Veterinarian's Corner
Study Notes onEssential Communication Skills for Veterinary Practice
Introduction
Working within veterinary practice involves coming into contact with and responding sensitively to human emotions on a daily basis. Developing effective, compassionate communication skills is essential in ensuring client care, patient welfare and reducing stress levels in the veterinary professional. Effective communication skills can:
· facilitate quicker diagnosis
· save time in consultations
· increase compliance with treatment protocols
· Enhance client perceptions of quality of care
(Broadfoot & Candrian, 2009).
Clear, unambiguous communication is essential when delivering bad news, explaining diagnoses, prognoses and treatment/referral options. Compassionate communication is at the heart of providing emotional support for distressed and grieving clients, during palliative care and bereavement. Developing a repertoire of communication skills can also help diffuse anger and reduce tension preventing escalation of volatile situations.
Within human medicine the quality of doctor – patient communication is positively correlated with psychological adjustment to chronic illness and increased satisfaction with medical care (Maguire & Pitceathly, 2002). Dissatisfied veterinary clients most frequently cite ambiguous, inadequate or unclear
communication as central in constructing difficulties, which could ultimately lead to official complaints (Gray & Moffit, 2010). Improved communication skills in doctors and nurses are linked with greater job satisfaction and reduced levels of stress (Maguire & Pitceathly, 2002) a pertinent factor for veterinary surgeons given the high suicide rate within the profession, which is four times the national average (Bartram & Baldwin, 2010; Mellanby, 2008).
Developing proficient communication skills enables clinical dialogue and partnership with clients and is the foundation for participatory care (Broadfoot & Candrian, 2009), what is often known as relationship-centred veterinary practice (Lagoni, Morehead, Brannan & Butler, 2001). Interestingly communication is not about being verbose, but rather rest on the type of communication, this is what shapes interactions with clients; the effectiveness of communication in practice can ultimately impact on animal welfare and quality of care.
Communication and relationship-centred veterinary practice
Communication skills are central within relationship-centred veterinary practice (Lagoni, et al., 2001). This paradigm of practice was first developed in the USA at The Argus Institute for Families and Veterinary Medicine at Colorado State University. Relationship-centred practice recognises and responds to the emotional needs generated by the human-companion animal relationship (HCAR) thus attends to both the medical needs of the companion animal (CA) patient and the emergent emotional needs of their owners (Lagoni et al., 2001).
Within relationship-centred veterinary practice the family member status of the CA (Dawson, 2007) is recognised, accepted and promoted within communications with owners. The guiding principles informing communication include:
· Respecting the owner’s agency
· Takes into account owner’s views, perceptions and perspectives
· Ensures animal welfare is not compromised through inadequate, unclear or unequal communication
Relationship-centred veterinary practice recognizes that there are emotional consequences for the human owner to every medical intervention; for every decision in veterinary practice there is a response in the client to the threat of a fractured or lost relationship with the CA. Adjusting to change brought about by chronic illness and disability of a loved CA may involve sensitively working with the owner’s grief reaction. Relationship-centred veterinary practice is committed to responding to these emotional needs with compassion, respecting the client’s individuality. Developing compassionate communication skills is central within this responding.
Responding to human emotions
The word emotion comes from the Latin meaning to move, excite, stir up or agitate. Stratton & Hayes (1999:90) conceptualise emotion as, “the experience of subjective feelings which have a positive or negative value for the individual.” Psychologists identify three components when working with human emotions and these are widely known as ABC:-
Emotions arise spontaneously rather than through a conscious process and are often involuntary (outside conscious control). CA owners’ felt and expressed emotions will be related to personal feelings, perceptions and beliefs; relationships between beliefs and feelings may involve past experiences; elements from reality and imagination; culture, religion, age, gender and social class. Positive human emotions (relief, happiness) are easier to be in the presence of, these can be contagious creating feelings of optimism, whereas it can feel more difficult to be in the presence of hostile, more negative human emotions such as anger or distress. Developing self-awareness (through integrated reflective practice) enables more accurate identification of the origin of moods within self and awareness of contamination by the emotions of others. It also facilitates greater awareness of possible prejudices grounded in personal experience and belief systems. This can be particularly important when working in highly emotionally charged and distressing situations, such as delivering bad news and euthanasia consultations.
Participatory care paradigms
This paradigmatic shift to a focus on the importance of human emotions and relationships in quality of client care mirrors changes in human medicine and illustrates how important communication skills are within practice (Broadfoot & Candrian, 2009). The Veterinary Consultation Model (Radford et al., 2006; Radford, 2010) is adapted from the Cambridge-Calgary Observation Guide (Silverman et al., 2006) and is now widely used in initial training for vets. The Veterinary Consultation Model (Radford et al., 2006; Radford, 2010) encompasses the following identified stages:
· Preparation
· Initiating the consultation
· Gathering information
· Physical examination of the companion animal
· Exploration and planning
· Closing the consultation
Present throughout these stages are:
· Providing structure to the consultation
· Building a relationship with the client
This programme aims to create awareness of and develop basic essential communication skills for veterinary surgeons to enable relationship building with clients. Aspects of both verbal and non-verbal communication will be explored, but before introducing these it is necessary to take a closer look at what is generally understood by these terms.
Defining terms: what is communication?
Communication enables people to initiate and sustain interactions with each other.
Communication involves conveying messages and shared understanding of the meaning of these. How the message is put across can enhance or hinder understanding (Kirwan, 2010). Communication is generally considered to be dynamic and on-going rather than a linear process (Hargie, 2007; Kirwan, 2010). As such communication is fluid, ever evolving because each contact is unique and specific (Kirwan, 2010). It can involve spoken words or sign language and essentially includes non-verbal communication (body-language). Effective communication within medical settings has been identified as involving:
· Observing and listening
· Reinforcing and encouraging
· Questioning
· Responding
· Giving information
(MacLeod Clark 1983 cited in Kirwan, 2010).
This expands the notion of what communication is from merely involving words to include interchange of perspectives and perceptions, as well as information. Of course within veterinary practice there are time constraints creating additional considerations.
How clients experience the practice environment e.g. are the consult rooms warm and welcoming or cold and clinical also shapes communication and can convey subliminal messages as well as initiate reactions
(both conscious and subconscious). Ways of communicating empathy and care through the practice environment are also explored in this programme as central within pre-consult preparation.
Defining terms: verbal communication
Words have power because we respond to them (Redmond, 2000). Verbal communication, using spoken words may be construed as unique to human beings, but this is arguable as research with other primates demonstrates. Verbal communication involves shared understanding of the language used, mutuality and reciprocity and interpersonal feedback. Tone of voice, emphasis on particular words, pitch and intonation all play their part in ensuring clarity and providing a portal into the personal meanings ascribed by both the speaker and listener. Similarly the role and value of silence should never be underestimated.
