and non‐verbally. These will be explained, in turn, starting with non‐verbal communication, also referred to as non‐verbal attending.
Firstly, it is important to physically demonstrate that there is time for this interaction (Sally & Dallas 2010). This can be achieved by closing the door, drawing curtains and providing privacy. It is also important to ensure there are no interruptions during the interaction. Sitting with the patient, as opposed to standing over them, also shows that there is time for this interaction.
Avoiding physical barriers is very important. It is tempting to take notes to ensure nothing is forgotten, but this is an immediate barrier to effective communication (Ali 2018). Therapeutic communication should be a conversation, so taking notes is not appropriate and may make the patient feel uncomfortable. Taking notes can create pauses and breaks, and should this happen, then natural communication is stilted. The use of furniture can also be an issue. If a table is in between the healthcare professional and the patient, then there is a physical barrier which may hinder the interaction, so this should be avoided. How the healthcare professional physically presents themselves is also important, as this is another element of non‐verbal communication.
Take Note
One way to remember how to optimise communication through body posture is the pneumonic SOLER (Egan 2010). Table 5.1 provides an explanation of the mnemonic SOLER.
It is important to note that silence is a very important part of communication, and not everyone will be comfortable with that. Silence allows a person time to gather their thoughts and time to find the confidence to say what it is that they needs to say. Allowing silence will also demonstrate that the interaction is not going to be rushed and that the importance of the interaction is understood. Prince‐Paul & Kelley (2017) explain that silence can be considered as a part of mindful listening and a powerful type of non‐verbal communication.
Table 5.1 SOLER.
Source: Based on Egan (2010).
| S | Sitting squarely |
| O | Open posture (arms not crossed) |
| L | Lean forward toward the other person |
| E | Maintain appropriate Eye contact |
| R | Relax |
Box 5.2 Examples of Different Question Types Focusing on Pain
| Closed | Do you have any pain right now? |
| Leading | You have pain right now, yes? |
| Open | Tell me about your pain. |
Verbal communication is an important part of active listening, and there are two different elements to this. Verbally attending is one of these elements. As discussed earlier, the communication interaction should be a conversation; in order to aid this, the use of open questions is imperative. Closed questions – where a yes or no answer is expected – allow people to give one‐word answers which are a barrier to communication; these types of questions do not encourage patients to communicate. Leading questions – where a patient is given the answer within the question – can result in patients not stating their own feelings but what they are led to agree with. These questions do not encourage communication. Open questions allow the patients to speak from their perspective with no prior expectations from the healthcare professional. Box 5.2 illustrates how the same question can be asked in three different ways to elicit more information.
The other element of verbal communication is referred to as vocally attending by Webb & Mille (2011). It is important to make noises to demonstrate listening at appropriate points. These give the patient reassurance and cue them to continue. These noises may include the use of small words such as ‘a‐ha’, ‘hmm’ and ‘yes’. Another option is using reflective statements including ‘I understand’, ‘I see what you mean’ and ‘that sounds like it was difficult for you’. These demonstrate understanding which also gives reassurance and encouragement to continue. A further element of verbal communication in active listening is paraphrasing what has been said. By repeating back what has been said and paraphrasing it, it is clear that the patient has been heard and that can create a good level of trust between the patient and the healthcare professional. It also shows that the healthcare professional has understood the patient.
Orange Flag
frightened, or scared
lonely
fed up, or ‘a bit down’
pain, or discomfort
worried
anxious
Another way of ensuring that open questions are used is remembering the 5WH model:
What?
When?
Who?
Where?
Why?
How?
See also Chapter 2 of this text for further discussion of the 5WH model.
These 5WH questions have their origins in Aristotle’s work or even earlier (Sloan 2010) and are an excellent way of finding out information, as none of these questions can be answered with a yes or a no. This gives the patients the opportunity to use their own words to explain their situation.
Barriers to Active Listening
There are many barriers to effective communication and active listening, and healthcare does present very specific challenges. It is important to recognise these barriers and try to find a way to minimise their effect on a therapeutic relationship.
One barrier to open communication is information giving (Ali 2017). As healthcare professionals with expert knowledge, it can be tempting to want to help the person and reassure them but by interrupting and not allowing them to speak, communication is stopped. Active listening is about listening,
