Barriers to Communication in Healthcare Settings

Categories: Barriers To Communication Health Care Nonverbal Communication

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In task two I will be writing a report, showing the range of support services targeted at providing resources for effective communication in a range of healthcare settings, including hospitals and the community.

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I will then be evaluating the strengths and weaknesses of these services.

This assignment will be split into two tasks. Task one will surround criteria 1.1 and 2.1, in this task I will be identifying the barriers to communication and the most appropriate verbal and nonverbal skills that should be used in each of the contexts, saying how and why I would utilise these to the best of my ability in a number of scenarios. In task two I will be writing a report, showing the range of support services targeted at providing resources for effective communication in a range of healthcare settings, including hospitals and the community. I will then be evaluating the strengths and weaknesses of these services.

Introduction

Assessment criteria

You need to ensure that while the group of family and friends are allowed to see him that they are calm when they do so. What approach and communication skills would you apply to this situation?

A 16-year-old male has been brought to hospital by ambulance. He has been hit by a car and his condition is severe. He needs scans but the hand over from the paramedic staff to hospital staff is delayed because his parents and other family members and some friends have turned up at the hospital and are shouting and angry and being abusive to staff. You need to ensure that while the group of family and friends are allowed to see him that they are calm when they do so. What approach and communication skills would you apply to this situation?

Scenario 1:

A patient's whole family can be thrown into a state of crisis when a family member is rushed to the hospital. When people feel they have a better understanding of what is happening, they can cope better with it. Because of the nature of the situation, there is a lot of emotion and tension, causing them to panic and often result in aggression towards staff. This can become a serious communication barrier. In this case, I would try to take a few family members into a private room. I would communicate with my colleagues and ask them to do the same in order to 'divide and conquer'. I would then sit down with the family, face to face, bending towards them and keeping a high standard of eye contact. This conveys concern on my part and may take the family away from the defence. I would then say, in a calm manner, "I want to make sure that I understand your concerns, can we talk about them?'. The establishment of clear boundaries is the key to mutually respectful and cooperative relationships (Collingwood, 2018). When talking with relatives I must set boundaries to establish what is acceptable and what is not going to be tolerated (Hinz, 2016). If tensions seem to rise I will respond with, "I will listen to your thoughts and answer your questions as long as you are willing to be respectful." Krozek (1991) suggests that, under stress, relatives may not hear everything that is said to them and it may therefore be necessary to repeat any given information. This is where I would ask the family if they have any questions. (274 words)

Steve is a thirty-five-year-old man who is profoundly deaf. You have to work with an interpreter when communicating with him. You have to discuss his discuss his condition and treatment plan. How will you approach this appointment and adapt your style of communication?

Scenario 2:

Before the appointment I would ensure that any environmental communication barriers, such as lighting and noise are kept at a minimal or removed. I could do this by adjusting the lighting to ensure myself and those attending can see clearly. At the beginning of the appointment I would introduce myself to both Steve and his interpreter, ensuring eye contact with them individually. I would speak directly to Steve during the clinical consultation, not to the translator. If Steve needs to explain something to the interpreter, he'll turn around and ask the interpreter. I have to let him do this, instead of trying to do it myself. When talking I will try to speak with my usual pace and voice tone, trying not to interrupt or hesitate while I'm talking and projecting my voice so it can be heard. As the interpreter signs to Steve, there's going to be a small pause. I have to keep in mind this delay when I speak and be patient as the translator finishes signing to Steve. Towards the end of the appointment, I would ask Steve if he has any questions or concerns, or if he would like me to provide any printed information that he can read over. Once these have been addressed I would then thank the interpreter for their services. (219 words)

A 45-year-old Somali speaking female with hypoglycaemia is admitted to A&E. She is accompanied by her husband. You have to take a blood sample and medical history. What factors will you consider in providing patient care?

Scenario 3:

Spoken language interpreters must be registered by the National Register of Public Service Interpreters (NPPSI). If the interpreter does not hold a DPSI (Health) it is acceptable to use an interpreter that is an English native speaker or another language with a minimum of NVQ level 3 (Stephenson, 2018).It may be more comforting to bring a partner to translate in care environments, but as they are not trained as a translator, there is a good chance that they are not very fluent in many of the clinical or professional terms that may be vital to translate. They is also a risk that the exact information may not be relayed, and they could input their own thoughts. In this situation I would arrange an interpreter to come in face-to-face or a translation phone call to take place, this is to ensure the patient is aware of what is being said. When asking questions, I must ensure I speak with a clear voice and provide the interpreter time to speak to the patient. I must also take into consideration the possibility of cultural differences. Cultural differences can relay behavioural differences that can increase miscommunication, such as body language, thinking processes, verbal and non-verbal communication, expectations, etc (Businesstopia, 2018). Cross-cultural awareness is a key feature in eliminating communication barriers. When talking it is vital for me to use the appropriate body language, for instance smiling, eye contact, sitting upright (Eckhardt, Mott and Andrew, 2006). The service user could notice the presence of body language gestures offering support. I would ensure that both the service user and her husband understand the small procedure I would be doing before taking any action.

