How communication skills are used in health and social care
Health and social care communication involves interpersonal relationships with healthcare professionals on one hand and clients and patients on the other. This process largely depends on the healthcare professionals or workers as they are the privileged class, i.e. their background, trainings and socioeconomic class are more privileged than their clients and the patients.
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But privileged as they are, good communication practices, and in this sense interpersonal relationships, largely depend on their communication skills (Brown, Crawford, & Carter 2006). Understanding how people use and interpret words and messages in different situations, cultures, and media, is a matter of great significance for people undergoing treatment.
Theories of communication
Communication is our way of transmitting information and enhancing our relationships with other people (Dougherty et al. 2009). We communicate through oral or written ways, signs and body language methods, and the latest is through technology or electronic media.
Culture and values influence communication. Brenda Allen (as cited in Craig 2007, p. 257) states that ‘facilitating positive sociocultural change through social constructionist inquiry is an urgent task for communication theory and research’. Speech as communication is influenced by cultural contexts. Silence is not a part of communication as it is ‘devalued and largely ignored’ (Craig 2007, p. 257).
An important theoretical term related to communication is ‘relationship’ (Thompson 1986 as cited in Moonie, 2005, p. 58). We communicate because we would like to improve our relationship with other people. Professionally, a healthcare professional, particularly a nurse, should be able to communicate effectively with the patient, and must improve this relationship through personal communication, taking into consideration the culture and values of the patient (Kreps 2008).
Communication is about understanding and discerning messages, not just knowing literal words. That is what happened in Jessie Lee’s predicament in our case study. The nurses and doctors in the hospital did not want to understand or discern the patient’s message. Doctors and nurses should know the standard operating procedures (SOP) in providing health care, particularly in hospitals or clinics.
Here, communication is automatic, meaning words do not tell but actions or body language speaks a lot or gives meaning. Lee should have been assigned to an ob-gyn specialist who could tell her what was going on, and the patient could reciprocate through actions. The people in the hospital made the situation worse for the patient. Will you just ignore a patient because you don’t understand her?
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Specifically, communication refers to speech, written language or speech symbols, but other nonverbal signs like interaction or body contact can also be communication in this sense (Buehler & Richmond 2006).
Written communication is as important as verbal communication, but verbal communication in the health and social care contexts should include understanding and discernment because doctors communicate with their patients through personal contact. Obviously, it is impossible to treat patients who do not understand what their physicians are saying.
A theory known as functionalism became popular in the 1950s and 1960s. During this time, health, sickness and death were related to people’s functions in the social structure. Healthcare researchers and theorists provided concepts based on those beliefs and made successful careers out of the functionalism contexts. Through the theory of functionalism, along with other emerging theories such as Marxism, there emerged other concepts called feminism, constructivism, including new literary theories (Fishbein & Capella 2006).
From these contexts, health professionals became interested in the function of communication over healthcare itself, particularly the nursing profession. Hildegard Peplau wrote the landmark thesis ‘Interpersonal Relations in Nursing’ in which the author exposed the significance of communication, written or verbal, in the nursing profession (Brown, Crawford, & Carter 2006, p. 2).
The theory states that to be a good communicator, one must have the skill (theory) and experience; but skill can be learned through experience, which makes an effective learning (Moonie 2000, p. 115).
We need effective communication in health to enhance patient safety, correct diagnosis and positive treatment (Johnson 2004 as cited in Taylor, Nicolle, & Maguire, 2013, p. 35). A nurse interviewed in the study by Taylor and colleagues (2013, p. 37) commented that ‘communication is 99% of our job,’ which means that healthcare cannot be given without proper communication, or, failure of communication is failure in the treatment process.
My experience in the use of communication skills
Talking to a patient from a different culture and a different language is indeed difficult, but I can say that after using my communication skills, I considered the job rewarding. The patient I am referring to was not too difficult to deal with, but she belonged to an ethnic tribe in Africa and her family has just migrated in the UK.
This young patient, about 16 years old, had been in the hospital for several days but she was alone and silent when I approached her. She had her recent visit by relatives about a few hours before I joined to talk with her. The doctor asked me to interview her, but how could I do it when she knew only a few English words?
I know a little bit of the African culture and have researched that African communication is deeply influenced by their culture, and so this was my only weapon. But we had a fruitful interview even if she was shy, because my enthusiasm in knowing her reciprocated this difficulty in communicating. She told me her name, age, address in London, parents’ names and everything about her family.
