Communication In Clinical Practice Research Articles

Personality Traits Influencing Effective Communication in Clinical Practice.

Personality Traits Influencing Effective Communication in Clinical Practice.

The narrative approach in Bioethics

Nowadays, the narrative approach in Bioethics is more and more considered and used. In our paper we would like to explain why – when we need to take a decision – it is essential and crucial that the patient tells his own history; we also indicate the main consequences that this approach has with reference to the choices at the bed of the patient. Selected Papers of the Congress “Narrative Based Medicine and Communication in Clinical Practice” · Cagliari, Italy · April 14 th , 2014 Guest Editors: Massimiliano Zonza, Vassilios Fanos, Gian Paolo Donzelli

3D-manufactured patient-specific models of congenital heart defects for communication in clinical practice: feasibility and acceptability

ObjectivesTo assess the communication potential of three-dimensional (3D) patient-specific models of congenital heart defects and their acceptability in clinical practice for cardiology consultations.DesignThis was a questionnaire-based study in which participants...

Complementary and alternative medicine: Interaction and communication between midwives and women.

Many pregnant women use complementary and alternative medicine. Although midwives are often supportive, how they communicate with women about the safe use of these therapies has received limited research attention. The aim of this study was to explore how midwives interact with women regarding use of complementary and alternative medicine during pregnancy. We utilised grounded theory methodology to collect and analyse data. Twenty-five midwives who worked in metropolitan hospitals situated in Melbourne, Australia, participated in the study. Data were collected from semi structured interviews and non-participant observations, over an 18-month period. How midwives communicate about complementary and alternative medicine is closely associated with the meaning they construct around the woman's role in decisionmaking. Most aim to work in a manner consistent with the midwifery partnership model and share the responsibility for decisions regarding complementary and alternative medicine. However, although various therapies were commonly discussed, usually the pregnant woman initiated the dialogue. A number of contextual conditions such as the biomedical discourse, lack of knowledge, language barriers and workplace constraints, limited communication in some situations. Midwives often interact with women interested in using CAM. Most value the woman's autonomy and aim to work in partnership. However, various contextual conditions restrain overt CAM communication in clinical practice.

How doctors view and use social media: a national survey.

BackgroundDoctors are uncertain of their ethical and legal obligations when communicating with patients online. Professional guidelines for patient-doctor interaction online have been written with limited quantitative data about doctors’ current usage and attitudes toward the medium. Further research into these trends will help to inform more focused policy and guidelines for doctors communicating with patients online.ObjectiveThe intent of the study was to provide the first national profile of Australian doctors’ attitudes toward and use of online social media.MethodsThe study involved a quantitative, cross-sectional online survey of Australian doctors using a random sample from a large representative database.ResultsOf the 1500 doctors approached, 187 participated (12.47%). Most participants used social media privately, with only one-quarter not using any social media websites at all (48/187, 25.7%). One in five participants (30/155, 19.4%) had received a “friend request” from a patient. There was limited use of online communication in clinical practice: only 30.5% (57/187) had communicated with a patient through email and fewer than half (89/185, 48.1%) could offer their patients electronic forms of information if that were the patients’ preference. Three in five participants (110/181, 60.8%) reported not being uncomfortable about interacting with patients who had accessed personal information about them online, prior to the consultation. Most of the participants (119/181, 65.8%) were hesitant to immerse themselves more fully in social media and online communication due to worries about public access and legal concerns.ConclusionsDoctors have different practices and views regarding whether or how to communicate appropriately with patients on the Internet, despite online and social media becoming an increasingly common feature of clinical practice. Additional training would assist doctors in protecting their personal information online, integrating online communication in patient care, and guidance on the best approach in ethically difficult online situations.

A Balint-inspired reflective forum in oncology for medical residents: Main themes during seven years

ObjectiveReflection groups for clinicians, often called Balint groups, are a way of refining professional competence in health care. This study presents a model for reflective practice in a group setting and describes the kinds of troublesome cases that medical residents are concerned about. MethodsFrom 2005 to 2012 a Balint-inspired reflective forum has been a part of the academic seminar program for physicians in training in a Department of Oncology at a Swedish university. The present study is focused on all 63 cases presented in the forum. ResultsThe cases were categorized into three kinds of challenges: Communication challenges in the patient–physician relationship, Communication challenges in organizational matters, and Communication challenges with close relatives of the patient. ConclusionThe study tells us something about the vulnerability of being a medical resident and the identified challenges have bearings on medical education curricula as well as on how the training of junior physicians is organized. Practice implicationsThe cases are contextual and multifaceted, and a forum of this kind might therefore be regarded as a potential way to develop professional competence and to refine communication in clinical practice. A structured evaluation of the forum would be valuable.

