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INTERPERSONAL COMMUNICATION Manual for Trainers of Health

1. a rente seen neri tens reser nnn nennen 21 O TYPES OEOUESTIONS 5 ee ro eite eere b deh beo E bees 23 UNIT 3 QUALITY ASSURANCE Ss ceca eee eset ev eve ee eaae tue utu ve eee ena aee pee vu LE eU va eaae beer eoa eR a e a ETE TER 26 UNIT 4 CLIENT PATIENT EDUCATION eene eene eene tn nana nente tasas ases e asses e sesta s sa asses en 31 1 WHATIS PATIENT GLIENT EDUCATIONZ eec teet eee eget eee eee gud eee eee d vo und 31 2 HOW TO ESTABLISH A PATIENT EDUCATION PROGRAMME 32 3 PATIENT EDUCATIONAN PRACTICE petere etie e etes etu ete cance uence OE SEP E Ue RT ERO ead 33 4 THEPATIENT S CHARTER sisi XC TE E CIS EE Te EE LS CE T RC EE Ere Ue dert 34 5 MEDICO LEGAL HAZARDS dec coss re e C E E ETE T R 35 UNIT 5 PUBLIC RELATIONS bb ne Pao oe e unn On eo coovessosvenccasecssnsbsucstososessecnsccssoees 39 ANNEX 1 NEEDS ASSESSMENT QUESTIONNAIRE FOR PATIENTS CLIENTS eA 44 ANNEX2 TRAINING NEEDS ASSESSMENT QUESTIONNAIRE FOR HEALTH CARE PROVIDERS IN INTERPERSONAL COMMUNICATION eerte entente 46 ANNEX3 NEEDS ASSESSMENT QUESTIONNAIRE FOR INTERPERSONAL COMMUNICATION IPC MANAGEMENT AND SUPPORT 5 49 ANNEX 4 TWENTY HINTS FOR HAPPIER PATIENTS e
2. Quality demands sacrifice Time well spent with a patient is time saved Quality costs less Satisfaction of needs between the consumer and the provider Optimum care to clients regardless of their ability to pay Being friendly and courteous to consumers and clients Commitment and respect Observing ethical practices Listening attentively Sharing information and explaining procedures sensitive to client s opinion providing appropriate constellation of service e g immediate attention listening and avoiding delays In conclusion holistic care that fulfils the needs and the rights of a patient client take into account the following l choice of care and treatment 2 providing relevant information to client 3 the right to a be treated with dignity and respect b know names of people serving you c have privacy and confidentiality of your records d receive explanations education and counselling e consent to or refuse any care or treatment In addition to the above the patient also has the right to speak out complain and acknowledge good performance 28 Some methods of assessing Quality Care are as follows COPE is the newest method of accessing quality care This will be explained further COPE stands for C Client O Oriented P Provider E Efficiency COPE is defined as a process and practical set of tools used to improve quality of health services at clinics hospitals or organi
3. Be specific Make sure they know when to come back Ask if there is anything else they would like to know 59 Brown Di Prette L et al Ewles L And Simnett I 1995 Green WL and Kreuter MW 1991 Green W L et al 1980 Holiday Inn Worldwide 1996 Hubbley J 1994 P L Hunsaker amp A J Alessandra Johns Hopkins University 1993 Ministry of Health 1993 REFERENCES Quality assurance of Health Care in Developing Countries Centre for Human Services 7200 Winsconsin Ave Bethsda USA Promoting Health A Practical Guide to Health Education John Wiley and Sons Health Promotion Planning An Educational and Environmental Approach Mayfields Publishing Co USA Health Education A Diagnostic Approach Mayfield Publishing co USA Guest Relations Manual Orlyplein 65 Budiyrl 1043 Amsterdam The Netherlands Communicating Health An Action Guide to Health Education and Health Promotion Macmillan London 1994 The Art of Managing People Prentice Hall 1980 Advances in Family Health Communication Baltimore Maryland USA Twenty hints for Happier Patients Seychelles Ministry of Health amp Child Welfare The Patient s Charter Gvt Printers Harare 1996 Stoner AFJ and Freeman RE 1989 Management Prentice Hall London Zimbabwe National Family Planning Council 1994 Information Education Communication IEC Reference Manual Harare 60 Suppo
4. Don t make excuses or blame others in your organisation The client wants a solution to the problem not an inquisition of your internal operations Give the client your full attention and establish eye contact Sympathetic nods help defuse situations and many clients feel they are receiving a fair hearing if they see someone jotting down a few notes Paraphrase their complaint in your own words to determine if you have correctly understood the situation Play the situation back to them to check for understanding just want to check that I have understood you correctly If you don t know the answer to their problem don t lie Adopt the old teaching maxim and admit you don t know but make a commitment that you will find out and get back to them within a specific time Do call back when you say you will even if for some reason you haven t been able to obtain a satisfactory answer by then Make the client part of the solution not part of the problem Conclusion Good public relations is making people feel good when you help them and feeling good yourself when you help others 42 Lesson Plan pom the topic and the objectives of the session Ensure that participants understand and agree to the objectives 2 Lecture Guided resent the topic of Public Relations 40 minutes Dialogue The importance of public relations Communication rules for creating a favourable impression ules for dealing with complaints 3 Brainstor
5. a discussion whether something should be done bm m 92 92 9 T True F False Not sure 10 Duplication Exercise Task Sheet for Participants Compare the following 10 statements with the information you have received Please tick off according to the information T the statement is in agreement with the information of the story F the statement contradicts the information in the story not sure 1 The executive had denied the employee a raise in pay T 2 The employee did not receive a raise in pay T 3 The employee was angry not to get a raise in pay and gave notice to leave the organisation T 4 The reason for the employee s wish to leave the organisation was the refusal to pay him more money T 5 The colleagues were sorry because the employee left the organisation T 6 The colleagues discussed with the employee T 7 The executive did not take part in the discussion T 8 The executive asked the employee to leave the organisation T 9 The colleagues felt sorry because the employee did not get a raise in pay T 10 The employee was generally well liked and there was a discussion whether something should be done T 11 UNIT 2 INTERPERSONAL COMMUNICATION IPC Interpersonal Communication IPC is direct face to face communication between two people or groups In this unit health care providers will seek to demonstrate its applicability and effectiveness in a health care s
6. e Patient education is a term for educational activities in health care settings linked to treatment procedures medication home care and rehabilitation procedures Other activities of patient education include AIDS education dental and mental education to bring about change in behaviour 31 Purposes of Patient Education Counselling and interpersonal skills of health care providers should be improved in order to e provide effective and efficient services to consumers in a healthy working environment e ensure that patients have a right to know their current health status and what they can do to achieve health e provide clear information to clients with dignity consent and respect e provide hospitality to patients clients in more friendly atmosphere e improve the corporate image of the hospital institution or organization 2 How to establish a Patient Education Programme Guidelines for setting up Patient Education Programmes e The responsibility for patient education programmes should be assigned to a selected committee in a hospital e Parameters for the development of patient education programmes must be according to available resources e goals must be specific and should be expressed in measurable terms for the purpose of evaluation e informed patient is an essential member of the health team Ensure that patients participate fully in establishing education goals According to Maradzika J 1994 a suc
7. LL LLL Can you give us suggestions for the improvement of services at this hospital 45 ANNEX 2 TRAINING NEEDS ASSESSMENT QUESTIONNAIRE FOR HEALTH CARE PROVIDERS IN INTERPERSONAL COMMUNICATION Please fill in this questionnaire to facilitate the improvement of patient care through Interpersonal Communication IPC l 2 Name of Institutom es oe ette e e a biu es edes ti ae Designation TA Wil Are you involved in patient education YES NO What are the aims and objectives of patient education 46 10 11 12 13 14 What are the essential element of the IPC process According to Patients Charter what are the rights and obligations of the patients Rights of patients 47 15 In which conditions or diseases would you require more information and management skills CONDITION DISEASE INFORMATION MANAGEMENT SKILLS ant Malaria HIV AIDS Diabetes Mellitus Hypertension Epilepsy Eye conditions Mental Health Breastfeeding Sexual Abuse Antenatal Care Postnatal Care Malignant Conditions Diarrhoeal Diseases e g Cholera Dysentery Other Specify 48 ANNEX 3 NEEDS ASSESSMENT QUESTIONNAIRE FOR INTERPERSONAL COMMUNICATION IPC MANAGEMENT AND SUPPORT SYSTEMS Please fill in this questionnaire to enable us improve patient care through Interpersonal Communication IPC Instructions Do not write your na
8. Session Talk e Select appropriate educational methods to meet each educational goals set for the patient and the family Identify opportunities and situation for patient and family education for each of the goals Determine specifically what should be taught by whom where when and how Reiterate target groups Analyze behaviour to be changed Outline objectives Outline resources Ascertain venue Implement Monitor and evaluate Evaluation of Patient Education Activities e what extent were the education methods appropriate To what extent were the educational needs from the medical point of view adequately identified e To what extent were patient and family knowledge adequately assessed e what extent were educational goals realistic and timely 4 The Patient s Charter The patients charter aims to improve the relationship between patients and health care providers It includes the information that patients receive to enable them to make informed judgements about their care and treatment The patient s charter should facilitate the following outcomes e improving the quality of all public health services in Zimbabwe e making services more responsive to the needs of individual citizens and e ensuring value for money Zimbabweans have a right of access to health care services in time of need either as non paying or paying patients The Ministry of Health and Child Welfare provides services to meet the client
