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PubMed2003

Communicating with patients in cancer care; what areas do nurses find most challenging?

BACKGROUND: Patient communication is a cornerstone of comprehensive oncology nursing care. Oncology nurses, however, do not appear to receive much advanced training in communication skills and many nurses do not feel adequately trained in this area. METHOD: We designed a 33-item questionnaire to assess nurses' perceived level of difficulty and skill in a variety of common clinical situations where patient communication was a challenge. Three hundred fifty oncology nurses in a major cancer center completed the questionnaire. RESULTS: Nurses rated areas where they addressed the physical complaints (pain, fatigue, appetite and weight loss) as least challenging and areas in which they were most prepared. Several items ranked as most difficult and where nurses felt they had the least skills had to do with issues related to death and dying, especially requests for euthanasia and patient loss. Advanced practice nurses rated their perceived communications skills more highly in several different areas. CONCLUSION: The communication challenges faced by oncology nurses require skills that go beyond simple supportive techniques like empathy and listening. Teaching advanced communications skills geared to specific problems identified by nurses may be useful.

Adult↗
PubMed1990

The hormone-induced regulation of contact-dependent cell-cell communication by phosphorylation.

Although there is insufficient evidence to propose an elaborate paradigm for the regulation of connexon gating, a simple model emerges from results of studies done to date. Basically, this centers around the most consistent findings: namely, that activation of pkA has an enhancing effect on cell communication while activation of pkC decreases that process. This fits well the reported phenomena associated with gap junctions, particularly those involving growth control. For example growth factors, including tumor promoters which work via pkC, usually reduce cell-cell communication whereas agents that decrease growth often raise cellular cAMP levels, which can lead to increased communication. It can be argued that this model is too simple because it fails to take into account other intracellular agents that are thought to alter junctional gating: cytoplasmic acidification, cellular free Ca2+, tyrosine protein kinases, and tentatively, pkG. Proton and Ca2+ transporting systems are mainly activated by serine/threonine protein kinases such as pkA and pkC. Some ion channels are not regulated by phosphorylation but instead are modulated by other ions. However, at the moment there is no evidence as to which ion-specific channels mediate the changes in cellular pH or Ca2+ that cause a loss in communication. Neither is it known whether pH or Ca2+ levels are in vivo regulators of the junctions. This is especially so as fairly high levels of injected Ca2+ pass through the gap junctions of viable cells. The role of tyrosine protein kinases in connexon gating may involve interaction with the pkA and pkC regulatory cascades. For example, the pkA inhibitor protein (pkI) is 80-90% inactivated when tyrosine-phosphorylated by the EGF receptor or pp50v-src (D. Walsh, personal communication). In this situation, activity of the C subunit of pkA could be enhanced, or the lifetime of its catalytic activity extended. In some systems, pp60v-src is known to activate the pkC pathway. Thus, tyrosine protein kinases may invoke pkA and pkC pathways; however, the amplitude of enzyme activation and the temporal kinetics of this process are unknown. The fact that gap junctions are regulated at the transcription level and probably at the protein level by protein kinases is of major interest. This is especially so as the only known molecular mechanism that gap junctional communication mediates is the activation of cAMP-dependent protein kinases by hormone-induced signals passed from receptor-bearing cells to receptorless partners.

Amino Acid Sequence↗
PubMed1995

Reduced cell-cell communication in a spontaneous murine model of autoimmune thyroid disease.

