Communication In The Delivery Of An Ultrasound
Communication is an important aspect of practice for health care professionals. The role of communication has been appreciated by health care providers worldwide. Effective communication includes the ability to receive, interpret and respond efficiently and clearly to messages (Craig 1993). Communication in health services is different from normal social disclosure because in medicine we discuss very private and sensitive issues (Levetown 2008). Communication should be effective and it is very important in the health care industry to establish a relationship between the patient and health care providers. According to Andy Betts, a nurse Consultant and Professor at Nottingham University claims that “Studies over last 3 decades identify communication problems as persistent causes for concern in delivery of healthcare” (Ellis et al 2003 pg.73). In this essay I will discuss the role of communication in ultrasound department.
A department made up of a group of people with different responsibilities and every individual involved in the system is an agent of communication. For example, the staff for booking appointments, the Sonographer’s, managers and doctor’s. Team work and communication among co-workers is also important for running a successful department. When communication is not good in departments it will result in poor patient care and satisfaction, easily made mistakes and a lack of confidence in care providers. Effective communication is essential for running successful health care departments.
Sonographers have a key role in providing information to patients. For effective communication, Sonographers not only develop communication skill but also their ability to listen and convey interest, compassion, knowledge and information are the key important factors in their practice (Craig 1993). According to a literature review, communication in ultrasound is a neglected area of research. In the last couple of years, there are studies going on which showed patient centred style of communication are to be encouraged.
It is also important that according to the NHS Plan, communication is the centre of effective patient care. In the NHS, according to their standard setup, all trust scanning services should have clear policies and procedure in place for communication of normal and abnormal ultrasound scan results (NHS Foetal Anomaly Screening programme March 2009). According to Communication standard in NHS (April 1996), ‘communication should be open, corporate, two way, timely, planned, consistent, clear, targeted, credible, efficient and integrated’.
According to recent news which was published in British medical journal, from April 2008 to March 2009, there were 14,866 complaints about clinical care. Among those there were 11,003 complaints which were about poor communication and attitude. Also, in the same journal there was a survey commissioned by healthcare quality improvement partnership and they also found that most complaints were related to communication between patients and health professionals.
Medical science today is advancing and we are seeing new changes and developments. In the field of Prenatal Ultrasound, the continual technical advances improve our diagnostic and therapeutic capabilities.
As a Sonographer it is our duty that our patient should be fully informed about the specific purpose of the scan and what are the limitations of ultrasound (Chesson 2002). So a verbal or written consent is very important. It is observed that if women get consultation before the scan, it will increase maternal foetal attachment and will reduce maternal anxiety. The privacy of the patient should not be neglected.
Ultrasound is very attractive to women and families as Ultrasound is a routine part of care in pregnancy. The literature on women and partners views of their experiences about this ultrasound technology is positive and women found this as a pleasurable experience and it gave them reassurance that the foetus is healthy (Crag – Svalenius et al 1996). We know that images of 2D/3D foetal scans are very important for parental bonding. Showing fetal images to parents and giving them the photograph are mostly appreciated by the parents and are a meaningful act. In so many clinics the setup for ultrasound scans are like that pregnant woman can’t see the screen. If possible there should be an extra screen in the room for parents and Sonographers. Sonographers should explain the things they are looking at so we can make this a good experience for parents. If it is not possible at least we can show them the heart beat and profile of the baby. And it is proved in studies that psychological impact of ultrasound has beneficial effects during pregnancy. It is always a good practice to start with a formal communication and give ease to patient and we should be able to understand the attitudes and feeling of different patients (emotional status such as happy or sad). This will greatly help us in dealing with the patient. If we think about ourselves, sometimes we are in the same situations with our co workers, friends or family. Take a look at what happens when you talk to each other, how you feel? You can use the same technique for developing a supportive conversation and by this you can communicate effectively with patients. In my experience, women usually go privately for a second opinion because they are not satisfied. The most common reason they give are that Sonographer was not explaining the things during the scan or he or she didn’t give enough time for questions. It was a quick scan or the Sonographer was not confident during the scan.
Communication is not just transmission of words or verbal but nonverbal communication such as eye contact, facial expression, body movement, posture, tone of voice and touch is also important. For example, if you are doing a scan and if there is a bad news or you diagnose a Foetal abnormality, then in such situation communication and information emphasize the need for clarity from the start and value of partner to be present. There are barriers that exist and one common barrier is talking too fast and using slang medical vocabulary. This will make it difficult for a woman and her partner to know what you are trying to say (Craig 1993).
