CHAPTER 3 INTERPERSONAL AND GENDERED COMMUNICATION INTERPERSONAL COMMUNICATION

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CHAPTER 3: INTERPERSONAL AND GENDERED COMMUNICATION

CHAPTER 3: INTERPERSONAL AND GENDERED COMMUNICATION

 INTERPERSONAL COMMUNICATION • At the heart of all health communication • Interaction between

INTERPERSONAL COMMUNICATION • At the heart of all health communication • Interaction between two communicators who know each other and share common goals – Provider and patient – Provider and provider • Requires interdependent efforts to be successful—both parties sending and decoding messages effectively © Springer Publishing Company, LLC. 3_2

 BUILDING RELATIONSHIP • Effective interpersonal communication is required in order to initiate, build/maintain

BUILDING RELATIONSHIP • Effective interpersonal communication is required in order to initiate, build/maintain an interpersonal relationship – Provider–patient – Provider–provider – Provider–family member • Both communicators have a right to expect shared information is – Accurate – Complete – Effectively communicated © Springer Publishing Company, LLC. 3_3

 VERBAL AND NONVERBAL COMMUNICATION • Messages are sent using verbal and/or nonverbal behaviors

VERBAL AND NONVERBAL COMMUNICATION • Messages are sent using verbal and/or nonverbal behaviors • Verbal communication requires that both communicators share common symbols – These symbols refer to a common language – Symbols can also be nonverbal cues • In health care it is not uncommon for providers who use health care language in their professional culture to have difficulty translating it for patients who are not part of the health care culture © Springer Publishing Company, LLC. 3_4

 VERBAL COMMUNICATION • In the United States nearly 10% of the population cannot

VERBAL COMMUNICATION • In the United States nearly 10% of the population cannot read • Almost 50% cannot understand prescription labels • Nearly 50% are unable to read at the eighth- grade-level • Almost 20% of high school graduates cannot read © Springer Publishing Company, LLC. 3_5

 VERBAL COMMUNICATION • Armed with an understanding of the literacy levels of so

VERBAL COMMUNICATION • Armed with an understanding of the literacy levels of so many Americans, it should not be surprising that providers and patients have frequent problems communicating effectively • Health care providers often use the language of their professional culture, which is significantly above eighth-grade-level • The context of health care also negatively impacts effective communication exchanges © Springer Publishing Company, LLC. 3_6

 HEALTH CARE CONTEXT • Often associated with fear, or emotional responses due to

HEALTH CARE CONTEXT • Often associated with fear, or emotional responses due to – Illness – Injury – Uncertainty • Context of health care adds noise to the communication channel – Say the word cancer and many people immediately stop listening and focus on their fear of the disease © Springer Publishing Company, LLC. 3_7

 INTERPERSONAL VERBAL COMMUNICATION • Has two distinct types of meanings – Denotative –

INTERPERSONAL VERBAL COMMUNICATION • Has two distinct types of meanings – Denotative – Connotative • Denotative meaning is the dictionary definition, so we can all agree on what a word means • Connotative meaning is much more personal, abstract, and/or subjective © Springer Publishing Company, LLC. 3_8

 DENOTATIVE VERSUS CONNOTATIVE • So cancer has a denotative meaning related to abnormal

DENOTATIVE VERSUS CONNOTATIVE • So cancer has a denotative meaning related to abnormal cellular changes/growth • However, the connotative meaning of cancer is much more difficult to recognize. • For one person, connotative meaning of cancer is related to a friend or relative’s death • Another person’s connotative meaning of cancer might be long-term sickness from chemotherapy or radiation © Springer Publishing Company, LLC. 3_9

 DENOTATIVE VERSUS CONNOTATIVE • Important for health communication because providers may think that

DENOTATIVE VERSUS CONNOTATIVE • Important for health communication because providers may think that patient’s understand the denotative aspect of a message, but fail to assess the connotative response • So telling a patient they have a virus, might mean the flu to one person, or HIV to another • It is only through questioning (feedback) that a provider can be assured that a patient understands the meaning of the communication as it is intended © Springer Publishing Company, LLC. 3_10

 LISTENING • There is a difference between hearing and listening • Hearing is

LISTENING • There is a difference between hearing and listening • Hearing is an anatomical and physiological process – If your ears are working normally—you hear • Listening on the other hand requires – Focus – Attention – Minimal “noise” © Springer Publishing Company, LLC. 3_11

 NOISE • Anything that interferes with the communication of a message – Environmental

NOISE • Anything that interferes with the communication of a message – Environmental factors • Loud noises • Temperature extremes – Sociological factors • Economics—for example, job loss • Family—for example, death, divorce – Psychological impairments • Fear/emotions—for example, cancer © Springer Publishing Company, LLC. 3_12

