The health unit coordinator (HUC) is the liaison among the doctor, the nursing staff, ancillary departments, visitors, and patients. The main responsibility of the HUC is to keep the nursing unit running effectively and smoothly. With the implementation of the electronic medical record (EMR), the HUC has expanded responsibilities and is often the “go-to” person to assist doctors, nurses, and ancillary personnel in use of the EMR system. The HUC also has a larger role in listening to visitor, patient, and nursing unit personnel complaints and also in problem solving. The nursing unit can become very hectic, and tensions can build easily. If communication breaks down and tempers become short, chaos most likely will result, and the risk of errors being made becomes higher. Hospitals are rated by The Joint Commission (TJC) on patient safety goals that include the communication process. The HUC as well as all health care professionals need to stay proactive to meet the requirements placed on the hospital. Many hospitals provide computer-based learning (including communication and other topics) for employees that can be completed on their own time.

Interpersonal Behavior

To develop effective communication and interpersonal skills, one must first attain an understanding of interpersonal behavior. Interpersonal refers to between persons; involving personal relationships. Behavior is how people act—what they say or do. We have many different relationships with people. Some researchers say that our definition of interpersonal communication must account for these differences; for instance, interactions with a sales clerk in a store are different from the relationship we have with our friends and family members. Research indicates that in conversation a person behaves according to who the other person is and how he or she behaves. An understanding of interpersonal behavior assists us in understanding our own behavior and in understanding the behavior of others.

Although several models may be used to study interpersonal behavior, we have chosen Maslow’s hierarchy of needs, developed by the late Abraham Maslow, a famous psychologist. Maslow’s human needs model emphasizes that all people have the same basic needs and that these needs motivate and influence a person’s behavior, consciously or unconsciously. The needs are arranged in a pyramid, with the most basic or immediate needs at the bottom of the pyramid and less critical needs at the top of the pyramid (Fig. 5-1). Needs that are lower on the pyramid have the greatest influence on a person’s behavior. For instance, a person will work harder to meet the need for water to drink than to meet the need for self-esteem.

As lower level needs are satisfied to an adequate degree, we become increasingly concerned about satisfying the next or a higher-level need. Most people find that all their needs are both partially satisfied and partially unsatisfied at the same time. Unsatisfied needs influence an individual’s behavior in terms of motivation, priorities, or action taken. According to Maslow, the average person is satisfied perhaps 85% in their physical needs, 70% in their safety needs, 50% in their love needs, 40% in their self-esteem needs, and 10% in their self-actualization needs.

Maslow’s Hierarchy of Needs

Physiologic Needs

Each person needs food, fluids, oxygen, physical activity, sleep, and freedom from pain. These needs are the most basic and the most dominant of all human needs. They are the first to develop in the human organism. The normal adult probably has satisfied his or her physiologic needs.

What about the person who is ill or hospitalized? The illness itself, diagnostic testing, or surgery may interrupt a person’s normal eating and drinking habits. Diseases such as emphysema make it impossible for the body to receive the amount of oxygen needed to function normally. Physical activity is decreased on the patient’s admission to the hospital, affecting the body’s need for exercise.

SCENARIO

Bill, a patient, has been fasting since midnight for a diagnostic imaging procedure. It’s now 10:45 am, the test has been completed, and Bill is ready for his breakfast. When the HUC informs him that his tray will not arrive from the nutritional care department until lunch time (12:00), Bill becomes angry. Bill’s behavior is influenced by his unsatisfied physiologic need.

Suggested Resolution

The HUC would (after checking Bill’s diet) give him a snack from the nursing unit diet kitchen and/or call the nutritional care department and request that his tray be sent early.

Safety and Security Needs

Everyone has safety and security needs—the need to be sheltered, to be clothed, to feel safe from danger, and to feel secure about one’s job and financial future. Each person has a need for a certain degree of sameness, familiarity, order, structure, and consistency in life. Freedom from fear, anxiety, and chaos is also important.

The normal healthy person probably has met these basic needs; however, illness or hospitalization may interrupt a person’s ability to continue to satisfy them. What about the patient who is waiting for test results to learn a diagnosis, the unpredictable course of a lengthy illness, the fear of death, the cost of medical care, or the unfamiliarity of hospital routines and medical procedures? Many obstacles may interfere with efforts to meet the safety and security needs of a person who is ill or hospitalized.

Note: Hospital employees who are new on the job may feel insecure and may make more mistakes during this stressful time. In addition, rumors about layoffs, true or not, can affect the security needs of employees and often send them scurrying to apply elsewhere for employment.

