CHCCOM005 Readings

If you are reading this book, you are probably an allied health student, and you might be asking yourself the following question: should I study communication as part of allied health?

The answer is that as an allied healthcare professional in the 21st century you need to have stronger communication skills than ever before. The standard of care demanded at all points of patient contact requires that you effectively communicate with patients and other members of the healthcare team. This means that you have the skills necessary to ensure clear and compassionate understanding when you encounter a patient in the waiting room, the examination room, on the telephone, or through email. You should also know how to work 4 Communication Skills for the Healthcare Professional efficiently and productively as a member of the healthcare team to ensure the highest level of effectiveness in serving patients' needs. You will be working and living in a society that is more diverse—and more complex—than any society the world has ever known. Serving patients from such a diverse population requires that you have the skills to bridge gaps in communication that earlier generations of allied health professionals could not or did not have to cross. As an allied health professional in the 21st century, you must not only possess the clinical skills necessary to providing excellent patient care, but you must also master the communication skills essential to ensuring positive health outcomes for patients. At the most basic level, this means that when you encounter a patient, or colleague, that person's message gets to you clearly, and, in turn, your response gets back to that person clearly. This may sound very simple, but as this book will demonstrate, getting the message clearly from one person to another can involve many sophisticated skills and the ability to overcome obstacles. These are the skills and abilities you will need as a future healthcare professional (HCP).

Therapeutic Communication

For our purposes, therapeutic communication, which is the primary focus of this book, as communication between [he IICP and the patient (as well as the patient's family) that, takes place to advance the patients well-being and care. Therapeutic communication has three main purposes:

1. To collect healthcare—related information about the patient;
2. To provide feedback in the form of healthcare—related information, education, and training, and
3. To assess the patient's behavior and, when appropriate, to modify that behavior.

At any time when you communicate with a patient or their family members, you are engaging in therapeutic communication. As an HCP, you should remain mindful that effective therapeutic communication is always characterized by support, clarity, and empathy. Any of the following could happen on any day in the doctor's office, hospital, or healthcare center where you will be working:

• You greet a new patient and, after escorting them to the examination room, prepare them for the physician who will arrive shortly to give [hem a physical examination.
• An elderly, hearing-impaired patient comes [0 your lab needing a pulmonary function test.
• A young mother with an at-risk pregnancy comes in to see you for her biweekly sonogram.
• A pharmacist leaves a phone message for the renewal of a patient's prescription.
  You, have just, drawn blood for routine screening from a 4-year-old boy who sits on his mother's lap and screams, "I want my blood back!"
• A physician in your practice asks you to contact, the radiology department, of a nearby hospital to make an appointment, for a, patient, 'Who needs a chest x-ray.
• A new patient who has heard great things about one of the doctors in your practice wants an appointment with that doctor, who is not currently accepting new patients.
  You answer the telephone and the person on the other end says they are a, patient 'in your practice and that they are currently having chest, pains.
• A paramedic brings in the unconscious victim ora gunshot, wound.
• Twenty minutes after a patient, on your ward has crashed and been rushed to the intensive care unit, a, family member who knows nothing of what has just happened shows up for visiting hours.

For each of these scenarios to be resolved successfully, effective communication needs to take place.

Effective communication is necessary for any human interaction to succeed. As a healthcare professional, you will need effective communication skills to provide care to patients, and to fulfill your obligations to your supervisor and your co-workers.

A Definition of Communication

Principle	Description
Effective communication	Effective communication is a two/multi-way process that conveys accurate information that is tailored, open, honest and respectful. It includes communications between healthcare professionals and with consumers, families and carers. Strategies to effectively communicate include structured communication, using agreed and common language, using check- back and closed loop communication, and contemporaneous and accurate documentation. Communication is prioritised and the team continuously works to improve and refine its communication skills. There are consistent channels for candid and complete communication, which are accessed and used by all team members across all settings.
Situational awareness and decision making	Situational awareness refers to the care team maintain an awareness of the 'big picture' and thinking ahead to plan and discuss contingencies. There is ongoing dialogue between team members, which keeps members up to date of the current situation, shared awareness of the best path to follow, and how they will respond if the situation changes.
Quality improvement: measuring processes and outcomes	The team agrees on and implements reliable and timely feedback on successes and failures in both the functioning of the team and achievement of the team's goals. These are used to track and improve performance immediately and over time.

We can say that communication is the successful transfer of a message and meaning from one person or group to another. "Meaning" is of greatest importance in this definition. For this transfer to be successful, both parties in the communication process—that is, the sender of the message and the message's receiver—must agree on the meaning of what is being communicated. This process usually contains five steps. In each of these steps, an effective communicator will take into account possible physical limitations or cultural differences that may inhibit or disrupt communication.

The Five Steps of the Communication Process

The Sender has an Idea to Communicate

This idea to be communicated can be the result of thought or feeling and can be influenced by the circumstances of the current situation, as well as the sender's mood, physical condition, culture, heritage, or back- ground. The sender simply has something they want to communicate to someone else. (For example, a radiology technologist must instruct a patient on how to place their injured arm on the x-ray table.)

The Sender Encodes the Idea in a Message

To encode the idea means to put the idea into some form that can be communicated. The sender puts the idea into spoken or written words, or perhaps into hand gestures, body movements, or facial expressions.

A good communicator always understands the importance of using words, symbols, or gestures that the receiver will understand. (The radiology technologist instructs the patient with words on how the injured arm should rest on the table.)

The Message Travels Over a Channel

There is always a particular means, or medium, by which the sender sends the message. This is the channel. The sender can choose to use a telephone, speak face-to-face, write on paper or electronic tablet, send a fax or an email, draw a picture, use body language, make facial expressions, or use hand gestures. Sometimes the channel can be disrupted by noise. Noise (which is discussed in greater detail later in this chapter) is anything that disrupts the channel's ability to carry the message clearly.

Static on a phone line, an improperly printing fax machine, and bad grammar in an email message are just a few examples of channel noise.

The effective communicator, however, will always try to minimize noise and ensure that conditions are optimal to send the message by the medium they have chosen. Healthcare professionals must accommodate patients who have impairments in sight or hearing. They must also be able to accommodate those who cannot use the technology on which many channels of communication rely today. (In addition to words, the radiology technologist uses gestures to demonstrate the arm's proper placement.)

The Receiver Decodes the Message

The receiver must then make some sense of the message. To do this, the receiver must decode the message, that is, translate the original message from its encoded form into a form that the receiver understands. This step in the communication process can be complicated by many factors, all of which are also types of noise. For instance, there may be cultural differences between the sender and the receiver. Perhaps the receiver does not have the education necessary to understand the content of the message. Finally, the receiver may have poor listening—and, therefore, poor communication—skills.

There might be physical conditions that prevent the receiver from decoding the message. These can sometimes be actual noises, such as the noise from a nearby construction site or a car horn, a telephone ringing or a baby crying, or even a family member interrupting the patient interview. Other physical conditions that can cause the receiver difficulties include physical sensations, such as an overheated room or a room that is too cold, or any discomfort from pain.

Finally, anxiety or fear can prevent the receiver from being able to concentrate on the message the sender is trying to transmit, again causing a breakdown in the communication process. (Despite the pain of the injury, the patient tries their best to listen to the radiology technologist's instructions.)

The Receiver Understands the Message and Sends Feedback to the Sender

The receiver understands the message and provides the sender with feedback, something that says, I have received your message and I understand it. This can be verbal or nonverbal—that is, the receiver can say something or make some gesture with their body or hands.

The sender of the original message can enhance this step in two ways. First, they can try to communicate at a time and under circumstances that are convenient to the receiver. Second, the sender can verify that the message has been received and understood, essentially asking of the receiver, Do you understand me? An effective communicator should always remain careful not to provide more information than the receiver can process at any one time.

The receiver can also enhance this step by paraphrasing back to the sender the original message, saying, This is what I think you said. (Placing their arm across the table, the patient says to the radiology technologist, "Is this how you want me to do it?")

Finally, the receiver can do nothing, that is, make no response— which is also a response of sorts—in effect telling the sender of the message that they have not received or understood the message. The sender must try again.

Noise

Anything that inhibits effective communication can be labeled noise. Although the term can at times refer to actual sound, noise does not have to literally prevent one or both parties from audibly hearing the other. Noise can come in many different forms. For instance:

• The receiver of the message may have some sort of physical pain or discomfort that prevents them from effectively "listening. "
• The receiver may be distracted by fear or anxiety about themselves or a family member or friend and cannot effectively concentrate on the message.
• There may be a language barrier or cultural differences that prevent the receiver from understanding the message.
• The receiver may not be interested in what the sender of the message has to say, either through a simple lack of interest or because of other concerns that have a higher priority for the receiver.
• The receiver of the message may be hearing or sight impaired.
• Finally, the channel by which the sender transmits the message may be faulty or may even break down as, for instance, when a phone connection has fuzzy static or when a fax machine runs out of toner.

Ultimately, anything that disrupts the communication process is noise.

An Illustration of the Five-Step Communication Process

The process can be illustrated with one of the examples from the beginning of this chapter. Suppose a pharmacist has called the medical practice where you work and left a voicemail message indicating that a patient wants a refill on a prescription for an asthma medicine that has expired. You transcribe the message and pass it on to the physician. The physician then writes the prescription and places it in the patient's chart. The chart is returned to you so that you can follow up by faxing the prescription to the pharmacy so that the prescription can be refilled.

This one scenario actually contains the communication process in a couple of layers. Let's look at just one layer of this process.

