Discuss about the Verbal Communication Process In Nursing.
As I am working as a nursing staff in the intensive care unit, I have chosen ‘verbal communication process’ at my workplace which I believe needs to be improved to benefit more number of patients visiting hospital each day. As a student of nursing, each day I experience lots of instances where a better communication process could have produced different results. This paper will critically analyze all the issues arising from inefficient communication process and the ways how to minimize it.
It is often said that verbal communication in a health care setting is considered as one of the most important tool for providing better patient care and project estimation. It is evident that care of patients at most of times involve different persons, where all need to share patient information in order to discuss their management (Maeseneer, et al., 2008). Therefore, there is increasing demand in the use of information and technologies for communication to support healthcare services.
If the information in the healthcare is life blood then communication system is the heart that pumps it. Even after so many discussions and investments in the information technologies and communication system. Although there is some major investment and research in highly specific areas like telemedicine but even the simpler services like electronic mail or voicemail is still not common in many health care services or centers (Coiera, 2006 ). This would only change when it is realized that the biggest information repository in the health care sites within the heads of the persons working on it and the biggest information network is the most complex web of discussions or conversations which inks the actions of these individuals.
It has been observed that there is a huge gap in our broad understanding of the role of communication services in health care delivery. The condition of laboratory medium is even more poorly studied than in other areas such as interface between the hospital services and prime any care. It is evident that ineffective communication between can lead to improper diagnosis and improper medical treatment. For example, if a patient is deaf or cannot hear or less proficient in English then the patient in this way may require an interpreter or help from the staff in order to communicate effectively with the health care staffs (Anon., 2014). According to the research conducted over the past 3 decades trend, it has been apparent that the health care providers ability to brief or explain, empathize and listen have profound effect on the physical and mental health outcomes as well as the patient satisfaction and experience of treatment. The perception on the quality of health care provided to patients depends upon the interactions between the health care providers and team (King & Hoppe, 2013 ). There are huge number of data which explains the advantage of effective communication in relation to the health comes of the day. the bond that a patient has with his or her participation in care, patient self-management and adherence to the treatment.
It is apparent that the effective communication between the patient and health care providers is important for the quality of care and safety of the patient. It is customary in health care organization to have effective and efficient communication process is to understand by both parties i.e. the doctor and patient and works in both direction to simply the message (Anon., 2016). There are several barriers which hinder the communication process at healthcare organizations. These include difference in culture, language, low health literacy. These can be recognized and minimized by using different preventive measures to ensure effective communication between the patient and health care providers.
Workplace issues:
According to my experience at workplace these are the issues which is seen on the regular basis:
Due to the globalization people from diverse background and culture work at the commonplace and hospitals are no exceptions to it. People from different parts of the world come visits hospital on the regular basis who comes in contact with the different doctors who too are from different cultural backgrounds (Norouzinia, et al., 2016). These language barriers create issues for the doctors to understand the actual concern of the patient. In other words, the doctors can misinterpret the patients and can advise the treatment might not be suitable for the patient (Lopez, n.d.). These days, the doctors have to rely on interpreters like family, friends, untrained support staff or even strangers to understand the problem of the patient. These interpreters most of the time lacks medical terminology which leads to wrong interpretation and further leading to misdiagnosis and wrong treatment.
The proxy interpreters who fail to understand the need of the confidentiality when it comes to explain the medical problems (Anon., n.d.). A patient may not feel comfortable to discuss the medical problems in front of his family friends or any strangers etc. the reason behind this may be related to domestic violence, family honor, sexually transmitted diseases, drug abuse, psychiatric concern of the patient and reveals everything within the patient’s social network.
The culture background of a patient or health care providers also act as barrier to effective communication process at hospitals. The cultural preferences and perceptions of the health problems, medical care, sickness of a patient varies with that of a doctor or health care organization the understanding of language does not guarantee the understanding of culture. For example, the patient from middle east prefers to hear religion chants or songs at the end moment of his life which may be inappropriate for some hospitals or clinics. This greatly affects the ongoing treatment and may leads to unfavorable outcomes. People from certain culture do not prefer to reveal all the issues when that problem is related to sexual or reproductive organs. This may mislead doctors and can suggest medications which may not be suitable for them.
