Difficult Communication Research Articles

Student perspective of classroom and distance learning during COVID-19 pandemic in the undergraduate dental study program Universitas Indonesia

BackgroundThe COVID-19 pandemic has become a global health issue and has had a major impact on education. Consequently, half way through the second semester of the academic year 2019/2020, learning methods were delivered through distance learning (DL). We aimed to evaluate the student perspective of DL compared to classroom learning (CL) in the undergraduate dentistry study program at the Faculty of Dentistry Universitas Indonesia.MethodsAn online questionnaire was sent at the end of the semester. A total of 301 students participated in the study.ResultsDuration of study influenced student preference. Higher number of first-year students preferred DL compared to their seniors (p < 0.001). Students preferred CL for group discussion, as DL resulted in more difficult communication and gave less learning satisfaction. Only 44.2% students preferred DL over CL, although they agreed that DL gave a more efficient learning method (52.6%), it provided more time to study (87.9%) and to review study materials (87.3%). Challenges during DL included external factors such as unstable internet connection, extra financial burden for the internet quota and internal factors such as time management and difficulty to focus while learning online for a longer period of time.ConclusionDespite some challenges, dental students could adapt to the new learning methods of full DL and the majorities agreed blended learning that combined classroom and distance learning can be implemented henceforth. This current COVID-19 pandemic, changes not only the utilization of technology in education but the pedagogy strategies in the future.

ЕМОЦІЙНЕ НАВАНТАЖЕННЯ СПОРТСМЕНІВ ПІД ЧАС ПОШИРЕННЯ ВІРУСУ «СOVID-19»

The impact of the spread of the virus «Сovid-19» on the economic, social and psychological aspects of human life is considered. The pandemic caused a situation of difficult communication with relatives and friends, without the usual way of life. Along with economic and professional challenges, there is a problem of adaptation to other, previously unknown conditions, which are often far from comfort and coziness. Congregation that person to achieve victory in the competition situation very important is the level of emotional stability«Сovid-19». The paper investigates the specifics of emotional load of professional athletes and amateur athletes during the spread of the virus «Сovid-19». It is proved that the effectiveness of sports activities in many respects depends on the level of emotional arousal, the ability to meet personal needs and the availability of appropriate social contacts. Peculiarities of preserving psychological well-being during quarantine restrictions in people who maintain an active lifestyle have been studied. Definitions, that one of the main problems is the limited professional activity and emotional stress, accompanied by anxiety before an uncertain and unclear future. A separate problem, in our opinion, is the affiliation of respondents to the category of people who are accustomed to active pastime. Isolation is seen as the impossibility of communication between members of the sports team, the lack of team training, non-compliance with team requirements, etc. The quarantine situation is a significant stress factor, which negatively affects the emotional state of the athlete. There is an urgent need to develop mechanisms to maintain the mental health, resilience and overall productivity of a person in conditions of forced isolation.

Comprehensive multi-variable analysis of signal-to-noise ratio in dining and social spaces

Difficult communication in dining and social areas is a common problem and the most common acoustical complaint in senior living and healthcare facilities. The signal to noise ratio is the major factor in this and is influenced strongly by architectural design. Prior simplified signal-to-noise-ratio analyses with few variables indicate impracticably high amounts of sound absorption required for acceptable results. This analysis adds the benefit of table-top reflections and the effects of the reverberant part of the signal (partially allotted to noise using known methods) and the direct part of the noise (using a closed-form approximation). It shows that the signal to noise ratio is strongly improved by table-top reflections and improved by (1) increased floor area per person (allowing more absorption and space between tables), (2) rooms with fewer people, (3) smaller table dimensions putting listeners closer to signal talkers, and (4) optimized discussion group size where possible to reduce the number of simultaneous talkers. Increased reverberation time due to higher ceilings is slightly detrimental. While a highly absorptive space is required, consideration of these other factors significantly reduces the required absorption to a more practical level.