The Communication Process. (A) The sender has an idea to communicate — the pharmacist (the sender) has a prescription that needs to be refilled for one of his customers; (B) The sender encodes the idea in a message—the pharmacist uses a specialized language to describe the prescription; (C) The message travels across a channel-the pharmacist uses a telephone and leaves a message on the medical assistant’s voicemail at the doctor's office; (D) The receiver decodes the message—the medical assistant transcribes the voice message into a written message for the doctor (the receiver); (E) Feedback travels to the sender—the medical assistant takes the approved prescription and sends it by fax to the pharmacist; (F) Success!

1. The Sender has an Idea to Communicate: The pharmacist has received information from the patient about getting a refill on a prescription for an asthma medicine. After checking the patient's records, the pharmacist sees that the prescription has expired and that the doctor must renew it. The pharmacist must, therefore, con- tact the doctor's office.
2. The Sender Encodes the Idea in a Message: The pharmacist uses a specialized language—a language that uses technical terms for drugs and dosage amounts as well as units from the metric system—to describe what the prescription is.
3. The Message Travels Across a Channel: The pharmacist picks up the telephone to call the doctor's office. Because it's 12:30 p.m. on a Tuesday, you, the medical assistant, are out to lunch and away from your desk. Speaking on the phone, the pharmacist leaves you a message on the practice's answering system.
4. The Receiver Decodes the Message: Having returned from your lunch, you listen to the message and write it down on a piece of paper. You then place the paper in the doctor's inbox.
5. Feedback Travels to the Sender: You take the prescription form out of the patient's chart and send it through the fax machine to the pharmacy.

Thanks to the successful completion of all five steps in this communication process, the patient will have an easier time breathing.

We may not always be aware of it, but even when we communicate the simplest ideas to other people, we use all of the steps in this process. A firm grasp of the communication process will help you understand all other aspects of communication. When you understand these, you should be better at communicating with others in general, and you'll be much more able to provide patients with the therapeutic communication necessary for effective health care.

Communication between healthcare professionals (HCPs) and their patients begins well before they actually say anything to each other. It occurs when the HCP observes the body language of the patient and even when the patient observes the body language of the HCP. Nonverbal communication, which may be unintentional, includes body movements, gestures, and facial expressions. These behaviors convey information that words alone often do not. Have you ever tried to have a sensitive or emotional conversation on the phone or via email? The possibility for misunderstanding is much greater than when you are speaking with someone face-to-face. Why? We rely on nonverbal behaviors to give further meaning to the message. In fact, it is generally accepted that of communication is nonverbal, 23% involves the tone of voice, and only 7% of communication occurs by the chosen words. Nonverbal communication provides a clue to a person's inner thoughts and feelings, and this form of communication is particularly important in stressful situations, as a message of need is most likely to be sent nonverbally.

Imagine entering a waiting room and observing the patients. There are universal, natural behaviors and positions that may convey significant meaning. For example, a patient may:

• Have their arms relaxed on the armrest or have their arms folded tightly across their chest; Sit up straight or slouch in a chair,
  Have a pleasant, content expression or have a frown.

Other behaviors exhibited by patients may also be revealing such as nail-biting, toe-tapping, and leg-shaking. No interaction may take place; however, these observations allow the HCP to begin formulating opinions about their patient and the patient's emotional state. As a result, the HCP can adapt their behavior and select responses with which to inter- act with the patient according to these impressions. For example, the nonverbal behaviors displayed by a seriously ill patient may convey a buildup of feelings, especially fear, anxiety, confusion, or anger. This patient may benefit from extra attention in the form of interest, concern, consideration, and emotional support. The HCP could invite the patient to release their pent-up feelings by talking about their concerns. There- fore, it is essential that the HCP observe and correctly interpret nonverbal behaviors displayed by their patients so that any unspoken messages are not lost.

It is important to remember that one cannot always be sure what certain behaviors indicate. For example, consider the patient who is sitting with their arms folded across their chest. An initial interpretation may be that the patient is angry or impatient. However, one must be mindful that this position could have other meanings. Does it provide them with some form of comfort or the feeling of protection from nearby people? Are they self-conscious about their figure? Or are they simply cold? Many aspects of nonverbal communication, especially eye contact, are culturally informed and need to be interpreted according to the sender's cultural background. Specific aspects of nonverbal communication related to cultural differences are addressed in Chapter 8, Cultural Sensitivity in Healthcare Communication.

Nonverbal Communication

Nonverbal messages can enhance or interfere with the verbal messages that are delivered. There must be congruency, or consistency, between the verbal and nonverbal messages. If there is conflict, then the nonverbal messages tend to be believed. It is also important to remember that the patient is reading the nonverbal messages transmitted by the HCP. Therefore, the most effective HCPs are those whose nonverbal messages are congruent with their verbal messages. As a result, patient satisfaction with care, patient compliance and health outcomes are improved. In fact, studies indicate that many types of HCPs, including nursing students, physical therapists, resident physicians, surgeons, and oncologists benefit from the inclusion of formal instruction in nonverbal communication in their training.

Types of Nonverbal Communication

There are several distinct categories of nonverbal communication, including:

• Kinesics (involving body movement in communication)—gestures, facial expressions, and gaze patterns;
• Proxemics (involving the physical distance between people when they communicate)—territoriality and personal space, position, and posture;
• Touch.

Interestingly, nonverbal messages tend to appear in groups or clusters. For example, a patient's gestures, facial expressions, and posture may all work together to convey the same message.

Gestures

Gestures include movements of the head, hands, eyes, and other body parts. Often used in place of words, gestures are one of the most obvious and common forms of nonverbal communication. For example, a hand extended outward may signify "stop" or "wait" and a finger across the lips may signify "quiet" Gestures may be used when speech is ineffective (e.g., a language barrier) or insufficient (e.g., complex content in the message). Patients who are intubated and mechanically ventilated, are most likely to use head nods, mouthed words, and gestures as their primary methods of communication. Gestures may also be used to relieve stress (e.g., running one's hand through one's hair). Finally, gestures are used to regulate the flow of conversation. For example, a head nod may signify "go ahead" or "continue" and a frown or raised eyebrow may signify confusion. Greater patient—HCP rapport has been reported when the HCP nods their head.

Illustrators are intentional gestures closely associated with speech. They serve to emphasize, clarify, or add to the verbal content of a message as well as to hold the attention of the listener. Illustrators are generally made by movements of the hand. Furthermore, they may serve many different purposes. For example, they may be used to:

• Demonstrate how to hold one's arm during a mammogram;
• Illustrate how to position oneself for an x-ray;
• Indicate where an incision will be located;
• Instruct a patient about how many pills to take;
• Encourage a patient to relax during blood pressure measurement, phlebotomy, or a painful procedure.

Other illustrators may demonstrate how a patient should take a deep breath during spirometry (a method of measuring lung function) or how a patient should open their mouth and say, "Ahhhh. "

Gestures may also be involuntary or subconscious. This is referred to as "leakage," when the true feelings or attitudes are revealed by an individual. For example, an 18-year-old football player may say that he is not afraid of the injection or the clinical procedure, but he wrings his hands or shakes his leg.

Many gestures have common interpretations. "Positive" gestures may include thumbs up, winks, handshakes, and fist bumps. These are signs of acceptance, encouragement, appreciation, and friendliness. "Negative" gestures may include looking at one's watch, rolling one's eyes, and tapping one's foot. These are signs of boredom and impatience. The use of gestures is one of the most culture-specific forms of nonverbal communication. In other words, a specific gesture may have very different meanings in different cultures. A gesture interpreted as positive by one individual may be interpreted as negative by another. Care must be taken not to unintentionally offend a patient. These concepts will be discussed further in Chapter 8.

Facial Expressions

The human face provides a complex but rich source of information regarding emotions for HCPs as well as patients. These expressions may also be used to punctuate a message or to regulate the flow of conversation between two individuals. Because patients are sometimes reluctant to express themselves verbally, it is essential that HCPs understand and accurately interpret their patient's facial expressions.

The facial expressions of many emotions, such as happiness, sadness, and fear, are biologically determined, universal, and learned similarly across cultures. Consider the small infant that smiles and giggles when happy and frowns and cries when startled, wet, or hungry. These responses are innate, not learned.

Facial expressions are one of the most important and observed non-verbal communicators. The eyes may reflect feelings of joy and happiness or sorrow and grief. A smile conveys a positive attitude and positive feelings. Interestingly, false smiles do not involve the cheeks or the eyes. Various movements of the cheeks, mouth, nose, and brow may express happiness, interest, surprise, fear, anger, disgust, or sadness.

Listeners use facial expressions to provide the speaker with feed- back. Facial expressions can show the speaker not only that the listener is interested, surprised, or disgusted by what they have heard, but that they have understood. The speaker is able to monitor these reactions and adapt communication accordingly. During a conversation with a patient, a smile serves as a reinforcer and encourages the patient to continue.

As with subconscious gestures, some people find it difficult to control their facial expressions. The face may "leak" information about a person's frue feelings. For example, it may be difficult to hide shock when treating a patient with a horrific wound or to disguise disgust when caring for an incontinent patient. HCPs must learn to control their facial expressions carefully to prevent conveying these potentially hurtful feelings to their patient.

The facial expression of pain is of particular importance to the HCP.

Grimaces of pain are not observed in a patient until that patient's threshold of pain is reached. (This threshold level varies among individuals.)

The literature suggests that, unfortunately, HCPs have a tendency to underestimate pain when performing clinical assessments. Furthermore, it appears that the more clinical experience one has, the more likely that one will underestimate the level of pain. Interestingly, studies also indicate that people who live with patients who have chronic illness made better assessments of pain than people who had not had that experience. In addition, a patient's voluntary exaggeration of pain in the presence of others may not be meant to be disingenuous, but rather may be a message to elicit care. These findings highlight the importance of the accurate interpretation by HCPs of nonverbal behaviors in their patients who may be in pam.

