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Results for “Communication Barriers”

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At least 109 records · Page 6Linked to original sources
PubMed2001

The effect of discussions about advance directives on patients' satisfaction with primary care.

BACKGROUND: Discussions of end-of-life care should be held prior to acute, disabling events. Many barriers to having such discussions during primary care exist. These barriers include time constraints, communication difficulties, and perhaps physicians' anxiety that patients might react negatively to such discussions. OBJECTIVE: To assess the impact of discussions of advance directives on patients' satisfaction with their primary care physicians and outpatient visits. DESIGN: Prospective cohort study of patients enrolled in a randomized, controlled trial of the use of computers to remind primary care physicians to discuss advance directives with their elderly, chronically ill patients. SETTING: Academic primary care general internal medicine practice affiliated with an urban teaching hospital. PARTICIPANTS: Six hundred eighty-six patients who were at least 75 years old, or at least 50 years old with serious underlying disease, and their 87 primary care physicians (57 residents, 30 faculty general internists) participated in the study. MEASUREMENTS AND MAIN RESULTS: We assessed patients' satisfaction with their primary care physicians and visits via interviews held in the waiting room after completed visits. Controlling for satisfaction at enrollment and physician, patient, and visit factors, discussing advance directives was associated with greater satisfaction with the physician (P =.052). At follow-up, the strongest predictor of satisfaction with the primary care visit was having previously discussed advance directives with that physician (P =.004), with a trend towards greater visit satisfaction when discussions were held during that visit (P =.069). The percentage of patients scoring a visit as "excellent" increased from 34% for visits without prior advance directive discussions to 51% for visits with such discussions (P =.003). CONCLUSIONS: Elderly patients with chronic illnesses were more satisfied with their primary care physicians and outpatient visits when advanced directives were discussed. The improvement in visit satisfaction was substantial and persistent. This should encourage physicians to initiate such discussions to overcome communication barriers might result in reduced patient satisfaction levels.

Advance Directives↗
PubMed1992

Differences in ethical decision-making processes among nurses and doctors.

The study reports results of an inquiry into the different patterns of ethical decision making used by doctors and nurses. The findings of the study are that nurses and doctors act out of different values, motivations and expectations and that there is a communication gap between them. Nurses place the highest value on the 'caring' perspective, which entails responsiveness and sensitivity to the patients' wishes. In contrast, the doctors value above all the patients' rights and the scientific approach that implies a major concern with disease and its cure. The study suggests that there is a need for the development of a new foundation, based on common professional attributes of the two groups, to which both groups are committed. This would provide a joint point of reference from which the two professions can solve shared ethical problems and would remove communication barriers.

Beneficence↗
PubMed2005

Dentist-patient communication in the multilingual dental setting.

BACKGROUND: Communication between dentists and patients can be exceptionally challenging when the patient and the dentist do not speak the same language, as is frequently the case in multicultural Australia. The aim of this study was to describe the issues involved in dealing with limited-English speaking patients in order to formulate recommendations on how to improve dental communication. METHODS: A cross sectional study was performed using a postal survey to Australian Dental Association member dental practitioners in Western Australia. Responses were collated and data analysis was performed using SPSS 11.5 for Windows. RESULTS: Most respondents encounter language-related communication barriers weekly or monthly, and the most satisfactory method of communication is informal interpreters. Despite reporting satisfaction working with professional chairside interpreters or dental staff interpreters, most respondents did not use them. The most common alternative communication methods were diagrams and models. Endodontics and periodontics provided the greatest challenge in communication. Informed consent was reportedly compromised due to language barriers by 29 per cent of respondents. Recommendations to improve communication included access to interpretation services, dentist technique/attitude to communication and patient preparedness for English-speaking encounters. CONCLUSIONS: Many respondents do not utilize the preferential communication methods, creating a potential compromise to both informed consent and the patients' best interests. The use of professional interpreters is recommended, and discussion should be supplemented with means of non-verbal communication. Dentists require access to lists of multilingual dentists and greater awareness of interpretation services to improve multilingual dentist-patient communication.

