Chapter 21 - The communication process

The objectives of the research were (1) to discover which mode of nonverbal communication did visitors most frequently use to communicate with non-native English-speakers countries and vice versa, (2) to know which mode of nonverbal communication did the visitors most rarely use to adapt to non-native English-speakers countries and vice versa, (3) to describe non-native English-speakers’culture when the visitors used nonverbal communication with them. Th e method of the research was descriptive. The research used content validity. The subjects of the research were 54 people taken from the second semester of Batam Center students of University of Riau Kepulauan majoring in English Education Department consisted of 28 students; 5 non-native English-speakers countries (European one) and 21 online respondents of 204.666 members of Backpacker International public group site. The data were collected through observation and interview then analyzed by SPSS 24 version on the base of Little John’s modes of nonverbal communication (2009). The results of the research were (1) 74.1% (kinesics/body language) was the most frequently used; (2) 75.9% (haptics/touch) was the most rarely used; (3) 180 degree of space when Nns met the visitor for the first time (proxemics/space), Nns barely used the touch unless for specific reason (haptics/touch);often used eye contact when focused on something, punctual (chronemics/time), flat face tended to be cold and rarely used gestures if not necessary (kinesics/body language), in the center city, women were more fashionable, average body liked their height got many benefits (physical environment-appearance). Like all Euroepan, Nns tended to speak faster and not clear enough (paralanguage/vocalics). In brief, the faster visitors could adapt to them the faster NNs opened themselves to the visitors.

Developing an International Core Outcome Set for SSD Interventions

Color lines: Disparities in pharmacy treatment, education, and practice

The challenges of COVID-19 for people with dementia with Lewy bodies and family caregivers.

Cybersecurity vulnerabilities of cardiac implantable electronic devices: Communication strategies for clinicians—Proceedings of the Heart Rhythm Society's Leadership Summit

Health Care Infrastructure Post-Katrina: Disaster Planning to Return Health Care Workers to Their Home Communities

Background: The interpersonal relationship between the nurse and other health care providers is poor. Moreover, the ineffective therapeutic communication skills within the health team are the bane to effective and efficient health care delivery system. Nurses, as members of the health team are supposed to communicate information about the client to other members of the team to enable them carry out a comprehensive plan of care, though this is found wanting. The lack of knowledge of the factors that influence or inhibit effective communication among health care providers contribute to the lopsided health care delivery system. Methods: A review of the process of communication in the nursing process utilizing relevant texts and papers obtained by manual/Medline search. Results: This paper reviews the process of communication, its skills in the nursing process which involves the client's family and other health care professionals in identifying the health care needs of the client. Factors that influence or inhibit effective communication is discussed. Effective communication establishes good working relationships between the nurse, client and other health care providers. Thus, this promotes client's well-being and reduction of death rates in our hospitals. Conclusion: Effective communication is necessary for the nurse's role in helping the client to adapt to the changes resulting from health alterations. Nursing is a communicative interaction and it is believed that the foundation of nursing lies in the communicative attitude. It is a fact that failure to communicate leads to serious problems that can threaten professional credibility. Keywords: Communication, Interpersonal, Relationship, Nursing care. Port Harcourt Medical Journal Vol. 1 (2) 2007: pp. 87-89

The Mig-HealthCare consortium conducted a qualitative study of the health care needs of vulnerable migrants/refugees in Europe. The research was conducted between Fall 2017 and Spring 2018. In total, 20 focus group discussions or, where necessary individual interviews (19), were organised with health care professionals and service providers; policymakers; and representatives from Non-Governmental Organisations - NGOs. Thematic qualitative analysis was employed. The main results of the analysis show that: Health care provision for migrants is uneven throughout the EU and variations exist even within the same country. Health care providers and NGOs agree that health care for migrants is inadequate and biased in favour of particular conditions and cases (minors, pregnant women and acute conditions). Challenges faced by different countries vary; while in some countries the main issue is legal access, in other basic needs such as sanitation and basic infrastructure were emphasised. Austerity measures following the 2008 financial crisis have negatively affected the health care system in general, which in turn has negatively affected the provision of health care for migrants/refugees. Discrimination linked to socio-economic and ethnic conditions is reported as a barrier to equal health care access. Knowledge, language and communication on both the demand and the supply side of health care provision emerge as crucial to ensure equal access for migrants/refugees. Gender may act as a barrier with women tending to be more marginalised in the host country, in terms of language proficiency and health literacy, lowering health care access. One of the main challenges for providing equal health care access for migrants has to do with the ability to balance a universal right to health with the particular means of achieving it. The evidence collected here shows how this tension between end and means is at work in different moments of the provision of health care for migrants/refugees.

