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(Listening and Learning & Building Confidence and Support)
Source : Infant and Young Child Feeding : An Integrated Counselling Course (WHO October 2005)
Listening and Learning
After completing this session participants will be able to:
List the 6 listening and learning skills List the 6 building confidence skills Give an example of each skill Demonstrate the appropriate use of the skills
Counseling is a way of working with people in which you try to understand how they feel and help them to decide what they think is best to do in their situation.
You may find them useful with your family and friends or your colleagues at work. . Counseling skills are useful when you talk to patients or clients in other situations.Counseling mothers about feeding their infants is not the only situation in which counseling is useful.
especially if she is shy.A mother may not talk easily about her feelings. and with someone whom she does not know well. . This will encourage her to tell you more. You will need the skill to listen and to make her feel that you are interested in her. She will be less likely to “turn off” and say nothing.
SKILL 1. USE HELPFUL NON-VERBAL COMMUNICATION .
Question: What do you mean by ‘nonverbal communication’? .
Demo 5 .Non-verbal communication means showing your attitude through your posture. your expression. everything except through speaking.
or write notes while you talk Helps: remove the table or the notes •Taking time: Helps: Make her feel that you have time. then.Skill 1 With each demonstration say exactly the same few words. and try to say them in the same way. show signs of impatience. Greet her quickly. . or down at your notes •Barriers: Hinders: Sit behind a table. •Touch: Helps: Touch the mother appropriately. •Eye contact: Helps: Look at her and pay attention as she speaks Hinders: Look away at something else. watching her breastfeed. for example: “Good morning. Sit down and greet her without hurrying. and waiting for her to answer. How is feeding going for you and you baby?” •Posture: Hinders: Stand with your head higher than the other person‟s Helps: Sit so that your head is level with hers. Hinders: Touch her in an inappropriately way. Susan. Hinders: Be in a hurry. look at you watch. just stay quietly smiling at her.
Helpful Non-verbal Communication Keep your head level Pay attention Remove barriers Take time Touch appropriately .
g. to be expressed in a counselling situation where it might appear as though we are judging a mother. religion.Our non-verbal communication often demonstrates to a mother or caregiver our approval or disapproval of a situation. e. . We should be careful to avoid allowing our own views on certain subjects.
Always try to sound gentle and kind when talking to mothers. . We need to be interested and to probe beneath the surface if we wish to learn their real worries and their concerns.Verbal communication: Tone of our voice is important. Try to find out how people feel.
SKILL 2 ASK OPEN QUESTIONS .
you need to ask some questions.To start a discussion with a mother. . This saves you from asking too many questions. It is important to ask questions in a way that encourages a mother to talk to you and to give you information. and enables you to learn more in the time available. or to take a history from her.
so I thought that my milk is not enough. How is (child‟s name)?” Mother: “He is well.Skill 2 2.1 Ask Open Questions: Health Worker: “Good morning. (name). I am (name). how are you feeding him?” Mother: “He is breastfeeding. and he is very hungry.” .” Health Worker: “Tell me. I just have to give him one bottle feed in the evening. the community midwife.” Health Worker: “What made you decide to do that? Mother: “He wants to feed to much at that time.
Open questions are usually the most helpful. Open questions usually start with How What Why Who When where . To answer them a mother must give you some information.
the community midwife.2 Ask Closed Questions: Health Worker: “Good morning.” Health Worker: “Is he breastfeeding very often?” Mother: “Yes” .” Health Worker: “Are you breastfeeding him?” Mother: “Yes” Health Worker: “Are you having difficulties?” Mother: “ No. (name). thank you. I am (name).2. Is (child‟s name) well?” Mother: “Yes.
Closed questions usually start with words like “Are you?‟ or „Did he?‟ or „Has he?‟ or „Does he?‟ .Closed questions are usually less helpful. They tell a mother the answer that you expect .and she can answer them with a „Yes‟ or „No‟.
and think that the mother is not willing to talk. or that she is not telling the truth. .If a mother says „Yes‟ to this question. you still need to know if she breastfed exclusively. or if she also gave some artificial feeds. If you continue to ask questions to which the mother can only answer „yes‟ or „no‟ you become frustrated.
For example. . you might ask a mother of a ninemonth-old baby : “How is your child feeding?” Sometimes a general question like this receives an answer such as. “Oh.How to use questions to start and to continue a conversation: A very general open question is useful to start a conversation. So then you need to ask questions to continue the conversation. very well thank you”. This gives the mother an opportunity to say what is important to her.
For example: “Did your child have any fruit yesterday?” After you have received an answer to this question try to follow up with another open question. more specific questions are helpful. . For example: “Can you tell me what your child ate for the main meal yesterday?” Sometimes you might need to ask a closed question.For this.
