(Re)Introducing communication competence to the health professions

Self-Perceived Communication Competence of Adults Who Stutter Following Communication-Centered Treatment

PURPOSE

The purpose of this study was to assess self-perceived communication competence of adults who stutter following participation in a non-ableist treatment for which one of the core components focuses on communication - with no direct or indirect goals designed to reduce or modify stuttered speech.

METHOD

Thirty-three adults who stutter completed the Self-Perceived Communication Competence scale (McCroskey & McCroskey, 1988) pre- and posttreatment.

RESULTS

Findings indicate significant gains in self-perceived communication competence posttreatment. Pre- to posttreatment changes in stuttering did not predict posttreatment gains in self-perceived communication competence.

CONCLUSION

The present study demonstrates that improvement in communication can be achieved independent of improvement in fluency, lending further support to the notion that stuttering and communication competence are distinct constructs.

Observer-rated outcomes of communication-centered treatment for adults who stutter: A social validation study

Previous studies have reported that adults who stutter demonstrate significant gains in communication competence, per self-ratings and clinician-ratings, upon completion of a communication-centered treatment, or CCT. The purpose of this social validation study was to determine whether communication competence ratings reported by untrained observers are consistent with client and clinician judgments of communication competence gains following CCT. Eighty-one untrained observers completed an online survey that required each to view one of two videos depicting an adult who stutters during a mock interview recorded prior to CCT or after CCT. Observers were then asked to rate the communication competence of the interviewee on a 100-point visual analog scale and provide additional demographic information. Communication competence of the adult who stutters who had completed CCT was rated significantly higher in their post-treatment video. Upon controlling for two demographic factors found to be associated with observer ratings (years of education, years the observers had known an adult who stutters), significantly higher ratings of communication competence for the post-treatment video were maintained. These preliminary findings provide social validity for CCT by demonstrating that the gains in communication competence reported in previous studies through clinician and client observations are also reported by untrained observers who are not familiar with CCT.

Nurse leaders' interpersonal communication competence: A mixed-method systematic review

AIM(S)

To identify and synthesize evidence available on nurse leaders' interpersonal communication competence.

DESIGN

Systematic mixed-methods review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist.

METHODS

The data were collected following predefined inclusion criteria. Two authors independently performed the study selection using Covidence software. Three authors assessed the quality using Joanna Briggs' Institute's critical appraisal tool and the mixed-methods appraisal tool. The data-based convergent synthesis design and narrative synthesis were used.

DATA SOURCES

CINAHL, PubMed, Scopus, Business Source Elite, Academic Search Premier, Communication & Mass Media Complete, PsycInfo, Web of Sciences, Medic and Finna.fi were searched and the screening of citations in relevant articles. The final searches were performed on 17 October 2022.

RESULTS

A total of 26 studies-15 quantitative, 9 qualitative and 1 of both mixed-method and multi-method-met the inclusion criteria. The nurse leaders' interpersonal communication competences described in the extant literature were categorized into three themes: message competence, relational competence and task competence. There were considerable differences in the levels of competence, as some competences were considered basic communication skills, while others required more advanced level competences. Furthermore, three competence levels were identified: novice, competent and expert.

CONCLUSIONS

This study unravels a unique hierarchical description of communication skills across competence categories, supported by the assumption that communication skills are structured hierarchically. The studies reviewed herein had a narrow perception of nurse leaders' interpersonal communication competence and indicated a transmissional understanding of communication.

IMPACT

This is the first mixed-methods systematic review that describes and synthesizes the evidence on nurse leaders' communication competencies hierarchically and across competence levels. The study suggests that further research should focus on a broader and more analytical understanding of the cognitive and affective aspects of interpersonal communication competence.

PROSPERO ID

CRD42023385058.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Impact of self-disclosure and communication competence on perceived listener distraction

PURPOSE

The purpose of this study was to investigate the distraction reported by unfamiliar adults when listening to a speaker who stutters, and whether listener distraction is influenced by two factors: self-disclosure and communication competence.

METHOD

Two hundred seventy-five adults watched a video vignette and were asked to rate their level of distraction when observing an adult Latinx male producing stuttered speech. Each participant watched one of six randomized videos of the same speaker sharing the same content systematically manipulated by (a) presence or absence of 15% stuttering, (b) presence or absence of self-disclosure, and (c) high or low communication competence.

