Comm Studies 431/531: Health Communications

Nicole English

Presentation Quotes and References

• BH, Master of Social Work (MSW) degree, worked in mental health in inpatient and outpatient settings for 11 years, published original research, and am in general a heckuva nice guy.
  • In a nutshell...
  • The terminology has changed over the years, but social work has traditionally viewed itself as operating at the interface between the individual and the environment. A graduate social work education includes coursework on systems theory, and a large part of social work practice involves identifying client needs and resources that can meet those needs, and making connections between the two. This may include such things as recognizing that a client needs information about how to manage their illness, resources for coping (aid programs, support groups, neighbors, whatever), practical and emotional support, etc.
  • In practice, the typical social worker, especially in a healthcare setting, is badly overworked, especially with discharge planning and helping arrange applications for benefits & entitlement programs. In an ideal world, each patient/family would get a thorough evaluation of all relevant needs; in practice, there's sometimes no time for anything but making sure benefit applications have been filed and the paperwork's in order. (I don't have to tell you how bad the problem of paperwork is....health care is one of the most information-intensive sectors of the economy, and much of it is still done with notes written in longhand on paper.)
  • Further complicating the situation is that as with any other industry, what isn't paid for isn't valued. Most reimbursement programs including e.g. Medicaid etc., only pay for specific activities with or on behalf of specific patients, not for general organization or prep activities that will benefit future patients in general. Thus, preparation of patient education materials is typically not reimbursable under any funding program. Bear in mind, in most settings, health care professionals are directly responsible for bringing in a certain amount of billing, usually a fairly high amount, and more is always better. This isn't even touching on the question of liability for anything that's written. So preparation of educational materials is easy to push off onto a "round tuit" basis. Even researching what resources are out there tends to get shoved off into the spare moments. And in a typical hospital setting, there are darn few spare moments.
• JC, MSN, Psychiatric Nurse
  • I have issues with communication among patients, nsg staff, and physicians. My biggest concern is not having integrated progress notes, (IE physicians write in one set and everybody else writes in the other). And I do not understand this r/t for years, mental health inpatient units have had only one set of notes, in which all disciplines note and share info RE: patients progress ( which HICFA and JCHO requires integrated care ). But since coming to a med/surge facility, I find they do not. But I have to realize they are following a medical model vs bio-psycho-social model of care. We have to care for the whole person. Primarily, that is why I chose Nsg. vs Medical school.
  • Another problem is someone forgot to teach basic communication skills. # 1 rule complete the FEEDBACK LOOP (was your message sent and received as intended) to ensure clear and concise communication.
• DP, Student in BSN program
  • Doctors often blame nurses for things beyond their control in front of patients.
  • Nurses' suggestions and observations are not taken seriously. ex. patients in pain.
  • Nurses get angry and frustrated with the system, doctors, and hence, with patients.
  • Nurse may not be a specialty of the patient's illness, may be filling in due to shortages.
  • Male nurse comradarie with male doctors may leave female nurses feeling frustrated and left out.
  • Often politics may interfere with patient care in hospital setting.
  • Differences in hospital corporate cultures from location to the next.
• Dr. BL, PhD.
  • My wife was having a knee replacement in her LEFT knee. The whiteboard in her room indicated she was having the RIGHT knee replaced! I chased the nurse down the corridor and asked her to change it, and she said she would "when she got to it". I told her I was going to linger until it was changed.
  • You feel in a dilemma in such situations, because you have to constantly be alert for snafus when staff is overworked. And worse, you know you are engendering resentment from the staff that the patient is going to eventually pay for sooner or later.