QUALITY AND COMMUNICATION IN HEALTH CARE - Health Care - ثالث ثانوي

التعليم Link to digital lesson CHAPTER www.ien.edu.sa 1 QUALITY AND COMMUNICATION IN HEALTH CARE Case Study Investigation You are working as a medical assistant in the office of an oncologist (cancer specialist). Rashmi, a 56-year- old Indian woman who moved to Saudi Arabia with her husband, who works in the oil industry, comes to the office accompanied by her 20-year-old daughter. Rashmi speaks very little Arabic, and only a little. English, but her daughter is bilingual. This visit was at the daughter's insistence after her mother admitted finding a small lump in her breast. Rashmi is very anxious about the visit. At the end of the chapter, you will be asked how you would work with this patient, including a review of her individual needs. LEARNING OBJECTIVES After completing this chapter, you should be able to: Identify and describe the essential core qualities demonstrated by effective health care professionals. • List six examples of how students can apply the essential core qualities while they are in school. Describe the five-step problem-solving process. • List the personal factors that should be considered when choosing a health care career. • Demonstrate the importance of effective communication in health care. Explain how health care professionals use communication to help patients. ⚫List the reasons why patients do not follow medical advice. • • • Identify and demonstrate the six steps in the communication process. List the goals that should be included in every interaction with a patient. Define and explain when to use the four types of questions. Explain the meaning and importance of nonverbal communication. Identify examples of positive body language. List the environmental factors that affect communication. KEY TERMS active listening aphasia assessment body language feedback integrity nonverbal communication objective data problem-solving process receiver scope of practice sender 16 CHAPTER 1 ucation GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 16 signs subjective data symptoms therapeutic communication 14/06/2023 10:26

INTRODUCTION Health care is an exciting and growing field. The purpose of this text is to help you make an informed career choice and acquire the basic knowledge to continue the studies necessary for your chosen field. Careers in health care can be sources of great satisfaction. Health care professionals perform valuable services that make a significant contribution to the community. Each day their work makes a difference in the quality of life of those they serve. Whether you choose to work directly with patients or provide support services, be assured that what you do is important and of benefit to others. As well as providing satisfaction, health care work makes many demands on those who pursue it. The work must be taken seriously because it affects the well-being of others. All tasks must be performed thoughtfully and conscientiously. Nothing can be taken for granted or done automatically, not even routine assignments. Health care professionals must be willing to devote their full attention to everything they say and do. Potential problems must be noted and addressed before they become critical. The consequences of mistakes can be devastating if, for example, a prescription for medication is incorrect or the wrong procedure is performed. The work can also be stressful. Depending on the chosen occupation, it can involve long hours, dealing with the death of patients, and working quickly under pressure. 1:1 GETTING OFF TO A GOOD START Take advantage of the learning opportunities available to you and commit yourself to doing your best toward becoming a competent, qualified health care professional. Once you have completed school, the skills you have learned will stand you in good stead in your post-school education. ESSENTIAL CORE QUALITIES OF HEALTH CARE PROFESSIONALS As a student, you have many opportunities in school to begin to practice good workplace habits. Work hard now to develop the skills that will make you a valuable employee. At the same time, you can be acquiring habits that also contribute to academic success. The qualities essential for health care professionals to be effective and successful can be applied in the classroom, in the laboratory, and later in your professional training. Start now while you are in school to develop and apply them. وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 17 QUALITY AND COMMUNICATION IN HEALTH CARE 17 | 14/06/2023 10:26

18 CHAPTER 1 وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 18 FIGURE 1-1 Successful health care professionals have compassion, and show respect and consideration for their patients. . Have compassion: Care about others. Apply knowledge and skills to decrease suffering and increase the well-being of others. When necessary, be willing to put the needs of patients ahead of your own. Have respect for all people and help them regardless of their race, nationality, economic status, religion, age, or lifestyle preferences (Figure 1-1). - - Start now: Show respect and consideration for instructors and classmates. Be kind to everyone, regardless of their background. Refrain from talking during lectures. Prepare for classes so the instructor does not need to take time to answer questions about material covered in the reading or study assignments. Practice courtesy in the classroom and throughout the school. Volunteer to help others as needed or as possible. • Have integrity: Be honest at all times. Respect the privacy of others. Be loyal to the employer. Accept responsibility for your actions. Start now: Do your own work. Never copy the homework assignments of others or cheat in exams. Always tell the truth. Never share anything told to you in confidence. • Be dependable: Be at work on time and as scheduled. Follow through and finish all assigned tasks. Perform work accurately and completely. Work without constant supervision and reminders. - Start now: Be at school on time and attend all classes. Complete assignments on time. Strive for accuracy in all written and practical assignments. Follow through on all obligations and anything you have volunteered to do. 14/06/2023 10:26

• Work well with others: Strive to understand the feelings and needs of others. Be courteous and considerate. Practice good communication skills. Be a good team member by cooperating and contributing to the achievement of group goals. Take directions willingly from the supervisor. Start now: Be understanding of the needs of instructors and classmates. Participate in class. Do your share when working on group assignments. • Be flexible: Be willing to adapt to changing conditions. Do what is needed to carry out tasks. Acquire knowledge and skills necessary to keep up with advances in technology and changes in the way health care is delivered. - Start now: Accept instructional differences, changes in class schedules, and other unexpected occurrences. Be willing to cooperate as needed. Be willing to learn: Keep skills up to date. Ask questions, attend workshops, read professional publications, use the Internet, and continue to acquire new skills. - Start now: Be willing to learn. Take your studies seriously. Make school a high priority. Dedicate sufficient time to studying throughout the length of each course to ensure maximum learning. LEARNING FOR MASTERY Health care professionals must know what they are doing. Mistakes on the job can result in serious consequences. It is essential that students commit to learning the material presented in their courses. Learning means more than just memorizing facts. It means striving to understand and remember information so that it can be applied to new situations. This understanding provides a basis for thinking like a health care professional, which is discussed later in this chapter. Students who do only the minimum necessary to pass tests may think they are learning, but in reality, they are not likely to have acquired the long-term knowledge necessary to perform on the job. Students who study to understand and always search out the 'why' of the subject increase their chances of becoming highly competent health care professionals who can think on their feet and meet new challenges as they arise. One effective way for students to master subjects is to ask themselves questions about what they are learning or doing. Questions serve to gather information, expand your view of a subject, and stimulate the mind. They help ensure that actions are not based on false assumptions or insufficient information. Questions can be asked mentally (to oneself) or of others وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 19 QUALITY AND COMMUNICATION IN HEALTH CARE 19 | 14/06/2023 10:26

FIGURE 1-2 One effective way for students to master subjects is to ask questions of themselves and others. CHAPTER 1 20 وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 20 14/06/2023 10:26