Verbal communication involves using a language; it requires an ability to send and receive messages (spoken or signed). Cultural considerations always need to be taken into account in addition to local dialects (present even within sign language).
In veterinary practice verbal communication involves asking questions, seeking clarification, providing information and checking understanding (Gray & Moffit, 2010). Partnership is central within communicating with clients and moves towards relationship-centred veterinary practice follow a participatory approach to client consults (Gray & Moffit, 2010). This requires creating rapport with a client, actively engaging interest in the client for their participation in their CA’s care. Open questioning techniques and reflective listening skills will be introduced later on with examples from practice to illustrate their importance in client-care and in enhancing quality of CA care too.
Of course verbal communication does not take place in vacuum it happens within social and cultural context which can be particularly salient in understanding body language i.e. non-verbal communication.
Defining terms: non-verbal communication
Much of the meaning we gain from communication is from non-verbal cues (Kirwan, 2010) and these are used powerfully to convey emotions such as warmth and acceptance. Most of human communication is actually non-verbal e.g.
· facial expressions
· eye content and gaze
· Posture and proximity
· Touch
· Personal appearance and the environment
(adapted from Kirwan, 2010:8).
Within practice attention to the environment is also essential. In the USA in line with principles of relationship-centred veterinary practice some practices and veterinary teaching hospitals, e.g. The Argus Institute (for Families and Veterinary Medicine at Colorado State University) have developed client comfort rooms.
These dedicated rooms either double up as consult rooms or are bespoke for end of life care consultations e.g. euthanasia decision making, pre-euthanasia discussions and euthanasia consults. These rooms are usually painted pastel shades, known to create a sense of calm and a less cold, clinical environment. Pictures, information about grief, non-toxic plants all create a sense of not being hurried or rushed, generate privacy and facilitate a more personal approach to delivering bad news.
In regular consult rooms, attention to colour schemes and pictures on the wall, ensuring there is somewhere to sit and paper tissues are available can make a massive difference in communicating, mutuality, respect and partnership within participatory care and relationship-centred veterinary practice.
Non-verbal communication involves picking up cues and must always take into account individual culture, e.g. in Japan engaging in direct eye contact is considered rude whereas in white Western this is taken to be a sign of attending behaviour and being fully present (Nelson-Jones, 2008). Cultural considerations shape human interactions.
Having an understanding of what is meant by communication we will now look at some essential communication skills beginning by looking at empathy, communicating empathy and reflective listening.
The core conditions
In 1957 Humanistic Psychologist Carl Rogers identified what have become known as the core conditions for therapeutic change: empathy, unconditional positive regard and congruence which form the foundation for reflective listening.
Empathy is an active process which helps access another’s feelings and experiences “as if” they were our own, but without ever losing that “as if” quality.
Empathy can be communicated in reflections these usually begin with “you” as these reflections are from the other’s perspective and frame of reference rather than our own. Responses from a client’s internal frame of reference can be more difficult than it first sounds. Nelson-Jones (2008) identifies empathy as a process
involving different dimension including: observing and listening, resonating, discriminating, communicating and checking. Having awareness of this process and putting it into practice can be really helpful in taking the client’s internal frame of reference.
In-practice example A
Dimensions of Empathy
(adapted from Nelson-Jones, 2008:30)
Euthanasia decision making and pre-euthanasia discussions are often emotionally charged and difficult for both client and vet. Communicating empathy within these consults is crucial. Euthanasia decision making should ideally never feel forced or rushed, although some emergency situations generate the need for a more prompt euthanasia decision to protect animal welfare.
Client: “I don’t know how to describe my feelings about making a decision – Monty is such a part of our life, part of the family but I can see how his hard things are for him on a daily basis and this leaves me feeling bad. Am I keeping him going just for me, just for us? Am I being selfish? I don’t know what the right thing is for him.”
Vet’s responding processes during consult
Observing and listening: observes and looks for emotions conveyed in body-language, listens carefully to spoken words.
Resonating: Uses empathy to put themselves in the client’s position and see things from their perspective, this helps gain an understanding of the complexities and difficulties.
Discriminating: Discriminates what is central for the client and makes this integral and the focus of their response. This response does not compromise what is in the companion animal patient’s best welfare interests but enables the opportunity for clarification and further exploration.
Communicating: “It feels difficult - you need to feel you are making the right decision for Monty, he is a part of your family and it is important for you his welfare comes first.”
This response demonstrates the vet’s grasp of the difficulty of both talking about the possibility of euthanasia for Monty and of making the decision; it shows the vet’s understanding of their client’s main concern that she is putting her dog’s welfare first and not being selfish.
Checking: The vet can leave a pause to check out if her understanding is accurate or ask their client directly, “have I got this right ?”
These dimensions of empathy allow a deeper level of communication that enables understanding and creates more of the vet-client partnership at the heart of relationship-centred veterinary practice.
Unconditional positive regard: this in essence is about communicating warmth and acceptance to a client and has two dimensions: level of acceptance/regard and unconditionality (Nelson-Jones, 2008). Feeling totally non-judgemental about some clients can be difficult where an animal’s welfare may be have compromised as a result of their actions. This can be particularly true in cases of animal abuse and suspected NAI (non-accidental injury). However behaving in a non-judgemental way i.e. not allowing judgement and personal prejudices to hamper communication and hinder the vet-client relationship is an important facet of professionalism. An alternative way of understanding unconditional positive regard is prizing the individual and respecting their uniqueness.
Congruence: Genuineness involves being aware of our own feelings, beliefs and processes; it requires self-awareness, transparency and honesty. For a vet in practice communicating authenticity, professionalism and integrity to clients builds rapport helping to build a trusting relationship. Congruence essentially involves being real.
These core conditions are essential prerequisites for reflective listening.
Reflective Listening
There is a difference between hearing and listening. Hearing involves receiving sounds but listening involves understanding what these sounds mean accurately. Reflective listening extends to feeding back that understanding to the client. This enables checking out if we have understood correctly what they have told us.
When hearing someone talk it is all too easy to become distracted by noises in the environment e.g. a barking dog in the waiting room, internal thought processes (e.g. a row with a partner before work) or our own past experiences. When we listen it requires focussed attention and showing that in our body-language to the client (eg. assuming an open posture, engaging in eye contact). This is often known as attending behaviour (being available to a client) and also has verbal components that tell the client we are fully present for them, listening and understanding what they are saying, thinking and feeling. To understand a client’s perspective requires seeing and responding to their internal frame of reference (i.e. their perspective) rather than the vet’s own perspective (external frame of reference).
In-practice example B
Vet responses from internal and external frames of reference
External frame of reference responses:
“I would have responded more quickly than you to these symptoms”
“I think you could give your cat these pills if you really tried”
“You seem very emotional about your dog’s heart condition.”
“That sounds like a plan.”
Internal frame of reference responses:
“You are beating yourself up about not bringing her in to be checked out sooner than you did.”