What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients

To examine the feedback given by nurse educators and clinicians on the quality of communication skills of nurses in interactions with simulated patients. The quality of communication in interactions between nurses and patients has a major influence on patient outcomes. To support the development of effective nursing communication in clinical practice, a good understanding of what constitutes effective communication is helpful. An exploratory design was used involving individual interviews, focus groups and written notes from participants and field notes from researchers to investigate perspectives on nurse-patient communication. Focus groups and individual interviews were held between August 2010-September 2011 with a purposive sample of 15 nurse educators and clinicians who observed videos of interactions between nurses and simulated patients. These participants were asked to give oral feedback on the quality and content of these interactions. Verbatim transcriptions were undertaken of all data collected. All written notes and field notes were also transcribed. Thematic analysis of the data was undertaken. Four major themes related to nurse-patient communication were derived from the educators' and clinicians' feedback: approach to patients and patient care, manner towards patients, techniques used for interacting with patients and generic aspects of communication. This study has added to previous research by contributing grounded evidence from a group of nurse educators and clinicians on the aspects of communication that are relevant for effective nurse-patient interactions in clinical practice.

Nurses’ experiences of using an interactive tailored patient assessment tool one year past implementation

BackgroundDespite evidence of benefits, integration of patient-centered communication in clinical practice is challenging. Interactive tailored patient assessment (ITPA) tools can contribute to a more patient-centered care approach. However, little research has examined the impact of such tools on nursing care once they have been implemented. ObjectiveTo explore nurses’ experiences of the benefits of and barriers to using an ITPA called Choice, in cancer care one year after its implementation. MethodsThis investigation is a part of a larger study examining the use of Choice in cancer care. Four focus group interviews were conducted with 20 nurses experienced in using the Choice application. The data were analyzed using qualitative content analysis. ResultsThree themes and nine sub-themes emerged: (1) “Choice as facilitator for shared understanding and engagement in patients’ own care,” with three sub-themes: preparing both patient and nurse for communication, shared engagement in care planning, and giving the patients a voice; (2) “enhancing the patients’ strengths,” with two sub-themes: releasing patient's internal strengths and confirming “normalcy” for the patient; and (3) “new challenges for the nurse,” with four sub-themes: organizational challenges, interactions with technology, a need for training in communication skills, and new ethical challenges. ConclusionsFindings suggest that, from nurses’ perspectives, integration of ITPAs such as Choice in clinical practice offers many benefits that can contribute to patient-centered care. However, to reap these benefits, use of such tools must receive equal priority as other routines, and require sufficient time, space and competence. Choice also challenged nurses’ professional roles and created dilemmas such as nurses’ ambivalence regarding patients’ levels of disclosure of sensitive issues and the nurses’ ability to respond to them. Although patient-centered care is advocated as model for good clinical practice, this is not always internalized. Tools such as Choice may help to make such a shift happen.

Barriers Against Psychosocial Communication: Oncologists' Perceptions

To explore oncologists' psychosocial attitudes and beliefs and their perceptions regarding barriers against psychosocial communication. A questionnaire was distributed to oncologists in Sweden (n = 537). Questions covered demography, the Physician Psychosocial Beliefs Scale (PPBS), and barriers against psychosocial communication. Stepwise multiple regression was used to determine what factors contribute the most to the PPBS score and the total number of barriers and barriers affecting clinical practice, respectively. Spearman rank-order correlation was used to determine correlation between PPBS score and number of barriers. Questionnaire response rate was 64%. Mean PPBS value was 85.5 (range, 49 to 123; SD, 13.0). Most oncologists (93%) perceived one or more barriers in communicating psychosocial aspects with patients. On average, five different communication barriers were perceived, of which most were perceived to affect clinical practice. These barriers included insufficient consultation time, lack of resources for taking care of problems discovered, and lack of methods to evaluate patients' psychosocial health in clinical practice. There was a positive correlation (rs = 0.490; P < .001) between the PPBS score and the number of perceived barriers (ie, less psychosocially oriented oncologists perceived more barriers). Oncologists with supplementary education with a psychosocial focus perceived fewer barriers/barriers affecting clinical practice (P < .001 and P = .001, respectively) and were more psychosocially oriented (P = .001). Oncologists perceive many different barriers affecting psychosocial communication in clinical practice. Interventions aiming to improve psychosocial communication must therefore be multifaceted and individualized to clinics and individual oncologists. It is important to minimize barriers to facilitate optimal care and treatment of patients with cancer.

