Self-Reflection in Communication

Original Editor - Robin Tacchetti based on the course by Marissa Fourie
Top Contributors - Robin Tacchetti, Jess Bell and Tarina van der Stockt

Introduction

Effective healthcare communication has beneficial effects on patients including decreased pain and anxiety, increased satisfaction, improved vital signs and treatment outcomes and increased participation in interventions.In a successful two-way dialogue between provider and patient, both parties speak freely and are listened to without interruptions. Both parties have the ability to ask questions for clarification while feeling open to expressing their opinions.

Since patient-centered communication can facilitate positive health outcomes, providers need to be responsive and individualised in their patient interactions due to different cultures, languages, values and beliefs. Providers must be mindful of their own values and beliefs that can cause barriers to patient communication.

Values

Values are described as context-independent, abstract and steady goals which people strive to achieve in life. They guide peoples' perception, behaviour and attitudes. They are distinct from norms, attitudes and beliefs but are related. Values are relatively stable through the lifespan, and in situations but do have the ability to change.

10 Basic Values

The Theory of Basic Human Values identifies 10 basic values that are each characterised by a different motivational goal.

1. power: dominance over resources and people, social status
2. achievement: personal success according to social standards
3. hedonism: gratification or pleasure for oneself
4. stimulation: novelty, challenge or excitement
5. self-direction: independence in action and thought
6. universalism: understanding, welfare and concern for all people and nature, tolerance
7. benevolence: increasing the welfare of people whom one is close to
8. tradition: commitment and respect to religious or cultural ideas
9. conformity: restraint of actions that may harm others or violate social expectations
10. security: stability and safety of relationships, self and society

Relationship of Values

These 10 basic values can be co-mingled to form two different subsets of values:

1. self-transcendence:
   • concern for welfare and interest of others
   • openness to change values
   • preserves tradition
   • self-restraint
   • social focus
2. self-enhancement
   • success and dominance over others
   • pursuit of ones own interest
     • personal focus
   • self-protective
   • avoiding conflict to control situations

Beliefs

Values identify what people feel are important and what goals they want to pursue. Beliefs on the other hand determine what people consider to be true and how they will pursue their respective goals. Beliefs offer an individual casual explanation (rooted determining factor) for perceived individual differences and observed behaviour. Stereotypes and prejudice are specific behavioural and cognitive tendencies that are associated with beliefs. Stereotypes are the association and attribution of specific characteristics to a group. It is the image that comes to mind when one thinks about a particular social group. Prejudice is an attitude (often negative) reflecting an overall evaluation of a group.

Self-Reflection

The healthcare provider must understand that their own rooted values and beliefs can hinder effective communication with their patients. Providers that examine and explore their own attributes and perspective through self-reflection will gain insight in how to improve in the future. In order to begin the process of reflection, one needs to recall, reconsider and reevaluate their own experiences. Intentional reflection on actions, emotions and experience is critical to informing the individuals existing knowledge base and making contextually appropriate changes.Reflective thinking should be learned and used continuously as a proof of professional behaviour and professionalism in clinical performance.

In addition to self-reflecting on ones own values and beliefs, providers should be aware of other physiological cues their body might be signaling that could hinder their patient interaction. Providers should take note of their current emotions, thoughts, non-verbal and physiological cues that could interrupt good patient communication. Below are some examples of reflective thinking a provider could do prior to engaging a patient:

Reflective Practice	Act
Emotions	consider your current emotions: are you feeling frustrated, anger, sadness, happy having a sense of your current emotions prior to the interaction may help avoid miscommunication
Thoughts	are you having ruminating thoughts it may be difficult to stop a thought from invading your mind be mindful of that thought and try and suspend it when you are with the patient
Non-verbal cues	are your current emotions and thoughts leading you to display non-verbal cues be mindful of non-verbal cues you might be exhibiting
Physiological triggers	is your body trying to tell you something: hunger, sadness, fatigue physiological cues can lead you to displaying non-verbal cues be mindful of physiological cues and how they might shape your non-verbal cues
Environmental triggers	do environmental triggers affect your ability to listen be mindful of subtle triggers such as foul smell, bright lights, and beeping machines that may affect your ability to communicate effectively

How to Self-Reflect

Clinicians can use various methods to learn how to incorporate self-reflection into their practice. Some of the following examples that can assist in self-reflection:

1. Connecting with a mindfulness training program or adopting mindfulness skills to foster attentiveness and self-awareness
2. Joining a professional development course where reflection and self-assessment are the core topics
3. Begin expressive writing to develop and nurture your reflective capacity and critical analysis skills

Resources

• Personal Values and Beliefs
• Clinical Reflection
• Communication Skills
• Culture and Communication