Health Coms Chap 1-5,8

Communication defined and Transactional Model

Communication defined and Transactional Model

C: anything but simple

T: People collaborate to construct meaning in a process of ongoing reciprocal influence.
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Health (WHO) and implications

A state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity. » Healthy ≠ the opposite of sick » Accounts for environmental influences

Communication with Multiple Levels of Meaning: Implications in a health context

Transactional communication is consistent with the relational approach which proposes that meaning is interpreted at two levels:

1. CONTENT: meaning is considered to be mostly denotive, subject to a literal interpretation

2. RELATIONAL: participants consider the implications of communication in terms of their relative status and feelings about each other. (considering how something is said, who says it, when they say it, and what they don't say)

Implications: » The ways communication takes place between patient and provider makes a big deal and influences the interpretation of the communication

Health Communication

» The way we seek, process, and share health information

» It is a process; meaning it is interpreted in light of past, present, and future expectations.

» It is shaped by many factors like personal goals, skills, cultural values, situational factors, and other's feelings

Biomedical model vs. Biopsychosocial model

BIOMEDICAL: based on premise that ill health is a phenomenon that can be explained, identified, and treated through physical means.

BIOPSYCHOSOCIAL: takes into account people's physical conditions (biology), their thoughts and beliefs (psychology), and their social expectations (social). » Emphasizes that no one approach works well with everyone. » More wholistic, superior

Are Benefits of studying health communication different than reasons to study?

REASONS TO STUDY:

1. Communication is crucial to the success of health care encounters.

2. Wise use of mass media and social media can help people learn about health and minimize the influence of unhealthy and unrealistic media portrayals.

3. Communication is an important source of personal confidence and coping ability.

4. Effective communication saves time and money.

5. Communication helps health care organizations operate effectively.

6. Health communication may be important to you because of career opportunities

Some dilemmas facing our health care system and arguments for reform

EARLY AND PREVENTATIVE CARE: » Chronic conditions not well managed are costly and hard to treat » If people were able to handle health concerns earlier, then they would not have to become such a large issue. » Japan spends half as much on health care but invests in preventative care which results in longer life expectancy than Americans

ACCESS AND HEALTH DISPARITIES: » People can rough predict life expectancy based on where a person lives and how much money they make. » This is partly because of the different health care and information people receive » Access to life insurance: making check-ups and medicine, treatments, and counseling more out of reach.

NAVIGATING A COMPLEX SYSTEM: » effective communication is needed to serve members of underserved populations » Many people feel confused or anxious navigating the health care system when they have problems » They also may not understand the directions they've been given, complicated insurance policies, contradictory info etc.

FOR REFORM: » Different kinds of insurance and managed health care » Universal Coverage: for all citizens are assured health care

How is our culture seeing a move towards patient empowerment?

more access to info, self education made a shift away from hierarchal structure

3 major areas of social change as it relates to our health care and their implications for our system.

1. AGE: Average age worldwide is increasing substantially, leading to high demand for health care services

2. DIVERSITY (PATIENTS): Ethnic and racial diversity increase the need for culturally sensitive health communication

3. DIVERSITY (PROVIDERS): Diversity among health care workers is not keeping pace with that of the overall population

Power differentials in communication between patients and their providers

Patients take lower places of power in nonverbals. Patients may be embarrassed, confused, fearful, etc.

» Therapeutic privilege: when medical professionals sometimes have the ability to withhold information from patients

Who talks the most in interactions? Why?

Typically Providers. Often times it is the result of providers' word choice or asking of close-ended questions. Maybe it is the result of a provider feeling rushed

Questions vs. Directives, Blocking, Patronizing behavior

PATRONIZING BEHAVIOR: » treating patients as if they were inferior by speaking down to them, withholding info, shrugging off their feelings as childish or inconsequential.

Disclosure decision-making model and components

Proposes that many patients do not simply say what is on their minds but instead weigh key factors first: » What outcomes can I predict if i share this info? » How is the other person likely to respond? » Can I share this information effectively?

Voice of Lifeworld vs. Voice of Medicine

LIFEWORLD: patients speak in a way that is primarily concerned with health and illness as it relates to everyday experiences. » Oriented to feelings and contexts. » EX: My back hurts when I pick up my son.

MEDICINE: care providers are expected to speak in a way of traditional biomedicine, characterized by carefully controlled compassion and a concern for accuracy and expediency. » Oriented to evidence, measurement, and precision. » Designed to help people, but limited to the facilitation of emotional expression.

Reasons Patients may not advocate for themselves

1. May think its appropriate to be passive (social expectations)

2. May be too fearful/anxious to be assertive

3. May not understand enough to participate in medical conversation

4. Socioeconomic factors like education levels may influence how actively they participate (resources, how they were raised etc)

5. May be discouraged by caregivers' communication style

6. The nature of medical visit (routine or symptom specific) may influence behavior (could be embarrassed, could have been told to do something that they haven't been doing)

7. Length of visit and people present may influence involvement.

What impacts patient satisfaction?

