Communication Breakdown Research Articles

Watch Out! It Is Not Delirium—It Is Wernicke's Aphasia!

Purpose: This case report aims to raise awareness among health care professionals and students that acute onset Wernicke's aphasia could be misinterpreted as delirium. In such a context, a patient's psychological/emotional reactions (e.g., agitation, anger) to aphasia associated communication breakdowns can be mismanaged as primary psychiatric concerns. Conclusion: Preliminary suggestions for relevant clinical practice are offered.

Unpacking the Role of Interdisciplinary Collaboration in Surgical Teams: A Critical Analysis of Operational Efficiency and Patient Outcomes

Interdisciplinary collaboration is essential for effective surgical operations, impacting both operational efficiency and patient outcomes. This critical analysis explores the dynamics of teamwork within surgical teams, focusing on how structured collaboration can streamline procedures, enhance resource management, and reduce surgical errors. Drawing from existing literature and recent empirical data, the article examines key factors that contribute to successful interdisciplinary collaboration, including role clarity, communication protocols, and mutual respect among team members. Findings reveal that well-coordinated interdisciplinary efforts lead to improved patient safety, reduced postoperative complications, and increased patient satisfaction. However, barriers such as hierarchical structures and communication breakdowns remain significant challenges. This analysis highlights actionable recommendations for fostering effective collaboration in surgical settings, such as targeted training, standardized communication strategies, and clear role definitions. Ultimately, strengthening teamwork within surgical teams not only optimizes operational efficiency but also enhances patient care quality, underscoring the importance of collaborative practices in modern healthcare.

Cost benefit analysis of flood risk in the area of Thrace in Greece

Cost-benefit analysis can significantly aid the decision-making process for flood risk reduction and mitigation. Decision-makers can use it to weigh the expenses of various flood mitigation strategies against their possible upside in terms of lowering the risk of losses and damage. Decisions regarding how to allocate resources for flood risk management can be made more intelligently with the use of this information by policymakers and stakeholders. During severe rainfall or snowfall, these rivers are prone to flooding, which can harm structures such as homes, businesses, and infrastructure, have negative impacts to land uses and as a result they can cause high opportunity costs. Flooding in the Thrace region can have indirect and direct expenses, including property damage and lost commercial activity. These costs can include communication breakdowns and higher insurance rates. The predicted total economic losses from erosion for all of Greece are €356 million and €649 million for a 0.5- and 1-meter sea level increase, respectively.

Code-ifying the Law: How Disciplinary Divides Afflict the Development of Legal Software

Proponents of legal automation believe that translating the law into code can improve the legal system. However, research and reporting suggest that legal software systems often contain flawed translations of the law, resulting in serious harms such as terminating children's healthcare and charging innocent people with fraud. Efforts to identify and contest these mistranslations after they arise treat the symptoms of the problem, but fail to prevent them from emerging. Meanwhile, existing recommendations to improve the development of legal software remain untested, as there is little empirical evidence about the translation process itself. In this paper, we investigate the behavior of fifteen teams---nine composed of only computer scientists and six of computer scientists and legal experts---as they attempt to translate a bankruptcy statute into software. Through an interpretative qualitative analysis, we characterize a significant epistemic divide between computer science and law and demonstrate that this divide contributes to errors, misunderstandings, and policy distortions in the development of legal software. Even when development teams included legal experts, communication breakdowns meant that the resulting tools predominantly presented incorrect legal advice and adopted inappropriately harsh legal standards. Study participants did not recognize the errors in the tools they created. We encourage policymakers and researchers to approach legal software with greater skepticism, as the disciplinary divide between computer science and law creates an endemic source of error and mistranslation in the production of legal software.

Experiences with diagnostic delay among underserved racial and ethnic patients: a systematic review of the qualitative literature

ObjectiveDiagnostic delay is a pervasive patient safety problem that disproportionately affects historically underserved populations. We aim to systematically examine and synthesise published qualitative studies on patient experiences with diagnostic delay...

