Modes of Communication: Difference between revisions

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* awareness of patient's non-verbal responses
* awareness of patient's non-verbal responses
** using those cues to makes decisions<ref name=":6" />
** using those cues to makes decisions<ref name=":6" />
Exline (1971) has categorised most of
these elements into two main groups,
affihative and dominant. Both of these can
be observed m a therapeutic setting
(Gallois et al 1979) Affiliative behaviours
are related to intimacy, are generally
regarded as being more feminine and
include, for example, touch, close
proximity, smilmg, friendly tone of voice
and eye contact.
Dominant behaviours are concerned
with power and influence, considered to
be more masculine, and include speaking
loudly, and for long periods of time,
interrupting, avoidance of eye contact and
attempts to be influential (Strongman
1979).
Since physiotherapy is primarily a
female profession, affihative behaviours
can be assumed to be more evident. Males
as well as females require treatment
however, so a more dominant style is
adopted, possibly to maintain professional
status (Gallois et al 1979) H owever Gallois
also found that affiliative behaviour was
more effective for successful treatment
Two non-verbal cues, touching and
close proximity, are usually considered
socially unacceptable unless in conditions
of intimacy, though there are cultural
variations However these two cues are
essential m a physiotherapeutic setting if
the physical care of the patient is to be
complete
Touch and Proximity
The physiotherapist's handling of a
patient cannot occur unless the space
between them is eliminated, and 'the
logical end of proxemics is touching'
(Weitz 1974). A thorough and accurate
physical examination must occur for
appropriate treatment to be carried out.
The patient's perception of the therapist's
feelings is altered by good or poor
handling. Touching can occur too within
the therapeutic process and indicate
encouragement, support or canng which
enhance the patient's perception of
rapport. Handling a patient's belongings
can also indicate to him whether a canng
relationship exists; throwing clothes
carelessly to one side, or pushing shoes
away with one's foot clearly might cause
the patient to perceive a fundamental
carelessness and could lead to feelings of
rejection.
Another aspect of touch is its
enhancement ofself-concept or self-worth
After an amputation, for example, the
patient's self-esteem can be devalued while
he adjusts to the loss of a limb The
physiotherapist's handling of the part
without aversion and withcareand interest
indicates that the physiotherapist accepts
the patient unconditionally (Pratt 1978)
This form of touch is termed 'acceptance'
by Perry (1974).
Sensitivity to 'non-touch' is important
in, for example, the treatment of a patient
with spinal injury. Adaptations of
kinaesthetic sense and balance reactions
are necessary in order to include the
wheelchair as a compensatory device for
paralysis of limbs If the wheelchair is
moved or tilted unexpectedly from behind,
the patient is unbalanced which gives rise
to anxiety and possible loss of trust in the
physiotherapist.
Facial Expression
Facial expression conveys a multitude
of meanings and much is revealed to both
patient and therapist, particularly at the
beginning of a treatment session The
benefits of smiling and a pleasant facial
expression need not be mentioned, since
so many examples of the effect on us of a
pleasant or unpleasant expression can be
brought to mind The same is true of
patients in their encounters with
physiotherapists
Much research has been undertaken in
the study of facial expression, notably by
Shapiro et al (1968), Ekman and Fnesen
(1971) and Dittman (1972, cited by Weit?
1974) Gallois et al (1979) found that
smiling at the patient by the physio-
therapist did not often occur during treat-
ment even though female physiotherapists
tended to smile more often than male
physiotherapists This could indicate that
females display more affihative behaviour
than males. Until the physiotherapist/
patient relationship is well established,
however, each will respond to the more
obvious cues — 'words, stereotypes, facial
expressions and gestures'(Dittman 1972)
A facial expression of genuine interest
and concern conveyed to the patient is
undoubtedly of value this cue when
integrated with the other non-verbal
elements, leads to rapport and trust in the
physiotherapist, so that the patient is
motivated to comply with instructions and
advice
Eye Contact
Eye contact is taken to be a signal of
either dominance, as in a stare, or intimacy
as in affiliative behaviours (Exline 1971),
Gallois et al (1979) found that long gazes
did occur, possibly as a means of signifying
dominance, or as a result of mixed sex
interactions as a sign of affiliation. How-
ever eye contact also suggests interest in, and
respect for the patient (Banville 1978) and
can be regarded as a significant factor in
the total non-verbal communication A
