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There can be health communication issues among nurses giving care to patients such as for example patients positive with breast cancer. Health communication among nursing care unit is a tough responsibility wherein oncology serves as one underlying factor in determining actual communication process. There can be imperative base of nurses skills in a clinical manner in which several cancer oriented nurses have received formal training in dealing with patients and communicate with them in all care level. Thus, there might have inadequate health related communication provided by nurses, can be due to culture related factors of breast cancer patients themselves like for instance, age and gender factors, family and social economic factors that adhere to the everyday life and work of these patients.
Poor healthcare communication among nurses may come into the picture without spontaneous and precise conformity of both sides. This means that, nurses should overcome culture related hindrances to apply effective healthcare communication mostly to those breast cancer patients living in remote areas and or indigenous sites. Health communication problems that are brought about by certain culture barriers can ideally cause such distressing mood for breast cancer patients as well as with their families, who often want considerable and accurate information coming from nurses and care providers more often as possible. Some of the patients leave consultation unsure about diagnosis and prognosis when culture communication issues strikes in a confusing way and the lack of compelling awareness by nurses in lieu to further diagnostic tests on patients’ situation and true standing of well being, putting communication issues in black and white state can lead to unclear health management plan and in turn, nurses will be uncertain about real therapeutic intent on the breast cancer treatment.
Accordingly, there have been initiatives upon improving health communication skills training for nurses and other care professionals located in the breast cancer field from influencing culture continuum in broader communication stature of nurses giving ultimate patient care and support. Health communication difficulty may slow down conscription of breast cancer patients into clinical trials, delaying introduction of effective innovative treatment into healthcare base.
The shortage of effective health communication among nurse specialists and care setting can cause culture oriented perplexity and such loss of poise amongst nursing care team. Culture disparities can put the scenario on higher assumption, healthcare system advocates will acknowledge insufficient training in health communication and management skills can be served with little dedication thus, contributing to nurses’ stress, lack of job pleasure and poignant burnout in the work area.
Case Study Example
There has been patients with an Egyptian background believe that dignity, identity, and security are conferred by belonging to a family and dealing with illness within a family context (Butow, Tattersall and Goldstein, 1997), Navajo culture provides another example of diverse cultural attitudes toward illness. Navajos feel that order and harmony are disrupted by receiving negative information (Baile, Lenzi, Parker et al., 2002) receiving an unfavorable diagnosis and prognosis is seen as curse (Mitchell, 1998). In some cultures, the negative stigma associated with the word cancer is so strong that the use of the word can be perceived as rude, disrespectful and even causal.
Another case was a study investigating the puzzling factors and solutions of family related barriers to truthfulness with patients who have terminal cancer was conducted through a nationwide survey conducted in Taiwan. The results showed that families believe it is unnecessary to tell aged patients the truth, and patients can be happier without knowing the truth (Hu, Chiu, Chuang et al., 2002). For Ethiopian refugees who are diagnosed with cancer, it is important to tell the family first but also important not to give unfavorable information at night so as to avoid the burden of sleepless night (Mitchell, 1998). There was awareness of the use of communication in some cultures and the psychosocial impact of terms such as cancer is helpful thus, it is essential to assess and consider patients cultural beliefs when communicating with them about their cancer.
In addition, there was also study of breast cancer experience of Asian American women (Tam Ashing, Padilla, Tejero et al., 2003) found that a lack of knowledge about breast cancer, cultural factors related to beliefs about illness, gender role and family obligations and language barriers contributed to Asian American women’s apparent lack of active involvement in their care. Cultural background greatly influences many aspects of the communication process. Although some cross-cultural descriptive studies have been conducted, especially on the views about disclosure of the diagnosis, relatively little is known about the specific influence of culture on the interaction between patients and their health care practitioners. How cultural variables might affect the information patients want, patients’ preferred and assumed participatory styles, and other aspects of the interaction warrant future study.