9. acceptable e Positive regard The health service provider shows respect and positive regard for the client irrespective of differences of age social and educational status race gender religion etc e Empathy The health service provider will elicit feelings from the client and reflect or restate those feelings to the client This expression of empathy with the patient helps to establish rapport e Non judgemental The health service provider makes an effort to validate the way the client is feeling without judgement so that the client will feel free to be frank and open e Concern The health service provider shows that he she cares about the client and the client s problem For example he or she might use statements such as I m worried about you or I m concerned that you are not taking care of yourself e Reassurance The health service provider encourages and reassures the client when appropriate while avoiding premature or unjustified reassurance 16 Team Work in continuity of care The IPC process is dependable upon team work Every discipline is part of the team at whatever level In order to provide comprehensive quality of care programme at institutional level each discipline has a special role to play Co ordination and collaboration is encouraged between all the stakeholders from time to time Mechanism to evaluate efforts should be encouraged in the form of 1 meetings 2 suggestion boxes 3 the COPE met
10. and receiver Following are some of the examples of communication barriers and how to overcome them I Sender Receiver Relationship Language clients may speak another language have different terminology and might not understand technical jargon Values Beliefs Sender and receiver of different cultural or religious background may differ in their values norms and beliefs Sex Gender and Age The roles of the sexes in a given culture are shaped during socialisation Men and women might differ in educational level literacy as well as in norms values etc The same is true for age each generation has its own value system not always shared by another generation generation gap Economic and educational status Clients as well as health service providers find it hard to relate to a person of different economic or educational status Environment noisy and disruptive environment can make the client uncomfortable and affect the impact of the message Timing The timing of the counselling might not suit the client or group The clients might not be ready for the message Use simple language that the client understands Avoid technical jargon explain technical terms Use acceptable inoffensive terminology Try to get information on the cultural and religious beliefs of your clients Respect the beliefs of your clients but clarify relevant misconceptions prejudices or fixed ideas Respect norms of your clients proper dres
11. her to understand the ilIness participate in decisions about treatment and follow the treatment protocol Relevance The health service provider focuses on the information that is most important to the client during the particular encounter thus reflecting an awareness of the priority and relevance of the message s Empowerment Counselling enhances the client s self esteem confidence and sense of competence in order to promote compliance and behaviour change specific to the condition as well as overall health and well being Behavioural recommendations The health service provider makes recommendations in concrete behavioural terms rather than in terms of outcomes For example rather than telling a client to lose 25 kgs the provider might recommend specific behaviours daily walks cutting out sweets that will help the client to move gradually toward the goal Good recommendations also take into account the client s social cultural and economic context e g can the client afford to follow the recommendations as well as enabling and reinforcing factor for behaviour being promoted specifically to the client Utilise social support networks The health service provider explores the client s social network in order to determine whether these supports can be used to enhance treatment Verification The health service provider checks for client comprehension and understanding during the session at the end of the session by asking the
12. lot of opportunities that can be utilized for IPC in this context and are discussed below as follows Overall Socio Emotional Communication The objective of effective socio emotional communi cation are e to establish and maintain a positive rapport with the patient throughout the encounter This is an integral part of all Interpersonal Communication e to enhance patients to open up and comply Socio emotional skills include the ability to use effectively and appropriately statements to show empathy concern positive regard and to give reassurance 13 2 The Process of IPC The following norms for quality in Interpersonal Communication focuses on the process of communication throughout the encounter The norms are based on the collective experience of Quality Assurance Programmes with staff in a variety of countries in Africa Asia and Latin America 2 1 History Taking Standard During the history taking session of the encounter the health service provider will use interviewing skills to effectively elicit from the client the information needed to make an accurate diagnosis Interviewing skills include question asking listening and dialogue Guidelines The following list of specific norms related to the content and methods used in an interview can help the health service provider communicate more effectively This list is illustrative and is not intended to be exhaustive These norms may be adapted according to the local con
13. partner to give additional or more detailed information They encourage the interview partner to expand and elaborate upon a topic or issue Examples Can you give me an example of what you mean by that Can you tell me more about it What other suggestions do you have Echo Questions These questions are used to draw more information on something the interview partner has said by taking up one part of the message word or sentence is repeated in a questioning tone of voice In many situations it is sufficient to echo back key words Example Interviewed person I could do much more if I had the proper support Interviewer Proper support Source P L Hunsaker amp J Alessandra The Art of Managing People Prentice Hall 1980 25 UNIT 3 QUALITY ASSURANCE Introduction The overall goal of the Ministry of Health and Child Welfare is to provide quality services to all citizens of Zimbabwe The Ministry of Health is committed to the provision of quality care given the limited resources that are available All health care providers should aim to provide services that satisfy the consumers Health care providers and the community are expected to work together to assess health needs and to select an appropriate health care approach Quality assurance promotes confidence improves communication and fosters a clearer understanding of community needs and expectations In order to provide a comprehensive packa
14. people to communicate effectively Literature recognizes four forms of communication Intrapersonal communication within oneself Interpersonal person to person communication Mass media through the mass media Organization communications within an organization or among organizations Steps in communication In its simplest form communication consists of the following steps In a social situation The Which Which 5 Which and The SENDER he she then he she then amp recei decoded by RECEIVER has specific encodes in sends by ved heard his her interprets and ideas the form of way of P read communi understands thought P symbols speaking cation the thoughts i p seen feelings words writing partner feelings etc E gestures acting i and acknowledges receipt of the message i e he she lets the sender know he she has received and understood the message Communication means making oneself understood and trying to understand the communication partner The person who wants to communicate something is the sender The person to whom this communication is directed is the receiver 1 The sender has a message idea thought feeling opinion etc that he she wants to communicate 2 The sender must code his her message He she must put his her thoughts or feelings into sounds words or written characters verbal communication or into gesture
15. provision of quality care Awareness of these factors promote client satisfaction which is the goal of the health care delivery system Patient education programmes are based on the premise that patients have a right to know the current status of their health what they can do to achieve optimum health and prevent recurrence of illness The entry point of a proper patient education programme can start with a proper need assessment 1 What is Patient Client Education Definition of Health Education There are many definitions of Health Education but in this module health education is defined as any combination of learning experiences designed to pre dispose enable and reinforce voluntary adoption of behaviour conducive to health Green 1991 Definition of Patient Education Patient Education is one of the major elements of health education Patient Education can be defined in various Ways e Patient Education is the term for one to one and group education provided to patients in clinics and hospitals for the treatment and rehabilitation process A well organized patient education programme can speed up the recovery process enables a hospital to discharge patients more quickly release hospital beds and reduce complications and the need for follow up Hubbley J 1994 e Bruce 1989 defines patient education as providing appropriate constellation of service e g immediate attention listening and avoiding delays to clients patients
16. questions Do you like better to work in an institution or as a free lancer Suggestive questions Don t you think you should be a bit more cautious Source P L Hunsaker amp A J Alessandra The Art of Managing People Prentice Hall 1980 23 TYPES OF QUESTIONS DIRECTION OF THE QUESTIONS Fact Finding Questions These factual questions are asked to gain information about specific facts on current situations goals and objectives The fact finding questions usually take the form of closed questions They are simple to answer and can be used to establish trust in an interview Fact finding questions in an interview should be easy to answer should be sensitive non threatening and non judgemental should only concern information that is necessary to the present interview It is important that the information received from the interview partner is is heard and recorded accurately It is usual to take notes and to summarize the information at the end of this phase in order to check their correctness Feeling Finding Questions In order to change the attitudes or the behaviour of a person it may be necessary to help the person to gain more insight and self knowledge This can be achieved by feeling finding questions They are used to find out about the interview partner s feelings attitudes convictions motivations They usually have the form of open questions The feeling finding questions in an interview are mor
17. s individual needs and expectations The client can expect to e treated with care consideration and respect in all their dealings with the health care providers e receive emergency care and treatment at any time on the basis of need regardless of her his ability to pay e giveor withhold her his consent to medical or other care and treatment e choose whether to take part in research or student training Aspects of the Patient s Charter include information about the following Services Confidentiality Privacy Discrimination 34 Consent Inter hospital transfers Outpatient services Care in the community Free services in Zimbabwe If things go wrong what to do The Patient s Charter improves the service provider client dialogue thereby reducing the incidence of medico legal Hazards 5 Medico Legal Hazards The main potential legal liability for the health workers is medical negligence that is act of omission or commission that may lead to prosecution of the health worker by the law Omission failing to perform a duty that was expected of one Commission performing a duty not expected of one The law expects the Health Service Providers to be safe practitioners and to undertake only those duties for which their training has prepared them Unreasonable risks should be avoided and it is up to the Health Service Providers to keep up to date with matters that affect their practice Ignorance is no defence in le