In an interview given by Mark Russell a Sonographer from Homerton University Hospital in Hackney at BBC News Channel on 25th August 2007, he told the viewers when he was asked “what is the hardest thing about your job?” and he answered “Breaking bad news when an abnormality is found with the baby or baby has stopped growing. There is no easy way to tell the parents and despite some training at college and counselling courses which many of us attended, it never really gets any easier” .Conveying bad news is one of the most important and challenging and there is not so much research has been done in conveying bad news.
A UK study by Simpson and Bar (2001) used interviews with Sonographers at two hospitals and also questionnaires to 180 Obstetrics Sonographers to explore the topic of giving bad news. This study showed that difficulties in breaking bad news were high on the list and Sonographers find it psychologically distressing.
In another study which was done in Canada 2004 on women preferences of caregiver behaviour when prenatal Sonographer findings are abnormal, it showed that women attached the most importance to information quality much more so than to promptness. It is also very important and our duty as a health care professional to explain the situation to the woman and her partner. And we must discuss with them very professionally because in some cases they need to make one of the biggest decision of their lives to consider whether they will continue the pregnancy if there is a major abnormality in foetus. If we see this area of Psychological and maternal anxiety less attention has been paid and studies on this area emphasized the use for health professional to ensure that parent should be fully informed before the procedures and make informed decisions. For giving parents bad news the important thing is that we should determine that parents are ready to know. When you think they are ready to hear bad news then you should discuss your findings. It is a good practice to leave the couple for a few minutes (especially pregnancy related bad news for example, if there is no fetal heart beat found). And then come in the room for discussion. Also important is that the atmosphere for good communication should be free of interference, where patient and you can communicate freely. Use of mobile phone should be avoided because it can affect communication. It is also important and this will give the couple an opportunity to discuss their concerns with each other and if their concerns remain undisclosed they are likely to become depressed and more anxious. As a Healthcare Professionals it is our duty that we should avoid false reassurance and it is a legal right of couple to know in detail about the findings and prognosis.
Melisse Piasecki has written a handbook on clinical communication and according to her there is a six step protocol for giving bad news and is widely used in teaching communication skill. The protocol has pneumonic: ‘SPIKES’. The ‘S’ is for setting and that patient should be comfortable with settings. ‘P’ is the perception that solicits the patient’s perception. ‘I’ is to invite and involve the patient in discussion. ‘K’ is for knowledge which should be provided to patient. ‘E’ is Emphasizes with expressed emotion. ‘S’ is summarize, that you should in end summarize the discussion. A key principle to follow for giving bad news is that you should give the true news and nothing should be hidden from patient and whatever information is available should be conveyed (Piasceki 2003 pg .87).
In our daily clinics we have to see some cancer patients as well. Cancer is not an individual problem but it affects the entire family. These patients are quite demanding and as a caregiver it’s our responsibility to give them full emotional support as well. A clear and correct communication is very important.
There is increased number of elderly people in NHS seeking health services. Dealing with old people is also very important and sensitive. We should give them time and involve them in their care.
If the patient’s first language is not English, you can ask for help from a trained interpreter. Usually in hospitals there are arrangements for such cases.
As a Sonographer sometimes you will be asked to communicate by telephone. When you do so make sure to give your name and department details and also ask the same information from the caller.
There is a saying that “it is not what you say but how you say that is important”. As a health professional we have to show that we care for patients. Our main aim as health care professionals is patient satisfaction. And this can be achieved if we are also able to effectively communicate and properly understand patient need. And for achieving this standard the staff who book appointments should be fully trained, especially in communication and dealing with patients. Sonographers and doctors who are performing specific ultrasound scanning should be formally trained and should have counselling expertise. Departmental heads should ensure continuing professional development, participation in team conferences, grand rounds and departmental meetings. And according to Nicholas J Toff’s article in British medical journal (2009), if there is a good backup by good communication and training in institutions, the result is a flexible and resilient organization. Still there is a need of wider research in this area. With communication skills, it is also important that we should become good listeners as well and convey knowledge and information in effective manner. If as Sonographers we can communicate properly, then we can have deeper satisfaction and it also leads to greater motivation. This can improve our health care system which as a health care providers, is our utmost duty and should be our goal.