In healthcare, some type of hierarchy is essential. Treatment decisions cannot be made through consensus alone, especially when a patient's life is in immediate danger. Also, seniority and areas of expertise are essential to define -- a more experienced nurse's decision-making ability must have priority over a novice nurse's. Certain areas of expertise, like the staff's registered nutritionist, must be respected when providing care. In fact, research in support of a communication theory known as decision-mapping notes that "groups with ineffective leadership" are less rather than more cohesive (Stephens 1999). Knowing there is an effective source of leadership can produce confidence. However, some consultation between different people, including the patient, family, nurses, physicians, and other caregivers, is ideal when coming to a conclusion about what step the unit should take in the futures. Ultimately, everyone in the group has to be respected, even if some members have greater decision-making power and seniority. The faculty at which I work is extremely diverse, and it is noteworthy that this diversity, rather than forming a barrier to effective communication, has actually become a source of strength. For example, some cultures tend to place more emphasis on having an extended family live within the same walls. People from such cultures (from cultures within the United States and recent immigrants from abroad) may be more resistant to allowing an elderly relative enter a nursing facility as a permanent resident, even if they can no longer care for the family member effectively at home. Dealing with the guilt that may arise as part of this family or cultural tradition has been easier when members of the staff are of the same culture, and can speak the language of the family. Likewise, for residents, speaking...

Culturally knowledgeable staff members can give insight to a physician or nurse is confused as why a patient may be resistant to certain necessary courses of medical action, such as eliminating certain foods, even if this is demanded for the patient's health.
One heartening development that I have seen over the course of my work at the facility that has been especially inspiring is the greater acceptance of women in decision-making roles. Nursing remains a predominantly female profession (although this is changing) but the ability of nurses to exercise leadership is now more respected, and the paradigm of nursing care has grown more important when striving to create a positive environment for patients. On all organizational levels, gender, class, and cultural barriers to leadership are breaking down. Seeing individuals of all races, ethnicities, and genders in positions of leadership has been instrumental in improving and customizing patient care -- as patients themselves are of diverse backgrounds.

Works Cited

Cartwright Stephens. (1999). Recasting groupthink as a consequence of ineffective leadership: Is cohesion the problem or the solution? Small Groups' Communication Context.

Retrieved January 20, 2009 http://www.uky.edu/~drlane/capstone/group/dmap.htm

Lane, Derek (2000). Groupthink. Small Groups' Communication Context.

Retrieved January 20, 2009 at http://www.uky.edu/~drlane/capstone/group/gthink.htm

Lane, Derek. (2000). Decision mapping. Groupthink. Small Groups' Communication Context.

Retrieved January 20, 2009 at http://www.uky.edu/~drlane/capstone/group/dmapping.htm

Communication theory in healthcare