Communicationg effectively in the Home/Hospital

Definition: Communication is defined as the transference of information (sound, message, meaning, or a signal) from one person to another or from one source to another. Communication cannot occur in a vacuum.

In the modern home and hospital many types of communications are occurring at the same time. It is beyond the scope of this article to go into the underlying reasons for the communications. Interpersonal communication takes place verbally/ by mouth, in writing, via the phone, intercom, email, faxes, body language, and gesturing. Not saying anything and having good or bad body odor are also different forms of communication.

Human beings “filter off” / do not pay attention to a lot of things which are going on around them. As a result we are very ineffective communicators. We often selectively listen to what we want to hear and ignore the rest. For communication to be effective both parties must be attentive to one another and there must be a desire to communicate. Further, the organs of voice production (larynx/voice box), hearing devices (ears) and the central nervous system must be functional. The medium of conduction, the air which surrounds us must be present. Transference of voice cannot take place in a vacuum.

It is not unusual to come across individuals with communication disorders. Many people with multiple communication disorders are unemployed and spend most of their time in the home or hospital. Expressive Language disorder, mixed expressive receptive language disorder, phonological disorder and stuttering are the four most common communication disorders. Persons suffering from these disorders can communicate but not very effectively. Care givers need to be alert and be perceptive of their needs and disability. Many normally functioning individuals are ineffective communicators, poor communications are to blame for the numerous divorces, adolescent problems and civil litigation.

To many people the purpose of communication is very clear but in the home and hospital setting it has many purposes which are not immediately apparent. The most important function is to obtain information from ill patients. This is often done by nurses, patients, doctors, administrators and other care givers. This communication has legal ramifications as some of these documents are required by the law. Communication is also used to give directions to patients and to receive instructions from patients. This sharing of important information is a very important function of communication. We also share information when we socialize. Last but not least we often express our feelings using other forms of communicating e.g. singing in the bathroom, whistling while cycling and humming to ourselves. Communication for the safety of patients and staff also occurs in the home and hospital environments.

For communication to be effective both parties must focus on the spoken word but this is not the only communication which may be going on at that time. Listening to the spoken message is only part of receiving communication. When communicating,

watch the other person’s body language and facial expressions. Listen, for the presence or absence of neologism and echolalia. The presence of either of these conditions indicates the presence of a psychiatric disorder, substance abuse, the occurrence of a cerebral stroke, or a transient ischemic episode. These need to be taken seriously. Professional medical help should be sought.

In the hospital setting, nurses are often faced with the challenge of trying to decipher what the patient is really wanting. A classical situation is when the patient comes to the nursing station and says to the nurse, “I want to discharge myself”. In this situation the nurse may not have a clue as to what is happening as the patient is using “tangential communication”. In this example, the patient was unhappy about the room he was given. Instead of saying to the nurse that he wanted better accommodation he chose to “discharge himself”. In this type of situation, it is often best to address the problem with an open ended statement. For example, ‘Mr. Jones, is there anything I can do to help you?”

For communication to be effective and fair sit at the same level as the person you are communicating with. Talk to the other person using language which he is able to understand. Treat the ill individual with respect and dignity. Do not use long, technical, or impressive words. When we are ill we often lose our technical skills and become regressed. The amount of regression is proportional to our illness. In some instances you may need to use the services of an interpreter.

Illness can cause a person to regress, as stated earlier. If English is the second language of your patient he or she may regress to the point where he/she will only communicate in his/her first language. This is not uncommon in acute hospital settings. Here too the usage of interpreter services is indicated. When the patient improves, he will start communicating in English, his second language, again.

Shouting is an indicator of frustration, on the part of the communicator. It is often annoying and intimidating to the receiver. Therefore, this type of communication should be avoided. Sometimes, when a person shouts at you, you may choose to respond in a soft spoken voice. This may communicate to the agitated person that you are in control and he/she may choose to change the style of communication.

If you, the care giver are a nurse, or professional person, it is illegal for you to communicate information about your patient to any person who is not part of the team who is caring for him/her. Never, discuss your patient’s information in the elevator, bus or any public place.

Listen very carefully when you are caring for a sick individual. Every behavior has meaning. Even suicidal patients communicate clues about their intent. Do not always look for a suicidal note. This is an extreme message. More subtle massages are common. Subtle messages include saying good bye to close friends, giving away personal items and giving away money to individuals who are close to the ill individual.

If you are looking after a depressed person you need to be very alert to his communications, both verbal and body cues. It is perfectly alright to sit close to this individual and listen. When you sit close to him you are communicating to him that you care about him/her and that you are available to help him. In these situations, it is not appropriated to read a book or watch TV. When you engage in these other activities, the message is different. It is, “I do not care about you, I love the TV program or the book I am reading, I am here because I am being paid to be here.

If you do not enjoy helping others it may be a good starting point to start looking for another job. Communicating is all accurate empathy and support. Human beings are social creatures.