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PubMedDate not supplied

Non-verbal communication: the importance of listening.

This article presents the author's personal reflection on how her nursing practice was enhanced as a result of losing her voice. Surprisingly, being unable to speak appeared to improve the nurse/patient relationship. Patients responded positively to a quiet approach and silent communication. Indeed, the skilled use of non-verbal communication through silence, facial expression, touch and closer physical proximity appeared to facilitate active listening, and helped to develop empathy, intuition and presence between the nurse and patient. Quietly 'being with' patients and communicating non-verbally was an effective form of communication. It is suggested that effective communication is dependent on the nurse's ability to listen and utilize non-verbal communication skills. In addition, it is clear that reflection on practical experience can be an important method of uncovering and exploring tacit knowledge in nursing.

Communication Barriers↗
PubMed2002

An experimental investigation of some properties of individual iconic gestures that mediate their communicative power.

It has been hypothesized that the iconic hand gestures that accompany talk communicate important semantic information. This research tests whether some gestures, in the absence of speech, are more communicative than others and considers what properties of gestures might affect their communicative power. Our research found that the communicative power of gestures does vary greatly, and that this is significantly affected by the viewpoint from which a gesture is generated, with character viewpoint gestures being more communicative than observer viewpoint gestures. It has also been suggested that gesture viewpoint is connected with the transitivity of the clause that it accompanies, and it was found in our study that respondents appeared to obtain syntactic information about the associated clause from the gesture. This conclusion was based on the observation that when respondents attempted to report what information was contained in gestures, viewed in the absence of speech, there was a significantly higher proportion of transitive structures in their answers after they had watched character viewpoint gestures compared with observer viewpoint gestures. Communication about the syntax of the accompanying clause might thus be a critical, but thus far neglected, aspect of the role of gestures in everyday talk.

Adult↗
PubMed1995

Changing the way we talk with elders: promoting health using the communication enhancement model.

Good communication is an essential component of optimal delivery of health care and health promotion efforts. In this article, we address the communication predicament faced by older adults when their opportunities for optimal care are limited by inappropriate communication with formal care providers. We then introduce the Communication Enhancement Model which promotes health in old age by stressing recognition of individualized cues, modification of communication to suit individual needs and situations, appropriate assessment of the health/social problems, and empowerment of both elders and providers. Applications of the Communication Enhancement Model are discussed for two high-risk groups (elders from ethnocultural communities and elders with dementia) to show how it can function as a guide for the development and evaluation of educational interventions with health and social professionals working with elders.

Aged↗
PubMed2006

Physicians' use of email with patients: factors influencing electronic communication and adherence to best practices.

BACKGROUND: With the public's increased use of the Internet, the use of email as a means of communication between patients and physicians will likely increase. Yet, despite evidence of increased interest by patients, e-mail use by physicians for clinical care has been slow. OBJECTIVE: To examine the factors associated with physician-patient e-mail, and report on the physicians' adherence to recognized guidelines for e-mail communication. METHODS: Cross-sectional survey (March-May, 2005) of all primary care physicians (n = 10253), and a 25% stratified, random sample of all ambulatory clinical specialists (n = 3954) in the state of Florida. Physicians were surveyed on email use with patients, adherence to recognized guidelines, and demographics. RESULTS: The 4203 physicians completed the questionnaire (a 28.2% participation rate). Of these, 689 (16.6%) had personally used e-mail to communicate with patients. Only 120 (2.9%) used e-mail with patients frequently. In univariate analysis, e-mail use correlated with physician age (decreased use: age > 61; P = .014), race (decreased use: Asian background; P < .001), medical training (increased use: family medicine, P = .001; or surgical specialty, P = .007; but not internal medicine, P = .112), practice size (> 50 physicians, P < .001), and geographic location (urban 17.2% vs. rural, 7.9%; P < .001). Multivariate modeling showed that only practice size greater than 50 (OR = 1.94; 95% CI = 1.01-3.79) and Asian-American race (OR = 0.26; 95% CI = 0.14-0.49) were related to e-mail use with patients. Remarkably, only 46 physicians (6.7%) adhered to at least half of the 13 selected guidelines for e-mail communication. CONCLUSIONS: This large survey of physicians, practicing in ambulatory settings, shows only modest advances in the adoption of e-mail communication, and little adherence to recognized guidelines for e-mail correspondence. Further efforts are required to educate both patients and physicians on the advantages and limitations of e-mail communication, and to remove fiscal and legal barriers to its adoption.

