Changes In Communication Skills Research Articles

Communication partner training for SLT students: Changes in communication skills, knowledge and confidence

This paper describes the changes in communication skills, knowledge and confidence in Speech Language Therapy (SLT) students in conversations with People With Aphasia (PWA) after Training Con-tAct, a Dutch Communication Partner Training. MethodsOn a voluntary basis, nine SLT students (2nd yr) completed Training Con-tAct, in which People With Aphasia (PWA) were involved as co-workers. A mixed method design with pre- and post-measures was used to analyze the students’ communication skills, knowledge and confidence. A quantitative video analysis was used to measure changes in students’ communication skills. Besides, a self-report questionnaire was used to measure the changes in students’ knowledge and confidence regarding their communication with PWA. To evaluate the perspectives of the students on Training Con-tAct, additionally a focus group interview was held. ResultsRegarding students’ communication skills the outcomes revealed a significantly higher score on the ‘supporting’ competence in students who took part in Training Con-tAct. The mean scores for the ‘acknowledging’ and ‘checking information’ competences did not improve significantly. The outcomes of the questionnaire showed students gained more knowledge and confidence regarding communication with PWA. The focus group interview provided insights into: motivation for participating in Communication Partner Training, content and structure of the training, feedback in CPT, and learning experiences. ConclusionThe present study suggests that SLT students may benefit from Training Con-tAct as the training leads to better skills, more knowledge about aphasia and more confidence in communicating with PWA. Training Con-tAct could be a valuable addition to the curricula of all healthcare disciplines, and eventually support interprofessional collaboration, resulting in improved access to health care, which is important for communication vulnerable people. Further research with a larger sample size and a control group is required.

Can teaching simulations in a virtual classroom help trainee teachers to develop oral communication skills and self-efficacy? A randomized controlled trial.

Effective oral communication skills are essential to ensure optimal teaching while preserving the teacher’s vocal health. Training these skills in representative settings is expected to promote their generalization. Since the implementation of such training in actual school situations is challenging, virtual reality (VR) may represent a solution.This study evaluated the effects of VR simulations on trainee teachers’ oral communication skills. Based on our Theoretical Framework for Teachers’ Vocal Behavior, we developed and empirically assessed a voice-related prevention program including noisy communicative situations in a virtual classroom. In a randomized controlled trial, the participants were assigned to one of two conditions: (1) individual voice training including simulations in the virtual classroom and a group information session (experimental group, n=21); and (2) a group information session only (control group, n=20). The purpose was to determine whether the experimental group would exhibit greater changes in communication skills and self- efficacy than the control group. Acoustic measures during speech production in noise (speech rate; spectral slope; phonetographic surface) and self-rated measures (vocal effort; communication self-efficacy in noise) were conducted pre- and post-intervention. Results indicated a positive effect of the intervention on phonetographic surface, vocal effort, and self-efficacy in both groups. The self-efficacy of the experimental group improved more than for the control group, illustrating the benefit of training sessions including simulations of communicative situations in noise and immersions in a virtual classroom. These findings suggest that practicing oral communication skills in situations as close as possible to their professional reality – by using VR – can improve (trainee) teachers’ belief in their ability to implement these skills in real-life situations.

직소모형(Jigsaw) 협동학습이 뷰티전공 대학생의 의사소통능력, 문제해결능력, 자기주도적 학습능력에 미치는 영향

This study attempted to investigate changes in communication skills, problem-solving ability and self-directed learning ability against students majoring in cosmetology after applying the jigsaw collaborative learning technique to hairstyling courses. The goal was to explore a teaching method which can reflect learners’ diverse needs and the stream of times by escaping from the conventional uniform teaching approach. For this, a questionnaire survey was performed before and after collaborative learning against 84 students from 3 different classes, who were taking hair dryer and iron courses among those from Department of Beauty Care, ‘Y’ University in Gyeonggi-do from October 3 to 31, 2022 (4 weeks). The collected data were analyzed, using SPSS 24.0, and the results found the followings: The jigsaw collaborative learning revealed a statistically significant influence on students’ problem-solving ability and self-directed learning ability. In other words, it is anticipated that improvements in such problem-solving ability and self-directed learning ability which are required in beauty industry by upgrading limited conventional school education would help learners build practical capabilities through harmony between the field and education. In addition, it could establish the ground for students to develop the capability to handle diverse issues through interactions, collaboration and communication after graduation. It is expected that the study results would be available for effective education which can help students have self-directed courses and develop their potential. In addition, there should be further studies on diverse topics such as behavior analysis and teaching methods which can promote collaborative learning against various study groups.

