Communication Bridges & Barriers

Jan 15, 2008

Change of Reading Chapter 6 A Journal Article (will be given in class)

Communication Bridges Caring and Respect Trust Empathy Confidentiality Ethical Behavior Empowerment

Empowerment What does it mean to empower the client?

Helping clients to take a primary role in the health care, by providing them with the knowledge, skills, and other resources.

What does a primary role mean?

Five Features of Empowerment Acceptance Affect Autonomy Alliance Active Participation

What is the significance of these components?

Acceptance Non-judgmental: refrain from condemning the

lifestyle, self-control, appearance, attitudes of the clients

Why?

Affect Explore not only the problem, but also

the client’s feelings associated with the problem

Why?

Autonomy Client’s involvement and participation

What are the client’s responsibilities? What are the HCPs responsibilities?

Why?

Alliance Work together with the client to tackle the health

problem the allies? the enemy?

Why?

Active Participation HCPs need to practice active listening

Why?

“Well…I’m not sure ar…I can’t make it on Tuesday morning, ar… oh yeah…actually I have to meet my son, Mark. It is his graduation day, ar…I mean …perhaps Wednesday… ar… actually ar…no, Thursday…ar… I’m going to …ar…to…ar.. The airport to pick up my daughter, Sussie.. ”

In summaryEmpowerment Helping the patients to identify what they want

to change Help them to identify feelings associated with

their health problem and to plan Establish commitment to change Explore possible barriers to change of

actions

Descriptive Study on Empowerment Kyngas et al, 1998

Procedures Ask adolescents to describe the HCPs The description is classified into “routine” and “motivating” “routine”: HCPs ask the same questions every visit; ignore the

adolescents’ opinions; make decisions according to their own choice

“motivating”: ask, listen, take notice of the adolescents’ opinions, and make decisions together

Results Adolescents in the “motivating” group are more likely to have

good compliance and better “metabolic control”. What does this study show?

Controlled Study on Empowerment Greenfield, et al, 1988 Procedures

Randomly assigned clients who visit the clinic to an experimental and a control group

In the experimental group: clients reviewed their medical records and educational materials with a clinical assistant, who encouraged the clients to use the information they learn to negotiate medical decision with the doctor.

Clients in the control group: clients reviewed standardized educational materials

Results Clients in the experimental group asked more questions. Clients in the experimental group showed significant health

improvement. What does this study show?

Controlled Study on Empowerment Kinmonth and colleagues, 1998 Procedures

Training HCPs to be more ‘client-centered’, i.e. active listening and negotiation.

Patients recently diagnosed with diabetes are randomly assigned into the experimental and control group.

In the experimental group, patients received a booklet encouraging them to ask more questions; in the control group, patients were not given the booklet.

Results Patients in the experimental group reported better communication

with HCPs, greater treatment satisfaction, and better emotional well-being.

What does this study show?

Review Do you know:

What are the 5 features of empowerment? Why are the 5 features important? Can you describe one of the studies on

empowerment? According to the findings of the health

research, what are the benefits of empowering the clients?

Barriers to Therapeutic Relationship Stereotyping Anxiety Space violation Confidentiality Violation

Stereotype A set of characteristics associated with

a particular group of people; the assumption that all members of the

group possess those traits, to a degree. Examples of positive and negative

stereotypes?

How do stereotypes operate?

Stereotypes guide our perception

Look for signs to confirms our stereotype

Stereotyped actions are over-emphasized, non-stereotyped are under-emphasized.

Stereotype is subsequently reinforced.

Illusion of outgroup homogeneity What does it mean?

Example: cross-racial facial identification

What’s the cause of this illusion?

Stereotypes in Health Care Stereotyping is one source of prejudice and

discrimination Studies show

A large percentage of health-care professionals (physicians, nurses, hospital workers report spending less time with AIDS patients than with people suffering from other illnesses (Gordin et al., 1987, Hunter & Ross, 1991)

Health Canada was accused of discrimination, given that members of visible minority groups systematically failed to get promotions, despite suitable qualifications and work records. (Human Right Commission 1997)

Questions to Consider How do stereotypes affect a HCP’s ability to provide

a therapeutic relationship? (Hint: How does it affect the HCP’s acceptance, affect, respect for autonomy, active listening abilities, and forming alliance with patients?)

What is outgroup homogeneity? How does it relate to stereotypes?

Why are stereotypes so hard to change?

Victim Responses to a Negative Stereotype Stereotype threat

People who are targets of stereotypes perceived that they will be evaluated in negative terms

The perceived threat can cause anxiety and affects task performance

Research on Stereotype Threat Croizet and Claire (1998)

Procedures Participants are people from high or low socioeconomic backgrounds. In one condition, participants were told that they were given a test

measuring their intellectual ability; in another condition, participants were told that they were given a test measuring the role of attention in memory. But the tests were the same.

Results Participants from lower socioeconomic background did poorer than

those from higher socioeconomic background when the test was described as a measure their intellectual ability. No difference between the two groups when the test was described as a measure of the role of attention.

Why? Because participants’ concern about being evaluated negatively causes

anxiety, which affects their performance.

Threats of Stereotype and Prejudice in Health Care What might be some of your worries when

you visit a doctor if you were: Someone from a visible minority group (African,

Asian, Middle Eastern) A gay man A young pregnant girl A prostitute

What can be done about stereotypes and prejudice in health care?

First Assignment Due Date: Jan 22 See Late Policy