Effective communication is one of the most significant factors in nursing practices that maximize the overall productivity of the unit and reduce the number of medical errors. Bedside shift report (BSR) concerns the healthcare information exchange between the incoming and outgoing practitioners, frequently involving the participation of patients (Jividen, 2021). This data might include the observation findings, the new guidelines, documentation changes, etc. (Jividen, 2021). Regardless of the specific information, bedside shift reports are associated with improved patient care and enhanced communication among nurses (Jividen, 2021).
Nevertheless, a large number of hospitals and medical facilities deny the implementation of bedside shift reports as an effective instrument of healthcare development (Jividen, 2021). Therefore, it is critical to increase awareness concerning the benefits of this method in the area of clinical practice. The current project demonstrates the efficiency of bedside shift reports by providing a transparent overview of existing literature and practicum experience.
Goal Statement and Project Objectives
The target population of the current paper includes healthcare specialists in various areas of medicine. Effective communication is the core component for most activities, whether it is highly skilled or labor-intensive occupations. A thorough analysis of nursing communication and bedside shift reports will reveal the necessity of emphasizing this focus area for improved patient care and reduction of medical errors. Therefore, the project objectives are the following:
examine the primary principles, advantages, and disadvantages of bedside shift reporting in the existing literature;
demonstrate the importance of effective communication in reducing the number of medical errors;
generalize the efficiency of bedside shift reports in the healthcare community.
Literature Review
Consequently, it is essential to provide an evidence-based literature review to justify the scope of the project and emphasize the problem. A large amount of scientific research has focused on the issues of bedside shift reports and effective nursing communication to increase the overall awareness of the problem in the community. For instance, Dorvil (2018) has found that nurse bedside shift reports have been proved to be consistently useful by analyzing twenty-five articles from 2006 to 2016. The benefits include the improved patient experience, nurse satisfaction, sustainability, and even positive financial impact (Dorvil, 2018). However, the author also notes the necessity of a careful approach to the implementation process to avoid the associated risks.
Small and Fitzpatrick (2017) present similar findings concerning both benefits and disadvantages of the method. The authors have surveyed the nurses from two medical units with a total number of 55 respondents (Small & Fitzpatrick, 2017). Most practitioners have noted that while bedside shift reporting is slightly more stressful than traditional communication frameworks, it also promotes patient safety and involvement (Small & Fitzpatrick, 2017). Therefore, there are certain advantages and disadvantages to bedside shirt reporting that should be taken into account.
However, the research demonstrates that most of the negative aspects of bedside shift reporting emerge due to the inappropriate implementation of the system. Schirm et al. (2018) show that the least liked features of BSR include the interruption of the reporting process, extension of the shift, and disruptive environment. These elements are subject to organizational culture and might be corrected by systematic changes (Schirm et al., 2018).
Nevertheless, most research emphasizes the benefits and advantages of BSR implementation. McAllen et al. (2018) have investigated the percentage of falls among the patients in a hospital and found a drastic reduction of such accidents after BSR implementation. However, the authors also note the challenges for nursing leaders since BSR is still a relatively new system for a large number of employees, and guidance is required (McAllen et al., 2018).
Lastly, certain obstacles to BSR and communication may emerge if the patient is unable or is unwilling to cooperate (Wolters Kluwer, 2017). For instance, sensory disabilities, lack of privacy, sleep, and increased cognitive efforts might obstruct the process of BSR (Wolters Kluwer, 2017). Overall, the literature review transparently indicates the benefits of BSR and effective communication; however, inappropriate implementation of the method might deteriorate the quality of healthcare services.
Methodology
The methodology for the current project covers a theoretical background review, practicum experience in a hospital with the implemented BSR system, and generalization of the results. The methodology is aligned with the project objectives and is aimed to determine the positive and negative effects of BSR and nursing communication. The first step examination is completed via a literature review, and the primary principles, advantages, and disadvantages of BSR are identified. The second step concerns empirical practice, and cooperation with a hospital with implemented BSR system is needed.
The study utilizes qualitative data collection methods, such as interviews and surveys with the nurses, to assess the efficiency of BSR in a semi-supervised environment. Similar to the existing research presented in the literature review, the objective of the practicum experience is to understand the perceptions of BSR from working practitioners. Lastly, the findings from empirical practice will be analyzed and contrasted with the results from the existing research.
Resources
The necessary resources for the current project primarily include the theoretical databases of medical knowledge, access to the hospital with the implemented BSR framework, and nurses willing to participate in the study. Ideally, the examined hospital should have the documented results of previous report systems to compare the efficiency of methods. Nevertheless, it is not the imperative condition, and the evaluation of nurses perceptions and opinions will suffice for the scope of the current project.
Formative and Summative Evaluation
Formative and summative assessments are highly significant to evaluate the results of learning and project objectives. Both types of evaluation are necessary to determine the current phase of the project and students knowledge (Duers, 2009). In the current work, formative assessment will be utilized after each interval to ensure the appropriate development course of the project. For instance, an evaluation of the literature review is necessary to establish the principles of BSR, which will be consequently used in the second phase of the project. Summative assessment will be conducted by comparing the results of the empirical practice with the existing research.
Practicum Time Log and Conclusion
The timeline representation of the project is classified into four primary intervals theoretical overview, practicum experience, analysis of the findings, and summative assessment. The first step includes the literature review and identification of BSR principles, advantages, and disadvantages. Practicum experience covers the empirical practice in the hospital with the implemented BSR system and surveys with the working practitioners. Consequently, the retrieved data is processed and analyzed to determine whether BSR is indeed an effective method to reduce the number of medical errors. Lastly, the data is compared to the existing research, and both the positive and negative effects of BSR are contrasted to determine the value of the current project. Ultimately, the practicum experience described in the time log is sufficient to achieve the project objectives and improve the students competencies in the chosen focus area.
Schirm, V., Banz, G., Swartz, C., & Richmond, M. (2018). Evaluation of bedside shift report: A research and evidence-based practice initiative. Applied Nursing Research, 40, 2025. Web.
Small, D. C., & Fitzpatrick, J. J. (2017). Nurse perceptions of traditional and bedside shift report. Nursing Management (Springhouse), 48(2), 44-49. Web.
