The Factors That Impact Communication and Communication Types in Healthcare. There are four basic communication styles: verbal, nonverbal, written, and visual. Verbal communication involves the exchange of spoken words and is essential to daily life. Nonverbal communication includes facial expressions, body movements, gestures, eye contact, touch, space, tone of voice, and pitch.
What are the Factors That Impact Communication and Communication Types in Healthcare
Effective communication in healthcare is critical for positive patient outcomes and is influenced by a variety of factors and communication styles. Key factors include cultural diversity, language barriers, physiological barriers, and the physical environment. Communication styles include verbal, nonverbal, written, and visual methods.
Factors That Impact Communication
When the message the sender transmits is what the receiver understands, clear and effective communication has taken place. However, elements that alter or affect communication can occur at any time during the process. Nurse leaders and managers must be aware of factors that can interfere with message transmission, including gender, generation, values and perceptions, personal space, environment, and roles and relationships.
Gender
Men and women commonly communicate differently: Typically, men tend to be assertive and more verbal, whereas women are more likely to collaborative and use nonverbal cues and metaphors (Marquis & Huston, 2015). In addition, men tend to talk more, disagree more, and focus on the issue rather than the person, whereas women overuse descriptive statements and qualifiers and more often relate personal experiences (Sullivan, 2012). Nurse leaders and managers can bridge the gen der gap by using gender-neutral language in all communication methods and being aware of how their own gender affects their communication style.
Generation
The nursing workforce is comprised of individuals spanning four different generations: veterans (1922 to 1945), baby boomers (1946 to 1964), generation X (1965 to 1981), and generation Y (1982 to 1999) (Murray, 2013). Each generation comes with its own unique characteristics, values, work ethic, communication style, and expectations of a work environment (Murray, 2013; Strauss & Howe, 1991). Nurse leaders and managers must identify and implement various communication strategies to reach all generations. For example, baby boomers prefer personal forms of communication, whereas generations X and Y are more comfortable with technology and favor electronic forms of communication.
Culture
A person’s culture can influence communication in many ways, whether because of the native language of the culture or because of verbal and nonverbal behavior variations. Nurse leaders and managers must be attentive to cultural differences in employees. In one study, health-care professionals identified the ability to adjust language, whether verbal or nonverbal, to the target audience as an important communication skill, whether communicating with patients and families or working in inter-professional and intra-professional teams (Suter et al., 2009).
Values and Perceptions
One’s own values and perceptions influence how one communicates. Patients, families, and other nurses may encode, send, receive, decode, and interpret messages differently based on their own value systems, life experiences, and worldviews. Nurse leaders and managers must consider differences in values and perceptions when communicating with patients, families, health-care providers, peers, and managers to avoid miscommunication and misunderstandings.
Personal Space
Personal space, or the space between parties when communication takes place, also influences communication. What one individual considers appropriate personal space, an amount that feels comfortable and safe, can differ dramatically from another person’s view (Hall, 1990; McLaughlin, Olson, & White, 2008). However, there are commonly accepted parameters for distance between persons communicating, depending on the situation.
Environment
Environment plays a major role in whether communication is effective, staff is productive, and teamwork is collaborative. Nurse leaders and managers should strive to create an environment that supports communication as a two-way dialogue in which people think and make decisions together and with minimal distractions (American Association of Critical-Care Nurses, 2016).
A supportive environment such as this allows patients and families to feel comfortable enough to share information, ask questions, and offer opinions. In addition, a healthy environment ensures that staff members feel more comfortable sharing ideas, asking questions, and offering solutions to problems. In contrast, a negative or unhealthy environment promotes one-way communication and a sense that staff and patients have little power.
Roles and Relationships
A nurse’s role and his or her relationships with others influence the communication process. Roles can influence the words people choose, their tone of voice, communication channel, and body language (Blais & Hayes, 2011). For example, nurses may choose a face-to-face method when communicating with patients and families but may use the telephone to communicate with health-care providers. Nurse leaders and managers often use a face-to-face method to communicate sensitive information to staff and e-mail to communicate policy changes.
To be an effective communicator, nurse leaders and managers must also adapt their communication style based on the ability of the individual—whether a patient, family member, or staff member—to process and comprehend the interaction (Smith, 2011). Often, noise occurs during transmission . Noise comprises the physical and/or psychological forces that can disrupt effective communication. Physical noise includes conspicuous environmental distractions, such as excessive sounds, activity, physical separation, and interruptions, that interfere with a per son’s ability to listen actively.