(Figure 1-2). Think: What? When? Where? Why? Who? How? The following examples show how questions can be used to promote learning: • When learning new information, ask why it is important and to whom. How does it relate to what is already known? • When working with patients, ask what might work best for them and when it should be done. • . When sharing important information with a classmate or co-worker, ask yourself what you know about this person that will help you communicate most effectively. • When working in a health care facility, consider how your work habits might be changed to improve overall efficiency. Some students believe that the role of their instructors is to tell them rather than ask them. In reality, instructors who continually ask questions that require students to explain their answers and actions are encouraging them to learn and to think like health care professionals. Some instructors even respond to a student's question with another question. Their intention is to teach students to begin to think for themselves and trust that they are capable of finding the answer. Instructors also use questioning to guide students in pulling known facts together, making connections, and applying what they know to new situations. For example, suppose that a respiratory therapy student is working with a hospitalized patient. He has studied the illness presented by the patient and knows how to perform the prescribed breathing treatments. Through questioning, the instructor guides this student to explain why these particular treatments have been prescribed. The student is encouraged to consider the nature of the illness and the properties of the treatments and medications, and draw conclusions about the relationships among these factors. GETTING THE MOST FROM YOUR STUDIES If necessary, spend some time now working to improve your study skills: taking notes, reading, writing, and preparing for tests. Something to keep in mind is that these skills can also help you to get a job and succeed. For example, taking a patient history requires good note-taking skills; understanding the instructions for a piece of equipment requires the ability to read and understand technical material; preparing a letter asking about job openings requires good writing skills; and if you think about it, everything you do when working with a patient is a test, something you must do correctly "to pass”. وزارة التعـ Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 21 QUALITY AND COMMUNICATION IN HEALTH CARE 21 | 14/06/2023 10:26

Name Subject study notes and questions to quiz self summary notes column Date Page # FIGURE 1-3 Page set-up for an efficient note-taking system. The following suggestions may help you to: • Take good notes: Concentrate on writing down the important points, rather than everything the instructor says. Write in outline form to keep notes organized. Set up pages to leave space for adding notes and questions after class when you review your notes (Figure 1-3). Read for comprehension and learning: When reading textbooks or information on websites, start by skimming through the chapter or section. Then focus your attention by creating questions and reading for the answers. Ask yourself the questions and try to answer without looking at the text. • Write clearly and accurately: Use logical organization and pay attention to detail, including spelling, grammar, and format. Check your writing for errors. . Prepare for tests: Plan to study every day, even for a short time. Reviewing material over time is much more effective than cramming at the last minute. 22 و زا33 التعليم Ministry of Education 2024-1446 CHAPTER 1 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 22 VOLUNTEERING If you have the time, volunteering is an excellent way to jump-start your career. Not only do you learn skills, such as working with others, you also learn more about the health care field and acquire information that can help you choose a career that is right for you. Although work in a health care environment is optimal, volunteering for nonprofit organizations also provides good experience. Some educational programs have an admission requirement that you have some experience in the field you are entering. When looking for a job, you can list on your resume the skills you learned through volunteering. This also shows potential employers that you have initiative and a sincere interest in helping others. The National Volunteer Portal (https://nvg.gov.sa) includes many volunteering opportunities. Students using the portal can add their volunteering hours to their records. 14/06/2023 10:26

PROFESSIONAL ORGANIZATIONS Joining a professional organization while you are a student gives you networking opportunities, a chance to learn how to be successful in your chosen field, and access to workshops and other learning activities. And, as with volunteering, putting a professional membership on your resume demonstrates your interest and initiative. checkpoint 1. How can you demonstrate that you work well with others? 2. How should you take notes? 1:2 LEARNING TO THINK LIKE A HEALTH CARE PROFESSIONAL A common problem in health care today is that some graduates spend months, or even years, accumulating information, but are unable to apply it when they need it on the job. The lack of effective thinking skills is a primary reason for this unfortunate situation. Regardless of the health care area or occupational level chosen by students, it is essential that they learn to think like health care professionals. This type of thinking actually involves many skills and, in this text, has the following meanings: • Learning for understanding, not simply to memorize facts. • Applying learned material to new situations. • . Having an organized approach to problem-solving. Basing decisions on facts, rather than on emotional reactions or biases. Drawing on many facts and creating relationships among them. Locating reliable sources of information with which to make decisions. Basing decisions on ethical principles. Practicing good communication skills when gathering and distributing information. Understanding exactly what you are legally allowed to do in your profession, known as "scope of practice". Thinking proficiently can be applied to the personal, as well as professional, areas of your life. Thinking like a health care professional can be described as an "examined process". This means not simply accepting situations without observing and considering the meaning of what is observed. Effective thinkers are aware of their thoughts and of why and how they are acting or making decisions. وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 23 QUALITY AND COMMUNICATION IN HEALTH CARE 23 | 14/06/2023 10:26

24 CHAPTER 1 وزوج التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 24 Nothing in health care work can be done routinely and without thinking. Mindless actions occur as the result of not paying attention or basing decisions on ideas that have been accepted “just because”. These ideas may come from family members, friends, personal experiences, television, movies, and magazines. Health care professionals must learn to think for themselves, gather facts, and use their own observations for making decisions. THE PROBLEM-SOLVING PROCESS Important applications of thinking skills are problem-solving and decision-making, two very important competencies for health care professionals. There are a variety of problem-solving and decision-making models. One approach is a five-step problem-solving process to help students and health care professionals to approach problem-solving in an organized manner (Figure 1-4): 1. Identify the problem. 2. Gather information. 3. Create alternatives. 4. Choose an alternative and take action. 5. Evaluate and revise as needed. (1) (5) Identify the problem. (2) Evaluate and revise as needed. The problem-solving loop Gather information. (4) Choose an alternative and take action. FIGURE 1-4 Steps in the problem-solving process. (3) Create alternatives. 14/06/2023 10:26

Step 1: Identify the Problem Identifying problems is not always as simple as it sounds. Factors that are described as the problem are often only symptoms of the problem. For example, Haya, a radiologic technologist, does not receive the high scores she had hoped for on her performance review at work. When she receives the rating “poor” in the dependability category, she feels upset and believes that her problem is “receiving a poor evaluation because her supervisor dislikes her”. Identifying the real nature of problems requires a willingness to observe, pay attention, and confront difficult issues. Problem-solvers must look beyond what seems obvious and use questions effectively to identify the real situation. Denying or ignoring problems does not make them go away. Problems that are not addressed tend to get worse because no action is being taken to resolve them. Haya's first reaction is, “I can't help it. My car is old and breaks down a lot." When her car won't start, she must rely on family and friends to drop her off at work. Their schedules are not the same as Haya's, so she often arrives late. Taking the time to think about what she has said ("I can't help it.”), Haya realizes that being at work on time is her responsibility. She is now able to identify the real problem: lack of reliable transportation. This enables her to start seeking effective solutions. Accepting responsibility for a problem makes it possible to start doing something about it. Step 2: Gather Information Good problem-solving is based on having accurate and reliable information. Acting on assumptions (untested ideas), opinions (beliefs not based on facts or knowledge), and emotions can result in poor decisions. In health care, gathering information is also known as assessment. There are many methods for gathering information: . • Review what is already known: What knowledge do I have about the problem or situation? About the causes? About possible solutions? • Collect objective data: What can be observed? Measured? Tested? What are the facts? When working with patients, objective data are called signs. • Collect subjective data: How do I feel about a situation? What do I want? What do others want? When working with patients, subjective data refer to what is reported by the patient, such as pain and feeling nauseated. Also known as symptoms, they cannot be directly observed or measured by the health care professional, but must nevertheless be taken into account. Conduct research: What are the facts? Are they from a reliable (trustworthy) source? How do I know? Are they scientifically based? (Can they be tested?) وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 25 QUALITY AND COMMUNICATION IN HEALTH CARE 25 | 14/06/2023 10:26

