Communication and Clinical Effectiveness in Rehabilitation

Frances Reynolds

• Publisher: Butterworth-Heinemann
• Year: 2004
• Print ISBN: 9780750656658
• eBook ISBN: 9780702038532
• Topic: Medicine
• Subtopic: Physiotherapy, Physical Medicine & Rehabilitation

Incorporating a patient-focused perspective on communication and health care, this new title for physical and occupational therapists and students provides practical strategies for effective communication with both colleagues and patients. Written in a straightforward, easy-to-understand style, it offers a multidisciplinary, evidence-based approach and an emphasis on reflective practice, making it a timely and useful resource for today's readers.- Discusses strategies for communicating with both colleagues and patients- Examines the evidence for the importance of effective communication in enhancing clinical effectiveness- Contains reflective exercises for self-awareness of personal communication skills and difficulties- Provides case studies that allow the reader to analyze a range of realistic communication problems- Includes research-based evidence throughout

Chapter 1

Introduction: taking a research-guided approach to communication

CHAPTER CONTENTS

Use of the term ‘patient’ in this book

What is ‘communication’?

Communication skills: why are they vital tools for physiotherapists and occupational therapists?

Why do health professionals sometimes communicate poorly with patients?

How may skilful communication influence patients?

Communication and clinical effectiveness

Evidence-based practice and clinical effectiveness

Research-guided practice

Finding relevant research evidence about patients’ needs and effective communication

Reviewing the evidence

Other sources of evidence and information relevant to communication

Observing and practising interpersonal skills

Communicationg with colleagues

Conclusion

A physiotherapist and an occupational therapist are working with a patient who is well known to them as he has been in the in-patient rehabilitation programme for some time. Ben has a spinal cord injury, and has made good progress in mobilising using a wheelchair. Today, Ben seems quiet, unmotivated and averts his gaze. The more senior therapist outlines the day’s programme in a cheerful, up-beat way. The more junior therapist notes the patient’s nonverbal behaviour, its change since their last session together, and comments: ‘You seem a bit downcast today. Is there something you would like to talk about before we begin today’s programme?’

This scenario, based on a patient’s experience, suggests that skilful communication is not necessarily mastered with age and seniority. Nor does an empathic response necessarily take time away from treatment. Indeed, an empathic understanding between therapist and patient may maximise the use of the time they spend together and the effectiveness of treatment.

Recent years have seen many new trends within the National Health Service (NHS) including an increasing emphasis on the need for health professionals to build collaborative partnerships with patients and to work cooperatively in multidisciplinary or interprofessional teams. Communication skills are now recognised to have a vital part to play in effective health care, maximising the outcomes of medical care and rehabilitation. The education of health professionals therefore needs to encompass more than technical expertise and knowledge. Furthermore, health care has been radically affected by a new emphasis on evidence-based practice, which encourages all practitioners to consult and appraise available evidence in order to formulate interventions capable of achieving the best outcomes.

Two central questions are addressed throughout this book. Can therapists take an evidence-based approach to communicating with their patients? Will a ‘tutored’ approach, based on communication theory, research evidence, clinical sensitivity and personal reflection, enhance the relationship between therapist and patient, and ultimately maximise the effectiveness of therapy?

The material presented will help occupational therapy and physiotherapy students to develop the insights, knowledge and skills that will enhance their communications with patients and colleagues. students of other health disciplines will also find much of the material relevant. Many of the exercises, together with the recommended reading, further references and theory, may also be of interest to those with more clinical experience. We will mainly focus on the needs of patients in the physical rehabilitation setting. However, many of the issues that arise are common to other settings too.

A four-pronged approach to learning about communication is taken, in which you are encouraged to:

• Increase your sensitivity to patients’ communication needs in the health care setting

• Consider theoretical models of skilful communication

• Consult evidence about the skills and strategies that increase the effectiveness of communication

• Practise reflective awareness of personal communication skills.

You will need to integrate these different aspects of knowledge and skill in order to achieve more effective, patient-centred communications in your clinical practice.

This chapter introduces you to the following terms and topics:

• What is ‘communication’?

• Communication skills: why are they vital tools for physiotherapists and occupational therapists?

• Why do health professionals sometimes communicate poorly with patients?

• How may skilful communication influence patients?