Psychological noise includes internal distractions, such as one’s values, stress and anxiety levels, emotions, and judgments that impede his or her ability to send or receive a message clearly. Nurse leaders and managers can prevent physical noise by creating a supportive environment with as few distractions as possible, as described earlier. Psychological noise can be reduced by encouraging staff to employ empathy for the patient. Physical touch and caring nonverbal cues also can help establish a calm atmosphere for a patient and his or her family.
Formal And Informal Communication
Communication in health care occurs along two different channels: formal and informal. Formal communication is described as “a type of verbal presentation or document intended to share information and which conforms to established professional rules, standards and processes and avoids using slang terminology” (“Formal communication,” 2014). Formal communication follows the line of authority in an organizational hierarchy (Marquis & Huston, 2015), and it also reflects the culture of the organization; communication is planned rather than allowed to occur randomly (Triolo, 2012).
Examples of formal communication that nurse leaders and managers may use include interviewing, counseling, dealing with complaints, managing conflict, evaluating, and disciplining (Sullivan, 2012). During the formal communication process, it is critical for nurse leaders and managers to maintain professionalism and be effective communicators by:
- Using plain, direct language and avoiding jargon
- Using familiar illustrations to get points across
- Listening objectively
- Keeping questions short
- Seeking frequent feedback
- Providing frequent feedback
On the other end of the spectrum, informal communication occurs among staff members at the same or different level in an organization with no formal lines of authority or responsibility (Marquis & Huston, 2015). Informal communication is a “casual form of information sharing typically used in personal conversations with friends or family members” (“Informal communication,” 2014).
Nurse leaders and managers may use informal communication when conversing with patients about personal business, such as children or pets. Informal communication is used for nurse managers and leaders to establish open lines of communication with staff and to create a culture in the workplace that allows employees to feel connected with each other (Parboteeah et al., 2010). One negative example of informal communication is the grapevine. Grapevine communication flows quickly and haphazardly at all levels of the organization and becomes more and more distorted as it moves along (Phillips, 2007).
Communication on the grapevine travels in multiple directions at a rapid speed and carries both positive and negative information. Misinformation can run rampant, thus causing low morale and decreased productivity. Nurse leaders and managers must monitor the grapevine and intervene quickly to provide accurate information to avert unrest and job dissatisfaction among employees.
Employees prefer regular communication from nurse leaders and managers, rather than hearing information through the grapevine (Triolo, 2012). To prevent grapevine communication, nurse leaders and managers must share as much information as possible with staff; the only information that should not be shared is information protected by law and ethics (Roussel & Swansburg, 2013).
Types Of Communication In A Health-Care Environment
Three types of communication come into play in a health-care work environment: organizational, inter-professional, and intra-professional. Nurse must understand and be able to apply all three when communicating.
Organizational Communication
Health-care systems must communicate important information, such as regulations, policies, and procedures. The goal of organizational communication is to convey the same message across the entire system. The ease with which communication flows through an organization has a great impact on the individual employee because it sets the tone for the climate of the working environment (Parboteeah et al., 2010). In fact, lack of effective communication at the organizational level can result in conflict and poor adherence to guidelines (Parboteeah et al., 2010; Pavlakis et al., 2011).
Various directions of communication may be used at the organizational level. Downward communication reflects the hierarchical nature of the organization (e.g., the sending of information by administrators to nurse leaders and managers or by nurse leaders and managers to staff). Downward communication includes directives to employees, expectations for employees, and performance feedback (Phillips, 2007; Sullivan, 2012).
Lateral communication is the sharing of information among nurse leaders and managers or other staff at the same level. Examples of lateral communication are coordination between units and services, information sharing, problem solving, and conflict management (Phillips, 2007). Communication with others in the organization that is not on the same level in the hierarchy is considered diagonal communication. This occurs, for example, when a nurse leader and manager communicate with the chief financial officer or the medical director (Phillips, 2007).
Finally, upward communication is the sending of information up the hierarchal chain (e.g., staff to the nurse manager or leader, or nurse leader and manager to higher level managers and administrators). Common instances of upward communication are requests for resources, sharing ideas or suggestions for improvement, and employee grievances (Phillips, 2007; Sullivan, 2012).
