TABLE OF CONTENTS
Title Page i
Dedication ii
Approval Page iii
Certification iv
Acknowledgement v
Table of Contents vi
List of table’s vii
List of figures viii
Abstract ix
CHAPTER ONE: INTRODUCTION
1.0 Background of Study
1.1 Statement of the Problem
1.2 Purpose of Study
1.3 Significance of the Study
1.4 Scope of the Study
1.5 Related literature review
CHAPTER TWO: THEORETICAL BACKGROUND
2.1 What is communication?
2.2Effective communication
2.3 Types of communication
2.3.1 Verbal communication
2.3.2 Types of verbal communication
2.4 Patients Education
2.5 Goals of patient education
2.6 Barriers to communication
2.7 Improving communication with patients
CHAPTER THREE: RESEARCH METHODOLOGY
3.1 Research Design
3.2 Target Population
3.3 Sample Size and Sampling Technique
3.4 Subject criteria
Tool for Data Collection
Method of Data Collection
3.6.1 Procedures for data collection
3.7 Method of Data Analysis
CHAPTER FOUR: RESULTS
4.1 Data presentation
CHAPTER FIVE: DISCUSSION SUMMARY OF FINDINGS, CONCLUSION AND RECOMMENDATIONS.
5.1 Discussion of the Findings
.1.1 DemographicFindings5.2 Summary of findings
5.3 Recommendations
5.4 Limitations of the Study
5.5 Areas of Further Research
5.6 Conclusions
References
Appendix 1
Appendix 2
LIST OF TABLES
Table 1: Number of Radiographers from various Hospitals studied
Table 2: Age and sex distribution of radiographers in the three hospitals
Table 3: Educational qualification of radiographers.
Table 4: Radiographers Response on telling patients their names
Table 5: Age and sex distribution of patients in the three hospitals
Table 6: Shows the communication gap and relationship between the radiographers and patients
Table7: Patient’s response on overall satisfaction with regards to the way the radiographer interacted with him/her
Table 8: Patient who indicated that the radiographer communicated effectively with them how they feel about it
Table 9:Shows the response of patients on if there is need for effective verbal communication in radiology department and improvement in the way radiographers talks to patients.
LIST OF FIGURES
Fig 1:Shows common request made by radiographers and the different responsefrom patients based on the terminology used.
Fig 2: A bar chart showing number of radiographer against their number of years of work experience
Fig 3:Shows the likely cause of the radiographer not communicating effectively with the patients during the examination.
ABSTRACT
One of the many radiographer responsibilities is to communicate with patients. After all, patients are the reason imaging professionals are employed. Radiographer-patient relationships can be strengthened and patient outcomes improved through improved effective verbal communication.1Imaging professionals have the responsibility to provide the best possible patient care, and proper verbal communication plays a large role in successful imaging interactions.1 Using open and honest communication, the radiographer can form a trusting relationship with patients and their families.2The purpose of the study was to investigate the level of verbal communication between radiographers and patients, identify barriers to effective verbal communication and to assess the patient’s reaction to verbal communication in diagnostic radiology departments.
A quanlitative research study was conducted at three hospitals in Enugu, namely University of Nigeria Teaching Hospital Enugu, National Orthopedics Hospital Enugu and Enugu State University Teaching Hospital. Data collection took place by means of questionnaires that were distributed to 50 radiographers and 130 patients randomly selected directly after they had undergone radiographic examinations. Data analysis indicated the level of verbal communication, barriers to effective verbal communication and patient’s reaction to verbal communication. The overall conclusion drawn from the research is that majority of the patients, who participated in the study, indicated that the radiographers communicated with them effectively. Limitations of the study were identified and recommendations to enhance practice were made.
