At 2100 hours you receive a call to a young male who has collapsed outside a public house. On initial assessment he has sustained multiple superficial facial cuts and abrasions and has broken his glasses. He is aggressive and unco-operative; his girlfriend is crying and anxious. Question Communication Describe the appropriate interpersonal skills which could be used to create effective relationships in this situation Submission date: 13 June 2003 1600 hrs.
As the world of pre-hospital care becomes increasingly diverse and multi-cultural, all health professionals need to possess excellent interpersonal and social skills, and be able to adjust accordingly to the special demands placed on the individual. Communication, be it verbal, paralinguistic aspects of speech or non verbal, is a two way process of sending and receiving information between two or more people, therefore creating an effective association.
Verbal communication relates to the words and phrases of the spoken language. It consists of four parts: content; relating to the meaning of the verbal content, structure; referring to the way in which the words are put together, form; how the sounds are combined to make words and lastly use of language; to give and seek information and to express feelings, therefore directing the actions of others. Paralinguistic aspects of speech relates to the elements of speech which are not actually words i.e. the timing of speech, the volume, intonation and pitch, the conversational oil which can be described as the vocal equivalent of head nodding or interjections of ‘mm’ or ‘hmm’.
Non verbal communication is brought about by the conveyance of messages through the initial approach towards a person, eye movement and eye gaze, facial expression, personal space and gesture, all of which can be summed up as body language. During an interaction between two people or groups of people verbal and non verbal messages are transmitted about thoughts and feelings. At numerous times throughout these interactions the role of sender and receiver is reversed and can be influenced by certain factors such as environmental issues, formality, privacy, mood, role, status, and gender.
The aim of communication is to effect change and create meaning, as is supported by Williams (1997:7) …..”The real purpose of creating understanding in another person is to influence the other person to effect some change” To initiate a change in any of the clients attended by Paramedics, they need to practice and acquire skills to become good listeners; this is supported by, Ewels & Simnett. (2003:187) who suggest ……”As a health promoter, you need to develop skills of effective listening so that you can help people to talk and identify their needs and feelings” Possibly the first skill to achieve this is to act as a good listener. As day to day life become increasingly busy and stressful we tend to ignore a lot of the information that is given to us. Individuals must change their body language from that of deflection to that of reception.
Good listeners listen with their faces. Whilst interacting with people it is significant if both parties are looking each other straight in the eye. Ewels & Simnett (2003:199) states … “as a general rule, a speaker looks away from the listener for most of the time when talking (because she is concentrating on what she is saying) and looks directly at the listener when she wants a response”. This will only occur if the speaker has got the attention of the listener. It is therefore essential as health promoters, who are mainly dealing with clients on a one to one basis, that they maintain this two way eye contact.
In maintaining eye contact it can show if a person is trustworthy, sincere or caring as supported by Zunin L (1972 http:// www. hamp.hampshire.edu 10 April 2003) who suggests … “that we communicate with those we don’t know mostly through our eyes”. It is possible that failure to do so would initiate a negative attitude towards the health promoter. This is supported by Balzer Riley (2000:123) who states. “When our verbal message doesn’t correspond with our facial expression, posture, tone of voice, and body language, clients and colleagues decode the disparity as two distinct and dissimilar messages”.
Body language as a whole speaks volumes “up to 93% of communication is nonverbal”. (http:// www.positive-way.com 23 April 2003). Other aspects of body language include proximity, touch, gesture, body posture and head movements. Proximity relates to the personal space created by parties during a social encounter. Williams (1997:6) cites Hall (1966) saying … “that it was possible to classify this space according to the encounter”.
The four areas he identified were intimate, personal, social, and public. An intimate zone can be described as approximately 45 cm. People are only allowed into another person’s intimate zone if they are in a loving and close relationship. When we are interacting with friends or in the more informal setting, a personal space is created of 45 cm to 1.2m. People often sense a feeling of unpleasantness when this space is invaded. The social or consultative aspect of proximity is a space of between 1.2m and 3.6m. Pre-hospital care personnel are one of the few professions who are authorized to cross this barrier in the diagnosis and treatment of a patient. Distances of over 3.6m are generally adopted by public speakers who also use height in order to be seen and be heard.
In the health care field the aspect of touching the client is inevitable, and it can be used as both a positive and negative form of non verbal communication. The action of putting an arm around a distressed client or a client’s relative could send the message, ‘I’m here for you’, and offers that person reassurance and excludes the feeling of isolation. Whereas, in a confrontational situation the medium of touch can possibly be used as a form of self defence combined with a way of protecting personal space.
As health carers are now working in an increasingly multi cultural society there is an increased need to be aware of these differences as touch can have numerous meanings. Different cultures have specific gestures and emotions. …. “Variation in greetings is found from one culture to another. Latin Americans shake hands longer, more vigorously and more frequently” Balzer Riley (2000:67) cites Sue and Sue (1990) whereas “the handshake of an East Indian woman consists of a quick touch of the palms” Balzer Riley (2000:67). In Islamic communities it is offensive to offer a greeting with the left hand, as this hand is reserved for personal hygiene
“I realise that the left hand has no significance for English people, but when someone hands me something with their left hand I can hardly bear to take. It goes right back to my childhood when if I gave or took something with my left hand I got a real scalding from my mother or one of my aunts for being so rude”. Henley & Scott (1999:262) These cultural differences must be taken into account whilst attempting to make that first contact with a client to gain their trust and respect. It will also help to promote the genuineness of the health professional.
The importance of posture should not be overlooked in forming an association with clients. The ‘I’m in charge’ approach, combined with standing over the client with arms folded, conveys the message of the health promoter being defensive and threatened by client. Perhaps the approach could include a smiling face, arms relaxed and neutral, or arms outstretched and upright to portray a welcoming message and a feeling of warmth and empathy towards the client.
Empathy or communicated understanding can be described as “the power of understanding and imaginatively entering into another persons feelings”. McLeod W (1990:323). To empathise with another person is to be aware and sensitive to their feelings and to put yourself in their shoes. It is more than hearing the words, it is understanding and showing acceptance of the other person’s message.
As promoters of health care it is essential to approach clients and their relatives, who in certain situations could develop into clients, with sympathy and understanding of their situation. Whilst displaying empathy towards a client, it is possible that an element of self disclosure, relating to situations yourself or someone you know has experienced, will reduce the feeling of embarrassment or guilt that the client may be feeling. After all, very few people have gone through life without witnessing confusing or distressing situations.
Without this reflection on life’s own experiences, there is an increasing danger of becoming pre-conceptual and judgemental, as we approach each situation. These are two very dangerous emotions in the world of pre-hospital care as no two situations are ever the same, as supported by Williams (1997:27) “The client forms a unique part of any interaction, the persons psychological needs will interfere with the ability to assimilate, process and respond to information”. In using this type of approach it is then possible to reflect closely on what the client is experiencing which will then enhance the trust and respect of the client. This is an imperative requirement in making an accurate and appropriate assessment of the situation. In achieving this mutual respect from both parties, it should lead into an honest and informative interaction between client and Paramedic, leading to a satisfactory conclusion.