Development and effects of a high-risk pregnancy emotive role-play program for nursing students: a quasi-experimental study.

This study aimed to develop an emotive role-play program for nursing students focusingon high-risk pregnancy and analyze its effects on communication skills, clinical performance, andemotional intelligence. A quasi-experimental nonequivalent comparison group design was adopted with 83nursing students (experimental group, 45; comparison group, 38) who participated voluntarily in anextracurricular program. The preliminary survey was conducted on November 3 and November 4,2020, and the follow-up survey was conducted on November 12, 2020, for the comparison groupand on November 27, 2020, for the experimental group. A program that included five role-play scenarios related to induced labor, preeclampsia, premature rupture of membranes, preterm labor, andinfertility was developed by a group of experts and presented to the experimental group over 11 totalhours across 3 days. Each student participated in a role-play scenario as a patient, family member, ornurse and observed three other scenarios. The comparison group received a workbook after the follow-up evaluation. The independent t-test was performed to analyze changes in communicationskills, clinical performance, and emotional intelligence. Communication skills (t=1.84, p=.035) and clinical performance (t=2.75, p=.004) significantly increased in the experimental group compared to the comparison group. A significant difference was not observed between the experimental and comparison groups for emotional intelligence(t=1.36, p=.088). The emotive role-play program concerning high-risk pregnancy was effective in improving nursing students' communication skills and clinical performance and can be used in nursingeducation related to high-risk pregnancy and childbirth.

하브루타 기반 수업을 통한 대학생의 의사소통 능력, 공감능력, 타인수용 변화

Objectives This study determined whether a Havruta based class would bring about a positive effect on communication skills, empathy, and acceptance of others to college students majoring in counseling psychology. Methods For this purpose, Havruta was applied for 12 weeks out of 15 weeks for 42 participating students. To analyze the effectiveness of the Havruta class, a response sample t-test was conducted to identify changes in communication skills, empathy, and acceptance of others. Results As a result of conducting the <Introduction to Psychology> major class for college students majoring in counseling psychology as a Habruta-based class for 12 weeks, the communication ability, empathy ability, and acceptance of others were statistically higher after class participation than before class participation. In other words a Havruta-based class were found to have a positive effect on the communication skills(verbal and nonverbal communication), empathy(cognitive empathy), and acceptance of others. Conclusions Based on these results, this study confirmed the possibility of a Havruta based class as a way for those studying counseling psychology to enhance communication skills, empathy, and being more accepting of others in an effective manner.

Nurse Handover with SBAR method: a quasi-experimental study

BACKGROUND:Handover is a crucial aspect for patient safety and continuity of care. Many factors can affect the quality of the information transmitted and handover may be ineffective or even harmful if the information is incomplete or omitted. OBJECTIVES:The primary objective of the study was to describe the changes in handover quality after introduction of the Situation, Background, Assestment and Raccomandation (SBAR) method. Secondary objectives were to describe changes in the number of interruptions and changes in communication skills in nursing handover. MATHERIALS AND METHODS:A quasi-experimental, monocentric study with pre/post test design was implemented in a sample of convenience. RESULTS:198 nurses participated in the study and 208 nursing handovers were analyzed. After the introduction of the SBAR method there has been a significant improvement in the quality of handovers, a reduction in the number of interruptions and an increase in communication skills. CONCLUSION:SBAR method demonstrably improves the quality of nursing handovers, reducing the number of interruptions and enhancing communication skills. The introduction of the SBAR delivery method improves the quality and safety of information transmission.

