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PubMed1989

Communicative performance of adolescents with severe speech impairment: influence of context.

The communicative performance of 4 preoperational-level adolescents, using limited speech, gestures, and communication board techniques, was examined in a two-part investigation. In Part 1, each subject participated in an academic interaction with a teacher in a therapy room. Data were transcribed and coded for communication mode, function, and role. Two subjects were found to predominantly use the speech mode, while the remaining 2 predominantly used board and one other mode. The majority of productions consisted of responses to requests, and the initiator role was infrequently occupied. These findings were similar to those reported in previous investigations conducted in classroom settings. In Part 2, another examination of the communicative performance of these subjects was conducted in spontaneous interactions involving speaking and nonspeaking peers in a therapy room. Using the same data analysis procedures, gesture and speech modes predominated for 3 of the subjects in the nonspeaking peer interactions. The remaining subject exhibited minimal interaction. No consistent pattern of mode usage was exhibited across the speaking peer interactions. In the nonspeaking peer interactions, request predominated. In contrast, a variety of communication functions was exhibited in the speaking peer interactions. Both the initiator and the maintainer roles were occupied in the majority of interactions. Pertinent variables and clinical implications are discussed.

Adolescent↗

PubMed1993

Issues raised by facilitated communication for theorizing and research on autism.

There is considerable disagreement in the literature and among clinicians about the success of facilitated communication, a new method of augmentative communication being used with people diagnosed autistic. Some claim almost everyone exposed to it achieves success, basing their claims upon their observations and experiences of naturally occurring facilitated interactions. Others claim minimal or no success, basing their claims on their observations of facilitated interactions under controlled experimental conditions. I argue here that both claims can be valid and that FC users with autism are sometimes competent and other times incompetent, depending upon the conditions under which they are evaluated. I support my argument by offering a collaborative view of communication in place of the commonly held view that communication involves passing messages over an invisible conduit. Given the assumption that facilitated communication does allow for the expression of unexpected competence for many with autism, I describe various unusual phenomena being revealed by facilitation and FC users and offer some theoretical approaches for explaining these phenomena. I then propose some research ideas for studying the phenomena associated with FC and offer them as suggestions for how we might proceed in our efforts to develop our understanding of when and how it works for people with autism.

Autistic Disorder↗

PubMed1996

Triangulation of communication skills in qualitative research instruments.

Triangulation is a credible and useful method of conducting research which can result in an increase in both quality and quantity of data gathered. The five documented types of triangulation (data, investigator, theoretical, methodological, unit of analysis) do not completely answer all the needs of nurse researchers, particularly in the field of qualitative research. Using more than one method of data collection from within the same research tradition (within-method triangulation) is an accepted and effective technique. Extending the concept of triangulation to include the development of research tools leads to the proposal that the conscious use of two or three types of communication within each qualitative research instrument would improve its effectiveness over a tool which used only one type. This application of 'triangulation of communication skills' is considered within each of the major qualitative research tools, and the benefits outlined. The implications for nursing research and nurse researchers of consciously using non-verbal cues to supplement verbal information are described. It is suggested that using triangulation of communication skills in this way may improve the validity of data obtained and, if clearly documented, increase the credibility of the findings. In particular, when conducting qualitative interviews, the expert use of triangulation of communication skills will enhance the quality and quantity of data gathered. To this end, novice researchers need education and practice in using communication skills to best effect, in order to ensure the validity and completeness of their findings.

Clinical Competence↗

PubMed1999

Non-verbal behaviour in nurse-elderly patient communication.

This study explores the occurrence of non-verbal communication in nurse-elderly patient interaction in two different care settings: home nursing and a home for the elderly. In a sample of 181 nursing encounters involving 47 nurses a study was made of videotaped nurse-patient communication. Six non-verbal behaviours were observed: patient-directed eye gaze, affirmative head nodding, smiling, forward leaning, affective touch and instrumental touch. With the exception of instrumental touch these non-verbal behaviours are important in establishing a good relationship with the patient. To study the relationship between non-verbal and verbal communication, verbal communication was observed using an adapted version of Roter's Interaction Analysis System, which distinguishes socio-emotional and task-related communication. Data were analysed in hierarchical linear models. The results demonstrated that nurses use mainly eye gaze, head nodding and smiling to establish a good relation with their patients. The use of affective touch is mainly attributable to nurses' personal style. Compared to nurses in the community, nurses in the home for the elderly more often display non-verbal behaviours such as patient-directed gaze and affective touch.