18. short and long term 32 Initiating Patient Education Identify interested persons Train a pool of the interested persons Appoint a health education officer or co ordinator responsible for planning Design scope of content Suggest an approach in a hospital composed of other stake holders The composition of a patient education team may include the following persons health education officer physician dietician social worker nurse pharmacist physiotherapist radiographer Laboratory technologist IEC Co ordinator Nurse aid EHT EHO Responsibilities of the team Identify training needs Carry out training Media design and development Implement Patient Education Programme Monitor and Evaluate NB There is need for a focal person to co ordinate the programme 3 Patient Education in Practice Typical examples of patient client education priorities Education should be about explaining how much how often and when medicines should be taken and possible side effects providing special diets and self administering of injections of insulin for diabetic patients explaining in advance details of operation to reduce anxiety providing advice for persons diagnosed to be suffering from an illness such as asthma diabetes HIV AIDS explaining to the parents of a dehydrated child on how to prepare and give their child oral re hydration solution 33 Example of a Plan for Patient Education
19. INTERPERSONAL COMMUNICATION Manual for Trainers of Health Service Providers Ministry of Health and Child Welfare Health Education Unit 1998 gtz Acknowledgements The writing of this module would not have been possible without the broad participation of different categories of health workers Nurse Tutors Nurses Information Education and Communication focal persons Public Relations Officers and Health Education Officers from around the country were all involved in the development of this module These health workers are too numerous to mention here by name Special mention should be accorded to a group of Health Education Officers for having dedicated much of their time at different stages of the development of this module from conceptualisation compilation pre testing editing and finalisation Mrs N Ngwenya former Chief Health Education Officer Ms D Dhliwayo former Principal Health Education Officer Mr S Tsoka Chief Health Education Officer Mr W Chauke and Mr S Simbi Health Education Unit Mrs J Sibanda Parirenyatwa Hospital and Mrs N Huni Harare Central Hospital all worked flat out in the development of this module Special thanks are also extended to Mrs J Maradzika lecturer Medical School Community Medicine Dept Ms P Dube Principal Midwifery Tutor Harare Hospital and Sr S Mukasa Health Education Co ordinator for Chitungwiza Hospital for their useful contributions and ideas Mr P Siebenhueh
20. UE GUIDANCE Acknowledgement e non verbal signs that the receiver is listening full attention directed towards the sender eye contact nodding pauses silent listening e half acknowledgement verbal signs that the receiver is listenenig assenting or consenting mumbling hhhmmm Go on I m listening Full acknowledgement good ok fine thank you Stop I have got the message Summarising e Summarizing the content of the message Demonstrating that the receiver has understood correctly e Echo Questions Repeating of the message or parts of the message steering the conversation by encouraging the sender to give more information Repetition of the whole sentence or parts of the sentence Repetition of selected words e Taking up body language encouraging the sender to give more information You smile You frown You re shaking your head e Taking up the emotional aspects of the message to encourage the sender to speak about his her feelings You are concerned You felt angry You feel disappointed Questions e Open Questions should be widely used They encourage the sender to open up leave a wide spectrum from answering often begin with a w what why where when who etc e Chose the direction of the question to explore the past How did the situation develop the present How do you see the situation now What is y
21. allenges in AIDS Counselling this video is an essential training tool for better IPC related to dealing with patients at risk of HIV AIDS Gather video obtainable at ZNFPC IEC Unit Making Things Clear video obtainable at Ministry of Health and Child Welfare Health Education Unit Next is not enough video obtainable at ZEDAP c o Pharmacy Department Ministry of Health and Child Welfare More videos are available via Media for Development Trust 135 Union Av PO Box 6755 Harare Zimbabwe Tel 263 4 733364 5 Fax 263 4 729066 E mail mfd mango zw 61
22. alth worker is found liable 4 Infection or spread of infection from Inadequate precautionary measures in the prevention of cross infections Dirty drains walls floors equipment utensils incubators oxygen tents and bath tubs Bad ventilation Lack of isolation wards Incorrect sterilisation methods and care of sterile apparatus Incorrect aseptic technique 5 Inadequate and incorrect treatment Giving the wrong drugs or giving drugs to the wrong patient Incorrect technique in giving drugs Omitting a drug Incompatible blood transfusion Tight plaster 6 Assault and battery The law says that any treatment examination operation etc performed without the consent of the patient constitutes an assault for which the aggrieved patient can recover damages Medical paternalism 1s neither ethically or legally acceptable Thus assault means threatening or attempting to make bodily contact without consent Actually carrying out the threat is battery Consent however should be informed In cases where parents of minor children unreasonably withheld consent one can obtain written authority to proceed from the Medical Superintendent or the magistrate The law also intervenes when withholding consent can endanger a third party e g the public health act calls for compulsory treatment of infectious diseases Consequences of Medico Legal Hazards The consequences of medico legal hazards are many both for the patient a
23. and pitch of your voice how you speak to transmit a positive attitude what your body language tells about you smile establish eye contact and have a good posture Try and remember the basics of good client communication These can be summed up in the process described by the memory aid SARAH SARAH contains five key aspects Stop talking give the patient the opportunity to explain his her concerns Adopt active listening do not simply hear what is being said but really listen Reflect content or feeling show that you have understood what the patient has said Act with empathy indicate that you understand and appreciate the feelings and the motivation of the client Show that you care 5 Handle the subject matter correct the problem AUC Below we will see how to implement these aspects in the routine of complaint handling Complaint handling In your encounter with a distressed patient you first need to realise that the complaint is a request for help and not a reflection on your personality Maintain your composure and leave personal feelings and opinions out Complaint handling should be simple and organised The following steps which have been built around the five key aspects of patent communication SARAH will help you be as effective as possible when dealing with dissatisfied patients in any situation 4l communication should be in the first person Use apologise not the royal We
24. basis of their observations Group work 45 minutes Presentation and discussion of the results of the group work 30 minutes 4 Role Plays Conduct a number of role plays with participants taking the role of health service provider and client 1 Interviews on quality of care Participants take the role of the health service provider interviewing staff and clients on their e view of the quality of services e recommendations for improvements 2 Reacting to complaints of client s calming an angry client Preparation Have participants prepare for the role of the client or staff members and decide on their needs complaints areas for improvement of quality etc Role play Finding out about client s views of quality issues Evaluation of the role play trainer and participants give feedback to the role players using the criteria laid down as guidelines Evaluation criteria e use of active listening skills exercises e helping clients express their concerns e taking clients concerns seriously e not getting angry yourself 4 hours 30 minutes Other suggestions Client centred discussions Recording compliments and complaints Keeping records and suggestion box Conducting exit interviews with clients Interviews with individual clients from different groups 30 UNIT 4 CLIENT PATIENT EDUCATION Introduction The concept of communication is enhanced through IPC with counselling being the central facilitating tool in the
25. but there are only two basic forms open questions which are non directive closed questions which are directive Open Questions Open questions are used to draw out a wide range of responses They leave a wide spectrum for answering without limiting or suggesting a specific response Open questions Cannot be answered simply by yes or no Usually begin with what where why or how Do not lead in a specific direction Increase dialogue by drawing out the partner s feelings and opinions Encourage the communication partner to elaborate on objectives needs wants problems and current situations Help the communication partner to discover things for him herself Allow the communication partners to exhibit their style more readily and accurately than other types of questions Examples What do you think about the situation How did the situation develop Whatis the most important objective we should follow Closed Questions Closed questions are often specific and require narrow answers usually a yes or no Closed questions do not yield as much unbiased information as open questions but they Allow specific facts to be obtained Require little thought by the person answering Are used to gain commitment to a definite position Can be used to direct a conservation into a desired area Closed questions can be Direct questions Where were you born Alternative
