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Abstract
Background and Objectives Elderspeak is an inappropriate simplified speech register that sounds like baby talk and is used with older adults, especially in health care settings. Understanding the concept of elderspeak is challenging due to varying views about which communicative components constitute elderspeak and whether elderspeak is beneficial or harmful for older adults. Research Design and Methods Rodgers’ evolutionary concept analysis method was used to evaluate the concept of elderspeak through identification of elderspeak’s attributes, antecedents, and consequences. A systematic search using the PubMed, CINAHL, PsycINFO, and Embase databases was completed. Results Eighty-three theoretical or research articles from 1981 to 2020 were identified. Elderspeak characteristics were categorized by semantic, syntactic, pragmatic, paralinguistic, and nonverbal attributes. The primary antecedent to elderspeak is implicit ageism, in which old age cues and signs of functional or cognitive impairment led to simplified communication, usually from a younger caregiver. Research studies varied in reporting whether elderspeak facilitated or interfered with comprehension by older adults, in part depending on the operational definition of elderspeak and experimental manipulations. Exaggerated prosody, a key feature of elderspeak, was found to reduce comprehension. Elderspeak was generally perceived as patronizing by older adults and speakers were perceived as less respectful. In persons with dementia, elderspeak also increases the probability of resistiveness to care, which is an important correlate of behavioral and psychological symptoms of dementia. Discussion and Implications Based on this concept analysis, a new definition of elderspeak is proposed, in which attributes that have been found to enhance comprehension are differentiated from those that do not. Recommendations for consistent operationalization of elderspeak in future research are made.
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Affiliation(s)
- Clarissa A Shaw
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Jean K Gordon
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa, USA
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Chevalier B, Watson BM, Barras MA, Cottrell WN. Developing Preliminary Steps in a Pharmacist Communication - Patient Outcome Pathway. Can J Hosp Pharm 2019; 72:271-281. [PMID: 31452538 PMCID: PMC6699868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Nonadherence to medication therapy has been associated with poor health outcomes and increased health care costs. The literature describes pharmacists as key health care professionals in identifying and addressing nonadherence issues but does not explain how and why effective pharmacist-patient communication affects patients' medication adherence. Previously published pathways used in linking effective physician-patient communication to patient outcomes are proposed for the context of pharmacist-patient communication. OBJECTIVES To develop preliminary steps in a pharmacist communication - patient outcome pathway, adapted from a physician-patient communication pathway. METHODS This longitudinal descriptive study, which took place in a large quaternary hospital, involved hospital pharmacists and patients. Patients' assessment of pharmacist communication behaviours and reporting of patient satisfaction occurred after the pharmacist-patient consultation. Medication-taking behaviour questionnaires were administered before the consultation and again 4 weeks after discharge. Developing the preliminary pathway (based on previously established physician communication pathways) involved 2 steps, with investigation of the following associations: (1) between patient-reported effective communication by pharmacists, as per the Communication Accommodation Theory (CAT), and patient satisfaction; and (2) between patient-reported pharmacist communication and satisfaction and patients' medication-taking behaviour. RESULTS Twelve pharmacists and 48 patients participated. For step 1, almost all patient-reported pharmacist communication behaviours were positively correlated with patient satisfaction statements. Strong associations between CAT-related pharmacist communication behaviours and patient satisfaction highlighted the pharmacists' behaviours that are important to patients and necessary for effective conversations to take place. In step 2, there were fewer correlations of medication-taking behaviour indices with pharmacist communication behaviours and patient satisfaction. CONCLUSIONS This study showed how a preliminary pharmacist communication - patient outcome pathway could be successfully adapted from existing physician communication pathways. Such pathways provide an initial platform upon which future pharmacist communication - patient outcome research can be built.
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Affiliation(s)
- Bernadette Chevalier
- , PhD, is an Honorary Fellow, School of Pharmacy, The University of Queensland, Queensland, Australia
| | - Bernadette M Watson
- , PhD, is a Professor in the Department of English, and Director, International Research Centre for the Advancement of Health Communication, The Hong Kong Polytechnic University, Hong Kong, SAR
| | - Michael A Barras
- , PhD, is an Associate Professor in the School of Pharmacy, The University of Queensland, and Deputy-Director in the Pharmacy Department, Princess Alexandra Hospital, Queensland, Australia
| | - William N Cottrell
- , PhD, is an Associate Professor and Director, Interprofessional Education, Faculty of Health and Behavioural Sciences, The University of Queensland, Queensland, Australia
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Abstract
Purpose This study identifies genres of communication that avoid the features of elderspeak and successfully engage cognitively or physically affected older adults in rich communicative interaction. Design and Methods The study examined 100 hr of audio- and video-recorded interaction between older Catholic nuns and their caregivers. The data were collected as part of a 7-year study on the linguistic and communicative factors that contribute to successful aging in a Catholic convent infirmary. Data analyzed in this article were selected from the corpus based on 2 criteria: (a) the interaction was absent of elderspeak and (b) the interaction was between a communicatively or cognitively impaired older adult and a caregiver. Results Linguistic analysis of the interactions revealed 3 alternatives to elderspeak that maintain lexically and grammatically rich communication while maintaining minimal opportunity for communicative failure or breakdown. These include: (a) offered and requested blessings, (b) jokes, and (c) narratives. Implications These 3 communicative strategies offer examples of lexically and grammatically complex ways to communicate with older adults who have little other opportunity for similarly complex interaction and may reduce resistiveness to care, and linguistic isolation, which has been linked to cognitive decline.