Aged↗

PubMed2001

Communication skills of nurses during interactions with simulated cancer patients.

AIM: In this paper the balance of affective and instrumental communication employed by nurses during the admission interview with recently diagnosed cancer patients was investigated. RATIONALE: The balance of affective and instrumental communication employed by nurses appears to be important, especially during the admission interview with cancer patients. METHODS: For this purpose, admission interviews between 53 ward nurses and simulated cancer patients were videotaped and analysed using the Roter Interaction Analysis system, in which a distinction is made between instrumental and affective communication. RESULTS: The results reveal that more than 60% of nurses' utterances were of an instrumental nature. Affective communication occurred, but was more related to global affect ratings like giving agreements and paraphrases than to discussing and exploring actively patients feelings by showing empathy, showing concern and optimism. CONCLUSION: In future, nurses should be systematically provided with (continuing) training programmes, in which they learn how to communicate effectively in relation to patients' emotions and feelings, and how to integrate emotional care with practical and medical tasks.

Adult↗

PubMedDate not supplied

Research directions in augmentative and alternative communication for preschool children.

PURPOSE: To review issues related to the use of augmentative systems with young children and present a case study of one child and family's experience with the System for Augmenting Language (SAL). METHOD: The case involved a preschool child with severe developmental delays who had little functional speech. Acquisition and use of graphic symbols on a speech-output communication device was studied in home and clinical settings. Language and communication behaviours of the child and his communication partners were observed and language assessment measures were collected. RESULTS: Child engagement state varied across the two settings with a stable profile seen in the therapy setting and a clear increase at home. Child communicative attempts increased following the introduction of the augmented system. Parents reported successful use of the SAL. CONCLUSION: SAL is a viable communication intervention approach for young children.

Child, Preschool↗

PubMed2005

Enabling frail older people with a communication difficulty to express their views: the use of Talking Mats as an interview tool.

The aim of the present study was to obtain the views of frail older people with communication impairments using an innovative interviewing method, Talking Mats. People with a communication disability are often omitted from qualitative research studies since they cannot respond to the more traditional methods of interviewing. However, their views are important and they may, in fact, have additional insights because of their communication situation. The 10 participants in this study were frail older people with a range of communication difficulties with causes including stroke, dementia and hearing loss. They had all recently (within 6 months) moved into care homes. Each participant was interviewed using Talking Mats to obtain their views on four aspects of their life: activities, people, environment and self. The findings are presented in a visual way, and the four life themes are discussed with reference to the different participants. Many insights were gained, such as the participants' views of the activities which they like and dislike, and the views of some of the people in the study about their nursing home environment. The advantages of the Talking Mats as an interview method for research, practice and policy in the care of frail older people are described. The study concludes that Talking Mats is a useful and enjoyable method of allowing frail older people with a communication disability to express views which they have difficulty conveying otherwise.

Aged↗

PubMed2006

The ComFor: an instrument for the indication of augmentative communication in people with autism and intellectual disability.

BACKGROUND: The ComFor (Forerunners in Communication) is an instrument to explore underlying competence for augmentative communication. More specifically, it measures perception and sense-making of non-transient forms of communication at the levels of presentation and representation. The target group consists primarily of individuals with autism and intellectual disability (ID) without or with only limited verbal communication. The ComFor is suitable for children and adults with a developmental level between 12 and 60 months. This paper describes the theoretical framework and structure of the ComFor, the results of a study on its psychometric properties and its clinical uses. METHOD: The ComFor was tested on a sample of 623 children and adults from the Netherlands and Flanders: a group with autism and ID (n = 310); a group with ID without autism (n = 174); and a control group of typically developing children (n = 139). RESULTS: The data generally support the reliability and validity of the ComFor. Internal consistency, inter-rater and test-retest reliability were found to be good. Construct validity (internal structure, convergent and divergent patterns) was established in different ways. The criterion-related validity has yet to be established, as predictive data are not available at the moment. CONCLUSION: Taken together, the results indicate that the ComFor is a promising instrument to explore underlying competence for augmentative communication. Areas for future research are outlined and the clinical relevance is discussed.

