Over the last 15 years, the teaching of professional interpersonal communication skills has become well established within the curriculum for most health professionals. Recognition is thereby given to the significance of interpersonal communication skills in professional practice. One of the challenges in teaching and learning in this area of skill is the recognition and analysis of examples of both good and bad practice. A multimedia package to assist in the teaching of communication skills has been developed to provide a number of such examples.Caring Communication: Strategies and Skills for Health Professionals consists of a video and workbook. The package consists of 33 vignettes in health care settings. These vignettes depict skills or groups of skills, illustrate negative and dysfunctional communication behaviours and, through the print materials, raise issues and topics for discussion, reading and further learning. The materials can be used by individual students and by both small and large groups with or without a facilitator.
All the scenarios are simulated. In the vignettes, some of the characters are portrayed by professional actors and some by health professionals. The vignettes concentrate on skills and behaviours related to listening, dealing with conflict, empathy, questioning, interviewing, and communication roadblocks. Vignettes are grouped together to provide a focus. The grouped vignettes are titled Listening, Conflict, Sensitivity, The Interview and Roadblocks.
During this teaching demonstration, participants will view two vignettes which focus upon listening skills and the use of empathy. They will then be invited to contribute to a group activity from the workbook designed to encourage analysis and discussion of the communication behaviours portrayed in the video.
Health professionals recognise that interpersonal relationships are central to their care. However, "knowing that" must be converted to "knowing how" to make interactions effective and meaningful (Stein-Parbury, 1993). If learning communication skills are to affect practice, health professionals need to be able to make the connections; to transfer their learning. They must be encouraged to become observers of both themselves and others as communicating beings; to look for examples of good and bad communication in their daily professional transactions. Having identified situations, health professionals need then to be given the opportunity to analyse those situations.
Listening is a skilled behaviour which goes beyond hearing, which is simply a physiological event. Listening is perhaps the single most important skill in effective communication. In health care contexts, professionals and clients are involved almost continuously in listening of one kind or another. Much of this listening may be ineffective because those involved have not learned how to listen. Bolton (1987) suggests that the skills of listening can be classified into three clusters. These are described as attending skills, following skills and reflecting skills. Active listening, which involves reflecting back a meaningful whole of your understanding of the message, is one of the most important skills to learn (Devito, 1995). Due to the recognised importance of listening, a scenario devoted specifically to listening was developed with five vignettes demonstrating effective and ineffective use of this skill.
Using empathy to illustrate sensitivity to others can significantly enhance the development of therapeutic relationships between health professionals and their clients. Effective listeners are able to use empathy and therefore appreciate the other person's point of view (Kagan & Evans, 1995). Sensitivity can also involve the use of other communication skills as well as reflective listening, such as the therapeutic use of touch, allowing for opportune periods of reflective silence and finally, assigning attention to the interpretation of non-verbal behaviours. The vignettes that comprise the Sensitivity scenario demonstrate examples of health professionals' successful and not so successful attempts to respond empathically to their client.
Conflict resolution is seen by Bolton (1987) as a three part process. This process consists of treating the other person with respect, experiencing the other side of the argument through the use of empathy and finally, stating one's own views, needs and feelings in an assertive manner. The vignettes relating to the Conflict scenario delineate positive and negative aspects of situations where conflict is evident. Each of these vignettes is examined from various perspectives in determining how conflict resolution can be impaired, facilitated and eventually achieved.
The Interview Scenario involves six vignettes that illustrate snapshots of the phases of an information gathering interview necessary for assessment purposes. The following issues are addressed: setting the scene, the development of rapport, using a client focused introduction, interpreting non-verbal cues, questioning techniques, reflective listening, the therapeutic use of touch and summarising at the completion of the interview. Demonstrations of the use of open and closed questions when clarifying information allows the viewer to assess their usefulness during different phases of the interview.
Roadblocks are communication behaviours that have the effect of stopping or temporarily halting a meaningful dialogue. Typically they occur in a two person communication situation when one person is really not listening. The non-listener responds in such a way as to create a negative feeling in the other person. This happens when the non-listener who puts up the road block is tuned in to his/her own agenda and responds in one of a number of habitual and dysfunctional ways. Roadblocking responses often express a feeling experienced by the responder rather than reflecting the feelings of the other person, as should occur in effective listening.