Gaze Patterns

Gaze is a form of communication as well as a method for collecting information. Specifically, it serves three primary functions:

• Monitoring—Assessing how others appear (e.g., a nurse gazing at a very sick patient for clues about their condition), or how a listener is responding to the speaker (e.g., interest, understanding, boredom, confusion)
• Regulating—Using gaze to regulate the conversation such as indicating when it is the other person's turn to speak (When a person finishes speaking, they tend to look at the listener and the listener perceives this as a cue that it is their turn to speak.)
• Expressing—Feelings and emotion

Few forms of communication carry more weight than looking a patient straight in the eyes. Eye contact illustrates that the HCP is interested in giving and receiving messages and acknowledges the patient's worth. A lack of eye contact or looking away while the patient is talking may be interpreted as avoidance or disinterest in the patient. On the other hand, staring is dehumanizing and may be interpreted as an invasion of privacy. It may come across as discourteous and even hostile, especially when a patient's appearance has been negatively affected (e.g., when a patient presents with any kind of disfigurement or dermatologic condition). The ability to examine the patient without staring at them and making them feel uncomfortable or self-conscious is a mark of professionalism in a healthcare worker.

Gaze patterns are affected by changes in mood. Sad or depressed people tend to make less eye contact and look down. Gaze also tends to be averted in patients with mental health problems.

There is a strong correlation between looking and liking. Patients who receive longer gazes from HCPs tend to talk more freely about health concerns, present more health problems, and provide more information about psychosocial issues. These findings highlight the importance of considering gaze and its functions during the patient interview.

Normal gaze patterns between individuals in conversation may be characterized as follows:

• Direct eye contact in a normal conversation occurs for about 50% to of the time.
• The average length of gaze is usually less than three seconds and the average length of mutual gazes is less than about two seconds.
• Therefore, the HCP should look directly at their patient, but not 100% of the time. Strive to establish an amount of eye contact where both you and the patient are comfortable.
• Speakers spend about of their time gazing at the listener and listeners spend about 75% of their time looking at the speaker with each gaze averaging about eight seconds.
• Gaze patterns in listeners last longer because of their function as a social reinforcer and a way to indicate attention.
• The speaker's gaze is more intermittent with the amount of eye-ganng becoming decreased as the complexity of the topic increases.
• This is a potentially important consideration when counseling patients or explaining complex procedures to them.
• Females tend to look more at the other person than males do.

Personal Space

Everyone has a personal space, or territory, that provides that individual with a sense of identity, security, and control. People often feel threatened or uncomfortable when that space has been invaded. It may create anxiety or feelings of loss of control. In a healthcare setting, patients are often required to give up this personal space so that they may be properly examined and treated. They may encounter any number of health-care providers during their time in such a setting, including doctors, nurses, phlebotomists, x-ray technologists, medical imaging specialists, medical assistants, physician assistants, physical therapy assistants, occupational therapists, and nutritionists. Patients who are hospitalized, or who are residents in nursing homes, often share rooms with strangers. These conditions and intrusions may cause a patient who is already sick, weak, or worried to become more anxious or tense.

Approaches that will help to lessen the anxiety created by intrusions and the loss of space include the following:

• Treat the patient respectfully—Recognize the patient's territory, their belongings, and their right to privacy.
• Allow the patient to exercise as much control over their surroundings as possible—Allow them to determine whether the lights are on or off, whether the shades are up or down, and whether the door is open or closed.
• Recognize the patient's need for privacy—Be discrete both verbally and physically. In other words, keep your conversation as private as possible and avoid leaving the patient exposed.

There are four generally accepted distance zones to be considered when interacting with others:

• Intimate distance up to 1.5 feet apart. This distance allows the individuals to touch each other. Clinicians often need to enter this zone to examine and care for the patient. HCPs are members of one of the few professions where it is not only legitimate, but necessary, to enter this zone.
• Personal distance 1.5 to 4 feet apart (about an arm's length). This is the distance at which personal conversations with soft or moderate voices may take place. The personal distance is commonly used in healthcare settings where a clinical procedure is being explained or a patient is discussing a personal matter.
• Social distance 4 to 12 feet apart. This distance is common in business or social settings. Many HCPs may maintain a social distance during a consultation.
• Public distance more than 12 feet apart. Used in larger events, this distance is intended to separate the speaker from the listener.

Clearly, the far side of the social distance and the public distance are inappropriate when dealing directly with patients and dis- cussing their health issues. Both intimacy and privacy may be lost at these distances. There are no set rules for HCPs to follow in every situation with a patient. However, the HCP should be sensitive to the distance norms for different situations and allow the patient to participate in establishing these distances whenever possible. When a patient feels that their space has been inappropriately invaded, they may use a shift in body position or use eye contact to send the message.

Allied health professionals may perform many personally invasive tasks during the course of their interaction with patients, such as taking vital signs, giving injections, withdrawing blood, or performing an ultra- sound. The HCP will find it helpful to explain any procedure that requires entering the patient's personal space before beginning the procedure. In this way, it is less threatening to the patient, it gives the patient a sense of control and dignity, and it builds a sense of trust in the HCP.

Position

Another important factor to consider when speaking with a patient is position. There are several best practices that will facilitate and enhance the communication process. It is helpful to maintain a close but comfortable position, perhaps about an arm's length from the patient. For example, in an examination room or triage area, have the patient sit in a chair while you sit on a stool that can move across the floor. In this way, you will maintain access to any materials and forms necessary for the visit, you will maintain eye-level conversation, and you will help the patient feel listened to and cared for. Conversely, standing over a patient may convey a message of superiority. Too much distance between the HCP and the patient may be interpreted as avoidance. Finally, moving away from the patient may be interpreted as dislike, disinterest, boredom, indifference, or impatience.

Most interactions between the HCP and the patient require face-to- face communication. This direct orientation increases patient satisfaction and understanding, especially when the patient is anxious. Conversely, an indirect orientation (facing away from the patient) may be perceived as dominance by the patient and could make them feel less comfortable and be less forthcoming.

A position leaning slightly toward the patient expresses warmth, caring, interest, acceptance, and trust. In fact, HCPs who lean forward have been rated as having higher rapport with their patients. The opposite is true for HCPs who lean backward.

Posture

Posture refers to the position of the body and limbs as well as muscular tone. The posture of a patient may reveal a great deal about their emotional status. For example, depression or discouragement is characterized by a drooping head, sagging shoulders, low muscle tone, and the appearance of sadness or fatigue. Conversely, anxiety may be characterized by increased muscle tone where the body is held in a rigid and upright manner. Patients tend to tighten up in fearful or unknown situations. Interest is conveyed by leaning forward with the legs drawn back, while boredom may be conveyed with a lowered head, outstretched legs, and a backward-leaning position. Finally, avoidance and rejection are displayed by a closed body posture. In this case, the patient crosses their arms and legs, leans back as if to create distance, and may even turn their body away from the HCP.

It is important that the HCP appear confident as this will enhance the trust that the patient has in them. A crucial aspect for showing confidence is the maintenance of a relaxed and open body posture. This posture is also perceived as more friendly, warm, and inviting. In fact, HCPs have been rated as having a greater rapport with their patients when their arms are uncrossed and symmetrical (i.e., arms loosely at their sides when standing or resting on the arms of their chair or in their lap when sitting) and their legs uncrossed. When sitting, the HCP should face the patient and lean slightly forward.

Touch

Caring for patients often involves some form of touch. Most obviously, it serves as a critical tool for examining (e.g., medical assistant takmg blood pressure), diagnosing (e.g., radiography technologist positioning a patient for an x-ray or a phlebotomist withdrawing blood), treating (e.g. , physical therapist assistant manipulating a patient's limb or a nurse applying a dressing on a wound), or simply caring for (e.g., CNA helping a patient to eat or to dress) the patient. Touch also has many other important functions in health care as it may serve to:

• Ease a patient's sense of isolation;
• Decrease patient anxiety,
• Demonstrate caring, empathy, and sincerity;
• Offer reassurance, warmth, or comfort;
• Enhance the rapport between the HCP and the patient;
• Supplement verbal communication.

Clearly, touch is critical in establishing rapport between the HCP and the patient. Interestingly, surveys have shown that many patients want to shake their physician's hand when they first meet. However, it is also important to remember that touch may evoke negative reactions in some patients. Not everyone likes to be touched, as it may make them feel embarrassed, uncomfortable, or threatened. Cultural differences are important factors in determining a patient's receptivity to touch and will be considered in Chapter 8. There are no set rules for determining when to touch or not to touch patients. Furthermore, there is no universally accepted meaning that may be derived from a given touch. Interpretation and receptivity to touch will depend on several factors, and the use of touch will require the exercise of good Judgment on the part of the HCP. General guidelines that can be followed to enhance the likelihood that touch will be perceived positively in the clinical setting include the following:

Tell your patient when, where, and how they will be touched during an examination or clinical procedure. This helps to put your patient at ease and will avoid starting them.

Use a form of touch that is appropriate for the given situation. For example, placing your hand on the arm or shoulder to ease a distressed patient or family member may be comforting. However, touching an angry patient may be less helpful than simply letting them vent their feelings.

Use touch to supplement your verbal message. However, do not replace words with touch alone. That may lead the patient to feel that the importance of their problem is diminished or that you are being superficial or demeaning. For example, consider the case where a patient describes the amount of pain felt in their neck following a car accident. If the HCP were to simply pat the patient on the back, the patient may interpret this gesture as placating and not really caring.

Conversely, the same touch accompanied by the words "Let's pre-scribe some medication for that pain" would be interpreted quite favorably.