• Communication and clinical effectiveness

• Evidence-based practice and clinical effectiveness

• Improving communication through research-guided practice

• How can you find relevant research evidence about patients’ communication needs?

– Books on communication in health care, health psychology, illness and disability

– Journal articles

– Electronic databases

– Reviewing the evidence

• Other sources of evidence and information relevant to communication:

– The clinical setting

– Internet sites

– Autobiographies of people living with illness / impairment

– Films, novels and poems

• Observing and practising interpersonal skills

• Communicating with colleagues

• Conclusion.

Later chapters expand on these topics.

Communication remains an art as well as a science. Common sense certainly does not supply all the answers, and no book can provide adequate rules or ‘recipes’ that guarantee successful interactions either with patients or colleagues. There are difficulties in applying a strictly evidence-based approach, as we will see later. Hence you will need to develop reflective self-awareness, by analysing how your own attitudes and interactive style promote or inhibit certain types of communication. You will need to plan strategies for managing difficult encounters, and will need to be prepared to learn from mistakes. The book will encourage you to continue to seek out evidence about effective communication strategies to apply not only in your current situation, or during your next clinical placement, but throughout your career. Given the complexity of human encounters, your communications with patients and colleagues cannot realistically become ‘perfect’. Yet communications based on education and reflection will almost certainly be more effective than ‘untutored’ attempts.

In conjunction with reading about communication skills theory and evidence, therapy students are strongly advised to carry out practical work, including the practise of interviewing and listening skills. Dickson et al (1997) suggest that communication skills are acquired in similar ways as other skills (such as driving a car). Learning occurs through preparation, active practise of specific skills and feedback from others, in addition to reading and reflection. Everyday encounters outside of the clinical setting can also provide opportunities for observation and further considerations about effective and ineffective communication strategies.

USE OF THE TERM ‘PATIENT’ IN THIS BOOK

The term ‘patient’ has generally been used in this book, although it admittedly carries certain unwanted meanings, including connotations of passivity and powerlessness. In some people’s view, the term conjures up images of people who are waiting gratefully to receive the treatment that is organised and delivered by medical and therapy staff. The term has been associated with the biomedical model of care, which has traditionally focused upon treatment of the body machinery, neglecting the person’s subjective experiences, active coping strategies and preferences (Reynolds 1996). Although the term ‘patient’ comes with unwanted baggage, other terms are not entirely satisfactory either. ‘Client’ is preferred by some health professionals, but it too connotes undesirable images, for example of the market-place and a customer buying services. ‘User’ is adopted in some health (particularly mental health) settings, as the term implies greater autonomy, power and choice than ‘client’. However, ‘user’ arguably generates negative images of manipulation, and also perhaps suggests a ‘voluntary’ status, which does not do justice to the complex dilemmas, suffering, and resourceful coping strategies of so many people living with physical and mental illness. We really need a new term for people who are working in collaborative partnership with health professionals, particularly for those people with long-term illness and impairment who form the majority of the case-load of most National Health Service (NHS) therapists in the UK. Nevertheless, given that ‘patient’ remains the most widespread term for people participating in physical rehabilitation, this term will be adopted in this book, albeit with reservation.

WHAT IS ‘COMMUNICATION’?

In everyday life, a person who is described as a ‘good communicator’ may be thought likely to be good at explaining information. You may anticipate that good communicators are persuasive and eloquent, adept at giving others verbal direction or advice, and clear about their own needs within the encounter. These are all information-giving or ‘sending’ skills, which rely primarily on speech. However, there is much more to communication than speaking and information-giving. The word ‘communication’ is derived from a Latin root, meaning ‘to...

Table of contents

• Cover image
• Title page
• Table of Contents
• Dedication
• Copyright
• Acknowledgements
• Chapter 1: Introduction: taking a research-guided approach to communication
• Chapter 2: Models of health, illness and rehabilitation
• Chapter 3: Understanding patients’ experiences of ill-health and health care
• Chapter 4: Patients’ communication needs in healthcare settings
• Chapter 5: Skilful communication and clinical effectiveness
• Chapter 6: Working in partnership with patients
• Chapter 7: Providing support
• Chapter 8: Patient education and empowerment
• Chapter 9: Teamwork in the rehabilitation setting
• Chapter 10: Conclusion
• References
• Index