In health care settings roadblocking communication is not uncommon, often originates in the health professional and may result in a range of feelings for the client, such as dissatisfaction, confusion, isolation and even a feeling of being put down. Roadblocks can deprive the client of control and dignity. In transactional analysis terms a number of roadblocks originate from the critical parent ego state (McKay, Davis & Fanning, 1995). Many people may be unaware that they are using a roadblock as they respond to a client and are even less aware that such behaviours create dysfunctional communication. Part of learning how to avoid putting up roadblocks is to learn how to recognise them. Health professionals must be able to recognise the constraints on their effective use of communication skills before they can devise strategies to overcome them (Kagan & Evans, 1995). The roadblocks presented in this package are: parroting, sympathy, advising, threatening, empty reassurance, diagnosing, diverting, using a cliche, ordering, criticising, moralising, false understanding and inappropriate or excessive questioning.
Hearing but not listening | |
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Vignette description |
This scene involving Nurse Rudd and John occurs some twenty minutes after their encounter in Scenario 1 "Too busy to Listen". Although the nurse hears what the patient says she does not listen effectively. (Time: 1.00) |
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Associated reading |
DeVito, J. (1995). The interpersonal communication book (7th ed.). New York: Harper Collins. Unit 3: Perception in interpersonal communication, pp. 60. Unit 13: Non verbal messages: body and sound, pp. 222-242.
Kagan, C. & Evans, J. (1995). Professional interpersonal skills for nurses. Melbourne: Chapman & Hall. |
| Activity | Q What does Nurse Rudd's body language seem to indicate as she asks the initial question? Q What comments would you make about Nurse Rudd's questioning ability? Q Identify stereotyping and defensive behaviours on the part of the nurse. Q Comment on the body language and paralanguage of both nurse and patient. Q What is the patient's "agenda" and what is the nurse's "agenda" in this scene? Q What is the overall effect of this communication? Q How could this communication be improved? |
If the package is being used for groups, a number of strategies can be employed. After viewing the vignettes, group presentations in response to the suggested activity can take the form of discussions, role play, further questions, and overhead transparency or butcher paper summaries. Individual students can view a vignette and then work through selected questions and activities. Associated readings can be completed before or after viewing a vignette and be incorporated into written assignments that address questions in the suggested activities. Readings have been selected to provide theoretical insights in the analysis of communication behaviours and in this sense can be used to provide "answers" to the questions and information related to the activities listed for each vignette.
Bradley, J. & Edinberg, M. (1990). Communication in the nursing context. (3rd ed.). San Mateo, CA: Appleton & Lange.
Devito, J. (1995). The interpersonal communication book. (7th ed.). New York: HarperCollins College Publishers.
Irurita, V. (1996). Preserving integrity: A theory of nursing. In Greenwood, J (Ed), Nursing theory in Australia: Development and application. Sydney: HarperEducational.
Johnson, D. (1997). Reaching out: Interpersonal effectiveness and self-actualisation. (6th ed.). Sydney: Allyn and Bacon.
Kagan, C. & Evans, J. (1995). Professional interpersonal skills for nurses. Melbourne: Chapman & Hall.
McKay, M., Davis, M. & Fanning, P. (1995). Messages: The communication skills book. (2nd ed.). Oakland, CA: New Harbinger Pub. Inc.
Smith, D., Garko, M., Bennett, K., Irwin, H. & Schofield, T. (1994). Patient preferences for delegation and participation: Cross national support for mutuality. Australian Journal of Communication, 21(2), 86-108.
Stein-Parbury, J. (1993). Patient and person: Developing interpersonal skills in nursing. Melbourne: Churchill Livingstone.
Associate Professor Tony Knight, Director, University Learning Systems, ECU.
Associate Professor Mike Grant, former Head of Media Services ECU.
Jan Herrington, Senior Instructional Designer, ECU.
Keith Burton - Graphic Designer, ECU.
David Crewes and all other staff involved in the Media Services Department.
Mike Finn, our former colleague and co script writer.
| Please cite as: Hauck, Y. and Hussey, T. (1997). Caring communication: Strategies and skills for health professionals. In Pospisil, R. and Willcoxson, L. (Eds), Learning Through Teaching, p144-148. Proceedings of the 6th Annual Teaching Learning Forum, Murdoch University, February 1997. Perth: Murdoch University. http://lsn.curtin.edu.au/tlf/tlf1997/hauck.html |