SCENARIO

Donna, a patient, has just been told by her surgeon that the test results show she has a tumor that may be malignant. The surgeon has recommended she have surgery as soon as possible. Donna is very upset and demands that the HUC put a call in to her family physician immediately. Donna’s behavior is motivated by unsatisfied security needs.

Suggested Resolution

The HUC would advise Donna’s nurse. After speaking to Donna’s nurse, and upon the nurse’s request, the HUC would place the call.

Love and Belonging Needs

Once physiologic and safety needs have been relatively well met, love and belonging needs surface. Now, the person has a desire for affectionate relationships with others and is motivated to belong to or be a part of a group. Patients who are hospitalized, especially for a long time, may be cut off from their family, friends, or group.

SCENARIO

Sarah, a 76-year-old woman, has been hospitalized for 2 weeks. During this time, she has been visited only once by her daughter. In an attempt to meet her belonging needs, she has been turning on her call light hourly for minor requests.

Suggested Resolution

The HUC would ask a volunteer to visit with Sarah. The volunteer could read to her, comb her hair, or just talk with her for a time.

Esteem Needs

As a person develops satisfying relationships with others, esteem needs and the need for self-respect and for the respect of others emerge. Esteem needs may be met by seeking special status within a group, excelling at a job, obtaining a promotion, learning a skill very well, or developing a talent to be performed for others. Attainment of self-respect leads to feelings of adequacy, self-confidence, and strength. These qualities result in prestige, recognition, and dignity for the individual.

Hospitalization frequently interferes with the ability to meet esteem needs. Many aspects of hospitalization such as wearing hospital gowns, sharing a room with others, having side rails on the bed, and being referred to as a room number or a disease instead of by name serve to depersonalize the patient. Often, busy hospital personnel overlook a patient’s past accomplishments and status.

SCENARIO

Tom has been hospitalized for longer than a week. He is walking past the nurses’ station and stops to read the name tag of the HUC. “You’re Jenny Mason. That’s a nice name. You know, since I’ve been in the hospital, no one has called me by my name. I feel like I’ve lost my identity.”

Suggested Resolution

The HUC would advise Tom’s nurse and the certified nursing assistant (CNA) of Tom’s comment and if applicable make a note on Tom’s Kardex to please call him by his name.^∗ This should be addressed at the staff meeting.

^∗All patients should be called by name.

Self-Actualization Needs

Once a person feels basic satisfaction of the first four needs, the next step is for him or her to become “self-actualized.” Self-actualization needs are met with the development of a personality to its full potential. Contentment, self-fulfillment, creativity, originality, independence, and acceptance of other people all characterize the self-actualized person. Self-actualization is growth motivated from within an individual. As Maslow expressed it, “What a man can be, he must be.” Thus, self-actualization is the desire to become what one is capable of becoming. It is growing and changing because you feel it is important. A self-actualized person has taken steps to make this happen.

SCENARIO

Mahatma Gandhi is an example of a self-actualized person. This Indian leader frequently sacrificed his physiologic and safety needs for the satisfaction of other needs when India was striving for independence from Great Britain. In his historic fasts, Gandhi went weeks without nourishment to protest governmental injustices. He was operating at the self-actualization level.

Examples of Different Needs in a Conversation

The human needs model can be used to demonstrate interpersonal behavior between HUCs and hospital personnel or between HUCs and patients or visitors.

HUC: “Mary is in isolation. You will need to put this gown on before going into her room.” (No dominant need expressed.)

Husband: “Mary is in isolation? What are you talking about? What for? I want to know exactly what is going on here!” (Safety need expressed. Mary’s husband is concerned about her safety and is also concerned that he may contract what Mary has.)

HUC (defensively): “Look, if you don’t want to wear the gown, don’t go in. I don’t make the rules here.” (Esteem need expressed. The HUC interprets the husband’s request for information as an attack on her competence; self-esteem is at stake. Fighting back is used to try to satisfy self-esteem needs.)

In this example, if the HUC had perceived that the husband’s question was motivated by safety needs, she could have responded with understanding rather than with defensiveness and aggression.

EXERCISE 1

Match the level of need from Maslow’s hierarchy of human needs listed in Column 2 with the human needs listed in Column 1.

