4. The specific goals of communication for health professionals: 2
CHAPTER OBJECTIVES
• Identify the role of gathering information
• Outline the appropriate manner of gathering information
• List the different types of questions, their purpose and their effect
• Use questions to gather information
• Understand the significance of comforting
• Understand that every response can encourage or discourage
• State the significance and characteristics of encouragement versus discouragement
• State the basis of, role of and reasons for confronting.
The overall purpose of providing family/person-centred practice should guide every interaction between health professionals and those seeking their assistance (see Ch 2). The specific purpose of communication for health professionals is outlined in this book in two parts. The first part of the discussion (see Ch 3) describes introductions and providing information. The second part of the discussion comprises Chapter 4 and examines the specific purposes of
• Gathering information – interviewing and questioning
• Comforting – encouraging versus discouraging
• Confronting unhelpful attitudes and beliefs.
Gathering information
A health professional gathers various types of information from many sources throughout the working day. When gathering information it is important to consider the possible responses of the person providing the information, the effect of the environment (see Ch 8) and the possibly sensitive nature of the required information.
ACTIVITY
Ask the person next to you
• Their name
• Their health profession
• Where they were born
• How they travelled today
• Do they have a tattoo? If so, where is it?
REFLECTION
• How easy was it to obtain the information about the person next to you?
• Were there any difficulties? If so, what were they? What caused the difficulties?
• How did the interviewee feel?
The most common method of gathering information through personal interaction is the interview (Mohan et al 2004), whether formal or informal. The interviewing process in the health professions usually begins (although not always) with a more formal setting – the initial interview. This type of interview seeks to gather both general and specific information about the person and the factors affecting the person. Whether the interview is an initial interview or not it is reassuring for the person (the interviewee) to know the purpose of the interview (Holli et al 2003). Therefore, taking the time to explain the reason for each interview is a way of demonstrating respect and care for the interviewee(s). Regardless of the particular health profession or the purpose of the interview, the major tool used in any interview is the question.
Questioning: The tool
A question is a tool and, in common with most tools, it requires skill to use questions successfully. The skill of asking questions that gather the maximum amount of desired information in the required time is valuable in all resource-stretched health professions. It is important to know the purpose of questioning, what types of questions exist, the information they typically gather and the effect that particular questions may elicit in the listener. This knowledge assists health professionals when deciding exactly what question types to use or avoid when gathering information.
Why use questions?
A health professional does not use questions only to gather information. Questions serve several purposes that contribute to family/person-centred practice. Initially, questions assist the health professional to develop trust and rapport (Mohan et al 2004, Tyler et al 2005). The right question at the right time encourages the person seeking assistance to relax and develop confidence in the health professional, and may assist them in recognising a person who is interested in them (Devito 2007). Secondly, the right question can encourage the person to communicate, either verbally or non-verbally (Milliken & Honeycutt 2004). Questions can facilitate exploration of and elaboration about particular areas and thus provide additional relevant information (Davis 2006). Questions also establish mutual understanding – they clarify whether the person understands the health professional and whether the health professional understands them. Finally, regardless of the type of question, the ultimate goal of questioning is to gather information. It is this information that will create a clear understanding of the person and thus allow the health professional to act appropriately to establish and fulfil goals relevant to that person.
Types of questions and the information they gather
There are two main types of questions – closed and open questions.
Closed questions
Closed questions elicit discreet information that is short and definite (Harms 2007, Mohan et al 2004, Tyler et al 2005). They are often recognised as questions that have a yes or no answer. For example, Is the pain sharp? Did you use the splint? Have you kept to your diet? Is your workstation comfortable?
In family/person-centred practice, after an introduction, the first question should be a closed one that seeks the permission of the person to ask some questions. For example, Is it all right if I ask you some questions? Such a question demonstrates respect, a desire to empathise (Davis 2006) and an indication that the person seeking assistance from this particular health professional may have control over the events directly relating to them. After asking this initial question it is best to use open questions until there is trust and adequate levels of rapport.
When communicating with people who do not have English as their native language it is important to remember that there are different ways of answering particular kinds of closed questions that can cause confusion. In English, the question It doesn’t hurt, does it? requires a yes if it hurts or a no if it does not hurt. In some languages such a question requires the opposite answer – yes indicates it does not hurt while no indicates it does hurt. This difference in responses provides a warning for health professionals; it indicates that the use of particular types of closed questions with individuals from non-English-speaking backgrounds requires careful clarification and negotiation to establish mutual understanding. It may be tempting to use closed questions with such people because they require minimal spoken language, however, confining the use of closed questions to simple questions may avoid confusion.