RESULTS

Listener distraction was higher when rating speakers with low communication competence, regardless of whether stuttering or self-disclosure were heard. Videos wherein the speaker was fluent were rated as significantly less distracting, but only in the context of high communication competence. For videos wherein the speaker stuttered, listeners reported significantly less distraction when the speaker demonstrated high communication competence and self-disclosed.

FINDINGS

These findings suggest that for persons who stutter, high communication competence and disclosing that they stutter will yield maximum reduction in listener distraction.

Preferred Communication Strategies Used by Physical Therapists in Chronic Pain Rehabilitation: A Qualitative Systematic Review and Meta-Synthesis

OBJECTIVE

Lack of clarity regarding effective communication behaviors in chronic pain management is a barrier for implementing psychologically informed physical therapy approaches that rely on competent communication by physical therapist providers. This study aimed to conduct a systematic review and meta-synthesis to inform the development of a conceptual framework for preferred communication behaviors in pain rehabilitation.

METHODS

Ten databases in the health and communication sciences were systematically searched for qualitative and mixed-method studies of interpersonal communication between physical therapists and adults with chronic pain. Two independent investigators extracted quotations with implicit and explicit references to communication and study characteristics following Standards for Reporting Qualitative Research and Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Methodological quality for individual studies was assessed with Critical Appraisal Skills Programme, and quality of evidence was evaluated with GRADE-CERQual. An inductive thematic synthesis was conducted by coding each quotation, developing descriptive themes, and then generating behaviorally distinct analytical themes.

RESULTS

Eleven studies involving 346 participants were included. The specificity of operationalizing communication terms varied widely. Meta-synthesis identified 8 communication themes: (1) disclosure-facilitating, (2) rapport-building, (3) empathic, (4) collaborative, (5) professional accountability, (6) informative, (7) agenda-setting, and (8) meta-communication. Based on the quality of available evidence, confidence was moderate for 4 themes and low for 4 themes.

CONCLUSION

This study revealed limited operationalization of communication behaviors preferred by physical therapists in chronic pain rehabilitation. A conceptual framework based on 8 communication themes identified from the literature is proposed as a preliminary paradigm to guide future research.

IMPACT

This proposed evidence-based conceptual framework for preferred communication behaviors in pain rehabilitation provides a framework for clinicians to reflect on their own communication practices and will allow researchers to identify if and how specific communication behaviors impact clinical outcomes.

What do we know about written assessment of health professionals' communication skills? A scoping review

OBJECTIVE

The aim of this scoping review was to investigate the published literature on written assessment of communication skills in health professionals' education.

METHODS

Pubmed, Embase, Cinahl and Psychnfo were screened for the period 1/1995-7/2020. Selection was conducted by four pairs of reviewers. Four reviewers extracted and analyzed the data regarding study, instrument, item, and psychometric characteristics.

RESULTS

From 20,456 assessed abstracts, 74 articles were included which described 70 different instruments. Two thirds of the studies used written assessment to measure training effects, the others focused on the development/validation of the instrument. Instruments were usually developed by the authors, often with little mention of the test development criteria. The type of knowledge assessed was rarely specified. Most instruments included clinical vignettes. Instrument properties and psychometric characteristics were seldom reported.

CONCLUSION

There are a number of written assessments available in the literature. However, the reporting of the development and psychometric properties of these instruments is often incomplete. Practice implications written assessment of communication skills is widely used in health professions education. Improvement in the reporting of instrument development, items and psychometrics may help communication skills teachers better identify when, how and for whom written assessment of communication should be used.

US Physicians' and Nurses' Motivations, Barriers, and Recommendations for Correcting Health Misinformation on Social Media: Qualitative Interview Study

BACKGROUND

Health misinformation is a public health concern. Various stakeholders have called on health care professionals, such as nurses and physicians, to be more proactive in correcting health misinformation on social media.

OBJECTIVE

This study aims to identify US physicians' and nurses' motivations for correcting health misinformation on social media, the barriers they face in doing so, and their recommendations for overcoming such barriers.

METHODS

In-depth interviews were conducted with 30 participants, which comprised 15 (50%) registered nurses and 15 (50%) physicians. Qualitative data were analyzed by using thematic analysis.

RESULTS

Participants were personally (eg, personal choice) and professionally (eg, to fulfill the responsibility of a health care professional) motivated to correct health misinformation on social media. However, they also faced intrapersonal (eg, a lack of positive outcomes and time), interpersonal (eg, harassment and bullying), and institutional (eg, a lack of institutional support and social media training) barriers to correcting health misinformation on social media. To overcome these barriers, participants recommended that health care professionals should receive misinformation and social media training, including building their social media presence.

