The comprehensibility of some X-ray leaflets

The role of the nurse in the medical ward round

Communication between hospital staff and in-patients, especially regarding the provision of information, has been found to be inadequate although improving information-giving has been demonstrated to have a number of beneficial effects. While the ward round might be a particularly valuable setting for communication, few studies have explored the multidisciplinary nature of rounds. This study obtained the views of 33 consultants, 14 nurses and eight patients and observed three ward rounds in order to determine the nature of present round functioning, and the nurse's role in such a round. The results showed that the rounds studied were not being conducted in a democratic fashion: medical staff dominated and other health care professionals had little involvement. Patients received few explanations and had great difficulty understanding the discussion. The functions nurses were seen to perform involved primarily providing information for medical staff. It is recommended that patients are more involved in rounds and are given more explanations and encouraged to ask questions. Nurses should be educated to assert themselves in ward rounds in order to fulfil roles they prescribe for themselves, and all professionals should aim towards more democratic, equal discussion. There is a need for further research to determine the effectiveness of nurse intervention on patient involvement and satisfaction with the round.

First diagnosis of severe handicap: a study of parental reactions

This paper reports the results of interviews with 190 parents of severely mentally handicapped children. Questions were asked about parents' satisfaction with the way they were first informed of the child's impairment. Most parents were informed by a doctor, and almost two-thirds were dissatisfied with the first information given. Satisfaction was associated with being told early in the child's life. There was a significant association between the time of telling and the diagnostic condition of the child: parents of children with handicap of no known pathology were more likely to be told during or after the second year of the child's life, while parents of children with Down's syndrome were most likely to be told at birth. The authors discuss ways in which parents can be helped through this difficult time and suggest procedures for breaking the news to parents in a sensitive way.

Doctor-patient communication in rheumatology: studies of visual and verbal perception using educational booklets and other graphic material

Patients (n = 404) with osteoarthrosis and control subjects (n = 233) were studied to examine the communicational value of five styles of illustration (cartoon (C), matchstick (M), representational (R), symbolic (S), photographic (P) and two levels of text ('easy', 'hard'), presented as educational booklets about osteoarthrosis. Booklet comprehension was tested with a multiple choice questionnaire (MCQ) scored by two raw score and two, more sensitive, weight-of-evidence methods. Further studies assessed perception of image detail, tone, and colour by ranking, rating, latency, and questionnaire methods. A subgroup was tested psychometrically. The main findings were: pictures in booklets enhance communication; perception of pictorial style depends on its vehicle of presentation, cartoons being most effective in booklets, photographs overall; simplifying text does not significantly enhance communication; certain picture-text 'interactions' appear to increase comprehension (e.g. 'hard' text with 'easy' pictures); several 'endogenous' factors are associated with increased comprehension: 'psychological' (e.g., intelligence, memory, reading skill); 'demographic' (e.g., the young, males, higher social grades, higher educational levels); 'disease' (e.g., longer disease duration, previous information about the disease).

Frames and heuristics in doctor-patient discourse

The medical interview can be viewed as a verbal exchange between two people trying to solve a problem. Research in linguistics and cognitive psychology casts interesting and useful light on such discourse. Using the concepts 'frames' and 'heuristics' from these fields, we viewed, transcribed and analyzed taped sessions between a family practice physician and sixteen patients to examine how those patients understood their illness. To be an effective teacher the physician must discover not only the causes of the patient's medical problem, but also something of the conceptual structure that supports the patient's perceptions and understanding of his problem. This paper presents a method to understand these conceptual structures and how they function.

Patient mislabeling of symptoms: implications for patient-physician communication and medical outcome

Mislabeling of symptoms was studied in a group of 587 chronic asthmatic patients. Results indicated a wide variation in both the frequency and type of mislabeling, with over 26 per cent of the patients mislabeling one or more nonairways obstruction symptom clusters as being an asthma attack. Several demographic and personality factors were found to correlate with mislabeling. Finally, mislabeling was associated with medical outcome, with mislabelers being 40 per cent more likely than nonmislabelers to be rehospitalized for their asthma within six months of discharge.

Effectiveness of methods of teaching dental health to 9- to 10-year-old schoolchildren in the United Kingdom

Dental health education employing five different teaching methods was given to classes of 9- to 10-year-old schoolchildren. A control class received no teaching. The dental health knowledge of the classes was assessed before teaching, and immediately, 1 week and 3 months after teaching by the use of a questionnaire. All methods resulted in a variable increase in marks immediately after teaching. This was followed by a fall in marks for each class over the 3-month period. The poster and pack methods of presenting information, overall, had little or no effect on the recall of information. The talk, visual aids and project methods all significantly increased dental health knowledge for the 3-month period.

A method for decreasing patients' medication errors

Eighty anxious and eighty depressed patients were assigned randomly to receiving one of three versions of an information leaflet about their medication, or to receiving no leaflet at all. Mean medication errors were reduced from 15 to 4% by provision of suitably constructed leaflets. The results show the practical importance of informing patients about their medication and of paying attention to the difficulty level of any leaflets issued.

Communication in the clinical setting

Recent research on the problem of communicating with the patient is reviewed. It is shown that the frequent failures of both informative and persuasive communications are due in part to patients not understanding and to their forgetting what they are told.

Factors making for difficulties in communication are outlined, and methods are described for reducing failures of understanding and for increasing memory of what is said. Evidence on the effectiveness of these remedial methods is presented.