Making clear and effective communication SOuND BETTeR for patients with communication barriers

The consequences of ineffective communication between patients and clinicians in the ED range from frustration to significant adverse events. Unfortunately, scenarios where we are unable to understand what our patient is saying to us are common, due to a multitude of factors including acute illness, disability and patient diversity. Current communication aids can be difficult to access and use in the Emergency setting due to lack of physical resources, specific training and time. Our aim was to develop a communication tool which allowed for the rapid identification of urgent patient needs. In order to overcome current challenges, the tool had to be resource-light, quick to use and not reliant on additional staff training or patient education for its effective use. The SOuND BETTeR communication tool is a list of yes/no questions, formatted as a mnemonic, which aims to identify the most common and urgent needs of patients in the ED. As the list of potential needs is not exhaustive, the tool does not purport to replace formal communication aids in the medium and long term, but to bridge the gap often left in the ED where urgent needs must be met and more formal communication aids are not yet available. The tool can effectively and quickly identify important needs in patients with expressive communication barriers such as those with aphasia, facial trauma and on non-invasive ventilation. In addition, the tool can be modified for use in patients with non-English speaking backgrounds. At this stage the tool has not yet been prospectively validated.     

Factors that enable nurse-patient communication in a family planning context: a positive deviance study

BACKGROUND: Family planning programmes in developing countries need a better understanding of nurse-patient communication in order to improve the quality of counselling. OBJECTIVES: To identify factors in the clinic and in the community that enable nurses and patients to communicate effectively with one another. DESIGN: The study explored the personal experiences of nurses and patients who communicate especially effectively during family planning consultations (so-called "positive deviants"). SETTING: Sixty-four randomly selected public clinics located in East Java, Indonesia. PARTICIPANTS: Seven positive deviant nurses and 32 positive deviant patients were identified from among 64 nurses and 768 patients who participated in an earlier patient coaching study. Flooding prevented 5 patients from participating in the study, reducing their number to 27. METHODS: Investigators conducted: (1) a content analysis of qualitative data collected by structured in-depth interviews and focus-group discussions (FGDs) with positive deviant nurses and patients, and (2) analyses of variance (ANOVA) of quantitative data on clinic, nurse, and patient characteristics. RESULTS: Positive deviant nurses identified four factors, listed in rough order of importance, that helped them communicate effectively: independent study to strengthen their knowledge and skills; communication aids; feedback from colleagues; and motivation stemming from a desire to help people, patients' appreciation, husband's support, and increased income. Positive deviant patients identified five enabling factors: motivation due to their need for a service; confidence in their own communication skills; positive feedback from nurses; belief in patients' right and responsibility to communicate with nurses; and communication aids. CONCLUSIONS: Insights from positive deviant nurses and patients suggest that efforts to improve nurse-patient communication should go beyond conventional communication skills training. Managers should consider a mix of clinic-based interventions (such as peer feedback, communication aids, and better management of patient flow) and community-based interventions (such as patient education and mass media).     

The ADL ability and use of technical aids in persons with late effects of polio.

OBJECTIVE: The purpose of this study was to describe functional performance in activities of daily living (ADL) and the use of technical aids among persons with late effects of polio. METHOD: Abilities in ADL of 150 participants 20 to 82 years of age were assessed with the Sunnaas Index of ADL, and the participants' use of technical aids was recorded. RESULTS: The activities in which most participants were independent were eating, daily hygiene, and communication. Many needed technical aids, adaptation of their homes, or both to perform mobility-related activities and to dress or undress, take a bath or shower, cook, or manage toilet visits. In total, 86 (57%) used mobility aids such as canes, crutches, and walkers. Thirty-one (21%) used wheelchairs within or outside the home. Bath and shower aids were the most commonly used technical aids other than mobility aids. The activity where most participants depended on others was housework. CONCLUSION: In spite of their disabilities, most participants performed well in many ADL, functioning independently by using technical aids and by living in an adapted environment.     

Fitting hearing aids with the Articulation Index: impact on hearing aid effectiveness

Although most clinical tests focus on how much a particular hearing aid improves speech audibility under controlled conditions, it is unclear how these measures relate to hearing aid effectiveness, or the benefit perceived by the patient under everyday conditions. In this study, the relationship between audibility and hearing aid effectiveness was examined in a cohort of patients who obtained hearing aids through the Veteran's Administration. The measure of audibility was the Articulation Index, a common index of speech audibility. Measures of effectiveness included two hearing-specific surveys and self-reported ratings of global satisfaction and hearing aid use adherence. Results indicated that there were no systematic relationships between measurements of improved audibility and patient ratings of communication ability. Additionally, improved audibility was not related to overall satisfaction with the amplification characteristics of the hearing aid (fitting). However, improved audibility is related to hearing aid use adherence, with patients who achieve better audibility reporting that they use their hearing aids more frequently.     