Attitude of Health Personnel↗
PubMed1994

The development of graphic symbols for medical symptoms to facilitate communication between health care providers and receivers.

Since there are a variety of communication barriers in health care settings in Japan, a study was designed to improve communication by the use of graphic symbols. At the beginning of this study, graphic symbols were developed to correspond to 26 basic symptoms. Seventy-six subjects voluntarily evaluated the comprehensibility of these symbols: nursing students (n = 29), manual sign language interpreters (n = 24), hearing impaired subjects with normal (n = 10), limited (n = 11), and minimal (n = 2) literacy abilities. The comprehension by each respondent of each symbol was compared with that of the authors. On the average, numbers of the matching meanings were 24.9 +/- 1.36 (mean +/- S.D.) for students, 24.5 +/- 1.77 for interpreters, 23.4 +/- 2.22, and 21.5 +/- 3.01 for the first two groups of the hearing impaired. Among the 26 symbols, 10 showed high levels of the matching rates (> 90%) for all groups. These symbols were considered to be effective alternatives to verbal expression. Further refinements of the graphic symbols were suggested to suppress the differences in interpretation of the remainder of the symbols. During this study, colleagues and subjects suggested cognitive strategies to clarify and enhance the meaning of the graphic symbols such as (a) the subtraction of excessive information, (b) the addition of further information, and (c) the simplification of the setting by minimizing social and cultural bias.

Adult↗
PubMed1996

Action on worksite health and safety problems: a follow-up survey of workers participating in a hazardous waste worker training program.

In it's worker health and safety training program, the California-Arizona Consortium aims to promote worker action to improve health and safety conditions. To assess action on worker-identified health and safety problems, 278 trainees were interviewed 3-8 months after training. Associations with three outcomes were analyzed: (1) attempted action, (2) problem correction, and (3) trainee participation. Perceived management support was associated with all three outcomes, pointing to its key role in maximizing the impact of training. Odds of attempted action were 2-5 times greater with support than without. Trainees for whom English was not the primary language (mostly Spanish speakers) attempted action as often as English speakers. However, the odds of their correcting problems were half that of the English-speaking workers. It is suggested this was due to a perceived lack of control over organizational resources for change, not simply due to communication barriers.

Arizona↗
PubMed2000

Empowering the deaf. Let the deaf be deaf.

Deafness is often regarded as just a one and only phenomenon. Accordingly, deaf people are pictured as a unified body of people who share a single problem. From a medical point of view, we find it usual to work with a classification of deafness in which pathologies attributable to an inner ear disorder are segregated from pathologies attributable to an outer/middle ear disorder. Medical intervention is thus concerned more with the origin, degree, type of loss, onset, and structural pathology of deafness than with communicative disability and the implications there may be for the patient (mainly dependency, denial of abnormal hearing behaviour, low self esteem, rejection of the prosthetic help, and the breakdown of social relationships). In this paper, we argue that hearing loss is a very complex phenomenon, which has many and serious consequences for people and involves many factors and issues that should be carefully examined. The immediate consequence of deafness is a breakdown in communication whereby the communicative function needs to be either initiated or restored. In that sense, empowering strategies--aimed at promoting not only a more traditional psychological empowerment but also a community one--should primarily focus on the removal of communication barriers.

Communication Devices for People with Disabilities↗
PubMed2004

Neuropathic pain: a guide to comprehensive assessment.