Informing and Evaluating Educational Applications With the Kirkpatrick Model in Virtual Environments: Using a Virtual Human Scenario to Measure Communication Skills Behavior Change

Increasingly, virtual environments are being used in educational and training applications. As with other types of applications that use virtual environments, these scenarios must be evaluated in terms of user experience. However, they also should be evaluated on the efficacy of the training or learning provided, so as to ensure learning transfer. Frameworks, such as the Kirkpatrick Model, exist to evaluate training scenarios, but application of these frameworks has not been fully utilized in development of virtual environment-based education and training. To address this gap and to also share our process with other virtual environment developers, we discuss our experience applying the Kirkpatrick Model to an existing virtual human (VH) application for medical communication skills training. The Kirkpatrick Model provides different levels of evaluation for training programs that include learners’ reactions to the training, the knowledge acquired from the training, behaviors indicating the training was applied, and the degree high-level results were impacted as a result of the training. While we discuss all of the Model’s levels, our focus for this work is Level 3 Behavior. The Kirkpatrick Model currently recommends that behavioral change may only be measured while a trainee is working in a real-world context. However, given existing evidence that VH applications have been shown to elicit real-world behaviors from participants, we suggest that VH training scenarios may be a method of measuring Behavior level metrics before trainees are evaluated in situ. Initial support for this suggestion is provided by our study examining whether VHs can elicit changes in communication skills learners’ message production behavior over time. This study indicates that learners displayed changes in several metrics over the course of the semester. Based on this finding, we suggest a direction for future research: observing learner behavior in a virtual environment as a pre-cursor to behavioral measures while in a real-world scenario.

Sexual and Gender Minority Communication Skills (SGM Comskil) Training for Oncology Clinicians: Development, Implementation, and Preliminary Efficacy.

Enhancing communicative competence of healthcare providers (HCPs) is a critical initiative for improving the healthcare experience of sexual and gender minority (SGM) cancer patients. This study presents the development, implementation, and preliminary efficacy of a new training curriculum for improving oncology HCPs' skills in providing a safe and welcoming environment for SGM cancer patients (SGM Comskil training). Thirty-three (N = 33) oncology HCPs including nurses, nurse leaders, and nurse practitioners participated in a 4.25-hour SGM Comskil Training between July and August 2019. Overall, participants reported highly favorable evaluations of the training, with more than 80% of the participants reacting positively to 12 of the 15 evaluation items assessing engagement and reflectiveness for experiential role-plays with lesbian, gay, bisexual (LGB) and transgender standardized patients (SPs), respectively. Participants also demonstrated significant improvements in SGM healthcare knowledge, self-efficacy, beliefs toward LGB and transgender persons, and SGM-sensitive language use skills following the training. Encouraged by the feasibility of conducting this experiential training with busy cancer care HCPs and the initial favorable participant evaluation of the SGM Comskil training, results clearly indicate that this training can be rolled out into clinical settings to ensure its translational potential. The next steps should assess observable changes in communication skills and SGM-sensitive language skills with SGM patients and improvements in SGM patients' healthcare experience.

The Effectiveness of Greenpreneurship Course for Students' Communication Ability and Entrepreneurial Interest

<em>Very tight work competition results in many unemployed people because of the imbalance between the number of jobs and the number of graduates. For this reason, universities prepare lectures that can equip their students in entrepreneurship. One of them is greenpreneursip lectures. This study aims to determine the effectiveness of learning greenpreneur on communication skills and student entrepreneurial interests. The research design used was the pre-experimental design one-group pretest-posttest design. The sampling technique is done by purposive sampling. The data collection method used in this study is the questionnaire method. Data collection instruments included 20 items of entrepreneurial interest questionnaires and 18 items of communication skills questionnaire used to determine changes in communication skills and entrepreneurial interests before and after the lecture. The results were obtained by the p-value of entrepreneurial interest> 0.05, which is equal to 0.475. the p-value of communication skills <0.05, which is equal to 0.049. The conclusion in this study is the greenpreneurship course does not affect student entrepreneurial interest, but has the effectiveness of student communication skills.</em>

Effects of a Communication Intervention Randomized Controlled Trial to Enable Goals-of-Care Discussions.