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Affiliation(s)
- Anna I Corwin
- Department of Anthropology, Saint Mary's College of California, Moraga
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Williams KN, Perkhounkova Y, Jao YL, Bossen A, Hein M, Chung S, Starykowicz A, Turk M. Person-Centered Communication for Nursing Home Residents With Dementia: Four Communication Analysis Methods. West J Nurs Res 2018; 40:1012-1031. [PMID: 28335698 PMCID: PMC5581294 DOI: 10.1177/0193945917697226] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Person-centered communication recognizes the individual as a person and responds to the individual's feelings, preferences, and needs. This secondary analysis tested four interdisciplinary strategies to measure changes in person-centered communication used by nursing home staff following an intervention. Thirty-nine nursing assistants were recruited from 11 nursing homes and participated in the three-session Changing Talk communication training. Video recordings were collected at baseline, immediately postintervention, and at 3-month follow-up. Staff communication was analyzed using behavioral, psycholinguistic, and emotional tone coding of elderspeak communication and content analysis of communication topics. Sign rank test was used to compare postintervention changes for each measure of communication. Postintervention improvements in communication occurred for each measure; however, the changes were statistically significant only for behavioral and psycholinguistic measures. Methods and results for each communication measure were compared. Implications for future research and use of measures of person-centered communication as a tool to improve care are discussed.
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Affiliation(s)
| | | | - Ying-Ling Jao
- 3 Pennsylvania State University, University Park, PA, USA
| | - Ann Bossen
- 2 The University of Iowa, Iowa City, IA, USA
| | - Maria Hein
- 2 The University of Iowa, Iowa City, IA, USA
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Chevalier BAM, Watson BM, Barras MA, Cottrell WN, Angus DJ. Using Discursis to enhance the qualitative analysis of hospital pharmacist-patient interactions. PLoS One 2018; 13:e0197288. [PMID: 29787568 PMCID: PMC5963749 DOI: 10.1371/journal.pone.0197288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 04/30/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Pharmacist-patient communication during medication counselling has been successfully investigated using Communication Accommodation Theory (CAT). Communication researchers in other healthcare professions have utilised Discursis software as an adjunct to their manual qualitative analysis processes. Discursis provides a visual, chronological representation of communication exchanges and identifies patterns of interactant engagement. AIM The aim of this study was to describe how Discursis software was used to enhance previously conducted qualitative analysis of pharmacist-patient interactions (by visualising pharmacist-patient speech patterns, episodes of engagement, and identifying CAT strategies employed by pharmacists within these episodes). METHODS Visual plots from 48 transcribed audio recordings of pharmacist-patient exchanges were generated by Discursis. Representative plots were selected to show moderate-high and low- level speaker engagement. Details of engagement were investigated for pharmacist application of CAT strategies (approximation, interpretability, discourse management, emotional expression, and interpersonal control). RESULTS Discursis plots allowed for identification of distinct patterns occurring within pharmacist-patient exchanges. Moderate-high pharmacist-patient engagement was characterised by multiple off-diagonal squares while alternating single coloured squares depicted low engagement. Engagement episodes were associated with multiple CAT strategies such as discourse management (open-ended questions). Patterns reflecting pharmacist or patient speaker dominance were dependant on clinical setting. DISCUSSION AND CONCLUSIONS Discursis analysis of pharmacist-patient interactions, a novel application of the technology in health communication, was found to be an effective visualisation tool to pin-point episodes for CAT analysis. Discursis has numerous practical and theoretical applications for future health communication research and training. Researchers can use the software to support qualitative analysis where large data sets can be quickly reviewed to identify key areas for concentrated analysis. Because Discursis plots are easily generated from audio recorded transcripts, they are conducive as teaching tools for both students and practitioners to assess and develop their communication skills.