“You are really struggling to give your cat his pills” this can then be followed by practical non-judgemental advice and demonstrations. Following up with a written information sheet can be helpful.
“You are feeling very upset and worried about how the heart condition may impact on your dog’s quality of life.” This statement validates and respects the client’s anxiety and can be followed up by clear information about the condition, including options for referral. Again written information can be helpful in reinforcing and clarifying understanding. The emotional component for the client of receiving a diagnosis and prognosis should always actively acknowledged, this communicates recognition of the importance of the companion animal as an individual and in the life-world of its owner.
“You have thought this through carefully and your care-plan seems a good fit.”
Avoiding sweeping statements that can be construed as dismissive is important within the vet-client relationship, it communicates that the client’s participation in the care of their animal is valued and recognised by the practice team.
Starting a response with “YOU” is helpful but does not always communicate understanding from the client’s internal frame of reference as the statement: “You seem very emotional about your dog’s heart condition,” shows. Emotionally loaded this could easily be construed as pejorative and judgemental, when in reality it is normal to feel upset about receiving a diagnosis for your dog of mitral valve disease! Normalising emotions such as distress communicates respect to clients. A simple paraphrased reflection communicates recognition and validates an emotion.
Reflective listening skills
Being available and communicating this availability to a veterinary client is unique because of the vet-client-animal patient triad. Examining the animal necessarily removes the focus from the owner to the animal, but getting the balance right in explaining what you are doing in clear unambiguous terms and occasionally looking at the owner communicates recognition of them, their contribution in diagnosis and their value as a client. This is partnership in care and animal welfare.
Adopting a professional, but relaxed and open body posture (without slumping or slouching) creates a sense of accessibility and approachability. This can help clients feel more able to ask questions and feel less intimidated by the clinical context. Using culturally sensitive and appropriate gaze and eye contact communicates “being with” and caring about the client. Staring, holding a gaze too long can be perceived as hostile; looking down or away or towards the door or the clock can give the sense of you wanting a client to leave or being disinterested in them or their animal.
Facial expressions are powerful in communication, conveying interest, fear, disgust, sadness, anger/hostility, surprise and happiness. A great deal of facial information is communicated through the mouth and eyebrows (Nelson-Jones, 2008); a smile can instantly communicate acceptance and warmth, whereas as a frown can convey judgement, anxiety or concern. Mirroring client’s emotions through facial expression and body language can be an important part of communicating empathy, however there are times in practice this not useful e.g. in trying to diffuse tension in an angry client emotions will intensify and escalate if the vet mirrors back angry facial expressions or uses hostile body language. Modelling (i.e. demonstrating to clients) calm, accepting and more neutral emotions can actually diffuse anger and this has a neurophysiological basis generated by mirror neurones in the brain (Rothschild & Rand, 2006).
Similarly gestures are important in reflective listening; a head nod is a common gesture that we are listening and can be perceived as a reward encouraging a client to continue talking, this can be useful in gathering information. Selective head nods though can be a means of controlling clients in communicating conditional acceptance; although sometimes within veterinary practice this is necessary to reinforce positive client behaviour. The use of touch with clients can be appropriate in some circumstances e.g. a gentle touch on the elbow or arm when a client is crying, but the intensity and duration of touch/contact should be sufficient to communicate care but not invade or intrude and particularly not be misconstrued as sexual interest (Nelson-Jones, 2008). Generally the upper back and arms are “safe” touch zones. Whilst touch is not off limits it should be used sparingly and with caution. Personal space should also be respected within the limitations of the consult room and examination of the animal.
Reflective listening also involves the following key verbal communication skills:
Paraphrasing, reflecting back and re-stating
Paraphrasing involves reflecting back to the client what they have said but using different words. There may be times when re-stating i.e. using the exact same word is more powerful and appropriate
Client: He starts coughing when he moves position and it is a deep cough that doesn’t bring anything up, but it is raucous.
Vet: Racous?
Using a questioning inflection with this re-statement enables the vet to seek clarification of what the client means by a raucous cough. Reflecting back involves repeating what the client has said verbatim using their words. This is a communication technique used to validate feelings and can be used to clarify understanding of what has been said depending on tone and intonation.
Paraphrasing is very useful in consults when gathering information, it requires brief, re-wording of the client’s key messages. It is important to try to keep close to the client’s own language.
In-practice example C
Example of paraphrasing
Client: After a long walk Hovis and of makes this creaking knows, well it’s more like a crack or a pop really then he starts limping on his left side. He doesn’t want his treats either, just loses interest in everything and seems really sorry for himself. He cannot run he just hobbles about.
Vet: You hear a popping sound after Hovis has been exercising; he loses interest in playing and food and cannot walk easily.
Competent paraphrasing is succinct and mirrors back in a way that provides clarity for the client as to what they have said. Summarising is similar to paraphrasing but is usually at the end of a consult or mid-way and is used to check out understanding and clarify information gathered so far.
Reflecting and mirroring client feelings within paraphrasing and summarising is an important skill. Identifying a client’s feelings can be tricky and time consuming; this often leads to side lining or minimising of client feelings in practice due to time constraints and fear of opening up a Pandora’s box without adequate skills to manage the emotions released. However attention to body messages e.g. how the client looks: sad,
angry, tired, crying can convey more than the spoken word and provide almost immediate access to feelings. Similarly noticing a client’s voice its pitch, tone and quality can alter when a client is angry, upset or weary; shouting is possibly the most obvious example of how voice can convey emotions. Sometimes clients may talk about their own physical reactions to observing their animal’s distress, decline or in response to a diagnosis e.g. “my heart was pounding, I had butterflies in my stomach.” If and how the client uses “feeling words” e.g. angry, sad, anxious, frustrated, can provide a portal into understanding the impact of a consultation on a client and inform sensitive responding. It is important to ensure that the practice has written support information for clients disclosing deep distress e.g. a practice information sheet of useful contact such as The Blue Cross Pet Bereavement Support Service, The Samaritans and Childline. Clients need to feel their vet has empathic understanding of their emotions. Reflecting feelings can powerfully communicate empathy and understanding. Opening reflections with “You feel” is a useful tool for this communication skill. Using a different word to the client’s to describe their feelings helps check out accuracy of your understanding. Wherever possible always communicate back the client’s dominant feelings (Nelson-Jones, 2008).
In-practice example D
Example of reflecting feelings
Client: I really feel worn out with this care regime for Pepa it is night and day I am giving him medication and then he is sick. I am feeling worn down by it.
Vet: You are exhausted from caring for Pepa round the clock.
It is important not reflect every feeling back to the client only the most salient for them. Small verbal rewards help to tell a client you are listening, understand them and are there for them:
Examples of verbal rewards
Please tell me more
Carry on
I am hearing you
Yes
Uh –hum
OK
So…
(adapted from Nelson-Jones, 2008:60).
Keeping the conversation and consult moving and making sure time is used well and usefully is a paramount concern. Using open questioning is facilitative of information gathering and also embraces principles of partnership in care because it enables the client to talk, offer their perceptions and perspectives and have these valued.
