15: Communication

CHAPTER 15 Communication

Chapter Points

• This chapter covers the requirements of the NEBDN syllabus Section 15: Communication. You should read this chapter in conjunction with Chapter 6.

Key point

‘Patients know if you care well before they care if you know’ (John Maxwell, American author and motivational speaker)

Working with patients

As a dental nurse you need to have, and be able to demonstrate, an interest in people: the dental nurse works with, rather than on, patients. You will need to listen to and to explore, with the patient, the beliefs and practices that are important to them and their situation, their feelings and their concerns about healthcare. Patients vary, for example in how they wish to be addressed, and so need to be asked. Remember, as mentioned in Chapter 6, not everyone is happy to be addressed by their first name. Some may also wish to involve in discussions and/or decisions people who are close to them. Check!

Communication

Greetings can ‘make’ or ‘break’ the professional relationship with a patient. So do greet patients with a smile. Always strive also to communicate in such a way that the person can understand what is being told them. This includes your facial expression and body language as well as what you say.

Good practice points in communication

• Smile.
• Speak clearly and directly to the patient, making eye contact as appropriate.
• Greet by saying ‘good morning’ or ‘good afternoon’, or the greeting appropriate to the culture concerned. For many people, especially people of African, American (North or South), European and other Western descent, the customary greeting is a gesture or a handshake but some patients may be uncomfortable shaking hands with a person of the opposite gender. Unless you are certain of their culture or religion, it is better to greet a patient with a handshake, seeing first if a woman offers her hand, and then say ‘Good morning/afternoon’ and use their title (Mr, Mrs, Dr, Professor) followed by their last name. Different cultures and religions have different traditions in greetings (Box 15.1).
• Never use the first name alone, except for children and when requested. Ask the patient for their family name and their most used personal name, and if they prefer, use their title and surname, confirming pronunciation if uncertain.
• Be very careful about touching anywhere but especially the upper arm or leg or chest (see Box 15.1 and below).
• Explain who you are and what you do, what is happening and what will happen.
• Sensitively enquire as to whether the patient understands the conversation.
• If possible, say something to put the patient at ease or say a few words in the person’s language.
• Encourage the patient to establish a relationship.
• Do not cut across conversations between the operating clinician and patient.
• A carer, family member, partner or companion may be present as an advocate to provide any information that the patient cannot perhaps provide. They may also help address any questions, but the essential rule in communicating is to address the patient directly.
• One of the most obvious ways to assist communication is to have clinic and other signs and material easily visible, in large enough font, readable and understood and available in relevant different languages.
Box 15.1 Greetings in different cultures and religions

Arabs: Greet with ‘As Salamu Alaikum’. Use title (Mr, Mrs, Dr, Professor) followed by last name.

To avoid any offence, wait to see if person wishes to shake hands.

Asians: Unless you are aware they are Hindu or Muslim (see below), bowing is a common practice in Asia, as a way of expressing respect as well as a form of greeting. Greet with a slight bow and a handshake. Shake hands with a woman only if she offers hers.

Buddhists: Greet with ‘Good morning/afternoon’ and use title (Mr, Mrs, Dr, Professor) followed by the last name.

Bowing is a common practice in Asia, a way of expressing respect and reverence, as well as a form of greeting. Greet Buddhist monks/nuns with a small bow with hands together in front of the chest and avoid hand shaking.

Chinese: Greet with ‘Good morning/afternoon’ and use title (Mr, Mrs, Dr, Professor) followed by the last name.

Christians: Greet with ‘Good morning/afternoon’ and use title (Mr, Mrs, Dr, Professor) followed by the last name.

Handshake, or, in some cultures such as those of southern European origin, if the person is known, by a touch of the cheek on the cheek of the other person.

Hindus: Greet with ‘Namaste’ and their title (Mr, Mrs, Dr, Professor) followed by their last name.

Handshake. When a Hindu meets a Hindu, they greet each other with the hands folded together at chin level.

Jains: Use their title (Mr, Mrs, Dr, Professor) followed by their last name and say ‘Jai Jinendra’.

Greet only men with a handshake. Whenever a Jain meets a Jain, they place hands together at chin level, and bow.

Jews: Greet with ‘Good morning/afternoon’ and use title (Mr, Mrs, Dr, Professor) followed by the last name.

To avoid any offence, wait to see if person wishes to shake hands.

Muslims: Greet with ‘As Salamu Alaikum’ (May peace be with you). Use title (Mr, Mrs, Dr, Professor) followed by the first and last names. The naming system used depends on the area from which the person comes.

To avoid any offence, wait to see if the person wishes to shake hands.

Roma: Use their title (Mr, Mrs, Dr, Professor) followed by their last name and say ‘Good morning/afternoon’ or the words in Roma for luck and health (‘baxt hai sastimos’).

Handshake. When a Roma meets a Roma, they greet each other with a raised palm.