Building the patient–clinician relationship through conversation based on narrative approaches

Cancer is a key priority worldwide, and caring for children and young people with cancer requires a range of specific knowledge, skills and experience in order to deliver the complex care regimes both within the hospital or community environment. The aim of this paper is to disseminate work undertaken to design and develop pedagogical practice and innovation through an eLearning resource for health care professionals caring for children and young people with cancer across the globe. The work undertaken evaluated an existing cancer course (which has been withdrawn) that was developed and delivered through the Paediatric Oncology Nurses Forum, Royal College Nursing (Nurse Educators) and Warwick University. The evaluation consisted of 26 open and closed questions relating to the previous resource and was circulated to all health and social care professionals involved directly within specialist oncology services through the Children's Cancer and Leukaemia Group. Questionnaires were sent out to a convenience sample of 773 health care professionals and the response rate was 14%. The findings identified that the course was predominantly accessed by nurses, but other health care professionals also found it useful. Participants highlighted several areas where they believed content could be developed or was lacking. This included areas such as palliative and end of life care, nutrition, sepsis and teenagers and young people. This feedback was then used to develop a site dedicated to the care of children and young people with cancer.

Introduction/Problem statement: Providing quality health care remains a challenge in many low and middle-income countries. The challenges are two-fold: quality of care is often narrowly defined in biomedical terms or technical effectiveness and, health care delivery systems are fragmented in poorly connected subsystems such as preventive and curative care, primary care and disease control programs, health and social care. Additionally, health care providers, health managers and policy makers are mostly trained within a biomedical health framework and often lack experience with people-centred and integrated care.Description /Aim of the intervention: The Institute of Tropical Medicine in Antwerp, Belgium, attempts to address this training gap in its international one-year Master in Public Health programme (1). Every year about forty experienced health professionals from Africa, Asia, Latin America and Europe are taught concepts and models pertaining to the analysis, planning, organization and evaluation of local health systems and their interactions with social services in the four-week course component on “Local Health Systems”. This course endorses people-centred and integrated health and social care as cornerstones of quality health care and aims to enable its participants to understand the strengths and weaknesses of dominant biomedical paradigms and to develop a more holistic vision on health care. Students are expected to use comprehensive models for the analysis of (local) health systems and the organization of health services.To reach these learning outcomes the course uses methods for adult learning that emphasize a participatory approach. The diversity of the participants, in terms of professional experience and academic background, constitutes a unique and rich opportunity for meaningful exchanges and experiential learning. The concepts and models on people-centred and integrated health and social care are taught through different learning activities such as interactive lectures, critical reading of scientific papers and real life case studies introduced by a Belgian general practitioner. In parallel, students are coached in a personal assignment in which they analyse the quality of health care in a local health system in their own or a known context. In this application participants are expected to gain further insights and develop a set of analytical skills from the exchange with their peers, coaches and lecturers.Beyond classroom learning, participants are also given the chance to observe the process of people-centred care in first-line health services and to interview key stakeholders such as doctors, nurses, social workers and psychologists in various Belgian municipalities. This study visit also includes the Public Centres of Social Welfare and other frontline social services. The objective of the visit is to illustrate the complementarity of the health and social sub-sectors in ensuring global and integrated health care. Participants are made aware of the need to go beyond exclusive biomedical answers to adequately address the problems people present with at general practice level.The participants are assessed in several activities: first, they present and discuss their personal analysis of a known local health system with peers and staff; after the study visits they share their analysis of the quality of care and the contribution of the social welfare system to people-centred health system; and finally the participants identify lessons from the Belgian situation that are relevant to their own local health systems and share these reflections in individual blogs. The presentations in the seminars and the blog writing exercise facilitate meaningful interactions amongst participants whilst enhancing their communication skills.Findings/Highlights: Following the training, most participants understand the comprehensive and systemic characteristics of people-centred and integrated health care; as well as the importance of including the social sector when organizing health services at local level. Interesting statements obtained from feedback sessions and blogs are: _“ I experienced a shift in the way I think about the organization of health services to provide quality health care”_,“From the site visit […] I think there are four important elements that promote PCC (people-centred care): sufficient time, qualified personnel, privacy and looking beyond the bio-medical aspects (e.g. social security issues and system barriers) of a patient’s suffering ….”Conclusions: Adequate public health training that broadens the vision on quality of care and allows the development of comprehensive analytical skills can contribute reducing barriers to implementing people-centred and integrated health care. Although the findings obtained during this course are useful, more research is required to define the most desirable skills mix that public health professionals and caregivers should possess.

This study was conducted to gain an understanding of bereaved hospice family caregivers' perceptions of the communication process from initial discussion of the need for end-of-life care and hospice through the decision to choose hospice and the transition home. One hundred eight bereaved hospice caregivers that were 36 months postpatient death responded to a quantitative mailed survey. Aspects of the end-of-life care communication process, including involvement of health care professionals at each step, were assessed. Serious illness and the need for hospice care were first mentioned to patients and caregivers by physicians. Often the caregivers recalled only one meeting in which hospice was discussed. Other than the physicians, social workers were the professionals most often present in at least one of these meetings. Nurses and social workers were both perceived to be helpful in the transition to home hospice. Social workers were reported to be most comfortable with discussion of end-of-life care, most knowledgeable, and most available during the communication process that led to a decision about end-of-life care. Suggestions that these caregivers had to improve communication with health care professionals were categorized from responses to an open-ended survey question as: the need to discuss vital information earlier and what to expect for care at end stage; be more forthcoming about reality of death; and treat people as individuals. Although many health care professionals play a role in the communication and transition to hospice care, physicians and social workers were found to be pivotal participants in this process. A coordinated team approach to end-of-life communication and decision-making may facilitate the process and possibly lead to increased and earlier referral to hospice.

