Difficult Communication Situations Research Articles

An educational approach using interprofessional (IP) role plays and patient narratives to inculcate empathy and communication among undergraduates in breast cancer management

BackgroundInteractive teaching methods such as patient narratives and role plays are effective tools in medical education. Incorporating the patient's perspective of the disease and standardized treatment in the teaching process helps the students become more empathetic and have better doctor-patient communication.MethodsAn interactive module was conducted using role plays and patient narratives to teach communication skills and doctor-patient relationships to randomly chosen Seventy-seven final-year(4th year) medical students to address the various psychosocial problems faced by the patients with breast cancer. Participants' perspectives regarding the intervention were collected using pre and post-tests, session feedback, and interviews. The data were analyzed quantitatively and qualitatively, as appropriate. Observed Structured Clinical Examination (OSCE)stations with case scenarios to break bad news to simulated patients were used for the assessment.ResultsMost participants felt that such interactive sessions were needed where they played the role of a doctor before facing an actual patient. While reading the narratives, they felt that the narrators’ emotions were genuine and that they felt involved. Most of them could relate to the social and emotional aspects of the patient and understood the Interprofessional (IP) teamwork in the treatment of a breast cancer patient. 93.4% of the participants felt they gained competence in managing difficult communication situations with patients.ConclusionInteractive teaching methods like narratives and role play may help enhance students' communication and empathy, which is vital for future doctors. They seamlessly integrate into existing curricula, offering practical experiences that deepen understanding and empathy without disrupting learning.

Standardized patients’ experiences of portraying characters in difficult communication scenarios: Narrative inquiry

Background There are limited studies that explored the preparation and challenges faced by standardized patients (SPs) in portraying characters in difficult communication scenarios, and the strategies used to overcome these challenges. The purpose of this study was to understand the experience of SPs in interpreting difficult communication situations and the learning needs of performing similar scenarios. And it allows the researchers to explore the meaning, beliefs, values, and aspiration associated with their role as SPs. The findings could shade light on the significance of their experiences and provide valuable insights for the development of future SP training programs. Methods The design of this study is framed by a narrative inquiry, using semi-structured guidelines to conduct in-depth interviews with 11 SPs who have participated in the performances of difficult communication situations. Research data were analyzed by Polkinghorne narrative analysis, and Riessman’s four criteria were used to establish rigor. Results Analysis revealed the following five themes: scenarios to real life connections, process of preparing for a performance, methods to detach from character, obtaining unexpected rewards, and needs for performance training. There are two to three subthemes that are subsumed under each theme. Conclusions To strengthen training in difficult communication for healthcare professionals, the use of SPs to interpret challenging difficult communication scenarios will continue to increase. Educators need to ensure that SPs are fully prepared physically and emotionally before, during and after their performance. Offering of continuing education and training in feedback techniques are crucial to extend the tenure of SPs, reduce their frustration, prevent attrition, and ultimately, reduce training costs. In the future, SP training should also include detachment and feedback techniques to alleviate SPs’ stress.

A37Does simulation-based training increase perceived confidence to address demanding communication situations within critical care?

Training nurses to improve their ability and confidence to communicate effectively in difficult situations is beneficial [1]. Simulation is an effective method to replicate difficult communication situations with colleagues, family or patients and improves communication skills [2]. Iyasere et al., (2022) [2] determined improving perceived confidence to communicate increased team-performance specifically amongst nurses. The main purpose was to evaluate the effectiveness of using simulation-based communication scenarios to improve critical care nurses’ perceived confidence to communicate in difficult situations. Fourteen (Band 5 and Band 6) critical care nurses attended three sessions of communication simulation. Participants were invited based on manager feedback either requiring improved communication or demonstrating excellent communication skills, an equal number from both spectrums attended each session. A diamond debriefing model was used after each scenario as the debriefing model provides reflection resulting in improved practice [3]. Debriefing was conducted by training simulation faculty. A survey was used to measure perceived confidence and ability to communicate in three difficult situations: escalating concern, next-of-kin communication (NOK) and colleague interaction. The survey was presented pre-, post-simulation and at six-weeks post. Results showed an increase in confidence and ability to communicate in all three communication situations, as shown in The average rating (1-10) of perceived confidence in each simulation element, at each interval Simulation-based training is an effective method to increase Critical Care nurses perceived confidence to communicate in demanding situations. Communication situations involving colleagues remains the most challenging communication scenario for nurses. Improving confidence to communicate is essential to effective team working and patient-centred nursing practice. Further study is needed but initial results suggest the method is beneficial to improve critical care nursing practice. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Social presence as a training resource: comparing VR and traditional training simulations

