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PubMed1994

Communication behaviors of infants of teen mothers. An exploratory study.

PURPOSE: To study the relationship between mother-infant interaction and an infant's preverbal communication skills among a group of teenage mothers and their infants, 13 teenage mother-infant pairs were videotaped in a free-play setting. The infants were then videotaped in a structured setting, with an examiner, designed to elicit preverbal communication behaviors. Mothers were < 17 years old and from low SES backgrounds. Their infants were 9-12 months old, full-term, first born, and developmentally normal. METHODS: Mothers' interactions were assessed from the free-play setting using the Parent-Infant Interaction Scale. The infants' preverbal communication behaviors were measured using the Communication and Symbolic Behavior Scales. Both the frequency of communication behaviors and the range of purposes of these behaviors were assessed. RESULTS: A significant correlation was identified between a mother's interaction scores and the range of purposes for which her infant used communication behaviors (p < 0.01). No correlation was found between maternal interaction scores and the frequency of communication behavior. CONCLUSIONS: Infants whose mothers scored poorly on the Parent-Infant Interaction Scale used most of their communication behaviors to demand or protest. Infants from more optimally interacting dyads used communication behaviors for social interaction and commentary as well as to demand or protest. Maternal interaction and an infant's early communication skills appear to be related in this exploratory study.

Adolescent↗
PubMed2004

Variation in communication loads on clinical staff in the emergency department.

STUDY OBJECTIVE: We determine whether there are differences in role-related communication patterns in the emergency department (ED). METHODS: This was an observational study of a metropolitan ED. Four medical officers and 4 nurses were observed for 19 hours and 52 minutes. Communication load was measured by proportion of observed time in communication, proportion of concurrent communication events, and proportion of interruptions. RESULTS: Eight hundred thirty-one communication events were identified, an average of 42 events per person per hour. Eighty-nine percent of clinicians' time was spent in communication. Synchronous communication channels, involving face-to-face or telephone conversations, were used in 84% of events. One third of communication events were classified as interruptions, averaging 15 interruptions per person per hour. Senior medical and nursing staff experienced higher rates of interruption than junior medical staff and registered nurses with an allocated patient load. CONCLUSION: There was considerable variation in communication loads on clinical staff occupying different roles in the ED. Medical registrars had a high proportion of interruptions and spent the most time dealing with interruptions. These new data suggest some clinical roles may be at higher risk of communication overload than those of the general clinical population.

Communication↗
PubMed2005

Pilot study of the development of a theory-based instrument to evaluate the communication process during multidisciplinary team conferences in rheumatology.

BACKGROUND: Coordinated teams with multidisciplinary team conferences are generally seen as a solution to the management of complex health conditions. However, problems regarding the process of communication during team conferences are reported, such as the absence of a common language or viewpoint and the exchange of irrelevant or repeated information. To determine the outcome of interventions aimed at improving communication during team conferences, a reliable and valid assessment method is needed. AIM: To investigate the feasibility of a theory-based measurement instrument for assessing the process of the communication during multidisciplinary team conferences in rheumatology. METHOD: An observation instrument was developed based on communication theory. The instrument distinguishes three types of communication: (I) grounding activities, (II) coordination of non-team activities, and (III) coordination of team activities. To assess the process of communication during team conferences in a rheumatology clinic with inpatient and day patient facilities, team conferences were videotaped. To determine the inter-rater reliability, in 20 conferences concerning 10 patients with rheumatoid arthritis admitted to the inpatient unit, the instrument was applied by two investigators independently. Content validity was determined by analysing and comparing the results of initial and follow-up team conferences of 25 consecutive patients with rheumatoid arthritis admitted to the day patient unit (Wilcoxon signed rank test). RESULTS: The inter-rater reliability was excellent with the intra-class correlation coefficients being >0.98 for both types I and III communications in 10 initial and 10 follow-up conferences (type II was not observed). An analysis of an additional 25 initial and 86 follow-up team conferences showed that time spent on grounding (type I) made up the greater part of the contents of communication (87% S.D. 14 and 60% S.D. 29 in initial and follow-up conferences, respectively), which is significantly more compared to time spent on co-ordination (p<0.001 and 0.02 for categories II and III, respectively). Moreover, significantly less time spent was spent on grounding in follow-up as compared to initial team conferences, whereas the time spent on coordination (type III) increased (both p-values<0.001). CONCLUSION: This theory-based measurement instrument for describing and evaluating the communication process during team conferences proved to be reliable and valid in this pilot study. Its usefulness to detect changes in the communication process, e.g. after implementing systems for re-structuring team conferences mediated by ICT applications, should be further examined.