MRL-lpr/lpr mice manifest a systemic lupus-like autoimmune disease. As part of this syndrome, the mice spontaneously develop autoimmune thyroiditis, which is morphologically and biochemically similar to human autoimmune thyroiditis. In this study we investigated whether thyroid tissue obtained from sites of chronic inflammation had altered gap junctional communication. Fresh tissue sections revealed that thyroid from the nondiseased mice (MRL-(+)/+) had connexins (Cx) localized to the plasma membrane at points of thyroid cell-cell contact. In contrast, the Cx in diseased mouse (MRL-lpr/lpr) thyroid tissue were not localized to the plasma membrane, and the fluorescent intensity was reduced for Cx43 and Cx26. Northern analysis confirmed that murine thyroid tissue expressed messenger RNA for these Cx. However, the diseased tissue expressed lower levels of Cx32 and Cx26 messenger RNA. The infiltrating cells and their biologically active products present in the diseased thyroid tissue may mediate the reduced Cx expression and aberrant gap junctional assembly. We established primary thyrocyte cultures to determine whether these differences persisted when the inflammatory factors were removed. The nondiseased thyroid cells were communication competent, with fluorescent dye transfer proceeding from the injected cell to primary contacts (95%) and to second and third order neighboring cells in 75% of the trials. Thyroid cells from the diseased mice were communication incompetent, in that 80% of microinjections failed to result in dye transfer to cells in direct contact. Immunocytochemistry indicated that the functional coupling in the normal mouse thyroid cells was associated with Cx43 located in the plasma membrane as assembled gap junctional plaques. The communication-deficient diseased thyroid cells had internalized Cx43 predominantly localized to perinuclear regions of the cells. Collectively, these data document altered Cx-protein distribution in the autoimmune diseased thyroid. The diseased thyroid tissue was devoid of plasma membrane identifiable gap junctions and deficient in intercellular communication. Culturing removed the inflammatory mediators; however, the disease cells retained their communication incompetence. These results suggest that if this deficiency was initiated by components of the inflammation process, then protracted changes must have occurred so that the continued presence of these factors was no longer required to sustain this difference.

Animals↗
PubMed2006

Communication in critical care environments: mobile telephones improve patient care.

Most hospital policies prohibiting the use of wireless devices cite reports of disruption of medical equipment by cellular telephones. There have been no studies to determine whether mobile telephones may have a beneficial impact on safety. At the 2003 meeting of the American Society of Anesthesiologists 7878 surveys were distributed to attendees. The five-question survey polled anesthesiologists regarding modes of communication used in the operating room/intensive care unit and experience with communications delays and medical errors. Survey reliability was verified using test-retest analysis and proportion agreement in a convenience sample of 17 anesthesiologists. Four-thousand-eighteen responses were received. The test-retest reliability of the survey instrument was excellent (Kappa = 0.75; 95% confidence interval, 0.56-0.94). Sixty-five percent of surveyed anesthesiologists reported using pagers as their primary mode of communications, whereas only 17% used cellular telephones. Forty-five percent of respondents who use pagers reported delays in communications compared with 31% of cellular telephone users. Cellular telephone use by anesthesiologists is associated with a reduction in the risk of medical error or injury resulting from communication delay (relative risk = 0.78; 95% confidence interval, 0.6234-0.9649). The small risks of electromagnetic interference between mobile telephones and medical devices should be weighed against the potential benefits of improved communication.

Anesthesiology↗
PubMed1997

Performance tests of a satellite-based asymmetric communication network for the 'hyper hospital'.

The Hyper Hospital is a prototype networked telemedicine system which uses virtual reality. We measured the performance of a novel multimedia network based on satellite communications. The network was a hybrid system consisting of a satellite channel in one direction and a terrestrial channel in the other. Each user was equipped with a standard satellite communication receiver and a telephone connection. Requests from the users were sent by modern and telephone line and responses were received by satellite. The user requests were initiated by clicking buttons on a World Wide Web browser screen. The transmission rates of satellite and normal telephone-line communications were compared for standardized text data. Satellite communication was three to five times faster. The transmission rate was also measured for standardized graphical data (GIF format). With a file size of about 400 kByte, satellite-mediated communication was 10 times faster than telephone lines. The effect of simultaneous access on performance was also explored. For simultaneous access of nine users to a single graphics file, 78% of the transmission speed was obtained in comparison with that of a single user. The satellite-based system showed excellent high-speed communication performance, particularly for multimedia data.

Hospitals↗
PubMedDate not supplied

Communication skills workshops in learning disability nursing.

