Effective clinical communication is about building a relationship, providing and sharing information, and sharing decision-making. Here are some things we can do to communicate effectively with our patients.
- Introduce yourself, explain your role and why you are seeing the person in language they understand. For example, 'I am a senior nurse' not 'I am a NUM'.1 You may need to repeat this throughout the patient’s stay; remember, hospitals are busy places with many clinicians coming and going.
- Wear a name badge with your first name written in large font and a simple role or treating team description (such nurse or doctor).2
- Ask people how they prefer to be addressed and respect this by using the names they choose.
- Use direct language that the older person can understand rather than medical jargon.1
- Verify with the older person what he or she has understood from your conversation.
- Orient older people to the ward, explaining ward routines such as when a doctor may visit.
- Be mindful of the language you use. Generalisations or labels such as ‘cute’ or ‘difficult’ can impede good communication and terms such as ‘a good teaching case’, ‘bed blocker’, ‘frequent flyer,’ ‘difficult family’, ‘failed discharge’, ‘just palliative’ and ‘granny dumping’ are inappropriate, dehumanising and not reflective of person-centred care. Using respectful language and gestures promotes dignity.3
- Find out what matters to your patients. As clinicians we can focus on what is the matter with our patients rather than exploring what matters most to them.
- Spend more time actively listening to patients.
- Ask, Tell, Ask, ask your patients what they want, tell them what you can, and then ask them what they understand.4
- Teach Back, a technique where a clinician asks the older person to teach what they have learned back to the clinician. This technique offers the opportunity to verify understanding and can screen for cognitive problems because if your patient cannot teach what they have learned, you should investigate why.5
- Acknowledge and respond to emotional cues. For example, if a patient says “I’ve been having a hard time lately and then I go and fall getting out of bed this morning”, don’t ignore the “I’ve been having a hard time lately”. Emotions can override cognitive thinking and emotional cues are shortcuts to important areas for discussion6.
- Be aware of non-verbal cues. People will rarely tell you that they are experiencing loneliness or are at risk of loneliness. Loneliness is a subjective, private experience. It does not necessarily relate to simply living alone, but rather to a perceived negative feeling of lack of quality relationships.6 It can have a profound impact on an person’s health and wellbeing. Look for signs like tearfulness or withdrawn behaviour, which may indicate that your patient is feeling lonely or depressed, or is vulnerable. These signs warrant further exploration.
Attitude and awareness
- Be positive, assume capacity rather than incapacity when meeting an older person.7
- Acknowledge and care for the older person as an individual person. Welcome and respect those defined by the older person as family or significant others.
- Set the scene: if possible sit at eye level with the older person, maintain eye contact (where appropriate), minimise external distractions, respond appropriately, focus solely on what older person is saying, minimise internal distractions, ask questions for clarification.1
- Be mindful of sensitive conversations on busy wards and consider noise levels and privacy before engaging in discussion, particularly of sensitive topics.1 For example, raising continence issues with older people in shared wards may best be done in a private meeting room. The conversation is important and should not be avoided because your patient is in a shared ward, but the environment must be appropriate for a sensitive discussion.
- Advocate for the older person’s involvement in decision-making to the extent they want. Encourage the older person to ask questions. Listen attentively to them and provide appropriate answers. If you can’t answer their questions try to find someone who can.
- Be mindful of your own feelings, perceptions, body language and expectations of older people, as these will impact on your communication with them. Before we can act to improve our communication we must be aware of our own beliefs and attitudes.8
1. The Gerontological Society of America, Communicating with Older Adults: An Evidence-Based Review of What Really Works, The Gerontological Society of America, 2012.
2. Risser, D.T., Rice, M.M., Salisbury, M.L., Simon, R., Jay, G.D., Berns, S.D. The Potential for Improved Teamwork to Reduce Medical Errors in the Emergency Department, Annals of Emergency Medicine, 1999, 34: 373-83.
4. Gawande, A. Being Mortal: Medicine and What Matters in the End, 2014. Metropolitan Books/Henry Holt & Company.
6. Perlman, D, Peplau L. Toward a Social Psychology of Loneliness. Personal Relationships 3: Personal Relationships in Disorder, (1981) Pp. 31–43.
7. Philips, J. Communicating with Patients, 2014. Centre for Palliative Care: Melbourne.
8. Tinney, D.J. Still Me: Being Old in Care, 2006. University of Melbourne.
Reviewed 05 October 2015