Divide the entire group into pairs. If there is an odd number, have that person observe the progress of the pairs. Role-play the following roles.
Nancy: You have not been attending for the intervention you originally sought. You like the health professional who telephones, however you are reluctant to explain your lack of attendance at the mutually agreed time for appointments. (You must decide the reason why you have not been attending – you may discuss your reason with the group facilitator or instructor if appropriate.) Do not initially give the reason to the person playing the part of the health professional; wait until you experience feelings of safety and affirmation. Reasons for not attending might include illness; concern about someone in your family; a sick pet; nausea because of a new liquid oral medication that smells and tastes horrible, despite the existence of a more palatable flavoured variety; pain that makes showering very slow and tedious.
Health professional: You are aware of the number of people waiting for intervention, but you are intent on establishing why Nancy has failed to attend over the past two weeks. You really want to assist Nancy so you persist when she is reluctant to provide an explanation for her absence. Demonstrate how you communicate both for Nancy-centred practice (using empathic responses) and to gather the information you need to assist Nancy.
•
How successful was the health professional?•
Does confidentiality affect this scenario? If so, how?•
Did the person playing the health professional achieve their goals?•
How did Nancy feel?•
What assisted Nancy to trust and disclose?•
What made it difficult for Nancy to trust and disclose?Repeat the role-play, swapping roles, and discuss any differences.
112
Empathy is a time-saving tool for the health pro-fessional. Willingness to explore the needs and prob-lems of the Person/s allows expression of the feelings associated with those needs and problems (Burnard 1992). The expression of these feelings can facilitate a sense of control for the Person/s. The health profes-sional should note and acknowledge the feelings immediately, and should encourage their expression to avoid difficulties and further problems. An imme-diate empathic approach allows efficient provision of appropriate interventions. It usually ensures collabo-ration with and effective fulfilment of the needs of the Person/s.
Touch
Touch is a powerful, non-verbal form of communica-tion (Mohan et al 2008). The habit of touching to communicate reflects a personal style of communi-cating, and should not be forced if it is not naturally part of the communicative style of the health profes-sional. The reality that different personality types have different communication styles (Houghton 2000, Opt & Loffredo 2003) means that sometimes the Person/s may find it difficult to communicate through touch. However, when there is a connection and resultant rapport, a gentle touch on the shoulder, pat on the arm or squeeze of the hand, for many dem-onstrates awareness of their plight. A gentle touch usually communicates a desire to collaborate to fulfil the needs of the Person/s without causing offence (Holli et al 2008), regardless of the personal style of communication. It is important that the health pro-fessional carefully observes responses to touching and avoids touching if there is a negative response.
Asking permission to touch the Person/s before touching may avoid a negative response. If there is established rapport and the touch is intended to comfort and encourage – indicating support and empathy – the Person/s usually senses this and appre-ciates the touch.
Each culture has norms that govern touch conven-tions when communicating. Sexual harassment is a reality in many professional workplaces. Awareness of the norms governing sexual behaviour for a particu-lar workplace is essential for all health professionals in order to avoid communicating inappropriately when using touch.
Touching can provide feedback about the emo-tions of the Person/s. A gentle touch may inform the
•
Are you a person who naturally touches others to communicate?•
In what situations do you touch?What part of the body do you touch?
•
How do you respond when relationship with the person touching•
Are these responses a result of your you?upbringing? Social norms? Bad experiences? Your personal tendency relating to touching?
•
Do you need to seek professional assistance if these responses will limit your effectiveness as a health professional?•
List the social norms governing touching in each culture represented in the group. Consider greeting, introducing, saying goodbye, variations in touching because of age and gender, comforting an upset person who is familiar,comforting an upset person who is a stranger, and any other situations that might include communication by touching.
•
If there are people from different cultures in the group, compare the differences in the social norms governing touching in different situations.•
If it is a monocultural group, discuss any experience of different norms governing touching – even within families.•
List ways in which these differences might guide the practice of a health professional.8 » AwAREnEss of THE ‘PERson/s’
113
health professional that the individual who appears relaxed and in control feels unsure and requires encouragement. This previously unnoticeable information encourages the health professional to communicate empathy by investing time and energy in exploring these upsetting emotions.
Parents and significant others communicate emotions through touch with their chil-dren. In families, touch is a powerful form of communication that expresses parental or sibling emotion. Kisses, cuddles, tickles and rumbles are fun and comforting; they com-municate ease, acceptance, love and affection (Mohan et al 2008). This manner of touch produces positive emotions in both the person touching and the person receiving the touch. Expressions of anger, frustration and disapproval communicated through either touch or tone of voice produce negative emotions in the child. Various types of touch, whether producing positive or negative emotions, can condition a child to respond in a particular manner when touched by anyone. Health professionals who use touch within their treatment media should consider the reaction of anyone they touch. Careful aware-ness of the responses and needs of children when touching is essential because this provides information about the touch experiences of that child. Accurate knowledge of the touch experiences of a child, if managed appropriately, has potential to restore and protect the emotional growth of the child and their future ability to both give and receive touch as a way of communicating expressions of concern.
When used appropriately to communicate, touch can be a powerful tool for the health professional who feels comfortable touching others.
Silence
Silence can be a powerful and comforting communi-cation device. Words are sometimes inappropriate.
Saying nothing with someone – just being with them – is more appropriate than words in particular circumstances.
When listening the health professional is silent, but the interaction is not silent because the Person/s is speaking. Refraining from speaking while listening, in combination with concentrating and focusing on the speaker, demonstrates skills in listening as well as
interest and respect (Stein-Parbury 2009). There are occasions while communicating, however, when words are inappropriate or inadequate. In these cases, just being with a Person/s and saying nothing indicates interest, care, respect and even empathy. There are occasions when the Person/s does not seek words but the presence of an interested and caring health professional. A carer or relative found sitting outside the room of their seri-ously ill or dying family member may not desire verbal communication but the non-verbal, silent presence of a previously known, concerned and interested health professional.
This presence communicates care and – even though the health professional may be skilful in verbal expressions of empathic care – simply sitting quietly with the Person/s can fulfil the needs of the Person/s at that time.
When the Person/s has difficulty expressing themself verbally, it is appropriate in some health professions to silently perform an activity with them in an interested and observant manner to build rapport (Schmid 2005). The possible people with whom a health profes-sional might use this type of silence include children, people with mental health disorders or communication difficulties, people experiencing severe pain and people in palliative care units.
•
How comfortable are you with silences in conversations?•
What is your natural tendency when there is a silence in a conversation?•
What does that mean for you as a health professional?114
Different cultures have different uses for silence.
Some cultures find that silence communicates more effectively than words. When communicating with a vulnerable Person/s from a different culture, it is important to clarify the uses and effects of silence (see Chs 14 & 15).
Silence, when used appropriately, can powerfully communicate interest, regard and a desire to assist if possible.