Organizational communication occurs in staff meetings, group discussions, committee meetings, and in-service education. Written communication is by far the most common form of organizational communication used (Parboteeah et al., 2010). E-mail, faxes, and bulletins posted in high-traffic areas are common forms of organizational written communication.
Inter-professional Communication
According to the AACN (2008), inter-professional refers to “working across healthcare professions to cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable” (p. 37). Effective inter-professional communication fosters patient-centered care and results in quality outcomes. To communicate inter professionally, nurse leaders and managers must communicate with all members of the health-care team, as well as with patients and their families.
The Inter-professional Education Collaborative Expert Panel (2011) identified communication as one of four competencies for inter-professional collaborative practice; the specific inter-professional communication competencies. Failure to effectively communicate interprofessional has been found to be a significant contributing factor associated with many preventable medical errors (Stevens, Bader, Luna, & Johnson, 2011).
In fact, evidence suggests that poor inter professional communication impacts patient safety and quality of care globally. The World Health Organization (2008) identified the lack of communication and coordination as the number one research priority in developed countries and the number three research priority in countries in transition. Specifically, miscommunication between nurses and physicians contributes to medication errors, patient injuries, and patient deaths (Kesten, 2011).
Part of the challenge in combating inter-professional miscommunication between nurses and physicians is that styles differ between the two disciplines: Nurses are taught to be more descriptive, whereas physicians are taught to communicate in a more concise manner (Thomas, Bertram, & Johnson, 2009). In addition, some traditional health-care environments often support a culture in which nurses are intimidated by physicians, thus leading to delays in sharing important medical information.
Communication between nurses and physicians should be timely, accurate, complete, and unambiguous for care to be safe and effective. Effective communication among all health-care professionals is a worldwide goal today (Mitchell, Groves, Mitchell, & Batkin, 2010). Common strategies that enhance and promote inter-professional communication include team rounding, TeamSTEPPS, and SBAR.
Inter-professional Team Rounding
One strategy that is enhancing communication among health-care professionals, producing quality outcomes, increasing patient satisfaction, reducing error rates, and improving patient safety is inter-professional team rounding (Baldwin, Wittenberg Lyles, Oliver, & Demiris, 2011). As the coordinator of care, the nurse possesses the majority of information that is valuable to the health-care team.
With inter-professional team rounding, key members of the inter-professional team gather at specified times to discuss the progress of the patient’s plan of care. The patient and his or her family have the opportunity to meet with all members of the health-care team as well. Each member of the inter-professional team, including the patient and his or her family, contributes during team rounding to provide individual expertise to a holistic plan of care.
For example, during inter-professional team rounding, the patient’s bedside nurse ensures that patient information is current and available for the meeting and offers the team insight into care issues, with the goals of advocating for the patient and respectfully communicating the patient’s wishes to the health care team (Weaver, 2010). After team rounding, nurse leaders and managers are responsible for communicating the outcome of the inter-professional team round to any members not present and for communicating feedback to the team as needed.
Team STEPPS
Team STEPPS, or Team Strategies and Tools to Enhance Performance and Patient Safety, is an evidence-based teamwork system developed by the U.S. Department of Defense in collaboration with the Agency for Healthcare Research and Quality (AHRQ) that is aimed at optimizing patient safety outcomes by improving communication and teamwork skills among health-care professionals (AHRQ, n.d.).
One of the competencies covered by Team STEPPS is positive and conflict-free communication as a requirement for effective teamwork. The focus of Team STEPPS is concise information exchange techniques, including the following (Guimond, Sole, & Salas, 2009; Sherman & Eggenberger, 2009):
- Two-challenge rule: Requires the nurse to voice concerns at least twice to receive acknowledgment from another inter-professional team member. The two-challenge rule is used when a standard of care is not followed. If the team member does not acknowledge the concern being challenged, the nurse takes stronger action or follows the hospital chain of command. Nurse leaders and managers use this technique when dealing with team members who do not follow policies.
- Call out: Simultaneously informs team members of important information and assigns tasks during a critical event or situation. Nurse leaders and managers use this technique when an emergency situation arises on the unit (e.g., respirawtory arrest).
