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PubMed1987

Communication theory as a basis for nutrition education.

Communication theories are reviewed and then applied in a model for communicating nutrition. The Nutrition Communication Model has two major components: inputs and responses (Figure 1). Inputs include both the decisions nutrition communicators make about the communication strategy (Nutrition Communicator Inputs) and the predispositions receivers bring to the communication event (Receiver Inputs). The combined contributions of receiver and nutrition communicator inputs, as well as the situational context, influence the responses to a communication. Responses occur at two levels: the intervening process and outcomes. Important stages of the intervening process are attention, comprehension, and interaction. The results, or outcomes, of the communication events are the receivers' acceptance or rejection of the changes the communicator intended. Acceptance or rejection may be in the cognitive (knowledge), affective (attitude), and/or behavioral domain (including behavioral intent and actual behavior).

Communication↗
PubMedDate not supplied

[Role of the occupational physician in risk communication].

Risk can be defined as the probability of suffering a loss or an effect because of some event. Communication can be defined as an exchange of information. Risk communication can be defined as the exchange of information among interested parties about the nature, magnitude, significance, or control of a risk. Although effective risk communication is difficult for several reasons, depending on the source, channel and receiver, communication plays a key role in occupational and environmental medicine. Risk communication is a "two-way process" involving an interactive exchange between occupational physician and workers. How risk estimates are communicated depends on who is talking, who is listening and what is being said. One of the most important findings to emerge from risk communication research is that occupational (and environmental medicine) physicians are among the most trusted and credible sources of information on occupational (and environmental) health issues. Trust and credibility are key issues in risk communication. The ability to establish useful and constructive channels of communication depends on whether the physician is perceived as trustworthy. Empathy-caring, competence-expertise, honesty-openess and dedication-commitment are considered as the most important factors in determining trust and credibility. Effective risk communication is a complex art and skill that requires substantial knowledge, training and practice: communication structure is important, as much as content.

Communication↗
PubMed1994

Speech by any other name: the role of communication aids in interaction.

The functional communication systems of four physically disabled children with severe speech impairment were evaluated in terms of: (1) perceived dominant modes of communication; (2) observed frequency of communication mode occurrence; and (3) role of communication device in total communication system. All four subjects used a range of communication modes to reflect personal and listener preferences, and in response to differing conversational requirements. 'Standard' communication modes were mentioned more frequently by teachers and parents, and were observed more frequently in interactions. Augmentative and alternative communication devices played a limited but important role within total communication systems. A hierarchy of influences affecting the choice of communication mode is suggested.

Child↗
PubMed1991

Percutaneous drainage of hepatic abscesses: comparison of results in abscesses with and without intrahepatic biliary communication.

Results of percutaneous drainage performed in eight patients with eight liver abscesses with intrahepatic biliary communication and 22 patients with 26 liver abscesses without biliary communication were analyzed to determine whether the presence of an intrahepatic biliary communication affected the outcome of treatment. The clinical features and response to treatment of both groups were compared. The presence or absence of biliary communication was determined by injection of contrast material into the abscess under fluoroscopic guidance either during or several days after initial drainage. Duration of drainage was longer (p less than .05) in patients with communication (range, 7-44 days; mean, 22 days) than in patients without communication (range, 1-33 days; mean, 13 days). Percutaneous drainage was curative in five (63%) and palliative or temporizing in one (13%) of eight patients with communication. It was curative in 15 (68%) and palliative or temporizing in five (23%) of 22 patients without communication (p = .317). Liver abscesses with intrahepatic biliary communication did not require percutaneous transhepatic biliary diversion for cure. Despite longer duration of drainage for abscesses with intrahepatic biliary communication, the cure rates of percutaneous drainage for both groups were similar. Patients in whom an intrahepatic biliary communication was shown did not require alternative interventional or surgical measures for cure.

Adult↗
PubMed2004

[Teaching courses on aspects of medical history taking and communication skills in Germany: a survey among students of 12 medical faculties].

