Dietetics:CommunicationCollaboration/Patient Communication 2018

Relevance of topic to dietetics student learning

• Assessing patient's needs and understanding
• Identify implications of and strategies for non-verbal communication
• Identify strategies for communicating with patients who have a disability and/or language barrier
• Accessing translation and/or language services out in the community or in a clinical setting
• Understanding the meaning of cultural competency and how this relates to dietetics practice

Summary of key principles

1. Education and Language Use

Assessing patient needs:

• Start by speaking at an appropriate level for a person's age.
• Ask questions about the person's daily life to get a sense of their communication skills. This gives you a chance to adjust your demeanour to match theirs and match the language they are using.
• Ask questions such as "what do you know about your condition" to get a sense of the patient's goals and knowledge in order to tailor your session appropriately.

Assessing patient's understanding:

• Mimic the language the client is using as the session progresses.
• Ask open-ended questions to gauge understanding.
• Check back frequently. Use phrases like: “If I say _______, am I understanding you correctly?”, “Can you clarify this for me?”
• Use the "Teach-Back" method.
• If you are still unsure about whether or not the patient understands, talk to the other members of the healthcare team

2. Non-Verbal Communication

• Non-verbal communication can include body motions, facial expressions, and use of space, sound and touch.
• Non-verbal communication can be vocal or non-vocal, intentional or unintentional.

The 5 dimensions of non-verbal communication include:

• Gestures
• Facial Expressions
• Gaze
• Space
• Touch

Main purposes of non-verbal communication:

• Expression of feelings or emotions
• Regulating the interaction
• Validating verbal communication
• Maintenance of self image
• Maintenance of relationships

For more detail on the dimensions or purposes of non-verbal communication, please refer to our videoscribe below.

3. Communication Difficulties

Cognitive Disabilities:

• Allow much more time for the session.
• Allow the client to choose where to sit if possible (aim to reduce the professional-patient power imbalance).
• Use labels such as "intellectual disability" as little as possible.
• Avoid use of professional jargon.
• Avoid “diagnostic overshadowing."
• Research the disability if possible to get a better sense of what to expect.

ESL Communication:

• Allow extra time for meetings.
• Avoid long polysyllabic words, jargon, slang, and abstract terms.
• Decrease speed of speech and pause between sentences.
• Don’t increase the loudness of your speech.
• Translator services available through Provincial Language Services.

When using a translator:

• Explain the overview of the expected interaction with the interpreter beforehand if possible.
• Look at the client when speaking.
• Speak in first and second person as you would in normal conversation when speaking with a patient in English i.e. “Do you have a fever?” rather than “Ask her if she has a fever.”

4. Cultural Competency

Culture: The system of shared beliefs, values, norms, behaviours, and artifacts through which people understand the world, themselves, and each other, and that are transmitted from generation to generation through learning.

Cultural Competency: Providing treatment consistent with the life experiences and values of clients. Recognizing that client identities include individual, group, and universal dimensions. Use of specific strategies at each level of identity.

How do we become culturally competent?

• By practicing cultural humility.
  • Cultural humility is the process of identifying and reflecting on our own attitudes, beliefs, and biases.
  • We can then work on orienting ourselves to being more open and curious to people who are different from us.
• Through continual learning and developing awareness, knowledge, and skills that increase your ability to successfully interact with people from diverse backgrounds.
  • Small things such as learning how to greet someone in their own language can help build rapport and trust.

Digital Media: Assessing Patient Needs and Understanding

This video was created to demonstrate ways to assess existing knowledge and to explain complex nutrition topics to people at different knowledge levels and/or age groups. Dietitians are equipped with a wealth of nutrition knowledge, however, it is important to refine client education sessions by telling them what they "need" to know, versus what may exceed their learning ability. The videos provide examples of how an educational session might play out when working with different types of clients.

Limitations: Some other clients not shown in this video may include those with language barriers and elderly populations. An education/counselling session may also be slightly different if the client has been living with a chronic illness for a number of years, as they may come to the session with a vast amount of knowledge on their condition as well.

Digital Media: Non-Verbal Communication

The purpose of our VideoScribe is to showcase the importance of non-verbal communication in dietetics practice using a visually engaging and memorable platform. In the healthcare environment non-verbal communication can influence patient trust, rapport and understanding, which can be critical to providing them with the best possible care. This piece of media describes different kinds of non-verbal communication that we use to express ourselves and how this expression may be interpreted by others. The video also explains how non-verbal communication can be used. Non-verbal communication can be a subtle form of expression but should always be considered when serving patients and their families.

Limitations: Our VideoScribe considers non-verbal communication primarily in the North American setting. It is important to remember that in Canada we tend to rely less on non-verbal communication and more on word use in comparison to other places of the world. The gestures used in other countries and cultures may hold different meanings then they do in Canada, which is important to keep in mind when working with a diverse and multicultural population.

Online resources for further learning

1. Health Literacy and Patient Safety (Manual for Clinicians): https://goo.gl/811LnV
2. Interpreting Services in BC: http://www.phsa.ca/health-professionals/professional-resources/interpreting-services
3. Working with Clients with an Intellectual Disability: http://www.aipc.net.au/articles/working-with-the-intellectually-disabled/
4. 5 Mistakes to Avoid When Counselling Clients with Disabilities: http://www.reifpsychservices.com/mistakes-to-avoid-when-counseling-clients-with-disabilities/
5. Tips for Communicating with People Who Are Hearing Impaired: http://www.chs.ca/communication-tips-0
6. Cultural Competence and Nutrition Counselling: https://goo.gl/BCQhRF
7. Cultural Competency in Palliative Care: http://www.livingmyculture.ca

Student authors

Jamie Lee Kwong, Shara Marchand, Hannah Mazure, Martha Staus, Katie Tsoupakis, Hannah Zmudzinski

Date developed: April 2018