Patients with neuropathic pain present a clinical challenge. Neuropathic pain, when chronic, often leads to disability. Diagnosis can be difficult because both positive and negative sensory and motor signs and symptoms may be present, as well as a variety of comorbid conditions. In addition, there may be a high degree of interpatient variability. Currently, clinical evaluation, rather than diagnostic tests, is one of the best available tools for assessment and diagnosis. As with all chronic pain conditions, the key to a thorough assessment is a thorough history that includes medical, functional, and psychosocial evaluations. Currently available pain assessment tools, which are widely used in nursing practice, are still inadequate for use in patients with neuropathic pain. The physical and neurologic examination remains a critical element for patient evaluation. This includes an assessment of spontaneous pain (continuous or intermittent), pain evoked by daily activities (allodynia), and other abnormal sensations that are not necessarily painful (paresthesias, dysesthesias). Sensitivity to pinprick, touch, pressure, cold, heat, and vibration are measured, often confirming the suspected diagnosis. Patients may be confused by the unusual sensations they are experiencing and unable to effectively describe or communicate their symptoms. This communication barrier may contribute to an inadequate physical examination. With improved skills in patient assessment and through enhanced communication with patients, nurses can make an important contribution to treatment outcomes in patients with neuropathic pain.

Activities of Daily Living↗
PubMed1984

Helping children express grief through symbolic communication.

Communication barriers erected by grieving children delay problem resolution. Use of the expressive arts--music, art, and body movement--in symbolic communication helps them to express overwhelming feelings and cope with trauma and stress.

Art Therapy↗
PubMed2003

The same but different: clinician-patient communication with gay and lesbian patients.

Surveys estimate that 3-6% of the patients seen by physicians are gay or lesbian. There are unique health risks of gays and lesbians that are important to the clinician in determining an accurate diagnosis, providing patient education, and arriving at an appropriate treatment plan. One of the most significant medical risks of these populations includes avoidance of routine health care and dissatisfaction with healthcare. Many of these healthcare risks are not addressed because of lack of communication based on a number of common assumptions including the assumption that the patient is heterosexual. This article includes a summary of the medical literature through computerized searches to March 2002 in MEDLINE, PsychInfo, HEALTHSTAR, and bibliographies in articles on health care with gay and lesbian patients. The search strategy included health care of gays and lesbians and clinician-patient communication, partner and family issues. Secondly, it will examine common communication barriers and provide strategies for enhancing communication with patients in a gender-neutral, non-judgmental manner including suggestions for enlisting the inclusion of patients' families.

Attitude of Health Personnel↗
PubMed1997

[Communication in the hospital. A qualitative study of the communication behavior within the nursing service between the wards of a psychiatric department of a general hospital].

In this project the behaviour of communication was examined of the nursing staff of a psychiatric clinic of a university hospital in Germany dealing with the staff of the other units. For this project qualitative methods of research with characteristics of the "Grounded Theory" have been used. The results show among others that communication barriers with regard to a cooperative communication process have existed in the past and are still showing some influence on todays' nursing staff. The interviewed nurses intend to realize a more cooperative communication and interaction on and between the units. A critical reflection of the "nursing conference", the "job rotation" or the "coaching of the team sessions by a neutral presenter" are examples of recommendations to improve and support the development of the communication process among the nurses.

Communication↗
PubMed1998

Strategies for reaching Asian Americans with health information.

INTRODUCTION: Cultural, linguistic, and economic barriers place many Asian Americans in jeopardy of missing opportunities for disease prevention, early diagnosis, prompt treatment, and participation in clinical trials. One way to learn how to address these barriers is through the development of a demonstration health education and prevention program focused on an indicator disease such as cancer. METHODS: In 1994, the University of California, San Diego (UCSD) Cancer Center began a highly focused cancer education program. Staffing was done with a variety of bicultural and bilingual undergraduates recruited from local colleges and trained to work as community health educators. Asian grocery stores were selected as optimal educational sites. Adaptation of sheltered English teaching techniques and hands-on teaching aids helped to overcome language and educational barriers. The educational intervention was evaluated using unobtrusive measures. RESULTS: With the volunteers' help, culturally sensitive means to disseminate information on cancer were evaluated. A variety of approaches evolved that effectively bridged many communication barriers. Fear of cancer itself, belief that thinking about cancer could provoke the onset of the disease, and financial barriers to care proved to be just as formidable barriers to cancer education in this ethnic group as they are in others. Using student volunteers and donated store space, this educational program was conducted with minimal expense. CONCLUSION: Reaching this population with the help of ethnically and linguistically compatible students was effective, but the barriers they faced when trying to connect with their potential audience were still considerable. Rigorous evaluation of the strategies used in this intervention is warranted.