Communication↗
PubMed2002

Communicative competence in the delivery of bad news.

Grounded in the Cegala and Waldron (Communication Studies 43 (1992) 105) model of communicative competence, the present study applied the McNeilis (Health Communication 13 (2001) 5) provider-patient coding scheme to video tapes of 3rd year medical students delivering bad news to a standardized patient. The goal of the study was to understand the specific communicative moves that are associated with perceptions of competence during bad news delivery. The coding scheme assesses Content, Acknowledgment Tokens, Interruptions, Alignment, and Function of the message. Naïve observers also evaluated the tapes on several items, assessing empathy and communicative effectiveness. Nonmedical talk was the most common type of content, followed by discussion of the current health problem. Neither acknowledgment tokens nor interruptions were frequent. The most common function of a message was a closed question, followed by explanations, assertions, and open questions. Summing across the functions indicated that information giving was the nost common behavior. The perceivers' data showed fairly neutral assessments of the medical students--they were generally not evaluated very positively, although they were not disliked. Regression analyses indicated numerous specific communicative behaviors that were associated with judgments of competence. Statements falling into the Nonspecific Content category were associated with more positive perceptions, while relational statements, moderately closed questions, solicited answers, expansions, restatements, assertions, explanations, open questions, bracketing, and small talk as well as information verifying, seeking, and giving (summed functions) led to more negative perceptions. The results indicate that the delivery of bad news requires communicative moves that differ from other kinds of medical communication. Depending on the results of future analyses of this topic health are providers may be well advised to focus little of their communication information seeking, giving, or verifying during the initial lab news delivery consultation, but rather to save most communication information for a follow-up scheduled shortly afterwards.

Clinical Clerkship↗
PubMed2002

Communication issues in migraine diagnosis.

OBJECTIVES: To examine the importance of good communication when informing the patient of the diagnosis of migraine; to review the essentials of successful communication between physician and patient on the aspect of diagnosis; to survey learning resources for physicians on communicating information to patients. METHODS: This paper is based on observations made by the author of the successful interactions of numerous international "headache experts" with their patients, on a review of the medical education literature pertaining to the teaching of communication skills, and on 30 years of not always successful communication with patients. RESULTS: Communicating the diagnosis of migraine is an opportunity to educate and reassure the patient, to lay the foundation for rational treatment and to help establish the successful doctor-patient relationship which is essential for effective management. No matter how accurate the diagnosis, failure to communicate it effectively to the patient (and often to significant others) may impair interactions with the patient and compromise therapy. Effective communication of a diagnosis requires clarity, relevance to the patient, a positive attitude, and reinforcement through repetition, questioning and dialogue. In terms of using the diagnosis to lay a foundation for therapy, it is useful to explain the symptoms as transient physical dysfunction of normal tissues, to indicate that there are multiple mechanisms underlying the dysfunction of which only some may presently be susceptible to treatment and to stress the relevance of emotions as factors which may powerfully affect, for better or worse, the underlying disturbed physiology of migraine. Into this model can be "plugged" all the relevant therapies for migraine. This is the ideal, but every day experience in the headache consultant's office suggest that in both primary care and specialist practice, it is infrequently attained. There are scant resources other than example for physicians to learn communication of headache diagnosis specifically but there are numerous print and web resources available to physicians wh wish to learn and/or teach the generic principles of effective communication, and these principles require little or no modification to be applied to the headache patient and the headache doctor.

Communication↗
PubMed1998

Teaching public health practitioners about health communication: the MPH curriculum experience.

