Modes of Communication

Introduction

ommunication, which is important to understand older adults’ needs and support their health and well-being [7], is defined as the process of sending and receiving messages to share knowledge, attitudes, and skills [8]. It includes both verbal and nonverbal components, since it is not just the mere transmission of information [9]. While verbal communication denotes the transmission of messages through spoken words [8], nonverbal communication describes the reaction of the face, body, or voice, including what is expressed between each other [10,11]. Nonverbal communication is important to convey affective and emotional information, demonstrate respect for patients, and build therapeutic relationships with patients [12,13]. This makes nonverbal communication unique and more important for effective communication between nurses and older patients. When nurses enhance their communication skills, it improves patients’ satisfaction as well as the quality of care [14,15].

Non-Verbal	Shows awareness of the non-verbal communication of both the patient and the healthcare professional (e.g. eye contact, gestures, facial expressions, posture) and responds to them appropriately. Actively listens, including using, interpreting, and responding appropriately to body language
Verbal	Uses techniques of active listening (e.g. reflection, picking up patient’s cues, paraphrasing, summarizing, verbal and non-verbal techniques). Uses appropriate volume, clarity and pace when speaking Presents expert knowledge effectively (e.g. presenting a patient and clinical details to others, speaking in front of a group, presenting scientific data). Shapes a conversation from beginning to end with regard to structure (e.g. introduction, initiating the conversation, gathering and giving information, planning, closing interview, setting up next meeting; time management
Written	Knows about the importance of supplementing verbal information with diagrams, models, written information and instructions and applies the information appropriately. Uses appropriate tone, language and content in written communication Maintains clear, appropriate, and accurate records (written or electronic) of clinical encounters and plans

Medical Communication

Environment: The ideal environment for spoken communication is characterised in the first instance by ‘caring surroundings’. Such surroundings support communication among clinicians and with patients by contributing to care safety and patients’ feeling psychologically and physiologically safe, as noted by this patient: Information exchange Spoken communication is effective when accurate and appropriate information is exchanged between the right people at the right time. Attitude and listening The literature associates effective communication with respect, commitment, positive regard, empathy, trust, receptivity, honesty and an ongoing and collaborative focus on care.7Aligning and responding While attitude and listening are important for optimising the negotiation of information, this fourth domain, aligning and responding, is critical for nurturing the clinician–patient relationship. Such nurturing develops mutual trust, confidence and ‘common ground’9 for the discussion of sensitive and private matters. This nurturing is not a one-off ‘check’ but an ongoing process.10 The elderly patient

Communication comprises exchanging and understanding medication information by using written, electronic, verbal and nonverbal means.5 Formal modes of communication involve planned communication events including ward rounds, clinical handovers, team meetings, family meetings, admission and discharge medication counselling, as well as health professionals' documentation of patients' progress, treatment goals and medication regimens in medical records. Informal modes of communication refer to opportunistic, unplanned, spontaneous, unstructured interactions that can take place at any time in different locations such as at the bedside, in corridors and in office spaces, and also involve self-initiated communication aids including handwritten notes or reminder scribbles.6

Research has shown that effective communication between patients and healthcare providers is essential for the provision of patient care and recovery effective communication is a two-way dialogue between patients and care providers. In that dialogue, both parties speak and are listened to without interrupting; they ask questions for clarity, express their opinions, exchange information, and grasp entirely and understand what the others mean. Also, Henly [11] argued that effective communication is imperative in clinical interactions. respectful communication between nurses and patients can reduce uncertainty, enhance greater patient engagement in decision making, improve patient adherence to medication and treatment plans, increase social support, safety, and patient satisfaction in care [12, 13

Special populations

Communicating with unique groups Greater care than normal needs to be taken when communicating with groups such as children and young people, people with problems understanding spoken English (eg, limited-English speakers, people with a hearing impairment, learning disabilities or cognitive impairment) and people who are distressed or have mental health conditions.14 These groups need extra time, along with a flexible, personalised, context-sensitive and holistic approach: one size does not fit all

Elderly

lthough involving older patients with cognitive impairment in formal interactions is challenging for health professionals, a few strategies have been found to be helpful for patients with mild cognitive impairment such as simplifying decisions, holding the discussions in a quiet environment, using teach-back methods and using printed tools including decision aids

Older adults tend to be less comfortable with online methods and instead prefer face-to-face, letters and phone communication