English for Medical Purposes: The Case of Korean Cosmetic Surgeons

EMP (English for medical purposes) has received more interest in South Korea to enhance the English competence of professionals working in medical contexts. Consequently, this study is based on two objectives: 1) to clarify cosmetic surgeons’ English needs and 2) to delve into cosmetic surgeons’ views regarding EMP courses they attended, focusing on the extent to which those courses met their English language needs. Data were gathered from 21 cosmetic surgeons through semi-structured interviews. The participants work at four hospitals in Seoul, which receive cosmetic surgery clients worldwide. The results conclude that most participants have to sharpen their communicative skills and strategies to establish effective doctor-client relationships and give outstanding health care. Nevertheless, the participants encountered English communication breakdowns because of the need for more productive vocabulary, unusual accents, and pronunciation issues. The cosmetic surgeons stated that the EMP courses they attended were not as helpful as expected, as the content did not match their English language needs at work. Therefore, the results imply that EMP courses’ teachers and designers have to create programs to meet the cosmetic surgeons’ English language needs.

Effects of divorce on nurses' performance in patient care

Divorce is a life-altering event that affects individuals and their professional lives [1]. For nurses who work in a highly demanding and emotionally charged environment, the impact of divorce can be particularly significant. Nurses are expected to maintain high levels of compassion, patience, and emotional stability while caring for patients. However, the emotional turmoil and stress that come with divorce may interfere with their ability to perform effectively at work. This article explores how divorce can affect nurses' performance, focusing on emotional, psychological, and physical aspects and strategies for coping and support [2]. One of the most immediate effects of divorce on a nurse's performance is the emotional toll it takes. Divorce can lead to feelings of sadness, anger, anxiety, and frustration, which may carry over into the workplace. Nurses, who are typically responsible for providing emotional support to their patients, may find it challenging to maintain a compassionate demeanor when experiencing emotional distress in their personal lives. This emotional strain can lead to burnout, reduced empathy, and a lack of patient engagement, negatively affecting the quality of care provided [3, 4]. The emotional stress of divorce can also contribute to communication breakdowns in the workplace. Effective communication is crucial for nurses to collaborate with other healthcare professionals and ensure patient safety. When emotionally overwhelmed, nurses may become more irritable, less focused, and prone to misunderstandings, leading to mistakes or conflicts with colleagues

Telepractice-delivered communication training for informal caregivers of people with aphasia: A pilot study

Purpose To establish proof of concept of a student-led, telepractice-delivered communication partner training towards enhancing communication between people with aphasia and their informal caregivers in everyday conversations. Method Two dyads were recruited, each consisting of a person with aphasia and their caregiver. A pre-training questionnaire was completed by caregivers, followed by a weekly communication training session delivered by graduate student clinicians via telepractice to each dyad over 12 weeks. The caregivers then completed a post-training questionnaire. Both questionnaires included 13 Likert-scale questions and one open-ended question requiring an extended response. Result Pre- to post-training improvements for both dyads were identified on two domains of the questionnaire: (a) frustrations of the caregiver and person with aphasia and (b) caregivers’ knowledge and confidence in using communication strategies. This quantitative data was supported by additional extended responses regarding informal caregivers’ current communication strategies when communicating with the person with aphasia. Conclusion Both informal caregivers reported integrating communication strategies learned as part of the training in their interactions with the person with aphasia and experiencing fewer communication breakdowns during the two weeks following the training. The pilot study offers proof of concept for incorporating telepractice-delivered caregiver communication training as part of aphasia rehabilitation.

A comparative study of how teachers communicate in deaf education classrooms.

This study investigates the communication practices of four teachers in 3rd to 6th grade classrooms with 9 deaf students with limited language proficiency and in stages of emergent writing development. Analyzing language modalities, utterance types, and class interactivity, we found that teachers using American sign language used student-centered approaches, generating a greater number of directives and responsive utterances. They persevered in increasing students' engagement and were successful in clarifying misunderstandings. Teachers using spoken English used teacher-centered approaches, making general comments directed at the whole class, which consequently reduced student participation and responsiveness. They also largely avoided repairing communication breakdowns with emergent writers, focusing instead on those with greater auditory and speaking abilities. These patterns reveal disparities in classroom communication that can affect student learning. Our findings highlight the need for teacher preparation programs to equip teachers with skill sets to employ accessible and effective communication during instruction, especially with deaf students who are still developing foundational language and writing skills.

Wait, What? What's Going On?- Pregnancy Experiences of Deaf and Hard of Hearing Mothers Who Do Not Sign.

