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Communication about parental illness with children who have learning disabilities and behavioural problems: three case studies.

Parental illness can have a profound impact on family relationships and children's behaviour. The amount and nature of communication between parents and children about the illness can play an important role, both positively and negatively, in mediating the outcomes. When children have a disability, families can be reluctant to communicate with them about family difficulties. They are often concerned about the impact that parental unavailability may have on their child's life. This paper reports on three families in which the mother was diagnosed with breast cancer and one child in the family had a disability. The extent and specific characteristics of their communication about the maternal illness with their children, behavioural changes in the children, explanations of communication strategies and attributions of behavioural changes are described. Family coping strategies are examined with reference to Lazarus's process model of stress and coping and the use of either problem-focused or emotion-focused strategies. Implications for possible clinical interventions are proposed. In particular it is suggested that families be offered consultation about: what children might understand; ways in which to communicate effectively; and strategies for coping with the long-term implications of serious parental illness.

Adolescent↗

Intentional communicative behaviours of Turkish-speaking children with normal and delayed language development.

BACKGROUND: Language profiles may predict whether children with slower language development will catch up to their peers by overcoming this transient phenomenon or will be at risk for persistent language disorders. The research of the last decade has focused on this topic. Some researchers have emphasized the significance of developing communicative intentions, which provide a potential predictor of later language competence. In Turkey, children with slower language development may not be diagnosed partly because of the lack of sufficient standardized assessment/evaluation tools, educational and therapeutic media, and qualified speech-language therapists. In devising appropriate evaluation instruments, it is necessary to examine cross-linguistic variation in early language acquisition. The purpose of this study therefore is to observe, describe and assess early communicative behaviours of 15-36 months old Turkish-speaking children by using a functional communicative approach. METHODS: The research was designed within a qualitative-descriptive paradigm, involving qualitative data collection, observation and data analysis procedures. A total of 16 children, eight typically developing and eight language delayed, served as subjects. The classification system used in this study for coding children's communicative intentions was mostly based upon a system used by Dore (1977). Each variable was referred to as one of three intentional categories: regulating behaviours (request for object, request for action and protest), social interaction (direct attention, greeting and acknowledgement) and joint attention (comment/statement, asking for information and responding). A non-parametric Mann-Whitney U-test was carried out to verify the descriptive measures in comparing the delayed and normal group performance. RESULTS: As expected, the mode of expressing communicative intentions varied as a function of age for both groups. Children with normal language development were observed to express intentions within the category of joint attention more frequently whereas the children with delayed language expressed intentions related to the variables of regulating behaviours and social interaction.

Age Factors↗

The role of communication in nursing care for elderly people: a review of the literature.

Communication in nursing care is an important topic assessing the specific needs of elderly patients and providing nursing care that is tailored to the individual patient's needs. In this review of the literature, we describe the role attributed to communication in theoretical nursing models and we report how research in communication in nursing elderly patients has taken place over the last ten years. It appears that since the eighties there has been an increase in observation studies into nurse-patient communication. There still is, however, a lack of observation instruments to do justice to the interactive nature of nurse-patient communication. Special attention should be paid to reliability and validity.

Aged↗

Emotional contagion, empathic concern and communicative responsiveness as variables affecting nurses' stress and occupational commitment.

Based on data gathered from registered nurses at two hospitals, this research examined the extent to which empathy variables contributed to nursing stress and occupational commitment. The empathy variables examined were emotional contagion (i.e. sharing the emotions of patients), empathic concern (i.e. being concerned for patients) and communicative effectiveness (i.e. effectively communicating with patients and their families). Nursing stress was explored through the variables of depersonalization, reduced personal accomplishment and emotional exhaustion. Multiple regression analyses revealed that the combination of the three emotional communication variables explained significant proportions of the variance in all three of the stress variables, as well as occupational commitment. The analyses further revealed that a lack of empathic concern and poor communicative responsiveness accounted for significant proportions of the variance in depersonalization. Lack of empathic concern, poor communicative responsiveness and high emotional contagion significantly contributed to reduced personal accomplishment. Emotional contagion explained a significant proportion of the variance in emotional exhaustion. Emotional contagion also significantly reduced occupational commitment. The findings are discussed in terms of nursing education and administration.