SKILL 3. USE RESPONSES AND GESTURES WHICH SHOW INTEREST .
” (nods.” Health Worker: “ Mmm. I was a bit worried the other day. smiles) Mother: “Well.Skill 3 Using Response and Gestures Which Show Interest Health Worker: “Good morning.” Health Worker: “Oh dear!” (raises eyebrows. I think. . How is (child‟s name) now that he has started solids?” Mother: “Good morning.) Mother: “I wondered if it was something in the stew that I gave him. because he vomited.” Health Worker: “Aha!” (nods Sympathetically). looks interested. (name). He is fine.
you must show that you are listening and that you are interested in what she is saying. „Mmm‟. you say „Aha‟. With simple responses. for example. „Oh dear!‟. for example. look at her.If you want a mother to continue talking. nod and smile. Important ways to show that you are listening and interested are: With gestures. .
REFLECT BACK WHAT THE MOTHER SAYS .SKILL 4.
(name). I think that my milk is drying up.” “He seems hungrier this week?” “Yes. Which formula is best?” . How are you and (child‟s name) today?” “He wants to feed too much – he is taking my breast all the time!” “(Child‟s name) is feeding very often?” “Yes. This week he is so hungry. and my sister is telling me that I should give him some bottle feeds as well” “Your sister says that he needs something more?” “Yes.Reflecting Back Health Worker: Mother: Health Worker: Mother: Health Worker: Mother: Health Worker: Mother: “Good morning.
However.Health workers usually ask mothers a lot of factual questions. The mother may say less and less in reply to each question. . the answer to factual questions are often not helpful.
so that it does not sound as though you are copying her. It is best to say it in a slightly different way. This is another way to show you are listening and encourages the mother or caregiver to continue talking and to say what is important to her. .It is more useful to repeat back or reflect what a mother says.
EMPATHIZE.SHOW THAT YOU UNDERSTAND HOW SHE FEELS .SKILL 5.
Empathy is a difficult skill to learn. it is useful to respond in a way which shows that you heard what she said. . When a mother says something which shows how she feels. It is difficult for people to talk about feelings. It is easier to talk about facts. and that you understand her feelings from her point of view.
Sympathy: Health Worker: “Good morning. (name). When my child was ill. I know exactly how you feel. I am worried he is ill.” Health Worker: “I understand how you feel. I was so worried.” Mother: “What was wrong with your child?” . How are you and (child‟s name) today?” Mother: “(Child‟s name) is not feeding well.
” Health Worker: “It must be very frightening for you. (name).” Health Worker: “You are worried about him?” Mother: “Yes. some of the other children in the village are ill and I am frightened he may have the same illness.Empathy: Health Worker: “Good morning. I am worried he is ill. How are you and (child‟s name) today?” Mother: “He is not feeding well.” .
When you sympathize you are sorry for a person.For example. perhaps like this: “You are feeling very tired all the time then?” Empathy is different from sympathy. but you look at it from your point of view. if a mother says: “My baby wants to feed very often and it makes me feel so tired!” you respond to what she feels. .
My baby wanted to feed often too. . and does not make the mother feel that you understand her.” This brings the attention back to you. you might say: “Oh I know how you feel. and I feel exhausted.If you sympathize.
She feels tired. and it misses what she said about how she feels. For example: “He wants to feed very often? But this reflects back what the mother said about the baby‟s behavior.You could reflect back what the mother says about the baby. .
Empathy is not only to show you understand her bad feelings. .So empathy is more than reflecting back what a mother says to you. It is also helpful to empathize with a mother‟s good feelings.
. AVOID WORDS WHICH SOUND JUDGING.SKILL 6.
(name).” (she looks worried) Health Worker: “Has he gained weight well this month?” Mother: “I don‟t know..” Health Worker: “May I see his growth chart?” .Using Judging Words: Health Worker: “Good morning.. I hope so..” Health Worker: “Do you think that you have enough breast milk for him?” Mother: “I don‟t know. Is (name) breastfeeding normally?” Mother: “Well – I think so. but maybe not.
I was pleased. (name). I haven‟t needed to give him anything else.Avoiding Judging Words: Health Worker: “Good morning.” Health Worker: “He is obviously getting learned about the mother‟s feelings?” . How is breastfeeding going for you and (child‟s name)?” Mother: “It‟s going very well.” Health Worker: “How is his weight? Can I see his growth chart?” Mother: “Nurse said that he gained more than half a kilo this month.
enough. properly. well. If you use judging words when you talk to a mother about feeding. wrong. you may make her feel that she is wrong. good. .„Judging words‟ are words like: right. badly. or that there is something wrong with the baby. especially when you ask questions. A breastfeeding mother may feel there is something wrong with her breast milk.
Using open questions often helps to avoid using a judging word. . You may have noticed that judging questions are often closed questions. especially the positive ones.Mothers may use judging words about their own situation. when you are building a mother‟s confidence. You may sometimes need to use them yourself.
