Development and evaluation of a program to improve clinician and patient communication during a telehealth consultation : C.R.I.S.P. Telehealth

Introduction: The delivery of health care in the 21st century will look like no other in the past. The fast paced technological advances that are being made will need to transition from the information age into clinical practice. The phenomenon of e-Health is the over-arching form of information technology and telehealth is one arm of that phenomenon. The uptake of telehealth both in Australia and overseas, has changed the face of health service delivery to many rural and remote communities for the better, removing what is known as the tyranny of distance. Many studies have evaluated the satisfaction and cost-benefit analysis of telehealth across the organisational aspects as well as the various adaptations of clinical pathways and this is the predominant focus of most studies published to date. However, whilst comments have been made by many researchers about the need to improve and attend to the communication and relationship building aspects of telehealth no studies have examined this further. The aim of this study was to identify the patient and clinician experiences, concerns, behaviours and perceptions of the telehealth interaction and develop a training tool to assist these clinicians to improve their interaction skills. Methods: A mixed methods design combining quantitative (survey analysis and data coding) and qualitative (interview analysis) approaches was adopted. This study utilised four phases to firstly qualitatively explore the needs of clients (patients) and clinicians within a telehealth consultation then designed, developed, piloted and quantitatively and qualitatively evaluated the telehealth communication training program. Qualitative data was collected and analysed during Phase 1 of this study to describe and define the missing 'communication and rapport building' aspects within telehealth. This data was then utilised to develop a self-paced communication training program that enhanced clinicians existing skills, which comprised of Phase 2 of this study to develop the interactive program. Phase 3 included evaluating the training program with 26 clinicians and results were recorded pre and post training, whilst phase 4 was the pilot for future recommendations of this training program using a patient group within a Queensland Health setting at two rural hospitals. Results: Comparisons of pre and post training data on 1) Effective communication styles, 2) Involvement in communication training package, 3) satisfaction pre and post training, and 4) health outcomes pre and post training indicated that there were differences between pre and post training in relation to effective communication style, increased satisfaction and no difference in health outcomes between pre and post training for this patient group. The post training results revealed over half of the participants (N= 17, 65%) were more responsive to non-verbal cues and were better able to reflect and respond to looks of anxiousness and confusion from a 'patient' within a telehealth consultation. It was also found that during post training evaluations, clinicians had enhanced their therapeutic communication with greater detail to their own body postures, eye contact and presentation. There was greater time spent looking at the 'patient' with an increase of 35 second intervals of direct eye contact and less time spent looking down at paperwork which decreased by 20 seconds. Overall 73% of the clinicians were satisfied with the training program and 61% strongly agreed that they recognised areas of their communication that needed improving during a telehealth consultation. For the patient group there was significant difference post training in rapport with a mean score from 42 (SD = 28, n = 27) to 48 (SD = 5.9, n = 24). For communication comfort of the patient group there was a significant difference between the pre and post training scores t(10) = 27.9, p = .002, which meant that overall the patients felt less inhibited whilst talking to the clinicians and more understood. Conclusion: The aim of this study was to explore the characteristics of good patient-clinician communication and unmet training needs for telehealth consultations. The study developed a training program that was specific for telehealth consultations and not dependent on a 'trainer' to deliver the content. In light of the existing literature this is a first of its kind and a valuable contribution to the research on this topic. It was found that the training program was effective in improving the clinician's communication style and increased the satisfaction of patient's within an e-health environment. This study has identified some historical myths that telehealth cannot be part of empathic patient centred care due to its technology tag.

Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language

Background Miscommunication in the healthcare sector can be life-threatening. The rising number of migrant patients and foreign-trained staff means that communication errors between a healthcare practitioner and patient when one or both are speaking a second language are increasingly likely. However, there is limited research that addresses this issue systematically. This protocol outlines a hospital-based study examining interactions between healthcare practitioners and their patients who either share or do not share a first language. Of particular interest are the nature and efficacy of communication in language-discordant conversations, and the degree to which risk is communicated. Our aim is to understand language barriers and miscommunication that may occur in healthcare settings between patients and healthcare practitioners, especially where at least one of the speakers is using a second (weaker) language. Methods/Design Eighty individual interactions between patients and practitioners who speak either English or Chinese (Mandarin or Cantonese) as their first language will be video recorded in a range of in- and out-patient departments at three hospitals in the Metro South area of Brisbane, Australia. All participants will complete a language background questionnaire. Patients will also complete a short survey rating the effectiveness of the interaction. Recordings will be transcribed and submitted to both quantitative and qualitative analyses to determine elements of the language used that might be particularly problematic and the extent to which language concordance and discordance impacts on the quality of the patient-practitioner consultation. Discussion Understanding the role that language plays in creating barriers to healthcare is critical for healthcare systems that are experiencing an increasing range of culturally and linguistically diverse populations both amongst patients and practitioners. The data resulting from this study will inform policy and practical solutions for communication training, provide an agenda for future research, and extend theory in health communication.