Deaf and hard of hearing (DHH) women experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared to their hearing peers. This study explores the pregnancy experiences of DHH women who do not sign to better understand their barriers and facilitators to optimal perinatal health care. Qualitative study using thematic analysis. Semi-structured, individual remote, or in-person interviews in the United States. Twenty-two DHH English speakers (non-signers) who gave birth in the United States within the past 5 years. Semi-structured interviews explored how DHH women experienced pregnancy and birth, including access to perinatal information and resources, relationships with healthcare providers, communication access, and their involvement with the healthcare system throughout pregnancy. A thematic analysis was conducted. The barriers and facilitators related to a positive perinatal care experience among DHH women. Five key themes emerged. For barriers, healthcare communication breakdowns and loss of patient autonomy highlighted DHH women's struggle with perinatal health care. In contrast, DHH participants outlined the importance of accessible health communication practices and accommodations, use of patient advocacy or self-advocacy, and assistive technologies for DHH parents for more positive perinatal care experiences. Perinatal healthcare providers and staff should routinely inquire about ways to ensure an inclusive and accessible healthcare experience for their DHH patients and provide communication accommodations for optimal care. Additionally, healthcare providers should be more aware of the unique parenting needs and resources of their DHH patients.

End-stage heart failure patients in ICU: the importance of advance planning and effective communication.

During the disease trajectory, patients with advanced heart failure are often hospitalised with a high probability of admission to the intensive care setting. Using a case study, this article explores the care given to a patient with decompensated heart failure in an intensive care unit (ICU). It will discuss the significance of holistic assessment and effective symptom management, in particular the research related to breathlessness management. The importance of effective communication within the ICU multidisciplinary team, including with the patient/family will be explored, as the ICU environment can often lead to communication breakdown, patients being unable to voice their wishes and over-medicalisation. The effectiveness of early involvement of the palliative care team in ICU will be examined, including the use of tools such advance care planning and a treatment escalation plan and whether use of these can enable a better patient and family experience at the end of life. The role of palliative care champions will be discussed.

The burden of sustaining communication: communication breakdowns experienced by deaf students and their communication support workers in a further education college

ABSTRACT The educational inclusion of deaf students in England is usually interpreted as placement in mainstream settings alongside hearing students, creating unintended pressure for assimilation to the communicative needs of hearing people. In this context, it is deaf students and their communication support staff who are left to deal with communicative disparities found in educational settings. This ethnographic study explored episodes of communication breakdown in communicative interactions of 5 deaf college students in a further education college in Northern England. Analysis coded what was the source of breakdown, who noticed it, who repaired communication and what strategy was used. Findings were organised into three themes, reflecting how breakdowns were dealt with either by deaf students or their Communication Support Workers, or as a shared concern with teaching staff. Overall, deaf students were noted to deal with miscommunication through translanguaging, deploying their multilingual and multimodal repertoires to engage with multiple audiences and repair communication. Findings reflect how deaf students are overburdened with responsibility for ensuring communication is sustained, which opens further questions regarding the pressure to assimilate to hearing normative ways of communicating. Restricting deaf students’ communication to English may limit their development as bi/multilinguals and their learning experiences.

Inadequate Postmortem Reports: Investigating the Underlying Factors

Postmortem reports play a vital role in forensic pathology, providing essential information about the causes of death needed for legal investigations. However, several factors undermine the quality of these reports, threatening their reliability and compromising the integrity of the judicial system. This study explores the key issues contributing to inadequate postmortem reports, such as the absence of standardized protocols, lack of adequate training for forensic staff, communication breakdowns, external pressures on forensic teams, overwhelmed laboratories with insufficient infrastructure, personnel, and equipment, and challenges in implementing new technologies. By examining these elements, the research seeks to identify opportunities for improvement to enhance the quality and accuracy of autopsies. An integrated approach is crucial for establishing standardized practices, upgrading facilities and equipment, increasing staffing and laboratory numbers, improving training for forensic professionals, and promoting better communication among all stakeholders in forensic investigations. The findings emphasize the need to address these systemic issues to produce more reliable postmortem reports, which are essential for delivering accurate forensic insights and ensuring just legal outcomes.

Together All To (Bid) Adieu (TATA) (Seamless Discharge Process)

The discharge process is a crucial step in patient care, often marred by delays, communication breakdowns, and other bottlenecks, leading to decreased patient satisfaction. This article emphasizes the need for seamless discharge planning, which begins at admission and continues throughout the patient's stay. Nursing staff play a critical role in ensuring a smooth discharge, coordinating various tasks from communicating discharge timelines to arranging for necessary equipment and medications. By following well-planned strategies, such as early discharge preparation, patient and family education, and timely return of medications, healthcare professionals can enhance the patient’s experience and ensure a positive conclusion to their hospital stay.