Open questioning
Open questions most often begin with:
· What ?
· How?
· When?
· Where?
· Why?
Using why can be delicate as it can infer judgement or feel like interrogation.
It is impossible answer an open question with a yes/no reply. Clearly without a consult there is a place for open questions and also for closed questions. Closed questions elicit a yes, no, sometimes response.
In-practice example E
Using open and closed questions
Vet: Has Ellie vomited?
Client: Yes.
Vet: What colour was it?
Client: Kind of green and frothy but it didn’t look to have any food in it.
Vet: How often is Ellie vomiting?
Client: A few times a day.
Vet: When in the day?
Client: There doesn’t seem to be an established pattern although it tends to be after having a drink of water. I feel awful watching her I am powerless to know what to do.
Vet: You have noticed she vomits after having a drink and you are feeling really upset because you don’t know how to stop it.
Here the vet interweaves reflections of the client’s main feelings skilfully whilst keeping on task in gathering relevant clinical information. Identifying, reflecting and responding to client’s emotions are not at odds with clinical consults. Putting into practice some key communication skills enables sensitive responding, the building of trust and rapport. This in turn generates a real sense of partnership in care.
Finally we will briefly look at ways the practice environment can communicate this ethos of partnership and care to clients.
Communicating through the environment
Creating a safe, ethical and professional emotion friendly climate involves paying attention to aspects of the environment and client support resources available.
In the USA, as previously described, some veterinary hospitals have developed client comfort rooms as more personal, private space for delivering bad news and euthanasia consults. More recently practices in the UK have followed this example and this also mirrors practice in human medicine with Family rooms. These dedicated spaces are more emotion friendly and this climate is created by careful attention to colour scheme e.g. pale greens and blues have been identified as having a calming effect. Ensuring there is somewhere comfortable for clients to sit if they want to and provision of padded mats to enable floor euthanasia of large dogs or where this best meets needs of companion animal and client.
Not every practice has the space or finances to develop comfort/family rooms, but a consult room can serve dual function. It is imperative that choice of colour scheme and availability of resources e.g. paper tissues, clay paw mould to make paw print impressions, having a Practice Book of Remembrance to memorialise deceased animals – all of these aspects of the environment communicate care and the importance of partnership between owner and practice in the care of their animal.
From the moment a client enters the practice impressions are made. Informative, interesting displays that tell clients about the services the practice offers e.g. nurse facilitated clinics, animal welfare education displays all communicate key messages about the practice and quality of care for client and animal patient.
This programme has introduced essential communication skills for veterinary surgeons and has situated these within the wider paradigms of models of veterinary practice grounded in the importance of establishing and building relationships and actively promoting partnership in care. Developing these communication skills involves practice; an integral aspect is developing self-awareness and reflective practitioner skills. Putting these essential communication skills into practice will enhance quality of client care, strengthen trust and enable greater professional comfort and satisfaction in providing safe and ethical emotional support for clients.
Recommended reading
Dr Susan Ella Dawson PhD MEd BA (Hons) PGCE MBPS MBACP, Psychologist and Consultant in Human-Animal Relationships
Dawson, S.E., Fowler, J., Ormerod, E., & Sheridan, L. (2007). Towards a Bond-Centred Practice. Veterinary Review, 134, 18-19.
Gray, C. & Moffit J. (2010). The Handbook of Veterinary Communication Skills.
Wiley-Blackwell: West Sussex.
Nelson-Jones, R. (2008). Basic Counselling Skills: A Helper’s Manual (2nd edtion).
Sage: London,
References
Dr Susan Ella Dawson PhD MEd BA (Hons) PGCE MBPS MBACP
Psychologist and Consultant in Human-Animal Relationships
Bartram, D.J., Sinclair, M.A., & Baldwin, D.S. (2010). Interventions with potential to improve the mental health and wellbeing of UK veterinary surgeons. Veterinary Record, 166(17), 518-523.
Broadfoot, K.J. & Candrian, C. (2009). Relationship-centred care and clinical dialogue: Toward New Forms of Care-full” communication. Natural Medicine Journal, 1(4), 1-2.
Dawson, S.E. (2007). Companion Animal Euthanasia: The Lived Paradox of the Human-Companion Animal Bond. Doctoral Dissertation. School of Psychology, Health and Social Care, Manchester Metropolitan University: Manchester, UK.
Dawson, S.E. (2010). Compassionate communication: working with grief. In C. Gray, & J. Moffett, (Eds.), Handbook of Veterinary Communication Skills, (pp. 62-98). West Sussex: Wiley Blackwell.
Gray, C. & Moffit J. (2010). The Handbook of Veterinary Communication Skills. Wiley-Blackwell: West Sussex.
Kirwan, M. (2010). Basic Communication Skills. In C. Gray, & J. Moffett, (Eds.), Handbook of Veterinary Communication Skills, (pp. 1-38). West Sussex: Wiley Blackwell.
Lagoni, L., Morehead, D., Brannan, J., & Butler, C. (2001). Guidelines for Bond-Centred Practice. Fort Collins, Colorado: Argus Institute for Families and Veterinary Medicine, Colorado State University.
Maguire, P. & Pitceathly, C. (2002). Key communication skills and how to acquire them. British Medical Journal, 325. 697-700.
Mellanby, R.J. (2005). Suicide in the veterinary profession (pp. 203-205). Proceedings Fecava Symposium held during FECAVA/WSAVA, VICAS Congress, Dublin.
Nelson-Jones, R. (2008). Basic Counselling Skills: A Helper’s Manual (2nd edtion). Sage: London,
Radford, A., Stockley, P., Silverman, J., Taylor, I., Turner, R., Gray, C. Bush, L. Glyde,M., Healy, A., & Dale Winter, A. (2006). Development, teaching and evaluation of consultation structure model for use in veterinary education. Journal of Veterinary Medical Education, 33(1), 38-44.
Radford, A. (2010) A framework for the Veterinary consultation. In C. Gray, & J. Moffett, (Eds.), Handbook of Veterinary Communication Skills, (pp. 25-38). West Sussex: Wiley Blackwell.
Redmond, M.V. (2000). Communication: Theories and Applications. Houghton Mifflin: Boston.
Rogers, C. (1957). The necessary and sufficient conditions of therapeutic personality change, Journal of Consulting Psychology, 21(3), 95-104.
Rothschild, B. & Rand, M. (2006). The psychophysiology of Compassion Fatigue and Vicarious Trauma. Help for the Helper Self-care Strategies for Managing Burn-put and Stress. Norton: New York.
Stratton, P. & Hayes, N. (1999). A Student’s Dictionary of Psychology. Arnold: London, 90.