Lack of auditory privacy: Patients' views. This patient feedback needs addressing what steps would you take to improve the patient experience?

'Other patients can hear even with the curtains around. Curtains are a visual but not a hearing barrier'. (Mr N13)

'I remember thinking, 'don't speak so loud' because everybody in the ward could hear what he'd done and what he'd found...you can't help it can you ' if you're laying in the next bed' I just thought you know 'Don't speak too loud' 'I'm not exactly proud of what's going on'. (Mrs D8)

Lack of auditory privacy: Patients' views. This patient feedback needs addressing what steps would you take to improve the patient experience?

'Other patients can hear even with the curtains around. Curtains are a visual but not a hearing barrier'. (Mr N13)

'I remember thinking, 'don't speak so loud' because everybody in the ward could hear what he'd done and what he'd found...you can't help it can you 'if you're laying in the next bed' I just thought you know 'Don't speak too loud' I'm not exactly proud of what's going on'. (Mrs D8)

Scenario 4:

Patient input is a valuable source of information that should help healthcare workers to make changes to improve the quality of care of all service users.

Naomi is 45 and has had a series of tests and scans over the past few weeks and has now had a portable scan. This last scan reveals that there is no longer a viable baby in the womb. You have to break the news that she will have to be induced to deliver an infant that will not be alive. How do you approach this?

Scenario 5:

Before meeting with Naomi, I would make sure there is a private room avaliable to talk to her in and tell my colleagues not to interrupt the meeting or enter the room. Once Naomi and I are in the room, I would try and make her feel as comfortable as possible, offering her a drink and asking if there is anyone she would like to be in the room with us. The next step is for me to assess what she knows about her condition or any tests that have taken place, I could say 'before we talk about your test results, I would like you to tell me what you understand about these tests and your condition'. I would respond to this empathetically and ensure I am remaining eye contact, this is to ensure Naomi can see that I care about what she is saying. I would sit down and ask open-ended questions. Letting Naomi talk without interrupting her with more questions. I then need to provide a "warning shot": this might be a statement like, "I'm afraid I've got some hard news," which can help Naomi to prepare for what's to come (Raymond, 2017). I would then ask Naomi how she would like me to give her the results. When talking to Naomi about her results it is important for me to not use extremely technical words, but instead use a simplified synonym that can still provide key information. Empathy is vital in these moments, emotional reactions of patients can range from silence to shock, weeping, denial, or rage when bad news is received. I must recognise and validate her emotions, I could do this by letting Naomi talk, moving closer to her and saying 'I understand this must be very difficult for you' or simply sitting for a few minuets without talking. It is my role to explain the next steps, talking in a slow, calm voice to ensure Naomi can hear me. I would then ask her if she has any questions or would like me to repeat anything. (343 words)

POINT - barrier(s) to communication

EXPLAND - appropriate verbal and nonverbal skills

COMMENT - how and why I would utilise these to the best of my ability

References:

Business topia. (2018). Cultural Barriers to Communication Business topia. [online] Available at: [Accessed 7 Nov. 2019].

Collingwood, J. (2018). The Importance of Personal Boundaries. [online] Psych Central. Available at: [Accessed 6 Nov. 2019].

Dougherty, L. and Lister, S. (2011). The Royal Marsden Hospital manual of clinical nursing procedures. 8th student ed. Chichester, West Sussex: Wiley-Blackwell, pp.194 - 201, 221.

Eckhardt, R., Mott, S. and Andrew, S. (2006). Culture and communication: identifying and overcoming the barriers in caring for non-English-speaking German patients. [online] Diversityhealthcare.imedpub.com. Available at: [Accessed 7 Nov. 2019].

Hinchliff, S.ed., Norman, S.ed., and Schober, J.ed. (1998). Nursing Practice and Health Care. 3rd ed. London: Hodder Education, pp.465- 472.

Hinz, C. (2016). How to Deal with Difficult Family Members of Patients - Daily Nurse. [online] Daily Nurse. Available at: [Accessed 29 Oct. 2019].

(UNSURE)

Krozek, C. (1991). Helping stressed families on an I.C.U. Nursing, [online] 21(1), pp.52-55. Available at: [Accessed 31 Oct. 2019].

Legal Language Services. (2016). 3 Reasons Why You Shouldn't Use a Family Interpreter - LLS. [online] Available at: [Accessed 6 Nov. 2019].

Meder, D. (2015). Tips for Working with Deaf Patients | In Demand. [online] In Demand. Available at: [Accessed 6 Nov. 2019].

RAYMOND, R. (2017). How to break bad news to patients: Experts offer best practices. [online] The DO. Available at: [Accessed 6 Nov. 2019].

Refugeehealthta.org. (2011). Best Practices for Communicating Through an Interpreter | Refugee Health TA. [online] Available at: [Accessed 6 Nov. 2019]. (UNSURE)

Roper, N., Logan, W. and Tierney, A. (1996). The elements of nursing. 4th ed. New York: Churchill Livingstone, pp.104-112.

Stephenson, S. (2018). Guidance for commissioners: Interpreting and Translation Services in Primary Care. 1st ed. [eBook] pp.11, 12. Available at: [Accessed 6 Nov. 2019].

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