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

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

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

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