Assertive Communication for Healthcare Professionals New

ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

GABRIEL SUSAYAN

ASSERTIVECOMMUNICATION SKILLS

FORHEALTHCARE

PROFESSIONAL

BY

23 – 24 September 2010

Facilitator: Mr Gabriel Susayan


GABRIEL SUSAYAN

Ever end up frustrated after a conversation with someone because

you didn’t feel like you communicated as well as you would have

liked? Ever walk away from a conversation asking yourself

what just happened?


GABRIEL SUSAYAN

The 4C's of Effective Communication

4C's of a diamond and how the Cut, Color, Clarity, and Carat Weight, will ultimately determine the fifth C cost. I believe there are also 4C's to Effective Communication.

CLEAR

We must communicate clearly or what we say may be

misunderstood. We must write legibly or our written

communication may be misunderstood. The terms

and phrases we use must be clear and understood by

all, or our communication will not be effective.


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CONCISE

Often in our communication, we ramble on and on and never really get

around to what it is we want to say. We need to be concise in our

communication to be effective.


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COMPLETE

Incomplete, inaccurate instructions result in countless problems in the shop. Directions such as: Please Fix, Solder, or Repair, often result in the wrong repair being done, incomplete repairs being done, or more work being done than the customer expected. Then work is performed that cannot be charged for, or it must be redone in the shop resulting in additional cost and expense to the store.

Now, being complete and being concise is not contradictory. Being concise means giving ONLY the pertinent information. Being complete means giving ALL of the pertinent information.


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CONSISTENT

We must communicate consistently from day to day in order for our communication to be effective. In addition, our staff must communicate consistently. If on one occasion we write the instruction ESTIMATE in big letters across the middle of the envelope, then another time write in small letters the abbreviation est. in the top corner of the envelope, then on a third occasion check off a small box, those instructions may be missed because they were communicated in an inconsistent manner.


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All of us use assertive behaviour at times... quite often when we

feel vulnerable or unsure of ourselves we may resort to submissive,

manipulative or aggressive behaviour.

Assertive communication actually increases the appropriate use of

this sort of behaviour.

It enables us to swap old behaviour patterns for a more positive

approach to life.

Why use assertive communication?


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Assertiveness is a style of communication that greatly enhances our

effectiveness with others and produces the most positive outcomes.

Assertiveness can enhance the following:

• Improve interpersonal relationships

• Reduce conflicts/anxiety

• Enhance self esteem

• Retrain self respect

• Minimize stress

• Treats others respectfully

• Reduce feelings of helplessness/depression

• Gives a sense of control


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• Assertive communication is the ability to express positive and

negative ideas and feelings in an open, honest and direct

way.

• It recognises our rights whilst still respecting the rights of

others.

• It allows us to take responsibility for ourselves and our actions

without judging or blaming other people.

• And it allows us to constructively confront and find a mutually

satisfying solution where conflict exists.

What IS assertive communication?


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What assertive communication is not...

Assertive communication is definitely

NOT a lifestyle!

NOT a guarantee that you will get what you want.

NOT an acceptable style of communication with everyone,

but at least it's NOT being aggressive.


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Four behavioural choices

direct aggression : bossy, arrogant, bulldozing, intolerant, opinionated, and overbearing

indirect aggression : sarcastic, deceiving, ambiguous, insinuating, manipulative, and guilt-inducing

Submissive : wailing, moaning, helpless, passive, indecisive, and apologetic

Assertive : direct, honest, accepting, responsible, and spontaneous


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4 STYLES OF COMMUNICATION.

1. PASSIVE

2. AGGRESSIVE

3. PASSIVE-AGGRESSIVE

4. ASSERTIVE


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• It tends to avoid conflict at all costs.

• It internalize discomfort rather than risk upsetting others.

• It tends to result in a lose-win situation, and results in feelings of

victimization, resentment, and a loss of a sense of control.

User beliefs

• that other peoples’ needs are more important than their own,

• that if he speaks up, others will ignore or reject him.

Passive

This individual usually has a low sense of self-esteem, and has a difficult time recognizing his/her own needs and knowing how to get them met more

appropriately.


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• It creates a win-lose situation. • This individual uses intimidation and control to get his/her needs

met, and is disrespectful and hurtful to others in communications.

User beliefs• that power and control are the only way to get needs met.

Aggressive

This person operates from a real sense of inadequacy and may have a lack of empathy for others.


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• It incorporates elements of both of the previous styles.

Passive-Aggressive

He tends to use procrastination, forgetfulness, andintentional inefficiency rather that being direct in

his communications with others.


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• Is directed with the goal of creating a win-win situation.• This style respects one’s own rights and opinions, as well

as those of the other person.