It was difficult at first since she was not yet enrolled in a local school, but she was very cooperative and not too difficult to deal with. I can proudly say that I successfully used my communication skills because we came out as friends. When the doctor finally came, I was fully equipped of the necessary information he wanted. I was there when he treated her and our conversation was done with a combination of sign and a few English words.
Methods of dealing with inappropriate interpersonal communication
The Jessie Lee story
The story of Jessie Lee, though this might be a fictional case study, relates to some of the tragic reality in city hospitals in developed countries today, including UK hospitals for that matter. Here is a patient who does not know how to speak English but was admitted in this country because she was married to an English husband.
If this was a true case, the English husband had all the right and reason to sue the hospital management, including the nurses and doctors, for ignoring the Mandarin-speaking patient and letting the baby inside her die. In this case study, Jessie Lee is in an emergency situation, and it is the responsibility of healthcare providers to determine the reason why this pregnant woman is in the hospital and what is she complaining about.
The doctors and nurses, even the medical students, are too busy; in fact, they do not know what they are busy about. Treating English-speaking patients who are easy to diagnose and treat? Or just plain irresponsible and ignorant of their job that they do not care what will happen to this patient?
Strategies to support users of health and social care services
The actions and emotional expressions of Jessie Lee should tell the doctors and nurses what was going on. She was looking for a lavatory, perhaps she felt vomiting and really in pain, and since the nurses did not understand and could not find a Mandarin speaking interpreter, they just left her in her pitiful situation.
The inaction of the nurses and the doctor tell us that they were unprofessional and indifferent to patients, quite contrary to the codes of practice they were sworn to in their professions. Lee’s body language and personal expressions spoke for her – she was communicating in the real sense which did not need speech to be understood. The nurse did not need to know Mandarin to understand the patient.
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Hospitals and health care professionals should implement strategies in providing health care to patients with special communication needs. The use of interpreters and translators can be costly, so hospitals can find ways by seeking the help of patients’ educated relatives and friends. A study by Wolff and Roter (2008) recorded visit companions of sick patients. The visit companions helped in facilitating interaction between doctors and their patients which resulted in effective treatment (Wolff & Roter 2008).
Health and social care professionals need communication education to equip themselves against the challenges of providing health and social care to people with special needs. Education has to focus on providing effective communication skills to health care professionals who have direct contact and interaction with their patients. Having proper communication education influences almost all types of discipline.
McCloskey (1994 as cited in Morreale & Pearson, 2008) indicated that “speech or talk” has been considered vital in the world today that it is one of the most idealistic topics of study in the world of education.
With this concept, McCloskey provides three basic principles to support his contention: a country with minority cultures should have better communication; we are in the midst of a communications revolution similar to the early days of the printing press; and there is a growing sector who earns their living through speech or talk. Health care professionals cannot provide positive treatment if they do not have effective communication skills (Wejnert 2010).
Values and cultural factors that influence the communication process in health and social care
One of the concerns in providing health care to ethnic minorities in England is the use of interpreters or translators because this exacerbates healthcare costs. The NHS uses this when providing health care to ethnic minorities who cannot communicate through the English language.
The UK spends between £23 million and £55 million annually in hiring interpreters for about ‘120 languages’ (Easton 2006, Khan 2011, Chapman 2012 as cited in Taylor, Nicolle, & Maguire, 2013, p. 35). Providing healthcare to ethnic minorities has not been too successful since caring for them is not different than giving support to people with special needs.
The ethnic population in the UK is an internationally diverse population (Rees et al. 2011 as cited in Taylor, Nicolle, & Maguire, 2013) making it difficult for the government in terms of planning and social inclusion services. Ethnic minorities come from China, African countries, and some from the European Union. Most of the groups have their own language and English is just a second language. Government policies should be geared towards this immigration reality because it affects the delivery of health and social care.
Language and literacy difficulties greatly affect treatment processes, cases where decision making is of vital importance and patients’ knowledge of drugs and treatment processes. Doctors try to avoid using jargon, but most patients with language barriers are likely to be admitted to the hospital (Safeer & Keenan 2005 as cited in Taylor, Nicolle, & Maguire, 2013). Similar situations may occur in many hospitals so that the best that managements could do is to provide interpreters where there are ethnic minorities in the area.
Taylor, Nicolle, and Maguire (2013) conducted a study on ethnic minorities with poor or no English language skills to determine whether patients who needed health care encountered barriers. The participants who were health care professionals were asked about: their perceptions of caring for people from ethnic minorities, particularly those who did not know how to speak English; the barriers encountered including language; and the many difficulties the ethnic groups encountered in accessing to healthcare.