This article investigates the effects of a combination of direct speech, language therapy and staff training on the communication skills of nursing and support staff working with people who have a severe learning disability and challenging behaviour. The approach aimed to help staff choose, prioritize and implement changes in communication. The input was effective in increasing the knowledge of the staff group with regard to challenging behaviour and communication breakdown, and in changing the communicative behaviour of staff. The changes measured were those of longer interactions occurring between staff and service users, and the use of non-verbal communication to support interactions. The implementation of the communication strategies is being audited.

Clinical Competence↗
PubMed2003

Speaking to silence: toward queering nonverbal communication.

The majority of nonverbal communication research and pedagogy reproduces heterosexist and sexist ideologies, normalizing and naturalizing gender and sexual binaries, and sanctioning an exceedingly narrow range of gendered and sexualized subjects, practices, and relationships. This essay proposes that nonverbal communication scholarship and pedagogy need to address these issues. First, I provide a brief summary of the history of the field of nonverbal communication. Second, I critique the conspicuous absence of the queer subject, the rigid essentialism, and the pervasive heterosexism in nonverbal communication textbooks in particular. Finally, I discuss three examples of communication research that avoid these pitfalls and herald what queering nonverbal communication might look like.

Female↗
PubMed1991

Students' perceptions of communication ease and engagement. How they relate to academic success.

The extent to which students' self-perceptions of communication ease and engagement relate to their academic achievement was assessed in a study of 95 high school students enrolled in a large urban school for the deaf. Four dimensions of classroom communication were measured: students' understanding of teachers, students' understanding of peers, and positive and negative feelings about communication at school. Engagement, the extent students report being excited and actively involved in the classroom, predicted only teacher-assigned grades when the variance of background variables such as residual hearing and IQ was removed. However, communication ease made a significant contribution to the prediction of the three standardized achievement test scores, as well as grades, when background variance was removed. The results suggest that students are more likely to learn if they perceive themselves as being effective in communicating and have positive feelings about the communication that occurs.

Adolescent↗
PubMedDate not supplied

Assessing provider-patient-parent communication in the pediatric emergency department.

Patient-provider communication is related to the satisfaction with and process and outcome of emergency department care. Barriers to communication include noise, anxiety, confusion about process, and differences in language and expectations. In the emergency care setting, as in nonacute ambulatory settings, children tend to be left out of discussions of their own care. Both retrospective and real-time methods are available for studying communication during emergency department visits. Well-standardized generic communication assessment tools are applicable to emergency department communication, but assessment tools specific for emergency settings have yet to be developed and standardized. Although the emergency department poses some methodologic difficulties not present in other settings, studies of communications are feasible and likely to yield useful data.

Child↗
PubMed2001

Selective gap junctional communication within the V79-4 Chinese hamster cell line.

The probability of cell-to-cell coupling between directly adjacent cells (communication capability) in the V79-4 Chinese hamster cell line was evaluated under standard conditions or after 18-h treatment with EG. The cell monolayer did not form a continuous network of cells interconnected via gap junctions, but an average cell was coupled to only one half of its directly adjacent neighbours under standard conditions, or to one third of its directly neighbouring cells after 18-h exposure to EG. The rest of the directly adjacent neighbours did not establish functional gap junctions with an injected cell, although they were competent to couple to other cells with a probability similar to that of the coupling between the injected cell and its direct neighbours. Moreover, all the cells possessed the identical connexin--cx43, present on all cell membranes. The results indicated that the choice of a cell to which neighbour be coupled was rather random in the standard cell population as a whole, although the population contained some clones whose capability to couple was more or less different from that of the original cell population. Ethylene glycol reduced the gap junctional communication by increasing the frequency of cells not coupled to any of their direct neighbours from 1% for untreated cells to 23.3% for cells exposed to EG, and consequently by reducing the number of directly adjacent cells coupled to communicating injected cells. The communication capability of the cell population appeared to be unstable. It varied slightly in time and so did the response of the cells to EG. The results indicate that a cell can control its coupling to different directly adjacent neighbours independently, being able to control the gap junctional communication not only in time but in space as well. All control mechanisms of GJIC, known so far, affect a cell as a whole, while our results indicate that another regulatory mechanism may exist, controlling the gap junctional communication to different adjacent neighbouring cells independently.