26. cessful patient education programme depends on the following factors policy statements agree with patient education programme establishing of a patient education committee assessment of patient s needs and identification of strengths weaknesses opportunities and threats as well as outlining people s roles Steps involved in planning for patient education Step 1 Find out what your intended audience thinks and feels about health issues and services Step 2 Identify learning needs of the patient which hard facts need to be explained in patient education which decisions have to be taken which attitudes should be encouraged e g positive attitudes towards recovery and confidence in one s own ability to cope Step 3 Apply the understanding gained in the two steps above and select most appropriate advice to give Step 4 Decide where and when the patient education should take place e g in the waiting area in the hospital ward or at the home of the patient during consultation after consultation Step 5 Decide who should do the patient education e g doctor nurse counsellor social worker Step 6 Decide which method s to use e g one to one counselling small group education or large meeting Step 7 Decide what learning aids would be required to support the programme e g posters charts slides videos take home reminders such as a leaflets Step 8 Decide on how you will evaluate the outcome of patient education in the
27. client to repeat key messages by posing questions such as What are the most important things that you are going to do when you leave rather than a less effective question Did you understand what to do at home 15 2 3 Socio Emotional Communication Standard The health service provider establishes and maintains a positive rapport with the client throughout the encounter The behaviours discussed below can help the provider to achieve this goal Guidelines The following list of specific norms relate to the methods used in effective socio emotional communication This is illustrative and is not intended t be exhaustive These norms maybe adapted according to the local context e Framing of the encounter The health service provider make a statement which establishes a positive environment for the client to share his her feelings attitudes and beliefs so that the client feels that the health service provider is interested in his or her perspective For example the health service provider might say Good morning Mrs Moyo my name is Dr Tinarwo and I want you to tell me about anything that you think may be affecting your health e Attention The health service provider focuses attention on the client and does not engage in other activities during the encounter e Constructive non verbal behaviours Behaviours such as forward body lean eye contact smiling and touching are appropriate and conducive to dialogue when deemed culturally
28. del Definition of communication 30 minutes The communication process The four sides of a message Discuss the model and answer any questions from the participants 3 Exercise To demonstrate the difficulties involved in communication use small exercises e g 30 minutes duplication exercise see page 10 11 passing on messages 4 Group Work Form working groups and to discuss effective communi cation rules for sender and receiver barriers to communication based on the experience of the audience e g Group 1 What is expected from sender counsellor and receiver client to make communication effective Group 2 Which communication difficulties barriers to communication do you experience in your field of work and how can the difficulties be overcome Introduction Task for the group work Group work phase 10 minutes Presentation and discussion of the results of the group work 60 minutes 30 minutes 5 Summing up Summary of lessons learnt Alternative Instead of group work you can show a video on communication 20 minutes e g Gather Making Things Clear or Next is not enough see page 61 do exercises and roles plays e g Participant in the role of the sender Presenting and explaining health messages adapting the message to the educational background of different groups of clients Evaluate the exercise by giving feedback on clarity factual correctness of the message adaptation of the message language e
29. ders in different departments Media groups Pro approach Promotion of service providers Advocacy and community mobilization Organizational mobilization Interpersonal Communication can be in the form of lecture role plays group discussions drama meetings counselling In addition visual aids such as posters charts flyers pamphlets and audio visual aids such as video films radio taped messages These can be used to reinforce IPC The IPC process should take into consideration the following key aspects Motivation persuasion Information Specific method Client assessment 18 4 Minimum Message Strategy One of the strategies which can be employed to enhance IPC is the Minimum Message Strategy e g the focus on key essential communication elements during a curative visit or a counselling session For example if a mother comes with a child with diarrhoea to the Out Patient Department a minimum message strategy could take this form Find out why the mother has come to the hospital Assess behaviour of mother and reinforce where appropriate Determine or assess whether the mother has knowledge about the disease Obtain context of illness and treatment Counsel appropriately and enter into responsive discussion 19 Lesson Plan 1 Introduction Present the topic and the objectives of the session Ensure that participants understand and agree to the 10 minutes objectives 2 Lecture Guided Present the topic of Inte
30. e personal and can address sensitive areas should be asked only after a strong rapport and a trust bond has been established allow the interview partner to find out more about him herself In asking this type of questions the interviewer should show empathy and practice active listening skills by using acknowledgement summarizing or paraphrasing the statements It might disturb the atmosphere of the interview 1f the interviewer takes too many notes during this phase Source P L Hunsaker amp J Alessandra The Art of Managing People Prentice Hall 1980 24 TYPES OF QUESTIONS QUESTIONS TO GUIDE THE CONSERVATION Clarifying Questions Clarifying question are a form of feedback They are used to verify the the content or emotional quality of the interview partner s message They have the form of paraphrasing or restating the message in the own words of the interviewer Clarifying questions may be used to Interpret in different words the speaker s message Invite the partner to expand and or clarify an idea or statement Help to clarify ambiguities Uncover the real opinions Ensure that both interview partners speak the same language and understand each other Examples If I understand you correctly your major concerns seem to be Is that so Are you referring to the personnel or the training department Developmental Questions Developmental questions are used to stimulate the interview
31. e realisation of good health and treatment outcomes There has also not been a monitoring and evaluation system in place making it also impossible to assure or measure the quality of communication interventions This manual is designed to bridge the gap between what exists and the ideal situation by targeting trainers and supervisors of health service providers This manual is designed to provide the trainer with basic skills in patient education communication and public relations The manual will also facilitate the monitoring and evaluation of programmes since rapid appraisal protocols for clients health service providers and management support systems have also been made available UNIT I THE COMMUNICATION PROCESS 2 The Communication Process Effective communication is the key to changing people s health behaviour Communication is necessary in all aspects of health education such as e encouraging community participation e developing inter sectoral co operation e sharing knowledge about health so that people can take more responsibility for looking after themselves Therefore health workers need to develop effective communication skills Definition Communication can be defined as the process by which people share ideas experiences knowledge and feelings through the transmission of symbolic messages The means of communication are usually spoken or written words pictures or symbols But we also give information through o
32. ent education programme YES NO CONSTRAINTS AND OPPORTUNITIES 12a What are the opportunities for Patient Education in this institution 52 Annex 4 Twenty Hints for Happier Patients Always receive and welcome patients with a smile and address them as Mr Mrs Miss or by the name Never next Explain any delay expected in keeping the appointment to time patient who is told the reason for a delay remains cooperative One who is ignored will be resentful Prepare the treatment room before the patient enters Get everything possible ready according to the record card The patient s entry should be the last action not the first No trace of a previous patient s treatment should remain visible Offer to help patients with their bags baskets shopping etc don t wait until they have put them in the wrong place and then reprimand them Choose words used within the patients hearing with discretion in order to avoid scaring the patient unnecessarily Try to make the patient as physically comfortable as possible under the circumstances Don t leave them in uncomfortable or embarrassing positions for longer than necessary Don t go away and leave the patient in the room without explanation e g to answer the phone The patient will wonder what is going to happen Never carry on a private conversation with another health worker in the presence of a patient This will make them feel uncomfortable and in the way Never show a patient a
33. ere esee esten 53 ANNEX 5 ELEMENTS OF THE NONDIRECTIVE DIALOGUE GUIDANCE e eeeeee tenete 55 ENAIUO Q 56 ANNEX 7 HOW TO PREPARE FOR PRACTICAL EXERCISES eeeeeeeeee 58 REFERENCES T 60 SUPPORT MATERIALS FOR 61 iii Background Introduction The purpose of Interpersonal Communication in Health Education Promotion is to facilitate enable and maintain behaviours conducive to health amongst our target audiences Interpersonal Communication has the advantage of complementing mass media communication in facilitating changes in attitudes and behaviour The messages in a face to face encounter can be tailor made to suit the specific needs of the target audience by taking into account the socio cultural and economic contexts of our clients Unfortunately there has not been a deliberate policy or standardised communication package in our health institutions in the past As a result of the above situation Interpersonal Communication programmes have tended to be ad hoc prescriptive or didactic i e without due regard to clients needs and circumstances This lack of policy and guidelines have resulted in sub standard delivery of health education promotion interventions thus affecting th
34. etting IPC is the central approach within the broad communication process that brings out people s emotions needs and feelings When people reveal themselves to us we are then able to respond positively to their needs and provide quality care Definition of Interpersonal Communication IPC Interpersonal Communication is a person to person two way verbal and non verbal interaction that includes the sharing of information and feelings between individuals or in small groups that establishes trusting relationships Hubbley J 1994 IPC in health care settings takes place between service providers and their clients and members of the community and is a key element in maximizing access to quality care IPC includes the processes of education motivation and counselling and starts with understanding the critical role of good client service Special features of IPC include the following e Interpersonal Communication is influenced by attitudes feelings values social norms and environment of the people involved e IPC is an influential means for the adoption of proposed health behaviour and the continued compliance with and maintenance of the health behaviours Interpersonal Communication complements reinforces and elaborates messages presented elsewhere The mass media can also be used to reinforce Interpersonal Communication 12 Application of IPC in Health Care History Taking Each intervention begins with a thorough analysis