The dissemination of health information to the public often occurs through the mass media. Media strategies as a component of behavior change assume knowledge of communication theories and methods by public health practitioners. We surveyed the curricula of 52 accredited graduate programs leading to the Master's in Public Health (MPH) degree to assess their communication component. Graduate bulletins for admission year 1996 were examined for public health mission statement, goals and objectives of the MPH training program, and for course titles. Courses were identified as having a communication focus if the terms communication, information, marketing or media were used in the title. There were a total of 82 communication courses offered, with 65 courses in 26 Schools of Public Health (SPH), 13 courses in 18 Community Health and Preventive Medicine departments (CHPM), and 4 courses in 8 Community Health Education departments (CHE). The difference in mean number of health communication courses was significant by type of MPH program (p < 0.003) with SPH offering an average of 3 courses, CHPM departments offering an average of 1 course, and CHE offering an average of 0.5 course. The distribution of communication courses ranged from 10 courses to 0 courses per program. Seven SPH offered 3 or more communication courses, whereas 5 SPH offered no health communication courses in the MPH curriculum. These data point to a shortcoming in the training of MPH students in health communication theory and skills as ascertained by course titles in graduate bulletins.

Communication↗
PubMed2004

Communications with research participants and communities: foundations for best practices.

Communities and research participants increasingly feel that they have rights to be equal partners with researchers and to have access to the results of studies to which they have contributed. Concurrently, research sponsors have become aware of legal liabilities, societal repercussions, and credibility impacts of ignoring research communication responsibilities. However, issues related to research communications are rarely discussed at professional meetings or taught in academic programs. As a result, individual investigators may not be clear about their duties to communicate the results of their research. It is important to address this gap between expectations and abilities, because researchers' lack of communication fosters a climate of distrust in science and implies disinterest or disrespect for participants and communities. Ethical, legal, and professional frameworks and practices were reviewed to develop insights about principles, guidelines, and means that can be used to promote best practices. A review of general research guidance and specific requests for proposals revealed sponsors' communication priorities. While there are barriers to research communication, there is an increasing awareness among sponsors and investigators that effective and responsive communication is not a cheap or uniform add-on to a project or proposal. Communications must be tailored to the project considering all potential stakeholders, and resources need to be allocated specifically for communication activities within projects. Researchers, sponsors, professional societies and academia all have opportunities to improve principles, policies, frameworks, guidelines and strategies to foster "best practice" communication of research results.

Australia↗
PubMed1982

Pragmatic analysis of the communicative behavior of an autistic child.

Differential responsiveness by social stimuli was demonstrated in the communicative performance of an 8-year-old autistic boy. The pragmatic behavior of the subject varied with different communicative settings (waiting vs. interaction conditions) as well as with different communicative partners (mother, stranger, clinician). Communicative intentions, relational communication, topic strategies and differential responding to adults to communicative and non-communicative utterances were analyzed. Results indicated that the adults' communicative performance was a function of their relationships with the subject (mother, stranger, clinician) as well as the different experimental conditions (waiting, interacting). The child's communicative behavior showed greater consistency in conditions with the same interlocutor than over comparable experimental settings. Conclusions were drawn on how to facilitate communicative behavior and how to enhance generalization of remedial effects to the subject's natural environment.

Autistic Disorder↗
PubMed1995

Initiation and repair of intentional communication acts by adults with severe to profound cognitive disabilities.

This study assessed the communication initiation and repair behaviors of 28 individuals with severe to profound mental retardation in a variety of experimental conditions. All of these individuals communicated through nonsymbolic gestures. The experimental procedures were devised to simulate the conditions that typically evoke two different types of initiations: comments and requests. Each subject initiation was followed by an experimenter response that indicated a communication breakdown to determine if and how these subjects would attempt to repair such breakdowns. Different indicators of communication breakdown were systematically varied in these scripted interactions, including explicit requests for repair (verbal and gestural) and implicit requests for repair (failure to respond or inappropriate response to the subject's communication act). All subjects initiated at least one communication act, and all but three subjects repaired at least one communication act following a breakdown. Significantly more subjects initiated protoimperative than protodeclarative communication acts, despite equal opportunities for both types of acts. Across all conditions, additions were observed to occur significantly less often than recasts or repetitions. There were no significant differences in the number of subjects repairing communication following the different types of communication breakdown.

Adult↗
PubMed2003

A discourse analysis study of 'good' and 'poor' communication in an OSCE: a proposed new framework for teaching students.

