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PubMed2002

Effective doctor patient communication: building bridges and bridging barriers.

The headache history is discussed as a model for establishing effective doctor patient communication. A thorough knowledge regarding headache onset, course and current features provides a basis for diagnosis and management. The principles of acceptance, validation, empathy, respect and advocacy are explored.

Communication↗
PubMed2000

Language barriers in Vienna hospitals.

As part of a wider investigation of cross-cultural communication practices in health care and social service institutions of Vienna, a survey among hospital staff was conducted to establish the need for mediated communication between service providers and non-German-speaking patients. The responses of 508 doctors, nurses and therapists demonstrate a substantial need for interpreting services, which is currently met by family members (most often children) and bilingual hospital employees (most often cleaners). Most of the respondents were well aware of the shortcomings of ad hoc interpreting arrangements and voiced a clear preference and demand for a hospital interpreting service to improve communication with and health care provision to non-German-speaking patients.

Adult↗
PubMed2002

Sharing of a single picture archiving and communications system among disparate institutions: barriers to success.

There has been a great deal of interest in sharing picture archiving and communications system (PACS) technology. Much of the discussion to this point has involved macro business/technical issues, such as cost for service, bandwidth, and storage technologies. In our own effort to share the Maine Medical Center PACS with other providers, we have found that the micro issues are just as important, including trust, cooperation, persistence, and dedication to fundamental change. It is not impossible to share a PACS, but a number of barriers must be overcome if the overall effort is to be successful. In this paper we present our experience with shared PACS technology by describing the impediments to sharing PACS among disparate institutions; explaining our early attempts to integrate "outside" images into our institutional PACS and the impediments that led to the failure of those early attempts; and suggesting a semi-quantitative means for calculating Likelihood of Success, based on lessons learned thus far. We also describe a new, multilevel effort at sharing our PACS, hoping to stimulate discussion of the barriers to success and to solicit input from PACS vendors and from fellow SCAR members.

Computer Communication Networks↗
PubMed1991

Improving compliance and increasing control of hypertension: needs of special hypertensive populations.

Approximately 60 million people in the United States have hypertension. More than half are either untreated or treated without blood pressure control, despite the well-known risks of hypertension and the established benefits of treatment. The major reason for inadequate control of hypertension is poor adherence to treatment. Approximately 50% of patients with hypertension fail to keep follow-up appointments, and only 60% take their medications as prescribed. Barriers to effective therapeutic adherence include poor doctor-patient communication, cost of antihypertensive therapy, and side effects of the drugs. To increase control of hypertension, compliance with therapy must be improved. Physicians and patients must be mutually committed to achieving control of blood pressure. Physicians should communicate instructions clearly and prescribe therapies that are effective, affordable, and have minimal or no adverse effects on patient quality of life or overall cardiac risk profile. The needs of special hypertensive populations (i.e., elderly, black, and young patients) must also be recognized and addressed. Patients must follow recommendations and alert their physicians to any problems with their medications--particularly those relating to side effects and cost. When selecting drug therapy it should be noted that older patients are sensitive to volume depletion and sympathetic inhibition. In this group of patients, initial drug doses should be low and increments smaller and more gradual than in younger patients. Black patients with hypertension show an accentuated response to diuretics and blunted responses to beta-blockers and angiotensin-converting enzyme (ACE) inhibitors as monotherapy. However, when used with a diuretic, there are no racial differences in the blood pressure lowering effects of beta-blockers and ACE inhibitors.(ABSTRACT TRUNCATED AT 250 WORDS)

Black or African American↗
PubMed2007

Nonverbal communication in veterinary practice.

Treating nonverbal communication with the thoughtfulness and observation with which we approach any other clinical problem can produce a set of skills that can be applied in every encounter. Skill development begins first with enhancing one's observations of nonverbal behavior and then diagnosing whether or not the client is feeling safe. Using one or more of the nonverbal skills when clients are feeling not-safe creates more satisfaction for the client and veterinarian and motivates clients to become full partners in their animal's care.