'Conditional candour' and 'knowing me': an interpretive description study on patient preferences for physician behaviours during end-of-life communication

OBJECTIVE: To understand patients' preferences for physician behaviours during end-of-life communication.

METHODS: We used interpretive description methods to analyse data from semistructured, one-on-one interviews with patients admitted to general medical wards at three Canadian tertiary care hospitals. Study recruitment took place from October 2012 to August 2013. We used a purposive, maximum variation sampling approach to recruit hospitalised patients aged ≥55 years with a high risk of mortality within 6-12 months, and with different combinations of the following demographic variables: race (Caucasian vs non-Caucasian), gender and diagnosis (cancer vs non-cancer).

RESULTS: A total of 16 participants were recruited, most of whom (69%) were women and 70% had a non-cancer diagnosis. Two major concepts regarding helpful physician behaviour during end-of-life conversations emerged: (1) 'knowing me', which reflects the importance of acknowledging the influence of family roles and life history on values and priorities expressed during end-of-life communication, and (2) 'conditional candour', which describes a process of information exchange that includes an assessment of patients' readiness, being invited to the conversation, and sensitive delivery of information.

CONCLUSIONS: Our findings suggest that patients prefer a nuanced approach to truth telling when having end-of-life discussions with their physician. This may have important implications for clinical practice and end-of-life communication training initiatives.

Individual Video Training iVT and Annotating Academic Videos AAV: two complementing technologies

Individual Video Training iVT and Annotating Academic Videos AAV: two complementing technologies 1. Recording communication skills training sessions and reviewing them by oneself, with peers, and with tutors has become standard in medical education. Increasing numbers of students paired with restrictions of financial and human resources create a big obstacle to this important teaching method. 2. Everybody who wants to increase efficiency and effectiveness of communication training can get new ideas from our technical solution. 3. Our goal was to increase the effectiveness of communication skills training by supporting self, peer and tutor assessment over the Internet. Two technologies of SWITCH, the national foundation to support IT solutions for Swiss universities, came handy for our project. The first is the authentication and authorization infrastructure providing all Swiss students with a nationwide single login. The second is SWITCHcast which allows automated recording, upload and publication of videos in the Internet. Students start the recording system by entering their single login. This automatically links the video with their password. Within a few hours, they find their video password protected on the Internet. They now can give access to peers and tutors. Additionally, an annotation interface was developed. This software has free text as well as checklist annotations capabilities. Tutors as well as students can create checklists. Tutor’s checklists are not editable by students. Annotations are linked to tracks. Tracks can be private or public. Public means visible to all who have access to the video. Annotation data can be exported for statistical evaluation. 4. The system was well received by students and tutors. Big numbers of videos were processed simultaneously without any problems. 5. iVT http://www.switch.ch/aaa/projects/detail/UNIBE.7 AAV http://www.switch.ch/aaa/projects/detail/ETHZ.9

Measuring outcomes of a communication program for older people with hearing impairment using the International Outcome Inventory

The main objective of this study was to describe the outcomes of a communication education program for older people with hearing impairment using the International Outcome Inventory - Alternative Interventions (IOI-AI) and the version for significant others (IOI-AI-SO). Ninety-six people aged 58 to 94 years participated in an interactive group education program for two hours per week for five weeks. The IOI-AI was administered at one to two weeks after the last educational session and 29 significant others also completed the IOI-Al-SO at this time. Overall, positive results were obtained using both questionnaires, and satisfaction with the program was particularly high. Findings also compared favourably to reports of outcomes for other audiological interventions (i.e., another communication training program and hearing aid fitting). Principal components analysis of the IOI-AI revealed a somewhat different factor structure than the original IOI-HA. The two versions of the 101 applied in this study are recommended as simple and effective measures of the outcomes of alternative interventions.

