Healthcare service delivery models and frameworks

Healthcare Service Delivery

Interpersonal communication in delivery of health communication

Interpersonal communication is the form of communication that exists between two people and it is the type of communication that is deemed universal in many measures. Interpersonal communication involves the daily exchange which could be informal or formal in nature depending on the purpose and surrounding, it can take the form of facial expression, sounds, gestures, written words, spoken words and postures (MBA Knowledge base, 2011).

Interpersonal communication, involves dissemination and reception of objective message or information between two or more people/groups with an aim of getting the desired effect on the receiving individual or groups (Ally & Bacon, 1999). Some professional however contend that for a communication to qualify to be considered interpersonal communication then the two parties involved must be at close proximity and must be familiar with each other or share something in common. The health sector depends greatly on communication and utilizes it for passing across critical information on a daily basis in order to make it clear to the receivers the safety measures and the conditions that they are in as well as the possible treatment that they should be undergoing in order to get better. Madeleine Leininger contributed to the nursing theories by coming up with the Transcultural Nursing, culture-care theory which was predominantly communication oriented. In this theory, Madeleine Leininger states that the essence of nursing is care, which is also its dominant trait, unifying and distinctive feature. She states that there can never be cure without some form of care being shown but there can be care without curing. She put emphasis on the fact that human caring is universal but it varies among different cultures by how it is expressed, processes involved and the patterns (Current Nursing, 2013). The expression of the care from the caregiver to the patient can only be achieved through effective communication of the health information hence it is incumbent on every caregiver to strive to be able to communicate in a cross cultural manner or setting. The core purpose of this theory is discovering and explaining factors involved in diverse and universal care that is culturally based that influence well-being, health, illness or death among groups or individuals. Transcultural nursing involves the studying of cultures in order to understand the differences and similarities that exist among groups of patients. In the transcultural nursing the nurses practice is based on the cultural considerations of the patient. It should start with cultural assessment that looks at the cultural background of a patient when assessing their health or needs. Apparently differences in cultures can be as obvious and overt as people from different language groups or races attempting to communicate, or as subtle as people of the same language and locality but one belonging to a subgroup of drug users and another not from the group and this was the case that presented itself in the DVD clip that will be analyzed below.

The clip under scrutiny is of a social worker Joe, who is attached at a children's hospital and works with mothers whose babies' lives could be at risk. Here, she works with Kim and Adam, Kim has three other children from her previous relationships all of whom have been taken up by social services and fro Adam this is his first baby. In this case, she works with the couple till the delivery of the baby and expresses her concerns and precautions to be taken by the couple to avoid the baby being taken by social services again. The clip is purely based on communication between the social worker and the two both of whom have serious problems; Adam has a history of mental illness and yet Kim has a problem of drinking.

Section I

a. Social Determinants of Health

Dahlgren and Whitehead, (1991) as portrayed in the North Nottinghamshire Public Health Network (2014) indicate that there are four levels that determine the well-being and the health of an individual. These levels are applicable to the case study at hand as follows;

Level 1- General socioeconomic, cultural and environmental conditions: these three help define a person who is healthy and well in general living or one who is not. For instance in the case study, the social worker realized that the social environment and the general environmental conditions could be wrong for the baby to live in after birth hence she came in to assess and suggest improvements if possible.

Level 2-Living and working condition: these cover the issues to do with food production, education, work environment, unemployment water and sanitation, healthcare services as well as housing. Though not explicitly indicate in the clip, the employment track, especially of Kim could be in doubt due to the previous incidences of inability to take care of three babies and having to be handed over to the social services. The family may not be living the best possible lifestyle they may want.

Level 3- social and community networks: these two defines the level four in this model of a person who is healthy and of well-being. He can easily socialize with others and also belong to groups and form networks like other people out there. This was not the case with this family since both had socialization challenges and inability to form permanent networks. Kim had a problem of drinking for many years, a factor that would hinder her ability to socialize and belong to positive groups. Adam has had a mental problem which may also hinder him from forming permanent networks hence the family cannot be sad to be healthy at this level.

Level 4-individual lifestyle factors: these cover the lifestyle issues like smoking, alcoholism, diet cases and physical activities all have the capability of making or destroying and individual's health. This family had a problem at this level since Kim was a habitual drinker hence unhealthy.

c. Ewles and Simnett's Planning Cycle and the health promotion

In the bid to communicate health information to the couple, the health worker uses the Ewles and Simnett's planning cycle to execute the health promotion. This planning cycle has seven basic parts that guide the planning process (Health Promotion at EACH, 2014).