Do not use a touch gesture that implies more intimacy with a patient than is desired. When a gesture suggests a degree of intimacy that is not shared, it will likely result in discomfort. When touching a patient of the opposite gender, it is advisable to have a colleague or a family member of the patient in the room in order to prevent any misunderstanding.

Observe and assess the recipient's response to the touch. Negative responses may include pulling away, a startled look or frightened appearance, a tense facial expression, or other anxious gestures or behaviors. You may safely assume that a patient has a positive response to touch if they appear to relax or seem more comfortable.

The person who touches may be perceived as having enhanced status. Therefore, it is important that the HCP remain mindful of its possible effect on the power dynamic between them and the patient. In some instances, the patient may feel a reduced sense of independence or autonomy.

Proper Interpretation of Nonverbal Communication: Congruency with Verbal Messages

Successful communication requires congruency between the verbal and nonverbal messages. In other words, the two messages must be in agreement, or consistent, with each other. For example, if a patient says, “Okay,” while shaking their head, then they are sending mixed messages. If the patient says, “Yes, I understand,” while maintaining a confused facial expression, then once again, they are sending mixed messages. As indicated previously, the nonverbal message is usually accepted as the intended message. If the patient is made aware of the conflict, then they may be encouraged to revise their response. In this way, the HCP may better appreciate what the patient is feeling:

• "You say that you are fine, but your frown tells me something else."
• "I notice that you are smiling. Can you tell me how you really feel about this diagnosis?"

The message of a patient's nonverbal behavior is lost unless it is observed and interpreted correctly. The HCP should remain mindful that the misinterpretation of a patient's nonverbal behavior can lead to more misunderstanding than simply ignoring it. When interacting with a patient and the meaning of their nonverbal behavior is unclear, the HCP must make this observation known. Consider the patient who is sitting with their arms folded across their chest and is turned away (Refer to Figure 2-3.). The HCP may take one of several approaches:

• Make a nonjudgmental observation of their behavior—"You have folded your arms across your chest." or "You are not looking at me."
• Ask for clarification—"What does this mean for you?" or "Can you tell me what you are feeling?" or "What's going on?"
• Offer an explanation or interpretation of the patient's nonverbal behavior—"Are you angry or upset?" or "I can see that you are per- haps frightened or anxious. "

In some instances, behavioral observation may be the only mechanism by which the HCP may derive information from a patient. For example, a patient may be speech impaired (e.g., due to stroke or intubation), too young (e.g., in the case of an infant), too sick (e.g., due to a semi-conscious or delirious condition), or simply unwilling to communicate verbally.

Proper Nonverbal Communication Skills for the Healthcare Professional

In order to create the best environment for effective communication with your patient, you must be mindful of your own nonverbal messages that may be conveyed to the patient. The most obvious nonverbal message conveyed by the HCP involves their appearance. Ideally, your body should be clean, your clothing should be clean and neat, and your breath and body should have a pleasant or benign odor. Heavy perfumes or aftershaves are inappropriate in the clinical setting. Another nonverbal message that may be conveyed by the HCP involves facial expressions. Few of us realize how we look in random or unguarded moments. For example, fry to recall a photograph of yourself that was taken when you were unaware and were not posing or smiling. Did the captured expression accurately convey your feelings at the time? Personal concerns and worries or work stress may be unintentionally apparent on our faces and in how we interact with our patients. In other words, an HCP who is actually quite warm and friendly may at times appear abrupt and unapproachable and not even be aware of it.

The HCP should be cognizant of these possibilities and attempt to maintain friendly or neutral facial expressions when interacting with their patients.

For a summary of the factors that contribute to the development of an ideal environment for communication between the HCP and their patients, see Table 2-1.

Table 2-1

Factors that Contribute to the Development of an Ideal Environment for Communication between the HCP and Their Patients

• Wear professional attire and maintain good hygiene.
• Offer the patient a firm handshake and a warm greeting.
• Sit down when speaking with the patient.
• Ensure privacy when speaking with the patient.
• Assume a position of about one arm's length from the patient
• Maintain a posture that is relaxed but attentive. When seated, lean slightly forward and be still but not motionless. Keep your hands visible.
• Eliminate barriers between you and the patient.
• Maintain a demeanor that is warm and friendly.
• Maintain an attitude of confidence and professionalism.
• Maintain eye contact with the patient. This will confirm your willingness to listen and will acknowledge the patients worth.
• Encourage the patient with affirmative head nods as opposed to listening without expression. This not only prompts the patient to continue and pro- vide more information, it makes the patient feel understood and empathized with.
• Recognize the different forms of nonverbal communication that may be conveyed by the patient In many cases, there are similarities in the way that most people physically react and express themselves. However, the HCP must remain mindful that various gestures, facial expressions, or postures may have many different meanings. Avoid making assumptions and try to confirm the proper interpretation of a patients nonverbal behaviors.
• Observe the patients reactions toward you. This will provide feedback about your own nonverbal behaviors.

This tip sheet covers one of seven domains used to measure cultural competence. Each domain includes a set of indicators of good practice.

How to support the effective and culturally appropriate exchange of information between your organisation and its clients, and between staff members.

Why is it important?

Culturally competent communication is critical for all aspects of service delivery. It can break down barriers, improve access to services and support better health outcomes for clients. It is equally critical for staff wellbeing and satisfaction.

Understanding different communication needs and styles of client population

Indicators

• There is a system to identify and record population and client language preferences, literacy levels and level of English proficiency.
• Staff receive training in cross-cultural communication.
• Staff apply effective communication techniques with diverse groups.

Good practice example

Hospital staff are introduced to interviewing tools that can be used to elicit sensitive information from clients. These tools allow clients to name and frame issues in their own words and understanding; they are used prior to filling out assessment forms. Staff also learn to check for client understanding by asking open-ended questions.

Culturally appropriate oral communication

Indicators

Staff are trained in the appropriate use of qualified interpreters

• Protocols are established for when and how to elicit sensitive information from clients
  • Clients can communicate in their preferred language/dialect at point of first contact and at all levels of interaction with the organisation
  • Clients can understand interpreted material.

Culturally appropriate oral communication (continued)

Good practice example

A disability service trains all client service staff in working with interpreters. There is a centralised booking system for interpreters and processes for collecting feedback from staff and clients. Clients are provided with in-language information on interpreters and client files are marked with ‘interpreter required’ stickers to alert staff that an interpreter needs to be booked at each appointment.

Culturally appropriate written communication

Indicators

• Printed, online and audiovisual materials are appropriate to the literacy of target populations.
• Quality review mechanisms are established to check the integrity of translated materials.
  • Culturally appropriate ways to disseminate written materials are identified
  • Clients understand written materials

Good practice example

A hospital discards its plan to translate its current nutrition booklet into Dinka, when it identifies that there are low literacy rates in this language amongst its target group. Instead, the dietician meets with community representatives to explain the information in the booklet. She discovers that the content needs to be modified to address the group’s level of knowledge, beliefs and dietary practices. As a result the hospital produces a simple poster that uses pictoral information and culturally appropriate food items.

References

• This tip sheet is based on Indicators of Cultural Competence in Health Care Delivery Organisations: An Organisational Cultural Competence Assessment Profile , prepared by the Lewin Group Inc. under contract with the USA Department of Health and Human Services (2002).
• Refer to the CEH Language Services tip sheets for guidance on using interpreters: www.ceh.org.au/resources/publications.aspx

Two Unique and Diverse Cultures

Australia’s first peoples are two distinct peoples that are culturally very different—Aboriginal peoples and Torres Strait Islander peoples. Each of these cultures have their own languages, kinship structures, cultural practices and ways of life. It is important to acknowledge and celebrate the diversity of these peoples.

Aboriginal peoples comprise diverse Aboriginal nations, each with their own language and traditions, and historically lived on mainland Australia, Tasmania and many of the continent’s offshore islands. Torres Strait Islander peoples historically lived on the islands of the Torres Strait, between the tip of Cape York in Queensland and Papua New Guinea.

Each culture has its own flag to symbolise and celebrates their separate and unique identities. In July 1995, both the Aboriginal flag and the Torres Strait Islander flag were proclaimed as official flags in section 5 of the Flags Act 1953.

History of the Aboriginal Flag

The Aboriginal flag was designed in 1971 by artist Harold Thomas, a Luritja man from Central Australia. The flag was first flown on National Aboriginal Day in 1971 at Victoria Square in Adelaide.

In 1972 the flag was flown above the Aboriginal Tent Embassy outside Parliament House in Canberra. After this event it was unofficially adopted nationally by the Aboriginal peoples.

Symbolic meaning:

• Black: represents the Aboriginal peoples of Australia.
• Red: represents the red earth, the red ochre and a spiritual relation to the land.
• Yellow: represents the sun, the giver of life and protector.

History of the Torres Strait Islander Flag

The Torres Strait Islander flag was designed by the late Bernard Namok of Thursday Island. The flag symbolises the unity and identity of all Torres Strait Islanders.

The Torres Strait Islander flag was flown for the first time in 1992. It is now flown and recognised more widely as Torres Strait Islander issues gain more prominence in Australia.
Symbolic meaning:

• White: Dari (headdress) is a symbol of Torres Strait Islander peoples. The white five pointed star beneath the Dari represents peace, the five major island groups and the navigational importance of stars to these seafaring people.
• Green: represents the land.
• Black: represents the people.
• Blue: represents the sea.

Collective Terms Used to Describe Aboriginal and Torres Strait Islander Peoples

Aboriginal and Torres Strait Islander Peoples

The plural use of the word ‘peoples’ acknowledges that within these two distinct cultures there are hundreds of unique and distinct communities, cultural and language groups, spiritual connections to land, environmental influences, families and kinship networks. Adding an ‘s’ emphasises this diversity.