The study pinpointed five difficulties for ethnic minorities accessing healthcare, such as: language barriers, low literacy and anxiety, difficulty to understand simple words and sentences, patients’ attitudes and health beliefs (Taylor, Nicolle, & Maguire, 2013).
A participant-nurse interviewed in an empirical study by Taylor and colleagues (2013, p. 38) lamented that ‘… people come to the UK for marriage and all sorts of reasons, with language barriers.’ This is one significant problem in the country which has to be addressed properly by health providers and policy makers themselves.
In the United States, about 46 million immigrants have English as their second language, which makes it difficult for health providers to do their job because of the language barrier and the values and culture accompanying them. Primary health care for those people cannot be provided effectively (Jacobs et al. 2004). The continuing urban migration has exacerbated the situation in the delivery of healthcare.
Laws and guidelines on nursing practice
There are laws and codes in the practice of providing health and social care which must guide professionals and organisations in the UK. Most organisations conduct intensive training programs with multicultural backgrounds (Irizarry & Gallant 2006).
Organisations also have to deal with diverse cultures in their workforce and managing a diverse workforce has got to do with delivering healthcare to a multi-diverse workforce. Health care managers should be able to understand the contexts and meaning of diversity management in relation to delivering healthcare because this is a part of the rights of employees under the EEO/A laws (Csikai & Raymer 2005).
Healthcare is an important part of the political agenda, which means policy makers and government people consider healthcare as an important part of the survival of a nation. Management of public services is in line with providing ‘effective system of community-based health and social care’ (Rachman 2001, p. 211). Social care for patients is already an important aspect in the political agenda.
Impact of the BBC expose
The BBC documentary, now available through YouTube, is about mistreatment, abuse and tragedy of elderly patients of the care homes in Essex and London. Two care workers have been arrested while a number were investigated and suspended from work. London’s Care Quality Commission reported that 406 homes have already been questioned and warned of the substandard quality of care of their facilities (BBC Panorama 2014).
At the Ovan House Care House in Essex, the family of Yvonne Grant left a secret camera to check on her care only to find the mistreatment of their loved one by care givers. The secret filming was taken on December 2012 and the video showed that Yvonne Grant, an 80-year old resident, continuously asked for help to be taken to the toilet but was refused help for more than an hour.
As recorded on camera, the woman called for help 321 times, but the care giver just told her to do it on her pad. The lights went out for about 20 minutes and she was still left unattended. Consultant Lynne Phair narrated that Yvonne suffered physical pain and trauma in the hands of the care givers, instead of being cared and consoled in her predicament.
Before the secret filming, some 11 whistleblowers had already testified of the substandard and inadequate situations in the homes. Patients were not attended to. Journalist Alex Lee was sent to investigate and install hidden camera. The result was some of the shocking experiences of residents. One care worker slapped a paralyzed woman who had dementia. Some residents were also seen mocked, bullied, and called ‘bitch’ by a care worker.
The code for nurses in the UK states that nurses and midwives should ‘treat people as individuals’ (Nursing and Midwifery Council: the code: standards of conduct, performance and ethics for nurses and midwives n.d.) This statement in the law tells us that a simple mistreatment is an unacceptable.
The reality in many homes in England may still be hidden; a few caregivers have been arrested while others were suspended or dismissed but the BBC documentary only exposed the tip of the iceberg. The guilty care workers should be punished with the full force of the law, and not just mere suspension or dismissal. Nurses and care workers must be held accountable for their practice (Accountability in nursing and midwifery: nursing & midwifery council code of professional conduct 2008).
On the other hand, Parliament should pass stricter laws to punish care workers who abuse, mock and maltreat the elderly residents of homes (Faccinetti 2008). Heavy penalty or closure should also be meted on care homes which tolerate this kind of abuse.
Ways of improving communication
In health communications, what is important is the welfare of the patient and respect for their right and dignity as individuals. Health professionals should provide ways for patients’ understanding of the facts about their illness which should be based on their values and culture (Peters, Lipkus, & Diefenbach 2006).
People are classified according to their socioeconomic status (SES) in life. Access to healthcare is sometimes based on people’s SES. People’s social and cultural belongingness differentiates their accessibility to health services. Individuals’ membership to groups or networks refers to their social or cultural capital which permits them to have some access to health or services, or advantages over other people (Brown, Crawford, & Carter 2006, p. 1). In this sense, social factors affect people’s accessibility to healthcare.