Introduction: business communication in the digital age – fresh perspectives

Digital Business Discourse offers a distinctively language- and discourse-centered approach to digitally mediated business and professional communication, providing a timely and comprehensive assessment of the current digital communication practices of today's organisations and workplaces. It is the first dedicated publication to address how computer-mediated communication technologies affect institutional discourse practices, bringing together scholarship from a range of disciplinary backgrounds, including organisational and management studies, rhetorical and communication studies, communication training and discourse analysis. Covering a wide spectrum of communication technologies, such as email, instant messaging, message boards, Twitter, corporate blogs and consumer reviews, the chapters gather research drawing on empirical data from real professional contexts. In this way, the book contributes to both academic scholarship and business communication training, enabling researchers, trainers and practitioners to deepen their understanding of the impact of new communication technologies on professional and corporate communication practices.

Patient Safety - A Psychological Perspective

This comprehensive book takes a psychological perspective on patient safety. It is based on the most recent theoretical and empirical research evidence from psychology (including clinical, work, and organizational psychology) and adjacent social and behavioral sciences such as human factors. Factors that influence safety-related experiences, behaviors, and outcomes of patients and professionals working in clinical settings such as medical practices and hospitals are reviewed, structured, and critically evaluated. Consistent with the complexity of the topic, the author takes a multi-level approach to patient safety, which includes a review of individual, team, and organizational factors and outcomes. The book describes how these factors, by themselves and in combination, can facilitate or impede patient safety. Individual factors include safety-relevant knowledge, skills, abilities, and personality traits such as conscientiousness and emotional stability. Team factors include group communication, training, and leadership. Finally, organizational factors include the safety culture and climate. Throughout the book, different evidence-based intervention programs are described that can help practitioners promote patient safety and prevent accidents. The book is a valuable resource for both researchers and practitioners interested in understanding, maintaining, and improving patient safety in a variety of applied settings. It is based on the most up-to-date research evidence from psychology and neighboring disciplines, and it is written in a clear and non-technical language understandable for a wide audience.

General Practitioner Antimicrobial Stewardship Programme Study (GAPS): protocol for a cluster randomised controlled trial

Background There is a strong link between antibiotic consumption and the rate of antibiotic resistance. In Australia, the vast majority of antibiotics are prescribed by general practitioners, and the most common indication is for acute respiratory infections. The aim of this study is to assess if implementing a package of integrated, multifaceted interventions reduces antibiotic prescribing for acute respiratory infections in general practice. Methods/design This is a cluster randomised trial comparing two parallel groups of general practitioners in 28 urban general practices in Queensland, Australia: 14 intervention and 14 control practices. The protocol was peer-reviewed by content experts who were nominated by the funding organization. This study evaluates an integrated, multifaceted evidence-based package of interventions implemented over a six month period. The included interventions, which have previously been demonstrated to be effective at reducing antibiotic prescribing for acute respiratory infections, are: delayed prescribing; patient decision aids; communication training; commitment to a practice prescribing policy for antibiotics; patient information leaflet; and near patient testing with C-reactive protein. In addition, two sub-studies are nested in the main study: (1) point prevalence estimation carriage of bacterial upper respiratory pathogens in practice staff and asymptomatic patients; (2) feasibility of direct measures of antibiotic resistance by nose/throat swabbing. The main outcome data are from Australia’s national health insurance scheme, Medicare, which will be accessed after the completion of the intervention phase. They include the number of antibiotic prescriptions and the number of patient visits per general practitioner for periods before and during the intervention. The incidence of antibiotic prescriptions will be modelled using the numbers of patients as the denominator and seasonal and other factors as explanatory variables. Results will compare the change in prescription rates before and during the intervention in the two groups of practices. Semi-structured interviews will be conducted with the general practitioners and practice staff (practice nurse and/or practice manager) from the intervention practices on conclusion of the intervention phase to assess the feasibility and uptake of the interventions. An economic evaluation will be conducted to estimate the costs of implementing the package, and its cost-effectiveness in terms of cost per unit reduction in prescribing. Discussion The results on the effectiveness, cost-effectiveness, acceptability and feasibility of this package of interventions will inform the policy for any national implementation.

Kantoaalto koulutuksesta työyhteisön viestintäosaamiseen : lyhytkestoisen viestintäkoulutuksen vaikuttavuuden avaintekijät