- Check-back: Requires the nurse to use closed-loop communication and verify that the information that is being received is correct. Nurse leaders and managers use this technique when assigning care to staff or when clarifying a change in treatment or medications.
SBAR
SBAR, or Situation-Background-Assessment-Recommendation, is a communication tool meant to simplify communication by framing it in the following manner (Institute for Healthcare Improvement, 2014):
S = Situation (a concise statement of the problem)
B = Background (pertinent and brief information related to the situation)
A = Assessment (analysis and considerations of options—what the nurse found or thinks)
R = Recommendation (action requested/recommended—what the nurse wants)
The SBAR communication tool is an effective method for improving communication within the interdisciplinary health-care team because it assists team members in organizing and prioritizing their thoughts before communicating with other health-care professionals. It fosters improved critical thinking and professional communication skills by developing a brief synopsis of the reason for the contact between providers through an organized and predictable format.
When used properly, SBAR allows for an assertive dialogue, the precise relay of crucial information, and an increased situational awareness that can greatly enhance safe delivery of patient care by setting expectations for the information communicated and for how information is delivered (Stevens et al., 2011).
By enabling the continuous and collaborative exchange of information pertaining to patient care throughout the care environment, the SBAR tool increases the satisfaction level of nurses, physicians, and patients while improving the safety of the care being delivered. In fact, SBAR can effectively decrease the rate and frequency of medical errors associated with miscommunication among health-care providers. Teamwork is crucial to the delivery of safe and effective high-quality patient care, and SBAR has been shown to build teamwork and strengthen working relationships among health-care providers.
Moreover, it can facilitate proficient communication and continuity during the transfer of care among nurses, levels of acuity, or other organizations (Thomas, Bertram, & Johnson, 2009). It also allows the nurse to express changes in patient status successfully and leaves little room for missed or inaccurate information being relayed, thereby leading to an increased level of safety and the quality of care given.
Research has shown that when SBAR is used, patients have reported an enriched atmosphere of patient protection within the hospital setting (Beckett & Kipnis, 2009). Nurses use SBAR during patient care and shift reports and to communicate an unexpected change in a patient’s condition. SBAR has been applied in many settings, including high-risk departments such as intensive care, emergency departments, and operating rooms, and has yielded improved satisfaction of patients and care providers, enhanced quality of clinical outcomes, improved communication among interprofessional team members, and an increase in the safety of the delivery of patient care (Kesten, 2011).
The SBAR technique can also be used to address nonclinical, management issues, such as workload and staffing levels. In one example, staff nurses on a rehabilitation unit used the technique to present poor staffing and workload issues to management. The tool provided them with a mechanism to present the issues along with recommendations for improvement in a professional manner (Boaro, Fancott, Baker, Velji, & Andreoli, 2010).
Intra-professional Communication
Intra-professional means “working with healthcare team members within the profession to ensure that care is continuous and reliable” (AACN, 2008, p.38). For nurses, intra-professional communication means working with other nursing staff to deliver safe and quality patient care. In the Principles for Collaborative Relationships Between Clinical Nurses and Nurse Managers developed by the ANA and the American Organization of Nurse Executives (AONE) (ANA and AONE, 2012), one focus is effective communication. The principles of effective communication can bridge the “us versus them” divide often prevalent between nursing management and staff (ANA and AONE, 2012). The principles related to effective intra-professional communication.
Nurse-to-Nurse Transitions in Care
Health-care organizations have found how important it is to standardize nurse to-nurse transitions in care. At one time commonly referred to as a handoff and more recently termed a handover to reflect more accurately the two-sided process (Barnsteiner, 2012), these transitions in care occur when a patient is transferred from one unit to another, when a nurse must accompany one patient to a procedure and leave other patients under the care of another nurse, when a nurse takes a break for lunch, and when there is a change of shift (Chen, Wright, Smith, Jaggers, & Mistry, 2011; Griffin, 2010).
The purpose of the nurse-to-nurse handover is to acquaint a nurse who has not cared for the patient with the patient’s needs and condition; to provide an opportunity for education on unfamiliar medications, equipment, and the care process; and to acquaint the nurse with the patient and not just the tasks (Griffin, 2010). The handover of patient care from one nurse to another requires effective communication to avoid negative consequences for patients (Barnsteiner, 2012).