Moral imagination in simulation-based communication skills training

Clinical simulation is used in nursing education and in other health professional programs to prepare students for future clinical practice. Simulation can be used to teach students communication skills and how to deliver bad news to patients and families. However, skilled communication in clinical practice requires students to move beyond simply learning superficial communication techniques and behaviors. This article presents an unexplored concept in the simulation literature: the exercise of moral imagination by the health professional student. Drawing from the works of Hume, Aristotle and Gadamer, a conceptualization of moral imagination is first provided. Next, this article argues that students must exercise moral imagination on two levels: towards the direct communication exchange before them; and to the representative nature of simulation encounters. Last, the limits of moral imagination in simulation-based education are discussed.

The Impact on Patient Health Outcomes of Interventions Targeting the Patient-Physician Relationship

Over the past 3-4 decades, numerous studies have been published evaluating interventions targeted at healthcare providers, at patients, or at both patients and healthcare providers, which are designed to, in some fashion, improve the provider-patient relationship and thereby enhance patient health outcomes. This article synthesizes findings from 14 literature reviews of relevant studies published between 1991 and 2007. Findings indicate that interventions aimed at physicians and other providers have consistently produced positive effects on provider communication behaviors and interpersonal skills. However, only moderately positive effects on patient satisfaction, and limited impact on patient healthcare behaviors such as compliance, appointment adherence, and resource use were found. Effects on primary medical outcomes were minimal although some positive effects on secondary medical outcomes such as quality of life were obtained. Patient-targeted interventions also showed consistently positive effects on patient-physician communication in addition to enhanced patient participation in decision making. Effects on patient primary medical outcomes were limited, and weak effects on patient satisfaction were obtained. Characteristics of studies and training programs that may have influenced outcomes are discussed, as are practical impediments to promoting better physician-patient communication in clinical practice.

Nursing Research Priorities for Ireland

The purpose of the study was to identify and rate clinical, managerial, and educational nursing research priorities in Ireland. The study design was a three-round, decision Delphi survey to identify and rate the importance of clinical, managerial, and educational research issues. A discussion group workshop was also undertaken to identify timeframes within which research on the issues identified should be conducted. A total of 1,695 nurses from all divisions of the nursing register in Ireland were initially surveyed. Response rates varied over the three rounds of the Delphi survey. A total of 122 nurses attended the discussion group workshop. This is the largest known survey of nurses to identify research priorities reported in the literature. Twenty-four nursing research priorities were identified. The five highest priorities were three clinical issues: outcomes of care delivery, staffing issues in practice, communication in clinical practice; and two managerial issues: recruitment and retention of nurses, and nursing input into health policy and decision-making. These research priorities identified for nursing in Ireland indicate, to an extent, the nursing research priorities identified in other European countries and in North America. The research priorities identified in this survey indicate that outcomes of care and the need to make nursing visible are attaining a higher priority than seen in previous studies. Also evident is that nursing shortages and increasing skill-mix in the clinical area have indicated a need for research into nurse recruitment, staff turnover, and staffing levels and how these issues affect patient outcomes. The priorities suggest research programmes that target the health service concerns identified in the national health agenda, such as the need to identify protocols and procedures that improve patient and client care outcomes and to examine and test solutions to workforce problems.