Introduction
Working within veterinary practice involves coming into contact with and responding sensitively to human emotions on a daily basis. Developing effective, compassionate communication skills is essential in ensuring client care, patient welfare and reducing stress levels in the veterinary professional. Effective communication skills can:
· facilitate quicker diagnosis
· save time in consultations
· increase compliance with treatment protocols
· Enhance client perceptions of quality of care
(Broadfoot & Candrian, 2009).
Clear, unambiguous communication is essential when delivering bad news, explaining diagnoses, prognoses and treatment/referral options. Compassionate communication is at the heart of providing emotional support for distressed and grieving clients, during palliative care and bereavement. Developing a repertoire of communication skills can also help diffuse anger and reduce tension preventing escalation of volatile situations.
Within human medicine the quality of doctor – patient communication is positively correlated with psychological adjustment to chronic illness and increased satisfaction with medical care (Maguire & Pitceathly, 2002). Dissatisfied veterinary clients most frequently cite ambiguous, inadequate or unclear
communication as central in constructing difficulties, which could ultimately lead to official complaints (Gray & Moffit, 2010). Improved communication skills in doctors and nurses are linked with greater job satisfaction and reduced levels of stress (Maguire & Pitceathly, 2002) a pertinent factor for veterinary surgeons given the high suicide rate within the profession, which is four times the national average (Bartram & Baldwin, 2010; Mellanby, 2008).
Developing proficient communication skills enables clinical dialogue and partnership with clients and is the foundation for participatory care (Broadfoot & Candrian, 2009), what is often known as relationship-centred veterinary practice (Lagoni, Morehead, Brannan & Butler, 2001). Interestingly communication is not about being verbose, but rather rest on the type of communication, this is what shapes interactions with clients; the effectiveness of communication in practice can ultimately impact on animal welfare and quality of care.
Communication and relationship-centred veterinary practice
Communication skills are central within relationship-centred veterinary practice (Lagoni, et al., 2001). This paradigm of practice was first developed in the USA at The Argus Institute for Families and Veterinary Medicine at Colorado State University. Relationship-centred practice recognises and responds to the emotional needs generated by the human-companion animal relationship (HCAR) thus attends to both the medical needs of the companion animal (CA) patient and the emergent emotional needs of their owners (Lagoni et al., 2001).
Within relationship-centred veterinary practice the family member status of the CA (Dawson, 2007) is recognised, accepted and promoted within communications with owners. The guiding principles informing communication include:
· Respecting the owner’s agency
· Takes into account owner’s views, perceptions and perspectives
· Ensures animal welfare is not compromised through inadequate, unclear or unequal communication
Relationship-centred veterinary practice recognizes that there are emotional consequences for the human owner to every medical intervention; for every decision in veterinary practice there is a response in the client to the threat of a fractured or lost relationship with the CA. Adjusting to change brought about by chronic illness and disability of a loved CA may involve sensitively working with the owner’s grief reaction. Relationship-centred veterinary practice is committed to responding to these emotional needs with compassion, respecting the client’s individuality. Developing compassionate communication skills is central within this responding.
Responding to human emotions
The word emotion comes from the Latin meaning to move, excite, stir up or agitate. Stratton & Hayes (1999:90) conceptualise emotion as, “the experience of subjective feelings which have a positive or negative value for the individual.” Psychologists identify three components when working with human emotions and these are widely known as ABC:-
- Affective – i.e. feelings e.g. relief, dread, fear, anger
- Behavioural – movements or actions a person engages in (voluntary and involuntary) e.g. shouting which could be associated with feelings of anger, crying with grief and feelings of deep sadness
- Cognitive – thinking, decision making, reasoning; when an owner is distressed it can be difficult for them to think clearly and rationally this may impact on ability to understand verbal and written information.
Emotions arise spontaneously rather than through a conscious process and are often involuntary (outside conscious control). CA owners’ felt and expressed emotions will be related to personal feelings, perceptions and beliefs; relationships between beliefs and feelings may involve past experiences; elements from reality and imagination; culture, religion, age, gender and social class. Positive human emotions (relief, happiness) are easier to be in the presence of, these can be contagious creating feelings of optimism, whereas it can feel more difficult to be in the presence of hostile, more negative human emotions such as anger or distress. Developing self-awareness (through integrated reflective practice) enables more accurate identification of the origin of moods within self and awareness of contamination by the emotions of others. It also facilitates greater awareness of possible prejudices grounded in personal experience and belief systems. This can be particularly important when working in highly emotionally charged and distressing situations, such as delivering bad news and euthanasia consultations.
Participatory care paradigms
This paradigmatic shift to a focus on the importance of human emotions and relationships in quality of client care mirrors changes in human medicine and illustrates how important communication skills are within practice (Broadfoot & Candrian, 2009). The Veterinary Consultation Model (Radford et al., 2006; Radford, 2010) is adapted from the Cambridge-Calgary Observation Guide (Silverman et al., 2006) and is now widely used in initial training for vets. The Veterinary Consultation Model (Radford et al., 2006; Radford, 2010) encompasses the following identified stages:
· Preparation
· Initiating the consultation
· Gathering information
· Physical examination of the companion animal
· Exploration and planning
· Closing the consultation
Present throughout these stages are:
· Providing structure to the consultation
· Building a relationship with the client
This programme aims to create awareness of and develop basic essential communication skills for veterinary surgeons to enable relationship building with clients. Aspects of both verbal and non-verbal communication will be explored, but before introducing these it is necessary to take a closer look at what is generally understood by these terms.
Defining terms: what is communication?
Communication enables people to initiate and sustain interactions with each other.
Communication involves conveying messages and shared understanding of the meaning of these. How the message is put across can enhance or hinder understanding (Kirwan, 2010). Communication is generally considered to be dynamic and on-going rather than a linear process (Hargie, 2007; Kirwan, 2010). As such communication is fluid, ever evolving because each contact is unique and specific (Kirwan, 2010). It can involve spoken words or sign language and essentially includes non-verbal communication (body-language). Effective communication within medical settings has been identified as involving:
· Observing and listening
· Reinforcing and encouraging
· Questioning
· Responding
· Giving information
(MacLeod Clark 1983 cited in Kirwan, 2010).
This expands the notion of what communication is from merely involving words to include interchange of perspectives and perceptions, as well as information. Of course within veterinary practice there are time constraints creating additional considerations.
How clients experience the practice environment e.g. are the consult rooms warm and welcoming or cold and clinical also shapes communication and can convey subliminal messages as well as initiate reactions
(both conscious and subconscious). Ways of communicating empathy and care through the practice environment are also explored in this programme as central within pre-consult preparation.
Defining terms: verbal communication
Words have power because we respond to them (Redmond, 2000). Verbal communication, using spoken words may be construed as unique to human beings, but this is arguable as research with other primates demonstrates. Verbal communication involves shared understanding of the language used, mutuality and reciprocity and interpersonal feedback. Tone of voice, emphasis on particular words, pitch and intonation all play their part in ensuring clarity and providing a portal into the personal meanings ascribed by both the speaker and listener. Similarly the role and value of silence should never be underestimated.
