Verbal and Nonverbal Communication

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The Impact of Verbal & Non-Verbal Communication In the Clinic During a Physical Therapy Evaluation : 

Presented by Dr. Sarah Anderson PT, DPT, OCS, MTC, Fellow in Training The Impact of Verbal & Non-Verbal Communication In the Clinic During a Physical Therapy Evaluation University of St. Augustine-Fellowship Program Professional Communications-Independent Study Course

Objectives : 

Objectives Course Objectives:Following lecture and and watching videos learners will be able to: Identify the three goals of practitioner communication involved in the practice of high quality healthcare. Describe the five reasons why verbal and non-verbal communication are important in healthcare. Recognize the five principles that characterize effective communication in the clinic. Define the three types of communication skills. Describe the stages of the Calgary-Cambridge Guide as a model for communication skills during the initial evaluation.

Objectives Cont. : 

Objectives Cont. Compare and contrast the differences between an initial musculoskeletal evaluation and the Calgary-Cambridge Guide as communication models. Discuss the verbal and non-verbal communication behavior in each stage of the initial evaluation. Interpret how mastering the skills of verbal and non-verbal communication will impact our individual patient care and the profession as a whole. Demonstrate ability to integrate verbal and non-verbal skills into clinical practice by passing an exam at an 80% proficiency level.

Agenda : 

Agenda I. Welcome II. Introduction III. Initiating the session IV. Gathering Information V. Physical Exam VI. Explanation and Planning VII. Closing the Session VIII. Building the Relationship IX. Providing Structure X. Summary XI. Exam Questions

“Observe, dear physician, the patient is showing you a cure.” 16 -Sir William Osler : 

“Observe, dear physician, the patient is showing you a cure.” 16 -Sir William Osler Three goals of practitioner communication:13,20 Accuracy Efficiency Supportiveness

II. Introduction : 

II. Introduction Why is Verbal and Non-verbal communication important in healthcare?1,2,4,7-13,18-20 Adherence Medico-legal Clinical performance Patient outcome Promote the profession of PT

II. Introduction : 

II. Introduction The five principles that characterize effective communication in the clinic13,19,20 Ensures an interaction vs. a direct transmission Reduces unnecessary uncertainty Requires planning & thinking in terms of outcomes Demonstrates dynamism Follows the Helical model

A Helical Model of Communicationfrom Dance 19675,13,20 : 

A Helical Model of Communicationfrom Dance 19675,13,20

II. Introduction : 

II. Introduction 3 types of communication13,20 Content skills: what clinicians communicate Process skills: how clinicians do it Perceptual skills: what clinicians are thinking & feeling Examine and discuss: Traditional evaluation model vs. a more patient-centered model- Calgary-Cambridge Guide13,20

Steps of a Traditional model of a Physical Therapy Musculoskeletal Evaluation16 : 

Steps of a Traditional model of a Physical Therapy Musculoskeletal Evaluation16 Pain Assessment Initial Observation History Structural Inspection-position Palpation for Condition Joint AROM Joint PROM Muscle Selective Tissue Tension Muscle length and myofascia Muscle Strength Special Tests Movement Analysis Palpation for Tenderness Neurovascular Imaging Evaluation Diagnosis & Prognosis Intervention

Calgary-Cambridge Guide13,20 : 

Calgary-Cambridge Guide13,20

III. Initiating the session : 

III. Initiating the session

poor communication- Initiating the Session : 

poor communication- Initiating the Session

III. Initiating the session1,3,4,6,8,13,14,18-20 : 

III. Initiating the session1,3,4,6,8,13,14,18-20 Preparation-Prepare yourself and the room for the patient. Establishing Initial Rapport-Greet the patient by introducing yourself, obtain their name, clarify your role, and attend to the patient’s comfort. Identifying the reasons for the consultation-Opening question, listen attentively, confirms problem list, negotiates an agenda.

III. Initiating the session : 

III. Initiating the session

Good communication- Initiating the Session : 

Good communication- Initiating the Session

III. Initiating the session : 

III. Initiating the session Good communication analyze components used in video

IV. Gathering Information1,3,4,7,8,13,15,18-20 : 

IV. Gathering Information1,3,4,7,8,13,15,18-20 Exploration of patient’s problems to discover the: biomechanical perspective, patient’s perspective, background information Accomplished by: -Encouraging patient to tell story chronologically -using open to closed questioning -facilitating patient’s response using verbal & non-verbal behavior -picks up patient’s verbal & non-verbal cues -summarizes -avoids jargon

V. Physical Exam1,4,8,13,19,20 : 

V. Physical Exam1,4,8,13,19,20 Asking permission Making patient comfortable Touch

VI. Explanation and Planning : 

VI. Explanation and Planning

poor communication- Explanation and Planning : 

poor communication- Explanation and Planning

VI. Explanation and Planning1,3,4,7,8,11,13-15,17-20 : 

VI. Explanation and Planning1,3,4,7,8,11,13-15,17-20 Providing the correct type and amount of information Aiding accurate recall and understanding Achieving a shared understanding and incorporating the patient’s injury framework Planning and shared decision making

