its a beautiful day, isnt it?

    Leading questions are not always positive, however. A health professional who uses leading questions will limit the development of trust and the accuracy of the gathered information. For example, questions such as You werent drinking while you were on this medication, were you? Youre all right, arent you? That didnt hurt so much, did it?

    We covered how to care for your back and I know you understand the importance of caring for your back, so I know you didnt try to move furniture, did you? It is best to avoid leading questions Mohan et al , if the health professional seeks to encourage an honest relationship based on trust, respect and non-judgement, as well as relevant and appropriate outcomes. The skill of questioning depends upon another beneficial skill listening see Ch 9. However, a successful interview involves more than skill in questioning and listening.

    Think back to the earlier activity: Ask the person next to you. What did you want to know more about? List questions that would gather this information. Was there anything that was not necessarily clear? List the questions that would clarify your understanding. Can you think of a leading question you might ask? Now, if possible, ask the same person a question that probes for more information, one that clarifies your understanding, and then maybe even a leading question. If the same person is not available, repeat the process with a different person.

    Discuss what feeling each question created in the interviewee. Note the different feelings experienced, if any, and relate them to the different types of questions. Comforting can be a valuable means of developing a therapeutic relationship. This knowledge may make it difficult for the health Consider a time when you were professional to understand the concerns, anxieties feeling anxious or negative about and negative emotions of vulnerable individuals.

    Did you share your feelings with anyone? How did they respond? The health professional is responsible for ensuring How did you feel after they that People are comforted in a manner that encourresponded? Was it the way they ages, affirms and empowers them to continue with responded that created your meaning, purpose and quality in their life Sullivan feelings? Remember that such People may also include a colleague new to the service or a student.

    TABLE 4. State that there is no need to feel the emotions Acknowledge the emotions but change the subject Interrupt, to avoid hearing the expression of such emotions Totally ignore the expressions of emotions. Classifying responses to negative emotions Consider each response to the following expressions of anxiety and decide whether it is encouraging or discouraging. Person: I am really worried about this surgery. Health professional HP : You dont need to worry. Dr Super is a great surgeon and the procedure is routine.

    Person: I dont know how I will cope at home. HP: Dont worry, youll be OK. Theres lots of help available. Person: I dont like hospitals my Dad died in one. HP: No wonder you dont like hospitals! That must have been difficult. Can you tell me about it? Person: Boy, we are busy today. Two new people have just arrived. I dont think I will get everything done. HP: The quicker you get over that feeling the better. It is always the same here busy, busy! Person: I am just not coping here I cant do this. HP: Youre feeling overwhelmed. Mmm watching as the person struggles to complete a task and then gives up that can be difficult.

    What are you struggling with most? Person: I am angry. I need that report for the appointment tomorrow and its not ready. HP: I understand your anger. I am not too impressed either it was supposed to be ready today. What time is the appointment? Maybe it can be delivered there tomorrow before the appointment. How would you typically respond to each of these statements? Change the discouraging, trivialising and dismissive responses to encouraging, affirming and empowering responses. It is obvious from the examples above that the easiest and shortest way to respond to negative emotions has a discouraging effect.

    It may seem appropriate to the health professional because they have both relevant knowledge and previous experience, but such responses do not meet the needs of the anxious or negative individual. Health professionals are often busy and thus it is easy to respond in a manner that requires minimal time or effort. Such a response is an investment that ultimately saves time.

    Responding in this manner is not always easy as the health professional has knowledge and understanding that overrides the negative. People often feel vulnerable when in an unknown area of expertise. Responses that demonstrate a superiority of knowledge without sharing that knowledge will only discourage and may appear dismissive. Practising encouraging responses Role-play each scenario in pairs, taking turns to be the health professional who responds encouragingly and the Person.

    Compare the responses and note the different effects of the responses. List encouraging, affirming and empowering responses. Person 1: You are worried about your family because you are the person who always prepares their meals and now you have a broken shoulder. Person 2: You are angry and frustrated because you have not improved in the way the doctor said you would after the surgery on your back. The doctor has not answered your questions nor given any explanation for your lack of improvement. Person 3: Your child is in the final stages of leukaemia. You are emotionally exhausted and worried about being able to remain emotionally calm and supportive to your spouse and family as you watch him die.