Constructions of sexuality and intimacy after cancer: Patient and health professional perspectives

With an increasing emphasis on the provision of psychosocial support for patients in cancer and palliative care, an emerging body of literature has highlighted the importance of providing the opportunity for patients to discuss issues of intimacy and sexuality with their health professionals. Very little is known about why health professionals struggle with this level of communication in clinical practice. The aim of this paper is to discuss constructions of intimacy and sexuality in cancer and palliative care from patient and health professional perspectives. A three stage reflexive inquiry was used to systematically and critically analyse data from semi-structured interviews ( n=82), a textual analysis of 33 national and international clinical practice guidelines and participant feedback at 15 forums where preliminary research findings were presented to patients and health professionals in cancer and palliative care. The study was conducted across one public teaching hospital in Australia from 2002 to 2005. Data were further analysed drawing upon the work of Giddens on reflexivity, intimacy and sexuality, to reveal that the majority of health professionals embraced a less reflexive, more medicalised approach about patient issues of intimacy and sexuality after cancer. This was in stark contrast to the expectations of patients. Cancer had interrupted their sense of self, including how they experienced changes to intimate and sexual aspects of their lives, irrespective of their age, gender, culture, type of cancer or partnership status. Key findings from this project reveal incongruence between the way patients and health professionals constructed sexuality and intimacy. Structures which govern cancer and palliative care settings perpetrated the disparity and made it difficult for health professionals to regard patients as people with sexual and intimate needs or to express their own vulnerability when communicating about these issues in the clinical practice setting. A degree of reflexivity about personal and professional constructions of sexuality and intimacy was required for health professionals to confidently challenge these dominant forces and engage in the type of communication patients were seeking.

Professionalism, Attitudes, Beliefs and Transformation of the Learning Experience: Cross-Cultural Implications for Developing a Spanish Elective for Non-Spanish-Speaking Physical Therapist Students

Background and Purpose. Cultural competency has been recognized as one of essential skills for physical therapists working in clinical practice today. The purpose of this pilot study was to investigate whether learning basic clinical Spanish language and would transform and shape non-Spanish-speaking physical therapist students' professional attitudes, beliefs, and behaviors when working with patients/clients whose preferred language is Spanish. Method/Model Description and Evaluation. Students participating in a Spanish elective at University of Miami completed questionnaires, took pre and post tests, and participated in a focus group regarding their clinical experiences preceding and following Spanish elective. Qualitative and quantitative data was collected and data was triangulated. Outcomes. Quantitative results showed statistical significance between pretest and posttest results (P Discussion and Conclusion. Our findings indicate that transformative learning took place in areas of frames of reference (ie, cultural diversity, cultural awareness), beliefs, self awareness, making and implementing plans related to physical therapy intervention based on this awareness, relationships and rapport with patients, ability to communicate in Spanish, body language awareness, and alternative approaches to living. Key Words: Cultural diversity, Spanish language, Professionalism, Transformative learning. BACKGROUND AND PURPOSE Cultural competency has been recognized as one of essential skills for physical therapists working in clinical practice today. The importance of cultural competency is reflected in both Physical Therapy Core Values' and in Generic Abilities2 In order to develop culturally competent values and behaviors, one first must understand concept of cultural competence. Cultural competence was initially described by Cross, Bazron, Dennis, and Isaacs3 in 1989. They defined it as the set of congruent behaviors, attitudes and policies that come together in a system, agency, or among professionals to work effectively in cross-cultural situatJons.p In physical therapist practice it is essential to respect culture, evaluate cross-cultural relations, understand dynamics of cultural differences, appreciate expanse of cultural knowledge, and determine how to modify one's services to meet culturally diverse needs.5 A recent pilot study on proficiency of clinical Spanish in physical therapist students demonstrated that clinical Spanish may help non-Spanish-speaking physical therapist students to feel more adequate and to be more helpful to their Spanish-speaking patients/clients in their community. The students believed that by intetacting directly with a patient/client who speaks Spanish they would be able to build a patient-practitioner relationship which would not be possible with a translator. The students also indicated that having a translator slowed down entire process of evaluation and treatment.4 Indeed, recent research has demonstrated critical importance of effective communication skills.5,6 Lopopolo, Schaeffer, and Nosse5 indicated that physical therapists need to have extensive knowledge of communication techniques and they should be skilled in applying these techniques in a clinical environment. Although their study did not specifically address language differences, their research recognized critical importance of communication in clinical practice. The National Alliance for Hispanic Health reported that culture influences how people express their feelings, as well as what feelings are appropriate to express, in a given situation. The inability to communicate can make both parties feel alienated and helpless.6 According to 2000 US Census, 57.3% of individuals in Miami are of Hispanic/ Latino descent.7,8 This article describes a pilot Spanish language elective we conducted to provide opportunities for students to transform their patient/client communication to demonstrate caring, culturally competent professional behavior. …