physiotherapist who leans forward, nods
the head appropriately, listens attentively
and maintains eye contact (La Crosse
1975) emanates warmth and regard for the
patient who responds appropriately.
Conversely, minimal eye contact with
frequent glances away from the patient
might indicate disinterest and boredom.
Gestures and Posture
Adjuncts to speech are gestures which
2 0 The Australian Journal of Physiotherapy Vol. 28, No 4, August 1982
mplify or modify verbal cues, involuntary
gestures reveal much about the patient,
particularly if the facial expression and
verbal content are guarded Leakage will
occur subconsciously (Ekman and Fnesen
1969). This term can be defined as
incongruity between two non-verbal
messages' for example, the facial
expression may display confidence but the
fingers may be tapping nervously.
Posture reveals tension or relaxation
(Strongman 1979); a patient could feel
more comfortable with the physiotherapist
sitting beside him in a position of co-
operation than in a face-to-face
confrontative or competitive situation
(Strongman 1979), though some
treatments necessitate such a position
Observation, Listening, Use of Silence
It is in these situations that the
physiotherapist requires skills in
observation and listening. The patient's
posture reveals the current state of mmd;
for example, a slumped position could
indicate depression whereas constant
postural shifts reveal agitation and
anxiety The cues are always observable
Listening is of great importance and can
reveal much to the physiotherapist who,
by emitting non-verbal cues, enables the
patient to talk freely if he wishes. Total
listening implies understanding of feelings
as well as content (Sutchffe 1970, Banville
1978) Positive regard, communicated to
the patient, helps him to restore feelings of
impaired self-concept, and to accept
himself as he is whatever his disability
Listening skills should be combined
with the understanding of the potency of
silence, A patient may have gained a
valuable insight into his problems through
the facilitation of the interactive process
and needs some time to reflect An
awareness of this need overcomes the
natural desire on the part of the
physiotherapist to break the silence,
unwittingly putting an end to the
therapeutic or healing process (Enelow
and Swisher 1972, Meares 1969)
Tone of voice
Since verbal communication is also an
essential part of the physiotherapist/
patient interaction, the tone of voice is of
great significance Mehrabian and Ferns
(1967) found that inconsistencies in vocal
and verbal messages led to an
interpretation from the tone of voice, not
content This was borne out by Milmoe
etal (1967) who found that alcoholics
responded more effectively to a physician
whose tone of voice intimated concern and
anxiety than when the tone of voice
expressed anger or matter-of-factness
These findings can be directly related to the
physiotherapeutic environment, where
instructions will be listened to more
attentively if the patient perceives concern
for his welfare Variations in the tone of
voice are very important in most
therapeutic situations, as for example in
effecting a voluntary response from a
poorly motivated patient, or producing
successful relaxation.
Patient anxiety
The one to one relationship experienced
by a patient and his physiotherapist can be
effectively utilised in a calm and unhurried
way. The time spent during treatment can
be lengthy, the average time taken for
application of a technique being half-an-
hour DiMatteo (1979) states that
satisfaction with the interaction resulted
not from the actual time taken, but from
the patient's perception of the time being
enough With the establishment ofrapport
(Meares 1969) the patient may feel
encouraged to express anxieties and fears
without feeling the pressure of imminent
dismissal. This is of great therapeutic
importance. Frequently the physio-
therapist is the only member of the helping
professions with time potentially available
for the patient to ventilate feelings related
to his disability, work or other areas of
anxiety; 4the opportunity is there' (Pratt
1978).
It is sometimes felt that every minute of
the allotted time for treatment must be
spent on techniques designed to
rehabilitate muscles, nerves, joints or other
physical disabilities However, it is of little
value to treat the effect without
understanding the cause. Denstad in 1974
(cited by Pratt 1978) suggests that 'the
problems concerning the patient's
expectations of being the passive receiver
are reduced when the patient is treated
from the onset as a participant in his
therapy and not as an onlooker'. In other
words, if a patient is made aware that his
tension headaches are related to external
factors and that modifying steps would
reduce stress and thereby the headache,
treatment will be far more effective.
Shafar and Ruddick (1976, p.82) cite
Cooksey (1969) as stressing *the large
number of cases with disorders of the
musculo-skeletal system where pain and
disability are accentuated by disturbances
in mental functioning Anxiety reactions
