Effective Communication in Paramedics Practice: Person-Centred Approach

Introduction

Effective communication is a vital skill for any health care professional, Silverman, Kurtz, and Draper state that “Communication is a core clinical skill, an essential component of clinical competence”. Therefore, this essay will discuss how Paramedics overcame actual and potential communication barriers during an incident we attended whilst on my clinical practice placement. This essay will provide a description of the event, then communication theory will be discussed. The essay will then progress to discuss actual and potential communication barriers related to the example given. Interventions used to overcome any barriers will be explained and conclusions will be drawn. For the purposes of confidentiality, all names and identifying features in this assignment will be changed.

Main body

During my practice placement, the Paramedic crew and I attended to a 58-year-old female who lived in supported living accommodation and was feeling unwell. Upon arrival, we were greeted by her support staff who informed us that the lady had a learning disability and communicated with limited vocabulary. The staff brought us to the patient, who was in bed and seemed confused and slightly distressed. We wanted to make the patient feel at ease, so we introduced ourselves and asked her name, which she was able to tell us. We ruled out any immediate life-threatening conditions which meant we were able to take time to better understand her level of communication. The support staff gave us the patient’s commination passport which helped us tailor our patient assessment for this lady. During the assessment it was established that the patient could not directly tell us details of what was wrong, therefore we adapted our communication style to suit her. Upon examination, the patient had a slight temperature, pale pallor, and a wheeze. The crew decided it wasn’t appropriate for the lady to go to A&E as this may cause her distress and she was more comfortable at home. The crew liaised with her out-of-hours GP and arranged for a Doctor to come to visit her at home. Our main communication barrier was that the lady had limited verbal communication but also a learning disability, so we were mindful of her level of understanding when asking questions.

Nixon states “Communication can be considered to be the process of passing information from one person to another”. Understanding effective communication is essential in the role of a Paramedic as it is important to put people at ease, and show that you care whilst making sure you give the most appropriate care to that patient. Therefore, understanding forms of communication will enable Paramedics to treat a variety of patients. Models such as The Calgary-Cambridge Guide provide a framework for effective communication for health care professionals. The guide reveals a range of communication skills, such as using open and closed questions and building a relationship with the patient by using appropriate non-verbal behavior. It also states that you should involve the patient and develop rapport. Following a framework will help healthcare professionals use different forms of communication with patients and colleagues such as verbal, non-verbal, interpersonal, and interprofessional communication.

Verbal communication is speaking using words to convey a message. The meaning of and the way messages we convey are perceived can be changed based on the paralinguistic features we use, such as volume and rate of our voice. When communicating with patients we must be mindful of our tone, pitch, pace, and volume of our voices as Silverman et al state that “Communication turns theory into practice; how we communicate is just as important as what we say”. For example, if a Paramedic was carrying out a patient assessment and began shouting and talking quickly this would frighten and alarm the patient. It is best if we speak with a relaxed and calm voice. When we entered the patient’s bedroom, we introduced ourselves and asked her name. As the patient seemed slightly distressed, we were mindful of the tone and rate of our voice as a calm tone and steady rate will put the patient at ease and reassure them. I could tell this put the patient more at ease and she seemed slightly less distressed, so we continued to use a calm tone throughout the patient assessment.

During a patient assessment, different questioning techniques can be used such as the use of open and closed questions, each having their benefits and limitations. Open questions are often broad, and the answer requires more of an explanation. Whereas closed questions are more focused and usually result in a yes or no answer. When using open questions patients can give answers with a lot of detail but their answers may not be structured, so it is important to listen carefully for the information you are trying to get. Closed questions can provide a more focused answer, although this may limit the amount of information you receive. Hence it is important to use a mix of open and closed questions when possible. As this patient had limited vocabulary, we started the patient assessment with open questions as we wanted to gauge her level of verbal communication. The Paramedic asked, “Do you have any pain?” she looked confused and did not reply. We adapted the question to see what she could understand. We asked, “Can you show us where is hurting?” she replied “In there” whilst pointing at her chest. For the rest of the assessment, we mainly used closed questions to try and establish why the lady was feeling unwell. This showed me that it was important to use a range of questioning and to adapt the assessment so that it was patient-centered.