The culture of the patient also acts as a barrier when it comes to explaining the actual cause of the problem. The patient hides the relevant facts about the case which leads to misdiagnosis. Sometimes, the health care professionals have to understand the culture of the patient to apply any medical procedure because patient from diverse cultural background may not agree to the procedure which he is not aware off (Macey, 2016). Hence, the healthcare providers must respect and understand the cultural procedures or treatments.
The poor health literacy kills also act as a barrier to effective communication process at hospitals. As per the report by the Institute of Medicine, there is a huge gap when it comes to how people comprehend and receive health information. The cultural and language barrier are linked with low healthy literacy. It is also observed in patient who are proficient in English language and are part of Australian culture. For example, the patient may take medications on his own based on the reference or incidences of his close personnel which may not be appropriate for his health people. people often practices or follows myths and habits which are passed down from their forefathers or earlier generations (Anon., 2016). These habits or practices are often not appropriate for the existing medical issue and thus can affect the health of the individual. It is also observed that, when a patient and doctors are from the same culture and language then lack of questions is considered as an understanding. However, in case when there is medical error or issue at the patients end then at that time doctors discovers the patient is functionally illiterate. The other issue includes the child patients. It is generally seen that the children try to hide the actual issue in order to save themselves from a possible punishment from their parents instead of revealing the actual incident. A child who has experienced or faced sexual abuse from the hands of his relatives or parents may be scared to reveal the actual incident. All this lead s to wrong diagnosis or treatment which may not address the actual problem of the patient. This also leads to biased diagnosis resulting the parent might be contacted by the organization looking after the issues and may take over the custody of the child. The solution to minimize the communication barriers at hospital is by the appointment of professional interpreters.
It is apparent that effective communication between the patient and the health care professional along with the patient’s surrogates in the intensive care unit is very crucial for quality care (Anon., 2017).
The health care professionals with poor communication skills are very unlikely to achieve success and are more likely to face litigations and complaints (Anon., 2017). The various practices and theories for effective communication at hospitals are:
The main aim of this theory is to focus on the client and nurse relation and therapeutic process that take place. The communication in this theory considers complex factors like environment, attitudes, beliefs and practices in dominant culture. This theory describes 4 stages of relationship to achieve a common target:
Orientation phase: in this phase, the nurse tries to engage patient in the treatment process and in that way, patient feels comfortable in asking questions and receive answers to those questions with explanations. this helps to develop trust and helps immensely in other phases.
Identification phase: in this phase, the nurse and the patient start to work together. This act as a basis for understanding, acceptance, trust and makes the patient active participation in treatment.
Exploitation phase: by this time, the e patient has all the advantage of all the services offered to him thereby strengthening the nurse-patient relationship to address treatment goals.
Resolution phase: by this stage the patient’s all demands and needs are met due to effective communication and moves towards full independence. The relationship ends in this phase as the patient is cured and no longer needs any hep.
The dyadic intervention communication model presents the dynamic relationship between the two people i.e. sender and recipient. the sender and recipient i.e. the encoder and decoder and the factor or influences such as attitude, perceptions, content and the physical and emotional elements and other factors which can change the message or the delivery of the message (Aguerrebere, 2015). In this mode, the recipient or decoder must be able to decode the message provided by the sender this model underlines the significance of awareness and clarity for all the factors which can affect nonverbal and verbal communication. The other theories include Habermas critical theory which has been accepted to identify the relationship between the physician and the nurse also including the motive to move from the basic information to challenge assumptions and distortions in the association.
The practice of crisis is communication in the intensive care unit where the team leader directs his member get through a clinical emergency successfully. The skills of these communication are very vital in emergencies as it teaches how to remain calm in pressure situation so that there are no medical mis happenings.
The interprofessional discussions directly affects the quality of care and safety of the patient. The regular ward visits with proper maintenance of readings and review of the treatment between the staff, doctors and nurses have tremendously reduce the length of ICU stay. The failure of this can lead to medical mishap which could have been avoided.
This can be difficult as communicating with patients may not be possible due to severity of the situation limitation of time, state as the patient, etc. limitation of time, state of the patient etc. however, once the communication takes place it eases the patient due to which the patient starts co-operating which really helps in further treatment process.
My experience during my tenure in intensive care unit has been full of challenges and learning from experiences as discussed above the best communication process which comprised of theories, models and skills differs from my workplace. At my workplace, we generally do not allow patient to communicate with all the staffs rather only doctor who is assigned for that particular patient. The doctor shares the evaluation report with the nurses and subsequent doctor of another shift, so that there is no disparity in the treatment.