The importance of the study is due to a number of factors that prove the relevance of the research. Saudi Arabia, which entered the G20 in 2019, is the leader in oil production in its region, which makes the state an important strategic partner for many other countries (Amralili, 2021). Constant interaction with foreign investors makes it necessary to search for optimal principles of risk communication to counteract the COVID-19 pandemic. Moreover, according to Saxena (2017), in addition to trade nuances, geopolitical factors need to be taken into account. Saudi Arabia is located at the intersection of three continents Europe, Asia, and Africa, which makes the state vulnerable to the continuous flow of tourists and entrepreneurs. As Behrouzifar et al. (2019) argue, the country ranks second in oil reserves in the world; thus, the region has great financial opportunities and is open to working with investors. The great Muslim holy cities, Makkah and Medina, are located in Saudi Arabia, which explains the importance of establishing effective risk communication to counter COVID-19.
The main contributions of this study refer to different areas. Firstly, one can highlight the efforts made by the Saudi government to fight the COVID-19 pandemic. Secondly, the topic touched upon can expand the knowledge of citizens about the role of social media campaigns in the fight against the coronavirus infection. According to Tripathi et al. (2020), many people are distrustful of the information they receive about COVID-19 from open sources, and this factor is a powerful argument for comparing the pros and cons of targeted media work. The religious, economic, and media sectors in conditions of social interaction challenges will be explored in more detail. Finally, the study will enhance not only the scientific but also the cognitive potential of Saudis and broaden the understanding of risk communication during the pandemic.
The planned research will have several limitations due to a narrow research focus. The key target audience will be Saudi citizens, including those living outside the country. In addition, specific social media platforms will be engaged as digital resources for communication campaigns, particularly Instagram, Facebook, Twitter, WhatsApp, YouTube, and Snapchat. As a data collection tool, online surveys will be offered to the participants, which narrows the range of interactions, and through a quantitative approach, the information obtained will be compiled to obtain specific outcomes.
To address the aforementioned limitations and broaden the scope of research on the use of social media for communication against COVID-19, several future studies can be identified. According to Hassounah et al. (2020), in Saudi Arabia, the peak of the use of online interaction platforms began in 2011, and since then, the countrys citizens have been actively using applications for virtual communication. One of the following possible studies may be named as follows: The Effectiveness of Saudi and Australian Risk Communication to Combat the COVID-19 Pandemic, which will allow comparing the approaches of two different states to the same problem.
To compare and contrast the work of different governments, the following study can be conducted: Communication During the Coronavirus (COVID-19): Comparison Study Between the Saudi Arabia Government and the US Government. To assess the best risk communication techniques, the topic of a future study may be as follows: Which Are the Most Effective Channels: Social Media Platforms or the Traditional Media Channels? Finally, from the perspective of the oil sector as the main industry in the country, the problem of combating the pandemic can be addressed within the framework of Saudi Aramco, the largest oil company in the country: The Communication of COVID-19 and Its Impact on the Nations Brand Saudi Aramco as a Model.
References
Amralili, K. (2021). G20 countries stock markets reaction to changes in oil prices [Unpublished masters thesis]. Vytautas Magnus University.
Behrouzifar, M., Araghi, E. S., & Meibodi, A. E. (2019). OPEC behavior: The volume of oil reserves announced. Energy Policy, 127, 500-522.
Hassounah, M., Raheel, H., & Alhefzi, M. (2020). Digital response during the COVID-19 pandemic in Saudi Arabia. Journal of Medical Internet Research, 22(9), e19338.
Saxena, S. (2017). Significance of open government data in the GCC countries. Digital Policy, Regulation and Governance, 19(3), 251-263.
Tripathi, R., Alqahtani, S. S., Albarraq, A. A., Meraya, A. M., Tripathi, P., Banji, D., Alshahrani, S., Ahsan, W., & Alnakhli, F. M. (2020). Awareness and preparedness of COVID-19 outbreak among healthcare workers and other residents of South-West Saudi Arabia: A cross-sectional survey. Frontiers in Public Health, 8, 482.
The nurse should have developed a personal relationship with Adelgonda Correa to enhance communication with the patient when offering medication. The nurse had not gotten adequate time during previous shifts to initiate a conversation with Correa since only required duties were performed. This shows that the nurse had not managed to develop a relationship with the patient hence the challenge in maintaining the flow of communication. The patient perceived the nurse as a stranger with whom she could not trust her information.
Another thing that the nurse could have done to foster communication with the patient is showing compassion. This would have helped to create a perspective in the patient that a nurse had respect for them (Dalvandi et al., 2019). Such patients are likely to trust the nurse and be more ready to share information. The nurse should also have had cultural awareness about the patients ethnic background. Patients come from different cultures and regions, therefore, have varying values and beliefs. In this case, common practices within a particular culture may not be applicable to others. By being culturally aware of the patients culture, the nurse would have established strategies to enhance communication.
Reasons Behind Patients Actions
The patient acted the way she did towards the nurse due to her cultural background. The patient has an Ecuadorian background, which might have influenced the assumptions made about the nurse. The patients culture could also be a barrier to the patient interpreting the shared message, hence the decision to ignore the nurse. The patient was also distracted by the television in the ward since she appeared to be paying more attention to it than the nurse. In this case, the nurse should consider initiating conversation with the patient in a location that has minimal distraction.
Reference
Dalvandi, A., Vaisi-Raygani, A., Nourozi, K., Ebadi, A., & Rahgozar, M. (2019). The importance and extent of providing compassionate nursing care from the viewpoint of patients hospitalized in educational hospitals in Kermanshah-Iran 2017. Open Access Macedonian Journal of Medical Sciences, 7(6), 1047.
Communication in almost any nursing setting can be extremely complicated. From internal power dynamics, which structure the transition of information in healthcare organizations, to postoperative patient readmission, which might devalue previous efforts of clinicians the pressure on nurses is high. The Early Discharge Education to Post-Op Patients to Reduce Post-Op Calls is an important project that can potentially benefit both healthcare personnel and patients. However, in order for the project to be a success, it should be properly presented and monitored.
The project involves four different positions Vice President of Nursing, Director of Nursing, Nurse Manager, and Registered Nurses. All people holding these positions should stay informed about the progress of the project. However, each of them also requires a unique approach in order to maximize the efficiency of communication. Understanding what is the best way to present the project to its participants is essential in ascertaining the most effective ways of communicating with them.