BACKGROUND: Good communication between patients and doctors has positive effects on health and the patients' quality of life. Communication skills can be trained. In many countries communication skills training is an important part of medical education and continuing medical education. In this study German medical students were questioned about current communication training. METHODS: Questionnaires were sent to 28 Medical Schools in Germany and distributed in General Practice courses. Using Likert scales students were asked to rate both existing teaching courses on communication skills and their ability to communicate. RESULTS: 377 students of 12 Medical Schools participated in this study. Two Medical Schools offer teaching courses on communication skills as part of their regular curriculum. On a scale ranging from 1 (no such courses available) to 7 (courses fully available) students assessed the practical teaching of communication skills to be 3 (median). In addition, on a scale ranging from 1 to 7 students rated their general communication skills as 3 (median) and their ability of taking a sexual history and breaking bad news as 4 (median). CONCLUSION: Although these results are not representative, they give a general idea of communication skills teaching in Germany. During their clinical education students should be especially trained for difficult situations in the patient-doctor encounter. The international experience of other Medical Schools should be taken into account when implementing communication skills training as part of medical education.

Curriculum↗
PubMed2005

A conceptual framework for patient-professional communication: an application to the cancer context.

We present a conceptual framework of one-to-one, in-person communication that occurs between a health-care professional and a patient. The framework is intended as a tool for organizing and summarizing relevant research but it can also help guide assessing the communication process and can help guide development of interventions to improve the process. The framework includes four key components, with a focus on elements that can be modified. The first component is the focus of the interaction: each participant's communication goals. The second component consists of the participants themselves, each with five key attributes that determine, in part, how they address their goals. The third component is the communication process: each person both conveys messages and receives messages, and the messages themselves can be verbal, non-verbal, or silent. The communication process is iterative and extended in time with one act having an impact on following acts. Finally, the fourth component is the environment in which the communication occurs, both the immediate physical setting and the context beyond. Important aspects of the environment, identified as external factors, affect the communication process through their impact on the participants' attributes. The framework builds on classic communication frameworks to which it adds unique elements. Some of its unique aspects include the prominent role of the participants' goals and its distinct recognition that messages are conveyed through silence. The framework serves as a common conceptualization of factors important to successful communication for the remaining review papers in this series and for future studies of practitioner-patient communication.

Communication↗
PubMed2005

Patient-professional communication research in cancer: an integrative review of research methods in the context of a conceptual framework.

This paper uses the conceptual framework of Feldman-Stewart et al. to organize and review the types of research methodologies used to investigate various aspects of patient-health care professional communication in the context of cancer. Research methods employed are classified as either non-experimental or experimental. Non-experimental designs include naturalistic observational studies (e.g. participant observation, audio- or videotaping of interactions) and retrospective introspective descriptions (e.g. self-report questionnaires, qualitative interview methods). Experimental designs often involve interventions aimed at improving communication, such as physician or patient training, and the use of technology to enhance communication (e.g. audiotapes, computers). Using the conceptualization of the communication framework description, we argue that the outcome measures used in these studies address either primary goals, enabling goals, or secondary communication outcomes. Outcomes that are related to primary goals of the communication exchange include assessing the level of understanding of information conveyed, aspects of decision making, planning around treatments, or general provision of care. Outcomes related to enabling goals focus on elements that affect the ability to achieve primary goals. Outcomes secondary to the communication do not relate directly to what the communication is attempting to achieve. We conclude by identifying priority areas for further research, such as identifying the goals of both participants, understanding how particular aspects of the communication process affect their ability to achieve their goals, and examining the external environment in which communication takes place.

Communication↗
PubMed2003

Student nurse-older person communication.