The Implementation of Communication Didactics for OB/GYN Residents on the Disclosure of Adverse Perioperative Events

Communication skills are key components of the patient-physician relationship, yet are not routinely taught during residency. Institutional data demonstrates 75% of residents regularly encounter difficult communication scenarios. This study's objective is to develop and pilot a communications didactic/skills training program for Obstetrics & Gynecology (OB/GYN) residents focused on the disclosure of adverse perioperative events. This was an observational, prospective cohort pilot study. OB/GYN residents completed a 4-hour interactive curriculum using VitalTalk methodology, certified facilitators, and simulated patients in 2019. Participants completed self-assessments of their skill levels at 3 time points: prior to training, immediately post-training, 3-month post-training. Wilcoxon signed rank tests were used to evaluate change in skill levels. University-based program in North Carolina. Participants included all OB/GYN residents from postgraduate years 1-4. Out of 31 residents, 27 participated in the training, 24 completed the immediately post-training survey, and 23 completed the 3-month post-training survey. At baseline, most residents rated their global skill level in communication as novice (37.0%) or advanced beginner (33.3%). Immediately following the intervention, 41.7% of residents ranked their global skill as "competent" and 20.8% as "proficient." These changes were statistically significant (p < 0.001). Notable improvements were seen across multiple variables, including the handling of emotional reactions (p = 0.046). No significant changes were noted between the immediately post-training and 3-month time points, suggesting skill retention. Majority of trainees (78.3%) felt that refresher courses would be useful for skill maintenance. A simulation-based formalized communication curriculum is effective for improving OB/GYN resident competence and skill levels in the disclosure of adverse perioperative events. Specific to adverse surgical complications, this curriculum appears feasible for implementation by other training programs. Further work is needed to identify the most beneficial timing and modality of these workshops.

How student paramedics navigate a changing UK healthcare landscape

Background: Paramedics have witnessed a huge shift in their role as providers of prehospital emergency care, although little is known about how student paramedics manage the competing demands they face in practice. Aim: To explore how student paramedics experience the changing healthcare landscape. Method: Semi-structured, focus groups and thematic content analysis was adopted. A purposive sample of student paramedics at different stages of their diploma preparatory training were invited to participate in focus group interviews. Findings: Participants considered that other services and the public perceived the purpose of emergency paramedics as largely a traditional one, as a service to transport patients to hospital. This appears to influence how they manage complex clinical situations. Student paramedics' clinical decision-making is frequently influenced by the emotional environments in which they work, combined with difficult communication with patients and a lack of support from the various professional groups involved in patient care. Conclusion: This study has highlighted the complexity of situations that student paramedics find themselves in while making decisions, which has important implications for paramedic educators and those supporting them in practice.

21. FAMILY CENTERED CARE: LONGITUDINAL COMMUNICATIONS TRAINING FOR RESIDENTS

Background Although a huge portion of medical care involves communication, there is little time dedicated to these skills. Additionally, family-centered communication is collaborative and interactive, and these skills are best taught through case-based approaches rather than passive lecture-type didactics. Objectives: We aimed to develop a longitudinal communication curriculum utilizing learner-identified content, delivered via interactive workshops over a 6-month period, supplemented with and guided by family feedback. Methods The curriculum was developed using Kern's scholarly approach. A needs assessment for resident communication skills was conducted with a survey and focus group. The Communication Assessment Tool (CAT) was used for parent feedback of residents’ performance early in the curriculum. Content for workshop sessions was developed from needs assessments, CAT results, and input from program leadership. The curriculum underwent expert internal and external review. Pediatric interns were randomly assigned to a control or intervention group. Six sessions were delivered over 6-months to the intervention group. CAT feedback was shared with the intervention group as part of the curriculum. Results Survey and focus groups identified themes of 1) lack of comfort with communication skills in difficult encounters, and 2) desire for more feedback and practice with these encounters. Five hundred surveys were collected on 36 interns using the CAT prior to the intervention. A 5-point likert scale was graded as 5 or non-5 scores. Residents performed most poorly in discussion of next steps (38% non 5) and in showing interest in families’ ideas of their children's health (28% non 5). Discussion There are self- and patient-identified performance gaps in many pediatric interns, underscoring the need for formalized curricula to teach skills specific to communication in pediatrics, particularly with emphasis on shared decision making and teach back methods. Narrative feedback from resident curriculum participants has demonstrated increased confidence and comfort levels with difficult communication. Future directions include assessment of the patient and family impact of this curriculum using follow-up CAT surveys.