Animals↗
PubMed1999

Affect, language and communication: loose ends.

The author begins by enquiring whether the three elements of his subject matter are intended to be discussed separately or in terms of the links between them. He goes on to consider the role of language in the development of psychoanalysis from Freud on. Notwithstanding the fruitful mutual influences of linguistics and psychoanalysis, he draws attention to the dangers of a one-sidedly linguistic approach to psychoanalytic theory and clinical practice. Turning to affect, the author reviews Freud's early neurophysiological conceptions and the possible distinctions between affect, emotion and feeling as reflected in the contributions of later workers. The aspects of anxiety, trauma, object relations, transference and infant development are touched upon and quantitative and metapsychological considerations are adduced. The author's starting point for his treatment of communication is Freud's well-known telephone simile. He goes on to discuss subsequent work on mother-baby communication in early childhood, communication as semiology, and communication through acting out and enactment; this section ends with a note on the etymology of the word communication. The author concludes by drawing attention to the importance in analysis of experience, in which the three entities of language, affect and communication are combined. Having failed to answer the question with which he began, he is left with the loose ends of his title.

Affect↗
PubMed2006

Integration of auditory and visual communication information in the primate ventrolateral prefrontal cortex.

The integration of auditory and visual stimuli is crucial for recognizing objects, communicating effectively, and navigating through our complex world. Although the frontal lobes are involved in memory, communication, and language, there has been no evidence that the integration of communication information occurs at the single-cell level in the frontal lobes. Here, we show that neurons in the macaque ventrolateral prefrontal cortex (VLPFC) integrate audiovisual communication stimuli. The multisensory interactions included both enhancement and suppression of a predominantly auditory or a predominantly visual response, although multisensory suppression was the more common mode of response. The multisensory neurons were distributed across the VLPFC and within previously identified unimodal auditory and visual regions (O'Scalaidhe et al., 1997; Romanski and Goldman-Rakic, 2002). Thus, our study demonstrates, for the first time, that single prefrontal neurons integrate communication information from the auditory and visual domains, suggesting that these neurons are an important node in the cortical network responsible for communication.

Acoustic Stimulation↗
PubMed2003

Relationship between burnout and communication skill training among Japanese hospital nurses: a pilot study.

We investigated the relationship between burnout and communication skill training among Japanese hospital nurses to improve the mental health of human service workers. The subjects were forty-five registered nurses referred to a self-expression skill intervention program by their section superiors, with each superior choosing from two to five nurses. The hospital was located in the Kyushu area and staffed by about four hundred nurses. The subjects were divided into an intervention group (19 nurses) and a reference group (26 nurses). The intervention group received the communication skill training in July and August, 2001. The communication skill training was carried out in accordance with the assertiveness training (AsT) precepts of Anne Dickson. In June, 2001, we delivered a set of questionnaires including age, gender, working years, a burnout scale, and a communication skill check-list as a baseline survey. The baseline questionnaires were returned at the end of June, 2001. In January, 2002, we delivered the same questionnaire again to the two groups and collected them at the end of the month. Excluding the only male and insufficient answers, twenty-six nurses (58%) returned complete answers in the initial and subsequent surveys. We found that the personal accomplishment and the two communication skills such as "accepting valid criticisms" and "negotiation" of the intervention group had improved significantly five months after the training as compared with that of the reference. Our results implied that communication skill training might have a favorable effect on burnout among Japanese hospital nurses.

Adult↗
PubMed2005

Content of communication by pediatric residents after newborn genetic screening.