Further, the word ‘peoples’ recognises that Aboriginal and Torres Strait Islander peoples have a collective, rather than an individual, dimension to their lives. This is affirmed by the United Nations Declaration on the Rights of Indigenous Peoples.

‘Aboriginal’ and ‘Torres Strait Islander’ should be capitalised to convey respect, as you would when naming any other nationality, like French or Korean.

The lower-case word ‘aboriginal’ refers to an indigenous person from any part of the world and does not necessarily refer to an Aboriginal Australian.

United Nations Declaration on the Rights of Indigenous Peoples

The United Nations Declaration on the Rights of Indigenous Peoples affirms the minimum standards for the survival, dignity, security and well-being of Indigenous peoples worldwide and enshrines Indigenous peoples’ right to be different. The Declaration was adopted by the General Assembly of the United Nations in September 2007. This was the culmination of more than 20 years of negotiation between the Indigenous peoples and governments of the world. The Australian Government announced its support for the Declaration in 2009. The Declaration is the most comprehensive tool we have available to advance the rights of Indigenous peoples. To find out more go to the Australian Human Rights Commission website.

Aboriginal and Torres Strait Islander as an Adjective

Using Aboriginal and Torres Strait Islander as an adjective is more person-centric, positive, inclusive and empowering to Aboriginal and Torres Strait Islander peoples.

Using the terms Aboriginals or Torres Strait Islanders is less respectful. Some alternatives are:

• Aboriginal peoples.
• Torres Strait Islander community representatives.
• Aboriginal and Torres Strait Islander children and families.
• Aboriginal and Torres Strait Islander Queenslanders.

Abbreviating Aboriginal and Torres Strait Islander

It is not respectful to abbreviate Aboriginal and Torres Strait Islander to ATSI.

An abbreviation should ONLY be used in a table or graph if there is not enough room to ‘spell out’ Aboriginal and Torres Strait Islander in full. If this is necessary, the more respectful abbreviation to use is A&TSI, as it provides a slightly better representation of the two distinct cultures.

It is acceptable to abbreviate Aboriginal and Torres Strait Islander when it forms part of an acronym such as an organisation’s name, for example:

• Aboriginal and Torres Strait Islander Legal Service (ATSILS).
• Queensland Aboriginal and Torres Strait Islander Child Protection Peak (QATSICPP).

The department’s Style Guidelines provide full details on the correct use of acronyms in written documents.

Use of Pronouns

It is not respectful to replace the words ‘Aboriginal and Torres Strait Islander peoples’ with pronouns such as ‘the’, ‘they’, ‘them’, ‘their’ and ‘those’. The use of pronouns objectifies Aboriginal and Torres Strait Islander peoples and creates a social distance between the writer and Aboriginal and Torres Strait Islander peoples, cultures, societies and histories.

The terms ‘we’ and ‘us’ need to be considered to ensure awareness of who is ‘included and excluded’.

Aborigine(s)

Although it is grammatically correct, carefully consider using the term Aborigine(s) as it has negative connotations with many Aboriginal people because it can be linked back to the terminology used in the periods of colonisation and assimilation. Aboriginal person or Aboriginal peoples can be used as an alternative.

Some Aboriginal people self-identify as an Aborigine, but it should be treated as an ‘in-group’ term (see page 8).

Australia’s First Peoples, First Nations Peoples

These are collective terms for Aboriginal and Torres Strait Islander peoples that emphasise Aboriginal and Torres Strait Islander peoples as the original inhabitants of Australia who lived here for many thousands of years before colonisation. First Nations Peoples is predominantly used in north America to refer to the original inhabitants of Canada, rather than in an Aboriginal and Torres Strait Islander context.

These terms are becoming more widely used by Aboriginal and Torres Strait Islander peoples in Australia and are respectful terms, but are not currently widely used.

Indigenous

‘Indigenous’ is defined as a person originating from, or characterising, a particular region or country. In an international law context, the term acknowledges a particular relationship of aboriginal people to the territory from which they originate.

In many government documents, Indigenous is capitalised when specifically referring to Australian Aboriginal and Torres Strait Islander peoples, however some Aboriginal and Torres Strait Islander peoples feel the term diminishes identity and homogenises Aboriginal and Torres Strait Islander cultures, and so it’s not considered to be the most respectful term.

‘Indigenous’ with capitalisation is acceptable when quoting an external source where the term is used, as part of an established program name or where it is part of the name of an organisation or organisational unit, for example the Indigenous Enabling Commonwealth Accommodation Scholarship (IECAS).

Murri, Goori, Koori, Palawa, Nunga, Yolngu, Anangu, Noongar

These terms are directly derived from Aboriginal languages and are the names used by Aboriginal peoples when referring to themselves. Many Aboriginal peoples from other areas of Australia live in Queensland and they would continue to refer to themselves using the term that best describes their original geographic identity, for example someone from New South Wales living in Queensland would still consider themselves to be a Koori.

Self-identifying terms for Aboriginal peoples denoting geographic identity
Name	State
Murri	is usually used by Aboriginal people in and from Queensland and north-west New South Wales
Goori	is usually used by Aboriginal people in and from northern New South Wales coastal regions
Koori	is usually used by Aboriginal people in and from parts of New South Wales and Victoria
Palawa	is usually used by Aboriginal people in and from Tasmania
Nunga	is usually used by Aboriginal people in and from South Australia
Yolngu	is usually used by Aboriginal people in and from Northern Territory (north-east Arnhem Land)
Anangu	is usually used by Aboriginal people in and from Central Australia
Noongar	is usually used by Aboriginal people in and from south-west Western Australia

Terms to Describe Aboriginal and Torres Strait Islander Individuals

Identifying an individual

Some individuals prefer to be identified by their clan, nation or language group, however some who have been displaced may not know their language or cultural group or there may be sensitivities.

These examples show some of the many different ways that Aboriginal and Torres Strait Islander individuals may refer to themselves:

• Dan Parsons, a Euahaly-i and Kooma man, conducted an Acknowledgment of Country.
• Sally Smith, a proud Aboriginal woman from Brisbane, addressed the group.
• Ken Wanat, a Meriam man from the island of Mer (Murray Island) in the Torres Strait, addressed the group.
• Julie Sailor, a Torres Strait Islander woman from Cairns, attended the meeting.

The Koori Mail’s hierarchy of preference

The Aboriginal-owned newspaper Koori Mail tries to be as specific as possible when writing about Aboriginal and Torres Strait Islander peoples. It recommends the following hierarchy in descending order of preference, which is a good guide, but most importantly pay attention to how someone refers to themself: The person’s language group, for example Kalkadoon. The area the person comes from, for example Murri. Aboriginal if they come from mainland Australia, Torres Strait Islander if they’re from there. And finally, Aboriginal and Torres Strait Islander.

Skin colour (black, dark and fair-skinned, caste — half, quarter, one-eights etc.)

It is disrespectful and divisive to judge a person’s Aboriginal and Torres Strait Islander identity based on their skin colour or appearance.

These terms were historically used to classify Aboriginal and Torres Strait Islander peoples according to skin colour and parentage, with the assumption that any Aboriginal and Torres Strait Islander person with any ‘European’ blood was more acceptable as a member of ‘Australian society’.

However in a contemporary context a reverse logic is often applied, whereby colour and lifestyle are used to quantify an Aboriginal and Torres Strait Islander person’s ‘authenticity’.

Aboriginal peoples, individually and collectively, define themselves by their culture and relationships, not by skin colour.

Identity Intact

No matter how much you dilute
Mix, match and try to pollute
Our identity remains intact
Something you can’t change, that’s a fact
Our spirit is not measured by the shade of our skin
But by something stronger found within
A place you cannot touch or take away It will remain shining out till our dying day
We all connect with it again
No matter how far we’ve been.

Deirdre Currie

Our history

There are particular sensitivities around this topic given Australia’s history of the Stolen Generation, where there were particular practices of removing children of fairer skin away from their darker parents as it was believed these children would have better success at assimilation. There are many stories of fair-skinned children being blackened with charcoal by the parents in the hope the government officers would not notice their colouring and thus not remove them. To learn more about aspects of our nation’s history, attend the department’s two day Aboriginal and Torres Strait Islander Cultural Capability Training. Enrol in iLearn.

Terms associated with Aboriginal and Torres Strait Islander communities, cultures and peoples

Many of these terms are ‘in-group’ terminology and there is a difference between respectful and appropriate language for those belonging to a group (in-group) and those who don’t belong (outgroup). Aboriginal and Torres Strait Islander peoples have reclaimed some once-derogatory terms and now use those terms to refer to themselves. The same term may offend when used by non-indigenous people (out-group).

By reclaiming it you take the power away from language. If you take a derogatory term and use it within your group it loses its power and it doesn’t become as hurtful anymore. You’ve reclaimed it as yours.

Aboriginal English

Aboriginal English, an adaptation of the English language, is spoken by many Aboriginal peoples throughout Australia.

While there is a commonality with Australian English, the accent, grammar, words, meanings and language used differentiates Aboriginal English or ‘lingo’ from Australian English and slang. There are also similarities between Aboriginal English and traditional Aboriginal languages.

It is disrespectful to use Aboriginal English in departmental documents or conversation, without express community endorsement. This also applies to imitating Aboriginal speech patterns.

About Aboriginal Languages
In Queensland, over 100 Aboriginal and Torres Strait Islander languages and dialects were once spoken. Today around 50 of these remain spoken (in varying degrees), with less than 20 being used as first languages, predominantly in the north of the state

Aunty and Uncle

‘Aunty’ and ‘Uncle’ are terms of respect within an extended family and may be applied to aunts, uncles, cousins and other blood relatives as well as those married into the family. The use of Aunty and Uncle in this way does not follow the traditional western use of the terms.