Achievement↗

Factors related to nurse communication with elderly people.

This study explores variables that might influence nurses' communication with elderly patients. Three groups of variables arise from the literature that seem to affect the quality or quantity of nurse-patient communication: variables related to nurses, to patients, and to the setting in which nursing care takes place. The study was conducted in two different care settings: a home for elderly people and a home care organization. In a sample of 181 video-taped nursing encounters, involving 47 nurses and 109 patients a study was made of nurse-patient communication. In addition, relevant data related to patients, nurses and situation were gathered by questionnaires and were combined with the results of observations of videotaped nurse-patient interactions. It was found that the educational level of nurses was related most strongly to the way nurses communicate with their elderly patients. Patient characteristics such as age, gender and subjective state of health appeared to play a minor role in the way nurses communicate.

Aged↗

The essence of cancer care: the impact of training on nurses' ability to communicate effectively.

BACKGROUND: The importance of effective communication between health professionals and patients with cancer is widely recognized. Training programmes aimed at improving key communication skills are becoming increasingly available. PURPOSE: To evaluate a communication skills programme delivered to 308 cancer nurses as part of degree/diploma courses. Based on previous work, it was hypothesized that a statistically significant improvement between pre- and postintervention scores would be observed. METHODS: Audiotaped nursing assessments with patients were undertaken before and after the course. These were evaluated according to coverage of nine previously identified key areas of communication. RESULTS: Mean postcourse scores rose by 5.9 points (P < 0.001) to 16.3 (out of a possible 27). All nine individual areas of the assessment showed statistically significant improvements postintervention (P < 0.001). The areas showing most improvement were those with a high emotional content. CONCLUSIONS: This study has demonstrated that an integrated approach to communication skills training has the potential to improve nurses' skills, particularly in emotionally laden areas across the spectrum of roles in cancer care.

Adult↗

Democratic deficit and communication hyper-inflation in health care systems.

There is a widespread perception of poor performance and reduced trust in relation to health care systems. The roots of this problem are interpreted in terms of the democratic deficit and communication hyper-inflation. The democratic deficit is characterized as a persistent but chronically unsatisfied demand for complete public authority over all significant societal institutions--including the health care system. However, such professional institution systems necessarily perform their functions using specialized internal languages, which are not transparent to external scrutiny. Furthermore, professional institution systems tend to eliminate all subjective and imprecise criteria, such as individual moral values. This situation encourages communication inflation, which describes the large and unpredictable divergence between the real and nominal informational content of communications. Hyper-inflation is generated by the development of morality-free information management subsystems (specifically public relations and advertising) to the extent that 'official' communications convey almost zero reliable information. Reduction of the democratic deficit and control of communication inflation depends upon successful penetration of the health care system by representative public values, including individual morality.

Attitude to Health↗

Evaluation of communicative and functional abilities in Wolf-Hirshhorn syndrome.

BACKGROUND: Wolf-Hirschhorn syndrome (WHS) is a genetic condition characterized by many clinical disorders, learning difficulties, dysphagia, neuromotor deficits and communicative deficits. Up until now, no studies in the literature have described the development of communicative and functional abilities in subjects with WHS. METHOD: In the present study of 11 patients with WHS, a descriptive analysis was made of several abilities and three groups of patients were identified on the basis of the severity of their functional deficit. RESULTS: A non-homogeneous picture of impairment emerged in various areas of development. Overall, the neuromotor abilities of these patients were more adequate than their abilities related to autonomy in personal life, alimentary function, and cognitive and communicative-linguistic aspects. CONCLUSION: Based on the identification of specific patterns of communicative and functional impairment in subjects with WHS, rehabilitative intervention strategies can be planned to increase their communicative opportunities, and possibilities for active and autonomous participation in various life contexts (e.g. home, school and the social environment).