Animals↗
PubMed2000

The role of the haemoglobinopathy nurse counsellor: an exploratory study.

The haemoglobin disorders are among the most common genetically inherited conditions within the United Kingdom. Individuals who are fully affected have severely impaired health while carriers may be faced with difficult reproductive decisions although generally they are well. Policy makers agree that counselling for families at risk should be undertaken in primary care settings and since the early 1980s this service has been undertaken mainly by specialist haemoglobinopathy nurse counsellors. Despite a number of government reports and recommendations for best practice, problems with service provision continue to be highlighted. However, there is little documented information about the work undertaken by the counsellors or how they perceive their role. A descriptive study was therefore conducted to fill this gap. It took the form of a questionnaire survey undertaken with 26 counsellors. The results were analysed by content and used to develop an interview schedule which was employed to obtain more detailed information from staff in four centres. The counsellors suggested that most of their time was spent in client-centred activities and most clients were first seen antenatally. However, there were significant barriers which prevented optimal service provision. These included: problems of communication with other health professionals, obtaining laboratory results crucial to the early identification of couples at risk, late referral from general practitioners and poor facilities for administration, especially maintaining computer databases essential for record keeping. Developing and obtaining written information suitable for families was particularly time-consuming.

Clinical Competence↗
PubMed2000

New perspectives and evidence on political communication and campaign effects.

We review recent empirical evidence that shows political campaigns are more potent than widely believed, focusing on the conceptual and methodological advances that have produced these findings. Conceptually, a broader definition of effects--that includes learning and agenda-control, as well as vote choice--characterizes contemporary research. This research also features two kinds of interactive models that are more complex than the traditional hypodermic (message-based) approach. The resonance model considers the relationship between message content and receivers' predispositions, while the strategic model highlights the interactions between competing messages. Finally, we attribute the emergence of stronger evidence in favor of campaign effects to the use of new methodologies including experimentation and content analysis, as well as the more sophisticated use of sample surveys.

Communication Barriers↗
PubMed2004

Approaches of South African traditional healers regarding the treatment of cleft lip and palate.

OBJECTIVE: Due to the large number of Black South Africans known to consult with traditional healers and the influential role they play in the developing world, this study investigated the approaches of a group of 15 traditional healers toward the treatment of cleft lip and palate. DESIGN: An exploratory-descriptive, qualitative research design was employed, which involved the use of standardized, semistructured interviews, conducted with the assistance of an interpreter who was fluent in several African languages. SETTING: Interviews were conducted outdoors in places in which traditional healers usually consult with their patients. These areas were in the fields close to the traditional healers' homes or under a highway bridge in the Johannesburg inner city. PARTICIPANTS: Individual interviews were conducted with 15 African traditional healers who had been practicing in their callings for at least 1 year. RESULTS: Traditional healers interviewed had treated one to six persons with a cleft lip, cleft palate, or both. Most informants believed that clefts were caused by the ancestors, spirits, and witchcraft. A variety of plant and animal products were used to treat these conditions and were augmented by spiritual resources from the ancestors. All except one healer had undergone formal training, although they had received no specific training relative to cleft lip and palate. Most participants reported referring patients to Western health care practitioners who were referred to as modern doctors but did not receive reciprocal referrals from these professionals. Patients generally consulted with traditional healers because this approach was part of their culture. CONCLUSIONS: These findings have important implications for health care professionals as well as traditional healers in terms of cross-cultural consultation, collaboration, and information sharing with regard to cleft lip and palate; the potential use of traditional healers in primary health care and education; and further research.

Adult↗
PubMed2004

Contemplating, caring, coping, conversing: a model for promoting mental wellness in later life.

This article is based on the premise that mental wellness for older adults can be promoted through communication and presents a model drawing on the constructs of contemplating, caring, coping, and conversing. The importance of interpersonal communication processes in the care of older adults and some barriers to communication and mental wellness are briefly reviewed. This article challenges nurses to develop awareness of their own caregiving styles and communication processes, and to assist others (e.g., family caregivers, care receivers) to communicate and interact more effectively to advance mental wellness for older adults.