Does family communication moderate the association between adverse childhood experiences and emotional and behavioural problems?

BackgroundAdverse childhood experiences (ACEs) and poor family support and communication can increase emotional and behavioural problems (EBP). Therefore, we assessed the association of difficult communication with mother and with father separately with both emotional and behavioural problems (EBP), and whether adolescents’ communication with mother and with father moderates the association of adverse childhood experiences (ACE) with the EBP of adolescents.MethodsWe used data from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia, comprising 5202 adolescents aged from 11 to 15 (mean age 13.53; 49.3% boys). EBP were measured using the Strengths and Difficulties Questionnaire. We used generalized linear regression adjusted for age, gender and family affluence to explore the modification of the associations between ACE and EBP by communication (easy vs. difficult communication) with mother and father.ResultsDifficult communication or a complete lack of communication due to the absence of mother and father increased the probability of emotional (exp (b): 0.96, 95% CI: 0.92|1.00; and 0.95, 95% CI: 0.91|0.99, respectively) and also of behavioural problems (exp (b): 0.96, 95% CI: 0.92|1.00; and 0.94, 95% CI: 0.90|0.97, respectively). We found a statistically significant interaction of communication with father on the association of ACE with EBP, showing that the joint effects were less than multiplicative.ConclusionDifficult communication with mother and father is related to EBP among adolescents, and adolescents’ communication with father moderates the association of ACE with both emotional and behavioural problems among adolescents.

Elaboration and validation of a simulation scenario for communicating institutional bond termination in nursing

Objetivo: Construir um cenário de simulação clínica para o ensino de comunicação difícil no desligamento institucional na equipe de enfermagem e validá-lo frente à face e conteúdo por peritos da temática. Métodos: Estudo observacional metodológico, que proporcionou a avaliação do cenário de simulação clínica por 17 peritos da área. Os dados foram coletados e processados por um sistema de internet clouds. Resultados: A versão final deste cenário de simulação clínica foi aprimorado, conforme as sugestões dos peritos, ao incluir tópicos relacionados a o título do cenário, aos objetivos educacionais, a descrição do pré - briefing, um fluxograma do design, ao protocolo de desligamento, o modelo do debriefing e as referências do cenário. Sendo ao final, validado frente à face-conteúdo com um nível de concordância de 94,6%. Conclusão: O cenário de simulação clínica está validado e integralmente disponível para a utilização e promoção do ensino da temática em sua população-alvo, para o ensino de comunicação difícil no desligamento institucional.

Performance Evaluation of Routing Protocols in Vehicular Ad-Hoc Networks (VANETs): A Comparative Study

VANET is a novel way for fast-moving autos to connect. VANET provided traffic engineering, management, emergency information to avoid accidents, and other user applications. VANETs are similar to Mobile Ad hoc Networks (MANETs), but they have fast speeds, mobility, adequate storage and processing power, unexpected node density, difficult communication environments with limited connection lifespans, etc. Hence, VANET protocol testing needs realism. Vehicular Ad hoc Network (VANET) is a new communication paradigm that allows road network V2V and V2I communication (V2I). It supports traffic engineering, emergency information transfer, and other user applications. Vehicular networks distribute data about road traffic conditions to keep vehicles safe and efficient. VANET Applications' characteristics—different network density, fast vehicle movement—make data dissemination difficult. Performance requirements determine these protocols' vehicle area network applicability. Vehicles talking with each other and roadside units constitute Vehicular Ad-Hoc Networks (VANETs), a specific type of MANET (RSUs). VANETs allow safety, traffic management, and infotainment. Due to vehicle mobility and frequent network topology changes, VANETs have routing difficulties. This paper compares VANET routing protocols. . Simulations reveal that mobility pattern, network density, and traffic load affect protocol performance.