CONCLUSIONS

US physicians and nurses are willing to correct health misinformation on social media despite several barriers. Nonetheless, this study provides recommendations that can be used to overcome such barriers. Overall, the findings can be used by health authorities and organizations to guide policies and activities aimed at encouraging more health care professionals to be present on social media to counteract health misinformation.

Including Communication in the Nursing Classroom: A Content Analysis of Communication Competence and Interprofessional Communication in Nursing Fundamentals Textbooks

The American Association of Colleges of Nursing identifies communication as one the four core competencies for interprofessional collaborative practice and teaches communication to nursing students across the United States. The purpose of this study was to examine how communication is presented in nursing fundamentals textbooks. Grounded in communication in the disciplines (CID) framework, communication was primarily presented using the interactive model, with an emphasis on nonverbal and affective communication. All the communication competencies were covered in the textbooks, with active listening featured prominently and feedback and appropriate language choice covered least. Communication competence was also featured in the textbooks, with an emphasis on knowledge. Skills was limited to multiple choice questions and motivation was absent from the textbooks. The findings offer insight and recommendations for how to better prepare nursing students for communication interactions.

Evaluating the effects of behavior change training on the knowledge, confidence and skills of sport and exercise science students

Background

Behavior change interventions have the potential to have a transformative effect on the health of populations. Allied health professionals have a key role to play in delivering these interventions. However, traditionally undergraduate allied health professional programs have not had a behavior change focus. The aim of this study was to assess the effectiveness of a training program on sport and exercise science students’ knowledge, confidence and skills in the provision of behavior change support.

Method

A mixed method convergent design was used to address the research question. Fifteen sport and exercise science students took part in a training program consisting of seven 90-min weekly face to face group sessions. Student satisfaction with training methods was assessed. Pre-to-post training changes in students’ confidence and knowledge in the provision of behavior change support was evaluated. Delivery of behavior change support was assessed by an audio recorded role-play rated by an expert using the Health Care Climate Questionnaire, and an adapted version of the Communication Evaluation in Rehabilitation Tool. Students also completed a reflective assignment.

Results

Students were satisfied with the training. There were increases in students’ confidence and knowledge of certain behavior change components post-training but not behavior change techniques. Students delivered behavior change support in a broadly needs supportive manner. The reflective assignment showed that students found particular behavior change strategies difficult to implement.

Conclusion

It is feasible to train undergraduate students in particular components of behavior change support. Academic institutions should embed behavior change training into the allied health professional curriculum to ensure graduates are job ready with the knowledge, confidence and skills to support health related behavior change within the wider health system.

Development of a comprehensive communication skills curriculum bases on intervention mapping in response to an urgent need for community health workers' education reform: A study protocol

BACKGROUND

Communication skills are one of the most important competencies required for community health workers (CHWs); however, there is no systematic evidence-based communication training course for them. In this study, we aim to develop a comprehensive communication skills curriculum for CHWs based on the intervention mapping (IM) approach.

MATERIALS AND METHODS

We used the IM approach to develop a systematic evidence-based communication skills curriculum for CHWs. First, we will determine the required competencies (by a literature search, a qualitative study, and a Delphi study), and then, we will develop a questionnaire for need assessment, and finally, we will implement the course and evaluate its efficacy by conducting a randomized controlled trial. This study was designed according to the steps of IM.

CONCLUSION

This protocol reports an example of developing a training course using IM. This course could be applied for similar health workers across the world, as well as the CHWs.

The Relationships Between Doctor-Patient Affectionate Communication and Patient Perceptions and Outcomes

The current article combines the literature on doctor-patient communication and affectionate communication. Using Affection Exchange Theory (AET), the study predicts that the need for affection and the benefits of affectionate communication translate to the doctor-patient setting, proposing a series of relationships from both perceived doctor affectionate communication and affection deprivation to several patient outcome variables (patient perception of the doctor, patient communication with the doctor, and patient satisfaction/adherence). The results strongly supported the predictions for both affectionate communication and affection deprivation, with affectionate communication positively relating to most outcome measures and affection deprivation negatively relating to most outcome measures. Affection deprivation served as a moderator for the relationship between provider competence and patient satisfaction, although affectionate communication moderated the relationship between provider competence and patient adherence. Implications and possible directions for future research are discussed.