CHAPTER ONE
INTRODUCTION
1.0 BACKGROUND OF STUDY
Communication (from Latin “communis“, meaning to share) is the activity of conveying informationthrough the exchange of thoughts, messages, or information, as by speech, visuals, signals, writing, or behavior1. It can also be defined as the “process of creating meaning.”1The American Registry of Radiologic Technologists (ARRT) and the American Society of Radiologic Technologists (ASRT) Code of Ethics outlines expectations for good communication practices in medical imaging2. Effective verbal communication is an absolute necessity at every stage in radiographic examination. Verbal communication, good or bad, affects in opposite ways and it has an immense potential for influencing the use of healthcare resources and finances on a grand scale.1 When surveyed, healthcare professionals (physicians, nurses, radiographers) cite “lack of time” as the chief reason for not talking more to patients. However, researchers have found that professionals who verbally communicate effectively with their patient spend no more time, per patient, than those professionals who report feeling “too rushed to spend time talking3”. Some studies have shown that total examination time actually decreased as verbal communication increased.3Health outcomes also depend on the extent to which patients adhere to the procedures being explained to them.
Effective verbal communication includes the display of professional conduct, an attitude of respect toward other professionals and the patient and the responsibility to act as a patient advocate through all aspects of the patient’s care. Radiographers are frequently responsible for acting as patient advocates, taking patient histories, providing instructions for fasting before contrast studies and explaining post examination care clearly in a way and language the patient will understand.4 Thus, it is important that Radiographers give explicit instructions, answer questions promptly and completely, coordinate patient care efficiently and work together with the patient. This responsibility includes being thorough in their questioning and ensuring the patient understands all instructions. Meyer 3 suggested asking specific instead of general questions, such as “Are you taking any prescription drugs, over-the-counter medications or any herbal supplements?” instead of “Are you taking any drugs?” When a patient is unable to answer questions or comprehend instructions, the patient’s family or guardian should be involved in both the history-taking and the decision-making processes. By encouraging family participation, feelings of stress and frustration toward staff are reduced and system dysfunction is less frequent. Like anyone else, radiographers can be unhappy, short-tempered, rushed and interrupted, ignorant on some subjects, or charmless.
Evidence is that healthcare fails without a conscious informed effort of communication which is the personal and professional responsibility of everyone concerned with the care of the sick.3
Improved communication between patient and healthcare providers results in patients who are happier with their overall healthcare experience.5-9
Patients want to play an active role in discussing their treatment, and they want to understand the benefits of different diagnostic and therapeutic options. They need to have their questions answered.10 Patients also express a desire to have interactions that feel personal, caring, and respectful. They want medical professionals (Radiographers) to relate to them as people.
Although research has been conducted on the attitudes of radiographers towards their patients, but no research has been done on effective verbal communication especially in Enugu metropolis. This study aimed to assess the level of verbal communication between radiographers and patients, to identify barriers to effective verbal communication and patient’s reaction to towards effective verbal communication.
1.1STATEMENT OF PROBLEM
- It has been observed that patients leave the hospital feeling dissatisfied probably due to poor verbal communication from the health personnel.
- It has also been observed that patients who come radiographic exam often are apprehensive and un-cooperative due to poor understanding of the diagnostic procedure.
1.2PURPOSE OF STUDY
- To assess the level of verbal communication between radiographers and patients
- To identify barriers to effective verbal communication
- To assess the patients reaction to verbal communication
1.3SIGNIFICANCE OF STUDY
- The study will define the level of verbal communication currently obtainable in the study area
- This study will define the barriers to effective verbal communication between radiographers and patients
- It will establish patients acceptance or otherwise of verbal communication
1.4SCOPE OF STUDY
Scope of study will consist of radiographers and patients who were referred from wards, clinics and casualty department, emergency department in University of Nigeria Teaching Hospital ItukuOzalla, Enugu State University Teaching Hospital and National Orthopedic Hospital Enugu for routine radiographic examinations.
