Modes of Communication

Introduction

Communication is defined as the method of sending and receiving messages to share skills, knowledge and attitudes.

Communication in the healthcare environment entails transmitting and receiving of information. Good communication within the healthcare setting is a fundamental clinical skill that establishes the therapeutic relationship between clinician and patient. Studies show that clinicians who explain, listen and empathise with their patients produce a profound effect on their patients health status and functioning as well as overall satisfaction in the medical care.

Historically, medical settings used direct face-to-face communication to relay information. In this format, everyone could not only hear the information, but they could also see facial expressions and body language to help better understand the meaning behind the words. Direct interactions have decreased as indirect interactions like video conferencing increase. Technology advances have aided in emails/texts replacing telephone calls. Written communication in medical care has many advantages including:

• traceability

• patient preference
• medico-legal value
• easily and simulataneously distributed to required number of caregivers
• educational

Medical Communication

Medical communication entails exchanging of information by verbal, nonverbal, written or electronic means. The two-way dialogue between patient and healthcare providers should have the following components:

1. where both parties speak and are listened to without interruption
2. exchange of information
3. ability to express their opinions
4. ask questions for clarity
5. exchange of information

Clinical communication interactions should be respectful to enhance patient engagement in decision making, increase patient adherence to treatment, increase patient satisfaction and reduce anxiety and uncertainty.

** The environment for verbal communication should be in a caring surrounding. This allows the patient to feel physiologically and psychologically safe.

Communication Delivery

Communication is delivered through the combination of verbal and nonverbal components. Verbal communication is delivered through spoken words or written language. Nonverbal communication conveys emotional information through reactions of the voice, body or face. . Both modes of communication can be influenced by a number of factors:

1. volume and pace of the interaction
2. exchange of glances
3. spatial proximity
4. extent or limits of physical contact
5. style of communication: friendly or authoritative

Verbal

Verbal communication encompasses both written and oral forms. Written communication is generally used to relay information in a permanent manner. With advances in technology written communication has increased over recent years. Examples of written communication include:

• emails
• reports,
• text messaging
• social media platforms
• discussion forums
• electronic medical records

Oral communication, also known as spoken communication includes:

• telephone calls
• face-to-face interactions
• video conferencing
• public speeches
• in-person meetings

** Effective oral communication requires active listening.

Listening

Effective oral communication requires active listening. In order to provide good communication, the clinician must pay attention and demonstrate good listening skills. Active listening is a critical component of good communication that involves giving the speaker your full attention. In order to be an active listener, the following steps should be performed:

1. Reflect: to confirm your understanding, paraphrase or repeat what they have said
2. Clarifying: to get a better understanding of what they said, ask questions
3. Summarise: provide a brief summary of what they said
4. Empathise. try to understand their speaker's feelings and perspective
5. Non-verbal cues: pay attention to body language, tone of voice and facial expresions
6. Avoid interruptions: allow them to finish without interruption
7. Avoid distractions: do not multitask or get distracted while they are speaking

Non-Verbal

Non-verbal communication is a way of conveying information without using words. It encompasses a wide range of physical cues such as:

• facial expressions
• tone of voice
• body language/posture
• gestures
• eye contact
• shrugging
• pointing

Non-verbal communication can help provide additional information or even contradict the spoken message. To respond appropriately to non-verbal cues, one needs to be an active listener noticing subtle cues. Equally important is to note your own non-verbal cues and how they might be interpreted by others.

** Note that individual and cultural differences can impact non-verbal communication due to different norms

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.

.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

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