From immersive simulations to interactive tutorials, Virtual Reality (VR) is transforming the way we learn and practise new skills. Especially for social skills training, a growing number of simulations have been designed in which trainees learn to master difficult communicative situations. One of the factors to which the effectiveness of VR as a learning technology is attributed to is the users’ feeling of social presence during the simulated interaction. This paper presents the evaluation of (1) a role play training, (2) a learning app and (3) a VR training application in a workshop series. Social presence was perceived as equally convincing and engaging for the prototypical VR scene as for the traditional form of role play, although the course of the interaction in VR was highly determined compared to the interaction dynamics of a human role play. In our interpretation, this confirms social presence as a valuable resource for training social interaction, which spans across various learning settings and methods in increasingly blended or hybrid learning and working contexts.

COMMUNICATION SKILLS USED BY BULGARIAN GENERAL PRACTITIONERS DURING THE MEDICAL CONSULTATION

Background: The concept of doctor-patient communication develops from the idea that its main function is to gather information to the idea that it is an interpersonal relationship and interaction. Aim:To evaluate and analyze the opinion of general practitioners on the application of basic communication skills in medical practice in the therapeutic process and in the process of health education of the patient. Material/Methods: An empirical sociological representative survey was conducted among 190 randomly selected family physicians from two regions of the country. Results: Half of the GPs try to motivate patients, and significant differences were found regarding their sex, age and work experience (p=0.004). For chronically ill patients, 96% GPs discuss and offer advice related to healthy life style, daily activities (toilet, nutrition, mobility) or social activities. The doctors often give advice on nutrition (77%) and physical activity (71%). The majority of GPs (90%) report that they can motivate their patients to maintain a healthy lifestyle if there is even a small interest to do it. However, general practitioners still make insufficient use of active listening techniques, maintain poor eye contact during the interview, and perform other activities during the patient's hearing. In addition, physicians rarely involved the patientin discussions for therapy anddecision making. Conclusion: Surveyed physicians report to a significant extent that they are committed to the health education of their patients in the form of advice on a healthy life style. They manage to deal with many of the difficult communication situations in general practice.

Emotional reactions of people who stutter in difficult communication situations: a preliminary study

Purpose: Few studies have examined the emotional responses of adults who stutter (AWS) in specific situations. The aim of this study is to determine the emotions of AWS in different communication situations at various times in communication.Methods: The study included 38 AWS. The first stage of the study determined the difficulties related to stuttering in communication situations by requiring the participants to complete a questionnaire consisting of open-ended questions. The four SLTs scored these situations from various aspects (e.g., common experience of difficulty for AWS) and the final version of the 19-item list of situations in the “Determining Emotions Regarding Communication Situations in Stuttering Questionnaire (DERCSQ)” has been reached. The DERCSQ also provided a list of 90 emotions related to communication situations and stuttering. The participants completed the DERCSQ by indicating their feelings in three communication situations (before, during, and after communication).Results: The results indicated that AWS frequently experience negative emotions in different communication situations. The participants indicated that they experience the following emotions in pre-communication: excited (194), anxious (143), restless (142), tense (128), and concerned (118). During the communication, the participants experience the following emotions: uneasy (90), excited (88), uncomfortable (81), insufficient (78), and restless (75). During the after-communication period, the participants indicated that they experience the following emotions: anxiety (38), uneasy (34), uncomfortable (34), insufficient (33), and self-rage (32).Conclusions: The emotions obtained are compatible with the stuttering and psychology literature, it is remarkable that emotions such as anxiety and uneasy after stuttering were prominent.