    Person 4: You have had your leg amputated because of a car accident. You cannot see how you can go back to work you are a roof tiler. You are worried about your finances. Person 5: You are a national sports star and you have recently had a relatively minor knee injury. You are worried that your coach will replace you while you are recovering. Person 6: You are tired, frustrated and desperate because your year-old husband fell more than 20 hours ago he is in extreme pain, has been left to lie on a trolley for all that time and no-one seems interested in examining him.

    In the busy life of a health professional it is important that all words are comforting and that they encourage and empower those seeking assistance. Confronting unhelpful attitudes or beliefs Sensitive confrontation requires respect and trust, and can improve service outcomes. Many individuals who seek the assistance of health professionals express attitudes and beliefs that restrict their communication, recovery and participation.

    If expressed sensitively and with empathy, confrontation or challenge can facilitate new perspectives, thoughts and behaviours in many individuals Egan , Ellis et al , Stein-Parbury , Salvador , thereby improving the effectiveness of communication. Confrontation provides an opportunity to highlight the discrepancies or inconsistencies apparent in the life or environment of the individual Holli et al Only experienced health professionals should attempt to confront attitudes or beliefs.

    Egan states that the health professional must earn the right to challenge. This statement indicates the significance of the therapeutic relationship when confronting. Any confrontation or challenge must arise from a developed therapeutic relationship that demonstrates respect and rapport Polcin If there is genuine mutual understanding and freedom from judgement, confrontation may increase the likelihood of positive communication and outcomes. Statements such as You are your own worst enemy you depress yourself will only discourage.

    However, asking a question relating to a particular belief e. Do you think it is true that your life is terrible? Can you think of anything that was good yesterday? It is important to avoid underestimating the power of confrontation to promote radical change in thought patterns A young person has failed an Sluzki A positive change in thought patterns assessment task, receiving a third of will increase interest, communication, participation the possible marks. Very distressed and and recovery.

    If the voice, anyway. It should not provide the opportunity for task, makes a choice about how to the health professional to express anger or frustration respond. Nor should confrontation or challenge ever be direct and assertive, because strength of expression may become a barrier that What is your response?

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    Will you judge? Instead, tenand why. Write down how to confront the attitude or belief and thus potentially and why. Will you confront and challenge? Confrontation is about respect and understanding Write down how and why. In groups of four, assign two people to observe and scribe, and two to play the following roles.

    Continue acting the role-play until there is some kind of closure. Person 1: You are the lecturer. Respond to the distressed student. Choose how you will respond before the role-play begins. Person 2: You are the distressed student. Talk to the lecturer. You feel that the mark for your assignment simply reinforces that you cannot be successful in this health professional course. You did very well during professional placement but you cannot do the academic work. Discuss the effect of the interaction the reactions and resultant feelings.

    How did the lecturer respond? Did the response encourage the student to change their beliefs about themself? Did the non-verbal behaviours support the words? Repeat the role-play and the discussion with different people in the different roles. The willingness of health professionals to challenge themselves, thereby increasing selfawareness, enhances the ability to confront Egan Confrontation in the health professions is not something that necessarily occurs every day. When used appropriately, however, confrontation enhances and produces effective communication, participation and recovery.

    Chapter summary Health professionals commonly gather information with an interview. Questions are a typical feature of interviews. Appropriate questions potentially assist the development of trust and rapport, and establish mutual understanding. They must also consider the effect of the envi ronment upon those responses, especially if they include sensitive information.

    It is important to explain the purpose of the interaction and to use the relevant type of questions, closed or open, for the situation. However it requires experience, effective listening, non-judgemental and appropriate non-verbal responses, along with tentative expression of those responses. In addition, in order to effectively use confrontation a health professional must confront their own attitudes and beliefs.

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    • When gathering information, the health professional must consider three major factors: i. Health professionals gather information by interviewing. When interviewing it is important to: i. Questions can achieve much, but five main achievements are noted in this chapter: i. There are two main types of questions. List five features of closed questions. Encouraging and discouraging responses have particular characteristics.

      List three characteristics of encouraging responses: i. Confrontation challenges attitudes and beliefs and has positive results. It requires: i. Pearson, Boston Davis C M Patientpractitioner interaction: an experiential manual for developing the art of healthcare, 5th edn. Churchill Livingstone, London Harms L Working with people: communication skills for reflective practice. British Medical Journal, b Doi Revista Rol de Enfermeria 33 11 Sluzki C E The pathway between conflict and reconciliation: coexistence as an evolutionary process.