Variety of Communication Needs for Team Members
The entirety of communication means is depicted in Appendix A. The project manager will provide nurses with objective feedback about flaws in their pre-operative work. Clinicians should also undergo specific online training organized by the manager to educate patients about self-care. The communication process with nurses can occur during zoom workshops, at the end of which, individual performance feedback and suggestions for improvement can be delivered to them by the project manager. Notably, post-op individuals require a unique approach to communication to ensure that the provided knowledge is adequately understood. Patients prefer to have an in-person consultation, but providing valuable data in writing is also helpful in health communication (Berry et al., 2018). Therefore, the project manager will recommend teaching patients in person before and after surgeries in oral and written form so that these individuals know the basics of self-care.
Communication with VP
Communication with any high-ranking individuals should be as straight to the point as possible. Vice President of Nursing is a person responsible for the overall management of all nursing services in a healthcare organization. As such, it is reasonable to suggest that VP would be involved in several projects simultaneously. The nursing hierarchy does not presuppose unlimited communication between key people in hospitals and lower-ranking nurses (Saleh et al., 2018). Subsequently, face-to-face meetings with VP would not be appropriate and effective.
Instead, the preferred communication format should be in-person and virtual meetings, as well as e-mail updates. Each Monday, a meeting with VP should be organized, which would bring them up to date with the progress of the project made over the course of the previous week. All important steps and hallmarks should be laid out in e-mails containing reports prepared by the Project Manager, which would keep VP informed without excessive time consumption. If the need arises for an unscheduled meeting, VP should be contacted and asked to schedule a corresponding meeting.
Communication with Director of Nursing
While presenting the project to the Director of Nursing, the matter of cost and benefit should be accentuated. As Director of Nursing supervises the department, they possess the most accurate information about the allocation of resources. As such, they should understand the benefits that can be harvested after the implementation of the project (Hee et al., 2019). Specifically, the emphasis should be put on the most attractive aspect of the project, which is reducing the workload of nurses.
Involving Director of Nursing in the monitoring of the project should be done in a way similar to VP, albeit with higher frequency. In person meetings should be held biweekly, on Tuesday and Saturday. The meetings should not be virtual as it might be necessary to make important points in the presence of nurses participating in the project. Naturally, Project Managers reports sent by e-mail will keep Director of Nursing informed. However, calls should also be employed as they allow obtaining immediate advice.
Communication with Nurse Manager
Nurse Managers are the middle ground between higher-ranking people and nurses. As much as middle managers in business, they are unique in their responsibility to balance between superiors and subordinates. Any Nurse Manager would be interested in a way to reduce the volume of work necessary to assign nurses to readmitted patients (Lalleman et al., 2017). As such, the benefit of time should be accentuated when presenting the project.
Face-to-face meetings and huddles before meetings with registered nurses are essential in communicating with nurse managers. Face-to-face meetings allow discussing issues pertaining to individual nurses participating in the project without alerting the entire team to them. Huddles are important because they allow project participants to brainstorm current issues in a non-formal setting. Nurse Manager should receive two reports by e-mail one from Project Manager on the projects progress and another from Director of Nursing with specific instructions to Nurse Manager.
Communication with Registered Nurses
Registered nurses are on the frontline of patient care, which implies that they are the direct beneficiaries of the project. The more postoperative patients are readmitted, the more nurses are psychologically pressured. Therefore, it is essential to accentuate the importance of teaching patients proper self-care for their own mental fortitude (Bray et al., 2017). Not only will nurses feel more satisfied with their job, but the project will also reduce their workload.
Communication with nurses should be done at least once a week. It should take the form of meetings with Nurse Manager and Project Manager, during which everyone would bring up-to-date with the projects progress. Such meetings are also useful for issuing additional and individual instructions. Research indicates that nurses respond well to online messengers, particularly Viber and Facebook (Bautista & Lin, 2017). They can be used to inform nursing staff of impeding meetings, during which nurses would listen to reports by Project Manager and Nurse Manager.
Conclusion
Altogether, it should be evident that e-mails are the most effective means of communication because they allow project members to quickly acquaint themselves with the progress of the project without actually meeting. Virtual meetings with VP also allow communication, when they are away from the hospital. In all other cases, virtual meetings are inconvenient as immediate input is required. As such, in person meetings are the most preferred communicative format. Nurse Manager can be involved in face-to-face meetings, which would provide the opportunity to discuss nurses, while nurses themselves should be gathered for meetings, where reports will be read. In all instances, communication transpires at least once a week.
The primary communication technique used for presenting the project is placing emphasis on the benefits each of the project members will have from participating in the project. VP will be rewarded with improved statistics because fewer postoperative patients are readmitted. Director of Nursing and Nurse Manager will benefit from the reduction of workload, as postoperative patients will be educated on proper self-care. As such, the necessity to assign nurses to patients will become less urgent. Finally, nurses will benefit from greater job satisfaction because fewer patients are readmitted. Ultimately, emphasizing how the project will benefit all participants is the most effective way of maintaining their motivation.
Bray, M. S., Appel, A. L., Kallies, K. J., Borgert, A. J., Zinnel, B. A., & Shapiro, S. B. (2017). Implementation of an enhanced Recovery after Surgery program for colorectal surgery at a community teaching hospital. WMJ, 116(1), 22-26.
I am typically exposed to the mass media in one and the same social environment, at home. However, despite the fact that the difference is not considerable, I feel that my perception of media is still affected even by the room, in which I consume information. To be specific, when I am in my bedroom, checking Facebook news or my friends recent updates, reading a book, or watching Netflix, I feel totally relaxed. I simply enjoy being alone and entertaining myself with videos, social networks, or books.
When I go to the living room to read, it means that I have to be more focused to study. It can hardly be done when I am in my bedroom as there are too many distracting factors there. When I watch TV in the living room, it means that I do not mind having a company to discuss the news. Finally, when I do the same in the kitchen in the morning, I am occupied with preparing and eating my breakfast; therefore, television serves as a background and I cannot be focused on the information that I receive.
Although the major part of media consumption takes place at home, I still stay online in social networks at the university. This environment makes a lot of difference since I cannot be active online during these hours. I have to concentrate on my studies and extracurricular activities. This implies that I only accidentally read some pieces of news or watch my friends photos and posts.
From this, I can conclude that the level of exposure to the mass media is the highest when the settings are informal but not overloaded with various types of amusement sources (like my bedroom). There should be only one source of media to ensure concentration.
Time of the Day
Although the schedule provided is highly approximate indeed, the deviations from it are not frequent. The fact that I can easily trace the pattern of my media experience allows me to claim that I am typically exposed to them at the same times of the day.