There is an increasing ageing population in western countries. Most nurses will be involved in caring for older people in the future. Over the last number of years much has been written about the benefits of effective nurse-patient communication. However, research findings indicate that the quality of nurse-older person communication has been and continues to be poor. The purpose of this mini ethnography was to ascertain how student nurses communicate with older people. This is relevant as today's students are tomorrow's registered nurses and the manner in which they currently communicate with older person may indicate how they will interact with this population in the future. Data were collected using both participant observation and semi-structured interviews. Data were analysed using latent thematic analysis. Four major themes were identified from the findings. These were: Types of communication, modes of communication, factors that either hinder or enhance effective communication and student nurses' approach to communicating with older people. There are a number of recommendations from this study. These include, promoting a person-centred approach to care of the older person, ensuring appropriate clinical supervision of student nurse-older person communication by preceptors, increasing theoretical input in relation to interpersonal skills and communication theory, facilitating reflective practice whilst students are on clinical placement and regular auditing of clinical placements as suitable learning environments.

Adult↗
PubMed2001

Nursing the patient with severe communication impairment.

BACKGROUND: Effective communication with patients is critical to effective nursing practice. Surprisingly, there is little information on nurses' experiences in caring for patients who are unable to speak. PURPOSE AND METHOD: This study provides descriptive information from interviews with 20 nurses who cared for patients with severe communication impairment. The interview protocol explored positive and negative experiences of nursing patients with severe communication impairment. Frequency counts and descriptive analyses were conducted to identify the major themes emerging from the interviews. RESULTS: The results suggest that nurse-patient communication is difficult when the patient has severe communication impairment, although some nurses discovered effective strategies to facilitate communication with such patients. Many of the difficulties could be viewed as a breakdown in understanding arising from the lack of a readily interpretable communication system that could be used by nurse and patient. CONCLUSIONS: The results suggest a need for training nurses in the use of alternative modes of communication. Nurses also need access to a variety of simple augmentative communication devices for use with patients who are unable to speak. Finally, nurses should collaborate with speech pathologists on the development of preadmission information and bedside training for people who are admitted to hospital with severe communication impairment.

Adult↗
PubMedDate not supplied

Intergenerational communication: fundamental but under-exploited theory for speech and language therapy with older people.

There is a body of research literature already applied in speech and language therapy practice that is concerned with communication between children and adults and the adaptations adults make to facilitate the development of language in children. There is much less and more recent literature concerned with intergenerational communication involving older people and older people in institutional care. This has not yet impacted on speech and language therapy practice, especially in the area of training others. The aims of this paper are (1) to describe some of the main theoretical concepts associated with intergenerational communication, (2) to present the results from a study of the opinions about and experiences of intergenerational communication in which children, community- based older women and professional carers of older people were included and (3) to discuss the implications for speech and language therapy practice. A hypothesis for the study was that views on and attitudes towards communication and ageing would vary among the age groups. Some of the main concepts and models associated with intergenerational communication with older people are reviewed, including the communication predicament and enhancement models and the concept of patronizing communication. A qualitative study of three different age groups of (mainly) women was undertaken using a variety of methods of data elicitation (including written questionnaire and focus group discussion). Themes arising from the data were illuminated using content analysis. Participants' responses demonstrate some current generally positive views across the life-span on what it means to be old and the value of communication with older people. The implications for speech and language therapy practice are outlined, with the main emphasis on the potential use of intergenerational communication theory in developing a new focus for training other staff groups who care for older people and for measures of effectiveness of such in-service training.

Adult↗
PubMedDate not supplied

Mother-child interaction revisited: communication with non-speaking physically disabled children.