Describe and compare patients', next-of-kin's and healthcare professionals' perceptions of the quality of care in community mental healthcare services. Patients value family involvement in mental healthcare, but next-of-kin feel unprepared and lack the necessary skills to be supportive. Since healthcare professionals predominantly focus on patients, they may fail to understand the complex needs of families. Thus, the quality of community mental healthcare may vary across patients, next-of-kin, and healthcare professionals.Cross-sectional study with patients, next-of-kin and healthcare professionals in community mental healthcare services in Norway. 140 participants, of whom 43 are patients, 43 next-of-kin, and 56 healthcare professionals. Participants filled in the translated version of the Quality in Psychiatric Care - Community Out-Patient (QPC-COP), Community Out-Patient Next of Kin (QPC-COPNK), and Quality in Psychiatric Care- Community Outpatient Staff (QPC-COPS).Next-of-kin and healthcare professionals scored the overall quality of community mental healthcare lower than patients. All three perspectives reported the Encounter to be of high quality. Patients rated Discharge, next-of-kin rated Next-of-kin, and healthcare professionals rated Environmentas havingthelowest quality of care.Patients were generally more positive than the next-of-kin and healthcare professionals about the quality of community mental healthcare. Patients, next-of-kin, and healthcare professionals rated interpersonal relationship between patients and healthcare professionals as having the highest quality of care. However, lowest quality scores were given by next-of-kin regarding being respected and invited to take part, and by healthcare professionals regarding the patients' trust in the healthcare professionals, and feeling secure in their home environment. This is important knowledge for health authorities, leaders, and mental healthcare clinicians in developing and providing quality care.

The Team Physician: Ethical and Legal Issues

Introduction : In the Netherlands, citizens increasingly stand up to develop initiatives with each other in the community that attributes to to iving at home longer. One of the ways by which they achieve this, is by organizing health and welfare services themselves, for and by citizens, bases on engagement and reciprocity. Vilans recognized a trend in the rise of these citizens initiatives in (long term) health care, social care and welfare. Since February 2015, the number of citizens’ initiatives in which citizens organise their own welfare and health services rapidly increased from 63, up to a total of 174 initiatives today. What lies underneath this development and these initiatives? How do they work? Are there different perspectives of the involved people about the initiatives? To gain insight into the values of the different stakeholders groups involved around a citizens’ initiative for healthcare and welfare, Vilans has conducted narrative research in 2015 in two sites. Also, Vilans made an inventory of all initiatives in the Netherlands. Theory/methods : Through a qualitative multiple-case study, we conducted narrative research at two different citizens’ initiatives for healthcare and welfare in Lierop (village) and Zoetermeer (city). For each initiative, we collected stories from various stakeholders; 1.) directors/initiators 2.) volunteers/providers 3.) care recipients 4.) external stakeholders such as local authorities or health care professionals. Based on the methodology of narrative research, the stories have been interpreted together with the groups in workshops. The values have been identified and prioritized. In addition, the stakeholders have outlined distinctive characters per citizens’ initiative. Progress report : In our study, 171 stories have been collected at the two citizens’ initiatives. These stories served as inspiration and insight for identifying and prioritizing the values in each group. This has resulted in the three most important values per group per initiative. In addition, the groups have outlined 4 distinctive characters per citizens’ initiative, which provide insight into the perspectives of the stakeholders towards the initiative. The results show the initiatives are relevant and new stakeholders in integrated care, who are only on the starting point of their development. Discussion : The study results show that the two investigated citizens’ initiatives in healthcare and welfare are both different and unique, but the study mainly shows merely similarities concerning key values. The boards of both initiatives have prioritized values which are directed towards stimulation, self-direction? and willingness. No conflicting value types have been named by the different stakeholders within the citizens’ initiatives or between the two initiatives although the initiatives differ in their appearance. The prioritised values of the different groups in both citizens’ initiatives were focussing on growth and development. Citizen initiatives develop and gain new tasks: first experiences with purchasing care and delivering care by the initiatives are running. Conclusion : The role of citizens organizing themselves brings a new dimension in integrated care. As new players their voice of the local people changes collaboration in the health and social care. The initiatives are developing themselves, have common values as health and social care professionals in integrated care and want to collaborate with ‘formal care’. How to do this and which roles to fulfill (for instance purchasing care) are new challenges to discover the coming years in the already 176 initiatives. The narrative research method was an intensive but effective method for collecting experiences in different groups through new collaborations. The respondents were enthusiastic about participation because the research helped them in the conversation and further collaboration with each other. The joint designation of experiences and values by different groups supports new and existing collaborations within the citizens’ initiatives. The found similarities and differences in the values of the initiatives can be further developed and serve as a key content for further cooperation between citizens’ initiatives, local authorities and care and/or welfare organizations.