New developments in hearing aid technology

The last decade has seen numerous and significant improvements in hearing aid technology. Digital hearing aids are becoming increasingly common and have already replaced a considerable portion of the hearing aids using the older analogue technology. Efficient noise reduction methods, most notably multi-microphone systems for hearing aids, can increase speech intelligibility in adverse listening situations and noisy environments. Accessories, such as e.g. wireless classroom communication systems (FM systems) and remote controls are becoming smaller and less visible. As a consequence of the increased complexity of modern hearing aids, however, hearing aid fitting has become considerably more complex.     

Putting the “Informed” in the informed consent process for implantable cardioverter‐defibrillators: Addressing the needs of the elderly patient

Implantable cardioverter defibrillator (ICD) management complexities challenge the ethos of fully informed consent, particularly for the typically multimorbid elderly patient considering the device for primary prevention. The Heart Rhythm Society recommends providers include discussion on the potential need for later device deactivation or nonreplacement at the time of first implant, and to revisit this at appropriate intervals. The initial consent procedure could meet this standard by incorporating the future need to discuss further such issues when the recipient's clinical condition changes to such an extent that defibrillation would no longer be beneficial. At the time of obtaining consent, some patients may lack the will or capacity to make medically complex decisions when it would be necessary for healthcare surrogate decision‐makers to contribute to this process. Ensuring an appropriate level of understanding and response may be enhanced by the use of information and decision aids. With improved communication regarding the nuances of ICD therapy, device eligible patients, and those close to them, will be empowered with a better understanding of the nature, benefits, and risks of ICD implantation, allowing them to make treatment decisions consistent with their values.     

Identifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams

Background

The application of non-technical skills (NTSs) in health care has previously been described in other health-care educational programmes. NTSs are behavioural principles such as leadership, task distribution and communication. The aim of this study was to identify NTSs suitable for improving team performance in multi-professional cardiac arrest teams, and to describe barriers to the use and implementation of such NTSs by using a qualitative method.

Methods

Individual semi-structured interviews were conducted with 11 Danish Advanced Life Support instructors during the period April 2006 to November 2006. Interviews were focussed on barriers and recommendations for teamwork in the cardiac arrest team, optimal policy for improvement of resuscitation training and clinical practice, use of cognitive aids and adoption of European Resuscitation Council (ERC) Guidelines 2005. Interviews and data analysis were supported by a template describing 25 NTSs derived from other educational programmes in health care.

Results

A framework with five categories relating to NTSs was identified: leadership, communication, mutual performance monitoring, maintenance of standards and guidelines and task management. Important barriers that were identified were inexperienced team leaders, task overload and hierarchic structure in the teams’ inability to maintain focus on chest compressions.

Conclusion

Interview participants pointed out that NTSs of teams could improve the treatment of cardiac arrest, but several barriers to this exist. Improving resuscitation training should include considerations regarding team leader experience, structured communication, mandatory use of cognitive aids, avoidance of task overload and mutual performance monitoring to avoid unnecessary interruptions in chest compressions.     

Occupational therapists' views about the use of robotic aids for people with disabilities

The use of robotic aids for persons with disabilities has potential benefits both in terms of cost cutting and improved health care. This article reviews robotic aids currently in use and reports the results of a survey of 51 occupational therapists at four hospitals offering rehabilitation services for patients with spinal cord injuries: Therapists were generally positive about the use of robotic aids and expressed interest in learning more about this technology.     

Comparison of three computer scanning modes as an interface method for persons with cerebral palsy.

Occupational therapists are becoming increasingly involved with interface assessments. This involvement is improving the ability of persons with physical disabilities to interact with computers, augmentative communication aids, and other devices. The ability to use these devices facilitates participation in activities that would otherwise be much more difficult to pursue, such as communication, education, work, and recreation. The purpose of the present study was to systematically compare three basic modes of scanning--automatic, inverse, and step--with the use of a single-subject experimental design. Six subjects--3 with spastic and 3 with athetoid cerebral palsy--from a local school volunteered for the study. Results indicated that the 3 subjects with spastic cerebral palsy had the greatest difficulty using the automatic scanning mode. The 3 subjects with athetoid cerebral palsy had the most difficulty using the step scanning mode. The results of this study suggest that clients should attempt each scanning mode and that their performance with each mode be compared to ensure the most appropriate recommendations.     