Interruptions and multitasking in surgery: a multicentre observational study of the daily work patterns of doctors and nurses

The aim of this study was to obtain baseline data on doctors' and nurses' work activities and rates of interruptions and multitasking to improve work organisation and processes. Data were collected in six surgical units with the WOMBAT (Work Observation Method by Activity Timing) tool. Results show that doctors and nurses received approximately 13 interruptions per hour, or one interruption every 4.5 min. Compared to doctors, nurses were more prone to interruptions in most activities, while doctors performed multitasking (33.47% of their time, 95% CI 31.84-35.17%) more than nurses (15.23%, 95% CI 14.24-16.25%). Overall, the time dedicated to patient care is relatively limited for both professions (37.21%, 95% CI 34.95-39.60% for doctors, 27.22%, 95% CI 25.18-29.60% for nurses) compared to the time spent for registration of data and professional communication, that accounts for two-thirds of doctors' time and nearly half of nurses' time. Further investigation is needed on strategies to manage job demands and professional communications. Practitioner Summary: This study offers further findings on the characteristics and frequency of multitasking and interruptions in surgery, with a comparison of how they affect doctors and nurses. Further investigation is needed to improve the management of job demands and communications according to the results.

Laughter, Humor, and Cancer: Delicate Moments and Poignant Interactional Circumstances

Conversation analysis is employed to examine transcribed excerpts drawn from a subsample of 75 naturally occurring and video recorded interviews between cancer patients and 30 doctors. Close examination is provided of how cancer patients initiate, and doctors respond, to laughter and humor during oncology interviews. Interactions demonstrate that communication about the disease "cancer" shares qualities similar to other medical areas (e.g., primary care): the tendency for patients to initiate laughter or humor to address troubling and challenging circumstances; and that during moments when patients address personal matters, doctors are not invited and do not reciprocate with shared laughter and humor. Prominent in talk about cancer are various precarious circumstances, awkward and delicate moments mirroring the lived experiences of cancer patients (e.g., when patients attempt to minimize fears, justify that they are well when threatened with sickness, claim normality in the midst of chronic conditions, and take stances that weight loss and gain are not problematic). These examples provide a compelling case that routine cancer care involves many poignant situations managed through laughter and humor. Implications are raised for how quality care might be improved through grounded understandings of laughter, humor, and cancer.

Supporting generalist nurses in the rural setting with the introduction of a clinical assessment process

The aim of this research was to evaluate the implementation of an assessment process for general nurses involved in providing end-of-life care. A mixed-method, three-phased study was conducted on a medical ward at a regional hospital in a rural setting. Participating nurses completed a questionnaire about their awareness levels of the five validated scales included in the assessment of patients receiving palliative care. Auditing of the completed assessment forms was conducted at the interim and post data collection points and focus groups were conducted in the final phase. Analysis of the data revealed that nurses were able to integrate the use of this assessment process into the care of this group of patients. The author concludes, while nurses working in rural settings require general clinical knowledge of a wide range of patient groups, validated assessment scales can assist them in the provision of evidence-based palliative care.

Efficacy and effectiveness trials have different goals, use different tools, and generate different messages

The discussion about the optimal design of clinical trials reflects the perspectives of theory-based scientists and practice-based clinicians. Scientists compare the theory with published results. They observe a continuum from explanatory to pragmatic trials. Clinicians compare the problem they want to solve by completing a clinical trial with the results they can read in the literature. They observe a mixture of what they want and what they get. None of them can solve the problem without the support of the other. Here, we summarize the results of discussions with scientists and clinicians. All participants were interested to understand and analyze the arguments of the other side. As a result of this process, we conclude that scientists tell what they see, a continuum from clear explanatory to clear pragmatic trials. Clinicians tell what they want to see, a clear explanatory trial to describe the expected effects under ideal study conditions and a clear pragmatic trial to describe the observed effects under real-world conditions. Following this discussion, the solution was not too difficult. When we accept what we see, we will not get what we want. If we discuss a necessary change of management, we will end up with the conclusion that two types of studies are necessary to demonstrate efficacy and effectiveness. Efficacy can be demonstrated in an explanatory, ie, a randomized controlled trial (RCT) completed under ideal study conditions. Effectiveness can be demonstrated in an observational, ie, a pragmatic controlled trial (PCT) completed under real-world conditions. It is impossible to design a trial which can detect efficacy and effectiveness simultaneously. The RCTs describe what we may expect in health care, while the PCTs describe what we really observe.