Sikhs: Use their title (Mr, Mrs, Dr, Professor) followed by their first and last names and say ‘Waheguru Ji Ka Khalsa, Waheguru Ji Ki Fateh’ or less formally by saying ‘Sat Sri Akal’.

Greet men with a handshake. When a Sikh meets another Sikh, they greet each other with folded hands.

Find out more

What methods are used in your workplace to assist communication?

Communicating across a language and/or cultural barrier can be time-consuming, difficult and frustrating. It is important to:

• Ask patients about their preferred language
• Recognise those situations in which use of an interpreter will minimise or eliminate barriers in communication
• Remember that even those with a good grasp of the language may not understand medical or dental terminology
• Explain as you go along
• Remember that head-nodding and smiles do not necessarily indicate understanding or agreement. And silence can have many meanings and sometimes indicates lack of agreement
• Never assume agreement or fluency until you are sure from the feedback from the patient.
• Remember oral fluency in a language often exceeds skills in reading and writing.
• Do not get disturbed if a bi-lingual patient reverts to their native tongue to speak with family or friends, as they are almost certainly not gossiping.

Notions of Modesty

Virtually all patients can be embarrassed by feeling exposed, particularly to the gaze of strangers or people of the opposite gender. Particular cultures may have specific rules or concepts about:

• What areas of the body can be exposed
• Touching
• Personal space
• Clothing to be worn.

Establish the patient’s wishes about opposite gender healthcare professionals and try to comply. If it is not possible, a chaperone of the same gender as the patient should be available. As a dental nurse, you may well have to act as the chaperone (see Chapter 6).

Do not remove from patients any clothing, head coverings, amulets or jewellery unnecessarily and, if they really must be removed, place them carefully in a clean receptacle and never directly on the floor. Ensure appropriate facilities for washing are available if working in a hospital.

Touching Patients

Males should:

• Volunteer the right hand to shake the right hand with a male
• Not shake hands with a female unless she offers her hand first.

Females should:

• Volunteer the right hand to shake the right hand with a female
• Not shake hands with a male unless he offers his hand first.

Give things with your right hand only, even if you are left handed. In some cultures, both hands are used.

Keep a respectful distance and touch within gender only; take care to touch only hands or upper limbs, not the head or legs and never anywhere near the breasts or genitals.

Interpreting

Interpretation requires time, patience and expertise. Try not to use family members, or interpreters/advocates of different sects, since there could be:

• Role conflicts
• Lack of medical vocabulary or understanding
• Confused perceptions or misunderstandings
• Withholding or distorting of information
• Differences in health beliefs
• Danger of conflict.

Translation services are available but, in some cultures and with some individuals, there can be concern and mistrust if the patient believes the interpreter may not accurately convey their messages to the dental care professional (DCP). In these circumstances, the patient may prefer a different professional interpreter. Where indicated, use interpreters of the same gender as the patient, preferably no younger than the patient – always ensuring first that the patient is comfortable with the interpreter. They should therefore meet, before the interview, which allows the interpreter also to assess the patient.

It is crucial before proceeding to take the history, for the clinician to check the interpreter’s understanding and to:

• Tell the interpreter what they want to achieve
• Ask the interpreter not to omit or to insert information
• Allocate adequate time.

Developing a Good Dcp–Patient Relationship

The relationship of a patient with their DCP can have a powerful therapeutic effect on them. In fact, it can be thought of like having a placebo effect. Failure to develop a satisfactory relationship means that this therapeutic effect will not be obtained. That’s why the communication with patients should include:

‘CLASS’:

• Context or setting
• Listening skills
• Acknowledge emotions and explore them
• Strategy for management
• Summary and closure.

Any bad news, e.g. telling a patient they have cancer, must be thought through carefully, and the ‘SPIKES’ protocol used for breaking the news:

• Setting and listening skills
• Perception by patient of condition and seriousness
• Invitation from patient to give information
• Knowledge – giving medical facts
• Explore emotions and empathise as patient responds
• Strategy and summary.

Term to Learn

Placebo effect: this is the well-known scientific fact that, for example, if someone believes that they have been given a medication or treatment to help them feel better they will feel better even if the medication or treatment was a dummy pill or tablet or sham treatment.

Teamworking

The dental team includes as a minimum a dentist and dental nurse but, much more commonly, a number of dental professionals as well as receptionists and secretaries. Technological advancements in clinical practice dictate that as a dental nurse, you should be a skilled professional with a broad range of knowledge of current techniques, materials and, most importantly, patient care.

The scope of practice of the dental nurse is outlined in

Related posts:

  1. 16: Dental Emergencies
  2. 12: Dental Drugs, Materials, Instruments and Equipment
  3. 2: Medical Emergencies and First Aid in the Dental Surgery
  4. 5: Oral Disease
  5. 10: Surgical Procedures
  6. 17: Human Diseases and Health Promotion

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Jan 8, 2015 | Posted by in Dental Nursing and Assisting | Comments Off on 15: Communication

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