Technology in the education of multiply-handicapped children

The number of technical aids now available has allowed severely multiply-handicapped children to better participate in their education. Project TEACH (Technical-Educational Aids for Children with Handicaps), a 3-year early childhood demonstration project of the Federal Office of Education, provided ten children with seating systems, mobility aids, feeding devices, and augmentative communication aids. The children's performance of academic, motor, daily living, and communication skills as they relate to their educational program is reported as well as the model used to deliver technical services in an educational environment.     

Individualization of compliance

Almost half of all prescribed drugs is taken by patients in an incorrect way, in a deficient way or not at all. Reasons for such an insufficient compliance behavior are multifaceted. In order to optimize patients' compliance, an individualized approach is necessary which requires both medical intervention and preventive measures. In the present article tools are described that may assist the physician in optimizing individual compliance. Such strategies are information, communication and verbal contract, treatment plan, auxiliary aids and follow-up appointments.     

Scientific presentation

To give a correct and effective scientific presentation, is an arduous task that asks for close examination of basic techniques of communication. This article proposes indications and suggestions to help public speakers to be communicators, to use visual aids and it explains how to capture the audience attention.     

Physical medicine respiratory muscle aids to avert respiratory complications of pediatric chest wall and vertebral deformity and muscle dysfunction

The purpose of this article was to describe the use of noninvasive inspiratory and expiratory muscle aids to prevent chest wall deformities including pectus excavatum, to prevent respiratory complications of vertebral surgery, to prevent acute and long-term ventilatory insufficiency and failure in children with paralytic disorders who develop these deformities, and to permit the extubation and tracheostomy tube decanulation of "unweanable" patients. Noninvasive airway pressure aids can provide up to continuous ventilator support for patients with little or no vital capacity and can provide for effective cough flows for patients with severely dysfunctional expiratory muscles. An April 2010 consensus of clinicians from 20 centers in 14 countries reported over 1500 spinal muscular atrophy type 1 (SMA1), Duchenne muscular dystrophy (DMD), and amyotrophic lateral sclerosis (ALS) patients who survived using continuous ventilatory support without tracheostomy tubes. Four of the centers routinely extubated unweanable DMD patients so that none of their over 250 such patients has undergone tracheotomy.     

Identifying the 'right patient': nurse and consumer perspectives on verifying patient identity during medication administration

Accurate verification of patient identity during medication administration is an important component of medication administration practice. In medical and surgical inpatient settings, the use of identification aids, such as wristbands, is common. In many psychiatric inpatient units in Victoria, Australia, however, standardized identification aids are not used. The present paper outlines the findings of a qualitative research project that employed focus groups to examine mental health nurse and mental health consumer perspectives on the identification of patients during routine medication administration in psychiatric inpatient units. The study identified a range of different methods currently employed to verify patient identity, including technical methods, such as wristband and photographs, and interpersonal methods, such as patient recognition. There were marked similarities in the perspectives of mental health nurses and mental health consumers regarding their opinions and preferences. Technical aids were seen as important, but not as a replacement for the therapeutic nurse-patient encounter.     

Acknowledging communication: a milieu-therapeutic approach in mental health care

Title. Acknowledging communication: a milieu‐therapeutic approach in mental health care Aim. This paper is a report of a study to develop milieu therapists’ acknowledging communication in their relationships with patients. Background. Gunderson’s therapeutic processes in milieu therapy have come into use in a broad range of mental health contexts in many countries. Research in nursing indicates that validation needs a more concrete development for use in clinical work. Methods. Schibbye’s theory, ‘Intersubjective relational understanding’, formed the theoretical foundation for a participatory action research project in 2004–2005. The data comprised the researcher’s process notes written during participation in the group of group leaders every second week over a period of 18 months, clinical narratives presented by participants in the same group, and eight qualitative interviews of members of the reflection group. Findings. The core concept in acknowledging communication, mutuality, was described as inter‐subjective sharing of feelings and beliefs in a respectful way. Participants presented their process of development as a movement from knowing what was best for the patient (acknowledging patients as competent persons, a milieu‐therapy culture based on conformity), to appreciating diversity and stubborn talk, to reflective wondering questions. Misunderstanding of acknowledgement occurred, for instance, in the form of always being supportive and affirmative towards patients. Conclusion. The concrete approaches in acknowledging communication presented in this article could be a fruitful basis for educating in and developing milieu therapy, both for nursing and in a multi‐professional approach in clinical practice and educational institutions. Future research should focus on broader development of various areas of acknowledging communication in practice, and should also include patients’ experiences of such approaches.     