35. formation experience expertise etc This helps to develop a trusting relationship in which one can work together to achieve common goals and objectives Questioning to give Positive Strokes and Build Trust Asking somebody for his her opinion is a form of flattery It shows that the partner s viewpoints are valued and thus helps to build a bond of trust Questioning to Determine Style By giving a person an opportunity to talk one can discover the personal style of the communication partner the style of communication the emotional disposition attitudes opinions and other traits of personality This helps to get to know the other person and to find a common level of communication and understanding To do this one can ask questions about goals hobbies likes and dislikes strength and weaknesses etc Source P L Hunsaker amp A J Alessandra The Art of Managing People Prentice Hall 1980 21 THE FUNCTIONS OF QUESTIONS Questioning to Activate the Communication Partner Questions will help to activate the communication partner and help them to open up and to participate in a conversation or in a problem solving process Greater participation will lead to more commitment By getting the employee talking and volunteering information you will build trust and will not have the feeling that they are only responding to the manager s demands Questioning to Gain Information about Facts or Situations These questions are m
36. gal proceedings Areas of potential legal liabilities 1 Incomplete records records must be regarded as legal documents Records containing the following must be carefully a Proper identification of patient b Physical and mental condition of patient at admission c Method by which patient was admitted i e whether walking in a wheelchair or on a stretcher d Vital signs on admission and subsequently as failure to communicate changes in patient s condition may lead to serious outcome like haemorrhage asphyxia or even death The reports on patient s condition must be clear and concise so that they can be understood by everybody e Kitting clothes and valuables 2 Lack of knowledge Duties and responsibilities Code of ethics Procedures which may lead to adverse effects e g blood transfusion Prevention of cross infection 3 Injury to patient due to e Use of defective equipment Abandonment leaving a patient unattended to in the ward on trolleys in the corridor or in unfamiliar surroundings e Falling out of bed or stretchers falling on slippery floors 35 Burns from hot bath incubators or heaters Over exposure to X rays Restrainers used incorrectly Damaged bedpans and urinals Suffocation in oxygen tents without oxygen Aspiration of feeds Trauma during procedures etc The list 1s not exhaustive one can come up with lots of other examples of incidents in which the patient may be injured and the he
37. ge of quality care all health care disciplines are expected to work as a team Quality Assurance There are various definitions of quality assurance The Quality Assurance project USA summed them up as Quality Assurance a set of activities that are carried out to set standards and to monitor and improve performance so that the care provided is effective and as safe as possible Quality Assurance programmes involve Orientation towards meeting the needs and expectation of the patient and the community Focusing on systems and processes i e dealing with root causes of health problems Use of data to analyse service delivery Encourage team approach to problem solving 26 The Quality Assurance Cycle The following cycle could be used for the Quality Assurance programmes 1 Identify problems and opportunities for improvement 2 Analyse and study the problem to identify its root causes needs 9 Develop solutions and actions for improvement 3 Set objectives for the improvement of 8 Redefine problem services operationally 4 Outline activities and set standards in line with the objectives 7 Implement and monitor activities using health indicators 5 Choose a team for 6 Communicate standards implementation of and activities h improvements Steps in the Quality Assurance Cycle Assess quality of care needs and organisational scope of operation Define the proble
38. hods so that consensus is reached at all times Appreciation of efforts should be encouraged rather than negative feedback which may be discouraging Lack of teamwork and lack of a proper service attitude are the main Barriers to IPC e Competition within departments Competition may have positive and negative aspects Unhealthy aspects would be monopolizing and hiding material resources meant for sharing between departments e Unclear definition of roles and responsibilities Unclear job descriptions may lead to lack of accountability e g this is not my job Workload If a unit is understaffed or distribution of manpower is inequitable this may lead to poor performance due to pressure of work and health workers being irritable e Top down approach on clients Giving information one way communication without involving the client in a dialogue is less effective than sharing information two way communication e Discrimination on the grounds of tribal political colour gender religion status and age will prevent effective IPC e Inadequate induction Lack of exposure of new staff members may not communicate properly due to lack of information e Lack of consultation There is a need to consult other health workers when in doubt Taking unilateral decisions i e not asking others when in doubt might prove to be dangerous 17 3 Methods and Approaches to IPC Identify trained personnel Training of Service Provi
39. ient for informing you Acknowledge empathise Even if you do not agree with the patient you can show your concern and understanding of the problem Identify the exact nature of the problem Investigate research the matter if necessary Apologise Offer a solution Let the patient decide whether the solution is acceptable Ask the patient what he or she feels needs to be done to correct the situation Learn the boundaries of your authority and work within those limits Take action immediately Keep the patient informed and follow up with a phone call or a letter Dealing with rude people Once in a while you may meet someone who is trying to provoke you into a heated response or to beat the system by threatening behaviour A patient s nervousness may translate into aggressive posturing Remember that rude people generally believe that rude behaviour is the only way they can get satisfaction Make it a challenge to prove them wrong Common sense good manners and a command of the 10 step process of complaint handling as outlined above will help you deal with rude people In summary Never get personally upset with offensive comments Remain professionally detached Let the person get everything off his chest let him explode Remain calm and patient as by doing so you may just shame a person into behaving better Concentrate on the facts and ignore the emotive tactics the person 1s using You can control a conservation by bringing
40. inutes How to establish a Patient Education Programme The Patient Charter Medico legal Hazards Conduct a number of role plays with participants taking the role of health service provider and client Chose from the 2 hours following situations 1 Educate patient by explaining how much how often and when medicines should be taken and possible side effects Educate patient on special diets and self administering of injections of insulin for diabetic patients Explain in advance details of operation to reduce anxiety Providing advice for persons diagnosed to be suffering from an illness such as asthma diabetes HIV AIDS Inform patients on their rights Preparation Have the participants prepare the message and prepare to act the role of the health service provider Role play Conduct education session Evaluation of the role play trainer and participants give feedback to the role players using the criteria laid down as guidelines Evaluation guidelines e Was a proper atmosphere created for the education Was the message clearly formulated Was the message adapted to the patient s understanding taking into account background education etc Were patient s questions answered and patient s concerns taken up 2 hours 30 minutes 38 UNIT 5 PUBLIC RELATIONS Introduction The Ministry of Health and Child Welfare s mission is to provide quality health care services Proper dealing with clients patients and especiall
41. ion sce eret us 6 Occupati eese Sort Craco aue sa aes 7 Level of education Never went to formal school Primary Education Secondary Education Tertiary Education 8 Which departments did you visit Where you happy or not with the services offered DEPARTMENT HAPPY NOT HAPPY COMMENTS Registration X Ray _____ _ __ _ G OutPatens Dep o G Pharmacy __ Mortuary Rehabilitation ____ G Laboratory FP p 73 Wards Specify Other specify 9 Would you recommend our services to any of your friends relatives YES NO 44 10 11 Sm moe ae op U a Did health care providers talk to you about the following YES NO Your condition LA Your treatment 54 Your tests Your results Would you like to get more information on health issues YES NO b If yes in which 3 health issues would you like more information In which ways would you prefer to learn about health issues Pamphlets Booklets Video films Radio Newspapers Health workers T V Other SDECIHTV csi egit ite eo die te E Holt Qr Comment on the following a Staff attitudes Friendly Indifferent Hostile Drs Mixed 1 b Waiting Time Before being attended to Less than 1hour I hour 4 hours More than 4 hours c Cleanliness of Institution Clean Very clean Dirty Very Dirty LL
42. m define gaps between actual performance and expected performance Develop solutions and actions think critically Develop guidelines protocols procedures and standards Communicate guidelines standards and specifications Provide support and supervision regarding guidelines Implement quality improvement efforts Monitor and evaluate poc par NB Planning is continuous and therefore component of all stages Quality assurance programmes are continuous as they aim at giving the clients better services Evaluation is equally important at all stages 27 Definition of Quality of Care The quality of technical care consists of the application of medical science and technology in a way that maximises its benefits to health without correspondingly increasing its risks The degree of quality is therefore the extent to which the care provider is expected to achieve the most favourable balance of risks and benefits Donabedian 1980 From the above quality is a comprehensive multifaceted concept which includes the following Technical Competence Access to Service Effectiveness Interpersonal Relations Efficiency Continuity Safety Amenities Facilities Quality of care implies serving clients in a way that meets their needs and makes them feel they are cared for and makes them want to recommend these services to their friends and relatives The following dimensions contribute to effective quality of care