Abnormalities, Multiple↗

Assessing communication skills of GP registrars: a comparison of patient and GP examiner ratings.

CONTEXT: General practice. OBJECTIVES: To compare ratings of GP registrars' communication skills by patients and GP examiners. DESIGN: A comparative study where the communication skills of GP registrars were assessed both by patients, using a validated tool called the Doctors' Interpersonal Skills Questionnaire (DISQ), and by GP examiners as part of the Fellowship examination of the Royal Australian College of General Practitioners (RACGP). PARTICIPANTS: These included 138 GP registrars, 6075 patients, and more than 70 GP examiners. RESULTS: Spearman rank correlations were used to test the strength of the relationship between Fellowship examination and DISQ scores. Findings showed that there were several communication skills areas with mild (but significant) correlations between patient and GP examiner ratings. These areas included warmth of greeting, listening skills, respect, and concern for the patient as a person. No significant correlations were detected for explanation skills. Interestingly, the correlations between GP examiner and patient ratings were stronger for female GP registrars. CONCLUSION: There is some evidence that patients' ratings of GP registrars' communication skills is aligned to ratings made by GP examiners as part of the summative RACGP Fellowship examination. However, further work is required to assess the strength of this alignment, given that patient-doctor communication is assessed more widely through new components of the examination.

Adult↗

Communication skills knowledge, understanding and OSCE performance in medical trainees: a multivariate prospective study using structural equation modelling.

AIM: To test the stability of medical student communication skills over a period of 17 months as exhibited by performance in objective structured clinical examinations (OSCEs) and to determine the strength of prediction of these skills by initial levels of knowledge and understanding. DESIGN: This is a prospective study using a 2-wave cohort. PARTICIPANTS: Medical undergraduates (n = 383) from 2 years intake (1996 and 1997) were followed through the first 3 years of a medical curriculum. PROCEDURE: The study procedure involved the objective structured video examination (OSVE) conducted at formative and summative examinations during the first year. Two OSCE measures were employed: expert examiners and simulated patients completed the Liverpool Communication Skills Assessment Scale (LCSAS) and the Global Simulated Patient Rating Scale (GSPRS), respectively. The OSCE data were collected at Level 1 and 17 months later at Level 2 examinations. RESULTS: The measurement model followed prediction. A causal model using latent variables was fitted with Level 2 OSCE performance regressed on Level 1 OSCE and OSVE marks. Expert and simulated patient OSCE data were fitted separately and combined to determine strength of model fit according to professional and patient opinion of student skills. The overall fit of the models was acceptable. Communication skills performance showed a high level of stability. Some negative effect of cognitive factors on future skills performance was found. CONCLUSION: Early development of communication skills shows stable performance following an introductory course. Knowledge of communication skills has a small but significant influence on performance, depending on the time of testing. New assessments of cognitive factors are required to include both tacit and explicit knowledge.

Clinical Competence↗

Communication effectiveness of nurses working in a variety of settings within one large university teaching hospital in western Japan.

This survey study measured the communication effectiveness of 176 nurses working on a variety of clinical units within one large university hospital in western Japan. The vast majority of the nurses demonstrated fair effectiveness in their communication skills. Although some of the nurses did demonstrate slightly higher communication effectiveness scores, few of the nurses' demographic characteristics appeared to influence how well they communicated. The major limitations of the present study were the use of one hospital for data gathering, and the possible lack of cultural sensitivity of the communication questionnaire.

Adult↗

The Communication Clerk role in the emergency department.

