Challenges in Communication: Barriers to Patient Care

• Hina Mirza

Communication has always been a fundamental need of human beings. Communication can be defined as an act of transmitting or imparting, which includes not only verbal messages, but all human behaviors (Sundeen et al., 1994). It is a vital part in mental health nursing or psychological care, because it’s a key to its achievement. It empowers health care provider to help clients in their anguish, to explore more essential data which can help to give better care to the patient. As literature states, interaction and care that is patient focused results in positive patient outcomes and increase chances of diagnostic accuracy (Rouf et al., 2009). There are several barriers to communication, could be from patient side or from the health care provider. On the other hand, managing patients with distinctive mental wellbeing issues is challenging, particularly when the patient is discouraged, detached or unmotivated (Sheldon, 2009). In addition to it, different clients have distinctive needs, as a health care proficient one ought to be equipped enough to evaluate those needs through different abilities, and make client competent enough to assess oneself. This paper will highlight some of the patient’s internal barriers to communicate, such as patient’s unmotivated behavior, and health care provider beliefs such as stigmatization about mentally ill patients which ultimately affect patient care and strategies to limit those barriers simultaneously. The case below is of a patient who was diagnosed with schizophrenia. It will highlight the barriers that can affect good communication:

A 23 year old patient came with complain of social isolation. Further history revealed substance abuse since 4 years. While taking interview of the patient, he was drowsy and seems to be not interested in talking. During the interview, late verbal response was observed; he was not maintaining eye contact, answered 4 to 5 questions after emphasizing and consuming lots

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of time for replying. Moreover, the patient sometimes repeats the same sentence of the interviewer. Due to consumption of plenty of time by the patient, I was not able to take a proper history from the patient, and lots of information remained incomplete. When I reflect back to the patient’s statements and body language, I realized he was unmotivated and discourage due to his substance abuse behavior. Next day, again same behavior was observed. After asking question related to change in behavior, patient reassures that he is at guilt and stated that his family will not accept him again due to his addicted behavior.

The above situation highlights many issues, one of them is, substance abuse that itself a source behind criticism for the patient and upon all that patients unmotivated or debilitate conduct. Also, the patient was not maintaing eye contact that resembles his social convictions, as numerous social beliefs may impact the correspondence styles and may affect on mental wellbeing like their way of expression, their family support and their coping mechanism. Some characteristics such as socioeconomic status, occupation, education, gender have more powerful effects on an individual which can alter the person’s behavior their way of communication (Fortinash et al., 2012). A part of the patients own cultural beliefs, the health care providers own values about the patient’s addicted behavior may hinder in patient care. As evidenced by literature that the mental health nurses values and skills shape their practice and care giving behavior (Morrissey et al., 2011).

Analyzing the issue from different perspectives of patient and health care provider which leads to ineffective communication. Firstly, the patient was given late verbal responses, as well as communicating in low voice volume, as the patient was diagnosed with schizophrenia, it could be one of the reasons that altered speech and it may be due to the disease process. “Abnormalities in language are central to psychosis, particularly the schizophrenic syndrome” (Kuperberg et al., 2003). Another related symptom was echolalia which was one of the reasons of consuming more time for replying. A psychotic condition, i.e.; patients with schizophrenia, Echolalia (repeating what someone else just said) may be observed (Kuperberg et al., 2003). Taking in concern this issue, as a health care provider one needs to be competent enough for dealing these kind of patients and certain strategies should be used such as giving more time to the patient to express his feelings, using frequent pauses, listen to the patient very carefully to make him feel about worth of explaining himself, paraphrase and summarize for the patient to reassure what patient meant to say, provide space without or with minimal distraction, use non verbal communication as interviewer expressions and body language is more communicative such as maintain eye contact other than staring. Moreover,the impact of difficulty in speech may have poor conversational skills, poor social perception and all this may hinder in socialization which could be a cause of isolation (Nacro, 2011) which was stated by the patient in the above scenario. Secondly, patient was apathetic or unmotivated due to his addicted behavior and dealing with such patient could be a challenge for nurses for motivating the client. For such patients, counseling style such as motivational interviewing (MI) was developed by Miller and Rollnick (2002). This is widely used approach for the patients with substance abuse which emphasize on exploring and reinforcing the intrinsic behavior of the client that leads to motivation of healthy behavior (Barnett et al., 2012). If through this approach client’s motivational level increase so his communication pattern will also improve.

Looking forward to the staff internal and external barriers to the communication one of the highlighting issue in this scenario was patient drug addiction which could be a foundation of stigmatization and may limit health care provide to provide efficient care. Here, theoretical framework of VCAT can be applied that choosing, prizing and acting accordingly with the prioritize responsibility of a nurse. Moreover, to gain knowledge about the specific behavior of the patient related to substance abuse and deepen the understanding could be one of the source to give empathy to the patient and change the behavior of oneself and others in society to help patients to recover instead of marginalizing the one in need. If a health care provider his/herself is affirmed in their value the better care will be provided as a result. On institutional level staff training should be provided for therapeutic communication to give quality care.

The care of the nurse should be in light of Care Framework to provide holistic care to the patient. According to the scenario, making patient realize the process of self harm by using drugs, using hidden self strength to cope up with such behavior and that realization could be achieved through therapeutic communication. It will enable the patient to engage effectively in health care (Shepperd et al., 2003).

To conclude, communication is the basic tool to approach effective care of the patient. Several barriers that can hinder the communication could be from the patient side that results from the disease process or patients’ own perception or could be a lacking of healthcare provider. Overall, a nurse should be competent enough to evaluate patients need through effective communication process limiting all barriers by using different strategy to indulge patient in his/her own care.

References

Barnett,E., Sussman,S., Smith,C., Rohrbach,L.A., & Spruijt-Metz,D. (212). Motivational Interviewing for adolescent substance use: A review of the literature.Addictive Behaviors,37, 1325–1334.

Fortinash,K.M., & Holoday-Worret,P.A. (2004).Psychiatric mental health nursing. St. Louis, MO: Mosby.

KUPERBERG,G.R., & CAPLAN,D. (2003). LANGUAGE DYSFUNCTION IN SCHIZOPHRENIA.

Morrissey,J., & Callaghan,P. (2011). Communication Skills for Mental Health Nurses: An Introduction.McGraw-Hill International.

Nacro. (2011).Speech, language and communication difficulties Young people in trouble with the law. Wales.

Rouf,E., Chumley,H., & Chumley,A. (2009). Patient-centered interviewing and student performance in a comprehensive clinical skills examination: Is there an association?Patient Education and Counseling,75, 11-15. Retrieved from www.elsevier.com/locate/pateducou

Sheldon,L.K. (2009).Communication for nurses: Talking with patients. Sudbury, MA: Jones and Bartlett Publishers.

SHEPPERD,C., & MCALLISTER,M. (2003). CARE: A framework for responding therapeutically to the client who self-harms.Journal of Psychiatric and Mental Health Nursing,10, 442–447.

Sundeen,S.J. (1998).Nurse-client interaction: Implementing the nursing process. St. Louis: Mosby.