Assertive

This individual operates from the belief that each of us is responsible for solving our own problems, and neither party in

communication has to justify themselves to each other. This person takes responsibility for his own decisions and actions.


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Much of our communication is non-verbal.

A person with an assertive communication style

• has a body language that conveys openness and receptiveness.

• Posture is upright, movements are fluid and relaxed,

• tone of voice is clear and with inflection.

• An assertive person makes good eye contact, and is aware of personal space.

WHAT DOES ASSERTIVE COMMUNICATION LOOK LIKE?


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When giving opinions,

• an assertive person is willing to express his opinion, and also is open to hearing other’s points of view.

• He is direct, but not argumentative or threatening.

• He does not use sarcasm or gossip as a way to communicate.

• He does not silently sit back out of fear of not being liked.


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When an assertive person receives feedback from others,

• He/she is able to listen and accept what the other person has to say, even if he/ she doesn’t agree.

• Many people have a hard time receiving feedback, even if it’s positive.

• An assertive person does not react to criticism by counter-attacking, denying, or feeling anxious or inadequate. She makes conscious choices about how to respond the criticism.

How many times has someone paid you a compliment and you simply dismiss it, or minimize it rather than hearing it and

simply saying “thanks”! No one likes to hear negative feedback


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There are six main characteristics of assertive communication.

Eye contact : demonstrates interest, shows sincerity

Body posture : congruent body language will improve the significance of the message

Gestures : appropriate gestures help to add emphasis

Voice : a level, well modulated tone is more convincing and acceptable, and is not intimidating

Timing : use your judgement to maximise receptivity and impact

Content : how, where and when you choose to comment is probably more important than WHAT you say

Characteristics of assertive communication


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Behaviour Rehearsal : which is literally practising how you want to look and sound. It is a very useful technique when you first want to use "I" statements, as it helps dissipate any emotion associated with an experience and allows you to accurately identify the behaviour you wish to confront.

Repeated Assertion : this technique allows you to feel comfortable by ignoring manipulative verbal side traps, argumentative baiting and irrelevant logic while sticking to your point. To most effectively use this technique use calm repetition, and say what you want and stay focused on the issue. You'll find that there is no need to rehearse this technique, and no need to 'hype yourself up' to deal with others.

Six assertive techniques


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Fogging : this technique allows you to receive criticism comfortably, without getting anxious or defensive, and without rewarding manipulative criticism. To do this you need to acknowledge the criticism, agree that there may be some truth to what they say, but remain the judge of your choice of action. An example of this could be, "I agree that there are probably times when I don't give you answers to your questions.

Negative enquiry : this technique seeks out criticism about yourself in close relationships by prompting the expression of honest, negative feelings to improve communication. To use if effectively you need to listen for critical comments, clarify your understanding of those criticisms, use the information if it will be helpful or ignore the information if it is manipulative. An example of this technique would be, "So you think/believe that I am not interested?"


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Negative assertion : this technique lets you look more comfortably at negatives in your own behaviour or personality without feeling defensive or anxious, this also reduces your critics' hostility. You should accept your errors or faults, but not apologise. Instead, tentatively and sympathetically agree with hostile criticism of your negative qualities. An example would be, "Yes, you're right. I don't always listen closely to what you have to say.“

Workable compromise : when you feel that your self-respect is not in question, consider a workable compromise with the other person. You can always bargain for your material goals unless the compromise affects your personal feelings of self-respect. However, if the end goal involves a matter of your self-worth and self-respect, THERE CAN BE NO COMPROMISE. An example of this technique would be, "I understand that you have a need to talk and I need to finish what I'm doing. So what about meeting in half an hour?"


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• Watch your body posture – practice using an open, assertive body language and voice.

• Think before you speak. Take a few seconds to make sure you are conveying the

• right message, and in the way you want to convey it.

• Don’t apologize if it’s not warranted.

• Remember it is ok to say “no”.

• Remember everyone is entitled to an opinion, and don’t try to convince others that yours is the “right” one. Also know that you don’t have to apologize or make excuses.

STRATEGIES FOR DEVELOPING ASSERTIVE COMMUNICATION


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• It helps us feel good about ourselves and others

• It leads to the development of mutual respect with others

• It increases our self-esteem

• It helps us achieve our goals

• It minimises hurting and alienating other people

• It reduces anxiety

• It protects us from being taken advantage of by others

• It enables us to make decisions and free choices in life

• It enables us to express, both verbally and non-verbally, a wide range of feelings and thoughts, both positive and negative

The advantages of assertive communication


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Others may not approve of this style of communication, or may not approve of the views you express.

Also, having a healthy regard for another person's rights means that you won't always get what YOU want.

You may also find out that you were wrong about a viewpoint that you held.

But most importantly, as mentioned earlier, it involves the risk that others may not understand and therefore not accept this style of communication.

