Judgments of emotion by nurses and students given double-bind information on a patient's tone of voice and message content

Professional voice use in health and nursing care - Time for reconsideration? A scoping review

BACKGROUND

Communication is a key tool in the nursing profession. It is known that listeners are sensitive to the speaker's voice and interpret the speaker's intentions primarily from the non-verbal signal conveyed.

AIM

To map and discuss the current state of knowledge and research evidence on professional voice use in health and nursing care.

DESIGN AND METHOD

A scoping review adherent to the EQUATOR guidelines PRISMA-ScR.

DATA SOURCES

Searches in the EBSCO, CINAHL, Medline, PubMed, PsychInfo and PsycArticles databases were conducted between 1 and 28 February 2023.

RESULTS

According to the data (n =  23), health professionals use voice as a vital aspect of caring communication and caring relationships, and in leadership as well as inter-professional collaboration, to facilitate information exchange and understanding and promote shared decision-making. The data showed that there is also a rising tendency to explore vocal demands and problems among health professionals. No studies were found on the use of voice in digital health and nursing care services or by social robots. Most of the reviewed studies were cross-sectional, rather small, and focused primarily on the perspectives of healthcare professionals.

CONCLUSION

The use of voice should be explored as a vital aspect of caring communication and caring relationships from the patients' perspective, and the effects of voice use on listeners' emotions and actions should be examined in different contexts with modern, voice-specific data collection methods. Studies focusing on voice use in digital health care and by social robots are also needed. By integrating training programmes, education and technological innovations, health care can leverage the full potential of voice-based communication to promote a more coordinated and patient-centred care environment, true inter-professional collaboration and effective leadership.

IMPACT

Professional voice use is an essential part of all health and nursing care and an impressive method that should be used consciously. Therefore, the meaning and methods of voice use, including speech accommodation, should be systematically introduced into health and nursing care and included in nursing education.

Listeners' attitudes towards voice disorders: An interaction between auditory and visual stimuli

OBJECTIVE

People with dysphonia are judged more negatively than peers with normal vocal quality. This preliminary study aims to (1) investigate correlations between both auditory-perceptual and objective measures of vocal quality of dysphonic and non-dysphonic speakers and attitudes of listeners, and (2) discover whether these attitudes towards people with dysphonia vary for different types of stimuli: auditory (A) stimuli and combined auditory-visual (AV) stimuli. Visual (V) stimuli were included as a control condition.

METHOD

Ten judges with no experience in the evaluation of dysphonia were asked to rate A, AV and V stimuli of 14 different speakers (10 dysphonic and 4 non-dysphonic speakers) Cognitive attitudes, evaluation of voice characteristics and behavioral attitudes were examined. Pearson and Spearman correlation coefficients were calculated to examine correlations between both Dysphonia Severity Index (DSI) values and perceptual vocal quality as assessed by a speech-language pathologist (PVQ_SLP) or perceptual vocal quality as assessed by the judges (PVQ_judge). Linear mixed model (LMM) analyses were conducted to investigate differences between speakers and stimuli conditions.

RESULTS

Statistically significant correlations were found between both perceptual and objective measures of vocal quality and mean attitude scores for A and AV stimuli, indicating increasingly negative attitudes with increasing dysphonia severity. Fewer statistically significant correlations were found for the combined AV stimuli than for A stimuli, and no significant correlations were found for V stimuli. LMM analyses revealed significant group effects for several cognitive attitudes.

CONCLUSION

Generally, people with dysphonia are judged more negatively by listeners than peers without dysphonia. However, the findings of this study suggest a positive influence of visual cues on the judges' cognitive and behavioral attitudes towards dysphonic speakers. Further research is needed to investigate the significance of this influence.

A clinical demonstration of the application of audiovisual biofeedback in the treatment of puberphonia

PURPOSE

The objective of this study was to demonstrate the effect of vocal audiovisual biofeedback in the treatment of puberphonia.

METHOD

This is a report of a single subject research study encompassing intervention and observation of results, involving three phases: baseline, treatment, and follow-up. Therefore, this study applied an A-B case study experimental design with follow-up for observation of treatment outcomes. Self-reported complementary data regarding feelings of voice usage included comparisons between pre and post intervention scores of the Voice Handicap Index (VHI) survey.