The use of information and communication technology (ICT) in health and social care
The use of Information and Communication Technology (ICT) has become a necessity in many areas of man’s endeavor. ICT has made delivering health and social care fast and easy, to say the least. Generally speaking, technology and the Internet have helped in providing health and social care.
Patients can communicate with their doctors through emails, video conferencing or chat, or send important information and images about sickness. Although there are some who have expressed reservations on the use of ICT in delivering healthcare, others have emphasised the implications that these tools could offer to healthcare (Andreassen et al. 2006).
On my part, I have used the Internet and emails with some of the patients in the hospital where I have worked as an intern. The use of emails has been a constant practice among us, students, professional nurses and doctors. Use of emails and the Internet is now a common practice among health professionals. The process is less costly on the part of the patients and provides immediate response (Brooks & Menachemi 2006).
The software that I recently used is PatientLink. This software is similar to email and we use the Web browser in sending information to patients. User name and password are assigned to the patients in the hospital with the doctor’s supervision.
When the patients log on to the Internet using their user name and password, they would receive messages and they could also use their mobile phones in sending and receiving messages. Patients also have a one-time code which they have to complete as a login requirement. When the doctor responds or sends messages, the patient receives notification through the mobile phone.
PatientLink was developed to provide exclusive communication between doctor and patient where both could exchange information about the latter’s sickness. It was also developed and implemented in line with the guidelines set by the American Medical Association on electronic communication (American Medical Association: opinion 5.026 – the use of electronic mail 2003).
We had this one-year software project in which the hospital employed six doctors, and participating in the project was voluntary. PatientLink is easy to use, designed primarily for patients who have difficulty in encoding messages (Eshraghian 2006). The patients in the project were volunteers and we had about a hundred patients divided into two groups. A group acted as control while the other one was the intervention group. Only the patients could initiate the conversation and the general practitioners (GPs) could send their responses.
Development of trust
Trust is essential in electronic communication. Patients need to trust their doctor in the project PatientLink. This is a must in electronic communication as demonstrated in empirical studies. Not only is trust needed in the project, it is important in the doctor-patient interaction.
We found that the PatientLink project would not have been successful had there been no trust between the doctor and the patients, especially on the patients’ side. According to Giddens (1991 as cited in Andreassen et al., 2006), the world is a risky world and full of chances, so we need to trust one another particularly in the delivery of health care. We consider risk a part of everyday living and receiving healthcare is also a risky business.
The patients were assessing their doctors in the electronic communication. One could not have a ‘lasting’ trust on his/her doctor. A few patients changed doctors when they had a misunderstanding in the use of PatientLink. One said that she could not trust her doctor in their e-communication and that the doctor did not have real answers to her questions regarding her sickness.
A disadvantage with PatientLink is that in one instance trust was lost during the doctor-patient interaction. The project was supposed to develop and enhance trust but it got lost in the process.
My view is that this should be first and foremost a basic requirement for the GPs and the patients before they volunteered for the project. Trust is important in using electronic communication and technology should not be used to develop the relationship between the doctor and the patient (American Medical Association: opinion 5.026 – the use of electronic mail 2003).
Moreover, there were positive outcomes of the PatientLink project. The use of electronic communication has helped patients in acquiring more information about their sicknesses and anything about healthcare. One of the patients who had a chronic heart sickness narrated during the interview that he had become accustomed to using the electronic communication when asking information about his illness from his doctor.
A patient expressed her satisfaction and indicated that whenever she felt something that needed consultation with her doctor, she would use PatientLink. Before she was introduced to the software, she was reluctant to go to the doctor. A study that supported this view is the study by Kummervold and colleagues (2002 as cited in Andreassen et al., 2006), which found that majority of the participants in a discussion group would like to reveal their personal problems online and not through personal consultation.
One of the benefits in the use of ICT is the comprehensive exchange of valuable information between doctor and patient and the reduced time of personal contact. A patient who was diagnosed with depression told us that she became very cooperative with her doctor by sending more information about her sickness through emails, instead of going personally to him.
Privacy is very important in the use of email and other software for use in the health and social care setting (Simovska & Jensen 2008). This is also provided in the guidelines set by the American Medical Association (American Medical Association: opinion 5.026 – the use of electronic mail 2003).
The guidelines are provided in detail by AMA’s website to ensure that the use of e-mediated communication will benefit the patient and enhance health and social care. In the project PatientLink, we did not know how secured the software was from viruses and malwares, although it is possible that the software can be contaminated by a virus and so an anti-virus software should be installed in the patients’ personal computers. The patients’ privacy is protected under the AMAs guidelines.
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