BACKGROUND: There is still a great deal to be learnt about teaching and assessing undergraduate communication skills, particularly as formal teaching in this area expands. One approach is to use the summative assessments of these skills in formative ways. Discourse analysis of data collected from final year examinations sheds light on the grounds for assessing students as 'good' or 'poor' communicators. This approach can feed into the teaching/learning of communication skills in the undergraduate curriculum. SETTING: A final year UK medical school objective structured clinical examination (OSCE). METHODS: Four scenarios, designed to assess communication skills in challenging contexts, were included in the OSCE. Video recordings of all interactions at these stations were screened. A sample covering a range of good, average and poor performances were transcribed and analysed. Discourse analysis methods were used to identify 'key components of communicative style'. FINDINGS: Analysis revealed important differences in communicative styles between candidates who scored highly and those who did poorly. These related to: empathetic versus 'retractive' styles of communicating; the importance of thematically staging a consultation, and the impact of values and assumptions on the outcome of a consultation. CONCLUSION: Detailed discourse analysis sheds light on patterns of communicative style and provides an analytic language for students to raise awareness of their own communication. This challenges standard approaches to teaching communication and shows the value of using summative assessments in formative ways.

Clinical Competence↗
PubMedDate not supplied

Speech acts, communication problems, and fighter pilot team performance.

Two aspects of team communication, speech acts and communication problems, and their relation to team performance in a team air combat simulator were studied. The purpose was to enhance the understanding of how team performance is related to team communication. Ten Swedish fighter pilots and four fighter controllers of varying experience participated. Data were collected during fighter simulator training involving four pilots and one fighter controller in each of two teams. Speech acts were collapsed over seven categories and communication problems over five categories. Communication was studied from two perspectives: critical situation outcome and mission outcome. Some problems were closely related to particular speech acts. Speech act frequency, especially meta-communications and tactics, was highest when winning. However, the timing of tactics in critical situations needs further research. Communication problem frequency was highest for runs which ended equally. The most common problem was simultaneous speech, possibly because of the simulator radio system. The number of speech acts was related to enhanced performance but in a complex manner. Thus in order to work efficiently team members need to communicate, but to communicate sufficiently and at appropriate times. This work has applications for fighter pilot and controller team training and the development of communication standards.

Aerospace Medicine↗
PubMedDate not supplied

Seropositive individuals willingness to communicate, self-efficacy, and assertiveness prior to HIV infection.

The purpose of this study was to examine possible communication similarities between human immunodeficiency virus (HIV) positive and HIV negative individuals. Forty HIV positive heterosexuals, who were infected through heterosexual sex, completed an on-line questionnaire to assess their safer sexual communication, willingness to communicate, condom self-efficacy, and assertiveness prior to HIV infection. Results indicate that prior to infection, HIV positive heterosexuals reported having similar safer sexual communication behaviors to those not infected with the virus. Participants in this study reported high levels of willingness to engage in safer sex communication, but low levels of actual communication. Further, results reveal that participants who engaged more often in safer sex communication were more likely to use condoms. Additionally, participants reported high levels of condom self-efficacy and moderate levels of assertiveness; both variables positively correlated with condom use. Finally, participants reported that they believed they did not need to discuss using condoms because they were not at risk. Previous safer sexual communication research reveals HIV negative individuals reported engaging in the same behaviors and holding the same beliefs reported by seropositive individuals. Hence, discussion of the importance of safer sexual communication and the utility of personalization to increase the communication of HIV negative individuals is explored.

Adult↗
PubMed1993

Specificity of gap junction communication among human mammary cells and connexin transfectants in culture.

