Every single day, healthcare professionals go to work in order to help people, regardless of their problem. These individuals are respected greatly for the dedication they put in to their job, for the good of the public (BBC News, 2002). Each separate profession has their own council, such as the Health and Care Professions Council (HCPC) for paramedics, and the General Optical Council (GOP) for optometrists. These councils have many rules and regulations which must be adhered to by the staff working within their respective domains. Despite many of these professions following different procedures, there are three common professional practice dimensions which they all share: communication and interpersonal skills, professionalism and decision making. This essay will be covering the former of the three dimensions, communication and interpersonal skills. It will explain its importance to professional practice in general, and its significance to paramedic practice, using contemporary evidence.
Communication is vital in all aspects of professional life, regardless of where you work, but even more so for healthcare professionals. Brooks and Heath (1989, p. 10) describe it as “a process during which information is shared through the exchange of verbal and non-verbal messages”. It is a dimension that is so vast, that it ranges from verbal communication to body language, and even to a hand on the shoulder. When people think of communication, a lot of the time they think solely about talking; it is often forgotten that communication also encompasses listening, at is just as important as articulating verbal information. Listening accounts for 24% of daily communication, compared to talking, at 20% (Janusik and Wolvin, 2009). Being a good attentive listener is a key trait amongst healthcare professionals (reference?), as in order to help the patients, they need to hear what is wrong from them. These different forms of communication are all important; however, some are used more than others. According to Mehrabian (1967), the most common form of communication is through facial expressions when referring to feelings and attitudes. Mehrabian (1967) states that just seven percent of communication is through spoken words.
Communication for paramedics is arguably just as important as the medicine and help given to the patients, with the World Health Organisation (2009) stating that communication is one of the most crucial elements of patient safety. In Leonard, Graham and Bonacum’s (2004) study, they found that communication failure accounted for seventy percent of sentinel events. Similarly, The Joint Commission (2014) show that communication failure is the third highest factor for sentinel deaths; behind that are leadership and human factors. It could be argued that these studies emphasise the importance of clear communication, as it really can be the difference between life and death.
Non-verbal acts of communication are also a key factor in healthcare practice (reference?). It can be split into different parts, such as facial expressions and gestures. Non-verbal information is more effective because it impacts the patients receiving the information more than verbal information (St. Pierre et al, 2011a, p. 231). This form of communication can create a vast amount of context following a verbal exchange, which is helpful when explaining things to patients. The benefits of having many methods of information delivery can aid patients with explaining or understanding their symptoms and treatment, but also assist colleagues in high pressure situations; for example, a paramedic raising their hand up to a colleague, to indicate they would like a piece of equipment handing to them, as they are concentrating on a more important task.
Although bad non-verbal communication and interpersonal skills lead to a significantly lower patient satisfaction score (Birhanu et al, 2010), it is not just the healthcare professionals who use non-verbal information, the patients do too (St. Pierre et al, 2011a, p.231). It is important to pick up on any clues they may be presenting which could indicate injury or deterioration, for example the sudden drooping of the face, possibly indicating a stroke (reference). It has been found that the face is one of the most suggestive parts of the body, which is especially important when communicating with patients, as it shows an active interest (Bledsoe, Porter and Cherry, 2010). Further research conducted by Simon et al (2008) shows that facial expressions of pain are more distinct and arousing, compared to that of normal facial expressions. There are however, instances whereby individuals struggle to communicate pain by using their facial features; this may be due to a cognitive disease, or from being in a coma (Lord, 2009). This means that paramedics who are called to a scene, need to be extra aware of how patients like this may be feeling, therefore expressing a feeling of empathy is necessary. This can be difficult for some paramedics, especially students, because being empathetic without disclosing home or personal information out, or even forming a friendship is a challenging situation to be in (HCPC, 2014b). Keeping this balance right will ensure that focus is kept on the patient, so they can be treated in a professional manner, whilst not getting too attached. Similarly, expressing the appropriate body language is vital, as research has shown that nodding, leaning forward and having uncrossed arms has a positive impact on patient outcome (Beck, Daughtridge and Sloane, 2002).
Another key part of non-verbal communication is personal hygiene. It is imperative that this is sustained during all working hours for every healthcare professional, especially regarding good hand hygiene, as it is the leading factor in reducing healthcare-associated infections (Allegranzi and Pittet, 2009). Paramedics are rated at 0.74 out of 1 when it comes to cleanliness and appearance according to the research of Brown, Margolis and Levine (2005). This is a surprisingly a low score, as it means each patient has a one in four chance of having an unhygienic paramedic treat them – this could greatly add to their already existing anxieties, unsettling them further. Maintaining a professional appearance and suitable level of hygiene, is a requirement for paramedics under the HCPC (2014b) professional standards. This is because it impacts the service users’ opinions of the profession and/or organisation. Uniform is a representation of authority, so it is important healthcare professionals appear approachable by following the standards set by their corresponding councils (reference?). If a patient can see a dirty and messy healthcare professional, they may start worrying about the cleanliness of equipment as well. Studies have also shown that healthcare professionals with large, visible tattoos negatively impact the views of the service users (Verissimo et al, 2016), which could consequently raise questions over an organisation’s professional standards. Non-verbal communication can also be expressed by writing, which is mostly relevant when reading or writing a Patient Report Form (PRF). These will be filled out by paramedics and shared with the appropriate healthcare providers, so it is vital all the information is documented nearly and accurately. If this does not happen, patients will be asked many of the same questions again, which could increase levels of frustration or anxiety.