Malpractice litigation in multidisciplinary cancer care: Navigating medico-legal challenges and shared decision making in India

Healthcare professionals participating in multidisciplinary team (MDT) cancer meetings may not have a comprehensive understanding of their medicolegal responsibilities in current times. This article aims to delineate the principal medicolegal issues pertinent to multidisciplinary cancer care and offer recommendations for future implementation. Key concerns highlighted in this literature encompass patient consent and privacy during MDT meetings, professional liability, the formal expression of dissenting views and the duty of care. The analysis of existing literature prioritizes several recommendations for addressing these issues. Given the limited precedent available for formulating recommendations, this article identifies foundational evidence that can inform the practicing clinicians of these concerns in future MDT practices.Navigating decision-making processes in cancer care poses significant challenges for patients. This article seeks to elucidate the significance of shared decision making (SDM) within the Indian clinical context while pin pointing disparities compared to Western practices. Through a systematic search conducted in Medline and Google Scholar from 2000 to 2019, approximately 400 articles were screened, resulting in the selection of 43 relevant articles (5 from India and 38 from Western sources). The literature underscores a scarcity of information on shared decision making in India as compared to Western contexts, potentially leading to adverse physical, psychological and financial consequences reported by patients. According to one study, While Western data demonstrate extensive involvement of both patients and physicians in consensus-building for treatment decisions, such engagement in India is predominantly observed in tertiary care settings, academic institutions or cases with high therapy costs. Cultural beliefs and biases further influence patient engagement, while communication breakdowns correlate strongly with medicolegal malpractice litigations. Future research endeavours are warranted to explore strategies for integrating shared decision making into routine oncology practice in India. Physicians must actively involve patients or their immediate family members in decision-making processes to ensure a patient-centric approach, thereby mitigating the risks of un-informed decision-making or mistrust in the treating physician's expertise. Efforts such as physician and patient education, tool development, policy formulation, widespread implementation and periodic assessments hold promise for advancing the practice of shared decision making.

Challenges faced by school mangers in implementing national school nutrition programme in the Harry Gwala District, KwaZulu-Natal

The purpose of the study was to explore challenges experienced by school mangers in their role to implement the national school nutrition programme in schools of the Harry Gwala District, in KwaZulu-Natal. This article is extracted from a Ph.D. thesis in which a qualitative research design was used with sample of school managers who participate in the school nutrition programme. Data was gathered through individual interviews and document analysis. The findings indicated that school managers experienced challenges in the implementation of the programme such as compliance of Service Providers with delivery regulation, delayed payments of Service Providers, insufficient and poor food stuff supplied by Service Providers. However, on the other hand, nutrition programme benefited learners from poor background, reduced learner absenteeism and increased school enrolment. This posed a challenge to school managers as indicated in Maslow’s theory in the hierarchy of needs that provision should be made for meals at schools if they do not receive an adequate nutrition at home. On the basis of the findings, the following challenges were faced by school management: poor infrastructural development, insufficient time allocated to feeding, communication breakdown between NSNP educators and Service Providers, none payment of Service Providers on time.

The Perspective of Haitian Parents on Heritage Language Maintenance in Children With Speech-Language Disorders

Purpose: This study is part of a larger study that explores the beliefs and attitudes of Haitian parents in the United States regarding heritage language maintenance. The study sought to understand Haitian parents' perspective of heritage language maintenance when the parent has a child with a communication disorder. Method: Semistructured interviews were conducted with seven Haitian parents of children who have or had a speech-language disorder. The interviews were conducted virtually through videoconferencing. A thematic analysis was used to explore the data and determine recurring themes. Results: Participants desired to preserve the heritage language; however, fear of further language delay and sociolinguistic factors influenced their language choice. Furthermore, the results revealed that the lack of Haitian Creole language maintenance led to a communication breakdown with family and parental regret on the missed opportunity to pass on the heritage language. Conclusion: The findings from this study demonstrate a need for continued education with physicians, SLPs, and other related service providers on the issues related to bilingual language development, language maintenance, and counseling families regarding home language practice. Supplemental Material: https://doi.org/10.23641/asha.27190611