26 CHAPTER 1 ع زوج التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 26 • Ask for help: Who has useful knowledge? Are there experts available who can give me reliable information and help me find a solution? When she starts out, Haya finds the idea of solving her transportation problem overwhelming. The only solution that makes sense to her is buying a new car, but she knows that most likely she cannot afford one at this time. When she puts her fear aside and commits herself to gathering information, she discovers the following: • Carpools have been organized at the facility where she works. • The most economical new car for sale in her area costs SAR 60,000. There are many articles on the Internet about how to buy a car. • A cousin has an older car that she wants to sell. • A local college offers a workshop that teaches people how to buy a car. • The local high school has a car mechanic training program. For a small fee, students will check over used cars before they are purchased. Step 3: Create Alternatives The third step in problem-solving is to create a list of alternatives. Ideas for solutions and actions are generated based on the information collected. All possibilities should be considered before one is selected. Some alternatives may prove, on further investigation, to be impractical or unworkable. It is essential to think through each one and consider the likely consequences, both positive and negative. Based on her research, Haya creates the following list: 1. Take the workshop on how to buy a car, then purchase a used one. The monthly car payments and higher insurance rates will mean having to budget carefully to meet all expenses. Chances of buying a poor-quality car can be reduced by using the service offered at the high school. 2. Continue to rely on others for rides to work. (Nonaction is also an alternative.) 3. Ask her father for a loan to buy a new car. While Haya would like to have a shiny new car, she has been financially independent for several years and prefers to remain that way. Some potential alternatives do not appear on the previous list because of information acquired during step 2: • Carpool participants must have a reliable vehicle of their own. This might be an alternative later, if she purchases a dependable car. • Her cousin's car has more than 175,000 kilometers and is not one of the more reliable models, according to the reports she studied. 14/06/2023 10:26

Step 4: Choose an Alternative and Take Action Step 4 is critical. A common difficulty in problem-solving and decision- making is failure to act. Opportunities are missed and accomplishments not realized when there is no follow-through. Haya decides to combine two alternatives. She will continue to rely on others for rides to work. She plans to buy a used car next year. In the meantime, she will create a personal budget to control expenses and save money, and will learn more about how to buy a car and which model is likely to give her the best value. Step 5: Evaluate and Revise as Needed Evaluation means reviewing the results of the actions taken. Even well- thought-out plans can prove to be ineffective or have unexpected, negative consequences. And circumstances can change. It is sometimes necessary to make adjustments or choose another alternative. It may even require going back to step 2 to gather additional information and go through the process again. When applying the process to health care work, it is important to remember that the needs of patients and facilities may change or additional information may become available. This can affect the process and force revisions to be made before the entire process has been completed. Problem-solving is a continual process. MAKING A CAREER DECISION There are hundreds of job titles in health care and the number continues to grow. They require a wide range of skills and abilities. Students who are considering a career in health care should learn as much as possible about the requirements, responsibilities, and conditions of their areas of interest. This knowledge will help them to make good career choices that match their preferences and abilities. For example, some individuals interested in health care would find the emergency medical technician's (EMT) job to be interesting and exciting. EMTs have opportunities to apply their skills to help others in significant ways, sometimes even saving lives. At the same time, the work is physically and emotionally demanding. It is often performed under difficult circumstances. Emergencies do not happen at convenient times and places. The schedules for EMTs include nights, weekends, and holidays, and they are called out to work in all types of weather conditions. All aspects of an occupation must be considered to increase the chances of choosing a career that will provide long-term satisfaction. When choosing an occupation, students should carefully consider the following factors about themselves: • Educational background. • The amount of additional time they can dedicate to their education. وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 27 QUALITY AND COMMUNICATION IN HEALTH CARE 27 | 14/06/2023 10:26

و زر28 التعليم Ministry of Education 2024-1446 CHAPTER 1 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 28 • Natural abilities. • Personality traits. • The type of activities they most enjoy. Preferences for workplace environment and conditions. checkpoint 1. What do you need to show to identify the real nature of a problem? 2. What is one common difficulty in problem-solving and decision-making? 1:3 THE COMMUNICATION PROCESS Communication is the process in which messages are exchanged between a sender and a receiver. The sender, also referred to as the speaker, is the person who creates and delivers a message. The receiver, also called the listener, is the person to whom the sender directs the message. Communication is successful when the receiver interprets and understands the sender's message as it was intended. Good communication is essential for the delivery of safe, effective health care (Figure 1-5). Modern health care systems rely on the efficient and accurate delivery of large amounts of information. Diagnoses and treatments are usually based on a variety of data that must be shared among many health care providers. There are vast networks of primary care providers, specialists, therapists, testing centers, medical facilities, and insurance companies that work together to provide and coordinate patient care. Chances of miscommunication increase as systems become larger and more complex. FIGURE 1-5 Good communication between members of the health care team is essential for providing good patient care. 14/06/2023 10:26

و زر28 التعليم Ministry of Education 2024-1446 CHAPTER 1 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 28 • Natural abilities. • Personality traits. • The type of activities they most enjoy. Preferences for workplace environment and conditions. checkpoint 1. What do you need to show to identify the real nature of a problem? 2. What is one common difficulty in problem-solving and decision-making? 1:3 THE COMMUNICATION PROCESS Communication is the process in which messages are exchanged between a sender and a receiver. The sender, also referred to as the speaker, is the person who creates and delivers a message. The receiver, also called the listener, is the person to whom the sender directs the message. Communication is successful when the receiver interprets and understands the sender's message as it was intended. Good communication is essential for the delivery of safe, effective health care (Figure 1-5). Modern health care systems rely on the efficient and accurate delivery of large amounts of information. Diagnoses and treatments are usually based on a variety of data that must be shared among many health care providers. There are vast networks of primary care providers, specialists, therapists, testing centers, medical facilities, and insurance companies that work together to provide and coordinate patient care. Chances of miscommunication increase as systems become larger and more complex. FIGURE 1-5 Good communication between members of the health care team is essential for providing good patient care. 14/06/2023 10:26

T CHAPTER 1 30 الوزارة Minist of Education 2024-1446 help relieve patient stress by showing compassion, providing appropriate information, and answering questions. Good communication has been shown to increase the speed of patient recovery. Another factor that affects communication with patients is the patient's ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Patients may not understand what their health providers are telling them orally, but may be too embarrassed to admit that they miss what is said. When patients are not comfortable expressing these concerns to their health care providers, there is no opportunity to address them. Good communication skills, discussed in this chapter, can assist health care professionals to better help their patients discuss their concerns. FIGURE 1-6 Good communication skills, combined with sincere caring about others, are essential for effective patient care. GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 30 14/06/2023 10:26

