Upward communication relates to the movement of information from people of a lower level on the organisation’s hierarchy, such as the lower level employees: clinical nurses, wardspersons, and wardclerks to those at the higher end of the hierarchy, such as the managers, directors, and chief executive officers (CEOs). Upwards communication refers to such things as suggestions, made to the lower level managers; or complaints, which are then sent upwards toward management. In contrast, downward communication deals with the movement of information from those at the higher end of the hierarchy to those at the lower end such as standing orders, when to have your meal breaks and basic organisational decisions made.
Upwards communication could be analogized with sending a computer the information with which it makes a decision, where the lower level employees are sending the managers information about the good things and the bad things about the organisation at a day to day level, and the managers are receiving it as a means of making decisions, which they will then process and pass back downwards as orders.
To understand the various forms of communication barriers, one must first understand the elements of communication and consider that a barrier exists when one or more of these elements are interrupted. According to Brown and Forrest, the main elements of communication are: ‘the communicator, encoding, the message, the medium, decoding, the receiver and the feedback’ (2005, p.83). Specific forms of communication barriers include, but are not limited to: filtering, selective perception, frame of reference, selective listening, value judgments, source credibility, semantic problems, filtering, language, status differences, proxemic behaviour, time pressures, stress, and communication overload.
Filtering is when a message sender (the communicator) purposefully manipulates information so that it is received more favorably by the message recipient (the receiver). A basic example of this at Nepean Hospital would be where an intern or young doctor fails to successfully put a central venous line in, but says to his or her superior doctor, ‘I’ve gotten five of those in today,’ but neglected to mention that he had attempted it on twenty patients.
Selective perception is when a person receives information selectively based on ‘their needs, motivations, experience, background, and other characteristics’ (Robbins et al 2004, p. 320). For example, one may selectively perceive that he or she is being attacked because the manager is speaking very loudly, and based on previous experiences he or she perceives this to mean that they are angry, when it may not be so.
Communication overload is where more information is communicated than can be physically processed by the individuals receiving that information, such as a manager being told about several problems that must be rectified immediately during a five minute period.
Language barriers deal with the concept that words may ‘mean different things to different people’ (Robbins et al 2004, p. 320), allowing them to misunderstand simple communications. A basic example may be that a manager hears the statement that ‘I didn’t come to work yesterday because I was hit by a bat while teaching my son to play’ and the receiver receives the image of the person being hit by a flying bat and decides he must be lying, because bats attack people.
Emotions determine how a person receives a message. For example, a person who is feeling happy will often receive a message of criticism better than a person who is already feeling angry and upset.
Examples of common communication barriers evident at Nepean ICU include: high levels of stress, communication overload, noise barriers, time constraints and selective listening. For example, the stress that if you do not receive the communication properly (such as a type of drug and its dose) you may kill a person increases the difficulty in understanding a communication. Often, because of the nature of intensive care patients may often have many things required simultaneously, such as taking down the patient’s vital sign observations, administering Nor Adrenaline, taking a blood sugar level, raising their temperature with a Bair Hugger, and ensuring the patient’s relatives know what’s going on, which all leads to information overload. Noise is another major communication barrier because there are numerous alarms, people speaking, and other sounds within the environment therefore causing a barrier at the medium. Time constraints on communication may cause a barrier. For example, when you are giving a hand over to another nurse or doctor about a patient’s medical history, you know that you have only a limited amount of time to spend doing so, and in that time you must communicate all the necessary information. Selective listening may be a barrier, especially when there has been a recent change to protocols or doctors. For example, when a person has been used to administering most drugs with normal saline, and all of a sudden the doctor requests it to be administered with Hartmans fluid one may inadvertently ‘hear’ normal saline.
The most common and important strategies implemented for overcoming these communication barriers are the use of communication feedback techniques, such as double and triple checking drug type and doses. For example, if the doctor (the communicator) asks for ‘2.5mg of morphine IV’ you should routinely then check via a communication feedback system and ask ‘2.5mg of morphine IV?’ Alternatively, if it is a written communication, you may then check for yourself that it states ‘2.5 mg of morphine IV’ and then give that piece of written communication to another colleague and ask them to tell you what it says.