Adult↗
PubMed2003

Classification of communication disabilities in children: contribution of the International Classification on Functioning, Disability and Health.

Problems in communication serve as frequent markers of developmental delay and disability in childhood. Documentation of delayed or atypical receptive or expressive communication is one of the key diagnostic factors in the identification of children for intervention and support. This paper (1) reviews issues in classification and measurement of communication disabilities, (2) presents an overview of the development and publication of the WHO International Classification of Functioning, Disability and Health (ICF), and (3) identifies the implications of the ICF for children and youths with communication disabilities. As a conceptual framework, the ICF may be used productively to define the focus for different efforts to address children's language and communication difficulties. Impairments of a physical or mental nature can be covered in the Body Function and Body Structure components, complementing the information provided by the ICD-10 with descriptive documentation. The component of Activities, encompassing performance aspects of communication, lends itself to functional assessment and intervention in habilitation and education programs. The component of Participation provides an operational basis for policy initiatives focusing on social integration and community life Finally, the Environmental Factors component serves as a framework for identifying the nature and extent of access and opportunity for individuals and populations.

Activities of Daily Living↗
PubMed1998

Electronic patient-physician communication: problems and promise.

A critical mass of Internet users will soon enable wide diffusion of electronic communication within medical practice. E-mail between physicians and patients offers important opportunities for better communication. Linking patients and physicians through e-mail may increase the involvement of patients in supervising and documenting their own health care, processes that may activate patients and contribute to improved health. These new linkages may have profound implications for the patient-physician relationship. Although the federal government proposes regulation of telemedicine technologies and medical software, communications technologies are evolving under less scrutiny. Unless these technologies are implemented with substantial forethought, they may disturb delicate balances in the patient-physician relationship, widen social disparities in health outcomes, and create barriers to access to health care. This paper seeks to identify the promise and pitfalls of electronic patient-physician communication before such technology becomes widely distributed. A research agenda is proposed that would provide data that are useful for careful shaping of the communications infrastructure. The paper addresses the need to 1) define appropriate use of the various modes of patient-physician communication, 2) ensure the security and confidentiality of patient information, 3) create user interfaces that guide patients in effective use of the technology, 4) proactively assess medicolegal liability, and 5) ensure access to the technology by a multicultural, multilingual population with varying degrees of literacy.

Communication↗
PubMedDate not supplied

Teenage partners' communication about sexual risk and condom use: the importance of parent-teenager discussions.

CONTEXT: Teenagers' communication with their partners about sex and their use of condoms may be influenced by the discussions teenagers have with their parents about sex. However, little is known about the process of parent-teenager communication on this topic. Understanding both what parents discuss with their children and how they discuss it may lead to a greater understanding of teenagers' sexual behavior. METHODS: Interviews were conducted with 372 sexually active black and Hispanic youth aged 14-17 from Alabama, New York and Puerto Rico. Regression analyses were used to examine parent-teenager discussions about sexuality and about sexual risk, and parental communication skills as predictors of teenagers' discussions about sexual risk with a partner and teenagers' condom use. RESULTS: Parent-teenager discussions about sexuality and sexual risk were associated with an increased likelihood of teenager-partner discussions about sexual risk and of teenagers' condom use, but only if parents were open, skilled and comfortable in having those discussions. Teenagers' communication with their partner about sexual risk also was associated with greater condom use, but the relationship between parent-teenager communication and teenagers' condom use was independent of this association. CONCLUSIONS: The influence on teenagers of parent-teenager discussions about sexuality and sexual risk depends on both what parents say and how they say it. Programs that foster parent-teenager communication about sexuality and sexual risk must emphasize both of these aspects.