This paper presents an in-depth analysis of the interaction between mothers and their severely physically disabled children who have motor speech disorders. The study was designed to partially replicate previous investigations, most notably those undertaken by Light et al., to examine if the patterns of conversation previously described were observed in interaction involving children of a wide age range. Twenty children who had four-limb cerebral palsy, with no diagnosed learning difficulties or sensory impairments, and who were between 2 and 10 years of age inclusive participated in the research with their mothers. Children's speech was unintelligible to their parents out of context and most had been provided with aided communication systems. Other carers were excluded from the research due to possible differences in interaction style. Conversation between mothers and children was videotaped in a standard play situation. The toys used to stimulate interaction had been shown to elicit the full range of communication skills targeted in the present study from non-disabled children. Videotaped interaction was coded to show the structure of conversation and the functions used. The mode of communication used by the children was also recorded. In addition, communicative functions were elicited from the children in a semi-scripted conversation with a clinician developed from that used by Light et al. Structural moves and communicative functions used by mothers and children were examined using mean proportions. Sequential analysis of mother-child interaction was also undertaken at both levels to investigate the patterns that recurred in conversation. Results support those obtained in previous studies, showing restricted conversation patterns and high levels of maternal directiveness. Mothers initiated most communicative exchanges, asking many questions and issuing many requests for attention, objects or activities. Children across the age range produced more response moves than any other move type. Their responses contained yes/no answers and acknowledgements, and to a lesser extent provisions of information. When children did produce communicative functions other than simple confirmation, denials and acknowledgements, they were often not fully understood and were followed by requests for clarification by the mothers. Children produced a wider range of communicative functions in the semi-scripted elicitation conversation with the clinician than in conversation with their mothers (z = 3.52, p = 0.0002). The results obtained support those of previous research and suggest that interaction for children with severe motor and speech impairments becomes 'fossilized', changing little throughout childhood. Findings support the two-pronged approach to intervention for children using augmentative communication systems that is now developing. Intervention should focus not only on the children, teaching them how to use their augmentative systems and to produce a full range of conversation skills, but also should focus on their carers. Training for carers aims to increase their interaction skills, teaching them how to facilitate and expand children's communication skills.

Cerebral Palsy↗
PubMed2004

An analysis of inpatient nursing communications needs.

The health care environment is communications and information intensive. Nurses especially have communications as part of their routine activities, yet little is known about specific nursing communications needs and technologies that might address these needs. This project analyzed the specific communications needs of nurses at Massachusetts General Hospital (MGH) in Boston, MA, through focus group meetings, nursing staff interviews, and direct observation of unit communications. Based on these data, an ideal requirements list for a nursing communication system was created. Data were also gathered and analyzed from units piloting cell phones as nursing communications tools. On non-cell phone units we found that the bulk of communication activity is from the front desk operations associate to the nurse through a sub-optimal overhead paging system that is often unclear or inaudible. The pilot of cellular phones has demonstrated improvements in nursing communications at MGH and there are indications that other emerging technologies will be better able to address the ideal communication needs of nurses.

Academic Medical Centers↗
PubMedDate not supplied

Regulation of gap junctional communication during human trophoblast differentiation.

During pregnancy, the trophoblast, supporting the main functions of the placenta, develops from the fusion of cytotrophoblastic cells into a syncytiotrophoblast. Gap junction channels consisting of connexins link the cytosols of cells in contact. Gap junctional communication has been involved in the control of cell and tissue differentiation. Recently, a gap junctional communication was demonstrated in trophoblast cell culture by means of the fluorescence recovery after photobleaching (gap-FRAP) technique. This gap junctional communication appeared to be stimulated by human chorionic gonadotropin (hCG). Therefore, the specificity of hCG action and the signalling mechanisms implicated in gap junctional communication were investigated by means of gap-FRAP. In culture, cytotrophoblastic cells develop into cellular aggregates, then into a syncytium, within 1-2 days after plating. During this in vitro differentiation, gap junctional communication was measured, and the maximum percentage of coupling between adjacent cells occurred on the fourth day. In the presence of 500 mIU/ml hCG, the percentage of coupled cells was increased at all stages of culture, and the highest proportion of coupled cells was observed after 2 days instead of 4 days in control conditions. The hCG action was specific, since the addition of heat-inactivated hCG of oFSH or of bTSH did not affect gap junctional communication in trophoblastic cells. The addition of a polyclonal hCG antibody decreased basal gap junctional communication as well as the response to exogenous hCG. Moreover, the presence of 8Br-cAMP (0.5 or 1 mM) mimicked the stimulation by hCG. Interestingly, H89 (2 microM), a specific protein kinase-A inhibitor, dramatically decreased the responses to hCG (500 mIU/ml) and the 8Br-cAMP (0.5 mM) stimulation of trophoblastic gap junctional communication. Calphostin (1 or 2 microM), a specific protein kinase-C inhibitor, strongly stimulated gap junctional communication. In conclusion, the demonstration by means of the gap-FRAP method of a gap junctional communication preceding cellular fusion could be considered as an objective and physiological criterion to mark the beginning of trophoblast differentiation. hCG, a hormone produced by the trophoblast, and two signalling mechanisms are implicated in this phenomenon.