BACKGROUND: Newborn screening saves lives, but psychosocial complications after genetic screening have led to doubts about expanding programs. Because complications have been blamed on ineffective communication of results, a population-scale system to ensure communication quality may improve outcomes. The objective of this study was to develop and evaluate a method to assess the content of communication after newborn genetic screening. METHODS: We abstracted content data and calculated quantitative scores for 3 communication quality indicators (key content, early placement of good news, and excessive background content) for 59 transcribed conversations between pediatric residents and simulated parents of an "infant" who was found via newborn screening to carry either cystic fibrosis or sickle cell hemoglobinopathy. RESULTS: Only 8.5% of transcripts contained the key content items that were thought to be necessary for parental understanding; 27.1% included reassuring news about carrier status within the first 10% of content. Scores for 3 quality indicators fell in the low performance range in 35.6%, 30.5%, and 27.1% of transcripts, respectively. The most common topic was background about the disease (22% of content statements) even though the infant did not have the disease. Surprisingly, 50% of sickle trait transcripts included counseling about a possible risk for sudden death. CONCLUSIONS: Assessment of the content domain of communication quality identified some high-quality communication interspersed with many missed opportunities. If integrated into newborn screening, our method may help to alleviate some of society's ethical concerns about benefit and risk after newborn and other genetic screening.

Adult↗
PubMed2006

Enhancing communication in the 21st century.

Quality communication is a critical component in all aspects of public health and clinical care. The quality of the process of communication between the patient/family and the physician affects the quality of the patient/family-physician relationship, patient behavior, and health outcomes. Advances in communication and information technologies can enhance the quality of communication, not only between patients/families and their physicians but also between clinicians and public health professionals. Communication and integration between the domains of personal health and public health have the potential to improve the delivery of health care and public health services and to yield the desired seamless continuum of health care. This article discusses some of the advances and efforts in the use of information technology to facilitate enhanced communication for quality health care.

Adult↗
PubMed2006

[Impact of the Internet on communication flow of scientific health information].

Communication flow of scientific information has been restructured with the development of new technologies and the Internet and their impact on social relations worldwide. The production of scientific knowledge has also been influenced by these cultural, social and economic changes and has contributed to new patterns of scientific communication. The objective of the study was to present the traditional scientific communication model and its evolution to electronic scientific communication stimulated by the use of electronic media and Internet and networking. While the traditional model is based on printed publications, the new one focuses on electronic publishing and open unlimited access to published literature. The challenges faced are in using all the potential of electronic media for improving traditional communication flow of scientific information and defining policies to support the new model of scientific communication to ensure quality, preservation and dissemination of information as a common good.

Access to Information↗
PubMedDate not supplied

[The therapeutic communication during installation of endovenous therapy: the use of video-taped simulation].

The use of therapeutic communication contributes to nursing care quality, mainly in procedures that cause fear and anxiety in patients, such as the installation of endovenous therapy. This study aimed to identify how nurses perceive therapeutic communication during the installation of endovenous therapy, as shown in a filmed simulation. This exploratory-descriptive and comparative study was developed in a Mexican city and involved 30 clinical nurses and 12 nursing faculty. The methodological process was: Construction and validation of textual content; Filming textual content with actors and validation; Presentation of the video to nurses and faculty and application of the semistructured questionnaire to identify therapeutic communication techniques in the simulation; perception of nurse-patient communication quality; perception of similarities between care practice and simulation; and difficulties to use these techniques in daily practice. Participants perceived the interpersonal relationship shown as "good"; they identified therapeutic communication techniques, which mostly corresponded to the description of the experience and expression of thoughts and feelings; no substantial difference was found between the perceptions of educational and care personnel. The most frequent difficulty to use communicative techniques was attributed to patients' problems to establish relations.

Communication↗
PubMed2004

Realigning the communication paradigm in nursing case management.

Communication underlies all of case management (CM), and better comprehension of the processes of communication within the context of the CM role may facilitate positive patient and organizational outcomes, and assist providers and policy makers in designing effective CM systems. Thus, the purpose of this qualitative, pilot project was to explore dimensions of communication of the nurse case manager role within a hospital setting. The results describe a "hub and spoke" model of communications and suggest the utility of this familiar model for understanding the communication dynamics for those who work as nursing case managers in hospital settings. Findings suggest that nurse case managers are at various times both advocates and mediators--communications roles that may encompass somewhat contradictory demands and perspectives.

Adult↗