Enfoque Audiológico

ROLE Personal Space and Position

In groups of three to four—one patient, one HCP, and one to two observers—act out each of the following scenarios.

1 A medical assistant greets a patient, brings them into the examination room, and asks a few initial questions as to the reason for their visit to the doctor.

2 A patient is hospitalized with a severe form of gastroenteritis and shares a room with three other patients. An RN asks the patient pointed questions about their vomiting and diarrhea.

In terms of personal space and body position, discuss the nonverbal behaviors displayed by the patient and the HCP. What behaviors displayed by the HCP were effective in facilitating communication with the patient? How did these behaviors make the patient feel? What behaviors impaired commu-nication with the patient? How did these behaviors make the patient feel?

FIGURE 2-5. Posture. Posture refers to the position of the body and limbs as well as muscular tone. Posture may reveal a great deal about emotional status.

Posture refers to the position of the body and limbs as well as muscular tone. The posture of a patient may reveal a great deal about their emo-tional status. For example, depression or discouragement is char -acterized by a drooping head, sagging shoulders, low muscle tone, and the appearance of sadness or fatigue. Conversely, anxiety may be char-acterized by increased muscle tone where the body is held in a rigid and upright manner. Patients tend to tighten up in fearful or unknown situa-tions. Interest is conveyed by leaning forward with the legs drawn back,

while boredom may be conveyed with a lowered head, outstretched legs, and a backward-leaning position. Finally, avoidance and rejection are displayed by a closed body posture. In this case, the patient crosses their arms and legs, leans back as if to create distance, and may even turn their body away from the HCP.

It is important that the HCP appear confident as this will enhance the trust that the patient has in them. A crucial aspect for showing con-fidence is the maintenance of a relaxed and open body posture. This pos-ture is also perceived as more friendly, warm, and inviting. In fact, HCPs have been rated as having a greater rapport with their patients when their arms are uncrossed and symmetrical (i.e., arms loosely at their sides when standing or resting on the arms of their chair or in their lap when sitting) and their legs uncrossed. When sitting, the HCP should face the patient and lean slightly forward.

PLAY

ROLE Posture

With a partner—one patient and one HCP—take turns playing the patient and, using only nonverbal communication, act out each of the fol-lowing: anger, fear, disgust, happiness, sadness, and surprise. Correctly inter-pret the displayed emotion. Discuss how, as an HCP, you would react to these messages. Discuss how, as the patient, these messages conveyed by the HCP made you feel.

Touch

FIGURE 2-6. Touch. Touch is critical in establishing rapport between the HCP and their patient.

Caring for patients often involves some form of touch. Most obviously, it serves as a critical tool for examining (e.g., medical assistant taking blood pressure), diagnosing (e.g., radiography technologist positioning a patient for an x-ray or a phlebotomist withdrawing blood), treating (e.g., physical therapist assistant manipulating a patient’s limb or a nurse applying a dressing on a wound), or simply caring for (e.g., CNA helping a patient to eat or to dress) the patient. Touch also has many other important functions in health care as it may serve to:

■ Ease a patient’s sense of isolation;

■ Decrease patient anxiety;

■ Demonstrate caring, empathy, and sincerity;

■ Offer reassurance, warmth, or comfort;

■ Enhance the rapport between the HCP and the patient;

■ Supplement verbal communication.

Clearly, touch is critical in establishing rapport between the HCP and the patient. Interestingly, surveys have shown that many patients want to shake their physician’s hand when they first meet. However, it is also important to remember that touch may evoke negative reactions in some patients. Not everyone likes to be touched, as it may make them feel embarrassed, uncomfortable, or threatened. Cultural differences are important factors in determining a patient’s receptivity to touch and will be considered in Chapter 8.

There are no set rules for determining when to touch or not to touch patients. Furthermore, there is no universally accepted meaning that may be derived from a given touch. Interpretation and receptivity to touch will depend on several factors, and the use of touch will require the exercise of good judgment on the part of the HCP. General guidelines that can be followed to enhance the likelihood that touch will be perceived positively in the clinical setting include the following:

■ Tell your patient when, where, and how they will be touched during an examination or clinical procedure. This helps to put your patient at ease and will avoid startling them.

■ Use a form of touch that is appropriate for the given situation. For example, placing your hand on the arm or shoulder to ease a dis-tressed patient or family member may be comforting. However, touch-ing an angry patient may be less helpful than simply letttouch-ing them vent their feelings.

■ Use touch to supplement your verbal message. However, do not replace words with touch alone. That may lead the patient to feel that the importance of their problem is diminished or that you are being superficial or demeaning. For example, consider the case where a patient describes the amount of pain felt in their neck following a car accident. If the HCP were to simply pat the patient on the back, the

patient may interpret this gesture as placating and not really caring.

Conversely, the same touch accompanied by the words “Let’s pre-scribe some medication for that pain” would be interpreted quite favorably.

■ Do not use a touch gesture that implies more intimacy with a patient than is desired. When a gesture suggests a degree of intimacy that is not shared, it will likely result in discomfort. When touching a patient of the opposite gender, it is advisable to have a colleague or a family member of the patient in the room in order to prevent any misunder-standing.

■ Observe and assess the recipient’s response to the touch. Negative responses may include pulling away, a startled look or frightened appearance, a tense facial expression, or other anxious gestures or behaviors. You may safely assume that a patient has a positive response to touch if they appear to relax or seem more comfortable.

■ The person who touches may be perceived as having enhanced sta-tus. Therefore, it is important that the HCP remain mindful of its pos-sible effect on the power dynamic between them and the patient. In some instances, the patient may feel a reduced sense of independence or autonomy.

PLAY

ROLE Position, Distance, and Touch

With a partner—one patient and one HCP—act out the following scenario.

A 45-year-old man is in a deep sleep in his hospital room. It is 2 a.m. and he needs to be given his medications.

Discuss the way in which the HCP used position, distance, and touch during the interaction. As the patient, which practices were received favor-ably? Why? Which practices were received unfavorfavor-ably? Why?

Proper Interpretation of Nonverbal