When communicating with people from a non-English-speaking background it may also be tempting to rely on movements of the head to indicate yes or no. This can also create confusion, however, because different cultures use shaking and nodding the head to mean different things. Thus, it is important for health professionals to be aware that the use of this type of non-verbal communication may also create confusion when attempting to establish mutual understanding with such individuals.
Some closed questions require specific and discreet information rather than yes or no (Mohan et al 2004). For example, Where is the pain most severe? For how long did you wear the splint? How many days did you keep to your diet? What is it about your workstation (e.g. desk, chair, computer) that causes the most discomfort or pain?
Another form of closed questioning that requires discreet or specific information is the multiple-choice question. Multiple-choice questions can be useful if people are unable to express themselves specifically. Instead, the health professional uses their knowledge of the specific situation to provide possible answers. These answers can assist the person to clarify their thoughts and thus provide an appropriate answer (Stein-Parbury 2006). Would you describe the pain as burning, sharp, dull, gripping, pressing, in a particular place or moving? is one example of a multiple-choice question.
REFLECTIVE ACTIVITY
• Think of an issue specific to your health profession and create a multiple-choice question about this issue. (If relevant you may use the questions above re pain, splinting, diet or workstation; if not, devise a relevant and appropriate question.)
• Use the question with a friend to test its clarity and effect. Explain any terms specific to your profession if necessary.
In all closed questions there is only one answer, which is short, definite and clear. The question does not require elaboration or descriptive detail. Closed questions can be useful when the health professional requires particular types of information. They demand little of the person, can save time and provide the exact answer without the complications of too much thought or too many words.
Open questions
Open questions are the other main type of question. There is no wrong or right answer to an open question. These questions give the person answering control over the interview and allow the health professional to listen, observe and learn (Harms 2007, Tyler et al 2005). Open questions are useful when the required information is not discreet and may need thoughtful use of memory, elaboration, opinion, detail and sometimes sharing of experiences and feelings. Open questions can be less threatening because they allow the person answering to control the information they give and, therefore, are best used at the beginning of an interaction. Open questions are useful when there is a need to explore or elaborate on a particular subject (Devito 2007). They are also useful when changing the subject or when gathering information from a sensitive or defensive person. Open questions may begin with How…? and What…?, but can also begin with phrases such as Tell me about….
ACTIVITY
Change the following closed questions into open ones.
• Do you feel angry?
• How many children do you have?
• Did you keep to your diet this week?
• Did you follow your exercise regimen carefully?
• Is your workstation comfortable?
Questions that probe
Questions that probe usually seek more information about a particular topic (Stein-Parbury 2006). They should encourage the person to provide more detail about the information already provided (Tyler et al 2005). The subject of probing questions usually arises from information provided during the interaction and begins with phrases such as Can you tell me more about…? What happened before…? What were you thinking when …… happened? How did you feel about…? The answers to probing questions provide specific detail about situations, people, events, thoughts and feelings. They can provide deeper insight into the person, their supports and needs and, often, their feelings.
Probing questions can also change the focus or return the focus to an earlier point in the conversation (Stein-Parbury 2006). A probing question is useful if the health professional requires information about something different to the current focus, or if the health professional thinks of something more they need to know about a previous point. Overuse of probing questions may create a negative response in the person seeking the assistance, however, because probing questions can produce the feeling of interrogation (Harms 2007). It is important to be aware of the responses of the person (see Ch 7) and react in a manner that fulfils both the general and specific goals of communication in the health professions.
Questions that clarify
Questions that clarify usually seek understanding rather than information (Stein-Parbury 2006). If the person gives information that is unclear or may be interpreted several ways, the health professional can ask for clarification or an explanation (Devito 2007, Mohan et al 2004), for example, What did you mean when you said…? Can you explain what happened…? Do you mean…? Questions that clarify can be used by either the person or the health professional. Such questions are important in order to avoid misunderstandings (Purtilo & Haddad 2002) and achieve mutual understanding. Any incomplete meaning or lack of understanding may result in assumptions that limit the possible outcomes of the interventions.
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