Adolescent↗

PubMed2005

Effects of exam-room computing on clinician-patient communication: a longitudinal qualitative study.

OBJECTIVE: To evaluate the impact of exam-room computers on communication between clinicians and patients. DESIGN AND METHODS: Longitudinal, qualitative study using videotapes of regularly scheduled visits from 3 points in time: 1 month before, 1 month after, and 7 months after introduction of computers into the exam room. SETTING: Primary care medical clinic in a large integrated delivery system. PARTICIPANTS: Nine clinicians (6 physicians, 2 physician assistants, and 1 nurse practitioner) and 54 patients. RESULTS: The introduction of computers into the exam room affected the visual, verbal, and postural connection between clinicians and patients. There were variations across the visits in the magnitude and direction of the computer's effect. We identified 4 domains in which exam-room computing affected clinician-patient communication: visit organization, verbal and nonverbal behavior, computer navigation and mastery, and spatial organization of the exam room. We observed a range of facilitating and inhibiting effects on clinician-patient communication in all 4 domains. For 2 domains, visit organization and verbal and nonverbal behavior, facilitating and inhibiting behaviors observed prior to the introduction of the computer appeared to be amplified when exam-room computing occurred. Likewise, exam-room computing involving navigation and mastery skills and spatial organization of the exam-room created communication challenges and opportunities. In all 4 domains, there was little change observed in exam-room computing behaviors from the point of introduction to 7-month follow-up. CONCLUSIONS: Effective use of computers in the outpatient exam room may be dependent upon clinicians' baseline skills that are carried forward and are amplified, positively or negatively, in their effects on clinician-patient communication. Computer use behaviors do not appear to change much over the first 7 months. Administrators and educators interested in improving exam-room computer use by clinicians need to better understand clinician skills and previous work habits associated with electronic medical records. More study of the effects of new technologies on the clinical relationship is also needed.

Adult↗

PubMed2006

Patterns of communication through interpreters: a detailed sociolinguistic analysis.

BACKGROUND: Numerous articles have detailed how the presence of an interpreter leads to less satisfactory communication with physicians; few have studied how actual communication takes place through an interpreter in a clinical setting. OBJECTIVE: Record and analyze physician-interpreter-patient interactions. DESIGN: Primary care physicians with high-volume Hispanic practices were recruited for a communication study. Dyslipidemic Hispanic patients, either monolingual Spanish or bilingual Spanish-English, were recruited on the day of a normally scheduled appointment and, once consented, recorded without a researcher present in the room. Separate postvisit interviews were conducted with the patient and the physician. All interactions were fully transcribed and analyzed. PARTICIPANTS: Sixteen patients were recorded interacting with 9 physicians. Thirteen patients used an interpreter with 8 physicians, and 3 patients spoke Spanish with the 1 bilingual physician. APPROACH: Transcript analysis based on sociolinguistic and discourse analytic techniques, including but not limited to time speaking, analysis of questions asked and answered, and the loss of semantic information. RESULTS: Speech was significantly reduced and revised by the interpreter, resulting in an alteration of linguistic features such as content, meaning, reinforcement/validation, repetition, and affect. In addition, visits that included an interpreter had virtually no rapport-building "small talk," which typically enables the physician to gain comprehensive patient history, learn clinically relevant information, and increase emotional engagement in treatment. CONCLUSIONS: The presence of an interpreter increases the difficulty of achieving good physician-patient communication. Physicians and interpreters should be trained in the process of communication and interpretation, to minimize conversational loss and maximize the information and relational exchange with interpreted patients.

Communication↗

PubMed2001

Health care provider communicator style and patient comprehension of oral contraceptive use.

PURPOSE: To explore reasons for the incorrect usage of oral contraceptive pills (OCPs) by examining the relationship between patients' abilities to comprehend and/or recall information presented to them by nurse practitioners (NPs) and the communicator style of their NP. DATA SOURCES: A convenience sample of 46 OCP users completed an instrument designed to test their comprehension of OCP use and an instrument designed to measure the communicator style of their NP. CONCLUSIONS: A multiple stepwise regression revealed that attentive and friendly communicator styles were positive predictors and the communicator image and dramatic styles were negative predictors of comprehension. PRACTICE IMPLICATIONS: Unwanted pregnancies that result from non-compliance with OCP regimens can have significant social and financial effects. A lack of understanding of proper OCP use may depend on the style of communication a NP uses to convey crucial information regarding the regimen.