Autism

he existing evidence suggests that autistic people may prefer written modes of contact. For example, autistic adults perceived success of healthcare interactions is associated with their willingness to provide written mode options (Nicolaidis et al., 2015), and a survey on Internet use indicated that autistic people typically preferred email over face-to-face interaction (nterviewed autistic Internet users, who reported that written Internet-mediated communication provides more control, thinking time, clarity and fewer sensory issues and streams of information that must be processed and interpreted. Similarly, Gillespie-Lynch et al. (2014) reported autistic people to perceive computer-mediated communication as beneficial, as it provides more control and increased comprehension in interactions. Consequently, there are reports of autistic adults utilising Internet-mediated modes of communication to foster and develop social connectiveness and relationships (Burke et al., 2010). This

Barriers

urthermore, organizational factors, such as competing demands of health professionals, staff workloads, temporal and spatial challenges,16 or inaccurate information transfer between health professionals and settings have been identified as hindrances to collaborative conversations between health professionals and patients during formal encounters upon patient admission and at hospital discharge.17 Temporal challenges included lack of availability of patients or family members at a time that coincided with health professionals' availability, whereas environmental and spatial challenges included barriers to communication due to distance of health professionals from patients' bedside.18 Notably, there has been a lack of focus on informal interactions between patients and health professionals concerning medication information19 and on patients' proactive communication about their needs and goals as they move across settings.1

Healthcare or institutional practices

Communication related

Environment related

Personal and Behavioural related

healthcare institutional practices or the healthcare system itself. Some of these factors are implicated in healthcare policy or through management styles and strategies.Shortage of nursing staff, high workload, burnout, and limited-time constituted one complex institutional and healthcare system-level barrier to effective care delivery [18, 19]. For instance, Loghmani et al. [20] found that staffing shortages prevented nurses from having adequate time with patients and their caregivers in an Iranian intensive care unit. Limitations in nursing staff, coupled with a high workload, led to fewer interactions between nurses, patients, and caregivers. Similarly, Anoosheh et al. [16] found that heavy nursing workload was ranked highest as a limiting factor to theraCare providers are more focused on completing care procedures than satisfying patients’ and caregivers’ needs and preferences. A consistent communication-related barrier in nurse-patient interaction is miscommunication, which often leads to misunderstandings between nurses, patients, and their families [20]. Other communication-related barriers include language differences between patients and healthcare providers [6, 16, 27], poor communication skills, and patients’ inability to communicate due to their health state, especially in ICU, dementia, or end-of-life care contexts To overcome the communication-related barriers, healthcare institutions must make it a responsibility to engage translators and interpreters to facilitate nurse-patient interactions where a language barrier exists. Moreover, nurses working in ICU and other similar settings should learn and employ alternative forms of communication to interact with patients. The environment-related barriers are obstacles within the care setting that inhibit nurse-patient interaction and communication and may include a noisy surrounding, unkept wards, and beds, difficulties in locating places, and navigating care services. Noisy surroundings, lack of privacy, improper ventilation, heating, cooling, and lighting in specific healthcare units can affect nurse-patient communication. These can prevent patients from genuinely expressing their healthcare needs to nurses, which can subsequently affect patient disclosure or make nursing diagnoses less accurate ay have different demographic characteristics, cultural and linguistic backgrounds, beliefs, and worldviews about health and illnesses, nurses’, patients’, and caregivers’ attitudes can affect nurse-patient communication and care outcomes. For instance, differences in nurses’ and patients’ cultural backgrounds and belief systems have been identified as barriers to therapeutic communication and care [12, 13, 21]. Research shows that patients’ beliefs and cultural backgrounds affected their communication with nurses in Ghana [16]. These scholars found that

How to fix it

Studies have shown that active listening among care providers is essential to addressing many barriers to patient-centered care and communication understanding patients and their unique needs [25], showing empathy and attending attitudes [7, 13], expressing warmth and respect [22], and treating patients and caregivers with dignity and compassion as humans. nviting their opinion, and collaborating with them constitutes another facilitator of patient-centered care and communication. When patients and caregivers are engaged in the care process, misunderstandings and misconceptions are minimized. When information is shared, patients and caregivers learn more about their health conditions and the care neede. health policy must be oriented towards healthcare practices and management to facilitate patient-centered care and communication.

References

• Hall, M. L., & Dills, S. (2020). The limits of “Communication mode” as a construct. Journal of Deaf Studies and Deaf Education, 25(4), 383-397. https://doi.org/10.1093/deafed/enaa009