bh communication

8/12/2019 BH Communication

1/6

Communication

Components of empathy

- the ability to discriminate an emotional state in another person

- the capacity to assume the perspective of that person

- the ability to regulate ones emotions

- a level of self/other awareness

Empathy multidimensional construct

bottom up: automatic or unconscious affective process that allow us to recognise anothers emotional

state

top down: is the conscious cognitive process that enables us to not only explain and predict our own and

others behaviour

Benefits of empathy in patient-centred care

- Helps the patient to feel safe to discuss difficult matters- Provides a meaningful experience where the patient is facilitated in expressing themselves- Helps the patient matintain an active role in their treatment paln- Enhances dentist-patient relationship- Improves patient outcomes

4 models of patient dentist interaction

1. Consensus: patient being exempted from social roles, work, duties but the access to the sick rolerequires a gatekeeper, suited to acute rather than chronic forms of dentistry

2. Mutual dependence:a. Activity-passivity: related to patients who cannot participtate(unconscious or incapable)b. Guidance-co-operation: related to forms of acute illnessc. Mutual participation: forms of chronic illness

3. Conflict: within DP interaction degree of conflict assumption: dentist always active and patientalways passive, divergence in cultural background of the dentist and patient

4. Conflict and controla. Paternalistic (high dentist- low patient control)b. Mutualistic (diminishing conflict by apportioning equal control)c. Consumerist (patient as client or consumer)d. Default (dentist or patient take little control)neither meets each others expectation

The setting

- Facilitate or inhibit the open transmission of information- Privacy- Comfort- Sufficient time

Sharing information in dentistry

- Eliciting information from patients to diagnose the condition and understand them


2/6


3/6

Body language: open and relaxed

Interviewing techniques / Oral health instruction

-

Open ended questions- Silence- Facilitation- Confrontation- Directed or closed questions

Strategies for giving information / Oral health instruction

- Instructions should beo Simplify the informationo Brief/specifico Jargon freeo Use repetitiono Stress importance of complianceo Primary effect +7 / -2: number of objects/chunks an average human can hold in the

working memory

Compliance: extent to which the patients behavior coincides with the medical or health advice

Factors associated with non-compliance

- Social characteristicso Individuals social situationo Lack of social supporto

Family instability or disharmonyo Patients expectations and attitude towards treatmento Residential instabilityo Environment that supports non adherent behavioro Conflicting demands

- Personal characteristicso Demographicso Sensory disabilityo Type and severity of psychiatric disordero Forgetfulnesso Lack of understanding

- Health beliefso Inappropriate or conflicting health beliefo Competing socio-cultural and ethnic folk concepts of disease and treatmento Implicit model of illness

Treatment factors associated with non-compliance

Preparation for treatment

- Characteristics of treatment setting


4/6

- Long waiting time- Time between referral and appointment- Timing of referral- absence of individual appointment times- lack of cohesiveness of treatment delivery system- poor reputation of treatment facility- inconvenience associated with the operation of clinicsImmediate character of treatment

- treatment recommendations- complexity of treatment regimen- duration of treatment- degree of behavioural change- inconvenience- expense- characteristic of medicine-

inadequeate labels- awkward container designConsequence of treatment

- medication side effects- fear of side effects- fear of dependency- fear of reduced effectiveness- do not fit in with life style- sign of weakness- do not fit with health belief-

social side effects

Understanding(definitions of illness, location of organs, casuality and seriousness)

Memory (influenced by anxiety, knowledge, intellectual level, importance of statement, primacy

effect, not related to age, recalling information after the consultation may be related to compliance)

- lead to satisfaction and eventually complianceCompliance

- affective aspect: emotional support- behavioural aspect: prescribing, adequate explanation- competence: appropriate diagnosis and referral- content of the consultation: information even bad news

Communication

- affiliative styleo good eye contact


5/6

o smileso leans towards patient(show interest and consideration)o informationo technical competenceo dentist job satisfaction and adherenceo dentist view of the patient

Chronic pain

- Any pain resulting from non malignant causes that is not alleviated by appropriate medical,pharmacotherapy or surgical treatment

- Behavioural and psychological factors play an important role in the development andmaintenance of chronic pain

Pain

- Unpleasant sensory and emotional experience associated with actual or potential tissue damage- Subjective- Personal experience that encompasses both sensory(pulling, burning, aching) and

emotional(anxiety and depression) qualities

- Intensity or aversiveness of the pain experienced is not necessarily related to the severity oftissue damage

Verbal pain behaviours

- Moaning- Complaints of pain- Yelling- Sighing

Non-verbal pain behaviours

- Taking analgesic medication- Guarded movement- Grimacing- Absence from work

Assessment of chronic pain

- behavioural interview- psychological assessment measures- self-monitored behavioural observations diary- direct observation of overt motor behaiours- psycho-physiological measurements

Behavioural interview

- How the patient spends their time during the day- What activities the patient has performed more or less since the onset of pain- Whether any activities have been eliminated since the onset of pain


6/6

- The degree to which the patient is experiencing depression or other psychological disturbances- If any relative or friend or family suffer from chronic pain

McGill Pain Questinnaire

- Evaluate sensory, affective, intensity, dimension of pain- 20 categories- Ranked order of pain intensity- First 11 scales sensory

o 2: jumping, flashing, shootingo 7: hot, burning, scalding, searingo 9: dull, sore, hurting, aching, heavyo 11: tiring, exhausting

- 12-15 affecto 13: fearful, frightful, terrifying

- 16 intensityo Annoying, troublesome, miserable, intense, unbearable

-

17-20 miscellaneous pain dimensionso 18: tight, numb, drawing, squeezing, tearingo 19: cool, cold, freezing

bh communication

Documents