Communication is the activity of conveying information through the exchange of thoughts, messages, or information, by speech, visuals, signals, writing, or behaviour. It is the meaningful exchange of information between two or more living creatures1. Effective communication is a reciprocal interactive process in which sender and recipient have responsibilities to ensure that a message has been received and understood. Health care professionals have to provide an efficient and effective service that addresses the needs of patients. Effective communication skills became a vital factor of clinical competence and compliance. Its objectives are to improve accuracy, efficiency and supportiveness. Its main goal is to enhance patient’s experience and to improve health outcome. By improving communication, a better coordination of care can be observed. Communication skills in health and social care setting involve content skills (what is communicated), process skills (how it is communicated), and perceptual skills (what are the thoughts and feelings at the time of communication). These can be enhanced with support of mentoring.
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Mentoring helps with personal and career development and at the same time increase organisational knowledge through sharing understanding and experience. It allows mentees to gain a valuable, practical knowledge and advice. Very often medical perspective and patient’s perspective are very different. Because of these differences, they require different management.2 By recognizing the patient’s perspective and allowing him/her to actively participate in their own care, the care provided can be of better-quality. There are many ways to enhance the communication in health and social care settings. Learning can be used to achieve this goal. Learning is the acquisition of knowledge or skills through study, experience, or being taught3. This can be accomplished by classical conditioning (involuntary behaviour by association), operant conditioning (voluntary behaviour), social learning theory (imitating others), cognitive learning theory (focusing on thought processes) on insight learning (thinking and problem solving).
Effective communication is not the only skill that health care professionals have to possess. To be able to succeed in health and social care setting, health care professionals need very good interpersonal skills. Interpersonal communication is a special form of unmediated human communication, occurring during simultaneous interaction between two people. It is two people attempt to mutually influence each other, usually for the purpose of managing relationships.4 It not only involves listening and observing others behaviour, but also not verbal factors such as facial expressions, body language or dress.
To engage in interpersonal communication, people have to have interpersonal attraction between each other. There are many factors involved in interpersonal attraction – attraction between persons. People tend to others who are similar to themselves. However, due to being hedonistic creatures in nature, we base majority of our interpersonal attractions on principles of enforcement – exchange of some sort of goods (not necessarily monetary) to maximise own pleasure and minimise own pain. There are barrier that can disturbing in interpersonal communication. Common barriers in interpersonal communication can be a breach of confidentiality and trust, misinterpretation, unrelated messages, lack of privacy, lack of dignity, abuse, poor self-image or self-preservation.
Different language, different interpretation of body language, cultural belief, prejudice, racism or stereotyping can also create a barrier that will interrupt interpersonal communication. These barriers lead to inappropriate interpersonal communication which can lead to a number of problems in health and social care setting. In case of inappropriate interpersonal communication it is very important to deal with it effectively and appropriately. The outcome of not handling it in an appropriate manner can be loss of trust of compliance, reduced cooperation and productivity, loss of self-esteem and loss of clients.
Certain methods have been suggested to overcome these behaviours. The crucial thing to resolve issues with inappropriate interpersonal communication and prevent the negative outcome is to keep an open mind and stay focused. Active listening will allow recognising the speaker’s attitude and understanding his /her point of view. The response should contain empathy and be deprived of any bias or prejudice. In case of major difficulties in trying to resolve the issue, it is recommended to get an advice from a higher source. Various different technics have been proposed and developed to overcome communication barriers such as SOLER technique, British Sign Language, or simply using diagrams and pictures. Understanding the main factors of interpersonal communication allows health care professionals a means of improving working relationships and preventing conflicts.
The situation in scenario 1 could leave a patient very disappointed due to lack of effective communication. Upon arrival a patient should have been made aware about a delay therefore he/she would not get inpatient. The appointment itself should not be rushed. A health proffessional should have explained everything in a clear and precise manner giving patient the opportunity to voice any concern or ask any additional questions. In regards to the appointment itself, the health professional has clearly failed to use any communication skills or any interpersonal skills. After an experience like this any patient would feel unsatisfied and would lose a confidence and trust in the professional and as a result of that a confidence and trust in the health care service as a whole.
