Adapting Communication to Different Populations

Introduction

Patient-centred care is provided when communication is shared amongst provider, patients and their families. This process encourages and invites patients and their families to actively participate in the healthcare decision-making process. Through this open communication patient's dignities and rights are valued with subsequent positive care outcomes and perceptions of quality of care.

Effective communication for providers begins with respect and building trust with their patients. Having that mutual understanding and openness is important for building a relationship. Successful communication is knowing how to adapt interactions to different groups such as children, seniors, people with disabilities, hearing impairments, cognitive impairments, mental health issues, people who speak another language etc. Providers working with these populations will need to be patient and flexible as they might need to spend more time with these individuals.

In order to be an effective communicator working with different populations and cultures, providers need to demonstrate culturally sensitive communication. This type of communication demonstrates a mutual respect and understanding of each other's beliefs, values, preferences and culture to promote culturally sensitive care. Clinicians will need to identify patient's needs through verbal and nonverbal communication. Without culturally sensitive care, patients and their families feel less satisfied with their care and consequently there are risks of miscommunication, poor adherence to treatment and poorer health outcomes.

For providers to effectively communicate to all types of individuals, three factors are important:

1. Adapting the questioning strategy
2. Be comprehensible to the patient
3. Treating patients in a dignified, respectful, and courteous manner, regardless of who and where they are in life

Question Strategy

When interacting with a patient for the first visit, open-ended questions are strongly recommended for gathering medical information. Open-ended questions can produce lengthy narratives, short answers or lists. They can be used alone or with close-ended questions that elicit a yes or no response. Clinicians working with patients can use a combination of question strategies to gain information. Questions can be classified into the five categories below:

1. general inquiries: "what can I do for you today", "what brings you in"
   • allows patients to describe their concerns in their own terms
2. gloss questions for confirmation: "sounds like you are uncomfortable"
   • formatted for a yes/no response however can have subsequent expansion of answer
3. confirming questions about symptoms: "you have been having pain at night for a week"
   • confirmation of concrete symptoms
4. how are you inquiries: "how are you doing"
   • general evaluations rather than problem presentations .
5. history-taking questions: "what medicine do you take"
   • close-ended; yes/no, fill in the blank, multiple choice

** General inquiries are used most often to elicit problem presentation and increased patients satisfaction

Comprehensibility

After gaining information from the patient through question strategies, the provider then needs to be able to communicate to the patient about the plan of care. In general provider should:

1. Not use jargon or technical terms as it might inhibit patients from asking questions and thus have a poorer outcome in care
2. Use patients experiences when describing medical terms versus anatomical terms
3. Use pictures and/or videos to help explain difficult concepts

As each patient is unique, providers will need to be able to adapt their communication style when explaining medical terminology and intervention techniques.

Language Barrier

When there is a language barrier, it can be very difficult for the provider and patient to communicate effectively. Studies have shown that patients that face language barriers have poorer health outcomes and less access to healthcare than those who speak the language. Patients with language barriers have decreased understanding of their diagnoses, decreased satisfaction with their healthcare and increased medication complications.

Professional translators or language services help are the recommended practice when language barriers present themselves. They can provide precise, clear translations without any interpretation or biases. Using apps like "google translate" can assist with simple questions however they are not reliable for history taking. Avoid using a family member or friend to translate as they are may reinterpret or edit information to avoid conflict or protect family members. In addition, the patient may be less forthcoming when their family members are translating.

Respect

Establishing trust and respect are essential to the communication process between providers, patients and their families. Trust transpires through interactions that are respectful and flexible to the practices, beliefs and needs of the patient by demonstrating a willingness to help and learn. As a provider it is important to consider the emotional, spiritual and cultural needs of the families and their influences on decision making. Cross-cultural communication can be enhanced by the LEARN model as stated below:

1. Listen: bring an attitude of humility and curiosity to promote understanding and trust
2. Explain: communicate your perceptions of the health issues while realisiing the patient might understand it differently based on their culture or ethnic background
3. Acknowledge: identify areas of agreement as well as differences and try to determine if belief systems may lead to intervention dilemma
4. Recommend: propse and develop a tr
5. Negotiate

Acknowledge: Be respectful when discussing the differences between their views and your own. Point out areas of agreement as well as difference, and try to determine whether disparate belief systems may lead to a therapeutic dilemma.

Recommend: Develop and propose a treatment plan to the patient and their family.

Negotiate: Reach an agreement on the treatment plan in partnership with the patient and family, incorporating culturally relevant approaches that fit with the patient’s perceptions of health and healing.

The first attribute involves encouraging patients and families to participate in communication and decision making to the degree where they feel comfortable. encouraging patient and family input, and by promoting effective interactions to overcome communication barriers. prioritising cultural considerations in the planning and provision of care. This prioritisation can be achieved by demonstrating respect for the culture of the patient and their family by asking culturally sensitive questions about the patient’s and family’s values, beliefs and practices; obtaining information about the patient’s perceptions and beliefs associated with their presenting illness; and assessing the individual’s psychological, physiological and sociocultural needs, secondary languages, non-verbal communication techniques, religion and food preferences. developing a trusting relationship with the patient and family. This trust can be achieved through using open and non-threatening body language that demonstrates a willingness to help and learn. Es of the patient and their family

Go to:

https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00684-2

1. talk directly to the patient
2. speak in normal tone
3. include the patient

W/c: eye to eye

hearing loss: less ambient noise

speech impediment: be patient, shorter concrete questions

intellectual: simple direct sentences, more media and visual forms, no abstract ideas and be prepared to repeat

older adults:feel vulnerable and exposed

peds: need family member and kid- three way relatoinship, be patient, understandable language

1. relationship buidling
2. promote pateint engagement
3. address emotion
4. enhancing of info
5. management of uncertaintity
6. fostering of hope

poor health literacy: ask less questions, healthcare person might see as not engaged, communicate clearly and in laymans terms

Resources

• Using Communication to Enhance Therapeutic Interactions with People Living with Dementia
• Communication and Children with Cerebral Palsy