Age, Race, Ethnicity and Communication
An important area of communication problem center on differences in communication between nurses and doctors and the patients as well, better patient and nurse communication has been associated with patient choice about treatment, satisfaction with care and the quality of cancer care, particularly for older and disadvantaged patients (Liang, Burnett, Rowland et al., 2002). There was a study examining health care disparities in older patients with breast cancer found that older age and Latina ethnicity were negatively associated with physician provision of interactive informational support, and these patients received less interactive informational support from their physicians than did younger patients (Maly, Leake and Silliman, 2003). The proponent have concluded that improving the quality of communication at the level of patient-physician interaction could be an important avenue to reducing age and ethnic group treatment disparities among patients with breast cancer (Maly, Leake and Silliman, 2003).
In one investigation, patients aged 80 years and older reported receiving markedly less information about treatment options than did younger patients, were less likely to state that they were given a choice of breast cancer treatment, and were less likely to initiate communication or to perceive that their surgeons initiated communication (Liang, Burnett, Rowland et al., 2002). Silliman, Dukes, Sullivan et al. (1998) highlighted the importance of communication between older patients with breast cancer and their physicians. Investigators found that although older women obtained information regarding breast cancer from different sources, they relied most heavily on their physicians for information. Despite expectation, knowledge about importance of patient nurse communication, and the increasing use of breast conserving surgery, breast cancer patients undergo surgery less frequent than younger women. Even though many factors could explain patterns of care, (Zuckerman, 2000) it is possible that quality of communication between patients and their nurses contribute to observed treatment variability though medical standard of care (Zuckerman, 2000).
Younger and educated patients are most likely to take an active role in medical decision making. Some researchers have observed that low income women who are not as well educated do not communicate as well with their physicians about their treatment preferences or concerns and fears (Degner, Kristjanson, Bowman et al., 1997; Hietanen, Aro, Holli et al., 2000; McVea, Minier and Johnson Palensky, 2001; Zuckerman, 2000). Being unmarried, having low socioeconomic status, and having treatment options discussed less frequently are risk factors that, in addition to older age, predicted receiving conservative primary tumor therapy (McVea, Minier and Johnson Palensky, 2001).
Influence of Culture/Ethnicity/Language
By using culturally appropriate approaches to communicating about cancer may lessen levels of distress for the patient and/or members of the patient’s family. Developing an awareness of cross-cultural practices regarding cancer disclosure issues allows the clinician to become more sensitive to the expectations of culturally and individually diverse cancer patients. When discussing diagnoses and treatment options with patients from different cultures, it is important for clinicians to consider how to balance a commitment to frank discussion and a respect for the cultural values of the patient (Hern Jr, Koenig, Moore et al., 1998).
In common, patients whose dominant culture is derived from a Western philosophy subscribe to certainty, predictability, control, and obtainable outcomes (Mishel, 1990). This culture has engendered an approach that fosters self determination and autonomy in making treatment decisions (Gordon and Daugherty, 2003). The patient centered society values having fully informed patients who make accurate assessments about their health as cultural prerogative (Hern Jr, Koenig, Moore et al., 1998). Western cultural assumptions exist about what is good and just in medical care. One such assumption is the principle of self-determination and its importance in enabling patients to make autonomous treatment decisions (Baile, Lenzi, Parker et al., 2002).
The Cancer Patient’s Family
Families can help patients make better decision about their care (Ballard-Reisch and Letner, 2003), some believe that patient centered approaches emphasizing patient autonomy in medical decision making should be shifted to family centered approaches because most decision making in health care is carried out in the context of family care and obligation. Health care professionals are valued when they establish a structured and ongoing dialogue with family members about treatment goals, plans of care, and expectations regarding patient outcomes (Given, Given and Kozachik, 2001).
Family caregivers must be considered an integral part of the advanced cancer care partnership (Given, Given and Kozachik, 2001). In one investigation, being welcomed into the medical setting was a simple action, greatly appreciated by caregivers, allowing them to move on with unfolding events (Morris and Thomas, 2001) also taking legitimate place in the cancer scenario, nurses may easily attend to the needs alongside those of cancer patient (Morris and Thomas, 2001).