Asian↗
PubMed2006

Erectile dysfunctions in patient-physician communication: optimized strategies for addressing sexual issues and the benefit of using a patient questionnaire.

INTRODUCTION: Erectile dysfunctions are prevalent but underdiagnosed and undertreated health problems. Communication barriers between patients and physicians are one of the main reasons for this and responsible for a low report rate of sexual dysfunction. AIM: The main aim of the study was to investigate which phrasing and communication strategies gained the highest acceptance from physicians and their patients and were considered the most effective. MAIN OUTCOME MEASURES: A documentation form on which each consultation was rated by the participating physicians. METHODS: A large group of physicians was asked to hand out a short patient questionnaire to all male patients over 30 years. The physician was instructed to discuss the questionnaire with the patient and to ask him about sexual problems. A total of 1,191 physicians took part in the study that documented a total of 10,622 consultations with an average duration of 15 minutes. RESULTS: The main results were: (i) the patient questionnaire found a high level of acceptance and 54% of discussions of sexual health were prompted by it; (ii) the patients' reaction to physicians addressing sexual health was positive in more than two-thirds of the sample and characterized by openness, willingness to communicate, and relief that their sexual problems had been addressed; (iii) from the physicians' perspective, the most favored communication strategies were a clear signaling of a willingness to talk, and addressing treatment possibilities or signaling that help was available; and (iv) the resulting discussion led to further diagnostic measures in 25% of patients and to further therapeutic measures in 60% of patients. CONCLUSIONS: There are good grounds for concluding that: (i) addressing a patient's sexual health as part of a physician's everyday routine is feasible in terms of duration and content; and (ii) a short patient questionnaire is an excellent aid for patients and physicians for initiating communication on the topic.

Adult↗
PubMed1995

Attitudes of Colorado health professionals toward breast and cervical cancer screening in Hispanic women.

BACKGROUND: A variety of economic, cultural, and communication barriers appear to be involved in breast and cervical cancer screening among Hispanic women. These barriers include culture-based embarrassment both for mammography and for Pap smears and fear and hopelessness concerning a diagnosis of cancer. Cost and access barriers are shared by low-income women from various ethnic and racial groups, as is a purported lack of physician referral. Hispanic women may have the latter problem enhanced by a language barrier between physicians and patients when the physicians do not speak or understand Spanish. PURPOSE: The goal of this project, conducted by the Cancer Education Division of the University of Colorado Cancer Center, has been to determine the attitudes and practices among health care providers in areas of Colorado with relatively large Hispanic populations (concerning screening mammography, clinical breast examination, breast self-examination, and Pap testing) and to design interventions to address any deficiencies or problems recognized. These studies were coordinated with telephone surveys and focus groups involving Hispanic women, directed by E. Flores in the Department of Sociology of the University of Colorado at Boulder and by C. Chrvala at the Colorado Department of Health. METHODS: Data were collected from 520 primary care physicians, nurses, and allied health personnel in 11 Colorado counties through focus groups and mailed questionnaires. Responses were analyzed by considering a variety of demographic characteristics of the respondents and by stratifying the associated practices by percent of Hispanic patients. RESULTS: The physicians involved in the focus groups and responding to the questionnaires, as well as their associated nurses and other health care personnel, are generally familiar with the breast and cervical cancer-screening guidelines as developed and disseminated by several organizations, including the National Cancer Institute and the American Cancer Society. Major barriers to screening Hispanic women, as perceived by these health care providers, appear to be cost; lack of transportation, child care, and release from work; fear of diagnosis of cancer; patients considering the test unnecessary; discomfort; and embarrassment. The prompt use of colposcopy to evaluate patients whose Pap smears indicated dysplasia appeared less than optimal, especially among internists. CONCLUSIONS: Familiarity with guidelines for breast and cervical cancer screening is widespread among Colorado physicians and associated health care personnel, including those with high percentages of Hispanic patients in their practices. Increased continuing education efforts may be indicated concerning the application of colposcopy to the evaluation of women with abnormal Pap smears and concerning the application of computer technology to cancer-screening reminder systems. IMPLICATIONS: Educational approaches to primary care professionals may improve the effectiveness of breast and cervical cancer screening, although a variety of other approaches will also be necessary to decrease barriers to screening of Hispanic women.

