Communication…the Essentials

By William R. Leahy, M.D.

 

The role of the caregiver has many facets.  An effective caregiver, whether a professional or family member, is interested in providing educated, nurturing and loving care to allow patients or loved ones to become as self-sufficient as they might be and to heal with dignity.
 
An effective caregiver must be an effective communicator. Communication is critical on several levels. The caregiver is the “eyes and ears” of the medical team, observing the patient daily, and must be able to develop a rapport with nurses, therapists and physicians. Secondly, the caregiver must be able to discuss with the loved one daily needs, both emotional and physical. It is evident, therefore, that the caregiver must be skilled in the art of communication.
 
Communication—talking, listening and exchanging information—is at the heart of caregiving. Effective exchanges will allow you to understand your loved one’s needs, express your concerns to the doctor and ask for help you need from others.
 
Communication becomes more difficult when people are tired, in pain, frustrated or depressed. It is easy to become distracted, confused or intimidated in a doctor’s office or on the phone with an insurance representative. When communication breaks down, the misunderstandings that arise can range from inconvenience to disastrous. By keeping a few basic communication principles in mind, you can keep the flow of information open with your family and with the care team.
 
First steps
 
Ascertain any special needs that your loved one has that might affect communication. Does he have hearing, vision or speech impairments? Is there dementia or confusion? Talk with any former caregivers to get an idea of what kind of communication has been effective for them. Also talk with healthcare professionals in the field relating to your loved one’s impairment for communication strategies. Be prepared to adjust communication strategies as his condition changes.
 
Talk to your loved one about the care she is receiving    Find out how she feels about the members of the care team, the care plan, and how it is being implemented. Ask how she has responded to treatments and how they have affected the quality of her life. Find out if there are any needs that she has that are not being met to her satisfaction.
 
Make consultation appointments with all of your loved one’s doctors to find out the details of the care plan.  Get as much information about treatment and expected outcomes as you can. It is helpful to ask for written information or even take a tape recorder with you to the consultation.
 
Communication Basics
 
Communication is the process that we use to send and receive messages and exchange information with other people. We communicate using signs and symbols, including words, drawings and pictures, and also by behavior and gestures. The simplest form of communication takes place between two people…a sender and a receiver. These two constantly switch roles as communication takes place. The next step, providing feedback, occurs when the receiver repeats or responds to the sender’s message, letting the sender know that the message was received and understood. During a conversation, this three-step process is usually repeated over and over.
 
Communication can be either verbal or nonverbal; that is, with or without words. Nodding your head instead of saying “yes” is nonverbal communication. The tone or emphasis we have to words is also nonverbal communication.
 
Body language is a form of nonverbal communication. Movements, facial expressions and postures can express different attitudes or emotions, including sadness, happiness,  anger and pain. Just as when speaking, we send messages with our body language that other people receive and interpret.
 
At times, people send one message verbally and a very different one nonverbally. Nonverbal communication often tells us how someone is feeling, despite what he or she is saying. Your loved one may tell you, “I’m feeling a little better,” but stay in bed and stare blankly at the wall. Such nonverbal clues can tell you he may be depressed. You may need to say something like, “Dad, you don’t seem to be feeling better. You seem to be feeling down today.” This could open the door for verbal communication and allow him to express his feelings, or at least allow you to acknowledge what he is feeling.
 
Barriers to Communication
 
Communication can be blocked or disrupted in many ways. The following are some barriers to communication and ways to avoid them.

a. Your loved one does not hear or understand what you say…speak clearly and check that any hearing aid is working.

b. You do not hear or understand what she is telling you. Ask her to repeat what she has said.

c. The meaning of words or terms is not clear. Use simple words and avoid medical terminology.

d. Using clichés makes your message meaningless.

e. Asking “why” makes your loved one defensive. The word “why” often does not allow you to open up a conversation that is helpful in resolving the question.

f. Yes/no answers end a conversation. Unless you are seeking direct information, ask open-ended questions that need more than a “yes” or “no” answer.

Accurate and Complete Communication
 
In addition to avoiding barriers to communication, these positive techniques will help you send and receive clear, complete messages.

a. Be a good listener. Allow the other person to express her ideas completely.

b. Provide feedback as you listen. Active listening involves focusing on message and providing feedback. Offering general but leading responses such as “on?” or “go on” or “hmmm” provide feedback and encourage the sender to expand the message.

c. Bring up topics of concern. If you know a topic may be of concern, raise it in a general, non-threatening way.

d. Let some pauses happen. Use silence to allow the other person to gather her thoughts or decide to convey another message.

e. Ask for more. When your loved one reports feelings, events, or symptoms, restate what you have heard to clarify. Ask if there is more he or she can tell you.

Communication with Medical Professionals
 
Communication with a care team is equally as important as communication with your loved one and within your family. Do not hesitate to take an active role in the care of your loved one. You, as caregiver, must understand what plan of care has been established. You must be able to send clear and accurate messages about the state of your loved one’s health. As a family caregiver, you are often in the best position to observe changes in symptoms, abilities and general health. The more clearly these are conveyed to the doctor, nurse or other professional caregivers, the better the care that will be provided. Planning your communication in advance and writing notes will help you get all necessary information across and ensure that all of your questions are answered. Be polite and focus on the information that you need to send and receive, rather than any frustrations you may have. While the experience of visiting a doctor’s office may be frustrating, it is more important to get the information you need than to express your aggravation.
 
Observing and Reporting
 
As a family caregiver, you probably spend more hours with you loved one than anyone else does. You are in an excellent position to observe and report on his condition, including any changes, occurrences or new symptoms.
 
Any of the following should be reported immediately to the doctor or agency. You may also need to call 9ll or go to an emergency room for assistance for falls, chest pain, severe headache, difficulty breathing, changes in mental status such as confusion, sudden weakness, high fever, loss of consciousness or bleeding.
 
Less urgent conditions should also be reported--loss of appetite, rash, difficulty sleeping, pain, weakness or fatigue, nausea, depression or withdrawal.
 
You should not try to diagnose the problem nor should you try to decide if a complaint is important or trivial. When in doubt, report it.
Always gather your information and write notes before calling the doctor or nurse. Plan what you will say in advance; writing notes is a good way to help you remember. If you have to leave a message, make it brief, complete and clear. If someone will call you back, keep the notes by the phone or in your pocket so you can easily find them. Write your observations, when you first noticed them, and any supporting details such as the presence of fever. Always be prepared to give the patient’s name, date of birth, Social Security number and insurance information.
 
These strategies for phone calls may also be used for visits to the office of professionals.
 
Communication at all levels is essential for the continued physical and emotional well-being of a loved one, and serves as a key bridge between the patient and the healthcare team. All caregivers should consider the importance of communication and reflect upon strategies to develop the art and science of communication.

Washington, DC neurologist William Leahy, MD, is the author of Caregiving at Home, and Providing Home Care: A Textbook for Home Care Aides. An Assistant Professor of Neurology at the Johns Hopkins Medical Institution, he has devoted his book royalties to a project teaching high school students heath care careers. He has been honored as "Washingtonian of the Year."

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