Adolescent↗
PubMed2001

Taking the pulse of personalized and online employee communication strategies: the second annual survey of major employer trends.

In their efforts to build workforce commitment, many employers are using personalized communication to reach out to employees. Benefacts, the personalized communication service of Aon Consulting, recently surveyed employers nationwide regarding their uses of personalized communication, especially in the online environment. The survey looked at organizations' current online and print communication strategies as well as their future plans. This article describes the needs of employees to understand organizational purpose and to find a balance between work and their personal lives. This examination of the uses of personalized communication to meet these needs and the analysis of current industry trends will help benefit professionals focus on their own communication plans as they strive to meet the challenges of today's workforce.

Commerce↗
PubMed1992

Communication key for family planning.

4 reports published by Demographic and Health Surveys (DHS) include information from husbands of the wives interviewed in the main part of the survey. All are from Africa--Burundi (1987), Ghana (1988), Kenya (1988) and Mali (1987). These surveys of husbands indicate the importance of programs that work to improve communication between spouses about family planning. In particular, they show a positive association between contraceptive prevalence and husband and wife communication about family planning. Husbands and wives were asked how often they discussed family planning in the past year. In Kenya, with a 27% contraceptive prevalence rate--the highest among the 4 countries--about 2/3 of the couples had discussed family planning during the past year. In Ghana, with a rate of 13%, and in Burundi, at 9%, about 1.2 of the couples had discussed family planning during the year. Mali had the lowest contraception prevalence rate of 5% and the least communication among the couples, with only 1.4 discussing family planning during the year. The importance of communication also emerges in data on methods used. In all 4 surveys, the wives reported lower use of male methods than did their husbands. Estimates of use of female methods were more consistent between husbands and wives. Questions were not exactly the same in all 4 surveys, so summaries for each country vary slightly. In Burundi, about 2 of 5 husbands said they used periodic abstinence, compared to about 1 of 5 wives. Husbands said 0.7% used condoms, with 0.3% of the wives giving that response. Husbands an wives agreed that there was no use of male sterilization. The use of vasectomy in Africa is considerably lower than for other regions of the world (see chart below). Ghana showed a similar pattern. Husbands said 2.1% of couples used condoms, compared to 0.3% according to the wives. Husbands also indicated more widespread use of periodic abstinence than did the wives. In contrast, except for pill use, husbands and wives gave similar responses for use of female methods. In Kenya, 1 of every 2 husbands said they were using family planning, compared to about 1 of every 4 wives. The largest discrepancy was in the data for use of periodic abstinence, where 3 times more husbands than wives said they were using this method--26% compared to 8%. Only in Mali, where total contraceptive use is only 5%, were responses from husbands and wives consistent. Even here, husbands gave higher rates of condom use (0.5%) than did wives (none). When it comes to choosing a method of family planning, women apparently think first of female methods. In general, women assume that their husbands will not be interested in using contraception themselves. Women may, however, underestimate their husbands interest or participation in family planning. Or men could be overstating the use of male methods. These DHS husband surveys suggest that programs aimed at both men and women should encourage more and better communication between spouses about family planning. More data related to communication on family planning will soon become available. Other DHS husbands surveys in various stages of completion are from Pakistan, Cameroon, Tanzania, and Egypt.

Africa↗
PubMedDate not supplied

[The communication of autistic spectrum children in group activities].

BACKGROUND: language is the most useful diagnostic feature in cases of infantile autism, and is many times connected with the prognosis. OBJECTIVE: to identify the communication profile of autistic spectrum children through the analysis of the functional use of language in two different communication situations. METHOD: five groups of recordings of 10 institutionalized children, during a period of 12 months, in two different communication situations: situation I (in a group with co-ordination) and situation II (in a group without co-ordination). RESULTS: in both situations of communication there was a significant change in the communication profile of these children. CONCLUSION: it can be observed that these children do perceive the differences present in situations of communication.

Adolescent↗
PubMed2004

Patients with disabilities and complex communication needs. The GP consultation.