Summary LISTENING AND LEARNING SKILLS Use helpful non-verbal communication Ask open questions Use responses and gestures which show interest Reflect back what the mother says Empathize.show that you understand how she feels Avoid words which sound judging. .
To build confidence and support we need additional skills… .Build Confidence and give support YOUR communication skills can help a mother feel good about herself and confident that she will be a good mother. Confidence can help a mother to carry out her decisions and to resist pressures from other people.
Accept what a mother thinks and feels Accept mother’s ideas and feelings Without agreeing Without disagreeing ACCEPTING is NOT AGREEING that she is right ACCEPTING .helps her to trust you Demo d-e .1.
Mother: “My milk is thin and weak. It‟s just looks that way.” Health Worker: “Oh no! Milk is never thin and weak.(nods. and so I have to give bottle feeds.Skill 1: Accepting what mother‟s thinks A. smiles) .
” Health Worker: “Yes – thin Milk can be a problem” . Mother: “My milk is thin and weak.Skill 1 B. and so I have to give bottle feeds.
Skill 1 C.” Health Worker: “I see. You are worried about your milk” . and so I have to give bottle feeds. Mother: “My milk is thin and weak.
Skill 1: Accepting what mother feels
D. Mother(crying): “It is terrible,(child‟s name) has a cold and his nose is completely blocked and he can‟t breastfeed. He just cries and I don‟t know what to d.”
Health Worker: “Don‟t cry – it‟s not serious.(child‟s name) will soon be better”
E. Mother(crying): “It is terrible,(child‟s name) has a cold and his nose is completely blocked and he can‟t breastfeed. He just cries and I don‟t know what to d.”
Health Worker: “You are upset about (child‟s name) aren‟t you.”
2. Recognize and acknowledge what is right
Case study A baby being weighed, and his mother. The baby is exclusively breatfed. Beside the mother and baby is the baby‟s growth chart. His growth chart shows that he has gained a little weight over the last month. However, his growth line is not following the reference curves. It is rising too slowly. This shows that the baby‟s growth is slow.
” •“your baby gained weight last month just on your breast milk.Which of these remarks will help to build the mother’s confidence? •“your baby‟s growth line is going up too slowly.” .” •“I don‟t think your baby is gaining enough weight.
I haven’t breastfed him yet. She is saying to the health worker: “no. Give Practical help Case study “This mother is lying in bed soon after delivery. My breasts are empty and it is too painful to sit up. She looks miserable and depressed.” .3.
and then I’ll bring you a drink.Which response is more appropriate •“you should let your baby suckle now to help your breast milk to come in.” •Let me try to make you more comfortable. .
• Use suitable words that the mother understands • Do not overwhelm her with information . Provide relevant information using suitable language Find out what she needs to know at this time.4.
The baby has developed diarrhea. His mother has recently started giving some formula feeds in the bottle in addition to breastfeeding. Should I stop breastfeedings?” . The mother is saying to the health worker: “He has started to have loose stools.Case study This baby is three months old.
don’t stop breastfeeding.Which response gives positive information • “it is good that you asked before deciding.” . He may get worse if you do that.” • “oh no. Diarrhea usually stops sooner if you continue to breastfeed.
• Do not tell her what she should do or must not do. • Limit your suggestions to one or two suggestions that are relevant to her situation.5. Make suggestions rather than commands Provide choices and let her decide what will work for her. .
Case study Health worker: “good morning (name). What can I do for you today? Mother: “can you tell me what you asked me what foods to give my baby. now that she is six months old.” .
Health worker: I am glad that you asked. the situation is this.” “However. Well now. a needs are higher than are provided by breast milk and also the zinc and other micronutrients. so less than the 700 calories that are needed. if you add foods that aren’t prepared in a clean way it can increase the risk of diarrhea and if you give too many poor quality foods the child won’t get enough calories to grow well. The vitamin. . Most children need more nutrients than breast milk alone when they are six months old because breast milk has less than 1 milligram of absorbable iron and breast milk has about 450 calories.
Refer her for more specialized counseling.Learn what help may be available . .6. . Arrange follow up and on-going support . .Refer her to a community support group .Offer a time to see her / talk with her .Many women are not able to do what they want to do or what you may suggest they do.Encourage her to see you if she has doubts or questions.
Responses: • “You must feed Amy at least 10 times a day.Case study Amy breast feeds only four times a day.” • “It might help if you feed Amy more often. Her mother thinks that she does not have enough breast milk. and she is gaining weight too slowly.” .
not commands .Summary • Accept what a mother thinks and feels • Recognize and praise what a mother • • • • and baby are doing right Give practical help Give a little. relevant information Use simple language Make one or two suggestion.