Strictly speaking, health care is typically patient-centered since the emphasis is mostly placed on the health of the patient. However, this model is increasingly being eliminated in the field of care provision. Many family members of patients feel that their preferences and concerns are not sought, and even when they present them to caregivers, they are ignored ( Stayt, 2007 ). On the other hand, the dedicated caregivers often feel under-appreciated or overworked. Proper communication with the family of the patient is fundamental to the art and science of caregiving. The nature of communication between a caregiver and the patient’s family has a significant effect on the patient’s well-being and the outcome of care. A broken communication between caregivers and their patients’ parents is likely to bring about an unfitting or ineffective care, and sometimes even disastrous errors (Loghmani et al., 2014). The paper reviews literature about the barriers to communication between caregivers and their patients’ families and the possible remedies in order to illuminate the issue and arrive at a suitable conclusion.
The communication between caregivers and patients and their parents is not straightforward; rather, it requires skill from all the parties involved. Some of it is quite basic, like the caregiver introducing himself or herself to the patients’ family (Loghmani et al., 2014). On the other hand, some of it may require specific expertise, like breaking bad news. For example, it may be difficult understanding cues from families about when to repeat a given statement, or when to give them a break following all the information they have taken in. Any misunderstanding that arises in the communication between these parties, therefore, constitutes ineffective or unproductive communication ( Whitlatch, 2008 ). Any gap in communication may result in an undesirable outcome of care.
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Review of Literature
Barriers to Communication
Perceptions of unfair treatment. Loghmani et al. (2014) attribute an improper communication between caregivers and their patients’ families to the families’ perceptions of unfair treatment by caregivers. In this study, caregivers reported that they are often compelled to provide priority services to patients with more serious conditions and, in the process, upset those patients who had less serious conditions and demanded prompt care. These caregivers used their professional judgment to conclude that the patients with more severe conditions were more in need of urgent attention. Several caregivers quoted their patients’ family as saying: “Oh we think we are already sorted out, and the caregiver just leaves to attend to the latest arrival.”
Human resource issues. Loghmani et al. (2014) also point out to human resource factors that undermined communication between caregivers and their patients’ families. Shortages in staffing, for example, did not allow caregivers to have enough time with their patients’ family. The small number of caregivers and the resultant increased workload led to these decreased interactions. The caregivers involved in this study attributed the shortage in caregiving staff to the aging nature of the current workforce in the United States today. A statement from one of the caregivers reads: “We do not have enough caregivers. I do not think it is appropriate for four caregivers to attend to thirty or more patients in a single shift. Many of us are just frustrated. We really get shorthanded sometimes.”
Forced dependence. Forced dependence in may be described as the use of manipulation by a caregiver to condition the patient and their families. This technique is mostly employed by caregivers when a patient or the family is perceived to be difficult, so the caregiver sees it necessary to create a situation where the patient and their families are compelled to obey orders. According to Loghmani et al. (2014), in an age where providing care requires the caregiver to be responsive to and respective of patient preferences, values and needs and making sure that the patient’s values guide all the key decisions.
Loghmani et al. (2014) hold that while forced dependence is most likely to “get the job done,” it undermines patient satisfaction. In this scenario, the caregiver is deemed to be powerful while the patient and their families are powerless. The patients’ families are forced to “trust and obey,” and the relationship is somewhat hierarchical. It is this inequality and lack of partnership that is perceived by the author to be a barrier to effective communication between the two parties.
Miscommunication. An ineffective communication between caregivers and patients’ families takes place when information provided by caregivers is not properly understood. According to Whitlatch (2008) , if the patients of their parents misunderstand what the nurses say there is a high likelihood of adverse health outcomes. Health care needs accuracy and concentration because a mere deviation from the required treatment may cause major health issues for the patient. For instance, when a patient takes medication at the wrong time, while the caregiver had given the correct instructions to the family, this constitutes a mix-up in communication between the caregiver and the patients’ family.
Miscommunication may also occur when the caregiver uses language that is too complicated for the patients or their family members to understand. Many times, people think they are supposed to have understood, so they are reluctant to ask for clarification. Whitlatch (2008) concedes that about 40% of patients and their family members do not have what is referred to as health literacy. It is unfortunate that some of them are branded “non-compliant” by caregivers just because they do not understand instructions. Ignorant caregivers tend to talk patients and their families in the same way they would talk to their fellow health professionals, using medical jargon.
Conflicts with patients’ family members. On their study on issues facing caregivers in long-term care facilities, Whitlatch (2008) established that one of the main shows of poor communication between caregivers and patients’ families was confrontations between the two parties. For instance, caregivers have a hard time dealing with relatives who do not observe the stipulated visiting hours of these institutions. Caregivers complained that some families insist on visiting patients outside visiting hours, thereby interfering with their work, and threatening the privacy of other patients. Many of these relatives fail to understand that the time intervals that are not included in the visitation hours are used for such activities as cleaning and making ward rounds. Coming in during such moments tends to disrupt the flow of work in a system that requires the highest level of order.
Caregivers, because they are human, are likely to give negative responses. There have been many instances of confrontations regarding this matter reported in this study. Whitlatch (2008) reveals that it is twice as likely for relatives who comply with institutional regulations to have efficient and productive communication with caregivers than those who are always confronting the caregivers.
