Module 5

Introduction

In module 4, we discussed formal and informal communication. We also covered informational roles and communication vehicles. In our final module for this course, we will discuss the role of emotion in communication and conclude with a section on the specifics of communication in healthcare.

This module consists of two sections:

1. The Role of Emotion in Communication
2. Communication in Healthcare

Section 1: The Role of Emotion in Communication

What are emotions? We all have them, yet when you take the time to try and explain what emotions are, you will find that they are extremely complex. Emotions are multi-faceted responses to events. Sometimes, they can be so overwhelming that many of the biochemical reactions get a little messed up. Have you ever been so happy that you cried? Or been so upset that you laugh?

In the 1970s, psychologist Paul Eckman identified six basic emotions that are experienced in all human cultures. They are happiness, sadness, disgust, fear, surprise, and anger. He later added emotions such as pride, shame, and excitement. In subsequent work, psychologist Robert Plutchik suggested that the six basic emotions are fluid in nature. He believed that, like colors, the basic emotions can mix with one another and cause a multitude of unique emotions.

Today, most social psychologists believe that there are three main categories of emotion: joyful/affectionate, hostile, and sadness.

Joyful/Affectionate

Happiness, love, and liking are all joyful/affectionate emotions. The most universally recognized emotion is happiness. Happiness is a state of joyful contentment. When we are happy, the neurotransmitters dopamine and serotonin are released within the brain. These feel-good chemicals translate to feelings of contentment and cause us to smile and our eyes to brighten.

Numerous studies have proven that happiness is contagious. However, it must be genuine happiness. As human beings, we have grown very adept at reading peoples’ emotions. Our pre-historic ancestors needed to develop these skills to determine if someone was friend or foe. These traits have been significantly honed through the generations as reading emotions correctly correlate to every aspect of our lives.

Several studies have shown that if someone in a group is faking happiness, the effect is minimal. Whereas, when someone in the group is generally happy, the moods of the group increase positively two-fold.

Within the joyful/affectionate category, while happiness is the most universally recognized, love is the most powerful. Happiness comes and goes often within minutes. However, love is far more in-depth. Do you remember your first broken heart? It probably took more than a few minutes to heal.

Hostile

Hostile includes the emotions of anger, envy, disgust, and jealousy. The most powerful among them is anger. Anger creates a rush of hormones throughout the body, chief among them adrenaline. Adrenaline increases our heart rate and puts us in a fight or flight stage. Blood surges to our hands and prepares us for swift, often violent reactions.

The Gottman Institute likens anger to an iceberg. Most of the iceberg remains hidden below the surface of the water. Similarly, anger is merely what is viewable on the surface and there are deeper underlying feelings that the anger is protecting. Often, anger is the first reaction to a much more complex emotional situation.

When we are angry, the portion of the brain that controls rational thought is subdued and the center that processes muscle reaction is heightened. For most of us, anger is an immediate response to an imposing stimulus. While it’s true that we can grow angry over time, it is more likely that we will react quickly to a trigger event.

Anger is a normal, healthy response to a perceived or real threat. It can help protect us and those around us. However, frequent anger can lead to

Sadness

Where hostile emotions often cause us to lash out, sadness has the reverse effect. We withdraw into ourselves and therefore, sadness can do as much harm as anger. Everyone feels sadness at some point in their lives. Most often, sadness is associated with loss.

When sadness becomes so overwhelming that it inhibits day to day function, we may be suffering from depression. If sadness lasts longer than two weeks, a person should be evaluated for depression. Depression is a mental disorder that can have long term debilitating effects. Often, despite a person’s life being otherwise calm, depression prevents a person from shedding sadness. Left untreated, it can become extremely serious very quickly.

Let’s return to the notion that sadness is usually associated with loss. In healthcare, loss is a common occurrence. In 1969, Elisabeth Kubler-Ross published her best-selling book ‘On Death and Dying.’ In it, she postulated a five-stage theory of grief that explains how we cope with loss.