Other Communication Barriers
Some researchers have found that indirect cues signaling informational and emotional needs are far more common from patients than direct requests for information or support. In parallel, doctors readily respond to direct expressions of need but find it difficult to detect and respond to indirect behaviors cueing patient needs. The indirect forms of communication that are particularly difficult for many doctors to apprehend are allusions, paraverbal expressions and nonverbal behaviors (Butow, Brown, Cogar et al., 2002).
Patients may assume that their doctors will tell them whatever is relevant; others worry about appearing foolish if they reveal their ignorance by asking questions some feel guilty about taking too much of busy nurses’ time (Fallowfield and Jenkins, 1999; Maguire, 1999). The other barriers to communication may include the multiple specialists that patients, multiple clinicians and others that the patient may see within the treatment team (middle level practitioner, nurse), challenges posed by variations in education level, cultural difference and ethnicity as well as the anxiety that often accompanies an initial stake affecting patient comprehension and understanding (Towle and Godolphin, 1999; Ballard-Reisch and Letner, 2003).
Role of Nurses and Communication
Nurses play an important role in communication and supporting patients through crisis of cancer and play an important role in today’s multidisciplinary cancer team. Nurses perform key functions at almost every stage of breast cancer trajectory. Clinic and inpatient nurses are frequently the first clinical contacts for patients and family members and, through their initial interactions, (Fallowfield and Jenkins, 1999; Maguire, 1999) set the tone for the support the patient will receive throughout his or her care. Nurses are sources of information about procedures, treatments and other aspects of patient care. Spending the most time with the patient compared to physician members of the treatment team, nurses are frequently most trusted member of the cancer team when it comes to obtaining information (Fallowfield and Jenkins, 1999; Maguire, 1999).
Nurses attend to patient and family emotional needs after bad news is given and deal first with other emotionally draining situations such as angry patients or family members or patients who are withdrawn and depressed, nurses provide direct patient care, often acting as physician extenders and managing much of daily care of the breast cancer patient. Health communication with patients has been recognized as one of important aspects of nursing people (Armstrong-Esther et al., 1989; Van Cott, 1993).
Furthermore, communication serves as an important aspect of the quality of care, from several studies it appears that poor communication is the largest source of dissatisfaction in patients (Macleod Clark, 1985; Ley 1988; Davies and Fallowfield 1991). As an outcome, the quality of care may improve with effective communication. Effective communication does not just depend on the acquisition of the right communication skills (Wilkinson, 1991). From the preceding account, there appears that time pressure, especially in the residential home, is determinant for the verbal communication of nurses and the topics that come up for conversation. As nurses experience more time pressure they talk less about topics concerning lifestyle and emotions. There can be an important point for consideration because, in nursing, high pressure is often present, appeared that simply employing more staff does not lead to better communication (Pool, 1996; Liefbroer and Visser, 1986; Wilkinson, 1991).
Therefore, poor communication with health professionals, particular nurses does create most distress for families of patients with cancer that, difficulties communicating with families also have been identified as potentially stressful for nurses. This is particularly the case for nurses working in breast cancer care settings. In addition, small research has been undertaken to examine specific culture related problem and challenge confronting nurses who endeavor to communicate with families of patients with cancer in healthcare setting. There will be a need to describe nurses’ perceptions of communication issues, potential barrier and strategies associated with nurses’ interaction into certain cancer care setting. Thus, it can be that nurses described communication difficulties being encountered when interacting with cancer patient families.
The culture related factors appeared to be central determinant of quality of nurses’ healthcare communication as nurses described difficulties associated with delivery of bad news and treatment plans that are not evidently defined for the breast cancer patient. Indeed, effects of poor communication on nurses were remarkable and brightly described, recommendation for nursing clinical practice and subsequent research are to take place in time. Lastly, upon continuing of nursing education nurses should be trained to be sensitive to the needs of patients and will need to create atmosphere that facilitate cancer patients’ question and express imperative needs. Amicably, nurses should be trained to use their time efficiently thus, appeared that nurses’ verbal communication is hardly connected to patient characteristics. Then, it is important for nurses to learn how to standardize cancer patient needs, in order to offer nursing care that is tailored to effective health communication and the success of it.
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