Cell Communication↗
PubMed2007

Physicians are different when they learn communication skills: influence of the locus of control.

PURPOSE: Although it is widely recognised that educational interventions may be more effective for people with an 'internal' Locus of Control (who believe that life outcomes are controlled by their own characteristics or actions) compared to people with an 'external' Locus of Control (who believe that life outcomes are controlled by external forces such as luck, fate or others), no study has yet assessed the influence of physicians' Locus of Control (LOC) on communication skills learning. This study aims to test the hypothesis that, in a communication skills training program, physicians with an 'internal' LOC would demonstrate communication skills acquisition to a greater degree than those with an 'external' LOC. METHODS: A non-randomised longitudinal intervention study was conducted between January 1999 and April 2001. Sixty-seven volunteer physicians from private and institutional practice in Belgium participated in a learner-centred, skills-focused, practice-oriented communication skills training program. Communication skills changes were assessed in 2 standardised simulated interviews before and after training (one two-person and one three-person interview). Communication skills were assessed using the Cancer Research Campaign Workshop Evaluation Manual. Physicians' LOC was assessed using the Rotter I-E scale. Communication skills changes of the upper and lower third of physicians in respect of their scores on this scale were compared using group by time repeated measures of variance. RESULTS: In the two-person and three-person interviews, changes in the use of open directive questions were more important among physicians with an "internal" LOC compared with changes observed among physicians with an 'external' LOC (P=0.066 and P=0.004, respectively). In the three-person interview, changes in the use of directive questions, assessing functions and moderate feelings stated explicitly were more important among physicians with an 'internal' LOC compared with changes observed among physicians with an 'external' LOC (P= 0.001; P=0.002 and P=0.011 respectively). CONCLUSION: This study shows that physicians' LOC is a psychological characteristic that could influence the efficacy of a communication skills training program. This evidence supports the idea that a psychological characteristic such as 'internal' LOC may facilitate communication skills acquisition through physicians' belief that communication with patients may be controlled by physicians themselves.

Adult↗
PubMed1999

The importance of importance: adolescents' perceptions of parental communication about sexuality.

High-schoolers (n=298) completed surveys describing the frequency and importance of mother and father communication about 20 different sex-related topics. There were four domains of sex-related topics: Development and Societal Concerns, Sexual Safety, Experiencing Sex, and Solitary Sexual Activity. Adolescents reported infrequent communication which varied by domain and gender of parent and teen. When communication occurred, it was most frequently about the first two domains. Mothers were reported as more frequent communicators about sexuality than fathers and girls received more communication than boys. Young people rated parental communication about sexuality as unimportant, with findings that paralleled those for frequency. Examination of the match between frequency and perceived importance of parental communication revealed more matches than mismatches. Almost all matches resulted from responses indicating low frequency and little importance. Most mismatches reflected a perception of insufficient rather than excessive parental communication about sexuality. It is argued that we need to consider the relative importance given to parental communication, as well as its frequency, if parents are to be effective communicators.

Adolescent↗
PubMed1989

Effects of trichloroethylene and its metabolites on rodent hepatocyte intercellular communication.