As we recognize that we are products of many cultures, traditions, and memories, it is very important to respect our differences by learning from other cultures and combining what we have learned with what we have already known. We can define culture as the behaviours and beliefs characteristic of a particular social, ethnic, or age group. Culture is created and shaped by us. It consists of ideas and assumptions about life that require a specific behaviour. It is later communicated through a common language which allows it to be transferred from one generation to another. A behaviour regarded as ‘normal’ in one culture can be regarded as unacceptable in another. This can then lead to cultural clashes. Cultural clashes can bring out very emotional reactions in people , who often feel their cultural values have been violated.
Culture consist of beliefs (mental or verbal statements that reflect particular knowledge and assessment of some idea), values (enduring beliefs that serve as guide for what is considered as appropriate behaviour), customs (overt modes of behaviour that are constituted as culturally acceptable), norms (social rules which define acceptable behaviours), mores (strongly held norms or customs derived from the established practices of a society rather than its written laws5), or rules (regulations and laws). Every culture has its own symbols. They can be verbal, non-verbal (colours), language, symbols (material object used to symbolize something invisible), signs (acts or gestures to convey an idea). The vital means of transmitting cultures is language.
Language is the method of human communication, either spoken or written, consisting of the use of words in a structured and conventional way:6 It consists of four main aspects: sounds, word structure, sentence structure and meanings. The effectiveness of language can be affected by linguistics (word meaning), proxemics (distance between speakers), pragmatics (cultural interpretations) and other non-verbal factors such as body language.
The culture can be seen in high, medium or low context depending on the size of the portion of the meaning that is conveyed by words. High context culture would be for example Japanese culture, where words have to be interpreted alongside the body language. The opposite would be the one with mainly explicit messages such as Swiss or German. Medium context culture would be the one where the meaning depends on the context in which the message is deliver as well as the actual words – English, Spanish or Eastern European.
Culture can create barriers in communication. This can be done by differences in language, body language, values, legislations or customs. As a very good example we can use the fact that Arabs interact at closer distances than other cultures who may see it as invasion of one’s privacy. It is very important for health practitioner to learn about different cultures to and understand them. Understanding cultural differences allows health professional too interact more with patient to achieve good communication relations and optimal care. This can also improve relationships between health practitioners themselves.
Certain charters, codes of practice and legislation have been passed and they surely have an impact communication process in health and social care setting. The most recognizable one is the duty of confidentiality.
The duty of confidentiality derives from common law. It means that information cannot be normally disclosed without the data subject’s consent. Anything relating to the patient, disregarding their mental health or age, have to remain confidential. This duty is enclosed in NHS Code of Practice. NHS Code of Practice offers a detailed guidance on protecting confidential information, informing patients about how any information is used, offering patient appropriate choices about the use of that information, and the circumstances in which confidential information may be used or disclosed. Patients’ health information and their interest must be protected through number of measures: procedures, recording, keeping patient information private and physically secure or correct disclosing. Information should be use proactively and it should only be discussed in a suitable place, away from others. Once it is disclosed it cannot be made private or deleted.
Understanding legislation and Code of Conduct prevents misuse of confidential information by health care professionals. The rule of confidentially found its recognition in the Data Protection Act 1998. There are however situations, where the duty to disclose information is created – legal requirement of the Children’s Act 2004 or in case of suspecting terrorism. Any patient can have access to any of his/her medical records based on the Access to Medical Reports Act 1988. The health and social care organisations should promote equality, as described in Equality Act 2010. It bans unfair treatments and prohibits discrimination on grounds of age, sex, gender, disability, marriage and partnership status, maternity, race, religion, sex or sexual orientation. Another very important legislation impacting communication process in health and social care setting is Human Right Act 1998. Professional staff has a duty to follow and obey these principles in order to promote and encourage good practice. Not following them can result in patient dissatisfaction and lose of trust in health care services. This can then escalate into legal matters and unnecessary litigation.