 LISTENING • Providers need to actively listen to patients, not be focused on

LISTENING • Providers need to actively listen to patients, not be focused on their own data-gathering needs • Providers need to use feedback via questions, or clarifications to assure the patient’s understanding—as well as their own • Providers need to recognize that a diagnosis, prognosis, or even treatment plan could create “noise” in the communication exchange and hinder the patient’s listening abilities © Springer Publishing Company, LLC. 3_13

 LISTENING SKILLS • To improve your listening – Make his or her message

LISTENING SKILLS • To improve your listening – Make his or her message your key focus – Avoid being provider centric – Wait to type/write until the patient has finished talking – Use eye contact to demonstrate your listening – Provide feedback, via questions, or restatement of what you heard to illustrate listening, understanding, and/or confusion © Springer Publishing Company, LLC. 3_14

 FEEDBACK • Critical to effective interpersonal communication • Demonstrates to other communicator that

FEEDBACK • Critical to effective interpersonal communication • Demonstrates to other communicator that you have been listening • Identifies potential miscommunication from another, or by, you • Uses questions, or nonverbal behaviors to assess understanding • Avoid asking if you were understood, ask for restatement of what you said, to assure assimilation and comprehension © Springer Publishing Company, LLC. 3_15

 NONVERBAL COMMUNICATION • In America, research has shown we trust nonverbal communication more

NONVERBAL COMMUNICATION • In America, research has shown we trust nonverbal communication more than verbal messages. • Nonverbal behaviors are used to – Express meaning – Manage flow – Complement verbal – Contradict verbal © Springer Publishing Company, LLC. 3_16

 NONVERBAL BEHAVIORS • In the United States we use nonverbal symbols to help

NONVERBAL BEHAVIORS • In the United States we use nonverbal symbols to help receivers determine – Our emotions • Smile • Frown • Tears • Laugh – Agreement versus disagreement • Head movement – Interest/listening versus disinterest/not listening • Eye contact • Body position/movements © Springer Publishing Company, LLC. 3_17

 NONVERBAL BEHAVIORS • Status and Power are illustrated via – Artifacts—white coats, scrub

NONVERBAL BEHAVIORS • Status and Power are illustrated via – Artifacts—white coats, scrub clothes – Name tags—MD, DO, APRN, PA, RN, and so forth • Used to assess verbal messages – Complimentary nonverbals—nodding your head while verbally agreeing – Contradictory nonverbals—shaking your head, or avoiding eye contact while verbally agreeing – Emphasis—raising your volume and/or pitch, “Fire!” © Springer Publishing Company, LLC. 3_18

 NONVERBAL CUES • Proxemics • Haptics • Kinesics • Artifacts • Vocalics •

NONVERBAL CUES • Proxemics • Haptics • Kinesics • Artifacts • Vocalics • Chronemics • Olfaction © Springer Publishing Company, LLC. 3_19

 PROXEMICS • In the United States research has shown there are specific distances

PROXEMICS • In the United States research has shown there are specific distances expected in communication contexts between communicators – Normal conversations = 4 to 12 feet – Friends/platonic interactions = 2 to 4 feet – Most intimate friends/lovers = 0 to 18 inches • In health care providers often violate expected proxemics in order to assess and treat patients – © Springer Publishing Company, LLC. Should be asking permission to invade patient’s space 3_20

 HAPTICS • Haptics refers to touch – Generally reserved for close friends or

HAPTICS • Haptics refers to touch – Generally reserved for close friends or lovers – Related to control, for example, who gets to touch and when – In the United States nonapproved touch is unacceptable and/or illegal – In U. S. health care few providers ever ask permission to touch • “May I feel your wrist to take your pulse? ” • “Do you mind if I put this tourniquet on your arm to get a blood sample? ” © Springer Publishing Company, LLC. 3_21

 KINESICS • Kinesics refers to body movements – Gestures (pointing, signaling, handshake, etc.

KINESICS • Kinesics refers to body movements – Gestures (pointing, signaling, handshake, etc. ) – Gaze (eye contact, or lack of it) – Facial expressions (smile, frown, fear, joy, etc. ) – Body positions (arms crossed on chest, leaning back in a chair, sitting with legs spread out) • Posture and/or gait • Reflect a person’s role, status, power, and/or interest © Springer Publishing Company, LLC. 3_22

 ARTIFACTS • Clothes • Hair styles • Jewelry • Body art (tattoos, piercings,

ARTIFACTS • Clothes • Hair styles • Jewelry • Body art (tattoos, piercings, etc. ) • White coats, uniforms, scrub suits = provider artifacts • Patient and provider artifacts are forms of nonverbal communication © Springer Publishing Company, LLC. 3_23

 VOCALICS • Paralinguistic cues using the voice, how we say things, not what

VOCALICS • Paralinguistic cues using the voice, how we say things, not what (verbal) we say – Volume – Pitch – Tone – Silence – Inflection – Laughing, crying, whining © Springer Publishing Company, LLC. 3_24

 CHRONEMICS • The use of time communicates nonverbally – Arriving early versus late