Patients with advanced cancer often have a poor understanding of cancer incurability, which correlates with more aggressive treatment near the end of life (EOL). We sought to determine whether training oncologists to elicit patient values for goals-of-care (GoC) discussions will increase and improve these discussions. We explored its impact on use of aggressive care at EOL. We enrolled and used block randomization to assign 92% of solid tumor oncologists to 2-hour communication skills training and four coaching sessions. We surveyed 265 patient with newly diagnosed advanced cancer with < 2-year life expectancy at baseline and 6 months. We assessed prevalence and quality of GoC communication, change in communication skills, and use of aggressive care in the last month of life. Intervention (INT) oncologists' (n = 11) skill to elicit patient values increased (27%-55%), while usual care (UC) oncologists' (n = 11) skill did not (9%-0%; P = .01). Forty-eight percent (n = 74) INT v 51% (n = 56) UC patients reported a GoC discussion (P = .61). There was no difference in the prevalence or quality of GoC communication between groups (global odds ratio, 0.84; 95% CI, 0.57 to 1.23). Within 6 months, there was no difference in deaths (18 INT v 16 UC; P = .51), mean hospitalizations (0.47 INT v 0.42 UC; P = .63), intensive care unit admissions (5% INT v 9% UC; P = .65), or chemotherapy (26% INT v 16% UC; P = .39). Use of a coaching model focused on teaching oncologists to elicit patient values improved that skill but did not increase prevalence or quality of GoC discussions among patients with advanced cancer. There was no impact on high care utilization at EOL.

Educational Interventions for Nursing Students to Develop Communication Skills with Patients: A Systematic Review.

Introduction: Nursing students establish therapeutic relationships with their patients and as future nursing professionals, they should be trained to be effective communicators. The objective of this systematic review was to know the impact of educational interventions on nursing students to develop their communication skills with patients. Methods: A systematic review of literature was carried out. The following databases were consulted: CINAHL, PubMed (Ovid Medline), SCOPUS and Web of Science. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this review. As for inclusion criteria, published articles in English from 2000 to 2020 were included. The methodological rigor of the included articles was evaluated with the JBI Critical Appraisal Checklist for Randomized Controlled Trial or Quasi-Experimental Studies. Changes in communication skills with the patient after the implementation of an intervention were analyzed. Results: Of the included studies in this systematic review (N = 19), two studies were randomized controlled trials, others were single group quasi-experimental studies (N = 11) and two group quasi-experimental studies (n = 6). The majority of the studies were carried out in the USA (n = 7). The most frequent educational intervention was simulation (n = 11). As for the improvement of communication skills, 13 of the 19 articles found statistically significant differences in patient-centered communication skills of nursing students. Conclusions: This systematic review provides preliminary evidence of the effectiveness of interventions used to train nursing students in patient-centered communication. Although all the interventions obtained significant results in communication skills, it has not yet been determined which methodology is more effective.

A Clinical Trial Investigating Telehealth and In-Person Social Communication Skills Training for People With Traumatic Brain Injury: Participant-Reported Communication Outcomes.

To investigate the efficacy of telehealth-based and in-person social communication skills training (TBIconneCT) for people with moderate to severe traumatic brain injury (TBI) based on outcomes reported by the survivor and a close communication partner. Australia. Two telehealth dyads were located outside Australia. Adults (n = 51) at least 6 months after moderate-severe TBI with social communication skills deficits, and their usual communication partners (family members, friends, or paid carers). Partially randomized controlled trial, with a telehealth intervention group, in-person intervention group, and a historical control group. La Trobe Communication Questionnaire (LCQ) (total score, and number of items with perceived positive change). Both self- and other-reports. Trained participants had significantly more items with perceived positive change than did historical controls. A medium effect size in the sample was observed for improvements in total score reported by trained communication partners after treatment. Comparisons between telehealth and in-person groups found medium to large effect sizes in the sample, favoring the telehealth group on some LCQ variables. Whether delivered via telehealth or in-person, social communication skills training led to perceived positive change in communication skills. It was unexpected that outcomes for the telehealth group were better than for the in-person group on some variables.

Возможности использования настольных игр для развития коммуникативных навыков у детей с расстройством аутистического спектра

The article presents an experimental study aimed at identifying the possibilities of using Board games to develop communication skills in children with autism spectrum disorder (ASD). The study involved 6 children diagnosed with ASD from 4 years 8 months to 8 years. The experiment lasted two and a half months, with each child was conducted about 20 classes (of 2 hours), during which each of the selected games was held 2 times. Two board games were used, corresponding to the level of development of children — “Walker” and “Memory”. Communication skills were evaluated in two directions — the ability to focus on the partner’s actions during the game and ways to address the partner in the game. The analysis of changes in communication skills of each child is presented. In General, the results obtained in the experimental study suggest that board games can act as an effective means of developing communication skills in children with ASD. Through board games, children were able to develop the skills of paying attention to the partner during the game, tracking their actions and waiting for their turn, addressing the partner and answering a question. The results obtained from the presented sample of subjects showed that better dynamics in the development of communication skills were demonstrated by children with initially higher development indicators, regardless of age.