1.5RELATED LITERATURE REVIEW
According to Ehrlich, McCloskey and Daly1 communication is conveying information accurately, to express oneself clearly and interchange information with others. Radiographers need to elicit confidence from their patients by providing accurate explanations and instructions at the appropriate time and at a level that the patients can understand.11
The investigative team of Hicksonet al12 identified several patient complaints. Problems included the healthcare professional not providing information through effective communication, not listening, not respecting the patient, and not being available and accessible in a timely fashion. Each of these complaints is consistent with the literature on radiographer-patient communication and patient satisfaction.4,7,9,12. Patients report feeling most satisfied when they feel fully informed. Patients want to play an active role in discussing their treatment, and they want to understand the benefits of different diagnostic and therapeutic options. They need to have their questions answered.
The first study by Entmanet al9 examined the connection between the malpractice claims history of Florida obstetricians and the quality of clinical care they provided to patients 5 to 10 years before the claims were filed. Entman et al9 used nurses and physicians to review charts and assess quality of care. No demonstrable correlation between the quality of care provided by the physicians and their malpractice claims history was found. These results are consistent with other data suggesting that quality of care does not appear to be a major factor that determines whether a patient initiates a malpractice claim.13Many malpractice claims are initiated when no lapse in quality of care has occurred and even when there is no evidence of medical injury.14
A study by Hicksonet al12 demonstrates that a breakdown in communication between patients and their healthcare professionals is a critical factor that leads patients to seek malpractice litigationIn fact, many true injuries to patients occur because of genuine medical negligence, yet patients do not seek compensation. According to the research of the Harvard Medical Practice Study, approximately 1% of hospitalized patients suffer a significant injury due to negligence, yet less than 3% of these patients or their families initiate a malpractice claim.15,16
Although it is assumed that radiographers conform to all the rules and regulations prescribed for their profession and communicate effectively it is postulated that they are not always aware of how patients perceive their attitudes. Attitude is described as a state of mind, an opinion or a feeling, often revealed by kinesic expression, tone of voice or other nonverbal signs.17 Connor mentions that there are key issues that sabotage employee performance and productivity, which include arrogance, ignorance, inconsistent communication patterns and clouded perceptions.18Kenagy et al19 make the analogy that most patients judge health care as they would an airplane flight. They assume that the airlines are reliable and are run by technically competent people. They judge the airline by more personal criteria, such as comfort, helpful friendly personnel, and on-time schedules. Most patients cannot judge a radiographer knowledge or skill, but they judge their health care on the basis of other dimensions that relate to areas that they personally know and value. Businesses that provide competitive services would be unable to survive if they treated customers with the levels of waiting, unanswered questions, not explaining the procedures and inconvenience that are the norm in health care. Kenagyet al19 believe that pleasing the patient improves the outcome and clinical satisfaction and can be cost-efficient.
Bertaks, K et al20 stated that “Inadequate communication between patients and their physicians is enormous and still yet to grow”. He also noted that failed communication was the leading cause in more than 25% of cases. Patient trust starts with the way the radiographer’s relates to his or her patients. If the visit with the radiographer is harried, questions will not be answered, patient comfort will not be achieved, and trust is diminished. Good verbal communication between patient and radiographer is necessary not only to avoid complaints and reduce the risk of litigation but as a part of the healing process. The vulnerability of patients and their need for care force them to trust radiographer. If this trust is to increase, it must be an interactive process and requires care, concern, and compassion from the radiographer. Robert .S. Sherman et al21 noted that “ proper diagnosis and effective communication has to be made to achieve a successful result”. Patients care and management especially when radiological examination is needed.kritenshiKaushal et al22 at C.W.M.H Radiology Department of Fiji where he discovered that the procedure is explained by 28% of the radiographers. While staffing shortages and inadequate resources and facilities for biomedical care are commonly cited as causes of discontent amongst clinicians of all kinds, it is the quality of their relationships with their patients and colleagues which is the most reliable global indicator of clinician satisfaction and happiness. Radiographers have a very high incidence of occupational morbidity, a major source of which is seen to be due to difficulties with personal relationships including radiographer patient relationships.
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