      Unannounced standardized patients ratings of physicians. Medical Care 44 12 Stein-Parbury J Patient and person: interpersonal skills in nursing, 4th edn. Academic Emergency Medicine 16 9 Possible responses of the person providing the information ii. Affects of the environment on any responses iii.

      The possibly sensitive nature of the required information. To explain the reason for the interview ii. Chose the appropriate type of question for the situation. They produce a clear understanding of the person ii. Questions can develop trust and rapport iii. Establish a therapeutic relationship iv. They allow those interacting to achieve mutual understanding v.

      They encourage collaboration to create appropriate goals and interventions. They produce short, clear and exact answers ii. The health professional maybe the focus of the interaction iii. They can create confusion with non-English speaking cultures iv. They save time, but there is only one correct answer v. They do not require much thought energy or memory to answer. List five features of open questions.

      There is no wrong or right answer to an open question ii. The person has control; they decide what they will say or not say OToole 2e. Open questions are less threatening iv. They encourage elaboration, use of memory, opinion, experience v. They allow the health professional to look, listen and learn. Vulnerable people do not usually have the required knowledge or understanding to feel comfortable.

      Responding to expressions of emotion can encourage or discourage. List three characteristics of encouraging responses. They acknowledge the emotions of the person ii. The acknowledge that such emotions and responses are OK and that others would respond the same way iii. They place the focus on the person and their needs. The health professional should respond with empathy and understanding. Experience ii. Effective listening iii. Non-judgemental responses iv. Tentative expression and non-verbal responses. What must a health professional confront in themself in order to confront effectively?

      Their own attitudes and beliefs. Effective communication requires an understanding of how an individual affects those around them and how those people affect the individual Higgs etal , It requires awareness of the self and the effects of personality and communication styles upon interactions.

      Effective communication requires an understanding of how elements of the self, the Person and the environment affect the results of interactions. Reflection is the circular process that uses experience, knowledge and theory to guide and inform thoughts, action and practice Hitchiner , Thompson Reflection achieves the necessary awareness of those factors contributing to the self-maintenance essential for health professionals Mann It also contributes to continuing professional development Collins , producing development of skills and effectiveness when communicating within practice.

      Reflection demonstrating continuing professional development is also a requirement for registration in many health professionals. These reasons make reflective practice important for health professionals. The what of reflection: a definition Reflection provides connection with, awareness of and clarity about unconscious emotional processing Pritchard , Please note that reflection in this context is not synonymous with meditation.

      Reflection occurs when individuals examine their attitudes and reactions to an interactive experience. It reveals causes of negative emotional responses, which facilitate understanding of these reactions. It allows resolution of these causes and, ultimately, changes in thought and thus behaviour in preparation for more positive responses in similar future interactions. The process of reflection usually makes some parts of an interaction clearer and may allow the fading or removal of other parts see Figure 5.

      Reflection for the health professional is certainly the basis of self-knowledge. Payne , describes reflection as being the bridge between theory and practice. Reflection can certainly form the theoretical basis of effective communication, because effective communication is difficult without reflection.

      Some view reflection as the process of revisiting experiences in order to understand them and promote different responses in future interactions Thomas Perhaps the best health professionals are both reflective and reflexive. Such reflection promotes understanding of the thoughts, attitudes and associated reactions that occurred during those interactions or while making those decisions. It facilitates clearer understanding of the causes of the negative reactions that can occur during interactions. Reflection highlights areas needing conscious attention and further exploration, and can result in acceptance and resolution of the causes of negative reactions.

      Resolution facilitates behavioural change and thus positive outcomes during future interactions. For health professionals, reflection is about careful, deliberate and critical consideration of events that occur during communicative interactions. It does not provide a formula for thoughts or behaviours, or a one-answer-fits-all solution, but it does provide insight and understanding upon which to base behaviour during future interactions Thompson It reveals the reality of the unique Consider the positive or negative nature of each individual and promotes understanding comments of a parent, teacher, of self and others Miller It has the potential to friend, acquaintance or fellow create a new awareness and provide direction for conworker.

      Thus reflection promotes change in future motivation and performance? How important are the opinions of Reflection is a process through which the individual others to you? The individual considers the meaning of their experiences and why the experiences have that particular meaning Andrews , Roberts This consideration facilitates understanding of the inadequacy, fear or vulnerability of the inner-self that manipulates and directs.

      These inadequacies and fears often cause negative and regrettable events during interactions. Reflection is the process that facilitates understanding of the action required to overcome the inadequacies, fears or vulnerabilities that manipulate the reactions of individuals when communicating.