When I wake up, I need some time for chatting with friends or simply reading their news on Facebook to set the mood of the day. It lasts for about 30-40 minutes while I am lying in bed, dressing up, and making some morning preparations before my studies. Media consumption easily fits in as it rarely distracts me from anything important.
Next, when I go to the kitchen to have breakfast, the situation is the same. I do not need to be particularly focused on the informative part of the news. I can eat or communicate with the members of my family at the same time. I do not browse social networks when I am not alone not to get detached from the interlocutor.
As I have already mentioned, I do not constantly update Facebook or Instagram at the university although I am online to have something to fill pauses.
Then, at home, I first read books (for studies or for fun) and then watch Netflix. I rarely change this order as I know well that if you start watching videos when you still have important information to memorize, you will waste too much time procrastinating. Finally, when I finish with the news in the evening, I go to bed to spend some time on social networks. There, I can read what I skipped during the day or simply relax watching funny pictures or videos.
As far as weekends are concerned, I believe that my consumption of the mass media in terms of settings is considerably different. The reason is that I do not spend so much time at home and usually visit friends or go to cafes or other public places. There, I can browse the Internet or watch TV being in the company of several people.
Media Functions
The most popular functions of the mass media for me are entertainment, information, and education. I believe that, despite the fact that initially printed sources were created to perform the informative function, the appearance of the television changed the picture dramatically. Todays media are so overloaded with information that the only way to attract new readers or spectators for them is to continuously provide entertainment. Some of the shows I watch even change their direction to attract a bigger audience.
For instance, the Big Bang Theory began as a show for science geeks and, besides being amusing, gave a lot of interesting facts that could foster you to enrich your background on a particular topic. However, now the show has already turned into a soap opera rotating around relationships. Sometimes, I give preference to educational shows (like those of Stephen Hawkings); yet, I still perceive Netflix as a source of entertainment and opt for smart but funny shows (like The Simpsons). The same amusement function is performed by Facebook and Instagram (although social networks can be rather informative at times).
It is different from television since it is not convenient for me to watch my favorite movies interrupted by advertising. That is why I watch TV only for the sake of the news.
As far as the educational function is concerned, it is mostly performed by books and documentaries. Currently, I read Henry Miller and watch Amanda Knox.
Business Models
The most frequently encountered business model supporting the channels I use is a subscription. Satellite television requires buying a package. I have the basic one since my family members are not big fans of watching TV.
As for Netflix, here the situation is different. I have the premium package because I like streaming in Ultra-HD, and the difference in price is not considerable. Prices start at $8 and increase by $2 with the next package. There are only three options available there.
Facebook and Instagram are based on subscription and advertising at the same time. You must have an account to use them but you are not obliged to pay. Instead, you have to watch numerous ads in each group, especially if the number of members is big.
Finally, the last kind of business model is a single-purchase. However, while it is completely single when you buy a printed book, it is not quite the same as Kindle. You have the platform to read your e-books but the number of them available for free is rather limited. Thus, you have to pay if you want to download something that is not available free of charge.
Media Messages
I do not think that I am particularly influenced by any of the messages I am exposed to although I can recognize them. For instance, in some shows that have been in production for many years (like The Simpsons or The Family Guy), it is typical to promote family values. Regardless of the fact how many unresolved conflicts or misunderstandings arise among the Simpsons, there has been no episode for 30 years, in which the family breaks apart. Despite the fact that the show is ironic and mocks at the American dream, it still sticks to the idea that family is the basic social institution.
In contrast, I have recently started watching Black Mirrora satirical drama that is focused on the topic of alienation created among people by modern technologies. The director shows how desperate we are as we have no close people around in the whole world. This topic is recurring in modern shows.
In fact, it is interesting that Instagram promotes being single as a positive phenomenon. Instead of concentrating on detachment from reality, it shows how cool it is when you are a blogger or a party animal and have no time for boring family life. The more events you visit or the more photos you take, the more popular you become regardless of your real personal and professional life. I am convinced that this distortion of values should not affect our minds if we want to develop as a society. Personally, I observe the trend but do not follow it.
Communication with patients is widely considered to be among the pillars of successful patient care. Most people believe that effective communication is essential for nurses to ensure positive patient outcomes and promote faster recovery. Therefore, many researchers and authors have sought to determine and outline the key principles of patient-nurse communication. Still, the research community uses the scientific approach to evaluate communication patterns and interventions.
Marcus Engel, on the other hand, presents a unique view on patient-nurse communication from the patients perspective. In his book Im Here: Compassionate Communication in Patient Care, Engel (2010) describes his personal experience with patient care and explains positive and negative communication patterns that can affect patient health.
The purpose of the book is to draw the attention of nurses and other health professionals to the importance of compassionate communication. I believe that this goal is relevant to the contemporary healthcare environment. Indeed, communication with patients in many institutions tends to be quite formal; nurses usually care for several patients at once, which is why it is difficult for them to utilize a personal approach for each patient.
However, for patients, nurses are the key point of contact among health professionals. Engel (2010) shows that nurses spend more time with patients than doctors and other medical professionals. Therefore, for patients staying in the hospital, communication with nurses becomes very important.
In order to convey his main idea, Engel (2010) chooses to describe his personal experience of recovering from a car accident that affected his sight. The writer admits that the recovery process was difficult and full of unexpected events; however, seeing compassion and genuine care from Nurse Barb helped him to feel at ease even at his most difficult moments. By sharing his view on compassionate care in nursing through a personal story, the author gains the attention of a wide audience while at the same time establishing a clear link between the patients personal troubles and his or her path to recovery.
The author describes his journey to recovery in moderate detail, focusing more on the emotional side of the events. Such an approach allows Engel (2010) to stress the importance of the support provided by Nurse Barb. In essence, Nurse Barb becomes the ideal of compassionate nursing care that is advocated in work.
Engel (2010) created a book that does not fit into the format of academic nursing literature but still captures the professional nurses minds. The author outlines his ideas in a thoughtful, refreshing, and deeply personal manner, which is empowering for the readers. A minor drawback of the work is that it does not provide a specific framework for applying compassionate communication to nursing care.
However, I believe that it adds value to the work, as it allows readers who are not professional nurses or medical specialists to be compelled by the book, too. Engels (2010) exploration of Nurse Barbs behavior and communication patterns serves the purpose of outlining the key characteristics of compassionate communication, whereas a personal perspective offered by the author shows its impact on the patients.