In addition the terms Aunty and Uncle are used as terms of respect and of reverence for senior people who are not necessarily a family member. In this case it is acknowledging that a relationship exists — either through the work that the Aunty or Uncle has done for the broader community or as a result of the support given to the individual — demonstrating respect to the senior person.

Blackfella

Blackfella is a derogatory term that has been reclaimed by Aboriginal and Torres Strait Islander peoples. This is definitely an in-group term and is highly likely to offend if used by someone from outside that group.

Clan

In an Aboriginal and Torres Strait Islander context ‘clan’ is a local descent group, larger than a family but based on family links through a common ancestry. A ‘clan’ is a subset of a nation. For example, the Yidinji Nation in Far North Queensland has several clans within it such as Mandingalbay Yidinji and Dulabed Malanbarra Yidinji.

It is important to realise that while there are shared connections, each clan group may have separate aspirations and should be regarded as a discrete group.

Community

Community is about interrelatedness and belonging and is central to Aboriginal and Torres Strait Islander peoples’ ways of being. To Aboriginal and Torres Strait Islander peoples, communities can be formed around a geographical location, country, their mob, extended family ties and shared experiences.

It is most common to refer to an Aboriginal and Torres Strait Islander community within a geographical location, but it’s also important to remember there will be great diversity of backgrounds, mobs, language groups and other differences within that community.

Country

Country is a term used to describe a culturally defined area of land associated with a particular, culturally distinct group of people or nation. The term ‘country’ is often used by Aboriginal and Torres Strait Islander peoples to describe family origins and associations with particular parts of Australia.

Aboriginal peoples and Torres Strait Islander peoples have diverse relationships with, connections to, and understandings of, the Australian environment. Some of these relationships are based on the traditional knowledge and practice passed down from generation to generation, while others have resulted from the various impacts of colonisation. Aboriginal and Torres Strait Islander peoples’ relationships to country are complex and interrelated.

Cultures

Aboriginal and Torres Strait Islander cultures are many and varied so it is most respectful to ensure that Aboriginal and Torres Strait Islander cultures are always referred to in plural. It is important to understand that while there are consistent elements, there is no single lived experience of culture for Aboriginal and Torres Strait Islander peoples. There was diversity even before colonisation and previous historical impacts may continue to impact on people’s understanding of how they define culture.

It is critical we recognise that as humans we are all cultural beings. We learn to communicate and understand our world through the context of our beliefs and values which are transmitted by our family behaviours, traditions and ultimately our personal experiences.

Your culture matters as it reflects your individual identity, creates a sense of belonging and influences the way you see yourself and what you think is important in the world. Before you can explore and understand someone else’s culture it is important to understand your own culture and how it shapes your attitudes and behaviours. This is sometimes referred to as your cultural lens and this cultural lens may hinder you from understanding the values and behaviours of other cultural groups, as you unconsciously compare them to your own norms and even your ways of thinking.

Deadly

Deadly is used by many Aboriginal peoples to mean excellent, very good. It’s similar to how the word wicked is used by many young English speakers.

Deadly, in this context, is certainly strongly ‘owned’ by the Aboriginal and Torres Strait Islander community but is not necessarily an in-group word. It is not disrespectful to express your appreciation for something by saying ‘that’s too deadly!’

It would be disrespectful for non-indigenous people to use the word deadly in a title, for example in the name of a program, in order to ‘appeal’ to the Aboriginal and Torres Strait Islander community. The decision to include deadly or any other ‘ingroup’ words should be owned and led by the Aboriginal and Torres Strait Islander community.

Deadly in DCCSDS
Within our department a group of Aboriginal and Torres Strait Islander staff decided that being highly culturally capable should be called ‘deadly’ in the department’s cultural capability continuum. These Aboriginal and Torres Strait Islander staff welcomed this language being embraced by the Director-General and the department.

Discrete Community

A discrete Indigenous community refers to a geographic location, bounded by physical or cadastral (legal) boundaries, and inhabited or intended to be inhabited by predominately Indigenous people, with housing or infrastructure that is either owned or managed on a community basis. Most Aboriginal and Torres Strait Islander peoples see these communities as their homes and communities and using the term ‘discrete’ is an unnecessary label. It is most respectful to just refer to a community, as you would with any other location.

Dreaming, Dreamtime

The term ‘Dreamings’ was coined by WEH Stanner in 1965 to represent the myriad individual names for traditional belief systems.

Use of the term ‘Dreamtime’ to refer to only the period of creation is inappropriate, and ‘spirituality’, or ‘spiritual beliefs’ is more appropriate. For Aboriginal and Torres Strait Islander peoples spirituality is a way of life, connectedness and belonging. Many Aboriginal and Torres Strait Islander peoples prefer to use the term Dreaming, which is about the current lived experiences and how these intersect with their sense of connectedness and belonging.

Terms such as ‘myth’ or ‘story’ convey the impression that knowledge from the Dreaming is not true, is trivial or happened in the past.

Elders

Recognised Elders are highly respected people within Aboriginal and Torres Strait Islander communities, as such the use of the word Elder should be capitalised.

Elders are men and women in Aboriginal and Torres Strait Islander communities who are respected for, and are custodians of, wisdom and knowledge of culture, law and lore.

Culturally, old age is always respected, but old age alone does not necessarily mean that one is a recognised Elder.

Mission

It is more respectful to use the word purpose, rather than mission.

Missions were first set up in the 19th century by Christian missionaries. Aboriginal peoples were taken to missions against their will, resulting in the destruction of families and cultures. On these missions, every aspect of Aboriginal people’s lives was controlled. Life on these missions was incredibly harsh, with poor living conditions, and no respect for human rights, or the cultural needs and practices of Aboriginal peoples.

The term ‘mission’ has negative connotations for Aboriginal and Torres Strait Islander peoples and can cause distress.

Mob

The meaning of Mob for Aboriginal and Torres Strait Islander peoples is very different from the western understanding of the word, which is as an unruly and large crowd of people. For Aboriginal and Torres Strait Islander peoples mob refers to strong connections and cohesive ties within a group.

‘Mob’ is a term identifying a group of Aboriginal or Torres Strait Islander peoples associated with a particular place or country, a Nation, language group or an historical community. For example the ‘Waka Waka mob’, the ‘Cherbourg mob’ or the ‘Inala mob’.

It is a term that is extremely important to Aboriginal and Torres Strait Islander peoples because it is used to identify who they are, where they are from and their group responsibilities and support. The individual is culturally less important than identifying with, being part of and fulfilling responsibilities to the mob.

Nation, language group, tribe

Nation refers to a culturally distinct group of people associated with a particular, culturally defined area of land or country. Each nation has boundaries that cannot be changed, and language is tied to that nation and its country.

Nations is generally the most respectful term, however language groups is also commonly used and may be the preferred term.

These terms are more respectful than ‘tribes’. There are two main reasons for this – firstly tribe/s implies a sameness of all Aboriginal and Torres Strait Islander language groups. Secondly, tribe/s can imply something that is negative or simplistic, however, while departmental staff should avoid using the word tribe there are Aboriginal peoples who use this word to describe themselves.

Spelling variations

Aboriginal languages have only relatively recently begun to be written down and have very different sounds and pronunciations to English, with more than half the sounds in some Aboriginal languages not found in English and vice versa. As such, there may be variations in the spelling of a Nation’s name, so if you come across a different spelling, do not automatically think it’s an error. An example is Kamilaroi, Gomeroi, Gamilaraay.

Natives, primitive, prehistoric, simple

These terms are offensive as they imply Aboriginal and Torres Strait Islander societies are not as ‘advanced’ as European societies. Using terms that imply negative values is disrespectful to Aboriginal and Torres Strait Islander peoples and cultures.

The effectiveness and sophistication of Aboriginal and Torres Strait Islander resource management, social organisation and science is becoming more widely recognised.

Sorry Business

The period of mourning for deceased Aboriginal or Torres Strait Islander peoples is commonly known as Sorry Business.

Sorry Business is a term used during the time of mourning following the death of an Aboriginal or Torres Strait Islander person. The term can also refer to the past practice of forcibly removing children from their families. Torres Strait Islanders may also use the phrase Bad News or Sad News.

In many Aboriginal communities there is a prohibition on naming someone who is deceased, which may last for months or even years. When this occurs, a different name is used to refer to the person who has passed away.

To understand the emotional impact of Sorry Business you need to appreciate that the collective sense of identity means the loss of an individual important to the group is felt deeply by all and that all of the protocols observed are designed as mechanisms to deal with that deep sense of loss. It is an essential part of the healing process that those connected to the person who has passed have the opportunity to come together to process this loss.

DATSIP Community Profiles
DATSIP has a range of Community Profiles that provide more detail of procedures in various communities across the state.

Torres Strait Creole

Torres Strait Creole (also known as Ailan Tok or Yuplatok) is spoken by most Torres Strait Islanders and is a mixture of Australian English and traditional languages. It developed from a Pidgin language as a result of contact with missionaries and others. Torres Strait Creole has its own distinctive sound, grammar, vocabulary, usage and meanings.

About Torres Strait Languages

There are two languages indigenous to Torres Strait Islanders and an Englishbased Creole/Kriol. Meriam Mir (also written as Miriam Mer) is the Language of the Eastern Islands of the Torres Strait. Kala Lagaw Ya (also written as Kalaw Lagaw Ya) is the traditional language owned by the Western and Central islands of the Torres Strait and is linguistically connected to the Aboriginal languages of the Australian mainland.