RESULTS

In this study, acoustic voice parameters measured revealed changes in vocal performance in the desired direction, as demonstrated by visual inspection and estimation of effect size of the data; changes were maintained during the follow-up phase. Examination of VHI results suggested post intervention improvement in functional and psychosocial aspects related to voice use.

CONCLUSIONS

Based on the results of this study, audiovisual feedback approaches are effective in the treatment of puberphonia. Results will apply to future considerations in the application of technology support for treatment of puberphonia and other voice related disorders.

Vivência de voz com profissionais de um hospital: relato de experiência

OBJETIVO: apresentar o relato de experiência de um grupo de Vivência de Voz realizado por fonoaudiólogos com profissionais e trabalhadores de um hospital. MÉTODOS: análise retrospectiva do processo de um Grupo de Vivência de Voz realizado com 20 profissionais de um hospital do interior de São Paulo, com foco analítico nos objetivos e atividades realizadas. RESULTADOS: foram contemplados os seguintes temas e objetivos: percepções dos sujeitos acerca da própria voz; uso profissional da voz e contextos e condições de trabalho; aquecimento vocal; impactos da voz/fala/comunicação/linguagem e da expressividade nas relações profissionais; possibilidades de mudanças. As ações educativas, contextualizadas nas condições, ambiente e organização do trabalho, possibilitaram gerar espaços de descobertas e de construção coletiva do conhecimento acerca do processo de trabalho no hospital e o grupo se mostrou como espaço social importante e efetivo para a sensibilização dos profissionais e trabalhadores do hospital em relação à voz/saúde vocal e aos seus impactos nas interações e nos processos comunicativos implicados no trabalho em saúde. CONCLUSÃO: afirma-se a importância da Fonoaudiologia na promoção de ambientes saudáveis e de processos comunicativos favoráveis à humanização das relações e melhoria do acesso e qualidade no acolhimento e atendimento em saúde.

What the voice reveals: within- and between-category stereotyping on the basis of voice

The authors report research that attempts to shift the traditional focus of visual cues to auditory cues as a basis for stereotyping. Moreover, their approach examines whether gender-signaling vocal cues lead not only to between-category but also to within-category gender stereotyping. Study 1 showed that both men and women vary within category in how feminine their voices sound and that perceptions of vocal femininity are highly consensual. Furthermore, the measured acoustic characteristics that differed between gender were also related to perceptions of within-gender femininity. Subsequent studies demonstrated that variability in vocal femininity affects gender stereotyping when the targets are all of the same gender (Study 2) and when the targets are of different genders (Study 3). In the latter case, evidence of both category-based and feature-based stereotyping was found. Mediation analyses showed that the relationship between acoustics and stereotyping was in part due to femininity.

Increased Pitch Increases Accuracy of Voice Identification

Previous work suggested that greater accuracy rates in identifying voices that have been increased in frequency over those that have been decreased in frequency may be due to complex vocal characteristics and specific memory for familiar voices. Here we asked 17 men and 21 women between the ages of 18 and 21 to learn a simple vowel exemplar produced by an unfamiliar target speaker and measured the proportion of times the frequency-shifted exemplar was identified as the originally encoded target speaker. Analysis showed that exemplars when increased in frequency were perceived as belonging to the target speaker significantly more often than exemplars which were decreased in frequency. These findings suggest that the greater accuracy in identifying speakers with increased frequency voice samples does not require previous familiarity with the vocalizations of a particular speaker or complex memory schemata for familiar voices.

Nurses' comprehension and recall process of a patient's message with double-bind information

We examined nurses' comprehension and recall process of patients' passage with double-bind information. We focused on two modes of communication, tone of voice and content of speech. The experiment followed a 2 x 2 x 2 design with respect to listeners (nurse vs student), tone of voice (positive vs negative), and verbal content (positive vs negative). Subjects were 79 nurses who worked at the university hospital and 99 students who were studying at the Faculty of Nursing. Nurses and students were randomly divided into four subgroups; each was presented one of four professionally tape-recorded scripts representing one possible combination of tone of voice and verbal content on the part of a fictitious patient. Listeners then rated the passages on scales and were asked to recall the passages in detail. Listeners recalled and understood passages better when the modes of communication did not conflict. Accuracy in recall reflected comprehension of passages rather than the listener's feelings about the "patient," especially in double-bind situations. Listeners tended to judge the speaker's feelings by tone of voice rather than verbal content.