VI. Explanation and Planning : 

VI. Explanation and Planning

Good communication- Explanation and Planning : 

Good communication- Explanation and Planning

VI. Explanation and Planning : 

VI. Explanation and Planning Analyze components used

VII. Closing the Session4,13,18-20 : 

VII. Closing the Session4,13,18-20 Forward planning Ensuring appropriate point of closure

VIII. Building the Relationship1,3,4,7,8,11,13-15,17-20 : 

VIII. Building the Relationship1,3,4,7,8,11,13-15,17-20 Using appropriate non-verbal behaviors (video/pictures) (video/pictures)

VIII. Building the Relationship1,3,4,7,8,11,13-15,17-20 : 

VIII. Building the Relationship1,3,4,7,8,11,13-15,17-20 Developing Rapport (video/pictures)

VIII. Building the Relationship : 

VIII. Building the Relationship Involving the patient (video/pictures) (video/pictures)

IX. Providing Structure4,8,13,20 : 

IX. Providing Structure4,8,13,20 Make organization overt by: Summarizing Signposting Attending to Flow by: Following a logical sequence Attend to timing

X. Summary : 

X. Summary Pull together information and reflect on the skills in the Calgary-Cambridge Guide. Highlight skills discussed and how they fit into the bigger picture of professional competence

XI. Exam Questions : 

XI. Exam Questions

References : 

References Beattie PF, Pinto M, Nelson MK, Nelson R . Patient Satisfaction With Outpatient Physical Therapy: Instrument Validation. . Physical Therapy. 2002; 82(6): 557-565. Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor-patient relationship and malpractice. Arch Intern Med. 1994; 154: 1365-70. Blatner A. About Nonverbal Communications. Part 1: General Considerations. 2009;http://www.blatner.com/adam/level2/nverb1.htm Croft JJ. Interviewing in Physical Therapy. Physical Therapy. 1980; 60 (8): 1033-1036. Dance FEX. (1967) Toward a theory of human communication. In: FEX Dance (ed.) Human Communication Theory: original essays. Holt, Rhinehart and Winston, New York Ely JW, Levinson W, Elder NC, Mainous AG, Vinson DC. Perceived Causes of Family Physicians’ Errors. J Fam Practice. 1995; 40: 337-44. Fernandez EI. Verbal and Nonverbal Concomitants of Rapport in Health Care Encounters: Implications for Interpreters. Journal of Specialised Translation. 2010; 14: 216-228 Grannis CJ. The Ideal Physical Therapist as Perceived by the Elderly Patient. Physical Therapy. 1981; 61(4): 479-486. Headache Study Group of the University of Western Ontario. Predictors of Outcome in Headache Patients Presenting to Family Physicians-A one year prospective study. Headache J. 1986; 26: 285-294. Ingram D. Opinions of Physical Therapy Education Program Directors on Essential Functions. Physical Therapy. 1997; 77(1): 37-45.

References Cont. : 

References Cont. Jeffrey JE, Foster NE. A Qualitative Investigation of Physical Therapists’ Experiences and Fellings of Managing Patients With Nonspecific Low Back Pain. Physical Therapy. 2012; 92 (2): 266-278 Jensen GM. 42nd Mary McMillan Lecture: Learning: What Matters Most. Physical Therapy.2011; 91 (11): 1674-1689. Kurtz S, Silverman J, Draper J. (2005) Teaching and Learning Communication Skills in Medicine, 2nd Edition. Oxford: Radcliffe Publishing. Kupst M, Dresser K, Schulman JL, Paul MH. Evaluation of Methods to Improve Communication in the Physician-Patient Relationship. Am J Orthopsychiatry. 1975; 45: 420 Nicholas MK, George SZ. Psychologically Informed Interventions for Low Back Pain: An Update for Physical Therapists. Physical Therapy. 2011; 91 (5):765-776. Patla C. (2005). E1 Extremity Evaluation & Manipulations-Seminar Manual; University of St. Augustine. pg 23-28. Payton OD. Effects of Instruction in Basic Communication Skills on Physical Therapists and Physical Therapy Students. Physical Therapy. 1983; 63(8):1292-1297. Roberts L, Bucksey SJ. Communicating With Patients: What Happens in Practice? Physical Therapy. 2007; 87(5): 586-594. Roter DL, Hall JA (2006). Doctors Talking with Patients/Patients Talking with Doctors-Improving Communication in Medical Visits, 2nd Edition. West Port, CT: Praeger Publishers Silverman J, Kurtz S, Draper J (2005). Skills for Communicating with Patients, 2nd Edition. Oxford: Radcliffe Publishing

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