Overall, I believe that Engels (2010) work is important and useful, as it addresses the important topic of compassionate communication with patients. By writing from the patients point of view, Engel (2010) is able to highlight the impact of compassionate communication and explain its key features. Therefore, the book offers a refreshing perspective on nurse-patient communication and is also an enjoyable read that would be beneficial for most professional nurses.
References
Engel, M. (2010). Im here: Compassionate communication in patient care (3rd ed.). Orlando, FL: Philips Press.
Among nurses and midwives duties, there is one that relates to the responsibility of speaking on behalf of patients. The NMC has created a set of videos intending to promote advocacy for patients health, specifically to ensure that healthcare professionals report abuse and other types of mistreatment of vulnerable patients. These films support the standards that NMC outlines in its Code of Conduct for Nurses (The code of conduct, no date; NMC, 2015). This paper will review healthcare advocacy using relevant theories and address potential communication strategies.
Advocacy
NMCs code of ethics outlines the standards of work that each nurse or midwife practising in the United Kingdom must adhere to daily. The NMCs (2015, p. 6) first standard is as follows: nurses must treat people as individuals and uphold their dignity. In the NMCs first scenario, the mans dignity is compromised since he continuously asks to give him glasses, and all nurses ignore his requests. Hence, the first scene shows that the standards set out by NMC are not met in some care facilities.
The importance of being aware of the need for advocacy within relationships in health care is linked to the patients not always communicating their needs clearly and effectively (Barr and Gates, 2029; Jackson, Gettings and Metcalfe, 2018). Hence, nurses have to recognise these issues and address them since they spend a lot of time caring for patients and communicating with them, which allows them to assess the latters needs (Nsiah, Siakwa and Ninnoni, 2019; Prestia and Dyess, 2020).
Regis College (no date) defines an advocate as an individual who speaks on behalf of the vulnerable people, whose voices and opinions may be lost due to bureaucracy or other issues. Consequently, a nurse advocate is a professional who observes and listens to ensure that all patients needs are met, including psychological. Nursing advocacy is not a novel concept, and it is integral to the job position. As part of the third principle by NMC (2015, p. 7), nurses have to assess patients physiological and psychological needs and act as an advocate for the vulnerable, challenging poor practise and discriminatory attitudes and behaviour relating to their care.
As becomes evident from the NMC film, there is still an issue with nurses failing to fulfil their advocacy role. In a discussion article by Nursing Times, Smith and Lee (2017) argue that nurses are often afraid to advocate for their patients since it requires them to challenge others. For example, in the NMCs first scenario, one of the nurses would have to confront the others about ignoring his request to ensure that he receives his glasses now and will be heard in the future. This confrontation can lead to conflict and stress, which humans naturally tend to avoid. As a result, nurses, who often work with and support vulnerable populations, such as older adults or disabled individuals, often fail to fulfil their role as advocates.
Evidently, to be advocates, nurses have to possess not only excellent knowledge of medicine but also leadership qualities. Regis College (no date) outlines leadership, communication, decision-making skills and negotiation capabilities as a necessity to support nurse advocacy. These skills are necessary because they allow nurses to follow through with identifying the problem, voicing it and collaborating with other teams to resolve it.
Advocacy may relate to the day to day work of nurses, such as helping an elderly patient find his glasses, or it may concern systematic problems within the healthcare continuum. According to Regis College (no date), nurses can advocate within their medical facility, legal system or families. Hence, a nurse can raise the question of understaffing the elderly care facilities, which leads to neglect and improper care to advocate for policy changes to ensure that the issue faced by the older man can be avoided in the future.
Communication Strategies
Communication and advocacy are linked since without being able to listen and voice the advocacy issue effectively, and a nurse will be unable to resolve a problem (Abbasinia, Ahmadi and Kazemnejad, 2020). A range of communication strategies can enable the development of therapeutic relationships and help support the values and attitudes of patients. Active negation and advocacy on behalf of people to ensure equal access to care and support are possible if a nurse can effectively understand how the environment and the sender-receiver relationship affects the therapeutic relationship (Communication theory and its applications in nursing and healthcare, no date).
There are several theories of communication applicable to the nursing profession. One of them is Peplaus Interpersonal Relationships Theory, which takes into account the environment, attitudes and beliefs shaped by a persons culture as the factors that influence the nurse-client relationship (Blaszko Helming et al., 2021; Thomas, 2019). Hence, according to this approach, nurses should understand the complex factors that impact their communication with a patient. For example, in the NMC film, the patient is an older man who states that he does not want to burden anyone (If you dont do something& NMC, 2017). However, his basic needs are overlooked since he repeatedly asks for glasses and does not receive them.
Following Peplaus theory, one can assume that nurses in this care facility overlook the fact that older adults are burdened by negative feelings and do not want to trouble others, which may prompt them to overlook some of their needs or not state them clearly. Peplau developed three nurse-client communication stages: orientation, identification, exploitation and resolution (Brown et al.; Thomas, 2019; Sundqvist, 2018). If the nurses assessed the mans needs during the orientation phase, mainly because he has bad eyesight and needs glasses to perform his daily activities, it would be easier for them to understand his needs during the identification and subsequent phases. Therefore, Peplaus theory is one example of how communication and advocacy are linked because, without adequate identification of needs, nurses may fail to advocate for their patients.
NMC Safeguarding Film
NMCs film under review is about using three scenarios that healthcare professionals may face in their practice. The first scenario is about an older adult placed in a care facility who faces neglect from the staff (If you dont do something& NMC, 2017). The communication strategy used by NMC in its Safeguarding film is negative because this approach helps support the urgency of the advocacy problem and show the distress the patient feels if his needs are unmet (Bola-Arotiowa, 2020; Peate, 2019). The main messaged is If you dont do something, who will?, which aims to encouraged people to report cases of abuse and mistreatment.
The NMCs film is an example of a negative communication strategy, and it shows the negative effect that neglect and mistreatment have on an elderly patient. This video shows a patient in distress, and the goal is to show the nurses, who are the target audience, the negative effect that neglect has on the individuals in care facilities. Hence, the negative communication strategy is justified here because the mental health consequences of neglect are severe, and it is vital for NMC to highlight this problem. If a positive communication strategy was chosen, the NMC could show a happy elderly patient in a care facility, who communicates with the staff and receives adequate care, but the message of this campaign If you dont do something, who will? would be perceived as less serious (If you dont do something& NMC, 2017).