invariably accompany the stress of
sickness and injury, and it would appear
that many doctors are insufficiently
concerned with the outcome of
explanations offered to the patient.
Palliative physiotherapy for lengthy
periods, culminating in discharge with
relief only serves to aggravate the pre-
existing anxiety and reinforces
psychological factors, especially when a
component of anger, resentment and
feeling of rejection is present'.
If a physiotherapist is aware that every
patient who comes for treatment
experiences anxiety and that this anxiety
varies in type and intensity for the patient,
then her treatment and interpersonal
relationship can be greatly enhanced and
lead to achievement of goals.
Conclusion
Social skills can be learned and it is less
helpful to the patient for the physio-
therapist to rely on instinct and experience
in order to understand his non-verbal
behaviour. Effective understanding and
use of non-verbal skills in the therapeutic
setting should be employed to achieve
successful outcome. A patient who has
confidence and trust in the physiotherapist
is far more likely to comply with
instructions and implement treatment
(Davis and Kenyon 1981, DiMatteo 1979)
than a patient who perceives lack of
interest or antagonism, even though the
verbal instructions may be identical. It
may be assumed that the motivated patient
is the one who volunteers the information
that he has performed the exercises at
home; the non-motivated patient will
The Australian Journal of Physiotherapy Vol. 28, No. 4, August 1982 2 1
amplify or modify verbal cues, involuntary
gestures reveal much about the patient,
particularly if the facial expression and
verbal content are guarded Leakage will
occur subconsciously (Ekman and Fnesen
1969). This term can be defined as
incongruity between two non-verbal
messages' for example, the facial
expression may display confidence but the
fingers may be tapping nervously.
Posture reveals tension or relaxation
(Strongman 1979); a patient could feel
more comfortable with the physiotherapist
sitting beside him in a position of co-
operation than in a face-to-face
confrontative or competitive situation
(Strongman 1979), though some
treatments necessitate such a position
Observation, Listening, Use of Silence
It is in these situations that the
physiotherapist requires skills in
observation and listening. The patient's
posture reveals the current state of mmd;
for example, a slumped position could
indicate depression whereas constant
postural shifts reveal agitation and
anxiety The cues are always observable
Listening is of great importance and can
reveal much to the physiotherapist who,
by emitting non-verbal cues, enables the
patient to talk freely if he wishes. Total
listening implies understanding of feelings
as well as content (Sutchffe 1970, Banville
1978) Positive regard, communicated to
the patient, helps him to restore feelings of
impaired self-concept, and to accept
himself as he is whatever his disability
Listening skills should be combined
with the understanding of the potency of
silence, A patient may have gained a
valuable insight into his problems through
the facilitation of the interactive process
and needs some time to reflect An
awareness of this need overcomes the
natural desire on the part of the
physiotherapist to break the silence,
unwittingly putting an end to the
therapeutic or healing process (Enelow
and Swisher 1972, Meares 1969)
Tone of voice
Since verbal communication is also an
essential part of the physiotherapist/
patient interaction, the tone of voice is of
great significance Mehrabian and Ferns
(1967) found that inconsistencies in vocal
and verbal messages led to an
interpretation from the tone of voice, not
content This was borne out by Milmoe
etal (1967) who found that alcoholics
responded more effectively to a physician
whose tone of voice intimated concern and
anxiety than when the tone of voice
expressed anger or matter-of-factness
These findings can be directly related to the
physiotherapeutic environment, where
instructions will be listened to more
attentively if the patient perceives concern
for his welfare Variations in the tone of
voice are very important in most
therapeutic situations, as for example in
effecting a voluntary response from a
poorly motivated patient, or producing
successful relaxation.
Patient anxiety
The one to one relationship experienced
by a patient and his physiotherapist can be
effectively utilised in a calm and unhurried
way. The time spent during treatment can
be lengthy, the average time taken for
application of a technique being half-an-
hour DiMatteo (1979) states that
satisfaction with the interaction resulted
not from<ref>HARGREAVES S. [https://reader.elsevier.com/reader/sd/pii/S0004951414607741?token=CC9C6100E67BDCC48DE73542640839598DC1ECCBCC324811BF40800453E720876AE8EE3622677C400BDF4419DBF43535&originRegion=us-east-1&originCreation=20230516143444 The relevance of non-verbal skills in physiotherapy]. Australian Journal of Physiotherapy. 1982 Aug 1;28(4):19-22.</ref>