Patient satisfaction is more closely linked to providers' communication than to their technical skills. » lack of explanation » curt or disrespectful communication » invasions of privacy » feeling rushed » expressions of empathy » information explanation » a sense of control

Unethical practices of Tuskegee Syphilis Study

Tuskegee Syphilis Study: long-term study 1930s-1972. Studied 400 African-American men w/ syphilis and 200 w/o. recruited without informed consent, DIDNT KNOW OF COMPLICATIONS EXPERIENCED BY OTHERS (death rate of syphilis was 2x higher than control group.) Pencilin was a found cure in 1940s and the researchers didn't inform the participants.

INFORMED CONSENT Patients must

1. Be made fully aware of known treatment risks, benefits, and options

2. Be deemed capable of understanding such information and making a responsible judgment

3. Be aware they may refuse to participate or may cease treatment at any time.

Why are medical students so prone to burnout and stress?

Conflict, emotional fatigue, and excessive workload

What affects caregivers' sense of satisfaction?

» Patients being friendly and upfront about needs » when providers are confident about communication skills » then they feel appreciated and proud of the work they do » Also sensitive to autonomy and respect. They are more likely to stay in the field if they feel that people recognize and honor their efforts and involve them in decision making

What causes stress and burnout among health professionals?

Emotional exhaustion: » the feeling of being "drained and used up" to where people can't summon motivation or compassion

Depersonalization: » tendency to treat people in an unfeeling, impersonal way. people asking may be seen as weak and contemptible so providers who are burnout may resent their requests

Reduced sense of personal accomplishment: » involves feeling like a failure

What does communication training consist of for health professionals?

» The ability to create and sustain a therapeutic and ethically sound relationship with patients

» To use effective listening skills and elicit and provide information using effective nonverbal explanatory questioning and writing skills

» Involves working effectively with others as a member or leader of a health care team or other professional groups

Relational Health Communication Competence Model

Observes that communication, social support, and emotional resilience are positively associated with each other.

» Investing in gratifying relationships » Research bears out that providers stress is eased when patients and colleagues are supportive of one another

Rote Learning vs. Problem-based Learning

ROTE: students Memorizing information without understanding it

PBL: students apply information to actual, real-life scenarios rather than simply memorizing it.

how organizational culture can impact a caregivers' sense of satisfaction

Org Culture: members' basic beliefs and assumptions about an organization, its members, and its place in a larger environment » familiar structure and routines often have a taken-for-granted quality that blinds people to alternatives » constraints that are systemic, not individual

Social Support

Behaviors that communicate to an individual that they are valued and cared for by others. » central function of social support is to increase a person's sense of control

types of social support

action-facilitating a. instrumental b. information nurturing a. esteem b. emotional c. companionship

types of social support

instrumental: » tasks and favors ex: someone broke their arm, help them with tasks

Informational: » doing research, sharing personal experience, etc. ex: cancer patient wants all changes in her body tested.

Esteem: » making another person feel valued and competent ex: aid asks if resident wants a spoon, gave it to her, and left.

emotional: » efforts to acknowledge and understand another's feelings ex: actively listening to someone vent, acknowledging what they are going through is hard. companionship: » Spending quality time; not necessarily talking or doing anything but almost like distracting ex: a friend's mom died, bring her food and stay over to watch movies

Buffering hypothesis

the idea that social support is most important when people encounter potentially stressful situations, in which case knowing that other people are there for them can buffer them from feeling overwhelmed or helpless

received vs. perceived availability of support and scientific implications

R: enacted support by a person received by another

P: perceived availability of support and knowing someone is available to support

Implications: Knowing someone is available is a form of social support and can help people from thinking that they are alone in times of stress

Direct effect/ Main effect model

» The proposition that social support is beneficial even when people are not encountering notable stressors.

» We may encounter fewer stressful episodes and enjoy greater overall health if we have strong social networks

Coping

The process of managing difficult situations » problem-solving: changing what can be changed » emotional adjustment: adapting to what can't be changed

primary social support researcher

Burleson

statistics on loneliness, older adults, and support

» older adults who are unsatisfied with support from friends and family are 2x likely to rate their condition as fair to low

» 70 year olds are 22% more likely to live another 10 years with an active social support rather than inactive

» lonely individuals are more likely to sleep poorly, feel stressed, and have poor health

Oversupporting

Excessive and unnecessary help.

» over-helping: too much instrumental » over-informing: too much information like forcing info on people when they are too distraught to understand or accept it. » over-empathizing: specifically emotional contagion where people actually feel emotions similar to anothers. can cause isolation.