In a previous paper (Lee et al., 1992), it was shown that normal human mammary epithelial cells (NMEC) express two connexin genes, Cx26 and Cx43, whereas neither gene is transcribed in a series of mammary tumor cell lines (TMEC). In this paper it is shown that normal human mammary fibroblasts (NMF) communicate and express Cx43 mRNA and protein. Transfection of either Cx26 or Cx43 genes into a tumor line, 21MT-2, induced the expression of the corresponding mRNAs and proteins as well as communication via gap junctions (GJs), although immunofluorescence demonstrated that the majority of Cx26 and Cx43 proteins present in transfected TMEC was largely cytoplasmic. Immunoblotting demonstrated that NMEC, NMF, and transfected TMEC each displayed a unique pattern of posttranslationally modified forms of Cx43 protein. The role of different connexins in regulating gap junction intercellular communication (GJIC) was examined using a novel two-dye method to assess homologous and heterologous communication quantitatively. The recipient cell population was prestained with a permanent non-toxic lipophilic dye that binds to membranes irreversibly (PKH26, Zynaxis); and the donor population is treated with a GJ-permeable dye Calcein, a derivative of fluorescein diacetate (Molecular Probes). After mixing the two cell populations under conditions promoting GJ formation, cells were analyzed by flow cytometry to determine the percentage of cells containing both dyes. It is shown here that Cx26 and Cx43 transfectants display strong homologous communication, as do NMEC and NMF. Furthermore, NMEC mixed with NMF communicate efficiently, Cx26 transfectants communicate with NMEC but not with NMF, and Cx43 transfectants communicate with NMF. Communication between Cx26 TMEC transfectants and NMEC was asymetrical with preferential movement of calcein from TMEC to NMEC. Despite the presence of Cx43 as well as Cx26 encoded proteins in the GJs of NMEC, few Cx43 transfectants communicated with NMEC. No heterologous GJIC was observed between Cx26- and Cx43-transfected TMEC suggesting that heterotypic GJs do not form or that Cx26/Cx43 channels do not permit dye transfer.

Blotting, Western↗
PubMed1992

Regulation of gap junctional communication in Syrian hamster embryo cells by retinoic acid and 12-O-tetradecanoylphorbol-13-acetate.

Retinoids enhance the frequency of Syrian hamster embryo (SHE) cell colonies with transformed morphology in a similar way to tumor-promoting phorbol esters. The present study shows that retinoids are also potent inhibitors of gap junctional intercellular communication in SHE cells at noncytotoxic concentrations. This is an apparent contrast to the results observed in transformation systems using the mouse cell lines C3H10T1/2 and BALB/c 3T3, where retinoids have been found to reduce the induction of transformation, and also to enhance gap junctional cell communication. Retinoids are thus potent modulators of transformation and cell communication in three transformation systems. For all three cell types, enhancement of communication by retinoids is related to reduced transformation, and inhibition of communication to enhanced induction of transformation. Communication in the SHE cells is completely blocked following 1 h exposure to 30 microM retinoic acid, while concentrations of 0.3-15 microM results in a gradual down-regulation of communication during 1-5 h exposure. Removal of retinoic acid results in complete restoration of communication to control values within a few hours. Primary SHE cells and the cell line BPNi show similar sensitivity for inhibition of communication after exposure to retinoic acid, while BPNi cells are far more sensitive to inhibition of communication by 12-O-tetradecanoylphorbol-13-acetate (TPA) than primary SHE cells. Retinoic acid does not induce inhibition of epidermal growth factor binding, potentiate adenylate cyclase activation or enhance arachidonic acid release, as does TPA, suggesting different mechanisms of action.

Animals↗
PubMed2005

Teaching inpatient communication skills to medical students: an innovative strategy.

At the University of Washington, a group of medical educators defined a set of communication skills, or "benchmarks," that are expected of second-year medical students conducting history and physical examinations on hospitalized patients. In order to teach the skills listed in the communication benchmarks, an educational strategy was devised that included training sessions for 30 medical teachers and the development of an innovative videotape tool used to train the teachers and their students. The benchmarks were designed in 2003 for the developmental level of the students and were based on key communication concepts and essential elements of medical communication. A set of five short videotaped scenarios was developed that illustrated various segments of a student history and physical examination. Each scenario consisted of an "OK" version of communication and a "better" version of the same scenario. The video scenarios were used in teaching sessions to help students identify effective communication techniques and to stimulate discussion about the communication benchmarks. After the training sessions, teachers and students were surveyed to assess the effectiveness of the educational methods. The majority of students felt that the educational design stimulated discussion and improved their understanding of communication skills. Faculty found the educational design useful and 95% felt that the curriculum and videotape contributed to their own education. The development of communication benchmarks illustrated with short videotaped scenarios contrasting "OK" with "better" communication skills is a useful technique that is transferable to other institutions.

Benchmarking↗
PubMed2003

Communication needs, methods, and perceived voice quality head and neck surgery: a literature review.

