Marie Rippingale1, Sophie Pearson1, and Rosina Lillywhite2 1 Bottle Green Training Ltd, Derby, United Kingdom 2 VetPartners Nursing School, Petersfield, United Kingdom Good communication skills are vital for the smooth and efficient functioning of a veterinary practice. Communication is important not only to send and receive messages but also to build and maintain positive relationships with work colleagues and clients. Communication takes many forms but is basically a two‐way process whereby a message is sent, received and responded to [1]. Effective communication is also a requirement of The Royal College of Veterinary Surgeons (RCVS) Code of Professional Conduct for Veterinary Nurses [2]. Therefore, effective communication skills are essential for registered veterinary nurses (RVNs) in order to progress their professional development. The communication process refers to the exchange of information, ideas, thoughts and feelings between individuals or groups. It involves a sender, a message, a channel, a receiver and feedback. The process works as follows [3]: The communication process is a dynamic and iterative cycle, where both the sender and receiver play active roles. It is essential for effective communication to ensure that the message is accurately encoded, transmitted through an appropriate channel, received and properly decoded by the intended receiver. Feedback helps in confirming understanding and addressing any misunderstandings or barriers that may arise. Figure 2.1 displays the steps involved in the communication process. Figure 2.1 The communication process [3]. Source: Rosina Lillywhite. Communication can be categorised as either verbal or non‐verbal. Spoken and oral communication is used for telephone and face‐to‐face communication. This form of communication can be used in digital marketing videos that can be posted on social media. With verbal communication, the choice of words used is important. Other important factors are the way and the speed at which the words are spoken [1]. Communication with clients takes practice, and experience can be gained from observing interactions between experienced colleagues and clients [1]. Written communication can be considered to be a type of verbal communication as it also uses words (or verbatim). Information relating to written communication can be found in Table 2.1. It has been suggested that 93% of the meaning of a message is transmitted non‐verbally; this can be broken down into the following [4]: Non‐verbal communication can include the following aspects [1]: Table 2.1 Examples of written communication used in veterinary practice [1]. Source: Marie Rippingale. Posture and body language can convey mood and the type of attitude that one person has towards another person and can therefore give the client a powerful message [5]. Communication is more effective when an open body posture is used, so folded arms and crossed legs should be avoided [1]. The communicator should face the person they are talking to and use appropriate eye contact. Standing behind barriers such as reception desks and computer stations should be avoided [1]. If the communicator needs to use the computer during the conversation, they should tell the client that this is what they are doing [1]. This will prevent the client from feeling like they are being ignored or unattended. Making eye contact is one of several skills known as an attending skill. Attending behaviours let other people know that you are focused on understanding them and ready to listen [4]. Making eye contact should not be confused with staring or a fixed eye gaze, as this can be unnerving. Eye contact should be maintained at a comfortable level for both the sender (communicator) and the receiver (client) [5]. Facial expressions provide a good source of non‐verbal information and are especially useful when conveying emotion [5]. According to research, the face reveals six primary emotions [5]: Facial expressions can be used as cues to help to evaluate emotions and to determine if the message was received correctly [5]. When communicating with clients, it is important that the communicator is aware of their facial expressions and an open and friendly approach is recommended [1]. Expressions must be appropriate to the situation for example conveying concern if the client is worried or upset [1]. It has been suggested that the power of facial expressions far outweighs the power of the actual words used [4]. Facial expressions are therefore an important part of communication and should be considered and used carefully. Paralanguage refers to aspects such as the tone, volume, pitch, timbre (quality of a voice distinct from its pitch and intensity) and intonation (the rise and fall of the voice in speaking) emphasis and fluency which accompanies speech [5]. Paralanguage can accompany words to make up the true meaning, and these features can help in the interpretation of the message by giving the receiver clues about the state of mind of the sender [5]. The tone of voice used can be influenced by the emotional state of the person. Therefore, in