ФОРМУВАННЯ КОНФЛІКТОЛОГІЧНОЇ КОМПЕТЕНТНОСТІ ПЕРСОНАЛУ ДКВС УКРАЇНИ В РОБОТІ ІЗ ЗАСУДЖЕНИМИ

This article examines the issue of the role of conflicts in determining the criminal behavior of convicts and persons taken into custody and the conflict-related formation competence of the personnel of the penitentiary institutions and detention centers. The purpose of the article is the “conflictological competence” skills by using training technologies and exercises which will allow to form the necessary skills of the penitentiary institutions personnel for the execution of punishments. Conclusions. Because it is not always possible to detect conflicts in time in penitentiary institutions, which is explained by their hidden nature. In addition, there are conflicts in the penitentiary institutions, which are caused by personal characteristics and leadership style of the correctional facilities personnel. The style of management of penitentiary institutions is connected with personal characteristics, temperament, lack of experience and professional personality deformation. Indicative program for training conflict-related competence of the penitentiary institutions personnel in four sessions, the purpose of which is to create the atmosphere of openness; trust and support of group cohesion of group participants; mastering the methods of conflict analysis and searching for regularities of adaptive behavior in difficult communication situations; building professional skills of active listening, understanding of another person in complex communication situations, learning effective methods of self-regulation of behavior and decrease emotional states in the conflict. Key words: conflict, conflict competence, the personnel of the State Criminal and Executive Service of Ukraine, prevention of conflicts, training of conflict-related competence.

Tactics of Reporting Bad News in Professional Communication between a Doctor and a Patient

The article is devoted to the development of the level of communicative competence of future doctors and the peculiarities of professional communication with patients. The basis of the work were the questions of determining the speech behavior of a doctor in one of the most difficult communicative situations — the situation of delivering bad news. Based on the material of real recordings of doctors’ speech, the analysis of risky communicative steps in the communication between the doctor and the patient is carried out, the most effective ways of implementing the doctor’s speech tactics in the situation of bad news are determined. Conclusions are drawn about the need to improve the level of professional communication of doctors and to train medical students in the communication skills of delivering bad news.

A Preliminary Cyber-Physical Study of a VR Training Material for Engineering Students to Give a Presentation in English

Due to the rapid globalization of engineering fields and studies, engineering students are required to present their research in English at an international level. However, many engineering students feel anxiety for speaking in English; thus, proper training is necessary for them by providing a simulated conference environment. In this study, the authors develop a prototype of virtual reality (VR) training material for engineering students to practice and experience difficult communication situations in English at an international conference. The effects of the material were investigated by measuring the changes in the hemoglobin (Hb) concentration of the frontal cortex and heart rates of subjects who participated in the VR training and evaluation sessions with an English conversation trainer. The physiological data measurements obtained from the subjects before and after the VR training showed that they were more relaxed when responding to difficult English questions at a mocked question-and-answer (Q&A) session after the training. The result indicates that the VR training material can reduce the anxiety of engineering students who need to give a presentation in English, and this type of learning material is expected to be effectively used from an educational standpoint.

The Use of Psychological Correction Programs to Improve the Occupational Fitness of Correctional Personnel

