Task-Focused and Patient Centered Communication Behaviors
Task-Focused and Patient Centered Communication Behaviors
Nurses are entrenched in a complex system of clinical relationships some of which include nurse-nurse, nurse-patient and nurse-physician. Communication forms the basis for these relationships and depends on the nurse’s ability in listening, assimilating, interpreting, discriminating, gathering and sharing of information within dynamic systems comprising of various disciplines and hierarchies. Communication is complex encompassing skill, emotion, cognition and value. Formulation and implementation of daily care plans are among the most vital patient related communications. These activities call for shared responsibility in order to enhance clear, concise, relevant and timely exchange of patient information across disciplines usually in chaotic environments. Lack of effective communication between patients, families and the healthcare team is one of the leading causes of medical errors. It also accounts for over 60% of sentinel event causes reported to the joint commission on accreditation of healthcare organizations since 1995 (Manning, 2006).
Relationships provide a foundation for building communication. Relationships change over time and vary between and among nurses as well as other members of the healthcare team. It is quite difficult to develop and nurture clinical relationships in dynamic healthcare environments because there is less opportunity. For instance, an initial encounter with a nurse may occur when there is a need to contact an unfamiliar physician to offer assistance in an emerging critical event. It is not easy to trust unknown colleagues on judgment, decision-making and clinical knowledge. The patterns of communication are highly variable. The factors that influence these communication factors consist of individual style differences, education, gender, previous experiences, perspectives, culture, fatigue, stress, social structures and established hierarchies. Environments for clinical care are often noisy, hectic and full of interruptions especially in common places (Miller, 2006). Conversation avoidance devices like personal digital assistants, audiotape players, text pagers and cell phones interfere with the ability of nurses to listen to other people. It is therefore worth noting that the complexity of clinical communication increases the chances of communication failure and hence resulting to inadvertent patient harm. However, adoption of certain standardized approaches and tools can provide solutions to the improvement of clinical communication, which in turn prevents medical errors (Manning, 2006). This paper will focus on what other people have written regarding the task focused and patient centered communication behaviours in the nursing field, particularly within the context of the United States.
Patient Centered Communication Behavior
Patient-centered communication (PCC) refers to a group of communication behaviors and strategies, which enhance mutuality, shared understandings and consequently shared decision making in day-to-day encounters of healthcare (Brown, 1999). It enables the patients to influence and participate in their healthcare. PCC is the root of patient-centered healthcare (Stein-Parbury, 2009). Patient-centered healthcare involves the provision of care that respects and responses to patient’s needs, preferences, and values while ensuring the guidance of patient values in all clinical decisions (Brown, 1999). A patient-centered approach to healthcare shifts the focus of nurses from a task orientation to patient-centeredness where the values and needs of patients are considered. Patient-centered care makes communication and relationship with patients the basis for nursing practice. A recent research study into experiences of patients with nurses’ communication points out that nurses focus more task as opposed to communicating with patients. This shows that not much has changed towards embracing the patient-centered approach and perhaps many healthcare institutions still lack practices and systems that present the core values of patient-centered care (Stein-Parbury, 2009).
The Institute of Medicine identified patient-centeredness as one of the specific aims in the carrying out the project of restructuring the American healthcare (Institute of Medicine, 2001). There is evidence indicating the use of certain patient-centered strategies by advanced nurses and patients in clinical practice to co-produce clinical discourse that are highly individualized (Brown, 1999). A study was conducted at a big children’s hospital in order to determine the extent to which PCC affects satisfaction with both communication and care. The study required parents of child patients to report on the communication practices of nurses, physicians and other hospital team members during their latest stay in the hospital. The results of the study linked the use of PCC behaviors, particularly immediacy and perceived listening to the satisfaction with communication and care. Additionally, the study indicated a frequent use of PCC behaviors with children in better health than those on poorer health status. Generally, a few people enjoy receiving healthcare because they often get distressed whenever they visit physicians. Patient anxiety may result from lack of supportive and patient-oriented communication behaviors among the healthcare providers (Wanzer, Booth-Butterfield, & Gruber, 2004).
Many government policies and initiatives have promoted service-user involvement and patient-centered communication as basic concepts in the delivery of high-quality healthcare. The World Health Organization (WHO) also encourages these initiatives by incorporating indicators of health services responsiveness, which is a combination of health system effectiveness and patient satisfaction, in its World Health Reports (Jones, 2006). For instance, some major policy programs have recently resolved to focus on patient-centered communication importance between patients and health professionals in delivering initiatives like shared decision-making (Institute of Medicine, 2001). In addition, various nursing literature have reflected and supported these initiatives. The assimilation of these concepts in both literature and health policy to enhance nursing practices raises questions as to what constitutes suitable and effective clinical communication. This scenario calls for more research concerning nurse communication practices as they transpire in clinical practice (Jones, 2006).
Among the limitations of research on nurse-patient interaction is the lack of work that sufficiently explores communication styles in natural clinically based conversations between patients and nurses rather than collecting research data from focus group discussion and staged interviews with nurses or interactions between nurses and the patients’ family members. Aled Jones from School of Health Science, Swansea University, United Kingdom, collected and analyzed research data from student-patient interactions in order to gain some insights into the present interaction practices between student nurses and patients. At the end of the study, he concluded that students experience difficulty in applying the principles of effective communication learnt from the classroom into their individual interactions with patients (Jones, 2006).