practice, it is important to be aware of your own individual emotional state and to manage this carefully when communicating with others. This is especially relevant in high‐pressure and time‐poor situations, as there may be a tendency to rush communication, which will then not be effective. Paralanguage also includes ‘non‐lexical’ aspects that can be added to speech, including marks of encouragement such as ‘ah’, ‘hmmm’ and ‘uh‐huh’ [1]. These marks can be used to encourage someone to keep speaking and also make up an important component of listening skills. These terms relate to the proximity to a person and touch [1]. The intimate space of a person is generally up to 45 cm and is reserved for intimate thoughts and feelings. The personal distance ranges from 45 to 120 cm and is used for less intense personal exchanges [5]. Both intimate space and personal distance for individuals are influenced by age, sex and culture [5]. In practice, it is important to read the response of the client to your proximity and adapt accordingly. Touch can be used to communicate affection, familiarity and sympathy [1]. Touch can, however, be a controversial subject and it is important to be aware that not all clients will respond well to being touched. There may be important cultural issues relating to touch that need to be understood [1]. The clothes that someone wears, their hairstyle and the colours chosen can all be considered forms of non‐verbal communication. In veterinary practice, the choice of uniform worn can affect physiological reactions, judgements and interpretations [5]. People form impressions of each other within 20 seconds to a few minutes [5], so it is important to convey a professional appearance at all times. Table 2.2 displays some key points relating to non‐verbal communication. Listening is an important communication skill. Poor listening skills have been cited in a large percentage of medical negligence cases and have been identified as one of the main reasons why individuals take legal action against healthcare professionals [4]. Attentive listening is considered to be one of the most important elements of therapeutic communication and requires an understanding of verbal and non‐verbal cues such as eye contact and paralanguage [5]. Table 2.2 Key points relating to non‐verbal communication [6, 7]. Source: Rosina Lillywhite. Attentive listening requires four main components [1]: The following are suggestions for achieving effective listening in a veterinary practice setting [1]: Effective questioning is an important skill to learn. RVNs are required to ask many questions during a working day, whether during a client consultation, for example, admissions or discharges or with colleagues when contributing to the formation of a patient care plan. Different types of questions may be asked, and these can be categorised as follows [5]. Example question: ‘Did the injection work?’ Answer: ‘Yes’ Example question: ‘What seems to be the problem with Tilly?’ Answer: ‘She seems very quiet and is not eating properly …….’ These questions give the listener the opportunity to follow up to get more details. The advantages and disadvantages of open and closed questions are displayed in Table 2.3. Sub‐categories of open and closed questions are as follows [5]: Table 2.3 The advantages and disadvantages of open and closed questions [8]. Source: Rosina Lillywhite. Communication styles vary between individuals, and this can lead to conflict and misunderstandings [9]. It is important to understand the characteristics and tendencies of different communication styles as this can help to facilitate positive interactions between people with differing styles [9]. There are four primary communication styles [9]: See Table 2.4 for further information. It is important to identify your own communication style and understand the advantages and disadvantages of this. Once your communication style has been identified, you can develop ways to adapt it not only to meet the needs of other people but to different situations. For example, the communication style adopted to deal with an aggressive client or conflict will need to be an assertive communication style. A passive communication style may be more appropriate in a sensitive situation, such as euthanasia. An awareness of communication style and possible adaptations that can be made, may also be useful when communicating with different colleagues. These factors can all help to contribute to a more efficient and productive working environment, and this will benefit all patients, colleagues and clients equally. Communicating on the telephone presents a unique set of challenges as aspects of non‐verbal communication cannot be relied upon [1]. The person receiving the information can only receive information from what is said and how it is said. Many situations require RVNs to communicate via the telephone, such as triaging emergencies, taking query calls, making appointments, delivering patient updates and carrying out follow‐up phone calls [1]. Table 2.4 The four primary communication styles [9]. Source: Marie Rippingale.