Аутистік спектрлі бұзылыстары бар балалармен жеке-дара жұмыс барысында коммуникативтік дағдыларды қалыптастыру

The article presents the results of correctional work on the program of communication development for children with autism spectrum disorders. The need for initial work on the development of communication skills in children with autism in an individual format, with an adult (defectologist) as the impetus and driver of communication, has been substantiated. The main components of communication, characteristics of the development of these components in children with ASD and their ways of formation and development have been given. The main methods included in the correctional and developmental program are sensory integration methods, music therapy, elements of ABA therapy, and game therapy. The structure of the program and the main principles on which it is based has been described. The results of implementing this program on three children with ASD have been analyzed, and the dynamics of changes in communication skills through the ABLLS-R questionnaire and the RCDI-2000 scale were tracked. It was found that the program for the formation of communication skills of children with ASD with the use of sensory integration methods, music therapy,elements of ABA therapy, and game therapy forms the basic components of communication and takes into account the specific features of the development of children in this category. There are noticeable improvements in the development of the emotional and volitional sphere of children, it has become much easier for them to express their emotions, preferences, desires and attitude to the situation, communicative motivation has begun to form, and basic prerequisites for communication have appeared.

Constructing a Communication Scale to Measure the Effectiveness of Interprofessional Communication

IntroductionIn our modern healthcare, healthcare teams are becoming increasingly multidisplinary which brings upon the need for them to be effective in order to have better patient outcomes. Communication failures can occur in interprofessional healthcare teams which leads to negative health outcomes. In order to evaluate communication in interprofessional groups, a communication scale is needed.AimGiven that there is currently no validated communication scale for interprofessional groups, the study's goal was to create and validate a communication scale in the context of an interprofessional based dissection course.MethodsObservations of the 34 students in the dissection study (N = 34) were conducted for the first 3 classes. With the use of these observations and prior qualitative analysis of focus group interviews from the course, a communication scale was constructed. The question items were then vetted by coordinators of the dissection course and research experts which led to the communication scale being shortened from 54 questions to 28 questions. The communication scale was used by each student in the class to assess themselves and two of their peers in their group resulting in 3 scores altogether. This procedure was repeated one week later to evaluate the reliability of the scale.ResultsThere is a 0.331 Pearson's Correlation between peer rater 1 and the self‐rater, a 0.139 Pearson's Correlation between peer rater 2 and the self‐rater and a 0.279 Pearson's Correlation between peer rater 1 and 2. These results indicate a significant difference between self and peer rating, and only a moderate correlation between any two of the three raters. Also, the large standard deviation associated with each of the 3 scores is indicative of large variability of scores around the mean total score.Discussion and ConclusionOverall, it is clear from the results that the constructed communication scale is not sufficiently reliable. Therefore, the next steps of the study is to improve reliability of the scale. This is by performing factor analysis to see whether question items can be decreased and grouped together to create subscales. Then, the subscales will be tested to see whether they are effective in measuring changes in communication skills of interprofessional groups over the duration of the course. Student feedback on the communication scale will also be used to improve on the effectiveness and reliability of the scale.Support or Funding InformationN/AThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Improving Diabetes-Related Parent-Adolescent Communication With Individualized Feedback.

To pilot a brief individualized feedback intervention to improve the communication skills of parents with an adolescent with type 1 diabetes. Parent-adolescent dyads (N = 79) discussed a diabetes-related problem, while an interventionist rated the parent's communication skills to give feedback to the parents. Parents were then randomized to a brief feedback session to target person-centered communication skills or an educational session. Dyads discussed another diabetes care problem to assess for change in communication skills. Independent raters coded parent communication skills from video recordings to rate behaviors in the service of examining possible changes in communication skills. Dyads completed ratings of perceived closeness and empathy after each conversation. Controlling for overall positive communication at baseline, parents who received feedback showed more improvement in specific person-centered communication skills than parents in the control group. Adolescents in the feedback group reported greater increases in parental empathy and intimacy from pre- to postmanipulation than the control. The feedback intervention showed preliminary efficacy for increasing person-centered communication skills and perceived empathy and intimacy.