THE PROCESS OF COMMUNICATION Messages can be exchanged in at least four ways: 1. Orally. 2. Nonverbally. 3. In written form. 4. Electronically. It is commonly believed that oral communication consists of simply talking and listening, activities that most people have been doing all their lives. We carry on dozens of conversations daily with family members, friends, classmates, and co-workers. Effective communication in health care, often referred to as therapeutic communication, is specifically aimed at meeting the needs of patients. It involves the application of a set of skills that can be acquired through practice. In this text, communication is organized into a six-step process. This process provides a structured approach for studying and learning the skills that make up effective communication. Like other health care skills, communication cannot be taken for granted or performed in a routine manner. Each communication encounter presents its own set of circumstances and requires the health care professional's full attention. THE SIX STEPS OF THE COMMUNICATION PROCESS 1. Set communication goals: Determine what is to be accomplished. This requires considering the receiver's specific needs and current circumstances, and the duties that have been assigned to the health care professional. 2. Create the message: Select and organize appropriate content based on the communication goals and characteristics of the receiver. 3. Deliver the message: Choose the delivery method best suited for ensuring that the receiver will understand the message. 4. Listen to the response: Employ listening and observational techniques to determine whether the message was received as intended. 5. Offer feedback and seek clarification: Rephrase what you hear, ask questions or use teach back (asking receivers to explain what you have said in their own words) to check the receiver's understanding of the message. 6. Evaluate the encounter and revise the message if necessary: Determine whether the goal was met. If not, why not? What other options are available? What should be the next step? These steps are illustrated in Figure 1-7. وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 31 QUALITY AND COMMUNICATION IN HEALTH CARE 31 | 14/06/2023 10:26

Set communication (1) goals. Create message. Deliver message. (2) (3) Evaluate encounter. (6) Offer feedback. Listen to response. (5) (4) FIGURE 1-7 The six steps in the communication process. 32 330 التعليم Ministry of Education 2024-1446 CHAPTER 1 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 32 SETTING COMMUNICATION GOALS Much of our everyday communication is spontaneous and superficial, and requires little or no planning. This includes everyday greetings ("Hi, how are you?"), which are said automatically and from which little real information is usually expected. Interactions in health care settings are more purposeful. Suppose a nurse has a goal of learning about the current health status of a patient. Instead of asking the patient, “How are you?”, which may result in a programmed response of “Fine,” she needs to ask more specific questions. These will be based on communication goals. Examples of specific questions include the following: • On a scale of 1 to 10, what is your pain level? Do you have any questions about your care? Are you feeling nervous about the procedure? Here are some examples of health care goals: • Gather information about a patient's condition. • Instruct individuals on postoperative home care procedures so family members can understand and follow them correctly. Inform a patient about the benefits of the recommended treatment. • Report patient care information to a colleague who is taking over the care of the patient. In addition to goals that are specific to the situation, there are three more that should be included in every interaction with a patient: 14/06/2023 10:26

1. Demonstrate sincere concern for the patient's welfare: - Have a warm smile. - - - Use a gentle manner. Do not act hurried. Listen carefully. 2. Establish trust: - Establish eye contact as culturally appropriate. - Explain why a procedure, treatment, or test is necessary. - Explain in advance everything you are going to do. Follow through with anything you say you will do (return in 5 minutes, call the patient to check on their progress, and so on). 3. Enhance the patient's self-esteem: - Involve the patient in decision-making whenever possible. - Clarify the patient's communication if you're unsure of meaning. - - Address the patient properly and respectfully. - Provide for privacy. - When appropriate, ask the patient for input on how he or she wants things done. It may seem unrealistic to try to achieve these goals in the brief time the health care professional spends with patients. There are other tasks to accomplish, such as taking a blood sample or performing a breathing treatment. Good communication, however, depends more on quality than quantity. A warm smile and informative reassurance are not time- consuming and can be included in any encounter. Patients today receive much of their care from strangers who are in a hurry. It is for this very reason that an effort should be made to personalize interactions as much as possible. COLLECTING INFORMATION To set appropriate goals, collect and review information that might affect communication. The following factors should be considered: • The patient's level of understanding: - Is the patient very young? - Does the patient speak or understand Arabic? - Does the patient have a learning disability that affects their ability to understand? - Does the patient appear to be confused or disoriented? وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 33 QUALITY AND COMMUNICATION IN HEALTH CARE 33 | 14/06/2023 10:26

34 CHAPTER 1 وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 34 - - What is the patient's ability to retain information? Is there short- term memory loss? What is the appropriate terminology to use? • Emotional factors: ― Does the patient's behavior indicate fear or anxiety? . - Are there signs that the patient is using a defense mechanism? Is the patient ready to accept the information that is to be offered? Physical factors: - Is the patient in pain? - Is the patient on medication that causes drowsiness or affects their ability to concentrate? ― Does the patient have a hearing, visual, or speech impairment that affects the communication process? • The urgency of the communication: Must the communication take place now? - Is this the appropriate setting for the communication? - What are the consequences if the communication does not take place or if it is unsuccessful? Learning to make these determinations quickly is an important health care skill that is developed over time. One technique for new health care professionals is to use mental checklists to help them prepare for communication encounters. CREATING THE MESSAGE Creating an appropriate message requires the selection of content and use of language that is based on the answers to the questions listed earlier. Health care communication usually takes place at a deeper level than everyday conversation and must be clear and accurate. It may involve sharing very personal information, such as a patient's fears. Information must be presented in a manner that the receiver understands. For example, although the use of medical terminology helps ensure accuracy in communications with other health care professionals, it can confuse and intimidate patients. Even everyday language may have to be simplified for some patients, depending on their age and language skills. At the same time, take care not to talk down to patients. Organize long messages to make them easier to follow. Here are some examples of organizational strategies: 14/06/2023 10:26

. Explain what you plan to do and what the patient should expect to hear, feel, and so on. • Rank information in order of importance. • List a sequence of steps for the patient to follow. • State facts, following each one with an explanation. • Present an overview of a procedure before detailing the individual steps. • Give instructions along with a description of possible consequences if they are not followed. • Break information into sections if possible, so the patient can grasp each part or set of facts before moving on to the next. • Use teach back: Have patients demonstrate understanding by explaining the information in their own words or by performing the task or exercise being taught. ASKING QUESTIONS Some messages are phrased as questions. Types of questions include: ⚫ Closed questions can be answered with a single word or a response of “yes” or “no”. This type of question is used to gather factual information. For example, the health care professional may ask closed questions when obtaining background information about a patient. Closed questions are not recommended when checking for understanding. Many patients will answer “yes” to the question, "Do you understand?" even if they do not. They are afraid of appearing dumb or do not want to “bother you" by having the information repeated. Examples include: “Is it your birthday today?” “Are you taking any medications?" • Open-ended questions cannot be answered with a simple "yes" or "no". They require a more complete response and are used to encourage patients to provide more detailed information or explanations. These questions can be used to learn about the patient's symptoms, to encourage them to share feelings and opinions, or to check understanding of the message. Example questions are: "How did you fall?" "Why do you think you are feeling sad?" Probing questions are requests for additional information or clarification. For example, they can be used to lead patients to more fully discuss their symptoms. If a patient states, "My stomach hurts," appropriate probing questions would inquire about the exact location and type of pain, when it first occurred, and when it is وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 35 QUALITY AND COMMUNICATION IN HEALTH CARE 35 | 14/06/2023 10:26