Column 1	Column 2
1. The need for oxygen 2. The need for shelter 3. The need to be safe from danger 4. The need to be loved 5. The need for respect 6. The need to feel self-confident 7. The need for acceptance within a group 8. The need to belong 9. The need for exercise 10. The need for the feeling of security	a. Physiologic needs b. Safety and security needs c. Belonging and love needs d. Esteem needs e. Self-actualization needs

UNDERSTANDING PATIENT NEEDS

Many hospitals have developed programs (Buddy Program, Pairs Program, and Pediatric Stars Program) that pair first-year medical students with individuals with early- to moderate-stage Alzheimer disease, children with sickle cell anemia, and children with cancer. The programs provide the students an “up-close and personal” experience of the impact and challenges patients with these diseases and their families face every day. The students also gain empathy and learn to see the patients as human beings and not just a disease. Often the friendships formed last beyond the end of the program.

Communication Skills

Most of us spend much of our time communicating, but few of us communicate as effectively as we should. Many factors contribute to communication difficulties. For instance, the English language has grown considerably throughout its history, and the language now consists of approximately 750,000 words. It is impossible to know how many words an individual may have in his or her vocabulary, but it is believed that an average educated person comprehends about 20,000 words. How does the speaker know which of the 750,000 words are included in the receiver’s 20,000-word vocabulary? The medical world also has a growing language of its own, which is made up of abbreviations and medical terms. “Remember now, Sidney is NPO” or “Your doctor feels that you may have diverticulitis, so she has scheduled you for a BE tomorrow” may have little meaning to those not familiar with the medical terms. Some words have more than one meaning. For instance, a chip in the computer world has a much different meaning than a chip used in a poker game.

Communication is 55% visual, including facial body language and symbolism; 38% vocal qualities, including tone, loudness, firmness, hesitations, and pauses; and 7% verbal, meaning actual words (Fig. 5-2). There is often inconsistency between what a person is saying and how he or she appears. (“Of course I’m listening to you, Mother,” says the 9-year-old boy as he sits glued to the television set, leaving the mother wondering whether the child is indeed listening to her.)

Figure 5-2 Verbal and nonverbal communication.

Another major weakness in the communication process involves poor listening skills. Often we are thinking of something else while the speaker is talking to us; we are formulating a response or prejudging what is being said.

Daughter: I’ve stopped eating breakfast meats.

Mother: But breakfast is the most important meal of the day. You should not give it up.

Instead of listening to what is being said, the mother has prejudged that the daughter is skipping breakfast altogether rather than just breakfast meats.

Because the HUC is the communicator for the nursing unit, effective communication is vital for job success and for proficient operation of the nursing unit.

Communication takes place daily with nurses (Fig. 5-3, A), physicians (Fig. 5-3, B), allied health professionals, patients (Fig. 5-3, C), visitors, and administrators. The HUC is often the first person seen by the new patient and visitors. The words, gestures, facial expression, and body posture that are used can suggest that one is opinionated, supportive, thoughtful, or insecure. The tone of voice, the words spoken, and the facial expressions used during the patient’s or the visitor’s initial contact with the nursing unit leave a lasting impression.

Figure 5-3 The health unit coordinator is the communicator for the nursing unit. A, Communicating with a nurse. B, Assisting a doctor. C, Answering a patient’s questions regarding visiting hours, operation of call light, and so on.

Components of Communication

Communication is the process of transmitting images, feelings, and ideas from the mind of one person to the mind(s) of one or more other people for the purpose of obtaining a response. The communication process consists of four components:

Sender: the person transmitting (sending) the message

Message: the images, feelings, and ideas transmitted (sent)

Receiver: the person receiving the message

Feedback: the response to the message

Communication seems like a simple process; however, the act of communicating does not guarantee that effective communication has taken place, nor that the message sent was the same as the message received. For example, a program was developed for a computer to translate one language into another. The computer translated the English phrase “out of sight, out of mind” into Russian, and then translated it back into English as “invisible idiot.”

Communication Model

A model is a representation of a process—a map, for instance. We will use a model to take a closer look at the communication process, to identify why so many of us communicate poorly, and to find ways to improve our ability to communicate with others (Fig. 5-4).

Sender

The sender must translate mental images, feelings, and ideas into symbols to communicate them to the receiver. This process is called encoding. When encoding, the sender decides whether to send the message in verbal symbols or in nonverbal symbols (Fig. 5-5). What are the right words to use so the receiver will understand the message? Different words are used if you are speaking to a child, to an adult, or to another health care professional. Nonverbal symbols, such as facial expressions, may be used to communicate the message. Encoding occurs each time we communicate. A poor choice of words or an inconsistency between verbal and nonverbal messages may result in unsuccessful communication.

Symbolic	Body Language
Clothing	Posture
Hair	Ambulation
Jewelry	Touching
Body art	Personal distance
Cosmetics	Eye contact
Automobile	Breathing
House	Hand gestures
Perfume or cologne	Facial expressions