43. me on this questionnaire Tick where appropriate sutton 2 neo etre don e e Wate BACKGROUND STATISTICAL DATA Catchment Population MALE FEMALE TOTAL Population under I year Population under 5 years Population 14 49 years 49 years Adult males GRAND TOTAL 2 a TOTAL ATTENDANCES 1995 1996 1997 eg eg 1995 1996 1997 YEAR 49 3 TYPES OF ILLNESS 5 IN PRIORITY ORDER ILLNESS 1995 1996 1997 5 gt lt 5 gt 5 lt 5 gt 5 3 B CAUSES OF DEATHS IN PRIORITY ORDER 4 e 1 Nurse patient ratio ii Doctor patient ratio 5 HEALTH EDUCATION MATERIALS AVAILABLE TYPE PRINT ELECTRONIC SUBJECT c d 50 6 HEALTH EDUCATION EQUIPMENT AVAILABLE a TVWWideo Recorder D Radio Casete Recordere Radio fJ je Overbead Projector d Slide Projector Lo o o y e Display Boards D Pamphlet Stands _ g Flipchart stands ete 7 AVAILABILITY OF OPERATIONAL POLICY GUIDELINES YES NO Hospital Departmental Programme EE E E E E EEEE A M aet a e 51 9 COURSES ORGANISED IMPLEMENTED TYPE OF TARGET NUMBER COURSE YEAR SPONSORING COURSE GROUP AGENCY 10 a Isthere a patient education committee YES NO D TENGO Why exte e Med 11 a Is there a planned and comprehensive pati
44. ming Brainstorming on how to handle patient s complaints and how 20 minutes o deal with rude people 4 Role Plays of health service provider and client Chose from the following situations 1 Handling patients complaints Dealing with rude people reparation Have participants prepare for the role of the patient and define their complaint or criticism ole play Conduct a series of role plays on handling complaints and dealing with rude people Evaluation of the role play trainer and participants give feedback to the role players using the criteria laid down as guidelines Evaluation guidelines Did the participants in the role of the health care providers observe the 10 steps of handling complaints Did they succeed in calming the patient client e Did they reach a mutual understanding Discuss with participants which factors will contribute to a positive image and good public relations interaction with patients with an eye on public relation issues 40 minutes 43 ANNEX 1 NEEDS ASSESSMENT QUESTIONNAIRE FOR PATIENTS CLIENTS Please kindly help us improve the quality of our service by responding to some questions were are going to ask you Be as open as possible since your responses will be kept confidential and only be used in the improvement of our services in the future 1 Name of hospital 2 ou qu e rete dese ee 2 renieu me 3 yrs 4 Sex F 5 Relig
45. n appointment book It is confidential Patients should not dictate when they will come next d Never say there s none second best t s finished in front of a patient The patient will think he is getting Always remember that a patient is more important than someone on the end of a telephone Keep your attention to the patient until you have finished dealing with them Don t leave the room for a time while looking for something leaving the patient in an uncomfortable position Do not send patients with more serious injuries back to the bench to upset all those following Take them elsewhere to recover Always tell patients the truth so that they know what to expect but help them accept it by being supportive and optimistic Slight physical contact with the patient is reassuring Talk to patients about what you are doing and why 53 Keep history taking confidential in all cases and at all times e Remember that the layout of the building itself may mean it 15 easy for people waiting outside to overhear you talking with the patient Make every effort to maintain confidentiality Make every effort to warn patients if their appointment has to be delayed Don t let them come to the health centre and then tell them to come back tomorrow Always remember the patient is a V I P at all times Be kind and thoughtful Adapted Ministry of Health Seychelles 1993 54 Annex 5 ELEMENTS OF THE NONDIRECTIVE DIALOG
46. nd to the health service provider Consequences for the patient include worsening of condition prolonged hospitalisation with extra expenses disability social and financial disruptions death 36 Consequences to the health service provider depend on the branch of the law that is taking up the case 1 Criminal prosecution the health service provider may be brought to the criminal court of law by the state Punishments range from fine to imprisonment 2 Civil prosecution the health service provider is sued for damages in the civil court of law by a patient or his her dependants 3 Disciplinary action The employing agent or the Health Profession Council may take disciplinary action in the form of a warning suspension or dismissal or being struck from the practising register in which case one cannot legally practise anywhere in the country The health service provider should remember that the clients in this country are usually much enlightened and aware of their rights Conclusion The success of client patient education programmes depend on the attitude and effective communication of health workers and clients and on good public relations 37 Lesson Plan 1 Introduction 2 Lecture Guided Dialogue 3 Role Plays Present the topic and the objectives of the session Ensure that participants understand and agree to the 5 minutes objectives Present the topic on Patient Education What is Patient Education 30 m
47. ne theory at a time Give feed back on results during the exercise Carry out error analysis of the outcome and allow corrections to be made Remember to keep attention and interest Observe change speech voice loudness voice modulation speed Interaction gt lt Share conversation Help strengthen client participation Agree on mutual focus Respect each other Equal Input 58 Exercise to demonstrate skills Emotion Handling skills Design a case study Conduct role play on the case study Discuss and evaluate the role plays Problem solving skills Aims to help Health Care Providers to gather information on people needs Encourages people to actively listen Encourages dialogue by asking open questions Avoid interceptions Good social skills aim at making people feel comfortable when they visit health institutions clinics Greet the client and welcome them Ask about the persons feelings Praise the persons efforts Encourage them to say more Show support and understanding Help them not to worry too much by suggesting alternatives Counselling and Education They are effective ways to explain health issues and treatment Find out the person s views on their illness Correct misunderstandings Use appropriate language Present information in a logical manner Check wether the clients understands what you have told them about their illnesses
48. ner Dr Sue Laver and Mrs D Luke assisted in editing the final draft ii CONTENTS BACKGROUND INTRODUGCTI ON endo Ro nonae o ee Feo noob PNE eee ep eonun op sa ine oae Uo epos 1 UNIT I THE COMMUNICATION eese tasa asses e 2 THE UNIT eter eee eto eoe rere ae Eee e e OVER EFE E ee TE Eee e b erre ere e Te Ud 2 2 THE COMMUNICATION PROCESS nete tes ceo eee iere ree epa vereor kp eere dere ska ee Veo ea doe e Ede er Pee EEUU 2 3 CHARACTERISTICS OF AN EFFECTIVE COMMUNICATOR eeeeennn n n nen nennen nhanh hahaha 5 4 BARRIERS TO COMMUNICATION ccccccccccccssssssececececsenssecesececsenenseseceeecseseaeseeeeecceessaaeceeceeenesaueeeeecscsensaseeeeeeess 6 UNIT 2 INTERPERSONAL COMMUNICATION IPC etta seen se seta seen esten see 12 TEOBIJECTIVES OE THE U NT ier th e E OEC EE ERE RENE EEU E I ERR ERE VET ERE YN 12 2 THEPPROGESS OETPC E ete C REOR rte HAE E i 14 3 METHODS AND APPROACHES TO DBC PE EET eer ree RR 18 4 MINIMUM MESSAGE STRATEGY sess asse sete tarn andes sete ette na eene 19 5 THE FUNCTIONS OF 5 8
49. od explain technical terms be able to adapt the same health messages to the educational background of the receiver As a receiver a good communicator should encourage the client to speak openly give full attention to the client listen carefully ensure that the message is understood show by way of acknowledgement that message was understood take questions and concerns of clients seriously answer any questions fully To be effective the communicator should aim to develop some of the following attributes Adequate knowledge Knowledge of the subject matter sound understanding of the subject under of subject area discussion Knowledge of the Having in depth knowledge of the people in terms of their wishes needs target group concerns hopes and interests Confidence Trust of one s own ability Credibility The communicator should be accepted and trusted by the community Friendliness cour Being kind pleasant and helpful polite respectful and considerate teousness Empathy Ability to share another s feelings as if they were your own Tactfulness Skill to not offend people ability to create a favourable impression by saying or doing the right thing Flexibility Ability to adapt to the needs of the people Tolerance patience Ability to bear up with something one does not agree with staying calm without getting short tempered 4 Barriers to Communication Barriers to communication can arise from sender message channel
50. of the existing situation in a given field The objective of history taking 15 for the provider to gather all the information needed to make an accurate diagnosis and to initiate appropriate treatment Question asking techniques listening to the patient and probing skills are particularly important to successful history taking Channelling The objective of channelling is to motivate the community to utilize the preventive and curative health services offered This is carried out through one to one communication and group education sessions Counselling The objectives of counselling are e share information about the disease and treatment options e to promote compliance through negotiation with the client over positive treatment and behaviour changes e to help clients make informed decisions Effective giving of information checking for understanding and comprehension establishing achievable behavioural objectives with the patient are important counselling skills Dialogue with Patients clients The objective of dialogue is to e determine what services are needed by the clients patients and what is the best way to provide those services This dialogue provides an opportunity to learn how patients client understand health and disease and negotiate with them about the organization and delivery of services e Management of diseases conditions and rehabilitation of patients and clients when they go to health institutions There are a
51. ostly direct which are used to find out more about a person or a situation In an interview with a person applying for a job they can be used to find out about the applicant s educational and professional background experience motivation goals objectives needs and wishes Questioning to Uncover Motives and Gain Insight The questions help to understand the employee s viewpoints and perspectives In any situation it is necessary to understand the viewpoint and the needs and motives of the actors before one can make meaningful suggestions or guide the actors to make their own suggestions These can be direct questions but often one can uncover hidden motives only by asking open questions in a non directive way Questioning to Reach Agreement If one wants to come to a mutual agreement one has first to find out about the present positions of the communication partners It is necessary to explore the areas of agreement and disagreement In doing this one should be seriously interested in the other s viewpoints Salesmen often use a tactic by asking a series of rapid fire questions to which the other has to respond with yes in order to get a yes to the crucial question These tactics are manipulative and will often lead to a breakdown of trust Source P L Hunsaker amp J Alessandra The Art of Managing People Prentice Hall 1980 22 6 Tvpes of Questions OPEN AND CLOSED QUESTIONS There are many types of questions