36 CHAPTER 1 العزوة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 36 experienced. It is important not to confuse the purposeful use of probing questions with digging for unnecessary personal details, which patients may find offensive. Example questions include: “You said that you've been experiencing pain in your chest. Where exactly in your chest do you feel the pain?" "When is the pain the most severe?" "Can you tell me more about when you get these headaches?" Leading questions are those in which all or part of the answer is included in the wording of the question. Leading questions should be avoided when they encourage the receiver to give the answer believed to be correct or what the health care professional wants to hear. However, leading questions can be useful when used with patients who have difficulty speaking or who do not understand the language well enough to phrase a complete answer. In these situations, take extra care to check for understanding to ensure that the patient is not simply agreeing with you. Examples are: "Would you describe the pain as sharp, dull, throbbing, or aching?” “Do you feel more nauseated in the morning, afternoon, evening, or during the night?" After asking a question, it is important to pause and give the receiver sufficient time to respond. Some people need more time than others to formulate answers. Do not interrupt or finish sentences for patients. If it is obvious that they do not understand the question or are unable to reply, reword the question and provide another opportunity for a response. Consider the state of each patient and his or her ability to answer questions. For example, Sara is an elderly patient who has difficulty remembering. Hospitalized for severe back pain, she cannot accurately respond to questions about how she is feeling today compared with yesterday. A more effective way to get the needed information is to ask her to rate her pain level on a scale of 0-10, with 0 being no pain and 10 being the highest level she can imagine. DELIVERING THE MESSAGE It is important to first determine to whom the message should be delivered. This is not always obvious. For example, if the patient is a child or elderly person, should communication be directed to the patient or to a family member? Patients who are able to understand any or all of the message should be addressed directly. Detailed information or instructions can also be given to a family member later. For example, a medical assistant who greets 87-year-old Fatima by asking her daughter, "How is Fatima doing today?" is failing to show respect for the patient. It is believed that many patients who cannot speak or respond can hear and experience touch. Under these circumstances, health care professionals can provide comfort by maintaining communication. 14/06/2023 10:26

FIGURE 1-8 Speak reassuringly and consider making appropriate physical contact, such as touching the patient's hand or shoulder when speaking. FIGURE 1-9 Positive body language conveys interest, caring, and the willingness to listen. They should speak reassuringly and consider making appropriate physical contact, such as touching the patient's hand or shoulder when speaking (Figure 1-8). NONVERBAL COMMUNICATION Nonverbal communication includes tone of voice, body language, gestures, facial expressions, touch, and physical appearance. Up to 70% of the meaning of messages are expressed nonverbally. Nonverbal communication is usually the most accurate expression of what the sender truly feels and believes. This is because it comes from within and is conveyed without the awareness of the sender. It takes place subconsciously. Health care professionals must be aware of the nonverbal communication of both themselves and others. The nonverbal communication of patients should always be observed. For example, if a patient reports feeling "fine" but appears very tense and nervous, the verbal and nonverbal messages do not match. In such cases, the health care professional needs to observe carefully, ask questions and provide opportunities for the patient to share what he or she is really experiencing. The appearance of the health professional is a form of nonverbal communication. It can influence the patient's confidence in the worker's competence, which, in turn, can affect how messages are perceived. BODY LANGUAGE Body posture and movements convey messages. Some body language can have a negative impact on the receiver. Examples include crossing the arms, shrugging the shoulders, tapping the fingers or feet, clenching the fists, and rolling the eyes. These can communicate disagreement, lack of interest, disbelief, and impatience. Positive body language conveys interest, caring, and the willingness to listen to the sender's message, even if there is disagreement (Figure 1-9). It encourages sharing information and promotes exchanging honest messages. Positive body language includes the following: . • Looking at the other person. Directing the body toward the other person. Leaning slightly toward the person being addressed. وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 37 QUALITY AND COMMUNICATION IN HEALTH CARE 37 | 14/06/2023 10:26

38j c التعليم Ministry of Education 2024-1446 CHAPTER 1 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 38 • Holding the body in a relaxed position. Nodding or verbalizing (“uh huh”, “yes”, “tell me more") occasionally to indicate acknowledgment. . Having open and warm facial expressions. • Approaching the patient, if standing at a distance. Stopping the performance of tasks to give your full attention. Positive body posture communicates, “I am focused on, and paying attention to, you and what you are saying." Actions must match words. For example, if a patient wants to discuss a sensitive matter and the health care professional listens while facing toward the door, the message to the patient may be, "I'm really in a hurry to leave." In another example, a health care professional wants to reassure a patient, but looks away nervously while speaking. The message will seem false and the patient will sense that important information, possibly negative, is being left unsaid. Establishing trust, an essential ingredient in effective communication, requires that spoken and nonverbal communications match. • Mime (body movements that convey ideas or actions) can communicate when speaking is not possible or when the patient does not understand the language. For example, acting out the movements a patient must make when performing an exercise can demonstrate exactly what needs to be done. • Gestures are helpful when patients cannot be attended to immediately. Acknowledging their presence conveys respect and creates good will. For example, if the medical receptionist is speaking on the telephone when a patient arrives for an appointment, the patient should be greeted with a smile, nod of the head, and quick hand gesture to indicate that he or she will be attended to shortly. • Facial expressions are an important form of nonverbal communication. The health care professional's expressions can be a source of reassurance or anxiety for patients, so it is important to learn to be aware of, and control, them. This can be difficult when dealing with situations that are challenging, unpleasant, or offensive. For example, you may feel very frustrated with the behavior of an angry patient. Efforts at calming the patient will be less effective if your face reflects signs of impatience and annoyance. The health care professional's face should reflect warmth, confidence, and interest in the welfare of the patient. • The use of touch has become a difficult issue in health care today. Many health care activities require entering personal space that is normally reserved for only the closest and most trusted people in the patient's life. It is important that patients be told what is to take 14/06/2023 10:26

place and why. Explain what they should expect to see, hear, and feel (Figure 1-10). For example, when administering an injection, the health care professional should inform the patient of its purpose, where it will be given, and what sensations might be experienced. PHYSICAL ENVIRONMENT The physical environment and how the health care professional is positioned in relation to the patient can affect the delivery of the message. Sitting behind a desk or standing over the other person projects a sign of authority or dominance. Other factors to consider include the following: • . Light sources: Can the patient see you clearly? Is there a glare on anything the patient is expected to see? Is light shining in the patient's eyes? Sounds: Can the patient hear you clearly? Are there unnecessary noises that are distracting? Should the television or radio be turned off? Privacy: Are there other people in the area who can hear the communication? If privacy is necessary, how can it be arranged? Are you speaking directly to the patient and only as loudly as necessary? Activity: Do you appear to be more focused on taking notes or entering data into a computer than on the patient? • Comfort: Is the patient exposed or in an awkward position? Can communication wait? FIGURE 1-10 Explain what the patient should expect to see, hear, and feel during an examination. وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 39 QUALITY AND COMMUNICATION IN HEALTH CARE 39 | 14/06/2023 10:26