Adolescent↗

PubMed2004

The role of culture in health communication.

This paper examines the role of culture as a factor in enhancing the effectiveness of health communication. We describe culture and how it may be applied in audience segmentation and introduce a model of health communication planning--McGuire's communication/persuasion model--as a framework for considering the ways in which culture may influence health communication effectiveness. For three components of the model (source, message, and channel factors), the paper reviews how each affects communication and persuasion, and how each may be affected by culture. We conclude with recommendations for future research on culture and health communication.

Communication↗

PubMed1997

Health communication in the prevention of alcohol, tobacco, and drug use.

Research on substance abuse prevention programs indicates that effectiveness is greater when multiple intervention approaches that address the specific vocabulary, perceptions, and values of the target population are employed. The field of health communication provides unique perspectives on media that can be applied to increase the salience and effectiveness of substance abuse prevention programs. Well-designed and well-delivered health communications have the capacity for reaching remote audiences, changing health attitudes and behavior, shaping social norms, changing the way health issues are portrayed by the popular media, and influencing decisions about legislation and policies. Health communication approaches are generally employed within the broad context of health promotion programs, along with education, community development, empowerment, and social change approaches. This article describes the role of health communication in substance abuse prevention, reviews major conceptualizations of health communication, and introduces the unique features of the four articles included in this special section of Health Education & Behavior.

Adolescent↗

PubMed2005

Adequacy of online medical command communication and emergency medical services documentation of informed refusals.

BACKGROUND: In the out-of-hospital setting, when emergency medical services (EMS) providers respond to a 9-1-1 call and encounter a patient who wishes to refuse medical treatment and/or transport to the hospital, the EMS providers must ensure the patient possesses medical decision-making capacity and obtain an informed refusal. In the city of Cleveland, Ohio, Cleveland EMS completes a nontransport worksheet that prompts the paramedics to evaluate specific patient characteristics that can influence medical decision-making capacity and then discuss the risks of refusing with the patient. Cleveland EMS then contacts an online medical command (OLMC) physician to authorize the refusal. OLMC calls are recorded for review. OBJECTIVES: To assess the ability of EMS to determine medical decision-making capacity and obtain an informed refusal of transport. METHODS: This study was a retrospective review of a cohort of recorded OLMC refusal calls and of the accompanying written documentation by Cleveland EMS. The completeness of the verbal communication between the paramedic and OLMC physician and the written documentation on the nontransport worksheet were measured as surrogate markers of the adequacy of determining medical decision-making capacity and obtaining an informed refusal. RESULTS: One hundred thirty-seven OLMC calls for patient-initiated refusals were reviewed. Vital signs and alertness/orientation were verbally communicated more than 83% of the time. The presence of head injury, presence of alcohol or drug intoxication, and presence of hypoglycemia were verbally communicated less than 31% of the time. Verbal communication stating that the risks of refusing had been discussed with the patient occurred 44.5% of the time. The written documentation of the refusal encounter was more complete, exceeding 95% for vital signs and alertness/orientation, and exceeding 80% for the remaining patient characteristics. The rate of written documentation that the risks of refusing had been discussed with the patient was 48.7%. Discrepancies between the verbal and written paramedic reports were clinically insignificant. CONCLUSIONS: Paramedic and OLMC physician communication for patients refusing out-of-hospital medical treatment and/or transport is inadequate in the Cleveland EMS system. A written nontransport worksheet improves documentation of the refusal encounter but does not ensure that every patient who refuses possesses medical decision-making capacity and the capacity to provide an informed refusal.

Adolescent↗

PubMed2006

Understanding medical interpreters: reconceptualizing bilingual health communication.

This article provides a new approach in conceptualizing bilingual health communication, emphasizing the differences between types of medical interpreters as well as the interrelationships among all participants in bilingual health communication. Confronted by the conflicting results of interpreting services in medical settings, the author used past research to explain why medical interpreters should be categorized into different categories (i.e., chance interpreters, untrained interpreters, bilingual health care providers, on-site interpreters, and telephone interpreters) so that their characteristics and interpreting styles can be better observed and understood. In addition, by recognizing that interpreter-mediated communications in health settings are dynamic situations and that all participants can influence the outcomes of the communication, researchers can start to investigate the interrelationships among all the participants and, thus, develop different strategies that will improve the quality of bilingual health communication.

