Propósitos y competencias en el plan de clase

This section outlines the potential barriers to effective nurse-patient

communication in healthcare settings. Barriers to nursing communication may occur at three levels: personal, professional and organisational level. Personal barriers are those resulting from the personality of the nurse. Professional related barriers gender age cultural religious’ background and personality in the individual of the nurse. Professional berries are those that arise from the nursing profession practice in hospital. The latter affect nursing in terms of the knowledge acquired. Organisational related barriers usually result from the regulatory regimen. These barriers will be captured under the following headings of personal, professional and organisational. The cultural contexts of these key domains are also critiqued in a later section within a Saudi context.

Communication barriers can be complex and overlapping. An Iranian study used the NSACS (Anoosheh et al., 2009) and concluded that heavy nursing

workload, hard nursing tasks and lack of welfare facilities for nurses were the main communication barriers. The same study findings revealed that shared

communication barriers were age difference, social class difference and having contagious diseases. It was concluded that nurse managers and policy makers should focus on eliminating or modifying the barriers stated by patients and nurses. The current study adopted this same survey, NSACS (Anoosheh et al., 2009), for the first phase to explore barriers and facilitators between nurses and patients in Saudi Arabia.

2.7.1 Personal barriers

This section clarifies the personal barriers of nurses’ communication towards patients. These personal barriers involve gender, psychological status, age and

language, and face local and international nurses during nursing communication with patients. Individuals differ significantly in terms of values, expectations and even how they interpret information, thus the variances in the nursing workplace. The nurses’ individual evaluations of situations associated with the workplace may not always be in-line with their expectations. Nurse communication barriers are further influenced by the specific characteristics of the patients. This may include sensory impairment and environment issues, with psychological barriers including

personality or disability (Finke, Light & Kitko, 2008).

2.7.2 Gender and nursing communication

This section outlines the way in which gender facilitates or inhibits

communication. In different cultural groupings, gender bias and gender-based norms may prevent the staff from being assertive or challenging opinions openly. In Iceland, a phenomenological study that sampled 11 registered nurses from seven countries showed the centrality of language to personal and professional wellbeing and how language and culture were inseparable entities (Magnusdottir, 2005). This European based study concluded that gender was experienced as a communication concern.

In the Middle East, a study by Bowen and Early (2002) highlighted that a male nurse does not have the authority to treat a female patient, though female nurses may attend to men. Further, the fact that most doctors were men, whereas most nurses are women, had a very negative impact on effective communication, leading to a subtle gender-based tension (Bowen & Early, 2002). A systemic review examined the impact of gender dyads on clinician-patient communication between (2005–2007) with 10 studies included (Sandhu et al., 2009). The meta-analysis represented numerous differences in communication patterns across health providers,

healthcare settings and clinical specialties and possible impacts on health outcomes. The meta-analysis concluded that the increase of woman health providers in the medical profession in Arabic countries implied that health authorities should improve the organisational and financial conditions of nurses, taking into consideration the cultural characteristics of the community.

2.7.3 Psychological barriers

Barriers to communication arise from the nurses’ perceptions, beliefs, attitudes and cognitions described as psychological barriers to communication. Attributes such as resilience in communication styles are seen to be critical for nursing to face the extreme challenges of the healthcare environment. Psychological barriers to communication are difficult to resolve since they are innate to an

individual. Dovidio, Hebl, Richeson and Shelton (2006) contended the importance of nurses to effectively counter any stereotyping.

2.7.4 Age-related barriers

Generation gaps hinder effective communication, such as in a situation when a younger nurse is attending to an elderly patient. Even if the two come from the same ethnic background, they may not communicate effectively due to their social orientations and circumstances (Cortis, 2000). A study exploring new young graduate nurses’ critical care orientation retention and financial impact concluded that failure of newly employed nurses to develop professional relationships with their patients negatively affected professional growth, nursing satisfaction and ultimately job retention (Friedman, Cooper, Click & Fitzpatrick, 2011).

In Saudi Arabia, a mixed-method study by Mitchell (2009) explored job satisfaction and burn-out among foreign-trained nurses, pointing out that the average age of actively engaged nurses was 40 years. Younger nurses both international and

in Saudi Arabia were not interested in pursuing nursing as a career, which may have serious workforce implications both short and long term. As result, most young Saudi nurses face frequent emotional and physical difficulties within the Saudi community that stresses nurses’ communication with Saudi patients.

2.7.5 Language barriers

In Saudi Arabia, international nurses’ language may differ from that of the local Saudi patients for which they care, jeopardising their ability to communicate effectively. The possibility of passing the wrong message increases when the nurse and the patient speak different languages. This was affirmed by a focused

ethnography study (del Pino, Soriano & Higginbottom, 2013) conducted with semi- structured interviews of 32 nurses in three public hospitals in southern Spain. It concluded that incorrect pronunciation and use of figurative language implied different things in different cultures and can mislead the patient or the nurse alike. Further, patients with poor literacy levels and skills may also face challenges to understand the information and care by nurses. Correspondingly, the use of slang by patients may breakdown communication especially in acute care communication.

In relation to nursing communication in settings such as oncology

departments, Jarrett and Payne (2000) interviewed nurses and patients about their communication experiences with cancer. The study concluded that patients with language difficulties expressed less satisfaction with medical services and lack of understanding of feelings by nurses compared with those patients without language difficulties. A study by Wilson and Reisfield (2003) investigated patients with metastatic testicular cancer and intractable pain, finding that providing complex care with easily understood language was important. The study revealed that nurses’ frequent use of medical terminologies and technical language led to ambiguities in

communication and patient dissatisfaction. The report concluded that health practitioners such as doctors and nurses commonly use such language, ignoring the fact that patients and families may not easily understand what they are saying and that it can distance the healthcare professional from the patient.