2
Professional Relationships and Communication
Introduction
2.1 The Dynamics of Communication
The Communication Process
Communication Categories
Verbal Communication
Non‐verbal Communication
Example of written communication
Points to consider
Clinical notes
These should be accurate, legible and completed in full with the author clearly identified. Preferably typed up rather than handwritten
Letters to clients
Any form of written communication from the practice should be on headed paper and preferably printed rather than handwritten. Letters should be clearly signed with the name of the author and their position in the practice. Correct grammar and punctuation should be used
Emails to clients, colleagues and allied professionals
Emails should be written with the same care and thought as a written letter. Correct grammar and punctuation should be used. Disputes should never be carried out over email, text, memos or social media
In‐house forms, e.g. clinical parameter sheets, critical care sheets, care plans and anaesthetic monitoring records
These should be accurate, legible and completed in full with the author clearly identified
Official documents, e.g. laboratory submission forms, insurance claim forms, admit and discharge forms
These should be accurate, legible and completed in full with the author clearly identified
Flyers and information sheets for promotional purposes
These should be well considered and contain only accurate information. Input should be included from different members of the team. Correct grammar and punctuation should be used. Any information should be proofread before being published
Notes and memos
These should be professional and convey a clear message. Disputes should never be carried out over email, text, memos or social media
Posture and Body Language
Eye Contact
Facial Expressions
Paralanguage
Proxemics and Haptics
Appearance
Listening Skills
Non‐verbal communication type
Things to do
Things to avoid
Posture and body position (Body language)
Maintain an open and approachable posture: Stand or sit upright with an open stance, facing the client directly. This conveys attentiveness and willingness to listen
Avoid crossing your arms or legs: Crossing your arms or legs can create a barrier between you and the client, making you appear defensive or disinterested. Keep your arms relaxed at your sides or lightly resting on a desk or table
Maintain appropriate eye contact: Make regular eye contact with the client to demonstrate active engagement and interest in the conversation. However, be mindful not to stare excessively, as it can make the client uncomfortable
Avoid fidgeting or nervous movements: Excessive fidgeting, such as tapping fingers or shifting weight, can convey nervousness or lack of confidence. Try to maintain a calm and composed demeanour
Use open and welcoming gestures: Use open hand gestures, such as keeping your palms facing upward or loosely clasping your hands in front of you. This encourages a sense of openness and approachability
Do not invade personal space: Respect the client’s personal space by maintaining an appropriate distance. Invading personal space can make them feel uncomfortable or threatened
Lean slightly towards the client: Leaning slightly forward demonstrates interest and involvement in the conversation. It shows that you are focused on understanding their concerns and needs
Avoid turning away or distractions: Face the client directly and give them your undivided attention. Avoid turning away, checking your phone or engaging in other distracting activities, as it can undermine the client’s perception of your attentiveness
Mirror the client’s body language: Subtly mirroring the client’s body language can help establish rapport and create a sense of connection. However, be cautious not to mimic them too closely, as it may appear insincere
Do not display negative body language: Avoid negative body language such as rolling your eyes, sighing or showing impatience. These gestures can create a negative impression and damage the client’s trust in your professionalism
Eye contact
Establish regular eye contact: Maintain regular eye contact with the client throughout the conversation. It shows that you are actively listening and engaged in the discussion
Avoid staring excessively: While maintaining eye contact is essential, avoid staring for prolonged periods, as it can make the client uncomfortable. Use natural breaks in the conversation to briefly glance away or focus on other aspects of the consultation
Show interest and attentiveness: Demonstrate your interest in the client’s concerns by maintaining focused eye contact. This conveys that their opinions and questions are valued
Do not constantly break eye contact: On the other hand, avoid constantly breaking eye contact, as it may convey disinterest or distractibility. Find a balance between maintaining eye contact and looking away occasionally
Use eye contact to convey empathy: Eye contact can help convey empathy and understanding. It shows that you genuinely care about the client’s feelings and their pet’s well‐being
Do not use eye contact to intimidate: Eye contact should be warm and inviting, not intimidating. Avoid using intense or aggressive eye contact that may make the client feel uncomfortable or defensive
Match the client’s eye contact: Mirror the client’s eye contact to create a sense of connection and rapport. If the client maintains strong eye contact, reciprocate by doing the same. However, be mindful not to make the client uncomfortable by staring excessively
Avoid distractions during eye contact: When engaging in eye contact, minimise distractions and focus solely on the client. Avoid looking at other things or checking your phone, as it can give the impression of disengagement
Facial expressions
Maintain a friendly and welcoming expression: Keep your facial expression warm, friendly and approachable. Smile genuinely to create a positive and welcoming atmosphere
Avoid displaying negative or judgmental expressions: Be mindful of your facial expressions to ensure you do not unintentionally convey negative emotions or judgments. Avoid frowning, rolling your eyes or displaying impatience, as these can make clients feel uneasy or misunderstood
Show empathy and understanding: Use facial expressions to convey empathy and understanding towards the client’s concerns. Displaying a compassionate expression can help reassure clients that their pets are in good hands