Communication↗

PubMed1997

Teachers' perceptions and actions in carrying out communication policies in a public school for the deaf.

The purpose of this study was to investigate teachers' opinions on school communication policies in a public school for the Deaf in Taipei, Taiwan. Specifically, the authors examined how teachers carried out communication policies, and examined possible discrepancies between teachers' perceptions of their communication methods and the methods they actually used in the classroom. Questionnaires were distributed to all 120 teachers at Taipei Municipal School for the Deaf. Thirteen of the 85 respondents were selected as subjects for personal interviews followed by direct classroom observation and videotaping. Sixteen deaf high school seniors at the school were interviewed concerning their opinions about the teachers' communication modes and abilities, and about the communication modes the students experienced.

Communication↗

PubMedDate not supplied

'Breaking it down': patient-clinician communication and prenatal care among African American women of low and higher literacy.

PURPOSE: Low literacy has been associated with poor medical adherence, but its role in maternal care utilization has not been explored. METHODS: We undertook a concurrent mixed methods study among 202 African American women of low (< or = 6th grade) and higher literacy receiving Medicaid. Poor use of prenatal care was defined by (1) starting care after the first trimester and (2) inadequate care utilization according to the Adequacy of Prenatal Care Utilization Index (APNCU). Participant-derived themes regarding prenatal care and care utilization were identified and explored through individual interviews (free listing and cultural consensus analysis; n = 40), and 4 confirmatory focus groups stratified by literacy. RESULTS: Thirty-three women (16%) had low-literacy levels, 120 (61%) women started prenatal care after the first trimester, and 101 (50%) had inadequate utilization of prenatal care. Neither measure varied by literacy (P >.05). Cultural consensus analysis identified a single prenatal care factor that was comprised of 9 items, shared by women of low and higher literacy (eigenvalue 0.881, SD 0.058). Focus groups confirmed these items among participants from both literacy groups. Communication with clinicians was a central theme linking all of the factor items. Effective communication, exemplified by "breaking it down," was described as encouraging, whereas ineffective communication discouraged use of care. CONCLUSION: Women who had both low- and higher-literacy skills had high rates of poor prenatal care utilization and reported that communication with clinicians influenced their use of prenatal care. Improving the clarity of communication by breaking down information into simple parts should be a priority for prenatal clinicians.

Adolescent↗

PubMed2002

Parent and physician attitudes regarding electronic communication in pediatric practices.

OBJECTIVE: To determine 1) the electronic mail (e-mail) capabilities of families, general pediatricians (GPs), and subspecialty pediatricians (SPs) from an integrated pediatric health care delivery system and 2) the knowledge base and attitudes of these groups regarding the potential issues involved in using e-mail for physician-patient communication. METHODS: Parents were interviewed in the offices of participating practices using a standardized survey tool. Pediatricians and staff were interviewed using a separate instrument. The data were entered into a database for analysis. RESULTS: A total of 325 parents and 37 physicians were interviewed. Fifty-seven percent of the 161 parents who were interviewed at the GP offices and 66% of the 164 families that were interviewed at SP offices had access to e-mail. Parents aged 31 to 40 years were significantly more likely to have access to e-mail than parents of other age groups. Access to e-mail increased with family income and parental education. Most (74%) parents who were interviewed expressed interest in using e-mail to contact their child's physician/physician's office for several purposes, including getting information or test results, scheduling appointments, and/or discussing a particular symptom. Although both groups of parents expressed concerns about confidentiality, parents at the GP offices were significantly more concerned (median(GP) = 95 vs median(SP) = 70). Seventy-four percent of GPs and 100% of SPs had access to e-mail; however, 79% did not want to use e-mail for physician-patient communication, citing concerns about confidentiality and the time demands that patient e-mail might engender. CONCLUSIONS: The majority of parents and pediatricians at both general and subspecialty pediatric offices are capable of communicating electronically. Parents and pediatricians are aware of the issues surrounding e-mail use for patient communication. Most parents express an interest in using e-mail for patient-physician communications, whereas most physicians are opposed to this practice.

Adolescent↗