OBJECTIVE: Analyse the clinical hours saved by the introduction of a dedicated Communications Clerk to the ED. METHODS: A Communications Clerk role was introduced at Flinders Medical Centre during 2002. Over a seven-week period the number of telephone calls taken and paging performed was logged. This function had previously been performed purely by clinical staff, and the number of clinical hours saved was evaluated. RESULTS: Over the study period the Communication Clerks worked for 509 h. A total of 7302 telephone calls were answered or made, and 924 pages made. The clinical hours saved was calculated at 243.3. The ratio of hours worked by the Communication Clerk to clinical hours saved overall was 2.1. CONCLUSION: The role of a Communication Clerk in a busy ED is an effective work practice change, particularly in relation to clinical hours saved.

Emergency Medical Service Communication Systems↗

Who's listening? Experiences of women with breast cancer in communicating with physicians.

The purpose of this qualitative study was to describe communication behaviors and attitudes of physicians that were most important to women living with breast cancer. Two focus group sessions were conducted, 1 month apart, involving 15 women who were members of a community-based breast cancer support group in Vancouver, British Columbia, Canada. Group dialogue was audiotaped, and notes were taken at each session by the coinvestigators, also members of the support group. Audiotapes, coinvestigators' written notes from the two focus group sessions, and the written homework assignments were used in the qualitative data analysis. Conceptual themes were identified and grouped to discern patterns within the data. The women were asked the following: (a) What were the most helpful things your doctor said or did at the time of your diagnosis? (b) What does a good intervention feel or look like? They were then asked to describe behaviors and attitudes they would like to influence in medical students who might later be communicating with women facing a diagnosis of breast cancer and to indicate which behaviors and attitudes they felt were most important. Women's positive experiences with physicians were characterized by communication based on active listening, awareness of the women's knowledge of their illness, honesty, and partnership. Physicians who showed interest in their patients as persons and who used touch to communicate caring were perceived as supportive communicators. Not surprisingly, there were similarities between the participants' positive experiences with their own physicians and the behaviors and attitudes desired in future physicians. Once again, "listening" was ranked as most important, followed by willingness to discern the individual patient's knowledge level.

Breast Neoplasms↗

Role for gap junctional intercellular communications in wound repair.

The participation of fibroblasts in wound repair is a coordinated effort requiring sequential cellular modulations to behavior including migration (entering), proliferation (increasing cell numbers), synthesis (depositing a collagen matrix), remodeling (organizing collagen), transformation into myofibroblasts, apoptosis, and elimination. Disruptions in that orderly sequence of behaviors will alter repair. Insights into controlling wound repair have focused on soluble factors such as cytokines and growth factors. Here we examine the direct communications between coupled cells through gap junctional intercellular communications. Molecules of less than 1000 MW pass directly between cells through gated gap junction channels. Sugars, amino acids, and oxygen, as well as second messengers such as cAMP, inositol phosphates, and calcium can pass directly between coupled cells. Does gap junctional intercellular communication affect fibroblast phenotype progression in granulation tissue maturation? In rats gap junctional intercellular communication uncouplers heptanol and endosulfan were injected daily into polyvinyl alcohol sponge implants. At 7 days, uncoupler-treated implants had capsules with increased fibroblast density, reduced cell penetration into the sponge, and diminished numbers of myofibroblasts. By polarized light, the uncouplers reduced the deposition and organization of collagen and thereby disrupted the coordinated phenotypic changes seen in fibroblasts during the repair process. It is proposed that gap junctional intercellular communication is critical for fibroblast progression from migratory cell to apoptosis as granulation tissue matures into scar.

Animals↗

Racial and ethnic disparities in the use of health services: bias, preferences, or poor communication?

African Americans and Latinos use services that require a doctor's order at lower rates than do whites. Racial bias and patient preferences contribute to disparities, but their effects appear small. Communication during the medical interaction plays a central role in decision making about subsequent interventions and health behaviors. Research has shown that doctors have poorer communication with minority patients than with others, but problems in doctor-patient communication have received little attention as a potential cause, a remediable one, of health disparities. We evaluate the evidence that poor communication is a cause of disparities and propose some remedies drawn from the communication sciences.