Do not overuse or fake expressions: Authenticity is crucial when using facial expressions. Avoid overusing or faking expressions, as they may appear insincere or manipulative. Let your expressions be a genuine reflection of your emotions and intentions
Use facial expressions to reflect active listening: Show your engagement and attentiveness through facial expressions. Nodding your head occasionally and maintaining an interested and focused expression can communicate that you are actively listening and processing the information
Do not let facial expressions overshadow verbal communication: While facial expressions are essential, ensure they complement your verbal communication rather than overpower it. Maintaining a balance between facial expressions and spoken words ensures clear and effective communication
Use appropriate facial expressions for different situations: Adjust your facial expressions based on the context. For example, you may display concern or sympathy when discussing a patient’s health issue or show excitement and happiness when delivering good news or positive outcomes
Avoid inappropriate or excessive smiling: While a warm and friendly smile is encouraged, be mindful of the context. Excessive or constant smiling without considering the seriousness of the situation may be perceived as unprofessional or insensitive
Paralanguage
Use a warm and friendly tone: Maintain a pleasant and inviting tone of voice when speaking to clients. A warm and friendly tone helps create a positive and comforting conversation atmosphere
Avoid speaking too loudly or softly: Be mindful of your volume and avoid speaking too loudly or softly. Speaking too loudly may come across as aggressive, while speaking too softly may make it difficult for clients to hear and understand you
Vary your pitch and intonation: Utilise appropriate variations in pitch and intonation to convey meaning and emphasise important points. Modulate your voice to express empathy, enthusiasm or concern as needed
Do not rush through your words: Avoid speaking too quickly or rushing through your words. Rapid speech can make it challenging for clients to follow along or comprehend the information being conveyed
Speak clearly and articulately: Enunciate your words clearly and avoid mumbling or speaking too quickly. Clear and precise speech helps clients understand you better and fosters effective communication
Avoid a monotone voice: A monotone voice lacks enthusiasm and engagement, which can make the conversation dull and uninteresting. Vary your tone and inflexion to keep clients engaged and convey genuine interest
Use a calm and reassuring voice: When discussing sensitive or difficult topics, employ a calm and reassuring voice to instil confidence and provide emotional support to clients. This can help alleviate their concerns and create a sense of trust
Do not sound condescending or patronising: Be conscious of your tone to ensure it does not come across as condescending or patronising. Treat clients respectfully and maintain a professional and courteous tone throughout the conversation
Proxemics
Respect personal space: Be mindful of personal space and maintain an appropriate distance when interacting with clients. Respect their comfort zone and avoid invading their personal space unless necessary
Avoid invading personal space: Invading a client’s personal space without their consent can make them feel uncomfortable or threatened. Maintain a respectful distance and allow them to dictate their desired level of closeness
Use proximity to convey attentiveness: During conversations, leaning slightly towards the client can indicate attentiveness and active engagement. It demonstrates that you are focused on understanding their concerns and needs
Do not stand too far away: Standing too far away from the client can create a sense of emotional distance or detachment. Find an appropriate balance between personal space and proximity to establish a comfortable and connected environment
Adapt to cultural norms: Different cultures have varying expectations regarding personal space. Be aware of cultural differences and adapt your proximity accordingly to ensure you respect and accommodate diverse cultural norms
Haptics
Use a gentle touch with consent: In certain situations, gentle touch can comfort and reassure clients. However, always seek consent before initiating any form of touch, such as a handshake or pat on the shoulder
Avoid intrusive or inappropriate touch: Respect personal boundaries and refrain from intrusive or inappropriate touching. Be cautious and sensitive to cultural and individual preferences regarding touch
Use touch to soothe animals: Touch can be beneficial in soothing and comforting animals. Employ gentle touch while handling and examining animals, ensuring it is appropriate and respectful to the animal’s needs and behaviour
Do not assume comfort with touch: Not everyone may be comfortable with physical contact, so it is important to be mindful and respectful of individual preferences. Always seek permission and respect their boundaries
Appearance
Dress appropriately: Wear clean, professional attire that is suitable for a veterinary practice. Follow any dress code guidelines your workplace sets and ensure your clothing is well‐fitted and neat
Avoid wearing inappropriate attire: Refrain from wearing clothing that is too casual, revealing or inappropriate for a professional setting. This includes items such as overly casual t‐shirts, shorts or clothing with offensive or controversial graphics
Maintain personal hygiene: Pay attention to personal grooming, including cleanliness, hairstyle and hygiene practices. Maintaining good personal hygiene helps convey professionalism and attention to detail
Do not neglect personal grooming: Ensure that your hair is well‐groomed, your nails are clean and trimmed, and any facial hair is well‐maintained. Neglecting personal grooming may give the impression of a lack of professionalism or attention to detail
Wear a name badge: Consider wearing a name badge that clearly displays your name and position within the veterinary practice. This can help clients easily identify and address you during interactions
Minimise strong or overpowering scents: Be mindful of using strong perfumes, colognes or body sprays, as they may be overpowering or cause discomfort for clients with sensitivities or allergies. Opt for subtle scents or avoid them altogether