ع زر40 التعليم Ministry of Education 2024-1446 CHAPTER 1 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 40 LISTENING TO THE RESPONSE Listening is not passive, but an active process that requires concentration, attention, and observation. Hearing and taking in words take place at a rate that is several times faster than the rate of speech. This is helpful when taking notes, but it also allows time for the mind to wander. Active listening is characterized by focusing fully on what the speaker is saying. Effective listening can be hindered by the receiver's reactions to what the sender is saying. For example, if the receiver strongly disagrees with the message, their mind may become occupied formulating mental arguments instead of listening carefully. Another common interference to listening is thinking about how one is going to respond when the speaker stops talking. The mind becomes engaged in self-talk and stops listening. Good listening also requires that receivers do not interrupt senders or complete messages for them. Allow enough time for senders to complete their messages. Encouraging remarks and gestures may be used as prompts: "I see," "Go on," or a nod of the head. Interrupting, however, can convey a lack of respect and impatience. It can also distort the sender's intended message, preventing important information from being conveyed. Effective listening skills can be developed. Start by becoming aware of lapses in your attention. When you realize you are losing focus, bring your mind back to the speaker. With practice, you can decrease internal interference and poor attention. Clear your mind of distractions. • Face the sender. ⚫ Focus your full attention on the sender. • Maintain eye contact as appropriate. • Turn off “self-talk”. • Do not make value judgments about what you hear. Periods of silence can be a meaningful component of communication. The purpose of health care encounters is not to maintain a steady stream of conversation, but to help patients solve their health problems. Silence allows time for thought and reflection. It also provides a chance to observe the nonverbal communication that takes place during silence. Some cultures have a high respect for the value of silence. Allowing periods of silence may feel awkward at first, but they can be a valuable tool in promoting good communication. 14/06/2023 10:26

FEEDBACK Feedback is a method used to check understanding of what is said. Did the message come across as the sender intended? All of us have had the experience of believing that we understood a message perfectly, only to discover later that we had misinterpreted it. Obtaining feedback helps avoid misunderstandings. Here are four ways to obtain feedback: 1. Paraphrasing: The receiver rewords the sender's message in the receiver's own words and then asks the sender for confirmation. Example: “I understood you to say that you have experienced these headaches every day for the past two weeks. Is that correct?" 2. Reflecting: This is similar to paraphrasing but prompts the receiver to complete or add more detail to the original message. Example: “You say that it's difficult for you to do the exercises the therapist has recommended because ...” (pause and allow time for the receiver to respond). 3. Asking questions: Request clarification and additional information. Many words, such as “difficult”, “painful”, and “a lot”, have different meanings for people. In health care, the use of questions can help patients describe their conditions more clearly. Accurate diagnoses and appropriate treatments depend, in part, on the clarity and completeness of information supplied by the patient. Example: "What symptoms are you experiencing when you say you are feeling terrible?" Questions can be used to check the receiver's understanding of important information. Instead of asking if the receiver understands, ask a question whose answer will demonstrate understanding. Example: "Can you list for me the three steps you'll take when giving your son his medication?” This is an example of teach back. Open-ended questions can be used to encourage patients to talk about their values and beliefs. Although it is not the role of the health care professional to make value judgments about patients, what is learned can help you better understand the behavior and motivations of patients, and find ways to meet their needs. Example: "Why do you say that you deserved to have the accident?" This question may help in understanding why a patient is making no effort to perform the exercises that will assist in recovering from injuries. 4. Requesting examples: Examples can help to more clearly explain and fill in meaning. Example: "Tell me about the kind of situations in which you feel lightheaded." Establishing clear channels of communication by using feedback also helps maintain good relationships with co-workers and supervisors. Developing competence as a health care professional requires monitoring personal progress and learning from mistakes. Feedback can be an important QUALITY AND COMMUNICATION IN HEALTH CARE 41 | وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 41 14/06/2023 10:26

42 CHAPTER 1 2 j.43 التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 42 tool for fostering professional growth. For example, Hamad's supervisor informs him that a report he has prepared is "unacceptable”. Hamad can request more specific feedback by asking questions such as, "What did I do or not do that made my performance on this task unacceptable?" and "Can you tell me exactly what it is that makes the report unacceptable?" These questions will encourage the supervisor to be specific and provide details from which Hamad can learn. EVALUATING THE ENCOUNTER The purpose of evaluation is to determine whether the communication goals have been met, demonstrated by the response or behavior of the receiver. If the goal is not met, the following questions can help identify the difficulty: • Did I clearly state my messages? • Did I present them at a level appropriate for the receiver? • . The Did I listen actively? Which part of the message was misunderstood? evaluation process actually continues throughout every communication encounter. A good communicator constantly checks for understanding by listening, observing, and asking for feedback as needed. That way, adjustments can be made as needed. Some communication goals are achieved over time, and the evaluation must be delayed. For example, if cardiac patient Abdullah is instructed about improving his eating habits, it may be weeks before the dietician finds out if he understood and was motivated to follow the low-fat eating plan. Another example of a long-term communication goal is making an effort over time to improve a relationship with a co-worker. COMMUNICATION THROUGH THE LIFE SPAN When communicating with young children, it is important to help them understand what is happening to them and how you are helping them. They may be fearful and need help reducing their anxiety. At the same time, children should be included as much as possible in decision-making and allowed to help with their care when appropriate. As with patients of any age, it is important to listen actively to children and answer their questions using age-appropriate language (Figure 1-11). Adolescents must be treated with respect and dignity. Show an interest in them as individuals by learning about what is important to them. They may be struggling to establish their identity as they move from childhood to adulthood. Do not talk down to them, but fully explain what doing and why. you are 14/06/2023 10:26

FIGURE 1-11 Your communication must be adjusted to the age and other characteristics of the receiver. Adulthood is a busy time of life with many responsibilities, such as career and family. Illness and injury at this time can be extremely stressful and it is important for the health care professional to listen to patients' concerns. Do not assume that adults understand medical vocabulary, detailed instructions, and preventive measures they should take now to avoid health problems as they age. Use teach back to check understanding. Older adults may have the most variation among individuals, from those who are active and mentally sharp into their 90s to individuals suffering from dementia (see Chapter 2). A goal for the health care professional is to help patients to remain independent as long as possible by providing them with the information they need to maintain their health. They need honest conversations about any chronic conditions as well as help in making end-of-life decisions. Strive for an approach that is respectful but not overprotective. checkpoint 1. What is active listening? 2. What are four ways to obtain feedback? وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 43 QUALITY AND COMMUNICATION IN HEALTH CARE 43 | 14/06/2023 10:26

44 CHAPTER 1 وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 44 1:4 OVERCOMING COMMUNICATION BARRIERS Obstacles or barriers sometimes block communication. Barriers include the following: Language differences. • Cultural influences. • Defense mechanisms. Sensory impairments. . • Medication effects. • Pain. • Physical distractions. Identifying and overcoming barriers requires the use of empathy, observation, questions, and feedback. Specific techniques can be employed and extra time can be allowed to promote effective communication. PATIENTS WHO ARE IN PAIN, MEDICATED, CONFUSED, OR DISORIENTED Patients who are in pain, medicated, confused, or disoriented may have difficulty communicating. Health care professionals can assist them by taking extra time and following these guidelines: • Identify yourself and say the patient's name. • Maintain eye contact. Speak slowly and clearly in a moderate pitch of voice. • Use simple language. Avoid slang and expressions that do not mean exactly what they say. • Keep each message short and to the point. For example, do not give a series of instructions or ask more than one question at a time. • Give the patient time to respond. • Use touch if the patient is comfortable with it. • • Try to schedule interactions when the patient is in the least amount of pain. Repeat the message as needed, without changing the content or words. • Review the content with the patient to assess retention of the message. • When appropriate, give the patient written information that can be referred to later. 14/06/2023 10:26