Adaptation, Psychological↗
PubMed1979

Communication and cooperation between professionals in the field of rehabilitation.

Some criteria and characteristics of Rehabilitation as a complex, multidimensional and interdisciplinary field of theory, practice and research are pointed out at the beginning of this paper. It is shown, that such a rehabilitation concept demands the cooperation between professionals in this field (a) in practice within the rehabilitation team, (b) in research for the realization of well coordinated and problem-oriented interdisciplinary projects, (c) in theory for the development of more adequate theoretical concepts and better strategies for teaching and training personnel. Improved mutual information on an international level is regarded as a basis or prerequisite for such cooperation. The multiple dimensions and directions of communication necessary to assure such cooperation are illustrated. In a description of barriers to communication in the field of rehabilitation the following facts are considered as possible causes for the present insufficient cooperation among professionals in this field- (1) specialization and exclusiveness, (2) language and presentation, (3) differences in culture, demographical situations and economic/historical development, (4) geographical, national, legal or administrative barriers, (5) professional competition, patenting and copyright, (6) lack of adequate documentation and dissemination of information, (7) inadequate use of existing information systems and communication channels. The article closes with suggestions on ways to improve communications and cooperation between professionals in rehabilitation.

Communication↗
PubMed2003

To tell or not to tell: barriers and facilitators in family communication about genetic risk.

Communication about genetic risk in families is an important issue for genetic counsellors. The objective of this study was to explore the barriers and facilitators in family communication about genetic risk. Semi-structured interviews were undertaken with patients in the Northeast of Scotland who had attended genetic counselling for risk of hereditary breast and ovarian cancer and Huntington's disease, and with some spouses/partners. The interviews confirmed that the issue of disclosure was a problem for some, and that there were generic communication issues common to both groups. Telling family members about genetic risk was generally seen as a family responsibility and family structures, dynamics and 'rules' influenced disclosure decisions. A sense of responsibility towards younger generations was also important. The level of certainty felt by a person in relation to his or her own risk estimate also influenced what he or she could tell other family members. Communication within a family about genetic risk is a complex issue and is influenced by both pre-existing familial and cultural factors and individuals' responses to risk information. If genetic counsellors understood how these factors operate in individual families they might be able to identify effective strategies to promote considered decisions and prevent unnecessary emotional distress.

Adult↗
PubMed2000

Barriers to client-centredness and their resolution.

This research sought to determine which therapist barriers prevent client-centred practice the most, and which methods are perceived as being most effective in resolving therapist barriers. A list of barriers that therapists bring to client-centred practice and methods to resolve these was identified from the literature and formed the basis of a questionnaire sent to 60 occupational therapists in the United Kingdom. The results showed that the therapist and client having different goals was the barrier which most prevented client-centred practice. The high ratings of other statements suggested that the values, beliefs and attitudes of therapists and of the employment culture make client-centred practice uncomfortable to use and hence prevent its implementation. Case examples showing how to practice in a client-centred fashion were rated as the most effective method of barrier removal.

Adult↗
PubMed1992

Cultural barriers associated with large gene frequency differences among Italian populations.

Analysis of geographic variation for eight red cell markers in Italy shows significant spatial structure for most alleles. Effective population sizes estimated from FST values at these loci are much smaller than those predicted from data on consanguineous marriage, suggesting the presence of factors (presumably barriers) that have reduced gene flow and enhanced the evolutionary weight of genetic drift. Most regions of sharp gene frequency change correspond to geographic and linguistic barriers. Two allele frequencies are significantly correlated with measures of linguistic differentiation but not with indexes describing broad religious and social attitudes. The similarity between patterns of genetic and linguistic variation in Italy, also observed in a previous study, suggests that in specific areas linguistic diversity has acted as a biological barrier constraining mating, dispersal, or both. There is no evidence for a similar role of other extent cultural barriers.

Communication Barriers↗