Crisis Symptom Management and Patient Communication Protocols Are Important Tools for All Clinicians Responding to COVID-19

Symptom management and skilled communication with patients and families are essential clinical services in the midst of the coronavirus disease 2019 pandemic. Although palliative care specialists have training in these skills, many frontline clinicians from other specialties do not. It is imperative that all clinicians responding to the coronavirus disease 2019 crisis have access to clinical tools to support symptom management and difficult patient and family communication.

Effectiveness of a Multiprofessional, Online and Simulation-Based Difficult Conversations Training Program on Self-Perceived Competence of Oncology Healthcare Provider Trainees.

Effective communication between healthcare providers (HCPs) and patients is important for HCP well-being, patient engagement, and health outcomes. Yet, HCPs do not receive adequate communication skills training and report feeling unprepared for difficult conversations. A needs assessment of 64 cancer HCP trainees in Toronto, Canada, found that a majority of trainees rated themselves with low competency in communication skills to support patients through difficult conversations, while nearly all rated these skills as important to their practice. A blended multiprofessional communications program was developed including online theoretical learning and reflective practice in addition to in-person simulation with standardised patient actors. Since communication skills mastery is highly unlikely to occur at the termination of a single training program, the goal of the program was to stimulate participants' motivational beliefs about difficult conversations communication skills in order to deepen their commitment to learning and mastery. The motivational beliefs assessed included self-efficacy (self-perceived competence), intent to use techniques learned, and confidence in task mastery. After completing the course, participants' self-perceived competence in dealing with difficult conversations significantly increased by an average of 25 points (p < 0.001) on a rating scale of 1-100 (n = 40). Participants' intent to use techniques did not change significantly and remained high with an overall average of 89 points. After the course, participants rated their confidence in mastering techniques learned at an average score of 71 points. Multiprofessional, simulation-based training is an effective way to improve HCP trainees' motivational beliefs around having difficult conversations.

Improving difficult airway communication – strengthening anaesthesia’s “Achilles’ heel”

Improving difficult airway communication – strengthening anaesthesia’s “Achilles’ heel”

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.

Speaking Clearly for Older Adults With Normal Hearing: The Role of Speaking Rate.

Purpose Talkers typically use a slow speaking rate when producing clear speech, a speaking style that has been widely shown to improve intelligibility over conversational speech in difficult communication environments. With training, however, talkers can learn to produce a form of clear speech at normal speaking rates that provides young listeners with normal hearing much of the same intelligibility benefit. The purpose of this study was to determine if older listeners with normal hearing can also obtain an intelligibility benefit from clear speech at normal rates. Method Eight older listeners (55-68 years of age) with normal hearing were presented with nonsense sentences from 4 talkers in a background of speech-shaped noise (signal-to-noise ratio = 0 dB). Intelligibility (percent correct key words) was evaluated for conversational and clear speech produced at 2 speaking rates (normal and slow), for a total of 4 conditions: conv/normal, conv/slow, clear/normal, and clear/slow. Results As expected, the clear/slow speaking condition provided a large and robust intelligibility advantage (23 points) over conv/normal speech. The conv/slow condition provided almost as much benefit on average (21 points) but was highly variable across talkers. Notably, the clear/normal speaking condition provided the same size intelligibility advantage (14 points), previously reported for young listeners with normal hearing (Krause & Braida, 2002), thus extending the benefit of clear speech at normal speaking rates to older normal-hearing listeners. Conclusions Applications based on clear/normal speech (e.g., signal processing approaches for hearing aids) have the potential to provide comparable intelligibility improvements to older and younger listeners alike.

Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis.

Principles of treat-to-target (T2T) have been widely adopted in both multinational and regional guidelines for rheumatoid arthritis (RA). Several questionnaire studies among physicians and real-world data have suggested that an evidence–practice gap exists in RA management. Investigating physician adherence to T2T, which requires a process measure, is difficult. Different practice patterns among physicians are observed, while adherence to protocolized treatment declines over time. Rheumatologist awareness, agreement, and claims of adherence to T2T guidelines are not always consistent with medical records. Comorbidities, a difficult disease course, communication barriers, and individual preferences may hinder an intensive, proactive treatment stance. Interpreting deviations from protocolized treatment/T2T guidelines requires sufficient clinical context, though higher adherence seems to improve clinical outcomes. Nonmedical constraints in routine care may consist of barriers in healthcare structure and socioeconomic factors. Therefore, strategies to improve the institution of T2T should be tailored to local healthcare. Educational interventions to improve T2T adherence among physicians may show a moderate, although beneficial effect. Meanwhile, a proportion of patients with inadequately controlled RA exists, while management decisions may not be in accordance with T2T. Physicians tend to be aware of current guidelines, but their institution in routine practice seems challenging, which warrants attention and further study.