When treating patients with physical or mental disabilities it is important to use a person-centered approach as it allows us to understand that person as an individual. As mentioned, the ladies' support workers showed us her communication passport, which is used for people with learning disabilities to highlight any potential communication barriers. This meant that we could tailor our assessment to suit this individual as the communication passport described the terminology this lady preferred to use such as “bady” instead of pain. We made sure we used the terminology that she understood, and I could see that this made the lady warm to us. After taking time to speak to her she became relaxed and seemed happy.

There are varied accounts relating to communication by health care professionals towards people with learning disabilities. It has been found that some promoted the patient’s understanding whilst others hindered it. It is important to have an awareness of and adjust a patient-centered approach to accommodate the needs of people with learning disabilities. One of the main issues regarding the quality of care that people with learning disabilities receive is concerned with effective communication. One reason for this could be that health care professionals may not be educated in or have experience working with people with learning disabilities. This could have been a potential barrier to communication as the patient assessment may not have been adapted to meet the needs of this individual, therefore vital information could have been missed. To overcome this obstacle, more training could be provided for Paramedics and other general health care professionals by specialists, such as Learning Disability Nurses. Gaining knowledge and experience would enable healthcare professionals to be more confident and appropriate in their approach when working with people with learning disabilities. It is also important to use a range of communication techniques including non-verbal communication.

Non-verbal communication does not rely on what we say, instead, it focuses on other ways to communicate such as, facial expressions, gestures, eye contact, and body posture. This form of communication can sometimes be more significant than the use of verbal communication as many emotions can be expressed. Clark and Griffith state that “body language can significantly affect the anxiety levels of the patient” so during the patient assessment we knelt next to the patient’s bed so that our body posture was non-threatening. We made sure we made appropriate eye contact and used soft and gentle facial expressions. As well as being mindful of our non-verbal communication it was equally important to pay attention to her non-verbal responses as flinching or grimacing could be an indication of pain. On the other hand, smiling could be an indication that she comfortable and happy. A better understanding of a person will mean we pay attention to their bodily responses when they cannot communicate in other ways. We made sure we paid attention to her reactions and facial expressions as we wanted to work out if she was confused because we were strangers or if there was something else going on. I could tell that the Paramedics were effectively communicating with this patient as her facial expressions and body language indicated that she warmed to us and became less confused and distressed.

It is important that your patients really know you are paying attention to them and listening properly, a good way to do this is by active listening. Caroline explains that “Active listening is repeating the key parts of a patient’s responses to questions”. Active listening is important as it reassures the patient that you are giving them your full attention and that you are focused on them. It also means you don’t miss any information which could be crucial in terms of the treatment pathway you provide for that patient. If the environment was noisy with a lot of distractions, for example at the scene of a road traffic collision, this could impede on your ability to actively listen to the patient. Fortunately, the environment for this incident was indoors and quiet which meant the crew could focus their full attention on this patient and listen properly.

As well as interpersonal communication I saw the Paramedics use good interprofessional communication skills as they liaised with the out-of-hours GP. It was especially important regarding this patient as she was unable to fully communicate herself, so we had to be very clear and concise and ensure that no points were missed as poor communication could impact on patient safety. Factors such as lack of handover structure, lack of training and not having enough time to deliver a handover could impact on delivering an effective patient handover. Fortunately, in this situation, the Paramedics were able to take their time to deliver a handover to the Doctor, which was well structured, so no points were missed. This meant they were happy to leave the patient at home as all areas were covered.

Conclusion

The evidence that I have come across confirms that effective communication is an essential part of the role of not only Paramedics but all health care professionals. It is important to maintain a high standard of interpersonal and interprofessional communication skills, as this will guarantee the best possible outcome in terms of diagnosis and treatment for patients. I found my experience with the Paramedic crew invaluable as I witnessed them work with a patient who at first seemed confused and distressed, then turn into calm and comfortable as the Paramedics utilized both verbal and nonverbal communication skills. I also learned that although people with learning or physical disabilities may not always have full verbal communication, they will find other ways to communicate so it is especially important how we interpret their behavior and other non-verbal forms of communication. Health care professionals must provide a patient-centered approach to care and adapt to patients’ communication needs, as this is essential to deliver a quality patient assessment and treatment.

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