Verbal communication involves using a language; it requires an ability to send and receive messages (spoken or signed). Cultural considerations always need to be taken into account in addition to local dialects (present even within sign language).
In veterinary practice verbal communication involves asking questions, seeking clarification, providing information and checking understanding (Gray & Moffit, 2010). Partnership is central within communicating with clients and moves towards relationship-centred veterinary practice follow a participatory approach to client consults (Gray & Moffit, 2010). This requires creating rapport with a client, actively engaging interest in the client for their participation in their CA’s care. Open questioning techniques and reflective listening skills will be introduced later on with examples from practice to illustrate their importance in client-care and in enhancing quality of CA care too.
Of course verbal communication does not take place in vacuum it happens within social and cultural context which can be particularly salient in understanding body language i.e. non-verbal communication.
Defining terms: non-verbal communication
Much of the meaning we gain from communication is from non-verbal cues (Kirwan, 2010) and these are used powerfully to convey emotions such as warmth and acceptance. Most of human communication is actually non-verbal e.g.
· facial expressions
· eye content and gaze
· Posture and proximity
· Touch
· Personal appearance and the environment
(adapted from Kirwan, 2010:8).
Within practice attention to the environment is also essential. In the USA in line with principles of relationship-centred veterinary practice some practices and veterinary teaching hospitals, e.g. The Argus Institute (for Families and Veterinary Medicine at Colorado State University) have developed client comfort rooms.
These dedicated rooms either double up as consult rooms or are bespoke for end of life care consultations e.g. euthanasia decision making, pre-euthanasia discussions and euthanasia consults. These rooms are usually painted pastel shades, known to create a sense of calm and a less cold, clinical environment. Pictures, information about grief, non-toxic plants all create a sense of not being hurried or rushed, generate privacy and facilitate a more personal approach to delivering bad news.
In regular consult rooms, attention to colour schemes and pictures on the wall, ensuring there is somewhere to sit and paper tissues are available can make a massive difference in communicating, mutuality, respect and partnership within participatory care and relationship-centred veterinary practice.
Non-verbal communication involves picking up cues and must always take into account individual culture, e.g. in Japan engaging in direct eye contact is considered rude whereas in white Western this is taken to be a sign of attending behaviour and being fully present (Nelson-Jones, 2008). Cultural considerations shape human interactions.
Having an understanding of what is meant by communication we will now look at some essential communication skills beginning by looking at empathy, communicating empathy and reflective listening.
The core conditions
In 1957 Humanistic Psychologist Carl Rogers identified what have become known as the core conditions for therapeutic change: empathy, unconditional positive regard and congruence which form the foundation for reflective listening.
Empathy is an active process which helps access another’s feelings and experiences “as if” they were our own, but without ever losing that “as if” quality.
Empathy can be communicated in reflections these usually begin with “you” as these reflections are from the other’s perspective and frame of reference rather than our own. Responses from a client’s internal frame of reference can be more difficult than it first sounds. Nelson-Jones (2008) identifies empathy as a process
involving different dimension including: observing and listening, resonating, discriminating, communicating and checking. Having awareness of this process and putting it into practice can be really helpful in taking the client’s internal frame of reference.
In-practice example A
Dimensions of Empathy
(adapted from Nelson-Jones, 2008:30)
Euthanasia decision making and pre-euthanasia discussions are often emotionally charged and difficult for both client and vet. Communicating empathy within these consults is crucial. Euthanasia decision making should ideally never feel forced or rushed, although some emergency situations generate the need for a more prompt euthanasia decision to protect animal welfare.
Client: “I don’t know how to describe my feelings about making a decision – Monty is such a part of our life, part of the family but I can see how his hard things are for him on a daily basis and this leaves me feeling bad. Am I keeping him going just for me, just for us? Am I being selfish? I don’t know what the right thing is for him.”
Vet’s responding processes during consult
Observing and listening: observes and looks for emotions conveyed in body-language, listens carefully to spoken words.
Resonating: Uses empathy to put themselves in the client’s position and see things from their perspective, this helps gain an understanding of the complexities and difficulties.
Discriminating: Discriminates what is central for the client and makes this integral and the focus of their response. This response does not compromise what is in the companion animal patient’s best welfare interests but enables the opportunity for clarification and further exploration.
Communicating: “It feels difficult - you need to feel you are making the right decision for Monty, he is a part of your family and it is important for you his welfare comes first.”
This response demonstrates the vet’s grasp of the difficulty of both talking about the possibility of euthanasia for Monty and of making the decision; it shows the vet’s understanding of their client’s main concern that she is putting her dog’s welfare first and not being selfish.
Checking: The vet can leave a pause to check out if her understanding is accurate or ask their client directly, “have I got this right ?”
These dimensions of empathy allow a deeper level of communication that enables understanding and creates more of the vet-client partnership at the heart of relationship-centred veterinary practice.
Unconditional positive regard: this in essence is about communicating warmth and acceptance to a client and has two dimensions: level of acceptance/regard and unconditionality (Nelson-Jones, 2008). Feeling totally non-judgemental about some clients can be difficult where an animal’s welfare may be have compromised as a result of their actions. This can be particularly true in cases of animal abuse and suspected NAI (non-accidental injury). However behaving in a non-judgemental way i.e. not allowing judgement and personal prejudices to hamper communication and hinder the vet-client relationship is an important facet of professionalism. An alternative way of understanding unconditional positive regard is prizing the individual and respecting their uniqueness.
Congruence: Genuineness involves being aware of our own feelings, beliefs and processes; it requires self-awareness, transparency and honesty. For a vet in practice communicating authenticity, professionalism and integrity to clients builds rapport helping to build a trusting relationship. Congruence essentially involves being real.
These core conditions are essential prerequisites for reflective listening.
Reflective Listening
There is a difference between hearing and listening. Hearing involves receiving sounds but listening involves understanding what these sounds mean accurately. Reflective listening extends to feeding back that understanding to the client. This enables checking out if we have understood correctly what they have told us.
When hearing someone talk it is all too easy to become distracted by noises in the environment e.g. a barking dog in the waiting room, internal thought processes (e.g. a row with a partner before work) or our own past experiences. When we listen it requires focussed attention and showing that in our body-language to the client (eg. assuming an open posture, engaging in eye contact). This is often known as attending behaviour (being available to a client) and also has verbal components that tell the client we are fully present for them, listening and understanding what they are saying, thinking and feeling. To understand a client’s perspective requires seeing and responding to their internal frame of reference (i.e. their perspective) rather than the vet’s own perspective (external frame of reference).
In-practice example B
Vet responses from internal and external frames of reference
External frame of reference responses:
“I would have responded more quickly than you to these symptoms”
“I think you could give your cat these pills if you really tried”
“You seem very emotional about your dog’s heart condition.”
“That sounds like a plan.”