CHRONEMICS • The use of time communicates nonverbally – Arriving early versus late for appointments, work, rendezvous, and so forth – Providers frequently arrive late for patient appointments – Patients usually arrive early, or on time for provider appointments – Can demonstrate power, control, and status in a relationship © Springer Publishing Company, LLC. 3_25

 OLFACTION • Smell communicates nonverbally – Personal hygiene – Perfume/cologne – Illness (diabetic

OLFACTION • Smell communicates nonverbally – Personal hygiene – Perfume/cologne – Illness (diabetic ketoacidosis) – Injury (burns) • For example, a lack of personal hygiene could communicate a psychosocial etiology – mental illness (dementia, etc. ) – sociological (homeless) © Springer Publishing Company, LLC. 3_26

 GENDERED COMMUNICATION • Sex versus gender – Sex is anatomical—vagina = female; penis

GENDERED COMMUNICATION • Sex versus gender – Sex is anatomical—vagina = female; penis = male • In general, we can tell a person’s sex based on their appearance – Gender is socially based • Cannot be determined based on appearance, requires analysis of behaviors • Masculine versus feminine gender spectrum • Male may be übermasculine, überfeminine, or somewhere along the spectrum • Females may be masculine, feminine, or somewhere along the spectrum © Springer Publishing Company, LLC. 3_27

 GENDERED COMMUNICATION THEORIES • Biological theory—gender is hormonally and/or genetically dependent – Testosterone

GENDERED COMMUNICATION THEORIES • Biological theory—gender is hormonally and/or genetically dependent – Testosterone levels determine levels of masculinity – Estrogen levels determine levels of femininity • Psychodynamic theory—focused on mother–child relationship – Female children identify more closely with mom because of anatomy and therefore are more likely to learn mom’s gendered behaviors – Mothers recognize need for male children to behave differently than female children © Springer Publishing Company, LLC. 3_28

 GENDERED COMMUNICATION THEORIES • Social learning theory—humans learn to be masculine versus feminine

GENDERED COMMUNICATION THEORIES • Social learning theory—humans learn to be masculine versus feminine by watching others and using feedback to determine which behaviors to adopt and which to reject – Boy praised for working on a car with dad – Daughter chastised for fighting with another girl at day care or kindergarten © Springer Publishing Company, LLC. 3_29

 GENDERED COMMUNICATION THEORIES • Cognitive development theory – Children are actively developing their

GENDERED COMMUNICATION THEORIES • Cognitive development theory – Children are actively developing their own behaviors based on • Listening • Observing • Choosing the ones that get the responses they want • Regardless of which theory is chosen, for health care providers it is important to understand that gender shapes humans’ – Lives – Communication – Decision making © Springer Publishing Company, LLC. 3_30

 MASCULINE VERSUS FEMININE GENDERED COMMUNICATION • Feminine gendered communication behaviors – Typically used

MASCULINE VERSUS FEMININE GENDERED COMMUNICATION • Feminine gendered communication behaviors – Typically used to nurture relationships • Family • Platonic • Romantic – Include valuing • Collaboration • Nurturing • Encouraging participation • Cultivating relationships © Springer Publishing Company, LLC. 3_31

 MASCULINE VERSUS FEMININE GENDERED COMMUNICATION • Masculine gendered communication behaviors – Typically used

MASCULINE VERSUS FEMININE GENDERED COMMUNICATION • Masculine gendered communication behaviors – Typically used to demonstrate independence, control, and/or power • One key masculine gendered behavior is frequently interrupting others (as health care providers have been observed doing) – Include valuing • Bluntness • Competition • Aggression • Independence © Springer Publishing Company, LLC. 3_32

 ASSESSING GENDER • Evaluating a patient’s gender using his or her communication may

ASSESSING GENDER • Evaluating a patient’s gender using his or her communication may help with provider’s – Data gathering – Information sharing – Decision making • For example, a masculine gendered patient, regardless of his or her sex, compared to a feminine gendered patient might be expected to – Not share information as readily – Not ask as many questions – Not value building a relationship as much © Springer Publishing Company, LLC. 3_33

 SELF-DISCLOSURE • One of the key aspects of interpersonal relationship development is the

SELF-DISCLOSURE • One of the key aspects of interpersonal relationship development is the use of self-disclosure – In U. S. culture, we generally save our most intimate self-disclosure for the most trusted people in our lives • Romantic relationships (“I love you”) • Platonic relationships (“please don’t tell anyone”) • Health care providers (“I had herpes, ” or “I had an abortion”) © Springer Publishing Company, LLC. 3_34

 SELF-DISCLOSURE • In all other interpersonal relationships in American culture we expect the

SELF-DISCLOSURE • In all other interpersonal relationships in American culture we expect the other communicator when we self-disclose to reciprocate – “I love you” – “I won’t tell anyone, but something like that happened to me” • However, in health care, providers do not reciprocate, but expect patient to self-disclose © Springer Publishing Company, LLC. 3_35