Introduction: the article examines the results of the application of a short-term psychological correction program, which includes conflict prevention and the development of adaptive behavior skills in difficult communication situations. Aim: based on the results of the study, to identify conditions for the effective use of psychological programs to overcome stress among prison staff. Methods: the tasks set in the work were solved with the help of general scientific research methods within the framework of comparative, statistical and logical analysis and empirical methods such as description and interpretation of the information. The study involved 80 employees of the security department of correctional institutions of the Pskov Oblast, divided into experimental and control groups. The trainings were conducted by full-time psychologists of the departments. To assess the effectiveness, we used the following methods: “Willpower self-assessment scale” by N.N. Obozov, the technique for determining the level of neuropsychic stability “Forecast”, and the questionnaire of interpersonal relations in the adaptation of W. Shchutz. Results: the analysis of the data with the help of mathematical statistics methods has shown that the use of such programs is advisable among employees included in the group of increased attention. These may be persons conditionally recommended for this type of activity, as well as those who have been subjected to the deforming influence of an unfavorable professional environment. A statistically significant result for the experimental group of subjects consisted in a change in the indicators on the sincerity scale, which can mean an increase in self-esteem, trust in the psychologist and the desire to answer the questions honestly. The greatest effectiveness of the training was observed when we were implementing the tested program; this is explained by increased motivation and responsibility for its results. No practical effect of participation in the training was revealed among the personnel who initially had indicators that did not require correction. Conclusions: in order to increase the effectiveness of trainings, it is necessary that psychologists have personal conscious motivation when they work out unique programs that take into account actual needs of correctional staff.

Практические аспекты работы с родителями в профилактике психологического насилия над детьми в семье

The issue of child abuse has been addressed by various agencies and authorities. Child abuse is often concealed, and some parents remain convinced that corporal punishment is an effective means of family upbringing. Psychological abuse is often used as an educational and disciplinary measure. While parents are not educated on how to be parents, they are expected to achieve positive results and are judged and condemned when unsuccessful. Today there is an effort to assist parents by organising various forms of group interaction, as well as by implementing programs aimed to improve parenting skills. However, such programs generally focus on the prevention of physical abuse and devote less attention to psychological abuse. This substantiates the need for creating a specific program for the prevention of psychological abuse. This article presents the results of a pilot study on the implementation of a prevention program in the form of a psychological training seminar which focuses on parenting skills development. It is further suggested that this way of interaction with parents may contribute to lower rates of psychological abuse towards children at home. There were 9 respondents involved in the pilot study, all were raising teenage children, residing in St Petersburg, and receiving social assistance from local public institutions. There were positive changes in the parents’ value orientations, particularly, a progress in their understanding and acceptance of the child’s real abilities, and in the willingness of the parents to spend time with their children. Towards the end of the program, all the participants improved the level of their parenting skills. In difficult communication situations between the parent and the teenager there was a decrease in unconstructive types of behaviour and an increase in constructive types. The most important achievement of the program is the fact that the children noticed the positive changes in their interactions with the parents and in the parents’ behaviour. Among the observed changes were easier and more pleasant communication, a longer time of interaction, decrease in the number of conflicts, willingness to spend time together, a better understanding of the child, and a clearer expression of ideas and requests by the parent.

Communication skills in the context of psychological flexibility: training is associated with changes in responses to chronic pain in physiotherapy students in Spain.

The aim of this study is to explore the effectiveness of a training programme aimed at managing patients' chronic pain in physiotherapy students in Spain. The programme addressed providing them with efficient skills to manage patients' chronic pain from psychological flexibility (PF) perspective. The programme integrates communication skills training into PF-based training. It sought to contribute to better recognise the role of psychosocial factors in chronic pain and to better promote adherence to treatment. This is an observational study with a pre- and post-training programme design and a 2-month follow-up. A total of 35 physiotherapy students, divided into three groups, participated in a 10-hour training course. Training focused on three areas: (1) communication skills, (2) therapeutic adherence and (3) managing distress and pain. The three areas were addressed from the PF point of view. Impact of training was measured through standardised questionnaires that assessed attitudes towards chronic pain, an ad hoc questionnaire that assessed responses to difficult communicative situations and a training satisfaction scale. Final analyses showed that attitudes changed significantly after training, biomedical attitude scores decreased and biopsychosocial attitude increased, while pain was considered less disabling, and informed empathic responses in communication situations increased. These changes were maintained at 2-month follow-up. Satisfaction with the training was high. We conclude that a brief training programme based on the PF model may help students develop a more comprehensive approach and improve their skills for managing chronic pain.