Stage 1: Denial. The initial shock of the loss may be so overwhelming that we become numb. Our brain enters into a state of denial as a self-protect mechanism. It knows that we cannot handle everything at once. Day by day, very slowly, the cloud of denial lifts and allows us to process that which has occurred.

Stage 2: Anger. As was mentioned above with the iceberg analogy, anger is much deeper than surface value. In this case, anger is a cover for overwhelming pain. We may be angry at ourselves for not being able to save our loved one. We may be angry at our loved one for leaving us, or we may be angry with the healthcare system or even with our Higher Power for taking them from us. As with denial, anger slowly abates.

Stage 3: Bargaining. During the loss or directly right after, we may find ourselves bargaining with our Higher Power. Promises are made and devotions declared that if You do this for me, I will do this for You. We pour our souls into a plea for help. Guilt is a close companion to bargaining. A person may feel guilty for living while their loved one suffers and passes.

Stage 4: Depression. When we realize that bargaining is not working, we often fall into depression. People who have experienced severe loss have often stated that the depression stage lasts the longest. Isolation, loss of appetite, and sleep problems are common in this stage. Unfortunately, some individuals succumb to substance abuse and even suicide.

Stage 5: Acceptance. It should never be confused that acceptance means that someone is okay with the loss of their loved one. A person will truly never be okay with the loss, but, they can find a spot when the loss is accepted. We have shed our guilt, moved beyond our depression, and have learned to live our life without our loved one.

Putting it All Together

Many healthcare organizations realize the importance of empathy in providing care. Empathy is much deeper than sympathy. Where sympathy is feeling sorry or pity for someone, empathy is the focused effort of putting yourself in someone’s shoes. It is the ability to share the emotions of another person.

To fully empathize with someone, we need to know their perspective. Knowing their perspective requires communication. However, and this is from experience, communicating is not merely the use of words. Silently holding someone’s hand or providing a shoulder to cry on is far more powerful than words. When a person is ready, they will open up as long as they know you are there and more importantly that you care.

Section 2: Communication in Healthcare

Throughout the course, we have periodically referred to the field of healthcare. In this final section of the course, we will turn our full attention to communication in healthcare.

Let us start this discussion with some shocking statistics:

• 25% of hospital readmissions would be avoided with better communication.
• 71% of malpractice cases are due to miscommunication.
• 25% of patients do not follow a doctor’s advice because of poor communication.
• $400 million lost annually because of miscommunication.
• Over 300 lives are lost annually because of poor communication.

As you can see, the costs of poor communication within the field of healthcare are staggering. The reasons behind miscommunication are easy to find but are often extremely difficult to correct.

Every patient that walks into a healthcare organization has a multitude of individuals working with and for them. From receptionists to physicians and dietary staff, it is not unlikely that a dozen or more people are assigned to one patient. Factors such as understaffing, complications, poor or incomplete notes or interruptions can all adversely affect a patient.

In a recent study, 7 out of 10 patients reported that their provider was interrupted while speaking with them. As a result, three of them stated that they left the office unsure of what to do next.

As a healthcare organization, what can we do? In addition to providing empathy training, employers can train their employees to be present. One such model of patient communication that has been developed is the AWARE model.

AWARE

Announce your presence.

Welcome the patient by introducing who you are and what you do.

Ask if the patient needs anything.

Review what was done and explain what happens next.

Exit by practicing empathy.

Lastly, it is extremely imperative that you document what occurred during the visit. Some hospitals are taking this so seriously that they have worked with software companies to develop employee monitoring systems through GPS. If an employee exits a room without documenting, the system will alert the employee and ask for confirmation that there was not a need for documentation. It is too soon to determine the effectiveness of such a program, but leadership is confident that it will improve patient outcomes.

In closing, communication in healthcare is key to both patient outcomes and employee satisfaction.