Implementation of the four habits model in intermediate care services in Norway: a process evaluation

BackgroundIntermediate care (IC) services bridge the transition for older patients from the hospital to the home. Despite the goal of involving individuals in their recovery process, these services often become standardised, leading to communication breakdowns. While evidence-based practices, such as the Four Habits Model (4HM), for effective communication are crucial for enhancing high-quality healthcare, research suggests their integration into routine practice remains limited. In this study, we aimed to investigate the implementation process of the 4HM through a two-day course that engaged healthcare professionals and managers in IC.MethodsWe conducted a process evaluation employing qualitative and quantitative methods: (i) individual interviews with three managers and two course participants pre-course, (ii) two focus group interviews with course participants (N = 11) and individual interviews with the same three managers post-course, and (iii) the NoMAD questionnaire (Normalisation MeAsure Development) administered four months later to assess the short- and long-term impact on course participants (N = 14). Reflexive thematic analyses were guided by Normalisation Process Theory (NPT), which offers insight into how new interventions become routine practices. The analysis of the NoMAD involved descriptive statistics.ResultsWe identified four themes in the qualitative data: (i) Decoding Interactions: Making Sense of the 4HM in IC services, (ii) Fostering Change: Legitimising 4HM Through Staff Engagement, (iii) Harmonising Practice: Integrating 4HM into Complex Situations, and (iv) Embedding Value: Normalising the 4HM into Everyday Work. These themes illustrate the normalisation process of the 4HM course within IC, establishing standard practices. Healthcare professionals and managers highlighted the urgent need to integrate communication skills based on the 4HM into daily care. They noted positive changes in their communication habits following the course. The consistent findings from the NoMAD questionnaire underscore the sustainability of implementing the 4HM programme, as participants continue to utilise it in their clinical practice beyond the initial four-month period.ConclusionThe 4HM course programme was deemed feasible for expansion within IC services. Both managers and staff found its focus on addressing communication breakdowns and readiness for change sensible. The study findings may benefit the stakeholders involved in IC service routines, potentially improving services for older patients and relatives.

INVESTIGATING THE RELATIONSHIP BETWEEN SURGICAL TEAM COMMUNICATION AND PATIENT OUTCOMES

Surgical team plays a vital role in the care of patients during the surgery. For safe patient outcomes, surgical team members must effectively communicate within the surgical site. Communication breakdowns in the complex operating room atmosphere can result in unfavorable outcomes. To reduce risks, avoid errors and provide the best possible care for patients, the surgical team must communicate clearly and effectively with one another. Enhancing the quality of surgical treatment requires an understanding of the connection between communication and patient results. Objective: The purpose of this study was to investigate the connection between patient satisfaction outcomes and surgical communication between teams focusing on how the improved communication practices can enhance the patient safety in terms of care quality and satisfaction level in surgical setting. Method: The study comprised of 187 health care providers between the ages of 18 and 65 who were examined for the association between surgical team communication and patient outcomes after ethical approval from Hospital ethical committee. Descriptive cross-sectional study was carried out in the District Headquarters Teaching Hospital, Kohat Development Authority Kohat from January 2022 to July 2022. Data was Analyzed on SPSS and shown in tables. Results: The analysis shows a strong positive correlation (.595) between team communication and patient outcomes, with healthcare professionals that rates the quality of communication at an average of 3.84 out of 5, which is closely linked to a decrease in surgical complications and an increase in patient satisfaction. Sticking and communicating according to communication protocols was rated at 3.76, underlining its importance in patient safety improvements. Conclusions: The study affirms the crucial impact of effective communication among surgical team members on improving patient outcomes and safety in the operating site. The enhanced communication directly relates with faster patient recovery, lesser complications and higher patient satisfaction.

ISBAR Communication Guideline: An Innovative Strategy to Facilitate Civility Among Prelicensure Nursing Students.

Competency in communication and collaboration is essential in forming interprofessional partnerships for nursing practice. However, many students in nursing programs struggle with professional oral and written communication, leading to poor communication and incivility. Generational differences and expectations exacerbate communication breakdown and incivility among students and faculty. Implementing communication guidelines using a standardized communication tool in a traditional bachelor of science in nursing program helped facilitate professional and civil communication between students and faculty. Using the standardized tool improved student civility, professionalism, and accountability.