PATIENTS WITH DEMENTIA Alzheimer's disease causes up to 80% of cases of dementia, but there are other conditions, such as vascular dementia that can follow a stroke (see Chapter 2). In addition to memory loss, dementia decreases the ability to communicate, both in understanding others and expressing oneself orally. Patients may forget the meaning of words and phrases, have difficulty finding the right words, and invent words to express themselves, such as calling a watch an “arm clock”. As verbal skills decline, they may rely more on gestures. Patients may also exhibit difficult behavior, such as name-calling, shouting, hitting, and pushing. Health care professionals must be compassionate and patient, stay calm, and not take this behavior personally. It is also important to continue to communicate with dementia patients in spite of the barriers. The following suggestions may be helpful for maintaining and improving communication: • Limit distractions and noise. . Approach patients from the front and introduce yourself. • Get the patient's attention: establish eye contact and call the patient by name. • Do not assume that the patient cannot understand or does not want to communicate. • Maintain a friendly expression. • Use simple language and short sentences. • Be patient. Allow long pauses for patients to formulate a response. . Agree or distract with a different subject when what the patient says does not make sense or is repetitive. وزارة التعليم Ministry of Education 2024-1446 . Respond to the patient's feelings rather than the words. • Do not confront, argue, or try to reason with the patient. • If the patient does not understand what you say, rephrase rather than repeating. • Offer suggestions instead of corrections. For example, if a patient mistakes her brother for someone else, say, “I think this is your brother, Omar." • If the patient is unable to communicate orally, observe their body language to learn what they want or need. GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 45 QUALITY AND COMMUNICATION IN HEALTH CARE 45 | 14/06/2023 10:26

46 CHAPTER 1 ع زروه التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 46 PATIENTS WHO ARE DEPRESSED It is not uncommon for patients with serious conditions, such as cancer, to be depressed. This is usually a temporary condition, as opposed to clinical depression (a mood disorder that causes persistent feelings of sadness and loss of interest), but it can result in feelings of distress and interfere with the patient's functioning and ability to communicate. Let depressed patients know: “I am here for you.” “I'm glad to listen." At the same time, realize that these patients may respond negatively to whatever you say. Specific suggestions for communication include the following: . Invite, but do not force, patients to talk about their fears, concerns, and how they are feeling. • Listen carefully without judging. . ⚫ Offer hope, but do not advise them to "cheer up" or "be positive". Allow for silence. PATIENTS WHO ARE ANXIOUS In addition to depression, anxiety is a common experience for patients. Even a visit to the dentist can bring on anxiety for patients who fear needles, pain, or embarrassment about the condition of their teeth. Anxious patients may have difficulty focusing and responding, so exercise patience. Be empathetic and reassuring. At the same time, do not trivialize the patients' feelings by telling them, “It's silly to be anxious," or "There's nothing to be afraid of." Clearly, for the patient, the situation is fearful. Instead, try the following suggestions: • Approach the patient calmly and with a smile. • Ask the patient to express his or her concerns. • Let the patient talk and listen carefully. • Keep your messages simple and to the point. . Stick to one topic to make it easier for the patient to follow. • Use feedback to check the patient's understanding of your message. PATIENTS WITH HEARING IMPAIRMENTS Hearing loss affects a significant number of people of all ages. When initiating conversation, especially with older adults, carefully observe the receiver and use appropriate feedback to check for understanding. It is important not to assume that people can hear just because they are not wearing a hearing aid or do not ask you to speak up. Many people who experience hearing loss are unaware of it because it can happen gradually 14/06/2023 10:26

over the years or they are embarrassed to admit it. Following are signs that a person may have difficulty hearing: • Leaning forward and turning the head. . Asking you to repeat information. • Failing to hear when not facing the speaker. • Not responding to you when you ask a question or finish speaking. Sign language provides a means of communication for people with significant or complete hearing loss. It consists of hand movements and shapes, facial expressions, and corresponding body postures to convey meaning (Figure 1-12). The following suggestions can significantly improve communication with the hearing impaired: • Position yourself close to the receiver and speak face-to-face. • Remove or turn off sources of noise. • Have the light source directed to your face. Make sure your mouth is visible to the receiver. • Keep your hands away from your face. • • Say the person's name before beginning the conversation. Determine whether the person hears better in one ear than the other. • Introduce the general topic of the conversation. . Speak distinctly and do not mumble. Speak slowly, but naturally. • Do not shout or exaggerate words. This can make it even more difficult for the person to understand. • Maintain a low to moderate pitch of voice. • Use short sentences. • Watch for signs of comprehension. • Do not change the subject without warning. PATIENTS WITH VISUAL IMPAIRMENTS Patients who have visual limitations need special consideration, too. They do not have visual clues with which to orient themselves physically. With most of the meaning of communication being conveyed nonverbally, it is understandable that the visually impaired person experiences special communication challenges. Here are some ways to improve communication with visually impaired patients: QUALITY AND COMMUNICATION IN HEALTH CARE وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 47 47 | 14/06/2023 10:26

48 CHAPTER 1 وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 48 FIGURE 1-12 Sign language provides a means of communication for people with significant or complete hearing loss. • Start by announcing your presence and identifying yourself. • Before starting a procedure, describe any equipment to be used and its position in relation to the patient. • • As you proceed, explain what will be done and where you will be touching the patient. Explain what noises the patient will hear. • Give clear and complete directions. For example, say, "Raise your left arm directly in front of you to a 45-degree angle,” not “Raise your arm like this," or "Lift your arm." • " Let the patient know when you are leaving the area. • If the patient is to leave unaccompanied, give specific instructions about doorways and other landmarks and obstacles, such as uneven surfaces, that the patient will encounter. • Give extra verbal information to describe anything that would usually be expressed through facial expressions, gestures, head nods, and other movements. 14/06/2023 10:26

PATIENTS WITH SPEECH IMPAIRMENTS Patients may be unable to speak because of an injury, stroke, or other neurological condition. The condition may be temporary, such as when on a ventilator or using an artificial airway. Patients who are unable to express themselves can become anxious, frustrated, and even panicked. Communication can be aided by the use of mime, pictures and drawings, writing, and specially designed communication boards that have the most common patient requests to which they can point. Aphasia is a condition in which individuals have difficulty understanding or producing language. Problems vary from mild deficits, such as difficulty finding the correct word, to severe deficits in language comprehension and production. The main cause of aphasia is stroke. It may also be the result of loss of brain function, as happens with Alzheimer's disease. Here are some ways to improve communication for people with aphasia: • Remove noise and distractions. • Use adult language. Do not treat patients as if they were children. Ask "yes" and "no" questions. • Give clear choices for possible answers. • Use visual cues, such as picture cards. • Encourage the patient to communicate with you through gestures and drawings as well as speech. • Check for understanding. PATIENTS WHO ARE ANGRY Anger is the emotional response of displeasure or extreme annoyance to a perceived wrong. The loss of personal control experienced due to illness or injury, worries about the expense of health care, and the inconvenience of having to wait for service can all result in patient anger. Anger can also be caused by problems unrelated to health care, such as family difficulties or the loss of a job. When dealing with an angry patient, try to determine the cause. In most cases, the anger is not the fault of the health care professional. Anger may be a form of displacement in which the patient is unable to direct anger at the real cause. However, if you discover that you have done something to upset the patient, apologize sincerely and try to establish good communication aimed at meeting the patient's needs. The following guidelines are helpful when dealing with angry patients: • Do not respond in anger or argue with the patient. Remain calm and courteous. Listen attentively to the patient's concerns. وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 49 QUALITY AND COMMUNICATION IN HEALTH CARE 49 | 14/06/2023 10:26