52. our assessment of the problem What should happen next What are your plans What do you expect e Avoid closed questions which influence the other person and suggest specific answers alternative questions Do you tend to react aggressively or to withdraw instead suggestive questions You do agree to take rather strict measures covert solutions Why don t you try negotiating with your opponent 55 ANNEX 6 COPE COPE is a process and a set of tools used to improve quality of health service at clinics hospitals or organisations Rationale for COPE simple to use easy to understand cost effective uses no resources at all it works it empowers COPE components self assessment client interviews client flow analysis action plan Self Assessment Managers should learn to assess themselves and encourage people to create a conducive environment for the staff particularly in the following areas equipment staff development safety appreciation OR Can I do more for the clients I have just examined Did I do my best Was I careful How did I communicate Did I treat clients with respect Did I allow choice Could I have done better Client Interviews Staff themselves should find how their clients feel about services offered Staff should seek for ways of improving service Staff is objective and want change 56 Client flow analysi
53. rpersonal Communication Together Dialogue with participants elaborate opportunities for IPC 30 minutes 3 Video Show a video on IPC client s perspective and discuss with participants rules and guidelines 40 minutes 4 Role Plays Conduct a number of role plays with participants taking the role of health service provider and client 1 History Taking To practice interviewing skills the participant in the role of the health service provider will mainly be the receiver applying the rules for non directive dialogue guidance see annex 2 Counselling In these role plays the participant in the role 4 hours of the health service provider will combine interviewing with listening skills receiver and sender Practise counselling skills using GATHER approach Some participants should pair in two s and practise GATHER skills for 15 minutes and other participants to evaluate Facilitator to explain GATHER Preparation Have participants prepare for the role of the client by establishing background reason for visit kind of disease etc Role play Evaluation of the role play trainer and participants give feedback to the role players using the criteria laid down as guidelines The first role plays can be conducted in the plenary so that participants know what to observe and how to give feedback Then form groups to conduct further role plays to coach participants in taking different roles of health service provider client observer Visits
54. rt Materials for Trainers Key sources for lists of available IPC training materials worldwide AHRTAG now called Health Link TALC Teaching Aids at Low Cost Farringdon Point PO Box 49 29 35 Farringdon Road St Albans London ECIM 3JB Herts ALI 5TX Tel 44 171 242 0606 Fax 44 171 242 0041 Fax 44 1727 846852 E mail ahrtag geo2 geonet de E mail talkuk g btinternet com Specific Resources recommended for IPC Communicating Health an action guide to health education and health promotion J Hubley TALC 6 30 Health Care Together Edited by M Johnstone and S Rifkin Training exercises for HCWs in communication skills and teaching methods TALC 3 80 Children for Health key health messages and communication ideas for HCWs dealing with children in out of the health care setting TALC 2 00 Communicating with Children Naomi Richman Aims to help those working with children to develop their listening and communication skills to identify and help children with particular needs TALC 2 80 Learning to Listen to Mothers J Vella and V Uccellani trainer of trainers manual in IPC skills for community health workers Focus on nutrition and child development monitoring Slide set from TALC self mounting 5 50 Raising Awareness of Safe Motherhood excellent slide set for all levels of health workers on how to communicate the importance of and issues around safe motherhood to patients members of the local community Ch
55. s appearance behaviour Take into consideration that some people prefer to talk to persons of their own sex and or their own age group on sensitive subjects Show a professional attitude and competence when dealing with sensitive issues with persons of the other sex or another age group Show professional self confidence when dealing with people of a higher status Treat persons of lower economic status politely and courteously Take into account the educational background of the clients when counselling Ensure a comfortable environment for the consultation Arrange the environment so that it does not act as a barrier If possible let the client choose the time Make sure there is enough time for thorough consultation III Communication Barriers on the part of the Sender Attitude Negative attitudes biases Put the client at ease by showing an understanding prejudices can affect the impact of helpful attitude the message Create a positive friendly atmosphere Message Messages are difficult to Give your message a clear structure by beginning understand when they with the general and then proceed with details in a lack clarity logical sequence are ambiguous Adapt the message to the level of understanding of are too loaded with the client information Give clear unambiguous instructions contain too little information Structure the information emphasise what the client must know essential important information should kno
56. s C F A Method of tracking clients from the time they enter the hospital to the time they leave the hospital Client flow analysis forms may be used Identify bottle necks Identify missed opportunities Identify missed contacts Measure client waiting time Provide personnel cost estimates Identify unscheduled client contacts Action Plan After obtaining data you should come up with an action plan that states the following The identified problem Recommend solutions or strategies Who is going to carry out plan What facilities resources are needed How are you going to monitor and supervise Evaluation Remember COPE belongs to the institution therefore solutions to be developed are for the institution 57 Annex 7 How to prepare for Practical Exercises The trainer should Motivate participants to learn by practical applications Provide examples of practical applications Assist learners to reflect on the need to apply skills learning as this assists participants to transfer from theory to practice Prepare for possible difficulties with practical applications Stress importance of exercise and point objectives List characteristics which indicate that the exercise is being carried out correctly Allow practical applications demonstrations Follow steps in the correct order Familiarise participants and demonstrate with participants Repeat exercise with participant Do o
57. s mime body position etc non verbal communication which are understandable to the receiver 3 The sender must now send the message in such a way that it can be received by his her communication partner 4 The receiver receives the message over one or more of his her perception channels If this takes place without any omissions or distortions the receiver then has an exact copy of the transmitted message 5 The receiver must decode and interpret classify and adopt the message in order to understand it correctly 6 The receiver must now acknowledge receipt of the message 1 e he she must let the sender know that he she has received duplicated and understood the message THE PARTS OF A MESSAGE Every message has four sides which must be properly recognized and taken into consideration while communicating Regardless of whether you are sending or receiving a message it is important to learn how to communicate with all four sides This holds true in particular for people who rely on communication as a tool such as teachers counsellors discussion leaders and moderators Factual Content Message Self revelation Appeal Relationship 1 Content Every message contains some form of information i e a portrayal of facts from the point of view of the sender This information should be easy to understand and unambiguous 2 Self revelation In addition to information on the fact
58. s to be communicated every message contains information on the sender It is possible to infer from a message how the sender views himself herself and how he she would like to be viewed by others It is also possible to infer characteristics from a message of which the sender himself herself is not even aware Self revelation therefore encompasses intentional self portrayal as well as unintentional self disclosure 3 Relationship A message also reveals the sender s and receiver s sentiments for each other A message therefore contains information on the relationship between sender and receiver This side of a message is often manifested in the tone of voice gestures and other non verbal signals as well as in the way the message 15 worded 4 Appeal A message is not usually just sent by the sender for no special reason Every message is almost always connected with the attempt to influence the other person The sender does not only want his her message to be understood he she also wants to achieve a specific effect 3 Characteristics of an effective communicator Effective communication 15 a two way process This calls for establishment of dialogue As a health counsellor one is both in the situation of the sender and the receiver As a sender good communicator should make sure he has the full attention of the communication partner speak in a loud and clear voice formulate the message clearly in a way that can be easily understo
59. sations b is one of the methods used to assess quality of care The following are some of the methods that can also be used Focus Group Discussions Client self assessments Chart Interviews Analysis of patients notes Client suggestion boxes Exit Questionnaires and or interviews Discharge Care plan review date instructions booking Team work in continuity of care Quality of care depends upon team work Every discipline is part of the team at whatever level In order to provide comprehensive quality of care programmes at institutional level each discipline has a special role to play TEAM stands for T Together E Everyone A Achieves M More Co ordination and collaboration is encouraged between all the disciplines from time to time Mechanisms to evaluate efforts should be instituted 29 Lesson Plan 1 Introduction Present the topic and the objectives of the session Ensure that participants understand and agree to the 5 minutes objectives 2 Lecture Guided Present the topic of Quality Assurance Dialogue Definition 30 minutes Quality Assurance Cycle Quality Assurance Methods 5 Visits Let groups of participants visit different departments and 45 minutes look out for problems and opportunities for improving quality of care and services including interviewing staff and patients 3 Group Work Form working groups and let participants elaborate recommendations and plans to improve Quality Assurance on the