Tracking

It is more respectful to use the word monitoring, rather than tracking.

Use of the word tracking is not appropriate as it can trigger memories of the regrettable period of history when under the control of European officers, Aboriginal people — as part of the various Native Police forces — tracked and hunted down other Aboriginal people. Even for much of the 20th Century, when Aboriginal peoples left the designated places where they were allowed to live, they were often tracked down and forcibly returned.

Welcome to Country and Acknowledgement of Country protocols

A Welcome to Country is a protocol where Aboriginal or Torres Strait Islander Traditional Owners welcome others to the land of their ancestors. An Acknowledgement of Traditional Owners and Elders differs from a Welcome to Country in that it can be delivered by both Indigenous and non-indigenous people. This practice demonstrates respect for Aboriginal and Torres Strait Islander cultures and recognises the importance of acknowledging Traditional Owners of the land and/or sea. See the Welcome to Country Protocol on the Cultural Capability Portal for more information.

Vulnerability

We must be conscious of using any language that stigmatises or labels Aboriginal and Torres Strait Islander peoples. There are many Aboriginal and Torres Strait Islander Queenslanders who may never need to access the services of our department and so there should be some care taken to differentiate between all Aboriginal and Torres Strait Islander peoples and Aboriginal and Torres Strait Islander peoples who are experiencing vulnerability.

Careful consideration should be given to respectfully referring to Aboriginal and Torres Strait Islander peoples who may need the services of the department.

Aboriginal and Torres Strait Islander peoples who are experiencing vulnerability is the recommended option as this avoids any sense of ‘labelling’ Aboriginal and Torres Strait Islander peoples as having lifelong vulnerability.

Women’s business and men’s business

The terms women’s and men’s business are often used to describe the practice of women and men discussing specific issues separately. Although this is one aspect, it does not fully describe the true meaning or cultural significance of the practice of women’s and men’s business. For Aboriginal peoples these terms define gender based roles and responsibilities that are core to spiritual belief systems and laws and highly complex cultural values. Using these terms in a manner that trivialises them or does not recognise their full cultural significance can cause offence and as such, these are not necessarily terms that should be used by non-indigenous staff.

While Torres Strait Islander cultures do have gender based cultural beliefs and considerations, the terms women’s and men’s business should not be used.

Strengths Based Language

Strengths based language is becoming the standard within the department. It can be defined as an approach which identifies opportunities to highlight and promote the existing strengths and capabilities of an individual to face a problem or concern. This is in contrast to focusing on the problem or concern and how the individual is coping.

The underlying impetus is a belief in the possibility of change and an acknowledgment that people can be resourceful and a part of their own change. This does not mean the problem or concern is not considered. This is usually done through questioning strategies that attempt to identify ‘what works’ for the person and ‘how it works’ so we can focus on developing these further.

When working with Aboriginal and Torres Strait Islander peoples it is important to identify the collective strengths and capabilities of the network around the person as those strengths and capabilities are shared with the person with whom you are working.

A different lens
It is critical to understand that the person you are working with may describe what they see as their strengths through a lens different to yours. For example, identifying the idea of reciprocity or sharing of resources across the entire group (such as food or money) as a strength, which may not align with your values.

Terms to describe Queenslanders who are not Aboriginal and Torres Strait Islander peoples

Non-indigenous

There are times when it is necessary, in writing and in conversation, to refer to Queenslanders who are not Aboriginal and Torres Strait Islander peoples. Using the term nonindigenous is a respectful option.

The broader Queensland community, other Queenslanders

Depending on the context of the communication, these options to collectively describe non-indigenous peoples may also be appropriate and respectful:

• ‘The organisation aims to assist Aboriginal and Torres Strait Islander Queenslanders to achieve health outcomes commensurate to that of the broader Queensland community’
• ‘Aboriginal and Torres Strait Islander peoples access this service at a higher rate than other Queenslanders’.

This guide is a living narrative and is part of our cultural capability journey. As such, it will change and develop over time. If you would like to contribute or give feedback, please email Aboriginal and Torres Strait Islander Cultural Capability.

References

• Aboriginal and Torres Strait Islander Peoples Engagement Toolkit 2012, Australian Human Rights Commission report.
• Appropriate Terminology, Representations and Protocols of Acknowledgement for Aboriginal and Torres Strait Islander Peoples.
• Communicating positively: a guide to appropriate Aboriginal terminology (2004), NSW Department of Health.
• Department of Aboriginal and Torres Strait Islander Partnerships.
• Foster their Culture: Caring for Aboriginal and Torres Strait Islander Children in Out-of-Home Care – 2008, Secretariat of National Aboriginal and Islander Child Care (SNAICC).
• Protocols for use of ‘Aboriginal’ and ‘Torres Strait Islander’ Working with Aboriginal people and communities: A practice resource, NSW Department of Community Services (2009).

6.1.1. Improving and acquiring clinical communication skills

A review of the literature showed that communication is a core clinical skill that can be developed and improved with practice, experience, continuous learning, mentorship and support. This skill needs to be maintained throughout a healthcare provider’s profession and translated into various clinical settings and situations.

Communication skills research and teaching has grown in health care over the past two decades,33 with effective communication being a well-recognised essential skill for all healthcare providers. Evidence also suggests that communication skills training is likely to help healthcare providers empathise more with their patients.

A systematic literature review, identified learning outcomes or competencies for communication skills were categorised into the following four domains:

• Knowledge: The understanding of information through which incoming data and experiences are processed and recorded. This includes an understanding of the purpose and importance of healthcare communication, and knowledge of the different aspects of effective communication in health care.
• Content skills: What is communicated, for example, what is done and said in communication interactions. This refers to the structure and framework for communication including opening and introductions, exploring concerns and shared decision-making, identifying roles and expectations with the team, and articulating information to other members of the team that is relevant to their respective roles.
• Process skills: How to communicate, for example, how communication interactions occur. This includes building relationships, demonstrating empathy, verbal and nonverbal behaviour, active listening skills, closed-loop communication and communication in different modes.
• Perceptual skills: An awareness of oneself and others, and how this may influence communication. For example the impact of thoughts, feelings, bias and attitudes. This includes reflection, self-evaluation and external evaluation. This could also include situational awareness skills, and an ability to understand the information within the task environment, understand what it means, what is likely to occur and what needs to be done.

It was identified that these four domains could provide a framework for educators from across all healthcare professions to develop competencies, learning outcomes and programs that are relevant to their setting. While there are different models for teaching communication skills, many cover the domains described above.

While healthcare providers may develop and learn these skills throughout their undergraduate studies and clinical experience; communication skills seem to be content and context bound,37 and learned in a developmental and longitudinal way.38 Acquisition and improvement of communication skills is therefore likely to require continuous, regular 17 Improving clinical communication, collaboration and teamwork in Australian health services targeted practice, experiential learning, observation and real-time, direct feedback in the clinical setting the healthcare provider is practicing in.

It is also important to recognise and address the context in which communication occurs in clinical practice. This includes managing communication with time pressures, documentation realities, workflow issues, different communication styles and professional relationships.39 This highlights the significance of customised training to suit the local context.

The importance of ensuring that teachers or facilitators of communication skills training are equipped with sufficient and appropriate training and experience to effectively teach and model effective communication skills, and undertake experiential learning, was also highlighted in the literature.

While there is limited evidence on the optimum length of training to be effective, the literature suggests that a training course of at least three days may be necessary to ensure there is a transfer of skills into clinical practice.

6.1.2 Improving and acquiring collaboration and teamwork skills

There are many different types of team training cited in the literature. Common competencies focus on skills for effective communication, leadership, coordination, situational awareness and monitoring, reflective practice, and role clarity.

Research into the effectiveness of team training in health care varies in quality of evidence, study design and sample size. Therefore, it is difficult to associate training interventions directly with improvements in clinical outcomes. However, there is evidence that teamwork and team training can have a positive influence on team behaviours, processes and clinical performance across various clinical settings. This can subsequently affect patient outcomes through improved clinical processes.

Research suggests that a multi-modal approach to training is highly effective in improving teamwork skills. This includes learning activities, practice and use of supportive tools, such as structured communication tools. The evidence indicates that simulation training by recreating real life scenarios, and training based on human factors principles (such as Crew Resource Management (CRM) training), can result in improved team behaviour, attitudes and perceptions of institutional support. However, there was limited evidence on the optimum length of training for it to be effective and the frequency of retraining for skills maintenance.

Team reflexivity is an approach defined as ‘the ability to pay critical attention to individual and team practices with reference to social and contextual information’. A recent systematic review, which focused on the use of team reflexivity to improve teamwork and communication, found that while it was difficult to draw conclusive evidence about the impact of reflexivity alone, the use of video-reflexive ethnography (VRE) could be well placed to provide locally appropriate solutions. VRE involves filming specific interactions or practices in-situ and replaying appropriate clips to the teams. In particular, VRE was able to make routine practices explicit, allowing teams ‘to identify commonly occurring features in their working practices, and to develop a common ground on how to organise and manage these practices collectively.

The Commission emphasises the need for flexible standardisation, and the importance of understanding local needs, risks, and relationships to ensure effective translation of teamwork and clinical communication skills into practice. In line with this, as with communication skills development, the literature identified the importance of team training that is customisable for local implementation. The research also suggests that team training Improving clinical communication, collaboration and teamwork in Australian health services should focus on both non-routine (e.g. emergencies) and routine (e.g. routine surgery) situations, as teamwork is equally important for patient safety in both situations.

Electronic patient communication policy

Current as of: [insert date of last revision]

Version No: [insert version number]

1. Background and rationale

   The Australian Privacy Principles govern the exchange of information to patients including messages sent by SMS, email, fax or other means. Patient consent is required in a documented form before communications can be initiated and health services need to take reasonable steps to protect personal information when using electronic methods of communication.