Speech-language pathologists’ support for multilingual speakers’ English intelligibility and participation informed by the ICF

PurposeTo use the ICF to classify characteristics and aspirations of multilingual university students and faculty who seek speech-language pathologists’ support for intelligibility in English and to identify activities, facilitators, and barriers that impact participation in society. MethodA retrospective record review was conducted on files of 175 clients attending a university clinic for intelligibility enhancement (accent modification). Participants came from 35 countries and spoke 28 different home languages. ResultsAssessment and intervention for intelligibility enhancement involved consideration of ICF components of Body Functions and Structures (e.g., articulating phonemes, rate, prosody), Environmental Factors (e.g., support), and Personal Factors (e.g., motivation). Consonant substitutions and deletions were common, although participants were often unaware of these. For example, only 25.6% of participants reported English dental fricatives (/θ/ and /ð/) were difficult to pronounce; however, 94.9% substituted them with other phonemes such as [t] and [d]. The combination of substitutions/deletions, fast speech rate, low speaking volume, and differences in word stress exacerbated poor intelligibility. More time conversing in English was associated with greater confidence and less difficulty communicating in English, although more time knowing English was not. Difficult communication situations were reported to be conversing over the phone, talking to strangers, and communicating in English on professional fieldwork placements. Participants were motivated to seek intelligibility enhancement for academic, employment, and social reasons. ConclusionsTo ensure multilingual speakers are able to participate fully in society, intelligibility enhancement requires a multi-pronged approach where speech and environmental characteristics interweave.

Struggling to communicate?

Are dental students well-equipped to deal with difficult communication situations?

Are dental students well-equipped to deal with difficult communication situations?

Are dental students well-equipped to deal with difficult communication situations?

Reflective practice and its role in facilitating creative responses to dilemmas within clinical communication - a qualitative analysis.

BackgroundGood communication is a major factor in delivering high quality in care. Research indicates that current communication skills training alone might not sufficiently enable students to find context-specific creative solutions to individual complex personal and interpersonal challenges in the clinical context. This study explores medical students’ experiences with real communication dilemmas in a facilitated group setting. The aims were to gain a better understanding of whether and, if so, how reflective practice can enhance students’ ability to find creative individual solutions in difficult communication situations and to identify factors within the reflective setting that foster their creative competency.MethodsThematic content analysis was used to perform a secondary analysis of semi-structured interview data from a qualitative evaluation of a group reflective practice training for final-year medical students. The categories that arose from the iterative deductive-inductive approach were analyzed in light of current scientific understandings of creativity.ResultsReflection on real difficult clinical communication situations appears to increase medical students’ ability to handle such situations creatively. Although group reflection on clinical dilemmas involving personal aspects can stir up emotions, participating students stated they had learned a cognitive process tool that enhanced their communicative competence in clinical practice. They also described changes in personal attitudes: they felt more able to persevere and to tolerate ambiguity, described themselves more open and self-efficient in such complex clinical communication situations and thus more motivated. Furthermore, they reported on factors that were essential in this process, such as reflection on current and real challenges, a group format with a trainer.ConclusionsReflective practice providing a cognitive process tool and using real clinical challenges and trainer support in communication education may provide learners with the skills and attitudes to develop creativity in practice. Implementing reflection training in clinical communication education may increase students’ overall communicative competency.

Emotional Creativity as a Resource of Communicative Competence of Students

Emotional creativity is considered as an internal resource of person’s activity and as a psychological means of successful interaction as the mechanism of a development origin and functioning of communicative competence. The interrelation of emotional creativity indicators and styles of communication of students is investigated. The participants of the research are 100 senior students of Moscow and Nizhny Novgorod universities. Positive connections of emotional creativity and such indicators of communicative competence as priority orientation on the achievement of main objectives of communication, abilities to understand and differentiate the experience, to distinguish emotions of partners in communication, and also to react emotionally in non-standard way in difficult communicative situations are revealed. Negative correlation connection is established with such indicators as domination, conservatism, conformality characterizing a personality as non-confrontational, democratic in behaviour, independent. Development of emotional creativity is one of the problems of improvement of quality of modern university education. The tasks of formation of students’ qualities of the emotional and creative personality and the conditions of emotionally attractive learning through the usage of substantially semantic and active methods of training based on interaction, reflection, creativity are formulated on the basis of the received results. DOI: 10.5901/mjss.2015.v6n6s7p175