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Affiliation(s)
| | - Bernadette M. Watson
- Department of English, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Michael A. Barras
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - William N. Cottrell
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel J. Angus
- School of Communication and Arts, The University of Queensland, Brisbane, Queensland, Australia
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Chevalier BAM, Watson BM, Barras MA, Cottrell WN. Hospital pharmacists' and patients' views about what constitutes effective communication between pharmacists and patients. Int J Pharm Pract 2017; 26:450-457. [PMID: 29210472 DOI: 10.1111/ijpp.12423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 11/09/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The study's objective was to explore hospital pharmacists' and patients' views about what constitutes effective communication exchanges between pharmacists and patients. METHODS This was a novel theory-based qualitative study using semi-structured interviews to elicit patients' and pharmacists' perspectives. Pharmacists providing clinical pharmacy services in either inpatient or outpatient settings were recruited first. Eligible patients had been admitted to a study pharmacist's practice area and were prescribed three or more medications to manage a chronic disease(s). Following each pharmacist-patient medication counselling session, semi-structured interviews were held separately with patients and pharmacists. Participants were asked questions intended to explore their views about what constitutes an effective pharmacist-patient conversation. Audio recordings were transcribed verbatim, analysed using a process of inductive thematic analysis and then mapped to Communication Accommodation Theory strategies. Observational notes and reflexive note taking were conducted throughout. KEY FINDINGS Twelve pharmacists each engaged four individual patients for a total of 48 pharmacist-patient conversations (resulting in 48 separate interviews with pharmacists and patients). An overall shared goal was the assurance of patients' confidence in managing their medications at home. Themes included shared colloquialisms/slang, well-explained information, engagement, established rapport and empowerment. Participants provided rich exemplars for each of the themes. CONCLUSIONS Pharmacists and patients provided valuable insights about what makes pharmacist-patient interactions effective. Patient-identified preferences for pharmacist-patient exchanges may help guide pharmacy students and practitioners to engage patients in effective conversations.
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Affiliation(s)
- Bernadette A M Chevalier
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, QLD, Australia
| | - Bernadette M Watson
- Department of English, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Michael A Barras
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia.,Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - William N Cottrell
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
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Chevalier BAM, Watson BM, Barras MA, Cottrell WN. Investigating strategies used by hospital pharmacists to effectively communicate with patients during medication counselling. Health Expect 2017; 20:1121-1132. [PMID: 28370932 PMCID: PMC5600236 DOI: 10.1111/hex.12558] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 11/29/2022] Open
Abstract
Background Medication counselling opportunities are key times for pharmacists and patients to discuss medications and patients’ concerns about their therapy. Communication Accommodation Theory (CAT) describes behavioural, motivational and emotional processes underlying communication exchanges. Five CAT strategies (approximation, interpretability, discourse management, emotional expression and interpersonal control) permit identification of effective communication. Objective To invoke CAT to investigate communication strategies used by hospital pharmacists during patient medication counselling. Design This was a theory‐based, qualitative study using transcribed audiorecordings of patients and hospital pharmacists engaged in medication counselling. Setting and participants Recruited pharmacists practised in inpatient or outpatient settings. Eligible patients within participating pharmacists’ practice sites were prescribed at least three medications to manage chronic disease(s). Main outcome measures The extent to which pharmacists accommodate, or not, to patients’ conversational needs based on accommodative behaviour described within CAT strategies. Results Twelve pharmacists engaged four patients (48 total interactions). Exemplars provided robust examples of pharmacists effectively accommodating or meeting patients’ conversational needs. Non‐accommodation mainly occurred when pharmacists spoke too quickly, used terms not understood by patients and did not include patients in the agenda‐setting phase. Multiple strategy use resulted in communication patterns such as “information‐reassurance‐rationale” sandwiches. Discussion and conclusions Most pharmacists effectively employed all five CAT strategies to engage patients in discussions. Pharmacists’ communication could be improved at the initial agenda‐setting phase by asking open‐ended questions to invite patients’ input and allow patients to identify any medication‐related concerns or issues.
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Affiliation(s)
| | - Bernadette M Watson
- Department of English, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Michael A Barras
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.,Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Abstract
Older persons ( N = 159) were surveyed for their impressions of and experiences with elderspeak from friends, same-age family members, younger family members, familiar service workers, and unfamiliar service workers. Two dimensions, “warmth” and “superiority,” emerged in the judgments of elderspeak from all five speaker types. Respondents perceived more warmth and less superiority in elderspeak from friends than they did in elderspeak from unfamiliar service workers. Among younger seniors, elderspeak was received primarily from unfamiliar service workers, whereas among nursing home residents, elderspeak was received from all speaker types. Variation thus exists in the covert experiences of elderspeak from different sources, and in the frequency of receipt of elderspeak from different sources.
