Health professions exist to provide specific services to individuals seeking their assistance.
Regardless of the particular health profession, communication is a vital activity within that service. Mutual understanding between the individual seeking the service and the health professional is a characteristic of any meaningful interaction. It is vital to ensure positive outcomes. Mutual understanding (successful exchange of information) provides the foundation for the development of a therapeutic relationship between the individual and the health professional. Similarly, this therapeutic relationship ensures that the needs and desires of the individual or group are at the centre of the goals and interventions, thereby facilitating family-centred, client-centred or Person-centred practice (Harms 2007, Harms & Pierce 2011, Hassan et al 2007, Higgs et al 2005, 2010, Holmes et al 2010, Parker 2006, Purtilo & Haddad 2007, Rini & Grace 1999, Stein-Parbury 2009) (see Fig 2.2).
The concept of family or Person-centred practice is the focus of discussion and publication in some health professions. In other health professions it is an underlying assumption but rarely discussed, while in still others it is neither an assumption nor a topic of discussion.
Please note the use of the word family applies particularly in practice involving chil-dren, although inclusion of the family in goal setting and interventions may occur in other contexts of practice. It is essential when working with children, but may significantly contribute to positive treatment outcomes in other practice contexts, depending on the desires and dynamics of both family and the Person.
FIGURE 2.2
A model to guide family/Person-centred practice.
Family/Person-centred practice is a partnership between the health professional and the Person/s seeking their services. This collaborative partnership exists to establish the
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Second response: One health
professional on the team took a different approach, expressing empathy and developing trust with Miss Brown. This health professional was able to establish that Miss Brown was very worried about her best friend and constant companion, Billy. Billy was her pet bird who needed daily food and water. The health
professional organised to bring Billy to the hospital. Miss Brown began seeing Billy every day and thus began enjoying her treatment and eventually returned home with Billy.
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Is this response health professional-centred or Person-professional-centred? Explain the difference.needs and goals of the person (Unsworth 2004). It enables them to achieve their goals with the assis-tance of the health professional (Duncan 2006).
Achievement of these goals empowers the individual to achieve positive outcomes including participation and fulfilment in their daily lives.
MUTUAL UNDERSTANDING
Mutual understanding means that those communi-cating share a common meaning – all parties com-prehend the verbal and non-verbal signals used during the interaction. In the health professions, mutual understanding must mean more than simply understanding words (see Ch 1).
A foundational factor that builds mutual under-standing and appropriate results in any health profes-sion is respect (Egan 2010). Respect of self and other people is a fundamental value of all health profes-sions. It affects the views that individuals have of themselves and of others. It requires unconditional regard for self and other people regardless of weak-nesses or failures, position or status, beliefs and values, material possessions and socioeconomic level (Rogers 1967, Purtilo & Haddad 2007). Respect demonstrates that the health professional values every individual. It is the basis of empathic reactions in a health professional.
As a health professional, it is imperative to under-stand that every person seeking assistance feels dis-connected and vulnerable. Many such individuals often feel inadequate to meet the demands of their current situation (Stein-Parbury 2009) and may be afraid of the unknown elements of the situation.
Vulnerable individuals want to know the health pro-fessional cares about them and desires to understand their life and experiences (Milliken & Honeycutt 2004). Demonstration of this understanding and care will increase the ability of the person to process and understand any information (Householder & Wong 2011). It is the responsibility of the health profes-sional to demonstrate this care and understand the vulnerability of each individual. Direct, clear and accurate recognition of the emotions of the indi-vidual and expression of this understanding is known as empathy (Stein-Parbury 2009) (see Ch 8). This does not mean expressing similar emotions (sympa-thy) – but accurately identifying, validating and accepting their emotions.
Miss Brown, a 78-year-old woman, was admitted to a rehabilitation ward after experiencing a stroke. Initially she was drowsy, but happy and cooperative. After a few days she became distressed and refused to be involved in any interventions or relate to anyone from the
multidisciplinary team.
First response: In response, every health professional on the team gently repeated that Miss Brown did not need to worry, she was all right now and everything would be OK. Some told her she could relax, as everyone on the team was there to help her. One health professional sympathetically said it must feel terrible suddenly finding yourself in hospital from a stroke, but that it would be OK in the end, so she should cheer up. She was also kindly told she simply needed to do as she was asked and she would eventually go home. This made her sob.
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Are these responses health professional-centred or Person-centred? Explain why.2 » THE OvERALL gOAL OF COMMUNICATION FOR HEALTH PROFESSIONALS
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Davis (2011) and Morse (2010) state that expressing empathy to the vulnerable indi-vidual enables both humane and beneficial communication. This manner of communicat-ing has a positive effect (Ley 1998) upon the participation of the individual in all activities associated with health professional interventions (see Fig 2.3). It is important to under-stand that statements like ‘I underunder-stand’ or ‘You are OK’ or ‘It will be all right’ do not demonstrate empathy and are rarely reassuring.
FIGURE 2.3 The doctor is IN.
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Draw a line down the middle of a page. Place the word ‘Empathy’ at the top of one column and
‘Sympathy’ at the top of the other column. Consider the scenario above.
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Write responses to Miss Brown in each column that demonstrate both sympathy and empathy.•
Suggest ways the health professional expressed empathy to discover the cause of the emotions dominating Miss Brown.•
If you are feeling vulnerable, how do you feel when someone indicates they are interested in what you are feeling and attempts to understand/validate your experiences and feelings?•
What actions demonstrate that someone is interested?•
How might expressing such interest and care affect communication?Expression of appropriate empathy requires both personal and professional skill. Such skill necessitates reflection about self (Pendleton & Schultz-Krohn 2006), practise in expressing empathy, making time to practise, commitment to the expression of empathy and in many cases self-control on the part of the health professional. It requires awareness of and respect for the feelings of the individual – being able to see the world from their viewpoint and respecting that viewpoint. Appropriate expressions of empathy require the health professional to make responsible choices about when, what and how they communi-cate. The health professional needs also to be aware
of and able to control, express or resolve their own negative emotions, without allowing them to affect the vulnerable individual (see Chs 5 & 6). Appropriate expressions of empathy take little time or effort, and they can result in the individual believing they are the only person in the world for that time. While expressions of empathy are beneficial in all areas of life, they are essential when practising as a health professional (Egan 2010, Harms 2007, Harms & Pierce 2011, Milliken & Honeycutt 2004, Stein-Parbury 2009).
See Chapter 8 for a deeper exploration of expressing empathy.
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Health professionals must consider whether they will validate and acknowledge the experience and associated needs of the individual and, if so, at which point (Davis 2011). While such choices require skill, health professionals must take every appropriate opportunity to express empathy with those around them because this indicates acceptance and validation of the emotions associated with the experience. Such acceptance and validation indicates respect. Respect is something that all individuals appreciate and it produces positive feelings that facilitate the develop-ment of trust during an interaction. The behaviour of a health professional will be open, honest, predict-able and relipredict-able if they are worthy of trust.
In combination, respect, empathy and trust are foundational for developing mutual understanding, the first step in achieving family/Person-centred goals and practice.