CHAPTER 1 50 الوزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 50 • Offer a sincere apology if necessary. • Do not raise your voice. • Be aware of your own body language. Look at the patient. • Express concern and interest, not annoyance. . Answer the patient's questions. If you cannot resolve the problem, discuss it with your supervisor or other appropriate person. • If the patient is being verbally abusive, state politely that you are willing to listen but will not tolerate cursing or threatening language. • Ask for help from a co-worker or security if necessary. PATIENTS WHO DO NOT SPEAK ARABIC Imagine yourself as a tourist in a country whose language you do not speak and where the health care practices are different from those of your country. You are involved in an accident and taken to a hospital where no one speaks your language. You cannot explain your needs, and the treatments are different from anything you have ever experienced. Health care professionals can demonstrate compassion and care for these patients by learning at least a few common phrases of the major languages spoken in their community. In addition, the following ideas are helpful when working with non-Arabic-speaking patients: • A smile is a universal sign of good will. ⚫ Determine if the patient speaks or understands any Arabic or English. • Find out if a family member or friend who speaks Arabic or English is available to help. (Be sure that the patient agrees to have the other person involved so that confidentiality is not violated.) Speak slowly and clearly. • Do not raise your voice. It will not help the other person understand. • Use simple words and sentences. Do not use slang or expressions that may be misunderstood. • Try repeating your message in different words. • Use gestures and mime to demonstrate what you need the patient to do. • Write the message. • Use pictures if available. • Request the services of an interpreter if necessary. 14/06/2023 10:26

checkpoint 1. How should a nurse respond to an anxious patient? 2. What is the best way to deal with an angry patient? 1:5 UNDERSTANDING THE PATIENT AS AN INDIVIDUAL Treating each patient as an individual is an essential component of good care. It is important to help patients to retain their dignity; strive to acknowledge their experiences and needs during the stressful period of illness or injury. The effectiveness of the health care professional's interactions and communication with patients depends to a great degree on understanding and respecting people's individual differences. Being sensitive to the variety of perceptions that patients bring to the health care setting enables health care professionals to better meet patient needs. There are a number of ways to learn about patients as individuals: . Observe the patient's behavior and ways of interacting with others: - Eye contact. - Degree of formality in conversation and body movements. - - - Outward signs of emotions such as nervousness, fear, or suspicion. - Presence of family members. - Interactions with family members. - Reaction to touch and close personal contact. • Determine whether language barriers are present: - - - Ask the patient in what language they are most comfortable communicating. Ask about language preferences for written information. Ask whether patient needs an interpreter when discussing health care information and treatments. • Ask questions to determine individual preferences: - What do you do to help you stay healthy? - - - - What do you usually do when you are sick or not feeling well? Who do you go to first when seeking help with health problems? Who will help you at home if you need assistance? In coping with this illness/injury, what are your expectations of the health care team and of yourself? وزارة التعليم Ministry of Education 2024-1446 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 51 QUALITY AND COMMUNICATION IN HEALTH CARE 51 | 14/06/2023 10:26

52 وزارة التعليم Ministry of Education 2024-1446 CHAPTER 1 GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 52 - - What do you think will be the most important factor in your recovery? Is there anything you would like to tell me that might help us understand your needs? • Listen carefully to the patient's responses. Explain what you are doing and why when performing procedures or asking questions that may be difficult for the individual based on what you have learned. In addition to being aware of individual differences, understanding human motivation and the need to preserve self-esteem will help you to communicate effectively and provide appropriate care, observing body language, and creating clear messages. Below is a summary guide to treating patients as individuals: • • Develop an understanding of the patient as an individual, including how their condition or illness affects the person, and how the person's circumstances affect their treatment and longer-term health. Ensure that factors such as physical or learning disabilities, sight, speech, or hearing problems, and difficulties with reading, understanding, or speaking Arabic are addressed so that the patient is able to participate as fully as possible in consultations and care. • Ask the patient about any factors, such as their domestic, social, and work situation and their previous experience of health care, that may impact on their health condition and affect their ability or willingness to engage with health care services, manage their own care, and make decisions about self-management and lifestyle choices. • Listen to and address any health beliefs, concerns, and preferences that the patient has, and be aware that these factors affect how and whether they engage with treatment. Respect their views and offer support to help them engage effectively with health care services and participate in self-management as appropriate. • Avoid making assumptions about the patient based on their appearance or other personal characteristics. • If appropriate, discuss with the patient their need for psychological, social, or financial support. Offer support and information to the patient and direct them to sources of support and information. Review their circumstances and need for support regularly. 14/06/2023 10:26

وزارة التعليم Ministry of Education 2024-1446 checkpoint 1. What does the effectiveness of a health care professional's interactions and communication with patients depend on? 2. What measures will help you to communicate effectively and provide appropriate care? Today's Research Tomorrow's Health Care Memories Restored by Flipping a Switch? Do you wish that you could always remember the names of people you have met before? Wouldn't it be nice to be able to turn memories on and off with the flip of a switch? You could eliminate all your bad memories and improve your good ones. Someday this may be possible. A team of biomedical engineers has figured out how to manipulate brain cells in rats so that they can be activated or suppressed. The study involved an area of the brain called the hippocampus, a region crucial for memory formation. The team inserted electrical probes in the hippocampus. They then taught rats to learn which of several levers had to be pressed to receive a reward. During the learning process, the researchers recorded changes in the brain activity of the rats between two major internal divisions of the hippocampus, subregions known as CA3 and CA1. They learned that these subregions interact to convert short-term memory into long-term memory. The scientists used electrical probes to stimulate the nerves, and found that the rats' performance improved, and the rats could remember the correct lever for a longer period of time. To check whether memory could be suppressed, the researchers gave the rats a drug that blocked the nerve-cell activity, and caused them to forget the task. A team then created an artificial system that duplicated the pattern of interaction in the hippocampus. When this system was inserted into the animals and the brain cells were stimulated with the correct pattern, long-term memory returned. A final discovery was that when the prosthetic hippocampus with its electrodes was implanted in animals with normal function, the device strengthened the memory being created. The research team has now worked with a team of doctors to implant the hippocampal prosthetic in patients as part of a medical diagnostic procedure for epilepsy. While the electrodes were in place, memory tests were performed, and the team was able to demonstrate up to 37% improvement in memory function. Additional research is now being conducted to customize the implants and test memory codes to see whether memories can be retained over a period of time. If this research is successful, it might be possible to create a prosthetic that can be permanently implanted in humans. This could help victims of Alzheimer's disease, stroke, or brain injury to recover memory that has been lost and could improve mental function. In addition, if the prosthetic can be used to suppress memories, the device might be a method for treating individuals with post-traumatic stress disorder or other psychiatric conditions, such as fears caused by a previous memory. Even though this research will require many more years of study due to the complex nature of memory in humans, if it is successful, it will be a major breakthrough for many individuals. Case Study Investigation Conclusion Rashmi is very nervous about what the lump might mean for her. She will be worrying that she has breast cancer. Were you able to work out a strategy for helping Rashmi? How can you reassure her about the process? Did you consider her daughter's needs as well? GE45.PATHWAYS.G03.S1-2.HC.ENG.SB.indb 53 QUALITY AND COMMUNICATION IN HEALTH CARE 53 | 14/06/2023 10:26