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Affiliation(s)
- Brian P O'Connor
- Department of Psychology, Thunder Bay, Lakehead University, Ontario, Canada.
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Chevalier BAM, Watson BM, Barras MA, Cottrell WN. Examining hospital pharmacists' goals for medication counseling within the communication accommodation theoretical framework. Res Social Adm Pharm 2015; 12:747-55. [PMID: 26626590 DOI: 10.1016/j.sapharm.2015.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Medication counseling opportunities are key times for pharmacists to speak to patients about their medications and any changes made during their hospital stay. Communication Accommodation Theory (CAT) posits that an individual's goals drive their communication behavior. The way in which pharmacists communicate with patients may be determined by the goals they set for these medication counseling sessions. OBJECTIVES To examine hospital pharmacists' goals in patient medication counseling within the CAT framework. METHODS Hospital pharmacist focus groups were held in two teaching hospitals. Interested pharmacists attended a focus group designed to elicit their goals in patient medication counseling. Focus groups were audio recorded and transcribed verbatim. NVivo(®) software was used to assist in coding and organization. The codes were reviewed for reliability by pharmacists independent of the focus groups. An inductive thematic analysis was applied to the data. RESULTS Six 1 h focus groups were conducted with a total of 24 pharmacists participating. Saturation of information was achieved after four focus groups. Greater than 80% consensus was achieved for reliability of the identified codes. Patient-centered themes constructed from these codes were to build rapport, to empower patients and to improve patients' experience, health and safety. Exemplars provided by pharmacists for the goals of building rapport and empowering patients were aligned with five CAT communication behaviors (approximation, interpretability, discourse management, emotional expression and interpersonal control). CONCLUSIONS Patient-centered goals described by hospital pharmacists for medication counseling aligned well with CAT behaviors necessary for effective communication. Further research using the CAT framework to examine the effectiveness of hospital pharmacist-patient exchanges that include both participants' perspectives is required to better understand how well pharmacists communicate with patients.
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Affiliation(s)
- Bernadette A M Chevalier
- School of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence, 20 Cornwall St, Woolloongabba, QLD 4102, Australia.
| | - Bernadette M Watson
- School of Psychology, The University of Queensland, Room 408, McElwain Building, St. Lucia, QLD 4072, Australia
| | - Michael A Barras
- Pharmacy Department, Royal Brisbane and Woman's Hospital, Butterfield St, Herston, QLD 4029, Australia
| | - William Neil Cottrell
- School of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence, 20 Cornwall St, Woolloongabba, QLD 4102, Australia
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Abstract
Veterinary professionals must meet the growing expectations of a diverse range of clients to sustain success in veterinary medicine. Few veterinarians, however, receive comprehensive skills training for communicating effectively with clients, particularly among special populations, such as children and older adults. An increasing number of veterinary professionals have recognized a need to master requisite skills for effectively interacting with pet-owning families. This article highlights the importance of the human-animal bond for children and older adults, addresses issues of pet loss, and provides suggestions for meeting the communication needs of both populations.
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Affiliation(s)
- Jennifer C Brandt
- The Ohio State University College of Veterinary Medicine, Columbus, OH 43210-1089, USA.
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de Haro-Fernández F, Blanca Martínez-López M. Instrumentalizar la comunicación en la relación enfermera-paciente como aval de calidad. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s1134-282x(02)77553-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Caris-Verhallen WM, Kerkstra A, Bensing JM, Grypdonck MH. Effects of video interaction analysis training on nurse-patient communication in the care of the elderly. Patient Educ Couns 2000; 39:91-103. [PMID: 11013551 DOI: 10.1016/s0738-3991(99)00094-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This paper describes an empirical evaluation of communication skills training for nurses in elderly care. The training programme was based on Video Interaction Analysis and aimed to improve nurses' communication skills such that they pay attention to patients' physical, social and emotional needs and support self care in elderly people. The effects of the training course were measured in an experimental and control group. They were rated by independent observers, by comparing videotapes of nursing encounters before and after training. Forty nurses participated in 316 videotaped nursing encounters. Multi-level analysis was used to take into account similarity among same nurse encounters. It was found that nurses who followed the training programme, provided the patients with more information about nursing and health topics. They also used more open-ended questions. In addition, they were rated as more involved, warmer and less patronizing. Due to limitations in the study design, it could not be demonstrated that these findings can entirely be ascribed to the training course. Further research, incorporating a randomized controlled design and larger sample sizes, is recommended to determine whether the results can be attributed to this specific type of training.
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Affiliation(s)
- W M Caris-Verhallen
- Department of Nursing and Caring Research, Netherlands Institute of Primary Health Care, NIVEL, Utrecht, The Netherlands.
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