Chronic exposure to trichloroethylene (TCE) results in hepatocellular cancer in mice but not rats. The induction of hepatic tumors by TCE appears to be mediated through nongenotoxic or tumor promotion mechanisms. One cellular effect exhibited by a number of nongenotoxic carcinogens and tumor promoters is the inhibition of gap junction mediated intercellular communication. In the present study, the effects of trichloroethylene (TCE) and its metabolites, trichloracetic acid (TCA), trichloroethanol (TCEth), and chloral hydrate (CH) on gap junction mediated intercellular communication in cultured B6C3F1 mouse and F344 rat hepatocytes were assessed. TCE and TCA inhibited intercellular communication in mouse hepatocytes but not in rat hepatocytes. TCEth and CH had no effect on hepatocyte intercellular communication in either rat or mouse cells. TCE and TCA inhibited intercellular communication in both 24-hr-old and freshly plated mouse hepatocytes. Both compounds produced greater inhibition of intercellular communication in freshly plated cells when compared to 24-hr-old cultures. TCE appeared to require cytochrome P450 metabolism by the mouse hepatocytes to exhibit its inhibitory effect on dye coupling since treatment with SKF-525A prevented the inhibition of intercellular communication by TCE. The inhibitory effect of TCA on intercellular communication was unaffected by treatment with SKF-525A. While the species dependent effect of TCE on intercellular communication may be correlated with different rates and extent of metabolism of TCE by rat and mouse hepatocytes, the inhibiting effect of TCA only on mouse hepatocytes suggests that other intrinsic factors in the male mouse make this species more susceptible to the effects of TCE and TCA on gap junction mediated intercellular communication. These findings may account, in part, for the observed species difference in susceptibility to TCE induced liver carcinogenesis.

Animals↗
PubMed1986

Communicative gestures in aphasia.

Gestural communications of 10 mild and moderate aphasics and five controls were examined in two conditions: Face-to-face informal dyadic conversation and restricted visual access between speaker and listener. Gestural production was significantly reduced with restriction of visual access, supporting the posited communicative function of the hand and arm gestures investigated in this study. No differences were found between aphasic and control subjects in the rate of gestural communication in the natural condition of face-to-face interaction. Moderate aphasics, however, were found to produce proportionally fewer of the complex semantic modifying and relational communicative gestures and more nonspecific, nonconsensually shared, unclear gestures. Gestural complexity was significantly negatively correlated with measures of linguistic impairment for the aphasics. The relationship between the frequency and complexity of communicative gestures and concurrent verbalizations was also examined. The findings of this study provide confirmation for the view that there is an identifiable class of gestures utilized by aphasics for communication, aphasics are impaired in their gestural communicative competence in natural conditions of communication, and the quality of aphasics' gestural communications parallels changes in their verbal communication patterns.

Adult↗
PubMed1995

Doctor-patient communication: a review of the literature.

Communication can be seen as the main ingredient in medical care. In reviewing doctor-patient communication, the following topics are addressed: (1) different purposes of medical communication; (2) analysis of doctor-patient communication; (3) specific communicative behaviors; (4) the influence of communicative behaviors on patient outcomes; and (5) concluding remarks. Three different purposes of communication are identified, namely: (a) creating a good inter-personal relationship; (b) exchanging information; and (c) making treatment-related decisions. Communication during medical encounters can be analyzed by using different interaction analysis systems (IAS). These systems differ with regard to their clinical relevance, observational strategy, reliability/validity and channels of communicative behavior. Several communicative behaviors that occur in consultations are discussed: instrumental (cure oriented) vs affective (care oriented) behavior, verbal vs non-verbal behavior, privacy behavior, high vs low controlling behavior, and medical vs everyday language vocabularies. Consequences of specific physician behaviors on certain patient outcomes, namely: satisfaction, compliance/adherence to treatment, recall and understanding of information, and health status/psychiatric morbidity are described. Finally, a framework relating background, process and outcome variables is presented.

Communication↗