Unidentified communication challenges in the intensive care unit: A qualitative study using multiple triangulations

BackgroundCommunication in the intensive care unit is challenged by patients’ inability to speak owing to intubation, treatment, and illness. Research has focused on the use of communication tools or techniques, characteristics of the communication between patients and clinicians, and their experiences of communication challenges. However, few studies have combined the perspectives of patients, family members, and clinicians. We explored communication from different angles and investigated challenges that cannot be explained by ineffective use of aids and communication techniques.ObjectivesThe aim of this study was to explore communication between patients, family members, and nurses and to investigate previously unidentified communication challenges.MethodsThis study used a case-oriented design with multiple triangulations. It was conducted in two general intensive care units at a Norwegian university hospital. Participant observations were conducted on nine mechanically ventilated patients while communicating with family members and healthcare personnel. Following the observations, individual interviews were conducted with six patients, six family members, and nine healthcare personnel.FindingsCommunication often seemed uncomplicated at the time of observations, but information from the interviews revealed another picture. We demonstrate what participants emphasised differently when they discussed their experiences, revealing a discrepancy in perceived importance in the situation. Family members had an important role in interpreting signs from the patient, uncovering challenges that would have been unknown to the nurses otherwise.ConclusionsThis study illustrates how communication challenges in the intensive care unit may not be perceptible to an observer or to all of the participants involved at the time of the communication. Nurses need to be aware of these communication challenges and realise that the patient might face issues that cannot be easily solved without extensive involvement of the patient, family, and nurses, and perhaps not even until a later stage in the patient's recovery process.     

作业疗法结合自助具训练对偏瘫患者上肢功能的影响

目的:观察作业疗法结合自助具训练对偏瘫患者上肢运动功能及日常生活能力的影响。方法:偏瘫患者50例随机分为2组各25例,均给予Bobath疗法及神经肌肉功能电刺激等常规康复训练,观察组在此基础上加用作业疗法及自助具训练。治疗前及治疗1、3个月后,采用Fugl-Meyer(FMA)评定量表评定患者上肢综合运动功能,Barthel(BI)指数评定日常生活能力。结果:治疗1个月后,2组BI评分均较治疗前明显提高(P<0.05),且观察组明显高于对照组(P<0.05);但FMA评分2组治疗前后差异无统计学意义。治疗3个月后,2组BI及FMA评分均较治疗前明显提高,且观察组更高于对照组(P<0.05)。结论:作业疗法结合自助具训练在改善偏瘫患者上肢运动及日常生活能力方面具有较好的疗效,有利于患者重返家庭,回归社会。     

Experiences of physical strain during person transfer situations in dementia care units

Caring for residents with dementia impose a higher challenge and workload on the nursing staff because of a higher degree of motor function and cognitive decline among the residents. Training in person transfer tasks for nursing staff has mostly been concentrated on ergonomics irrespective of the nature of the resident's functional decline. An increased knowledge about the nursing staffs' experiences of physical workload in dementia care and in how to reduce their physical strain is needed.
Aim:  The aim of the study was to describe nurse's aids' experiences of physical strain during person transfer tasks at dementia care units.
Method:  Four focus group interviews with altogether 16 nurses' aids, working at special care units for people with dementia, were performed.
Results:  The results show that knowledge about the disease and personality of residents in dementia care units can help to decrease the physical strain on nurses' aids in person transfer situations.
Nurse's aids need to be flexible when performing transfer tasks to accommodate variations in the resident's functional ability. Physical strain associated with person transfer tasks is not related to the weight of the resident. Misunderstandings because of cognitive decline and communication problems increase physical strain on nurses' aids. Specialized training in person transfer tasks is needed for nurse's aids working in dementia care.
Conclusions:  These results may serve to guide physiotherapists working in dementia care units in assessing residents' functional ability, in when to use assistive devices and mobility aids and in training and supervising nurse's aids in person transfer tasks.