i. Distractions most commonly come through sensory perceptions, such as poor lighting or background noise, including music, talking, ringing phones, and interruptions by others. Papers, reports, and heavy workloads can also be distracting.
b. Inadequate Knowledge
i. The sender and receiver may be at different levels of knowledge, particularly in this time of highly specialized and technical knowledge bases. For multiple reasons, one person may not seek clarity from the other.
c. Poor Planning
i. The process of organizing, planning, and clearly thinking through what needs to be communicated is very helpful. If the interaction is more spontaneous, it can more easily fall into a non-rhythmic pattern.
d. Differences in Perception
i. Both the sender and the receiver have their individual mental filters-the way in which they see the world. Because of this individuality, no two filters are the same. Thus the same message is interpreted differently. Add to this, for example, socio-cultural, ethnic, and educational differences, and it is easy to see how these differences can occur.
e. Emotions and Personality
i. Someone who is experiencing distress may not be able to receive another message or may have difficulty keeping his or her emotions out of an unrelated message. Most humans, at some point, bring distress or problems from home to the workplace. If these remain unconscious, they can influence the work setting in a negative or nonproductive way.
i. These relationships have changed as physicians' typical mode of practice moved from a singe, private enterprise to multi-group practices that also include nurse practitioners, certified nurse midwives, nurse anesthetists, CNS, RNs, etc.
ii. Also includes HMOs, managed care programs, physician-hospital organizations, accountable care, and patient-centered medical homes.
iii. When visiting a group practice, they might not have the option of selecting a specific healthcare provider.
iv. Rural consumers may have seen local hospitals closed or purchased by large systems resulting in the need to develop new relationships. May feel more critical of care, alienated, insecure, decreased mutual respect and trust.
v. Registered nurses and advanced practice nurses are in ideal position to provide oversight and facilitate communication through care coordination.
1. Case management.
2. Transitional care.
3. Disease management.
4. Health information technology.
vi. Trust important component of these relationships
• Coordination of care more challenging and more important than ever
- No choice in provider selection
- Provider as part of HMO, managed care or accountable health organizations
- Few single practice physicians
• Groups with PAs, NPs, CNSs, etc.
i. One solution to containing costs is consumer-directed healthcare plan, which generally has high deductibles with the goal of reducing healthcare costs by providing consumers with information about choices, risks, benefits, and costs.
ii. The goal is greater emphasis on case management, disease management, and patient education.
iii. These plans use report cards, risk assessments, nurse-help telephone lines, websites, consumer education materials.
iv. <20% of those with consumer-directed health plans understand that consumer directed health plans exempt preventative services, medical tests, and screening from their deductible.
v. More consumer education needed.
d. Nurse-Consumer Relationships
i. Generally personal and intensely meaningful.
ii. Nurses can influence and promote positive consumer relationships.
iii. Managers set tone for effective staff patient interactions.
iv. Nurses are taking roles as primary care providers.
v. Teachers, managers, educators, home healthcare managers, advocates, particularly in insurance areas and compensation.
vi. Gatekeepers of healthcare system.
vii. Liaisons between the consumer and a complex healthcare market.
• Decreased length of stay and increasing costs of healthcare has moved patients into home health agencies
• May have lack of choice due to insurance
• More patients comparison shopping based on cost and quality ratings