Interventions
Partnering with Patients’ Families. Whitlatch (2008) insists that even though working with patients and their families as true partners while providing care is neither intuitive nor easy on the part of the caregiver, it is an important step towards improving communication. Taking this step would require significant logistical and cultural changes. Nonetheless, there is an increased pressure from relevant institutions to encourage partnership between caregiver, patients, and patients’ families. For instance, the Joint Commission on Accreditation of Healthcare Organization (JCAHO) has partnered with the Institute of Medicine (IOM) in setting objectives regarding the involvement of patients’ families.
Health institutions working with the Institute for Healthcare Improvement (IHI) are considering various ways of ensuring respect between caregivers and patients’ families, such as placing family members on vital committees out of the typical grievance committee, training caregivers on more efficient ways of communicating, particular in complex clinical settings, allowing the patient’s relatives to contact the health institution’s Rapid Response Team if they feel the patient is in danger and employing the assistance of family members in reviewing daily medication lists. In some cases, family members may also be allowed to be present during resuscitations or include them in daily rounds.
Learning to Listen. Useros et al. (2012) argue that genuine partnership goes beyond merely providing information and more access. Caregivers have to be willing to search and appreciate input from patients’ families on matters both broad and specific. The author considers this step to the most challenging and where a great leadership is most vital because caregivers seldom share responsibility or trust the opinions of other parties while providing care. This may involve inviting patients and their family members to planning committees, where they would offer their feedback concerning their care experiences. From such interactions, caregivers may learn some aspects of care that they did not now before, thereby improving outcome for future cases.
According to Shin et al. (2016) , it is common for caregivers to believe that they are thinking about and for the best interest of the patient. However, there is a difference between assumptions and engaging in actual discussions with the patient’s family to confirm the belief. Proper communication between caregivers and their patients’ families goes beyond good intentions to incorporate the latter’s preferences.
There is no better way of knowing these preferences than asking. Especially in cases where the patient is unconscious or is not able to communicate properly, Shin et al. (2016) hold that it is important to seek the opinion of the patient’s family regarding the nature of care being offered. Many family members prefer to be asked about their concerns before getting into a speech about the patient’s current condition. If there is a particular concern the family members have, then it is likely that they would pay less attention to whatever the caregiver says before they get to that concern.
Conclusion and Recommendations
For the purposes of this study, both the barriers of communication and the factors that enhance communication have been elaborated. The reviewed literature offers some guidance to issues of communication between the caregivers and their patients’ families. The former have to put themselves into the latter’s shoes, which would enable them to provide better quality care to patients and their families. In instances where the caregiver displays a show of disrespect or ignorance in communication, the respective institution would need to enforce a code of ethics or use disciplinary procedures to let caregivers know that the abuse of a patient’s family is not acceptable in their profession ( Azoulay and Pochard, 2013 ).
Learning to listen and appreciate patients’ families’ at the individual patient-care level may require significant changes in practice for both the caregiver and the respective institution. These adjustments are both vital and necessary ( Whitlatch, 2008 ). Patients and their relatives are more knowledgeable of health issues today. For example, they review medication, they now the primary measures for heart failure, they refer to the internet for more information on specific health issues and are asking important questions ( O'Malley et al., 2009 ). If the caregiver does not appreciate the reasoning behind this behavior, if they take it as a show of lack of trust, then they would only create adversarial interactions with these family members.
It may be concluded that communication between caregivers and their patients’ families is contextually sophisticated, controversial, and at a constant risk of failure ( Whitlatch, 2008 ). Additionally, given that caregivers work in different settings, the findings for one workplace may be inconsistent with another. Thus, there is a need for further studies to create a proper understanding of the challenges and facilitators of caregiver-patient’s family communication.
References
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Loghmani, L., Borhani, F., & Abbaszadeh, A. (2014). Factors affecting the nurse-patients’ family communication in intensive care unit of kerman: a qualitative study. Journal of caring sciences , 3 (1), 67-82.
O'Malley, P., Favaloro, R., Anderson, B., Anderson, M. L., Siewe, S., Benson-Landau, M., & Keefer, N. (2009). Critical care nurse perceptions of family needs. Heart & lung: the journal of critical care , 20 (2), 189-201.
Shin, D. W., Cho, J., Roter, D. L., Kim, S. Y., Yang, H. K., Park, K., ... & Park, J. H. (2016). Attitudes toward Family Involvement in Cancer Treatment Decision Making: The Perspectives of Patients, Family Caregivers, and Their Oncologists. Psycho‐Oncology .
Stayt, L. C. (2007). Nurses’ experiences of caring for families with relatives in intensive care units. Journal of advanced nursing , 57 (6), 623-630.
Useros, M. V. D., Espín, A. A., Parra, E. C., & Martínez, A. B. (2012). Family Caregivers: Nurses’ Perception and Attitudes. Social Medicine , 6 (3), 151-161.
Whitlatch, C. (2008). Informal caregivers: Communication and decision making. AJN the American Journal of Nursing , 108 (9), 73-77.