Conclusion
In summary, this paper assesses the importance of nurse advocacy and communication strategies using a case study scenario by NMC. In the first part of the video by NMC, a man in an elderly care facility asks for glasses, but nurses ignore his needs. From an advocacy viewpoint, this is a severe violation of the NMCs standards of practice, which require nurses to assess and advocate for their patients needs, both physiological and psychological. This video is an example of a negative communication strategy, which is used to emphasise the message of the campaign. Hence, the NMCs scenario supports advocacy by showing a common issue in an elderly care facility and emphasising the distress that the patient feels. Moreover, this film shows the importance of the potential need to be aware of advocacy issues as patients do not always explain or justify their needs. Peplaus theory of communication offers four steps of communication and can be used to develop a therapeutic relationship, values and attitudes.
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The complexity of human behavior has led to an agreement among researchers that the behavior of health caregivers has significant power on patient recovery. For example, health providers traits, the ability to express warmth and concern for the patient have appeared to increase a patients recovery rate drastically. Interpersonal traits involve more than how one communicates with others since it involves the speakers confidence and ability to listen and understand.
How effectively one solves problems and manage stress is what is referred to as interpersonal traits. Malpractice lawsuits usually arise from inadequate communication with patients, and this can be easily be avoided with caregivers paying extra attention concerning communication with patients. Lee et al. (2002) point out that effective interpersonal communication between a patient and a caregiver is determined by the way a caregiver presents him or herself at the patients bedside. Patients judge this as a major indicator of their caregivers general competence.
Statement of Problem
How a caregiver relates with a patient has a remarkable effect on whether the patient will be satisfied or raise concerns. However, in most cases, caregivers do not encourage two-way communication between themselves and the patients, especially when the discussion touches on sensitive issues such as the severity of a patients condition. In other instances, caregivers tend to prefer patients to take everything they are told without raising too many questions that could lead to patient dissatisfaction with the services provided to them at the end. This study, therefore, aims at establishing instances of failure of interpersonal traits and probable ways to address these problems (Clack, et al. 2004).
Purpose of Study
The purpose of this study is to establish if interpersonal traits affect relationships between patients and caregivers (staff) in healthcare environments.
Research Question
The study seeks to answer the question: what are the effects of interpersonal traits in relationships between patients and caregivers in health environments?
Organization of Study
This paper has three chapters. Chapter 1 deals with the introduction and research questions. Chapter 2 deals with the literature review, and conceptual models while the last chapter deals with data collection methods, analysis, and the conclusion.
Literature Review
Interpersonal Traits
Skills used by a person to interact effectively with other people are referred to as interpersonal traits. These include listening skills, facial expressions, gestures, communication skills among others. These traits are easily developed and enable caregivers to earn huge rewards to their profession as well as ensure maximum patient satisfaction.
Importance of Interpersonal Traits
Interpersonal traits in a healthy environment can make a caregivers life happy and successful and there is, therefore, a need to improve these skills. Satisfied patients are advantageous to a caregiver in terms of reduction of work-related stress and burnout and job satisfaction. A caregiver with good interpersonal traits will for example evaluate and know in advance the best way to respond to a patients questions without annoying the patient and ensuring that the patient is satisfied with the service provided.
Successful communication between a patient and a caregiver is an essential clinical function. Arora (2003) explains the communication between a patient and a health provider as the heart and art of medicine and a central component in the delivery of health care.
The main objectives of effective interpersonal communication between a caregiver and a patient include the creation of good interpersonal relationships, facilitating the exchange of information, and including patients in decision-making, especially those about their health. Through effective communication, a caregiver can easily regulate a patients emotions and enable the patient to improve his or her comprehension of medical information as well as easily identify a patients needs, perceptions, and expectations. Caregivers who practice better interpersonal skills have more patients with better recovery rates as compared to those with poor interpersonal skills (Stewart, et al. 2000).
Barriers to Effective Communication between HealthCare Givers and Patients
It is known worldwide that medical training is strenuous since it takes several years of vigorous reading, practical as well as examinations. This causes emotional and physical strain to a medical trainee, and it has been attributed to the depreciation of the quality of interpersonal skills among most caregivers. There are instances in which caregivers avoid emotional and social discussions relating to patients problems. The caregiver unknowingly may harbor these emotions and in the end, feel guilty and emotionally distressed to an extent that his or her work is affected negatively. Also, it could affect the level and quality of care given to subsequent patients (Maguire & Pitceathly, 2002).
Lack of sufficient explanation of a patients condition by a caregiver may lead to patient dissatisfaction. In some instances, caregivers may be unwilling to explain fully a patients condition and the best method of treatment. Other caregivers discourage their patients from asking too many questions leading to a lack of understanding by the patients. For example, with the emergence of technology and the internet, patients are increasingly able to understand their conditions and in some instances, even prescribe treatment plans for themselves. Other patients easily resist expert authority that society has granted caregivers.
Lee and Garvin (2003) go-ahead to explain that in some instances, patients choose to ignore whatever advice they get from caregivers or simply shut the caregiver out. Miscommunication of important information may negatively affect the choice of treatment plans that patients decide. This could have a significant influence on the disease a patient is suffering from.
Effective Communication
This is transmitting information in a way that the recipient can understand clearly without distortion or misunderstanding. However, this is not always the because of hindrances such as ethnicity, gender, and culture among others. In a health setting, miscommunication can be fatal to a patients health. Some of these factors include a patients way of life that may hamper how he or she communicates with a caregiver.
Instances of language barriers are a major challenge that caregivers get in trying to understand and pass information to a patient. Socioeconomics that include literacy levels, economic status, personal beliefs, and behaviors may hinder how information is passed and perceived between caregivers and patients. Some medical jargon does not have similar terms in the nonprofessionals language and therefore, caregivers a faced with the hard task of trying to look for close words to explain a particular medical term. This especially can be hard for patients with low literacy levels to understand.
Models of Health Care Giver- Patient Relationship
The Paternalistic Model
In this model that is also called the priestly model, physicians solely determine the best treatment plan for the patient. The caregiver goes ahead to present the plan to the patient for consent after establishing that it is the best treatment plan. The model assumes that there are shared objectives between patients and caregivers however even if the patient does not fully agree with some suggested treatment plans the caregiver will go ahead and administer the treatment plan in the hope that in the long run, the patient will be grateful. During emergency cases, this model is very appropriate. In instances where there are no emergencies, this method is not justified and even caregivers agree to this.
