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Introduction

Sometimes it seems that no one understands our profession, what we do, and what our patients need. Social media is full of amusing anecdotes about this issue – but when it affects patient care, it’s no longer funny. It’s evidence that we have work to do. It’s our responsibility to communicate effectively with others.

SLPs working in medical professions collaborate, request information and action, provide education and training to many different audiences: patients, families, physicians, other allied health providers, and supervisors/managers. With such varied information to convey to a diverse set of listeners, no wonder clinicians are overwhelmed, particularly if the setting is new to them or if the disorders are complex.

Establish positive relationships

Relationships with colleagues matter; professional relationships, both positive and negative, send us “powerful messages about who we are and how we are valued” (Gersick, Dutton, & Bartunek, 2000; p. 1026). Establishing these relationships is a process; one cannot walk into a health care setting with an assumption that one’s judgment will automatically be respected. Respect is earned, partly through understanding and meeting the needs of “the listener.”

The old sender – message – receiver model of communication (Shannon & Weaver, 1949) was part of most communication sciences courses. Applying that model to our work may help clarify and manage our challenging communication situations.

Consider the listener’s code

Communication is interactive – it cannot take place without the receiver. However, what the sender says is not necessarily the same as what the receiver actually hears and processes. The receiver interprets the message in the context of their own experience and the way they think and feel about situations. Receivers aren’t cognizant of this – they automatically use their own code when interpreting messages (Kourkouta & Papathanasiou, 2014).

A focus solely on content misses an integral component of professional communication – the receiver

When the SLP becomes the sender of important information, messages should change depending upon how the receiver/listener might interpret the information. What is priority in the patient’s case, in the mind of the listener? How does my message fit THAT priority? Failure to consider the listener and the listener’s code leads to less efficient communication and reduced professional credibility.

Much of the literature addressing communication in allied health professions has focused on communication with patients (Parry, 2008). SLPs are already generally quite adept at communicating with communicatively impaired patients. Initiatives in interprofessional education and practice (Prelock, 2013) mean that clinicians must become competent communicators with individuals from other disciplines, understanding their roles and their scope in patient care (Titzer, Swenty, & Hoehn, 2012).

Give them what they need

The amount communicated matters. Ellis, Goddfried and Freiberg (2013) describe the importance of developing an “elevator speech,”   a short (30 seconds to 3 minutes) narrative that essentially “sells” your services. The brief nature of “elevator communication” is taken from the typical length of time one might have on an elevator with a professional colleague to communicate something important. One of the items in their presentation, the “so what?” test, directly affects how, in what manner, and for how long we communicate with different people. In a study of nursing-physician communication, physicians described frustration with information that was presented in a disorganized fashion, with a “lack of preparation to answer questions, inclusion of extraneous or irrelevant information, and delay in getting to the point” (Dixon, Larison, & Zabari, 2006, p. 377). These authors recommend the use of the SBAR communication method, which organizes content as follows: describing the situation (S), providing sufficient background (B), an assessment (A), and recommendations (R). Whether or not a specific format is used, it is vital that sufficient and efficient information is provided.

Examples

In the following communication scenarios, for whatever clinical reason, the patient needs an instrumental assessment of swallowing. The clinician must communicate this to several different people. Each dyad should consider the listener’s role and priority in patient care, their time constraints, and how the request would impact the situation in a way that matters to that listener.

Physicians

Physicians have limited time. Keep communication brief, to the point. Let them know what is needed and why, but in a way that reflects understanding of the case at that point. Priority in acute care is primarily length of stay and medical stability, with little concern at that point for quality of life – that comes later in the process. In other settings, meeting rehabilitation goals and outcomes are paramount. In longer term situations, quality of life and minimizing complications become important.

“Mr. Johnson’s dysphagia is affecting his fluid intake. Right now he’s IV hydrated and so his poor fluid intake isn’t a big issue, but that’ll change when the IV is pulled and he is d/c’d. We need to see the dynamics of that swallow before he goes or he’ll just be back here. So he needs a videofluoroscopy before discharge.” (acute case)

Nurses

Nurses also have limited time, so ask WHO HAS your patient before asking ABOUT your patient. Assure that the nurse has a moment to talk. Let them know what is needed and why, but from the nursing perspective, length of stay is less important than care concerns and general health status. Experience has also shown that invoking a sense of community can be helpful.