== Resources ==
== Resources ==

Revision as of 14:19, 17 May 2023

Original Editor - Robin Tacchetti based on the course by Jason Giesbrecht
Top Contributors - Robin Tacchetti, Jess Bell, Naomi O'Reilly and Tarina van der Stockt

Introduction[edit | edit source]

Communication is defined as the method of sending and receiving messages to share skills, knowledge and attitudes.[1]

Communication in the healthcare environment entails transmitting and receiving of information between clinician and their patients . Good communication is a fundamental clinical skill that establishes the therapeutic relationship between the clinician and their patients. Studies show that clinicians who explain, listen and empathise with their patients produce a profound effect on their patients health status and functioning as well as overall satisfaction in the medical care. [2]

Historically, medical settings incorporated direct face-to-face communication to relay information. In this format, patients could not only hear the information, but were able to see facial expressions and body language to help better understand the meaning behind the words. Direct interactions are decreasing as indirect interactions like video conferencing increase. Technological advances have also aided an increase in written communication (emails, texts, etc) between providers and patients. Besides patient preference written communication has many other advantages in medical care including it is educational, easily distributed, traceable and can hold medical-legal value.[3]

Communication Modes[edit | edit source]

Clinical communication interactions that are respectful enhance patient engagement in decision making, increase patient adherence to treatment and patient satisfaction and reduce anxiety and uncertainty.[4] Medical communication between patient and provider should entail a two-way dialogue of mutual respect. Effective communication between both parties would incorporate the following components:

  1. exchange of information
  2. ability to speak and listen without interruption
  3. ability to express their opinions
  4. ability to ask questions for clarity[4]

Medical communication is delivered through three modes, verbal, non-verbal and visual. [2] Verbal communication is delivered through spoken words or written language. Nonverbal communication displays emotional information through the body or face. [1] Visual communication delivers messages through visual cues suck as illustrations and diagrams.[5]. Both verbal and non-verbal communication can be influenced by a number of factors including the volume and pace of the interaction, the spatial proximity, the style of communication (friendly vs. authoritative) and the extent or limit of physical contact.[2]

1. Verbal[edit | edit source]

Verbal communication encompasses both written and oral forms. Written communication is generally used to relay information in a permanent manner. With advances in technology written communication has increased over recent years. Examples of written communication include emails, text messaging, electronic medical records, reports etc. Oral communication, also known as spoken communication includes telephone calls, face-t0-face interactions, video conferencing, etc. [5]

2. Non-Verbal[edit | edit source]

Non-verbal communication is a way of conveying emotion and information without using words. It provides the listener with additional information or even contradicts the spoken message.

It comprises a wide range of physical signs such as:

  • facial expressions/gestures
  • body language/posture
  • eye contact
  • shrugging
  • pointing

Equally important is to note the listener has their own non-verbal cues and should consider how they might be interpreted or perceived by others. In addition, within non-verbal communication lies paraverbal attributes which include the inflection of voice, tone, rhythm, intonation, and verbal flow. These paraverbal factors relay communication as well. [2]

** Note that individual and cultural differences can impact non-verbal communication due to different norms[5]

3. Visual Cues[edit | edit source]

Visual communication is a way to deliver messages and ideas through visual cues such as charts, photographs, videos and illustrations. When it is difficult to relay messages through words, visual communication can be a highly productive tool. Often times a single diagram, illustration or photograph can relay information complex information in a more succinct manner than words. Additionally, if there is a language barrier between provider and patient, visual cues can cross the lines to be easily as universal language. Visual cues allow patients to understand easier and retain information greater than written or spoken words.[5]

Active Listening[edit | edit source]

Effective oral and non-verbal communication requires active listening.[5]. Active listening is a critical component of good communication which involves giving the speaker your full attention without distractions or interruptions. Active listening is more than simply listening to the speaker. The components below detail what is involved in active listening:

  1. Reflect: confirm your understanding by paraphrasing or repeating what they have said
  2. Clarify: ask questions to better understand what they said
  3. Summarise: provide a brief summary of what they said
  4. Empathise. attempt to understand their feelings and perspective
  5. Non-verbal cues: pay attention to body language, tone of voice and facial expressions
  6. Avoid interruptions/distractions: allow them to finish without interruption/distractions[5][2]

Barriers[edit | edit source]