Black or African American↗

Evaluation of a visual risk communication tool: effects on knowledge and perception of blood transfusion risk.

BACKGROUND: Effective risk communication in transfusion medicine is important for health-care consumers, but understanding the numerical magnitude of risks can be difficult. The objective of this study was to determine the effect of a visual risk communication tool on the knowledge and perception of transfusion risk. STUDY DESIGN AND METHODS: Laypeople were randomly assigned to receive transfusion risk information with either a written or a visual presentation format for communicating and comparing the probabilities of transfusion risks relative to other hazards. Knowledge of transfusion risk was ascertained with a multiple-choice quiz and risk perception was ascertained by psychometric scaling and principal components analysis. RESULTS: Two-hundred subjects were recruited and randomly assigned. Risk communication with both written and visual presentation formats increased knowledge of transfusion risk and decreased the perceived dread and severity of transfusion risk. Neither format changed the perceived knowledge and control of transfusion risk, nor the perceived benefit of transfusion. No differences in knowledge or risk perception outcomes were detected between the groups randomly assigned to written or visual presentation formats. CONCLUSION: Risk communication that incorporates risk comparisons in either written or visual presentation formats can improve knowledge and reduce the perception of transfusion risk in laypeople.

Adult↗

Oral motor, communication, and nutritional status of children during intrathecal baclofen therapy: a descriptive pilot study.

OBJECTIVE: To describe the oral motor, communication, and nutritional status of children receiving intrathecal baclofen (ITB) therapy for spasticity of cerebral origin. DESIGN: Observational cross-sectional design. SETTING: Tertiary-care regional children's hospital. PARTICIPANTS: Thirty children with spasticity of cerebral origin receiving ITB therapy. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: One interviewer administered a structured in-person interview tool designed for this pilot study, data from which were collapsed into 4 change categories: communication and speech, feeding and nutrition, oral motor function, and gastrointestinal function. Functional severity was ranked with the Gross Motor Function Classification System (GMFCS). RESULTS: Speech: 10 improved (5 in GMFCS level V) and 2 worsened. Use of assistive technology to communicate: 6 improved (5 in GMFCS level V). Appetite: 10 improved (6 in GMFCS level V) and 4 worsened. Self-feeding: 9 improved (2 in GMFCS level III, 4 in level IV, 3 in level V) and 2 worsened. Saliva control: 10 improved (1 in GMFCS level III, 1 in level IV, 8 in level V) and 8 worsened. Cup drinking: 12 improved (5 in GMFCS level V) and 2 worsened. Indicates thirst: 9 improved (4 in GMFCS level IV, 5 in level V) and none worsened. Stool frequency: 8 improved (8 in GMFCS level V) and 14 worsened. CONCLUSIONS: Some aspects of speech, communication, and saliva control seemed to have improved, with bowel movement frequency decreased in some children receiving ITB. Fewer changes in feeding and nutritional status were reported. On the basis of this pilot study, prospective management guidelines are proposed that relate objective outcome measures of oral motor function, communication, and nutrition to changes in spasticity with ITB.

Adolescent↗

Affective communication in normal and brain-damaged adults: an overview.

In the past few decades an increasing number of investigators have examined how emotions are communicated through facial expression, speech prosody, and language in nonclinical and brain-damaged populations. Disorders of emotional communication (often referred to as affective processing disorders) are commonly associated with brain damage. These disorders include difficulty with expressing and perceiving emotional information, regulating emotions in communicative interactions, and demonstrating sensitivity to the emotional expressions of communicative partners. The purposes of this article are to: (1) describe "normal" affective communication; (2) review disorders in affective expression, perception, and regulation; (3) discuss the modality of facial expression and disorders of affective facial expression; and (4) present some informal tools for assessing affective processing.

Affect↗