Handovers also transfer accountability and responsibility from one nurse to another (Griffin, 2010). Nurse-to-nurse Handovers vary with each facility. For example, handovers in the acute care setting look very different from those in an outpatient care environment. Handovers may also vary from unit to unit in inpatient settings, although inpatient care facilities have begun standardizing handovers to reduce errors (Chen et al., 2011; Griffin, 2010).
Reports on handovers may be verbal or written and given in an individual or group format. Many health-care institutions are deciding to “bring report to the bedside” in an effort to improve patient satisfaction and reduce medical errors because studies show that increasing patient involvement reduces errors in communication and the continuum of care (Griffin, 2010). The Institute for Patient- and Family-Centered Care (2011, para 1) identified four concepts that apply during nurse-to-nurse handovers, specifically if given at the bedside:
- Respect and dignity: Nurses must understand and respect the choices of patients and families and honor perspectives. The nurse must clearly communicate those perspectives and choices that directly affect care choices and help to create meaningful partnerships among patient, family, and nursing staff.
- Information sharing: Accurate and unbiased information regarding care choices and plan of care must be shared with patients and families to include them in the care process. Information sharing at the time of nurse-to-nurse report, if given with the patient present, may bring to light information of which the patient or the nurse is unaware.
- Participation: When report is given at the bedside and patients or family members are included, this allows them to participate in care in a meaningful way and at the level that they choose. Participation must be outlined by the competent adult patient and may vary from day to day based upon the emotional and physical well-being of each party.
- Collaboration: Patients and family members may provide insights into the care process or report process that may be invaluable to future patients. Collaborating with patients and family members, not only regarding the care of the patient but also in exploring how the process can be more patient centered, provides endless resources to improving the process of including the patient at bedside report. Patient care handovers can result in important information gaps, omissions, errors, and harm to the patient (Staggers & Blaz, 2013). Potential causes of errors during handovers include the following (Chen et al., 2011, p. 380):
- Environmental distractions
- Simultaneous transfer of equipment and knowledge
- No previous information for the receiving nurse on the patient’s history or condition, thereby creating a situation in which vast amounts of information are shared in a limited time
- Clinically unstable patients who require attention during handovers, thus resulting in a limited time for reviewing medical history It is not possible to eliminate all of these causes for error during the handover process; for instance, if a patient requires care immediately, it must be given.
However, standardizing handovers may help to decrease confusion and errors. When the receiving nurse is given information in a format that is familiar, such as SBAR, the information will not seem overwhelming. In addition, this approach provides a standard of care for what information is shared and reminds the nurse who is giving report to furnish complete information on each point before moving onto the next (Chen et al., 2011).
Conclusion
Communication is one of the knowledge, skills, and attitudes that nurse leaders and managers and in fact all nurses must use with extreme proficiency. Communicating across the organization, among professionals, and among nurses is critical for safe and quality patient-centered care. Miscommunication is a source for error that could be potentially harmful to patients, so nurse leaders and managers must genuinely try to understand what others are saying, listen carefully, and maintain composure in difficult situations (Batcheller, 2007).
Lack of effective communication can impact the health-care work environment and result in misinformation, misunderstanding, fear, suspicion, insecurity, and job dissatisfaction, as well as compromise patient safety and quality of nursing care. Nurse leaders and managers who are role models for good communication skills can provide staff nurses with informal support and leadership, which ultimately create a positive work environment and improve nurses’ confidence, motivation, and morale (Timmins, 2011).
Read More:
https://nurseseducator.com/didactic-and-dialectic-teaching-rationale-for-team-based-learning/
https://nurseseducator.com/high-fidelity-simulation-use-in-nursing-education/
First NCLEX Exam Center In Pakistan From Lahore (Mall of Lahore) to the Global Nursing
Categories of Journals: W, X, Y and Z Category Journal In Nursing Education
AI in Healthcare Content Creation: A Double-Edged Sword and Scary
Social Links:
https://www.facebook.com/nurseseducator/
https://www.instagram.com/nurseseducator/
https://www.pinterest.com/NursesEducator/
https://www.linkedin.com/in/nurseseducator/
https://www.researchgate.net/profile/Afza-Lal-Din
https://scholar.google.com/citations?hl=en&user=F0XY9vQAAAAJ