BACKGROUND: People with complex communication needs vary in terms of their underlying disability and the methods and strategies they use to communicate. OBJECTIVE: This article describes the varied communication profiles that a general practitioner is likely to encounter in patients with disabilities, and the various types of augmentative and alternative forms of communication that might be used in such consultations. DISCUSSION: This article provides strategies to facilitate doctor-patient communication involving patients with complex communication needs, some of which are illustrated in a case study of a young woman with an intellectual disability.

Adult↗
PubMed1991

[The occurrence of communicative acts of preschool Afrikaans-speaking hearing-impaired children ].

This study researches the occurrence of communicative acts of preschool Afrikaans-speaking hearing-impaired children. The relevance of communication and the incidence of verbal versus non-verbal communication behaviour was also measured. To this end communication samples (30 minutes each) were made of ten three-to-five year old severely hearing-impaired Afrikaans-speaking children in interaction with a familiar adult. The main conclusions of this study were: the subjects as a group are able to express a variety of communication acts appropriately, making use of both verbal and non-verbal behaviour. However, non-verbal behaviour predominates in the communicative behaviour of the group. Some of their verbal utterances are produced without voice.

Child, Preschool↗
PubMed2005

A framework for clinical communication supporting healthcare delivery.

Interpersonal communications related to healthcare delivery, called clinical communications, take up a considerable amount of time. Nonetheless, there exist few tools in electronic health record systems that support clinical communications. We describe a framework for clinical communications and describe our experiences implementing tools to manage and document them within an electronic health record system. Categories of clinical communications include communications between patients and healthcare providers, among healthcare providers on a single clinical team, between healthcare providers in different clinical teams and different institutions, and between healthcare providers and individuals who can provide additional educational or evidence based materials to support care delivery.

Communication↗
PubMed1984

Gestural communication in deaf children: the effects and noneffects of parental input on early language development.

We previously reported that deaf children of hearing parents can develop a gestural communication system with some of the observed properties of early child language. In the present study, this phenomenon of gesture creation was replicated in four deaf children aged 1-4 to 3-1 at the time of the first interview. Each child, despite his atypical language-learning conditions (in particular his lack of usable conventional linguistic input, either oral or manual), developed a gesture system comparable in semantic content and structure (specifically, constructional ordering of elements, differential probabilities of production of elements, and recursive concatenation of semantic relations) to the gestural systems of the six deaf children of hearing parents in our original study and comparable as well to the spoken and sign systems of children acquiring conventional languages under typical learning conditions. This phenomenon suggests that the human child has strong biases to communicate in language-like ways. Nevertheless, it is possible that the deaf child's hearing parents, and not the child himself, were responsible for the emergence of the child's structured (yet idiosyncratic) gesture system. To investigate this possibility, we considered three possible parental influences on the child's sentence structures. First, we entertained the hypothesis that the children's sign sentences were merely imitations (perhaps even uncomprehending imitations) of a hearing adult's immediately preceding gestures. Second, we considered the possibility that the regularities underlying the deaf children's structured sign sentences were induced from their hearing parents' gestures taken in toto. Finally, we considered the possibility that the deaf children's sign sentences had been shaped by their parents' responses to those sentences. We found no evidence to support any of these hypotheses. The data reported in this series of studies confirm that deaf children lacking a conventional linguistic input can develop a gestural communication system that shows some of the structural regularities characteristic of early child language. The results suggest that communication with a number of language-like properties can develop in a markedly atypical language-learning environment, even without a tutor's modeling or shaping the structural aspects of the communication. The data are consistent with the hypothesis that the deaf child himself plays a seminal role in the emergence of the structural aspects of these communication systems.

Child, Preschool↗
PubMed1995

Communication theory and the search for effective feedback.

