Challenging communication encounters
Often, people presenting with challenging communication behaviour are unwittingly expressing an unmet basic human need. 135 Understanding what underpins challenging communication behaviours, together with being aware of the behaviours that trigger an emotional response within them, 131 can assist the Triage Nurse to respond to the issue behind the behaviour rather than to the behaviour itself.
Developing a basic strategy to interpret communication behaviour quickly may assist in minimising the effects of challenging communication behaviours upon the triage assessment. Table 3.1 outlines the four basic human needs, common signals that may indicate that a need is not being met, and some basic strategies to overcome this, as suggested by Martin( 2001). 135
Table 3.1: Identifying and dealing with the four basic human needs 135
Basic human need Common signals that this need is not being met
To be understood Repeating the same message; speaking slowly and / or loudly; getting angry; bringing a support person to speak for them.
To feel welcome
To feel important – one’ s self-concept
Need for comfort – psychological and physical
Looking around before entering; looking lost or unsure.
Drawing attention to themself; getting angry; appearing helpless; loss of control.
Appearing ill at ease, nervous or unsure; requesting assistance / help.
Suggested strategies to fulfil this need
Separate emotions from content.
Ask questions, shifting the focus from the emotion to exploring the health concern.
Acknowledge their feelings; empathise with their concerns.
Reflect back your understanding. Inform them of what will happen and why.
Do not take expressions of anger personally.
Check your own reactions.
Provide a warm and friendly welcome.
Use appropriate language.
At the end of the triage encounter, keep communication lines open.
Call the person by their name; acknowledge their concerns; tune into their individual needs.
Allow anger to diffuse – listen; say nothing; allow the person to release their emotions.
Try not to react to the emotion.
Explain the procedures carefully and calmly; reassure.
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Department of Health and Ageing – Emergency Triage Education Kit