Applying these rules to Scenario 2, it is clear that these principles were not followed. The receptionist spoke out loudly about patient’s confidential information in a place that clearly was not appropriate to disclose that sort of information. She did not understand cultural differences (demand of a female doctor) and lack of skills in operating the computer screen. She should have paid more attention to the rule of confidentiality and be more approachable and understanding in regards to cultural and language barriers.
Information Communications Technology (ICT) in widely used in health and social care settings. These systems integrate the different sections of the health care organisation to work collectively, which then allows them to achieve the common goal – providing the highest quality of service possible. ICT It not only improves quality of care, reduces health disparities, increases efficiency in care delivery system, but also increases patients’ safety by decreasing medical errors. It allows flexibility and convenience.
A good example of ICT having a positive impact in health and social care setting is E-prescribing. Prescription orders are inputted electronically by clinician and are later send to the pharmacy. This eliminates hard to read hand written prescriptions and errors in dispensing such as wrong drug dispenses due to very similar name or dosage. Electronically managed clinical notes systems is another example. These include patient’s medical history; any nurse/doctor notes as well as patient’s personal details. All information is easily accessible, which saves time. Going through often hard to read paper records can be very time consuming.
Test orders and results can also be done electronically – blood test, CT, MRI. The accessibility of this information in one place results in clinical information, diagnostics and treatment to be delivered within timely manner. It allows greater efficiency in managing patients and more efficient decision making process.. Information can be easily exchanged between practitioners, collapsing time and distance issues. That has a large impact on breaking down barriers to communication between health care professionals. ICT allows a large amount of data to be transferred between different location within the NHS. It can be done through a Local-Area-Network. The information can be then accessed from anywhere in the world proving health practitioner has an access to it. ICT also improves administrative activities taking place in health and social care settings, such as patient registration and reporting or personnel management systems and rotas. It is also widely used in finance such as billing systems or payroll system.
There is variety of ICT systems that assist in diagnosing patients or monitoring individual with chronic diseases. All these, help health care organisations to work more efficiently and effectively. This allows the delivery of the highest quality of service possible to their users. Despite the cost and complexity of ICT implementation, which usually requires significant work process and cultural changes the advantages clearly outweigh the disadvantages of the use of ICT in health and social care settings. It is particularly hard to implement ICT when payment policies require a fragmented delivery of care. Using ICT in health and social care setting also benefits the service user. It allows right people get a right treatment at right time (patient management system); it makes medicine to be widely available to patients; it delivers high quality of care meeting individual treatment needs; it ensures accuracy of record; it improves communication due to highly sophisticated medical devices.
The use of ICT at work is governed by various legislations the Health and Safety at Work Act 1974, the Health and Safety Regulations 1992 and the Date Protection Act 1998. It requires employers to safeguard, so far as it practicable, the health, safety and the wealth fare of their employees who may be affected by the work activity. In relation to using computers at work it mainly focuses on the fact that employees using computer for long period of times are prone to health problems. Many of them are avoidable such as Rapid Strain Injury, Eye strain, back problems or work related stress. The Data Protection Act 1998 had a tremendous effect of the use of ICT.
It requires anyone processing personal information to comply with its principles. Main principles of the Data Protection Act 1998 require that accurate and up to date adequate and relevant information must be fairly and lawfully processed for specific purposes. It must not be kept for longer than necessary; it must be secure, not transferred outside EEA and must be processed within individuals’ rights. The Data Protection Act 1998 makes the Information Commissioner’s Office (ICO) responsible for promoting good practice in handling personal data, keeping a register or organisation that are required to notify him about their information processing activities, helping to resolve disputes by deciding whether it is likely or unlike that the organisation complied with the Act when processing personal data.
Individuals who feel there has been a breach of the data protection rules can complain to the ICO who will then make a judgement. He will do that by conducting assessments, serving enforcement notices, prosecuting those who commit criminal offence under the act, conducting audits, reporting to Parliament on the issues in concern or applying monetary penalties. The use of ICT in health and social care setting bring an enormous amount of benefits and despite of some small negatives still remains highly recommended.