The purpose of this research is to examine whether short-term communication training can have an impact on the improvement of communication capacity of working communities, and what are prerequisites for the creation of such capacity. Subjects of this research were short-term communication trainings aimed at the managerial and expert levels of enterprises and communities. The research endeavors to find out how communication trainings with an impact should be devised and implemented, and what this requires from the client and provider of the training service. The research data is mostly comprised of quantitative feed-back collected at the end of a training day, as well as delayed interviews. The evaluations have been based on a stakeholder approach, and those concerned were participants to the trainings, clients having commissioned the trainings and communication trainers. The principal method of the qualitative analysis is that of a data-driven content analysis. Two research instruments have been constructed for the analysis and for the presentation of the results: an evaluation circle for the purposes of a holistic evaluation and a development matrix for the structuring of an effective training. The core concept of the matrix is a carrier wave effect, which is needed to carry the abstractions from the training into concrete functions in the everyday life. The relevance of the results has been tested in a pilot organization. The immediate assessment and delayed evaluations gave a very differing picture of the trainings. The immediate feedback was of nearly commendable level, but the effects carried forward into the everyday situations of the working community were small and that the learning rarely was applied into practice. A training session that receives good feedback does not automatically result in the development of individual competence, let alone that of the community. The results show that even short-term communication training can promote communication competence that eventually changes the working culture on an organizational level, provided that the training is designed into a process and that the connections into the participants’ work are ensured. It is essential that all eight elements of the carrier wave effect are taken into account. The entire purchaser-provider -process must function while not omitting the contribution of the participants themselves. The research illustrates the so called bow tie -model of an effective communication training based on the carrier wave effect. Testing the results in pilot trainings showed that a rather small change in the training approach may have a signi¬ficant effect on the outcome of the training as well as those effects that are carried on into the working community. The evaluation circle proved to be a useful tool, which can be used while planning, executing and evaluating training in practice. The development matrix works as a tool for those producing the training service, those using the service as well as those deciding on the purchase of the service in planning and evaluating training that sustainably improves communication capacity. Thus the evaluation circle also works to support and ensure the long-term effects of short-term trainings. In addition to communication trainings, the tools developed for this research are useable for many such needs, where an organization is looking to improve its operations and profitability through training.

Implementation of a nursing competency assessment system in public hospitals

Numerous problems are frequently observed when nursing competency assessment systems (NCAS) are implemented. How to effectively implement a nursing competency assessment system, according to academic and practical contributions, is poorly reported in the literature. The purpose of this paper is to present a set of recommendations for public hospitals and nursing management in order to facilitate the implementation of a NCAS. To achieve this objective we have revised the existing literature and conducted a Delphi study with nursing managers and human resource managers of the public hospitals of the Basque Health Service. The results are that the implementation of a NCAS requires a well-planned strategy that managers must consider before implementing any NCAS. This strategy must include, at minimum, the following aspects: communication, training, leadership, and content where the NCAS is concerned. The context of the organisations and the cultural dimensions may also influence the results of the application of the system.

Fatores críticos de sucesso como antecedentes da aceitação de um sistema de informação em uma universidade federal

In recent decades the public sector comes under pressure in order to improve its performance. The use of Information Technology (IT) has been a tool increasingly used in reaching that goal. Thus, it has become an important issue in public organizations, particularly in institutions of higher education, determine which factors influence the acceptance and use of technology, impacting on the success of its implementation and the desired organizational results. The Technology Acceptance Model - TAM was used as the basis for this study and is based on the constructs perceived usefulness and perceived ease of use. However, when it comes to integrated management systems due to the complexity of its implementation,organizational factors were added to thus seek further explanation of the acceptance of such systems. Thus, added to the model five TAM constructs related to critical success factors in implementing ERP systems, they are: support of top management, communication, training, cooperation, and technological complexity (BUENO and SALMERON, 2008). Based on the foregoing, launches the following research problem: What factors influence the acceptance and use of SIE / module academic at the Federal University of Para, from the users' perception of teachers and technicians? The purpose of this study was to identify the influence of organizational factors, and behavioral antecedents of behavioral intention to use the SIE / module academic UFPA in the perspective of teachers and technical users. This is applied research, exploratory and descriptive, quantitative with the implementation of a survey, and data collection occurred through a structured questionnaire applied to a sample of 229 teachers and 30 technical and administrative staff. Data analysis was carried out through descriptive statistics and structural equation modeling with the technique of partial least squares (PLS). Effected primarily to assess the measurement model, which were verified reliability, convergent and discriminant validity for all indicators and constructs. Then the structural model was analyzed using the bootstrap resampling technique like. In assessing statistical significance, all hypotheses were supported. The coefficient of determination (R ²) was high or average in five of the six endogenous variables, so the model explains 47.3% of the variation in behavioral intention. It is noteworthy that among the antecedents of behavioral intention (BI) analyzed in this study, perceived usefulness is the variable that has a greater effect on behavioral intention, followed by ease of use (PEU) and attitude (AT). Among the organizational aspects (critical success factors) studied technological complexity (TC) and training (ERT) were those with greatest effect on behavioral intention to use, although these effects were lower than those produced by behavioral factors (originating from TAM). It is pointed out further that the support of senior management (TMS) showed, among all variables, the least effect on the intention to use (BI) and was followed by communications (COM) and cooperation (CO), which exert a low effect on behavioral intention (BI). Therefore, as other studies on the TAM constructs were adequate for the present research. Thus, the study contributed towards proving evidence that the Technology Acceptance Model can be applied to predict the acceptance of integrated management systems, even in public. Keywords: Technology