“Mr. Johnson is having a lot of trouble swallowing. Right now we’re just guessing about where that liquid is going, and we’ll all be able to care for him better if we know what’s going on. He really needs a video. We’re flying blind now and it’s because they didn’t do the test before pulling that IV and sending him here. I wish they would have done it before he left, but that happens so often, don’t you think?”

Administrators

Administrative personnel responsibilities differ – they are not providing patient/resident care, but answer to the financial and legal aspects of the institution. This may not be an area with which the SLP is comfortable, but it is still important. Our communication should address that piece, and clinician credibility is enhanced when we appreciate that aspect of the administrator’s position.

“Mr. Johnson needs to have a videofluoroscopy. I understand we have to foot the bill for it, but the cost of that test can easily be saved in the reduced nursing hours of care he’ll require if we can get him off that feeding tube/get him on a less restrictive diet. And with better nutrition and hydration, both he and his family will be much more satisfied with his care here.”

Patients and family

Patients and their families are not “on the job,” but are in a state of crisis. The only reason we even meet them is due to a catastrophe, so they are dealing with many emotions (uncertainty, fear, anxiety, guilt, etc.), all of which make it more difficult to process information. Given that most families have never studied swallowing and that health care settings are uncomfortable, both the content and the context are unfamiliar and intimidating. As a result, the vocabulary and manner must change. Patients and families must be able to direct their own care, including making decisions about undergoing tests, so communication should provide reassurance while simultaneously providing information in a way they can understand and process. Here, there is time and often need for longer, more involved conversations with reflective listening.

“Let’s talk some more about your dad’s swallowing and that test we discussed the other day. Here’s what that test would do for him. We can’t see inside his throat to know exactly what is happening with his swallow – I wish we could, but we can’t. No one can. With that test, we would learn more about what is happening in his throat to make sure we are doing everything we can to keep his eating and drinking as comfortable as possible. It would also give your dad and you information you all need to make choices about his care. This test doesn’t lead immediately to changing or taking away his food or drinks, like you said you’d heard. That’s not the case. It would give us all information, so we can all sit down and talk about it. That way your dad keeps as much control over his life as he can have right now.”

Summary

A focus solely on content misses an integral component of professional communication – the receiver. Imagine providing the administrator- or physician-oriented response to the family, and it becomes immediately clear that we must consider the listener’s needs as we formulate messages. A valuable activity can be to practice conveying the same basic information to different stakeholders. What would be the importance to each listener? How can you best meet that need for each listener? What changes in the message, and what does not change?   Professional communication skills that include clinical competence AND interpersonal competence can greatly improve the clinician’s effectiveness on the job.

 

References

  1. Dixon, J., Larison, K., & Zabari, M. (2006). Skilled communication: Making it real. AACN Advanced Critical Care, 17(4), 376-382.
  2. Ellis, K., Gottfred, C., & Freiberg, C. (2013) Elevator Speeches: Get the Word Out!…advocating for your profession,yourself, your clients. Annual convention of the American Speech Language Hearing Association, Atlanta, GA.
  3. Gersick, C. J., Dutton, J. E., & Bartunek, J. M. (2000). Learning from academia: The importance of relationships in professional life. Academy of Management Journal43(6), 1026-1044.
  4. Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia socio-medica26(1), 65.
  5. Parry, R. (2008). Are interventions to enhance communication performance in allied health professionals effective, and how should they be delivered? Direct and indirect evidence. Patient Education and Counseling73(2), 186-195.
  6. Prelock, P. (2013). From the President: The Magic of Interprofessional Teamwork: Interprofessional education in communication sciences and disorders isn’t just a nice-to-have. It’s a need-to-have. The ASHA Leader18(6), 5-6.
  7. Shannon, C. E., & Weaver, W. (1949). The mathematical theory of communication. Urbana, Illinois: University of Illinois Press
  8. Titzer, J. L., Swenty, C. F., & Hoehn, W. G. (2012). An interprofessional simulation promoting collaboration and problem solving among nursing and allied health professional students. Clinical Simulation in Nursing8(8), e325-e333.

 

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