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Active Listening

Editor: Tammy J. Toney-Butler Updated: 9/13/2023 1:18:50 PM


Active listening is a fundamental aspect of professional interaction, and mastery requires cultivating deliberate practice. Communication is characterized by an exchange in which one party, the sender, transmits information via verbal, written, or nonverbal means to another party, the receiver. In active listening, it is critical that the receiver acknowledges receipt of the information and provides feedback to the sender to ensure mutual understanding. The ability to communicate effectively is not innate; it is a learned skill that requires ongoing practice and refinement. This proficiency underpins teamwork and builds strong patient relationships, vital for positive healthcare outcomes. Effective communication promotes problem-solving efficacy within teams and significantly reduces the likelihood of errors.

Many professionals underestimate the challenges of maintaining clear communication in a demanding healthcare environment. This misjudgment often amplifies stress in the workplace. For instance, in the operating room, where everyone is task-focused and striving for positive patient outcomes, responses to queries can be curtailed due to time pressures. Such abbreviated communication can lead to misinterpretations, which may increase team stress. Therefore, despite time constraints, striving for clarity and completeness in communication is essential for minimizing misunderstandings and enhancing overall team performance.[1]


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Upon receiving transmitted information (including sentiments or concepts) from the sender, the receiver's role extends beyond a mere acknowledgment of receipt. The conveyed information, which may be interpreted as either positive or negative, holds the potential to influence the sender's desired outcome. For effective communication, the receiver must provide feedback to the sender. Feedback encompasses an acknowledgment from the receiver coupled with a recapitulation of their understanding of the sender's message. This allows the sender to confirm the accuracy of the received message or offer a restatement for better clarity. This process allows the receiver to seek further clarification through questions, facilitating a better grasp of the message.

Significantly, this communicative clarification process does not consume additional time or detract from the tasks. On the contrary, it improves patient care by incorporating improvisational elements into communication.[2] Simultaneously, understanding the impact of attention-engaging listening tasks on auditory-motor integration is beneficial.[3] The interaction between physician empathy and breaking terrible news significantly affects patient outcomes, and the timing of these interactions may influence the survival rate among lung cancer and pleural mesothelioma patients. Thus, the receiver's empathetic response and accurate understanding are critical factors in communication, particularly in healthcare settings.[4]

Issues of Concern

Several factors can obstruct effective 2-way communication, which is crucial for active listening. The sender's message delivery mode is as significant as the content of the message itself. Misinterpretation of message tone is common, hence necessitating a feedback mechanism. Verbal communication, whether written or spoken, carries an implicit tone that can significantly affect the receiver's understanding of the message. This dynamic can give rise to conflicts in various contexts, including workplaces and patient-care settings. For instance, responses must be concise and precise in an operating room. The tone accompanying the information delivery also plays a critical role; underlying emotions or attitudes conveyed in the sender's words could lead to misunderstandings and communication breakdowns. The written form of verbal communication may, at times, foster negative emotions due to an assumed tone, contrasting face-to-face exchanges that tend to be more direct. Misinterpretation of tone from written words is frequent, especially in surgical environments. Being detail-focused and task-oriented, surgical teams often state their messages by conveying specific information. As a result, pleasantries are frequently omitted, contributing to potential misunderstandings.[5][6]

Nonverbal communication constitutes a significant component of interaction, encompassing body language, touch, and periods of silence. The communicator and the recipient exhibit body language, indicating positive engagement or discomfort. A person's physical demeanor often reveals their genuine sentiments, even when these may contrast with their spoken words. Examples of body language include abrupt departures after information exchange, eye-rolling, sighing, shaking one's head, avoiding eye contact, placing hands on hips, or maintaining a rigid posture. These gestures may suggest a range of emotions, from indifference and disagreement to outright displeasure. Touch, another element of nonverbal communication, can serve as an expression of empathy or an attempt to exert dominance. While these gestures typically convey benevolent intent, their reception may vary based on individual comfort levels. It is paramount to respect personal boundaries for all team members and patients. Silence, often overlooked, can deliver a potent message. It may suggest thoughtful contemplation or profound shock, rendering an individual speechless. Providing the individual adequate time for processing the information and formulating a response is crucial during such instances. Periods of silence, commonly referred to as 'dead space,' do not necessarily require filling with inconsequential conversation.

Clinical Significance

To provide effective feedback, one must first develop strong listening skills, facilitating a clear transmission of ideas from the sender. The following tips can aid in becoming a proficient listener:

  1. Concentrate on the sender. Give your full attention to the speaker and their message.

  2. Listen for the intended message. Rather than hearing what you want or expect, strive to understand the speaker's intended meaning.

  3. Refrain from premature judgment. Avoid making swift judgments if your relationship with the sender isn't robust. Observe their body language to gain insights into their attitudes toward the message.

  4. Reflect and paraphrase. Reiterate what you have understood in your own words. This demonstrates your engagement and confirms your comprehension.

  5. Ask for clarification. Do not hesitate to ask if any part of the message remains unclear. This will ensure accurate understanding and prevent miscommunication.

  6. Maintain focus. If the sender veers off-topic, gently steer the conversation back to the original issue or concern.

  7. Avoid distractions and assumptions. Stay focused on the sender's words rather than letting your thoughts wander or make unfounded assumptions.

  8. Listen fully before responding. Ensure you have heard and understood the entire message before responding. Active listening is a two-way process.

Active listening calls for full engagement. Both your colleagues and patients will highly value this enhanced communication tool.

Enhancing Healthcare Team Outcomes

Cultural competence holds a pivotal position in healthcare and significantly influences the process of active listening. Interacting and effectively communicating with individuals from diverse cultures often necessitates modifying conventional communication techniques. Individuals from different cultures uphold unique norms, which may not align with those widely recognized within one's own country. Thus, it becomes imperative for healthcare professionals to participate in educational programs or informative sessions to broaden their understanding of the cultural nuances prevalent in the demographic regions they serve. To facilitate ongoing growth and understanding, these programs should provide continual learning opportunities and feature speakers from various ethnic backgrounds who can accurately represent their culture's distinct communication styles.[7][8]

Interpreters play a critical role for patients facing language barriers, and their services significantly improve patient satisfaction. However, the power of active listening, which includes attentive body language and meaningful gestures, should not be underestimated. Despite language differences, these nonverbal cues can foster a robust connection within the patient-provider relationship.[9] Individuals have an inherent right to uphold their cultural traditions, and they must receive respect for their unique identity. Investing in comprehensive training, knowledge acquisition, and increased cultural sensitivity can bolster teamwork and communication. These enhancements ultimately lead to superior patient outcomes.[10]



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Level 3 (low-level) evidence


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Level 1 (high-level) evidence