Um olhar bioecológico sobre os efeitos da comunicação alternativa na interação professor-aluno com paralisia cerebral

Estudos sobre a sintática da comunicação têm revelado que tanto a repertório verbal como a não-verbal produzem modificações significativas na interação social, e, portanto, no desenvolvimento humano. A fala, por exemplo, tem sido vista como uma modalidade comunicativa socialmente exigida para a construção de relações nos diferentes contextos e culturas. Entretanto, essa modalidade nem sempre é o recurso mais disponível principalmente para aqueles que apresentam alterações no seu desenvolvimento. Diante disso, é comum que a pessoa com deficiência tente buscar formas compensatórias para expressar seus desejos, pensamentos e frustrações, por meio das expressões faciais, do movimento ocular e/ou de piscada e de movimentos intencionais como o apontar. Nesse sentido, os recursos e estratégias de comunicação alternativa tem sidosão utilizados como ferramentas úteis para que o indivíduo possa alcançar maior participação social nos diversos contextos em que se apresenta. No entanto, a literatura tem destacado que, no ambiente escolar, os entraves de comunicação entre o professor e o aluno com deficiência podem acarretar prejuízos ao processo de ensino-aprendizagem. Por isso, esta pesquisa teve como objetivo analisar a interação professor-aluno com paralisia cerebral antes e após a introdução dessas ferramentas. Para tanto, realizou-se estudo de caráter qualitativo, do tipo estudo de caso com pesquisa intervenção. As etapas principais deste estudo foram: filmagens dos episódios interativos sem os recursos de comunicação alternativa, capacitação dos professores na escola e filmagem dos episódios interativos com os recursos de comunicação alternativa. Os dados foram analisados de forma qualitativa, considerando as quatro dimensões do modelo bioecológico de desenvolvimento humano proposto por Bronfenbrenner (1998): Processo, Pessoa, Contexto e Tempo. Dentre os resultados desta pesquisa destacam-se: maior engajamento mútuo no desenvolvimento dos episódios, com aumento na extensão de elos comunicativos; melhor percepção da professora acerca das habilidades de comunicação da aluna e tendência desta educadora para a utilização dessas ferramentas com finalidade de ensino. A partir disso, concluiu-se que esses recursos dinamizaram as interações entre a professora e a aluna com paralisia cerebral. Contudo, a implementação de tais recursos no cotidiano escolar requer a interdependência positiva de diversos fatores, dentre os quais os atributos pessoais desenvolvimentalmente geradores e maior base de tempo regular com o uso dessas ferramentas.

Criação de contexto favorável ao compartilhamento do conhecimento operário: pesquisa no ambiente vidreiro

In search for better competitiveness, the automotive industry has discussed and applied several concepts related to people and processes. However, in many organizations, the adopted concepts are implemented and kept unarticulated. In this context, authors recognize the role of the knowledge as competitive advantage, but it is still dealt in an implicit way with the traditional models of Production Management. Exploring opportunities in this scenario, this Thesis aims to analyse worker knowledge sharing using factors of Knowledge Management, Work Organization and Production Organization. For the realization of the present Thesis, the scope of the research was restricted to be the labour environment of the glass plants shop floor. The choice of the glass sector is justified due to high dependency on the tacit knowledge of blue-collars. The research uses a qualitative-quantitative approach and employs interviews with workers and managers to identify factors. To assess the importance of these factors in the management judgments, is employed the technique Incomplete Pairwise Comparisons based on Analytic Hierarchy Process Saaty (2001). The result indicates integration among factors and highlights the importance of systematic and technical conversation among operators to share better your knowledge. Also, worker knowledge sharing is improved using communication, training and work instruction. This research extends the conceptual frameworks encountered in literature from the factors integration of Knowledge Management with the Organization of Work and the Production and makes explicit use of the theme of knowledge. This contributes to promote of a favourable context for the creation and sharing of knowledge, among the people in the labour environment, and to support incremental innovation

Cateterismo cardíaco: da compreensão do usuário ao planejamento das orientações de enfermagem

Pós-graduação em Enfermagem (mestrado profissional) - FMB