Acoustic-phonetic characteristics of older children’s spontaneous speech in interactions in conversational and clear speaking styles

This study investigated (a) the acoustic-phonetic characteristics of spontaneous speech produced by talkers aged 9–14 years in an interactive (diapix) task with an interlocutor of the same age and gender (NB condition) and (b) the adaptations these talkers made to clarify their speech when speech intelligibility was artificially degraded for their interlocutor (VOC condition). Recordings were made for 96 child talkers (50 F, 46 M); the adult reference values came from the LUCID corpus recorded under the same conditions [Baker and Hazan, J. Acoustic. Soc. Am. 130, 2139–2152 (2011)]. Articulation rate, pause frequency, fundamental frequency, vowel area, and mean intensity (1–3 kHz range) were analyzed to establish whether they had reached adult-like values and whether young talkers showed similar clear speech strategies as adults in difficult communicative situations. In the NB condition, children (including the 13–14 year group) differed from adults in terms of their articulation rate, vowel area, median F0, and intensity. Child talkers made adaptations to their speech in the VOC condition, but adults and children differed in their use of F0 range, vowel hyperarticulation, and pause frequency as clear speech strategies. This suggests that further developments in speech production take place during later adolescence. [Work supported by ESRC.]

Intelligibility of speaking styles elicited by various instructions

The acoustic-phonetic modifications made by talkers are attuned to the specific communicative situations that listeners are experiencing (Lam and Tjaden, 2013; Hazan and Baker, 2011). The extent to which such modifications are under explicit control remains largely unknown. This study examined the extent to which native and non-native talkers can implement acoustic-articulatory enhancements following specific instructions and the extent to which these changes will improve intelligibility. Ten native and 10 Korean-accented talkers read sentences in various styles including in conversational and clear speech, while imitating a native speaker’s conversational and clear speech, with exaggerated vowels, more slowly, and more loudly. Sentences were mixed with noise (−5 dB SNR) and presented to native listeners. Intelligibility results revealed that nonnative talkers were overall less successful in enhancing intelligibility following different instructions compared to native talkers. Instructions to speak clearly and imitating native clear speech sentences provided the largest intelligibility benefit while the instructions to slow down were least successful in improving intelligibility across talkers. Speaking loudly and exaggerating vowels increased intelligibility only for native talkers. Acoustic analyses will examine which acoustic-phonetic changes were implemented following each instruction. The results have important implications for enhancing intelligibility in difficult communicative situations (e.g., classrooms).

Lebensqualität im Fokus des Qualitätsaudits in der Langzeitpflege

Quality of life - an important outcome factor of long-term care - development and psychometric testing of an audit instrument, the Quality of Life Index, (QoL index"), to assess the consideration for individual quality of life aspects during the care process in long-term care settings is evaluated - even for clients with limited communication skills.A stratified random sample of n=209 residents was drawn out of the population of N=1 128 residents of 8 nursing homes and their individual QoL-aspects were assessed with SEIQoL-DW or in difficult communication situations with "LQ-Index-Informationssammlung". The LQ-Index's new items were validated via a parallel testing with the reference instrument SEIQoL-DW, the split half-reliability, the interrater reliability (Kappa) and a structured expert review according to the cognitive interview technique.All 209 participants were assessed via LQ-Index. The SEIQoL-Interview was completed and estimated valid by 18 (8.61%) residents. The psychometric testing results and the expert review indicate high feasibility, good reliability, validity and objectivity of the instrument "LQ-Index".As a result of this study a feasible and valid instrument is now available to assess the consideration for individual quality of life aspects during the care process in long-term care settings - even for clients with limited communication skills.