Patients with head and neck cancer experience complex and frustrating communication problems after surgery, yet patient communication during the in-hospital postoperative period has received relatively little attention in clinical and research literature. A computerized and hand search of the medical (MEDLINE, Cancerlit), psychological (health and psychosocial instruments), and nursing (CINAHL) literature (1968 to August, 2001) produced 10 published studies and 1 clinical case report specifically addressing the communication needs, methods, or perceived voice quality of patients with head and neck cancer during the postoperative period (3 days to 19 months). This review presents a summary and critique of research and related literature on in-hospital postoperative communication with adult patients who have head and neck cancer. Four major themes are addressed: 1) information needs, 2) communication methods and perceived voice quality, 3) adjustment and adaptation to communication impairment, and 4) quality-of-life perceptions related to communication and socialization. This review shows that the communication needs, communication methods, and perception of voice quality among patients with head and neck cancer have been ignored during the in-hospital period. Clinical issues and technological advancements in augmentative and alternative communication applicable to the in-hospital period are discussed, and research implications are presented.

Adaptation, Psychological↗
PubMed2005

Psychosocial aspects of risk communication and mutation testing in familial breast-ovarian cancer.

PURPOSE OF REVIEW: As cancer genetics services develop, psychosocial research evaluating risk communication and mutation testing for familial breast-ovarian cancer has expanded rapidly. It is timely to review findings in key areas. These will inform risk counselling practice and help prepare women making risk management decisions. RECENT FINDINGS: The psychological effect of risk communication and genetic counselling has been elucidated and women's risk perceptions explored. Knowledge of optimal risk communication strategies is lacking, but recent research shows both consistency in information giving and deficiencies in specific communication skills; the need for personally tailored risk information, which addresses counsellees' concerns, is highlighted. Outcome assessments of risk communication, such as risk perception and psychological distress, are useful but insufficient to evaluate the complex communication process, and decision making in this context is underresearched. Subsequent diffusion of risk information and interfamily communication pose difficulties for high-risk individuals. The short-term psychological consequences of predictive mutation testing are an important focus of research and are largely reassuring, but long-term outcomes are sparse. SUMMARY: Our understanding of the psychological benefits and limitations of risk counselling and mutation testing can now inform clinical practice, but insufficient knowledge exists of long-term outcomes. Most women are unlikely to be distressed following risk communication, but some may need psychosocial support in the short term following predictive testing for BRCA1/2. Different approaches to risk communication need to be developed and evaluated in parallel with communications skills training to ensure an adequate focus on the women's agenda.

Breast Neoplasms↗
PubMed2004

Nurse-patient communication: an exploration of patients' experiences.

BACKGROUND: Patient-centred communication is a basic component of nursing and facilitates the development of a positive nurse-patient relationship which, along with other organizational factors, results in the delivery of quality nursing care. Nurses are frequently described in the literature as poor communicators, however, very few studies have examined patients' experiences of how nurses communicate. AIMS AND OBJECTIVES: The aim of the study was to explore and produce statements relating to patients' experiences of how nurses communicate. DESIGN: A qualitative perspective using an hermeneutic phenomenological approach was considered to be the most appropriate methodology for this study. METHODS: Using purposeful sampling, eight patients in a general teaching hospital in the Republic of Ireland were interviewed. Data were collected using unstructured interviews. Data analysis was a reflective process and the findings were presented through the description and interpretation of themes and sub-themes. RESULTS: Following data analysis four themes emerged. These were, 'lack of communication', 'attending', empathy' and 'friendly nurses'. CONCLUSIONS: The findings of this study indicate that, in contrast to the literature that suggests that nurses are not good at communicating with patients, nurses can communicate well with patients when they use a patient-centred approach. However, health care organizations do not appear to value or recognize the importance of nurses using a patient-centred approach when communicating with patients to ensure the delivery of quality patient care. RELEVANCE TO CLINICAL PRACTICE: The implication of these findings for clinical practice is that the task-centred approach to patient care that is associated with nursing in the past, appears to be alive and well. If health care management want to ensure that patients receive quality nursing care, they will need to consider patient-centred communication to be essential to encourage and support nurses to communicate in this manner.

Adult↗