2. Purpose

   Our practice is mindful that even if patients have provided electronic contact details, they may not be proficient in communicating via electronic means and patient consent needs to be obtained before engaging in electronic communication. Electronic communication includes email, facsimile (including eFax) and Short Message Service (SMS).

   Communication with patients via electronic means is conducted with appropriate regard to privacy and therefore it is important to have a policy in place to set expectations for staff and patients regarding the use electronic communications tools.

3. Procedure

   Our practice’s primary reason for communicating electronically to patients is [amend as required: to issue appointment reminders, to issue preventative health reminders, to advertise/offer goods or services] and we verify the correct contact details of the patient [amend as required: at the time of the appointment being made, when the patient consultation takes place].

   Whilst not encouraged, our practice allows patients an opportunity to obtain advice or information related to their care by electronic means, but only where the practitioner determines that a face-to-face consultation is unnecessary and that communication by electronic means is suitable. Our practice will only provide information that is of a general, non-urgent nature and will not initiate electronic communication (other than SMS appointment reminders) with patients. Any electronic communication received from patients is also used as a method to verify the contact details we have recorded on file are correct and up to date.

   Communication with patients via electronic means is conducted with appropriate regard to privacy. Before obtaining and documenting the patient’s consent, patients are fully informed through information contained [insert methods used to ensure patients are aware of the risks associated with engaging in electronic communication] of the risks associated with electronic communication in that the information could be intercepted or read by someone other than the intended recipient. As an additional precaution, we will request a patient sends an email to our practice to which we will respond to avoid the risk of sending to an incorrect email address. Our practice also has an automatic email response system set up so that whenever an email is received into the practice, the sender receives an automated message reinforcing information regarding these risks.

   When an email message is sent or received in the course of a person's duties, that message is a business communication and therefore constitutes an official record. Patients are informed of any costs to be incurred as a result of the electronic advice or information being provided, and all electronic contact with patients is recorded in their health record [specify how the message is recorded in the patient health record].

4. SMS Messaging and the SPAM Act
   When sending SMS messages with the purpose of advertising or offering goods or services at the practice, our practice complies with the Spam Act (Cth) 2003.The SMS message:
   • Clearly and accurately identifies our health organisation as the authorised sender
   • Includes accurate information about how the recipient can readily contact the practice
   • Contains a functional and clearly presented unsubscribe facility / option to allow patients to opt-out of receiving future messages

5. Staff responsibility

   All members of the practice team are made aware of our policy regarding electronic communication with patients during the staff induction process and are reminded of this policy on an ongoing basis. Staff are made aware that electronic communications could be forwarded, intercepted, printed and stored by others. Each member of the practice team holds full accountability for emails sent in their name or held in their mailbox, and they are expected to utilise this communication tool in an acceptable manner. This includes, but is not limited to:

   • Limiting the exchange of personal emails
   • Refraining from responding to unsolicited or unwanted emails
   • Deleting hoaxes or chain emails
   • Email attachments from unknown senders are not to be opened
   • Virus checking all email attachments
   • Maintaining appropriate language within electronic communications
   • Ensuring any personal opinions are clearly indicated as such, and
   • Confidential information (e.g. patient information) must be encrypted.

   • Only staff members with the appropriate permissions in the software and the necessary training are authorised to send SMS messages to patients and the message details/content are controlled by the use of a template which does not contain sensitive information such as test results or diagnosis/condition details. It is our policy not to respond to patient SMS messages.

     Our practice reserves the right to check an individual’s email accounts as a precaution to fraud, viruses, workplace harassment or breaches of confidence by members of the practice team. Inappropriate use of the email facility will be fully investigated and may be grounds for dismissal.

     The practice uses an email disclaimer notice on outgoing emails that are affiliated with the practice stating [insert details of the disclaimer notice].

6. Related resources

   Recommendations when using SMS messaging | Avant

   Secure use of email | RACGP

   Avoid sending spam | Australian Communications and Media Authority

Social media policy

Current as of: [insert date of last revision]

Version No: [insert version number]

1. Background and rationale

   Social media and its use by individuals and organisations are continually growing and user-generated content, such as social networking sites, websites, discussion forums and message boards and blogs also continue to proliferate as forms of information exchange.

   As such, health professionals need to maintain professional standards and be aware of the implications of their actions online. Regardless of whether an online activity is publicly available or limited to a specific group, health professionals need to be aware that information circulated on social media may end up in the public domain and remain there. Health practitioners should be aware of their ethical and regulatory responsibilities when they are interacting online, just as when they interact in person.

2. Policy

   ‘Social media’ is defined as online and mobile tools and social networks that are used to disseminate information, share opinions, experiences, images and video through online interaction.

    

   Regardless of whether social media is used for business related activity or for personal reasons, the following standards apply to members of our practice team. Practitioners and team members are legally responsible for their postings online. Practitioners and team members may be subject to liability and disciplinary action including termination of employment or contract if their posts are found to be in breach of this policy.

3. Procedure

   Our practice has appointed [insert name/position title of the person with designated responsibility for managing the practice’s social media] as our social media officer with designated responsibility to manage and monitor the practice’s social media accounts. All posts on the practice’s social media websites must be approved by this person.
   When using the practice’s social media, all members of our practice team will not:
   Post any material that:

   • Is unlawful, threatening, defamatory, pornographic, inflammatory, menacing, or offensive
   • Infringes or breaches another person’s rights (including intellectual property rights) or privacy, or misuses the practice’s or another person’s confidential information (e.g. do not submit confidential information relating to our patients, personal information of staff, or information concerning the practice’s business operations that have not been made public)
   • Is materially damaging or could be materially damaging to the practice’s reputation or image, or another individual
   • Is in breach of any of the practice’s policies or procedures
   • Use social media to send unsolicited commercial electronic messages, or solicit other users to buy or sell products or services or donate money
   • Impersonate another person or entity (for example, by pretending to be someone else or another practice employee or other participant when you submit a contribution to social media) or by using another’s registration identifier without permission
   • Tamper with, hinder the operation of, or make unauthorised changes to the social media sites
   • Knowingly transmit any virus or other disabling feature to or via the practice’s social media account, or use in any email to a third party, or the social media site
   • Attempt to do or permit another person to do any of these things:
   • Claim or imply that you are speaking on the practice’s behalf, unless you are authorised to do so
   • Disclose any information that is confidential or proprietary to the practice, or to any third party that has disclosed information to the practice
   • Be defamatory, harassing, or in violation of any other applicable law
   • Include confidential or copyrighted information (e.g. music, videos, text belonging to third parties), and
   • Violate any other applicable policy of the practice.
4. Staff responsibility

   All members of our practice team must obtain the relevant approval from our social media officer prior to posting any public representation of the practice on social media websites. The practice reserves the right to remove any content at its own discretion.

   Any social media must be monitored in accordance with the practice’s current polices on the use of internet, email and computers.

   Our practice complies with the Australian Health Practitioner Regulation Agency (AHPRA) national law and takes reasonable steps to remove testimonials that advertise our services (which may include comments about the practitioners themselves). Our practice is not responsible for removing (or trying to have removed) unsolicited testimonials published on a website or in social media over which we do not have control.

   Any social media posts by members of our practice team on their personal social media platforms should:

   • Include the following disclaimer example in a reasonably prominent place if they are identifying themselves as an employee of the practice on any posting: ‘The views expressed in this post are mine and do not reflect the views of the practice/business/committees/boards that I am a member of’, and
   • Respect copyright, privacy, fair use, financial disclosure and other applicable laws when publishing on social media platforms.
   • Social media activities internally and externally of the practice must be in line with this policy.

5. Related resources

   Social media guidance | AHPRA

Practice website policy

Current as of: [insert date of last revision]

Version No: [insert version number]

1. Background and rationale

   Patients are increasingly researching health practitioners online, accessing education and information about their illness or condition online, and taking advantage of opportunities to book healthcare appointments through online platforms.

2. Policy

   Our practice is committed to making information about our practice and its services readily accessible for all patients and the community. We regularly update our content to ensure currency of the information and [Add additional services here e.g. we provide an email address for inbound communications provide a web-based enquiry form] that clearly states when and how you will respond to a patient or potential patient's enquiry.

3. Procedure

   In complying with the Privacy Act 1988, our practice provides the following advice to users of our website about the collection, use and disclosure of personal information. The aim of this advice is to inform users of our website about:

   • What personal information is collected by our practice
   • Who is collecting the personal information
   • How personal information is used by our practice
   • Access to personal information collected by our practice, and
   • Security of personal information collected by our practice

   In line with our policy of providing readily accessible information, our website also contains information about:

   • Our fees and charges
   • The services we provide
   • Surgery hours (including who to contact after hours)
   • How to book an appointment and
   • How to make a complaint

   The practice’s privacy policy is posted on the website and is available for download. The website is continually monitored to ensure it is kept current and contains at a minimum the information included on our practice information sheet. Any changes to our practice information sheet are also reflected on the website.

   As our website contains advertisements from time to time, we ensure any advertising complies with the AHPRA’s guidelines for advertising of regulated health services and includes a disclaimer on any advertising which states that the practice does not endorse the advertised services or products. We also use the AHPRA self-assessment tool to check any advertising for compliance with the guidelines before it is published on our practice website.

4. Staff responsibility

   Access to update the practice website is limited to staff that have been assigned this responsibility in their position description and are suitably trained to perform this task.

   Updates are approved prior to being published by the practice manager.

5. Related resources

   Advertising compliance | AHPRA

   Advertising compliance self-assessment tool | AHPRA