Pay attention to accessories and jewellery: Choose accessories and jewellery that are tasteful and minimal. Avoid wearing excessive or distracting accessories that may draw attention away from the conversation
Avoid excessive or distracting makeup: Keep your makeup natural and professional. Excessive or distracting makeup can draw attention away from the conversation and may not be appropriate in a veterinary practice setting
Questioning Skills
Type of questioning
Advantages
Disadvantages
Closed
Efficiency: Closed questions typically require a short and specific answer, which allows veterinarians to gather information quickly. This can be particularly useful when time is limited and there is a need to collect important details efficiently
Limited information: Closed questions tend to elicit brief, specific responses and may not allow clients to provide additional details or elaborate on their concerns. This can restrict the amount of information gathered, potentially overlooking important factors that could contribute to a more comprehensive understanding of the animal’s condition
Clarification: Closed questions can help veterinarians clarify specific information or details about the animal’s condition or history. This can lead to a better understanding of the situation and enable the veterinarian to make more accurate diagnoses and treatment decisions
Lack of client engagement: Closed questions can create a one‐sided conversation, with clients feeling like passive recipients of questions rather than active participants in the decision‐making process. This may reduce client engagement and their overall satisfaction with the veterinary consultation
Control over conversation flow: Closed questions allow veterinarians to guide the conversation and control the direction of the consultation. This can help ensure that essential information is obtained and prevent the conversation from straying off‐topic
Potential for misinterpretation: Closed questions may not provide enough context or opportunity for clients to express themselves fully, potentially leading to misinterpretation of their responses. This can hinder accurate diagnosis or treatment planning if critical information is overlooked or misunderstood
Limited response options: Closed questions typically provide a limited set of response options (such as ‘yes’ or ‘no’ or selecting from a predetermined list). This can simplify decision‐making and allow for more structured data collection and analysis
Restrictive communication: Closed questions can limit the flow of conversation and inhibit open communication between the veterinarian and the client. This may hinder the development of a trusting relationship and prevent clients from fully expressing their concerns or asking questions that could provide valuable insights
Open
Comprehensive information: Open questions encourage clients to provide detailed and descriptive responses, allowing veterinarians to gather a more comprehensive understanding of the animal’s condition, history and any related concerns. This can facilitate accurate diagnoses and tailored treatment plans
Time‐consuming: Open questions often result in longer responses, requiring more time to elicit and listen to the client’s answers. In a busy veterinary practice, this may limit the number of cases that can be seen or lead to delays in appointment schedules
Client engagement and satisfaction: Open questions promote active client participation in the conversation, making them feel heard and involved in the decision‐making process. This can lead to increased client engagement, satisfaction and a stronger veterinarian–client relationship
Tangential information: Open questions sometimes elicit off‐topic responses or provide excessive and unrelated information. This can make it challenging for veterinarians to extract the relevant details and may require additional clarification or redirection
Exploration of client perspectives: Open questions allow clients to express their thoughts, concerns and observations in their own words. This can provide valuable insights into the animal’s behaviour, environment and other factors that may be relevant to their health. It also allows veterinarians to better understand the client’s perspective and address any specific needs or preferences
Lack of structure: Open questions do not provide a predetermined set of response options, potentially making it more difficult to categorise or quantify the information gathered. This can impact data analysis and may require additional effort to organise and make sense of the collected data
Flexibility and adaptability: Open questions provide flexibility in the conversation, allowing it to flow naturally and adapt to the client’s responses. This can lead to unexpected but relevant information being shared, leading to a more nuanced understanding of the situation
Potential for information overload: Open questions can encourage clients to provide extensive information, which can overwhelm both the client and RVN. It may require active listening skills and the ability to filter and prioritise relevant information to avoid getting bogged down in excessive details
Communication Styles
Telephone Communication
Communication style
Details
Identifying features
Methods of dealing with this communication style
Passive
Typically quiet and does not seek attention. May be indifferent during debates. Rarely take a strong stance or assert themselves. Do not usually share their needs or express their feelings
Take a direct approach: Initiate one on one conversations, as private interactions may be more comfortable for a passive communicator
Ask for their opinions: Allow plenty of time for them to think about their responses
Use open questions: This will encourage some elaboration. Give the person time to think and respond
Aggressive
Frequently express their thoughts and feelings. Tend to dominate conversations. Can react before thinking, which can negatively affect relationships and decrease productivity. Can be intimidating to clients and colleagues
Be calm and assertive: Try not to be intimidated. Focus the conversation on an actionable approach to the problem
Keep conversations professional: Direct the conversation away from personal issues or emotions
Know when to stop: Leave the conversation if the aggressive communicator becomes too demanding or there is a lack of positive progress
Passive–aggressive
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