The Interpretive Model
In this model, the caregiver helps the patient to determine the best treatment model to adopt. The caregiver acts as a counselor in this model and therefore does not make decisions on behalf of the patient but rather provides the patient with the pros and cons of particular treatment plans and help the patient settle on the best and most appropriate treatment plan. Despite the positive aspects of the model, unwittingly caregivers may impose their values and judgments on the patient and fail to effectively consider what the patient wants.
The Deliberative Model
The caregiver carries out moral discussions with the patient. In this model, the caregiver persuades the patient to undertake a particular treatment plan based on ones experience. Here the caregiver acts as a teacher or friend to the patient. This model allows caregivers to judge patients values and promote particular health-related values. This is even though a caregivers values may conflict with those of his or her patients. Besides, caregivers and patients may have different moral deliberations.
The Informative Model
In the model, the caregiver provides the patient with all information about the patients disease state and all the relevant information about this disease. The caregivers role in this model is just to provide information to the patient. In this model, also there is no place for the caregivers values and understanding a patients values. The patient has autonomous control over medical decision making here.
The caregiver acts as a competent technical expert and whatever decision the patient adopts, the caregiver executes it without question. This model is extremely inaccurate because the caregiver has to agree to whatever the patient wishes; even when it is clear the patient is wrong (Bach & Grant, 2009). The paternalistic model is preferred in cases of emergency. There is a need to adopt all four models to come up with the best model to use. However, the need for shared decision making to come up with the best treatment plan for the patient is usually encouraged (Maguire & Pitceathly, 2002).
Characteristics of a Great Caregiver
There is a need for a caregiver to be an excellent communicator which involves being able to effectively pass information as well as being a great listener. Caregiving is a stressful profession with many instances of traumatic occurrences. Caregivers should be able to accept death and suffering without letting it affect their individuality. Caregivers should also be able to appreciate heartwarming experiences in their jobs that include seeing patients recover and reunite with their families. Great caregivers can feel compassion and a passion to provide comfort. Patients look at caregivers with so much expectation. This hence puts the caregiver in an awkward position and they have to learn to be there for their patients. Caregivers should have the important quality of empathy (Maguire & Pitceathly, 2002).
Flexibility in terms of working hours and taking many shifts is another major quality of a great caregiver. The ability to work overtime, during weekends and nightshifts without complaint should be what motivates and drives a caregiver. Caregivers should pay attention to every detail and leave nothing to chance. This is because a simple mistake can spell tragedy for someone elses life. Besides, a great caregiver should have excellent problem-solving skills as well as the ability to respond quickly to situations. A caregiver should be prepared to always handle emergencies at any particular time of their profession. Great caregivers should therefore have the unique ability to respect people and rules. This includes the ability to realize that the patient comes first, no matter what the situation is.
The Quality of the Interaction Between Physician and Patient Can Be Extremely Influential in Patient Outcomes.
Caregivers like having a professional identity. In most cases, they achieve this through the number of patients they have successfully treated. Good interpersonal skills go a great way in aiding patient recovery. Patients who have been treated well in a healthy environment are a great way of advertising a doctors name as the patient sells the good word to his or her friends and family about the services of a particular caregiver.
Ways of Improving Interpersonal Skills
Patients value a caregivers interpersonal skills even more than their medical expertise. Some of the suggested methods and strategies of improving interpersonal skills include:
Time with patients: Patients value caregivers who spend time with them discussing personal and medical issues. There is a need for caregivers to ensure that they are easy to talk to by being good listeners and put patients suggestions into consideration (Stewart, et al. 2000).
Good Medical opinions: Caregivers should research and study changes in medical procedures to enable them to provide sound medical decisions to the patients.
Asking the right questions: patients do not usually understand what is ailing them and it is for this reason that they visit hospitals to get expert verdicts on the exact problem. Therefore, caregivers need to ask probing questions but in a tactical way to ensure, they get full information about a patient and at the same time not offend the patient (Karen, Barbara & Rimer, 2008).
Dignity and Respect: Being on time for appointments and not keeping patients waiting for long is among the ways that a caregiver can show respect to a patient. Availability during emergencies: Caregivers need to be available whenever there is an emergency. This can be done by instituting emergency numbers or even giving patients direct phone numbers where they can easily be reached.
Essentials of Patient Satisfaction: The patient always wants to be provided with an opportunity to tell his or her own story and feel that the caregiver is paying attention as well as considering everything.
Caregivers should take a patients problems seriously, be able to explain information clearly as well as try to understand a patients experience and expectations. Patients should be encouraged to express their concerns, fears, and ideas. This makes them feel and control and therefore more satisfied.
A patients social and psychological functioning should always be put into consideration by a caregiver. Doing this greatly increases a patients satisfaction. Besides, patients prefer frequent visits from caregivers as this makes them feel that they have been taken care of well. Patients greatly value how the entire staff relates to them. For example cleaners, nurses, laboratory staff among others. Therefore, there is a need for a healthy environment to always ensure that all its employees can treat patients with great respect and dignity. Patient satisfaction is greatly increased when they receive continuous treatment and referrals from the same caregiver (Lee & Garvin, 2003).
Chapter Summary
Communication between a caregiver and a patient is a critical part of a patients life. With effective communication, a lot of complaints and lawsuits can easily be avoided. It has been noted that most patient complaints are related to issues of communication and not clinical incompetence. Patients want caregivers who can treat them as well as effectively communicate with them. Effective communication can also put a caregiver in an advantageous position in which they can detect problems in advance, therefore, preventing medical complications and expensive treatment methods.
Methodology
This chapter provides background information on the study topic. It highlights the relationship between patients and caregivers interpersonal traits and the methodology used to collect and analyze the data collected.
Data Needs
Data were collected on patients to come up with different outcomes on how patients who received effective communication from caregivers reacted to treatment as well as how those who did not get effective communication responded to treatment. The major aim of this data was to establish if there is a relationship between the recovery rate of patients and effective communication and interpersonal traits from caregivers (Hughes, et al. 2004). Information was also collected about caregivers who practiced effective communication and interpersonal traits and how this influenced both their professional and personal lives.
Data Collection Methods
Secondary data collection method was majorly used: This involved a literature review of documented information from health care practices and how communication influenced the outcome of treatment offered. The literature on different caregivers and how different situations were handled was also reviewed for comparison purposes. Direct observation and personal experiences were also used to collect the data needed (Houghton, Marshall & Thomas, 2010).