Internal frame of reference responses:
“You are beating yourself up about not bringing her in to be checked out sooner than you did.”
“You are really struggling to give your cat his pills” this can then be followed by practical non-judgemental advice and demonstrations. Following up with a written information sheet can be helpful.
“You are feeling very upset and worried about how the heart condition may impact on your dog’s quality of life.” This statement validates and respects the client’s anxiety and can be followed up by clear information about the condition, including options for referral. Again written information can be helpful in reinforcing and clarifying understanding. The emotional component for the client of receiving a diagnosis and prognosis should always actively acknowledged, this communicates recognition of the importance of the companion animal as an individual and in the life-world of its owner.
“You have thought this through carefully and your care-plan seems a good fit.”
Avoiding sweeping statements that can be construed as dismissive is important within the vet-client relationship, it communicates that the client’s participation in the care of their animal is valued and recognised by the practice team.
Starting a response with “YOU” is helpful but does not always communicate understanding from the client’s internal frame of reference as the statement: “You seem very emotional about your dog’s heart condition,” shows. Emotionally loaded this could easily be construed as pejorative and judgemental, when in reality it is normal to feel upset about receiving a diagnosis for your dog of mitral valve disease! Normalising emotions such as distress communicates respect to clients. A simple paraphrased reflection communicates recognition and validates an emotion.
Reflective listening skills
Being available and communicating this availability to a veterinary client is unique because of the vet-client-animal patient triad. Examining the animal necessarily removes the focus from the owner to the animal, but getting the balance right in explaining what you are doing in clear unambiguous terms and occasionally looking at the owner communicates recognition of them, their contribution in diagnosis and their value as a client. This is partnership in care and animal welfare.
Adopting a professional, but relaxed and open body posture (without slumping or slouching) creates a sense of accessibility and approachability. This can help clients feel more able to ask questions and feel less intimidated by the clinical context. Using culturally sensitive and appropriate gaze and eye contact communicates “being with” and caring about the client. Staring, holding a gaze too long can be perceived as hostile; looking down or away or towards the door or the clock can give the sense of you wanting a client to leave or being disinterested in them or their animal.
Facial expressions are powerful in communication, conveying interest, fear, disgust, sadness, anger/hostility, surprise and happiness. A great deal of facial information is communicated through the mouth and eyebrows (Nelson-Jones, 2008); a smile can instantly communicate acceptance and warmth, whereas as a frown can convey judgement, anxiety or concern. Mirroring client’s emotions through facial expression and body language can be an important part of communicating empathy, however there are times in practice this not useful e.g. in trying to diffuse tension in an angry client emotions will intensify and escalate if the vet mirrors back angry facial expressions or uses hostile body language. Modelling (i.e. demonstrating to clients) calm, accepting and more neutral emotions can actually diffuse anger and this has a neurophysiological basis generated by mirror neurones in the brain (Rothschild & Rand, 2006).
Similarly gestures are important in reflective listening; a head nod is a common gesture that we are listening and can be perceived as a reward encouraging a client to continue talking, this can be useful in gathering information. Selective head nods though can be a means of controlling clients in communicating conditional acceptance; although sometimes within veterinary practice this is necessary to reinforce positive client behaviour. The use of touch with clients can be appropriate in some circumstances e.g. a gentle touch on the elbow or arm when a client is crying, but the intensity and duration of touch/contact should be sufficient to communicate care but not invade or intrude and particularly not be misconstrued as sexual interest (Nelson-Jones, 2008). Generally the upper back and arms are “safe” touch zones. Whilst touch is not off limits it should be used sparingly and with caution. Personal space should also be respected within the limitations of the consult room and examination of the animal.
Reflective listening also involves the following key verbal communication skills:
Paraphrasing, reflecting back and re-stating
Paraphrasing involves reflecting back to the client what they have said but using different words. There may be times when re-stating i.e. using the exact same word is more powerful and appropriate
Client: He starts coughing when he moves position and it is a deep cough that doesn’t bring anything up, but it is raucous.
Vet: Racous?
Using a questioning inflection with this re-statement enables the vet to seek clarification of what the client means by a raucous cough. Reflecting back involves repeating what the client has said verbatim using their words. This is a communication technique used to validate feelings and can be used to clarify understanding of what has been said depending on tone and intonation.
Paraphrasing is very useful in consults when gathering information, it requires brief, re-wording of the client’s key messages. It is important to try to keep close to the client’s own language.
In-practice example C
Example of paraphrasing
Client: After a long walk Hovis and of makes this creaking knows, well it’s more like a crack or a pop really then he starts limping on his left side. He doesn’t want his treats either, just loses interest in everything and seems really sorry for himself. He cannot run he just hobbles about.
Vet: You hear a popping sound after Hovis has been exercising; he loses interest in playing and food and cannot walk easily.
Competent paraphrasing is succinct and mirrors back in a way that provides clarity for the client as to what they have said. Summarising is similar to paraphrasing but is usually at the end of a consult or mid-way and is used to check out understanding and clarify information gathered so far.
Reflecting and mirroring client feelings within paraphrasing and summarising is an important skill. Identifying a client’s feelings can be tricky and time consuming; this often leads to side lining or minimising of client feelings in practice due to time constraints and fear of opening up a Pandora’s box without adequate skills to manage the emotions released. However attention to body messages e.g. how the client looks: sad,
angry, tired, crying can convey more than the spoken word and provide almost immediate access to feelings. Similarly noticing a client’s voice its pitch, tone and quality can alter when a client is angry, upset or weary; shouting is possibly the most obvious example of how voice can convey emotions. Sometimes clients may talk about their own physical reactions to observing their animal’s distress, decline or in response to a diagnosis e.g. “my heart was pounding, I had butterflies in my stomach.” If and how the client uses “feeling words” e.g. angry, sad, anxious, frustrated, can provide a portal into understanding the impact of a consultation on a client and inform sensitive responding. It is important to ensure that the practice has written support information for clients disclosing deep distress e.g. a practice information sheet of useful contact such as The Blue Cross Pet Bereavement Support Service, The Samaritans and Childline. Clients need to feel their vet has empathic understanding of their emotions. Reflecting feelings can powerfully communicate empathy and understanding. Opening reflections with “You feel” is a useful tool for this communication skill. Using a different word to the client’s to describe their feelings helps check out accuracy of your understanding. Wherever possible always communicate back the client’s dominant feelings (Nelson-Jones, 2008).
In-practice example D
Example of reflecting feelings
Client: I really feel worn out with this care regime for Pepa it is night and day I am giving him medication and then he is sick. I am feeling worn down by it.
Vet: You are exhausted from caring for Pepa round the clock.
It is important not reflect every feeling back to the client only the most salient for them. Small verbal rewards help to tell a client you are listening, understand them and are there for them:
Examples of verbal rewards
Please tell me more
Carry on
I am hearing you
Yes
Uh –hum
OK
So…
(adapted from Nelson-Jones, 2008:60).