The patient does not generally get friendly with the doctors due to less communication duration. This sometimes-created consequences in which the patient doesn’t wish to continue with the treatment (Gauntlett & Laws, 2008). The strict policy of our hospital, has greatly affected the less engagement of patient with the doctor and nurses. The patient fails to shar all the issues which at times had produce unfavorable results.
The mental patient normally does not get the kind of support they need, is the staff only approaches them at time of medical procedure and treatment. Although the staff over are well trained, they lack interpersonal skills which is one of the major barriers to communication.
The communication between the patient and physician is one of the integral part of clinical studies the ways to improve the communication process are as follows:
It is wise to ask the patient what he already knows about his or her medical condition instead of acting upfront. Most of times, the doctor or physician fails to ask the important information and directly starts the treatment by assessing the situation which may lead to medical misshapenness. This can also lead to coloring the patient perception and also the overlapping of new information which creates confusion (Wanga, et al., 2018).
It is important to understand the expectation of the patient before imposing any medical treatment as it helps to maintain good rapport with the patient and in turn helps in the treatment process (Happ, 2011). It has been observed that, not all patients with same diagnosis desires same level of details about their condition or treatment.
It is one of eh basic skill set that all physicians should develop in order to recognize the hidden or unexpressed emotions of their patients. These emotions once share needs to be acknowledge and has to be explored as it helps the physicians to understand the actual cause of the illness. The physician addressing the emotions enhances the satisfaction level of the patient.
Slow down:
The physician should provide the information in a slow and steady manner so that it helps in comprehending the new information. The steady delivering of information with pauses also allows the patient to formulate queries which can be useful in providing the further bits of useful information.
The physician does not avoid using medical terminologies or jargons which creates confusion in the mind of patient. The doctors should not engage in long monologues while they are in front of the patient (Slatore & Hansen, 2012). The physicians who only provides simple, short and clear explanations helps in improving comprehension and reduces the emotional distress in the patient.
It is very important to provide true information to the patients care taker or family or even the patient depending upon the scenario (A.Tappenden, 2013). The doctors should not minimize the impact of what they are saying. For example: the euphemisms may help in delivering the sad news but it can have other consequences. The use of words like left or gone can be interpreted wrongly by the patient anxious family members as it might mean the patient is alive and has gone to take any test or to another place.
Observing the patient’s body and face:
The majority of information between a doctor and patient is conveyed through nonverbal communication. The physician who notes every detail of the patient facial expressions, body language with appropriate concern to these cues can suggest or have major impact on the patient illness. Lastly, the more attentive physician can have a more satisfied patient.
The people from other parts of the world who comes and visits hospital on regular basis comes in contact with doctors who too can be from different cultural background. This acts as a barrier as the patient from middle east not having English as their as primary language can have difficulty in expressing the actual issue (Juckett, 2014). Here the comes the interpreters which can help these types of patient by helping them explaining the actual concern so that doctor can suggest the correct medications. The role of interpreter is very important here because a non-professional interpreter may not be able to understand the medical terminology which may lead to wrong interpretation, further leading to mis diagnosis and wrong treatment. The interpreter explaining the dietary plan to a patient should understand the side effects of wrong interpretation and hence that’s why the interpreters should be from the same medical background.
All these above steps if implemented can help in improving the overall communication process at my work place (Jacobs, 2004). The upper management of the hospital should assess the current condition and should develop and implement policies accordingly. The management collect the feedbacks from the staffs, patients and their families so that every single issue is addressed before planning any policies. The staffs of the hospitals should be informed about the changes that is going to happen so that they are prepared for the same. There should be proper training and awareness programs to educate the staffs about the importance of effective communication programs.
Conclusion:
From the above paper it is evident that effective communication is important for the quality and safety of the patient. The article discusses the various aspects of inefficient communication at health care centers and now the same can be improved. The health care professional should properly assess the state of the patient before initiating any treatment. The health care provider should respect and understand the culture, ethnicity etc. of patients so there is proper cooperation from the patient which eventually helps in providing appropriate treatment. In case of patient having English as their second language should have a professional interpreter who could properly explain the medical issue to the health care professionals to get proper treatment. The article also included the ‘Peplau interpersonal theory’ and ‘Dyadic interpersonal model’ which suggested ways to improve the communication process between the patient and the health care professionals. Lastly, for the proper implementation of this process the staff should understand the importance of effective communication process at workplace along with the consequences of ineffective communication.
References:
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