Despite understanding good communication practices, there are always barriers to good communication within the healthcare environment. Barriers can limit or prevent the patient from expressing their healthcare needs and/or limit the provider from giving critical information in a clear, concise manner.[4]One of the most common barrier for providers is an institutional barrier of staffing shortages and high workloads ultimately leading to burnout. Providers suffering from burnout will have difficulty with active listening. High caseloads creates limited time to interact with each patient as the providers have too many patients to attend to in a day. [6][4]As their interaction time is decreased, patients might not have the opportunity to provide all the details the provider needs to care for them appropriately. In addition, the patient may not have the opportunity to ask questions which could alter their adherence to treatment or medication.[4] Decreased time with patients is not the only barrier leading to misunderstood treatment and medication instructions. A poor communicator or language barrier could alter how a patient understands what their interventions are and how to perform them correctly. Hiring translators and interpreters would assist with interactions when language barriers exist.[4] Language barriers may accompany cultural or value norm differences. In this scenario, providers may not understand factors such as personal proximity, touch, or body language. [7]Lastly, there are environmental challenges which may hinder communication between provider and patient. In a medical setting, the distance between the provider and the patient's bedside may be too far weakening the connection and not allowing the patient to engage fully. In addition, the rooms may be noisy, messy and/or dark increasing distractions during interactions. Lastly, the lack of privacy can keep a patient from communicating important details the provider might need. [7] The environment for verbal communication should be in a caring surrounding. This allows the patient to feel physiologically and psychologically safe.[8]

Physiotherapy and Communciation[edit | edit source]

Physiotherapists can attain the necessary communication skills through experience, age and accumulated knowledge. Communication is encouraged through verbal skills in the physiotherapist/patient relationship. Ruso et al., 2017 performed a literature review and determined that the below factors help build good communication between physio and patient:

  • using respectful greetings to the patient
  • expressing ideas in a direct way using short phrases
  • use of positive phrases and words
  • avoiding the use of adjectives as much as possible
  • keeping the patient abreast from the beginning about expectations, techniques, rules, recovery, etc.
  • explaining technical terms to avoid misunderstanding
    • adapting language to the education and understanding of thepatient
  • avoiding placing the patient in an embarrasing or uncomfortable situation
  • using professional and respectful language
  • flexibility
  • using jokes when appropriate
  • use of an interpreter when necessary
  • identifying and decreasing communication barriers
  • use of active listening technique
  • repeating when necessary[9]

Ruso et al., 2017 also identified ways to encourage non-verbal communication within the therapeutic relationship as seen below:

  • being aware of the non-verbal cues you as the provider are displaying during the meeting
    • looking at the clock, expression on your face, etc.
  • awareness of your own noverbal bias
    • obsese patient, poor hygiene patients, etc.
  • awareness of patient's non-verbal responses
    • using those cues to makes decisions[9]

Resources[edit | edit source]

References[edit | edit source]

  • Hall, M. L., & Dills, S. (2020). The limits of “Communication mode” as a construct. Journal of Deaf Studies and Deaf Education, 25(4), 383-397. https://doi.org/10.1093/deafed/enaa009
  1. ↑ 1.0 1.1 Wanko Keutchafo EL, Kerr J, Baloyi OB. A Model for Effective Nonverbal Communication between Nurses and Older Patients: A Grounded Theory Inquiry. InHealthcare 2022 Oct 22 (Vol. 10, No. 11, p. 2119). MDPI.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Chichirez CM, Purcărea VL. Interpersonal communication in healthcare. Journal of medicine and life. 2018 Apr;11(2):119.
  3. ↑ Vermeir P, Vandijck D, Degroote S, Peleman R, Verhaeghe R, Mortier E, Hallaert G, Van Daele S, Buylaert W, Vogelaers D. Communication in healthcare: a narrative review of the literature and practical recommendations. International journal of clinical practice. 2015 Nov;69(11):1257-67.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Kwame A, Petrucka PM. A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC nursing. 2021 Dec;20(1):1-0.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Giesbrecht, J. Modes of Communication. Plus. 2023
  6. ↑ Ozavci G, Bucknall T, Woodward‐Kron R, Hughes C, Jorm C, Manias E. Creating opportunities for patient participation in managing medications across transitions of care through formal and informal modes of communication. Health Expectations. 2022 Aug;25(4):1807-20.
  7. ↑ 7.0 7.1 Communication Theory. Cultural Barriers of Communication. Available from: https://www.communicationtheory.org/cultural-barriers/
  8. ↑ Iedema R, Greenhalgh T, Russell J, Alexander J, Amer-Sharif K, Gardner P, Juniper M, Lawton R, Mahajan RP, McGuire P, Roberts C. Spoken communication and patient safety: a new direction for healthcare communication policy, research, education and practice?. BMJ Open Quality. 2019 Sep 1;8(3):e000742.
  9. ↑ 9.0 9.1 Rusu O, Chiriță M. Verbal, non-verbal and paraverbal skills in the patient-kinetotherapist relationship. Timisoara physical education and rehabilitation journal. 2017 Sep 1;10(19):39-45.
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