Associations Between Participant Ratings of PREP for Strong Bonds and Marital Outcomes 1 Year Postintervention

After completing a relationship education program, collecting participant evaluations of the program is common practice. These are generally used as an index of “consumer satisfaction” with the program, with implications for feasibility and quality. Rarely have these ratings been used as predictors of changes in marital quality, although such feedback may be the only data providers collect or have immediate access to when considering the success of their efforts. To better understand the utility of such ratings to predict outcomes, we evaluated links between participant ratings and changes in self-reported marital satisfaction and communication scores 1 year later for a sample of 191 Army couples who had participated in a relationship education program delivered by Army chaplains (PREP for Strong Bonds). Overall ratings of general satisfaction with the program and the leader did not predict changes in marital outcomes 1 year later, whereas higher ratings of how much was learned, program helpfulness, increased similarity in outlook regarding Army life, and helpfulness of communication skills training predicted greater change in communication skills 1 year later. Higher ratings of items reflecting intent to invest more time in the relationship, and increased confidence in constructive communication and working as a team with the spouse predicted greater increases in both marital satisfaction and communication skills 1 year later. The constructs of intention and confidence (akin to perceived behavioral control) suggest that the Theory of Planned Behavior may be particularly useful when considering which Army couples will show ongoing benefit after relationship education.

乗船実習前後におけるコミュニケーション・スキルの変化

This study aims to clarify the changes in communication skills before and after on-board training. This study conducted a questionnaire survey before and after two kinds of on-board training (14-day and 4-day training) using the ENDCOREs scale. This scale has 24 items to measure four sub-skills each for the six main-skills factors and is used in fundamental or practical studies on communication skills.

Impact of focused training on communication skills of final-year medical students in a medical school in India.

Although communication skills are important for a good physician-patient relationship, Indian medical curricula give very little emphasis on training medical students in this aspect. To determine the change in communication skills of final-year medical students following focused training. This was an educational interventional study done at Pondicherry Institute of Medical Sciences, a tertiary care teaching hospital in South India, to assess communication skills among final-year MBBS students. Fifty-two students (24 males and 28 females) participated in the study. A pre-test was conducted in the form of an objectively structured clinical examination (OSCE), followed by focused training for four hours. The same OSCE was administered as post-test. A comparison between the pre-test and post-test scores was done using Wilcoxon Signed Ranks Test. Ninety-six per cent of participants (50 out of 52) showed improvement in their performance after the focused training. The mean marks of the pre-test and post-test were 10.77± 3 and 18.04±2, respectively, out of a maximum mark of 20 (p<0.05). One out of 52 participants did not show any improvement, and one participant scored less in the post-test compared to the pre-test. There was no significant difference in the performance between male and female students. Focused training can enhance the communication skills of medical students. Hence, it may be included in the curriculum of undergraduate medical teaching programmes in India.

Do occupational therapists’ communication behaviours change with experience?

Background: An increasing amount of literature has studied changes in communication skills in medical and nursing undergraduate students. Aim: To evaluate whether occupational therapists’ communication behaviours change with experience. Material and methods: A total of 45 participants (second-year OT students, final-year OT students, professional OTs) were enrolled and met three simulated clients. The role plays were video-recorded and analysed through OT-RIAS (Occupational Therapy-Roter Interaction Analysis System). Chi-square tests were used to analyse the statistical differences between groups for the OT-RIAS categories. Results: Process represented 30.74% of communication for second-year students, 33.69% for final year students, and 35.58% for professional OTs; Occupational therapy ranged from 30.41% in the second-year students to 32.54% in the undergraduates and 37.04% in the professional OTs; Medical increased from 18.66% to 34.33% of the final-year students and 47.01% of the professional therapists. Personal and Psychosocial slightly decreased through experience. Emotional decreased gradually: 39.8% in the second-year students, 29.54% in final-year students, and 30.66% in professional OTs. Conclusion: During training in occupational therapy the communication skills changed, assuming a more technical shape, increasing control and content-related OT communication. Nevertheless, the therapists’ communication behaviours showed the endurance of attention to the client’s point of view.