Principles and effects of electronic communication systems between healthcare providers and managed-care organisations

The present paper studies the issue of electronic communication among healthcare providers, patients and Managed-Care Organisations (MCOs) and how this communication could be exploited in order to increase the quality of health services. Specifically, we review the existing electronic communication systems in health and how they are used by the stakeholders and the medical staff. After reviewing the barriers to using online communication in clinical practice, we emphasise the challenges and the advantages of embodying such systems in daily healthcare services.

The impact of factitious disorder on the physician-patient relationship. An epistemological model.

Theoretical models for physician-patient communication in clinical practice are described in literature, but none of them seems adequate for solving the communication problem in clinical practice that emerges in case of factitious disorder. Theoretical models generally imply open communication and respect for the autonomy of the patient. In factitious disorder, the physician is confronted by lies and (self)destructive behaviour of the patient, who in one way or another tries to involve the physician in this behaviour. It is no longer controversial that the physician should communicate his consideration of a factitious disorder without insistence that the patient accepts this diagnosis. However, the balance between patient autonomy and open communication on the one hand, and the preservation of the patient's health, physician integrity and of a constructive physician-patient relationship on the other is easily disrupted. In this article, an epistemological model is described to facilitate a positive outcome of confrontation in treatment of factitious disorder. Analysing the problem in terms of systems theory will help the physician to assess what information is appropriate to use in which phase of the patient's treatment, while preserving the physician-patient relationship.

Risk communication in clinical practice: putting cancer in context.

Clinicians are increasingly urged-even mandated-to help patients make informed medical decisions by paying more attention to risk counseling. For many, the role of risk counseling is new and unfamiliar. This effort is made more difficult given the practical constraints created by 15-minute visits and competing demands (e.g., patient's chief complaint and institutional needs). We detail a three-part approach for improving risk communication, acknowledging the role of clinicians, patients, and other communicators (i.e., media or public health agencies). Office-based tools to help clinicians do more. We suggest two ways to help make up-to-date estimates of disease risk and treatment benefit easily available during office visits. We propose the development of a comprehensive population database about disease risk and treatment benefit to be created and maintained by the federal government. Educating patients. We propose "Understanding Numbers in Health" a tutorial that reviews basic concepts of probability and their application to medical studies to help people become better critical readers of health information. Guidance for communicators. Finally, we propose a writer's guide to risk communication: a set of principles to help health communicators present data to the public clearly and objectively. In addition to tools to help clinicians better communicate risk information, serious efforts to improve risk communication must go beyond the clinic. Efforts that help the public to better interpret health risk information and guide communicators to better present such information are a place to start.

DMS-IV meets philosophy.

The authors discuss some of the conceptual issues that must be considered in using and understanding psychiatric classification. DMS-IV is a practical and common sense nosology of psychiatric disorders that is intended to improve communication in clinical practice and in research studies. DSM-IV has no philosophic pretensions but does raise many philosophical questions. This paper describes the development of DSM-IV and the way in which it addresses a number of philosophic issues: nominalism vs. realism, epistemology in science, the mind/body dichotomy, the definition of mental disorders, and dimensional vs. categorical classification.

Communication in Clinical Practice.

"All that glisters is not gold," and all that has to do with people is not necessarily communication. This book contains explicit contributions to communication, implicit references to communication, and articles that have nothing at all to do with the communicative process. This scattering is perhaps unavoidable, considering that when 15 authors contribute to a single volume the level of sophistication, the relevance of the articles, and the readership to which they are addressed will vary. Four articles were contributed by well-known authors. J. G. Miller's "Psychological Aspects of Communication Overload" and A. Rapoport's "Tacit Communication in Experiments in Conflict and Cooperation" were written by two behavioral scientists who have worked for years in the field of communication. S. L. A. Marshall's "Communication Under Stress" was drawn from the author's long-term experience with communication under wartime conditions. And R. W. Waggoner's "Communication With a Patient" reports an