1. Identify needs and priorities: for Joe, the social worker here, she has a clear priority and has identified the need very clearly. Her concern is to be sure that the couple takes care of the baby before it is born by keeping off alcohol and any other harmful behavior and to reassure her that they can take care of the baby after birth, otherwise the baby would be adopted. There is the need to have a very clear assurance and exhibition that Kim can and shall keep off alcohol for the entire period that she will be pregnant and that Adam would be supportive of Kim before and after birth of the baby. This step helped the social worker to clearly identify the problems and then prioritize the problems at hand.

2. Set aims and objectives: in planning out her action plan, the social worker had clear aims and objectives. The first was to ensure that Kim stays off alcohol during the pregnancy period, to ensure Adam provides the needed support to Kim and to ensure the safety of the baby after the birth.

3. Decide the best ways to achieve these aims: Joe saw that the best way to achieve this was to communicate clearly the needs that she had, the consequences of not meeting the required conditions and even have the couple commit by writing to a willing agreement to abide by the conditions that would help them stay off the social adoption register and possibly lose their baby to social services. The clear communication and having the concerned people voluntarily accept the conditions and commit in writing was the best ever possible way of achieving the objectives.

4. Identify resources: this involves knowing what one would need in terms of money, personnel and other items that will help in the accomplishment of the plan. Joe needed the support of the law through the social services and the possibility of the child being taken up by the government. She also had the hospital personnel who gave her the necessary information about the progress in terms of expression of care for the baby the couple.

5. Plan evaluation methods: this involves follow-up steps after the implementation of the action plan. These would be the information and data collected after the action implementation and would involve taking stock of whether the problems have been solved or there is need to change the approach to solve the problem. In this case the social worker depended on two major informants, the husband to Kim and the healthcare workers. Adam was to inform Joe if Kim went back to drinking so that she cold implement the alternative approach to ensuring the safety of the child. The healthcare givers in the hospital also acted as a pivotal source of information on the progress of the couple and hence the effectiveness of her intervention.

6. Set an action plan: the action pan here is the center of the entire intervention plan and would be followed to ensure the social challenge one goes through is changed. Joe set out an action plan with the first option being the voluntary signing of the agreement to keep of alcohol and be caring to the baby. Adam on the other hand had the duty of taking good care of the wife. The second plan if this initial plan failed would be to initiate the take over by the social services.

7. Action. Implement the plan including your evaluation: this is the action stage that things get rolling and in or case, Joe made the couple to sign an agreement, talked to Kim about the care for self during and after pregnancy and also made several calls to the hospital as a follow up to know how well the couple is doing in taking care of the baby and see if there is need to turn up the baby for adoption.

Section II

b. Barriers to communication

In the interaction between the social worker and the family, there were several barriers to the communication between them, in as much as the communication could be viewed as widely successful.

(a). Language barrier; this is one of the first and foremost barriers that may exist, particularly if one is looking at the cross cultural communication. The difference in cultures may not be necessarily people from different parts of the world, but can be people from the same geographic location but varying age groups or professions or social settings hence cultural orientation. For instance when Kim was taken away to have a private talk with the social worker, Adam felt that he was being isolated hence protested and from there he formed mistrust in the process. This was a barrier that was caused since the language of social work was not understood by Adam. 2003).

(b). Environment; this is another major contributor to the nature and effectiveness of communication. Environment will influence the quality of communication and the accuracy of the message and attentiveness of the receiver. It has been observed that a comfortable environment enables the sender to send message more accurately and can come from being conversant with the people you are talking to or sending the message to. It is therefore essential for the receiver and the sender to create an environment that make each other comfortable to share detailed information that could be necessary in an interpersonal communication (Education Resources Information Center, 2008). In as much as the social worker and the mother had good communication hitherto her going to the hospital, this changed once she was admitted and Joe had to rely on the nurses to get information up to the stage where the mother was stable enough.

(c). Prejudice; this is another factor that most of the time hinders effective interpersonal communication among the people particularly in a cross cultural environment. As noted by Dattner Consulting LLC (2009) the prejudice can greatly compromise communication in the long run though and not instantly. It manifests itself in form of stereotypes in most cases which leads to a gradual meltdown of avenues and environment that can lead to effective communication. This was exactly the feeling that Kim had since when asked whether she trusted the social worker, she said she did not bearing the history with other social workers in the past. This was a prejudice formed against the social workers. The same was evident in Joe since she also indicated that she never trusted the family bearing their past experiences the two have had.

d. Types of communications in the case study