Verbal communication plays an equally important role for healthcare professionals, as non-verbal does. It is believed that if communication is provided in a coherent manner, communication is made easier between individuals (Forsyth, 2012). For healthcare professionals, this means using terminology that the service users will understand, which is also a requirement in the guidelines for paramedics (HCPC, 2014a). Talking clearly and in a way everyone can understand is vital in the transference of information, and even more so when using a radio or phone. Having a weak connection or
signal can make it even harder for paramedics to communicate with other staff members – this means that repeating information, instructions or questions has more importance in these circumstances, to make sure all parties have understood and received the relevant information (Blaber and Harris, 2014). Even when a good signal strength is obtained, words can be interpreted in different ways, or even misheard, especially when healthcare professionals have strong accents, a low voice or mumble (St. Pierre et al, 2011b, p. 236). When paramedics arrive to treat a patient, they need to get collect all the facts from them. They are gathered by asking many different questions, which come in two forms: open, or closed questions. Open-ended questions are asked when more detailed information is required, for example, “can you describe the pain for me?”. Closed-ended questions obtain a short reply, which can be useful when under time constraints, for example, “can you hear me?”. This could lead to a short verbal reply of “yes”, or a non-verbally suggested “no” if there is no reply at all. Both forms help to create a rapport between patient and paramedic, which is important as it can impact the quality of interaction, and health promotion (Auvinen and Palukka, 2012).
Actively listening to patients and colleagues plays a key role in the job of healthcare professionals, and is especially important for emergency department staff, when paramedics handover patients (reference?). Jenkin, Abelson-Mitchell and Cooper (2007) identified that a lack of active listening creates annoyance amongst paramedics, as it forces them to repeat themselves multiple times. This increases the likelihood that potentially vital information will be forgotten over time. Transport Canada (1997) identify five factors individuals need to fulfil, to become an active listener: observe and hold eye contact, ask questions, paraphrase and mirror, be patient, and be supportive. Becoming an active listener may even help build a rapport between patient and paramedic, making the patient feel more inclined to hand over extra information about their problem(s), thus making it easier to identify causes (Williams, Boyle and Earl, 2013) and decide on an appropriate action plan for treatment (Willis and Dalrymple, 2015).
Feelings of pain and suffering can make patients feel very vulnerable and anxious, so reassuring them verbally is important, to allay their fears. Being empathetic is an interpersonal skill which all healthcare providers need to express. It reduces any concerns a patient may have, and it also makes the healthcare professional’s job easier, as Williams, Boyle and Earl (2013) identify that a good empathetic relationship between healthcare provider and patient can lead to more accurate examinations, enhanced patient satisfaction, and a positive clinical outcome. Separate research by Street Jr et al (2005) also shows that the gender of the healthcare professional and patient, impacts the service provided, as male patients receive less empathy than their female counterparts. It also concludes that female patients express their concerns more freely, therefore suggesting that healthcare professionals should make more of an effort to communicate with male patients. This therefore helps to ensure they are more satisfied during and after treatment, which from the results, show that satisfaction is not currently a mutual feeling amongst genders.
Overall, research shows that communication and interpersonal skills are an integral part of a healthcare professional’s job. It allows paramedics to form professional social relationships with patients (Auvinen and Palukka, 2012), assess patients more accurately, give advice, work as a team, and pass on information they have gathered, to the emergency department staff (Jenkin, Abelson-Mitchell and Cooper 2007) . Studies also highlight how broad the term ‘communication’ is, identifying that it ranges from body language, to written information, to the way words are said. Being empathetic is also a key interpersonal skill for healthcare professionals because it aids both the healthcare provider, and service user (Williams, Boyle and Earl 2013). Communicating well and using interpersonal skills will remain a key part of a healthcare professional’s life, which will be used daily throughout their careers. With technological innovation, it will see some forms of communication change and improve, with other forms such as physical writing, fade out, favouring more a more electronical approach. It is clear that communication and interpersonal skills are vital in a healthcare setting, and its function is key to achieving positive patient outcomes, however, it is not the only key feature. Professionalism and decision making work hand-in-hand with communication – all three of these professional practice dimensions merge together to help form the highly qualified healthcare service that is used by thousands of people each day.