Integration of Prioritisation Criteria in the Design of Energy Efficient Retrofitting Projects at District Scale: A Case Study

The evident need for improving the existing building stock still suffers from important barriers, such as the fragmentation of the value chain, the lack of information regarding some solutions, and the lack of confidence with respect to energy savings, which prevent unlocking investments, and the difficult communication among stakeholders. Therefore, new processes based on exploiting the potential of existing and new tools are required. In this framework, the OptEEmAL project has developed a tool that integrates stakeholders, data and tools in order to ease the process of designing energy efficient retrofitting projects at building and district scale. This tool works around an optimisation framework in order to evaluate, compare and optimise candidate retrofitting scenarios against a set of indicators showing the performance of the district. This evaluation and optimisation method is based on aggregating indicators through transforming the priorities of stakeholders into a mathematical weighting scheme, which makes it possible to provide scenarios within their expectations. Therefore, the generation of these scenarios is driven by their design parameters, being thus flexible and adapted to their needs. This paper shows the implementation of this tool and specifically 3 different prioritisation schemes, analysing how they impact into the decision making process and selection of the retrofitting strategy.

Measuring the outcomes of volunteering for education: development and pilot of a tool to assess healthcare professionals’ personal and professional development from international volunteering

ObjectiveThe development and pilot of a self-report questionnaire, to assess personal and professional development of healthcare professionals gained through experiences in low-income and middle-income countries.DesignThe instrument was developed from a...

医療職における困難な対人コミュニケーション場面の認知 : 理学療法士・作業療法士の場合

医療職における困難な対人コミュニケーション場面の認知 : 理学療法士・作業療法士の場合

Aspect of pedestrian safety at road intersections with traffic lights

The Processes of Globalisation, mobility of the society, modernization of transport infrastructure, the desire to own means of transport contribute to the increased number of road vehicles and many transport problems. These include, above all, the occurrence of transport congestion, which in turn is the source of further problems of road transport systems. Environmental pollution, increased noise, occurring traffic hazards, difficult communication has a negative impact on the functioning of users of urban transport systems. In contrast to the increasing expectations of users of urban transport systems, systems supporting their safety and increasing the capacity of transport networks come out. One of the examples of the system is traffic lights. The implementation of this system allows for safer movement of individual road users, including pedestrians. The article discusses the problem of pedestrian safety in road traffic. The analysis of police statistical data on the number of accidents and their effects with the participation of pedestrians was presented. In addition, the results of research on the subjective assessment of pedestrian safety at road intersections using traffic lights are present-ed. The method of direct interview involving pedestrians as participants of road traffic was used.

Teach-In: Positive Responses during Divisive Times

ABSTRACTIn response to the well documented divisiveness throughout the 2016 presidential campaign, faculty members at one university developed a “teach-in” to help students identify and respond to the resulting difficult communications in positive ways. This was accomplished through planned activities implementing micro/macro theories and skills. In March 2017, as part of Social Work Month, 71 BSW and MSW students participated in a Teach-in event. Paired sample t-tests showed significant differences between pre-post test scores on seven measured items. The teach-in appeared to be successful in increasing student preparedness to talk to individuals with differing political opinions through self-reflective participatory exercises related to their own (and conflicting) political perspectives, knowledge related to understanding contemporary political conflicts, and instruction on positively and professionally responding to divisive communications. Social work educators are important catalysts in helping students effectively respond to and advocate for those threatened during these divisive times. Teach-ins may also be an appropriate tool for addressing contemporary issues when curriculum requirements provide limited options for additional elective course offerings.