Adult↗
PubMedDate not supplied

The use of gaming strategies in a transcultural setting.

Saudi Arabia's vast economic resources have enabled the development of state-of-the-art hospitals. Nurses recruited from around the world staff these hospitals creating one of the most multicultural practice settings in the world. Ethnic, educational, and experiential diversity; language and communication barriers; and alternative ways of knowing and learning challenge nurse educators to be more creative and explore opportunities for greater participation and learning among various cultural groups. Gaming, as a teaching-learning strategy for multicultural participants, affords the necessary flexibility and nonthreatening atmosphere which facilitates positive interactions among different, and often competing, communication patterns and learning styles. This article explores how and why gaming is as an effective educational strategy in a transcultural setting.

Communication Barriers↗
PubMed2006

ACOG Committee Opinion No. 343: psychosocial risk factors: perinatal screening and intervention.

The American College of Obstetricians and Gynecologists advocates assessing for psychosocial risk factors and helping women man-age psychosocial stressors as part of comprehensive care for women. Psychosocial screening of all women seeking pregnancy evaluation or pre-natal care should be performed regardless of social status, educational level,or race and ethnicity. Because problems may arise during the pregnancy that were not present at the initial visit, it is best to perform psychosocial screen-ing at least once each trimester to increase the likelihood of identifying important issues and reducing poor birth outcomes. When screening is completed, every effort should be made to identify areas of concern, validate major issues with the patient, provide information, and, if indicated, make suggestions for possible changes. When necessary, the health care provider should refer the patient for further evaluation or intervention. Psychosocial risk factors also should be considered in discharge planning after delivery. Many of the psychosocial issues that increase the risk for poor pregnancy outcome also can affect the health and welfare of the newborn. Screening should include assessment of barriers to care, unstable housing, unintended pregnancy, communication barriers, nutrition, tobacco use, substance use,depression, safety, intimate partner violence, and stress.

Domestic Violence↗
PubMedDate not supplied

Deaf women's experiences and satisfaction with prenatal care: a comparative study.

BACKGROUND AND OBJECTIVES: The quality of communication between physician and patient is a major contributor to patient satisfaction and treatment adherence. Deaf patients who use American Sign Language experience significant communication barriers in most medical settings. This study investigated factors impacting deaf patients' satisfaction with prenatal care and prenatal care disparities between deaf and hearing women. METHODS: Questionnaires modified from Omar and Schiffman's prenatal satisfaction measure were administered to 23 deaf and 32 hearing women. RESULTS: Deaf women were less satisfied than hearing women with physician communication and less satisfied with overall care. Deaf women's expectations about provision of interpreter services being met or exceeded was significantly associated with overall satisfaction. Hearing women had more prenatal care appointments and reported receiving more information from their doctors. CONCLUSIONS: Maximizing communication effectiveness with deaf patients results in better prenatal care and improved patient satisfaction. Good communication includes conveying concern and making efforts to ensure that whatever communication methods used are effective.

Communication Barriers↗