60. text e Effective Listening Health service providers show concern and interest while the client is speaking they demonstrate understanding by acknowledging the clients statements and do not interrupt the client unnecessarily etc e Dialogue Good communication means that the client has the opportunity to give information and to ask questions e Probing Health service providers encourage client inputs by using methods such as probing paraphrasing when appropriate and encouraging clients to tell them more about their conditions e Appropriateness Effective questions take into account factors such as the social and cultural context the medical condition in question the educational level of the patient etc e Completeness A complete interview includes questions about all symptoms and all relevant medical history 2 2 Counselling Counselling is of high quality when the information is sufficient relevant comprehensive and acceptable Skills such as verification organization of information into blocks and the employment of social support networks when possible are some methods which enhance counselling Standard During the counselling session of the encounter the health service provider effectively uses information giving and educational skills to orient the client about his or her condition To promote compliance with medical treatment and or behavioural changes that will improve the health of the client the provider uses nego
61. the discussion back to the facts Techniques of handling patients clients complaints Don t be defensive Be calm at all times Don t take criticism personally It is not you the client is angry with try to be objective and put yourself in their shoes Offer an apology even if the disservice is not your fault I m terribly sorry you are so upset does not admit blame but does establish some rapport with the client Show empathy by using such phrases as can understand how you feel I appreciate what you are saying Address patient by name 40 How to handle patient s complaints It is inevitable that you shall have to deal with dissatisfied patients some time Dealing with an aggrieved patient may be demanding but if you make every effort to resolve all complaints while the patient 15 still on the premises almost every problem can be resolved In failing at the initial stage to deal adequately with a disappointed patient you are actually creating your own demanding patient who will be far more difficult to deal with as his problem escalates When communicating with an unhappy client patient you are the public face and voice of your institution Therefore your ability to communicate well with a client is of paramount importance Consider all the aspects of communication how you look clothing and adornment how you act facial expression head movements gesture what you say content and how you say it tone
62. tiation skills There is need to create rapport with client allow client to tell their side of the story without interruption listen actively give information and education to orient the client about her condition help client to make an informed decision 14 Guidelines The following list of specific norms related to the content and methods used in counselling can help the health service provider communicate more effectively This list is illustrative and not intended to be exhaustive These norms may be adapted according to the local context Appropriate Language The health service provider delivers counselling in the client s language of fluency Local language and or translations should be used when necessary Comprehension The health service provider communicates in ways that are easy to understand i e avoiding technical jargon and by taking into account the cultural and educational level of the client Organisation of information The health service provider presents the information in blocks according to a few categories in order to make it easier for the client to remember Acceptability The health service provider presents treatment options solicits information about client preferences and involves the client in decision making in order to ensure that the treatment and other recommendations are acceptable to the client Sufficiency The health service provider gives enough information to the client to enable him or
63. to different departments 8 hours 20 minutes 20 5 The Functions of Questions Questioning to Check Understanding and Interest When one is the receiver one can check that one has understood the message of a communication partner This feedback question is usually combined with a summary of the partner s message I understand you to say Does this accurately summarize your points Doing this shows that one is listening attentively demonstrates that the partner s message is important acknowledges the message and avoids misunderstanding The sender uses questions from time to time to make sure that the listener has understood his her own message by asking Have I explained that to your satisfaction to check the receiver s reaction How does this look to you Questioning to Bring Attention Back to the Subject If the listener s attention wanders a question might serve to bring the concentration back to the subject Sometimes the lack of attention is only momentary and can be cured by any kind of question If the listener s boredom and inattention is very obvious and prolonged one can make this the subject of one s questions and find out why there is a lack of interest and how one can improve one s communication Questioning to Start Communication Partner Thinking Questions that ask for opinions and suggestions serve to get the communication partner thinking and activate him her to contribute in
64. ur body language Gestures postures looks facial expressions can show how we feel and what we think about an issue or another person Good communication is mutually beneficial for the sender and the receiver of information The above definition calls for attention to the following points e Communication involves people and therefore involves trying to understand how people relate to each other e Communication is about sharing meaning agreeing on the definition of terms they are using e Communication is symbolic this means gestures sounds letters numbers and words only represent approximate ideas meant to communicate e Communication aims at bringing about desired effects such as improving knowledge change of attitudes and behaviour of the receiver Communication involves a wide range of behaviours such as talking listening reading writing and thinking These behaviours occur over time and they overlap with one another While we seek mutual understanding when we directly communicate with one another research has proved that communication never really ends Research also says that perfect communication is difficult to achieve While the production of a brochure poster video or radio show may have value in getting messages across communication is more effective when all participants are actively involved and when there is interaction and dialogue between the participants Interaction dialogue and active participation enables
65. w could know nice to know but not essential Attitude of Receiver People will only e Create attention and interest by get a message when they are ready Starting from the client s reality their problems to be a receiver i e when they are knowledge interest emotions motivated to listen with attention pointing out the relevance of the information for and interest the clients solution to their problems benefits Understanding misunderstandings e Support the client s understanding by caused by misinterpretation due to using clear simple language preconceived ideas prejudices giving examples from the client s sphere of life previous experience explain relationship of facts e g cause effect not understanding words and relationships technical terms bringing out and diffusing preconceived ideas contradictory information from and prejudices or misinformation from other other sources sources Acceptance of a message will only occur e Convince clients by when clients are convinced and arguing realistically agree on the content of the message giving background data pointing out the benefits and advantages of what you have to offer giving clear instructions on how they can use the information to their advantage Lesson Plan 1 Introduction Present the topic and the objectives of the session Ensure that participants understand and agree on the 10 minutes objectives 2 Lecture Present the communication mo
66. xamples etc to the client group Exercises In doing exercises the facilitator will provide clear guidelines rules for role plays In addition the facilitator should take note of the following Making it possible for each group to steer its self Recognizing difficulties of communication if any Creating a friendly atmosphere Observing moods and encourage reflections and praise learners Acknowledging contributions DUPLICATION EXERCISE The Story One executive did not propose a raise in pay for one of his employees The employee gave notice to leave the organisation His colleagues felt sorry because of this for he was generally well liked There was a discussion whether one could do something about it Correct answers 1 The executive had denied the employee a raise in pay 2 The employee did not receive a raise in pay 3 The employee was angry not to get a raise in pay and gave notice to leave the organisation 4 The reason for the employee s wish to leave the organisation was the refusal to pay him more money 5 The colleagues were sorry because the employee left the organisation 6 The colleagues discussed with the employee I I I 7 The executive did not take part in the discussion 8 The executive asked the employee to leave the organisation 9 The colleagues felt sorry because the employee did not get a raise in pay 10 The employee was generally well liked and there was
67. y skilful and honest handling of their complaints has become a vital mechanism which will enable the health institution to retain people s loyalty In this regard every health service provider has a public relations role to play Definition Public relations is about marketing the image of the institution organisation so that patients and health care providers are appreciative of each other s responsibilities making everyone s job less complicated The image of an organisation is formed by the ideas and opinions about this organisation in peoples mind positive image of the health system can be created through the deliberate provision of information but most of all through what clients patients experience when dealing with health care providers Public relations is a continuous and systematic effort to promote mutual understanding between the client and the institution e Continuous and systematic effort Not a once only action but a policy An ongoing planned sustained improvement process that systematically measures client satisfaction and takes necessary action to maintain and improve health services e Mutual understanding Gain information on patients clients needs and expectations and use it for the design and improvement of health services e Make sure the client is aware of your efforts in making them satisfied 39 The 10 easy steps of complaint handling Listen Thank the pat

INTERPERSONAL COMMUNICATION Manual for Trainers of Health

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