Disadvantages of assertive communication


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Specific qualities of good bedside manner

Prepare for the Visit

Spend a few minutes reviewing the patient's history and medical problems before you even enter the room. Patients are impressed if you know what's going on with them ahead of time without having to look up or ask for a lot of information about them while you're in the room with them.

Simple Courtesy

Knock before you enter. Excuse yourself if you have to take a phone call. Always be polite. Always use the person’s last name prefaced by Mr., Mrs., Dr. or Dato., or whatever his or her official title is. Pay attention to this. Don’t call a Doctor or Dato, Tan Sir..a “Mister”. The only exceptions to this rule are a) if your patient is a child or at least less than 18, or b) if your patient specifically requested or insisted you call him/her by their first name or nickname.

Importance of bedside manners


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Make eye contact

Let the patient know that you are there for the sole purpose of seeing him/her. With computers in every room, there is a tendency just to go in the room, right to the terminal, and barely glance at the person whose life you have in your hands. Patients notice this.

Greeting

Say a word or two to the patient with a smile as a way of recognizing his/her humanity. “Nice to see you.” Or, “How are you?”

Listen

Hear the patient out as much as you have time for. This is what patients complain about most – that their doctors never listen to them. The patient needs to feel that you understand what is going on with them. If you’re not looking at the person when s/he is talking to you, you will be perceived as not listening, even if you have heard and digested every single word.


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Respect

Respect your patient's opinions, acknowledge his/her beliefs even if you don't agree. NEVER be condescending. Remain open-minded. Never be so entrenched in your own opinions that you can't allow your self to see the other side.

Don't discuss your own problems with patients.

Don’t discuss your problem with patients. They're not coming to visit you to discuss your difficulties. They have enough of their own. If you're having a bad day, don't let it show. It's the mark of being a professional to surpass your own difficulties in order to take care of theirs.


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Dealing with difficult patients

Before you lose your temper with a patient, Dr. Michael F. Lubin suggests that

you try this four-step procedure:

1. Tell the patient someone is paging you.

2. Go to a supply closet.

3. Place folded sheets on a gurney.

4. Pound repeatedly.

These actions will help you obey the fifth of Dr. Lubin's 10 Commandments for

dealing with difficult patients. "You may never lose your temper," Dr. Lubin of

Emory University, Atlanta, told participants at a session on managing difficult

patients at the annual meeting of the American College of Physicians.

"If you find yourself losing your temper, get it under control," he advised. Once

calm, a physician is better able to assess the situation.


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Ten Commandments for dealing with difficult patients

Commandment I

Do the right thing. "It's so much easier to do the right thing than think of a legalistic way to handle the situation," he said. Physicians should always stop and think about what they are doing, and approach the problem with compassion and empathy. The physician and the patient need to find a mutually satisfying solution.

Commandment II

Be sure that the patient has decision-making capacity. "Otherwise you'll be in big trouble," Dr. Lubin said. "Allowing a patient to leave when he's a danger to himself and others is not the right thing to do." If a patient is waiting for care and suddenly wants to leave, the physician should find out why For example, a patient with breast pain may want to leave because she has seen people die from the disease in recent months and is alarmed about the possible diagnosis.


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Commandment III

Do not discharge a patient from your care without the best possible treatment you can give, and always follow up with the patient, "You can't abandon the patient," Dr. Lubin said. If a physician explains why leaving is inadvisable but the patient leaves anyway, the next commandment is especially vital.

Commandment IV

Meticulously document what happened. "This includes what you told the patient about the consequences [of the patient's actions] and the treatment and follow-up that you have arranged," he said. He also suggested that physicians get documentation from others about what happened.

Commandment V

Never lose your temper. If you feel the urge to vent, there's always the supply closet, Dr. Lubin said. Losing your temper with colleagues and ancillary staff also isn't allowed.


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Commandment VI

Do not feel obligated to put yourself in danger of physical assault. Keeping tabs on your own temper doesn't mean that you should accept foul language or violent behavior from a patient.

Commandment VII

Never be distressed by insistent patients.

Commandment VIII

When a patient has a lot of new nondescript complaints, be sure to explore the possibility of depression.

Commandment IX

You have an obligation to care for your share of these difficult patients

Commandment X

Do not act as if your ego or your wellbeing is adversely affected by the patient's nonadherence


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Assertiveness is a useful communication tool. It's application is contextual and it's not appropriate to be assertive in all situations. Remember, your sudden use of assertiveness may be perceived

as an act of aggression by others.There's also no guarantee of success, even when you use

assertive communication styles appropriately.

"Nothing on earth can stop the individual with the right mental attitude from achieving their goal; nothing on earth can help the

individual with the wrong mental attitude" W.W. Ziege

Documents

Assertive Communication for Healthcare Professionals New