Data Analysis
Data collected was analyzed to establish the effects of interpersonal skills between patients and healthcare givers as well as propose measures to improve interpersonal traits. A review and analysis of four conceptual models were done to try to establish the preferred model. All the models are best suited during different scenarios, therefore, need to be adopted concurrently.
Results
The research paper established that interpersonal traits greatly affected relationships between caregivers and patients. Effective communication was found to greatly assist in patient satisfaction and recovery time. Caregivers with effective interpersonal traits were found to be happier and satisfied by their work. Cases of lawsuits against caregivers and patients were found to be minimal in facilities with effective interpersonal communication between caregivers and patients.
This greatly increased quality of services provided as well as profits reaped in cases of private health facilities. Some medical jargon does not have similar terms in the nonprofessionals language and therefore, caregivers a faced with the hard task of trying to look for close words to explain a particular medical term. This especially can be hard for patients with low literacy levels to understand.
References
Arora N. Interacting with cancer patients: the significance of physicians communication behavior. Soc Sci Med. 57(5), 791806.
Bach, S. & Grant, A. (2009). Communication and Interpersonal Skills for Nurses. Web.
Clack, G. B., Allen, J., Cooper, D., & Head, J. O. (2004). Personality differences between doctors and their patients: implications for the teaching of communication skills. Med Educ., 38(2), 177-86.
Houghton, G., Marshall, S. & Thomas L. (2010). Interpersonal Traits, Complementarity and Trust in Virtual Collaboration. Web.
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Modern media and especially social networks have become a major part of peoples life. Online communication is ousting traditional live conversation slowly, but surely; nowadays, most people have at least one social network account and spend an impressive amount of their time chatting online. On the one hand, the fact that people can communicate remotely is an important foot forward in not only personal, but also business relationships.
On the other hand, with the abundance of opportunities for communication, the latter seems to have lost its value, with the unceasing conversation process triggering a considerable lack of personal time and self-analysis. People need to be alone, whereas social networks deprive them of this opportunity.
Solitude in the Era of Enhanced Communication
The problem of solitude in the era of social networking is one of the most hot-button issues. Hundreds of friends and followers in social networks demand a constant attention, which means that an average user has little to no personal time left. However, arguably, the process of communication is controlled by each user to the same extent and can be ended whenever one wishes to. More to the point, one is free to stop frequenting the network for a couple of days. Therefore, the problem of the lack of personal time seems to concern not only the emergence of social networks, but also the human psychology.
Locating the Problem: Being Alone and Being Lonely
One must mention that Marche touches upon not one, but several issues when talking about the loneliness of virtual communication. First, the author raises the issue concerning the lack of personal time that new media has triggered. However, digging a bit deeper, one will notice that the author taps on a range of other important issues, such as peoples dependency on social networking, the social ostracism that the people without a social network account are subjected to, and the fact that people willingly deprive themselves of their right to be alone.
Indeed, one might claim that no one demands people to register in a social network. However, seeing that the communication process occurs nowadays mostly in social networks, the people denying the latter are most likely to be isolated from the rest of the society. Those submissive to the power of the social network, in their turn, also lack communication, since they feel that its quality has dropped. Thus, the vicious circle emerges. As the enthusiasm, with which the society engages in virtual communication, is the key reason for its opponents to be ostracized and its supporters to become disappointed quickly, one might assume that it is the false anticipation that triggers problems in communication for most users of social networks.
Conclusion
Despite the obvious benefits of social networks, active online networking leads to drastic lack of personal time, particularly, the time for solitude. A very basic need, it is an integral part of personal development, and its deprivation is likely to lead to drastic results. However, a close analysis of the problem reveals that the issue concerns a much more complex conflict between the psychology of the crowd and the needs of an individual. Therefore, to address the problem of personal solitude and the social networks, one must consider the chances to change peoples attitude towards social networking in general. Otherwise, the conflict will persist.
Mustafa Abdul is a 78-year-old resident of the UAE and a retired archivist and newspaper editor. After several decades of working in the field of media and communications, he is able to evaluate the changes that occurred to media with the advent of the new technology and define the positive and negative effects of these changes.
Changes in the UAE Communication and Media
According to Mustafa, the basic change that happened to media and communication concerns the speed with which information is transferred and processed. What used to take several hours, like the process of having a film developed, takes several minutes nowadays with digital cameras.
What Seems to Have Improved: New Opportunities
In the course of the interview, Abdul admitted that the introduction of new media into the culture of the UAE has resulted in more opportunities for communication between the UAE residents (Appendix A). According to Abdul, the information landscape has changed drastically.
The fact that with the help of the new media, information can be conveyed not only in a much faster, but also in a much more efficient and convincing manner, should also be viewed as a positive change, as Mustafa explained.
For instance, the interviewee claimed that new media tools, such as YouTube and Facebook, as well as other social networks (Al Jenabili, 2012), were soon recognized as a powerful tool in reaching out for not only the UAE citizens, but also major companies and organizations (Appendix B).
Regarding the Downsides: Obstacles to Regular Communication
Unfortunately, the introduction of new media also has its downsides, the primary one being the obstacles to the traditional communication. According to the results of the interview with Mustafa Abdul, an impressive shift towards the use of social media can be observed in the UAE, which leads to the deterioration of the live communication culture of the Emirati people (Healy, 2010).
Another obvious change that occurred to the UAE communication and especially media concerns the content and its underlying message. While in the past, the significance of a particular idea was valued in media and communication, nowadays, the marketability of the idea is considered the priority (Appendix C).
In Search for Solutions: What Can Be Upgraded
The current informational evolution is rather natural, given the fact that the current society is defined as informational one. However, it is still necessary to reinforce traditional cultural values to make sure that the national identity of the UAE citizens is not going to be lost in the process of updating the sphere of media and communication (Al-Khazraj, 2009).
Seeing how the traditional values have already been shifted towards marketability, as Mustafa claims, there are reasons to consider the reinforcement of traditional cultural values (Appendix D).
Conclusion: Greater Changes Are Yet to Come
To sum up the results of the interview, new media in the UAE is clearly changing the current cultural landscape. The UAE culture is merging with the ones of other states and becoming more flexible towards the influence of other cultures. While the given tendencies show that the state is ready to evolve culturally, socially and technologically, the necessity to filter the information that is provided by modern media arises.
Reference List
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Healy, F. (2010). Response to the Telecommunication Regulatory Authority consultation on the definition of Relevant Markets for the purposes of ex ante market reviews. Web.