Keeping the conversation and consult moving and making sure time is used well and usefully is a paramount concern. Using open questioning is facilitative of information gathering and also embraces principles of partnership in care because it enables the client to talk, offer their perceptions and perspectives and have these valued.
Open questioning
Open questions most often begin with:
· What ?
· How?
· When?
· Where?
· Why?
Using why can be delicate as it can infer judgement or feel like interrogation.
It is impossible answer an open question with a yes/no reply. Clearly without a consult there is a place for open questions and also for closed questions. Closed questions elicit a yes, no, sometimes response.
In-practice example E
Using open and closed questions
Vet: Has Ellie vomited?
Client: Yes.
Vet: What colour was it?
Client: Kind of green and frothy but it didn’t look to have any food in it.
Vet: How often is Ellie vomiting?
Client: A few times a day.
Vet: When in the day?
Client: There doesn’t seem to be an established pattern although it tends to be after having a drink of water. I feel awful watching her I am powerless to know what to do.
Vet: You have noticed she vomits after having a drink and you are feeling really upset because you don’t know how to stop it.
Here the vet interweaves reflections of the client’s main feelings skilfully whilst keeping on task in gathering relevant clinical information. Identifying, reflecting and responding to client’s emotions are not at odds with clinical consults. Putting into practice some key communication skills enables sensitive responding, the building of trust and rapport. This in turn generates a real sense of partnership in care.
Finally we will briefly look at ways the practice environment can communicate this ethos of partnership and care to clients.
Communicating through the environment
Creating a safe, ethical and professional emotion friendly climate involves paying attention to aspects of the environment and client support resources available.
In the USA, as previously described, some veterinary hospitals have developed client comfort rooms as more personal, private space for delivering bad news and euthanasia consults. More recently practices in the UK have followed this example and this also mirrors practice in human medicine with Family rooms. These dedicated spaces are more emotion friendly and this climate is created by careful attention to colour scheme e.g. pale greens and blues have been identified as having a calming effect. Ensuring there is somewhere comfortable for clients to sit if they want to and provision of padded mats to enable floor euthanasia of large dogs or where this best meets needs of companion animal and client.
Not every practice has the space or finances to develop comfort/family rooms, but a consult room can serve dual function. It is imperative that choice of colour scheme and availability of resources e.g. paper tissues, clay paw mould to make paw print impressions, having a Practice Book of Remembrance to memorialise deceased animals – all of these aspects of the environment communicate care and the importance of partnership between owner and practice in the care of their animal.
From the moment a client enters the practice impressions are made. Informative, interesting displays that tell clients about the services the practice offers e.g. nurse facilitated clinics, animal welfare education displays all communicate key messages about the practice and quality of care for client and animal patient.
This programme has introduced essential communication skills for veterinary surgeons and has situated these within the wider paradigms of models of veterinary practice grounded in the importance of establishing and building relationships and actively promoting partnership in care. Developing these communication skills involves practice; an integral aspect is developing self-awareness and reflective practitioner skills. Putting these essential communication skills into practice will enhance quality of client care, strengthen trust and enable greater professional comfort and satisfaction in providing safe and ethical emotional support for clients.
Recommended reading
Dr Susan Ella Dawson PhD MEd BA (Hons) PGCE MBPS MBACP, Psychologist and Consultant in Human-Animal Relationships
Dawson, S.E., Fowler, J., Ormerod, E., & Sheridan, L. (2007). Towards a Bond-Centred Practice. Veterinary Review, 134, 18-19.
Gray, C. & Moffit J. (2010). The Handbook of Veterinary Communication Skills.
Wiley-Blackwell: West Sussex.
Nelson-Jones, R. (2008). Basic Counselling Skills: A Helper’s Manual (2nd edtion).
Sage: London,
References
Dr Susan Ella Dawson PhD MEd BA (Hons) PGCE MBPS MBACP
Psychologist and Consultant in Human-Animal Relationships
Bartram, D.J., Sinclair, M.A., & Baldwin, D.S. (2010). Interventions with potential to improve the mental health and wellbeing of UK veterinary surgeons. Veterinary Record, 166(17), 518-523.
Broadfoot, K.J. & Candrian, C. (2009). Relationship-centred care and clinical dialogue: Toward New Forms of Care-full” communication. Natural Medicine Journal, 1(4), 1-2.
Dawson, S.E. (2007). Companion Animal Euthanasia: The Lived Paradox of the Human-Companion Animal Bond. Doctoral Dissertation. School of Psychology, Health and Social Care, Manchester Metropolitan University: Manchester, UK.
Dawson, S.E. (2010). Compassionate communication: working with grief. In C. Gray, & J. Moffett, (Eds.), Handbook of Veterinary Communication Skills, (pp. 62-98). West Sussex: Wiley Blackwell.
Gray, C. & Moffit J. (2010). The Handbook of Veterinary Communication Skills. Wiley-Blackwell: West Sussex.
Kirwan, M. (2010). Basic Communication Skills. In C. Gray, & J. Moffett, (Eds.), Handbook of Veterinary Communication Skills, (pp. 1-38). West Sussex: Wiley Blackwell.
Lagoni, L., Morehead, D., Brannan, J., & Butler, C. (2001). Guidelines for Bond-Centred Practice. Fort Collins, Colorado: Argus Institute for Families and Veterinary Medicine, Colorado State University.
Maguire, P. & Pitceathly, C. (2002). Key communication skills and how to acquire them. British Medical Journal, 325. 697-700.
Mellanby, R.J. (2005). Suicide in the veterinary profession (pp. 203-205). Proceedings Fecava Symposium held during FECAVA/WSAVA, VICAS Congress, Dublin.
Nelson-Jones, R. (2008). Basic Counselling Skills: A Helper’s Manual (2nd edtion). Sage: London,
Radford, A., Stockley, P., Silverman, J., Taylor, I., Turner, R., Gray, C. Bush, L. Glyde,M., Healy, A., & Dale Winter, A. (2006). Development, teaching and evaluation of consultation structure model for use in veterinary education. Journal of Veterinary Medical Education, 33(1), 38-44.
Radford, A. (2010) A framework for the Veterinary consultation. In C. Gray, & J. Moffett, (Eds.), Handbook of Veterinary Communication Skills, (pp. 25-38). West Sussex: Wiley Blackwell.
Redmond, M.V. (2000). Communication: Theories and Applications. Houghton Mifflin: Boston.
Rogers, C. (1957). The necessary and sufficient conditions of therapeutic personality change, Journal of Consulting Psychology, 21(3), 95-104.
Rothschild, B. & Rand, M. (2006). The psychophysiology of Compassion Fatigue and Vicarious Trauma. Help for the Helper Self-care Strategies for Managing Burn-put and Stress. Norton: New York.
Stratton, P. & Hayes, N. (1999). A Student’s Dictionary of Psychology. Arnold: London, 90.
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