If messages transmitted to the public, patients and health professionals could be assured of being received, understood and acted on as intended by the senders of messages, there would be little need to focus on communications and feedback. That the physician's office, the healthcare system and the community are littered with messages that 'never got through' attests to the problem of ineffective communications and the absence of effective feedback. Communication theorists, health psychologists and thoughtful health professionals, particularly those working in community hypertension programmes, have developed approaches that improve the probabilities of 'getting the message through'. Theory-based communications with built-in feedback and 'feed-forward' enhance the probabilities of success considerably. This presentation explores these problems using the SMCR model of communication. Differences between linear models and transactional models are discussed. On the assumption that the health message environments of the future will be increasingly complex with highly differentiated target audiences in a rapid paced computer and electronically driven world, 'getting the message through' will become an even greater challenge than in the recent past. Specific steps to change communication approaches in this setting are proposed.

Communication↗
PubMed1997

Communication skills among females with Rett syndrome.

The present study describes communicative behaviors of 42 Norwegian girls and women with Rett syndrome (RS) aged 2 1/2-47 years. Most of them did not seem to show behaviors which may be interpreted as indicative of an intention to communicate. Many did not use gaze shifts and the shifts of those who did were usually limited to 1-3 turns. The implication for intervention is a need to apply structured overinterpretation where significant people in the environment systematic interpret behaviors indicative of interests, needs and preferences as communicative, as well as structured total communication to provide non-speech means of communication. It is argued that although the use of these strategies often will not lead to intentional communicative behaviors in females with RS, they may contribute to a responsive and predictable environment for the females and to the establishment of a set of strategies which may be used by significant people in their environment.

Adolescent↗
PubMed2006

Physician communication when prescribing new medications.

BACKGROUND: Communication about taking a new medication is critical to proper use of drug therapy and to patient adherence. Despite ample evidence that medications are not taken as prescribed, few investigations have detailed the elements of communication about new medication therapy. This article describes and assesses the quality of physician communication with patients about newly prescribed medications. METHODS: This was an observational study that combined patient and physician surveys with transcribed audiotaped office visits from 185 outpatient encounters with 16 family physicians, 18 internists, and 11 cardiologists in 2 Sacramento, Calif, health care systems between January and November 1999, in which 243 new medications were prescribed. We measured the quality of physician communication when prescribing new medications. RESULTS: Physicians stated the specific medication name for 74% of new prescriptions and explained the purpose of the medication for 87%. Adverse effects were addressed for 35% of medications and how long to take the medication for 34%. Physicians explicitly instructed 55% of patients about the number of tablets to take and explained the frequency or timing of dosing 58% of the time. Physicians fulfilled a mean of 3.1 of 5 expected elements of communication when initiating new prescriptions. They counseled the most about psychiatric medications, fulfilling a mean of 3.7, 3.5, and 3.4, pulmonary, and cardiovascular elements, respectively. CONCLUSIONS: When initiating new medications, physicians often fail to communicate critical elements of medication use. This might contribute to misunderstandings about medication directions or necessity and, in turn, lead to patient failure to take medications as directed.

Adult↗
PubMed1997

Gender differences in physician-patient communication. Evidence from pediatric visits.

OBJECTIVE: To determine whether physician gender and patient gender influence the process of communication and parent and child satisfaction during pediatric office visits. DESIGN: Content analysis of videotaped pediatric office visits. SETTING: University-based pediatric primary care practice. SUBJECTS: Videotaped communication between 212 children, ages 4 to 14 years, parents, and physicians. Thirty-eight percent were child health supervision visits, and 62% were for the management of minor or chronic illnesses. MAIN OUTCOME MEASURES: An established coding system of physician-patient communication and measures of parent and child satisfaction with medical care. RESULTS: Female physician visits were 29% longer than those of male physicians (P < .001). Compared with male physicians, female physicians engaged in more social exchange (P < .01), more encouragement and reassurance (P < .01), more communication during the physical examination (P < .05), and more information gathering (P < .01) with children. Male and female physicians engaged in similar amounts of discussions regarding illness management. Children were more satisfied with physicians of the same gender (P < .05), while parents were more satisfied with female physicians (P < .05). CONCLUSIONS: Children communicate more with female than with male physicians and show preferences for physicians of the same gender. These findings are consistent with communication patterns in adult patients and may have a significant influence on gender disparities in health care. Efforts at improving the process and outcome of medical care should address gender differences.

Adolescent↗