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UBC Theses and Dissertations

Communication effectiveness within a hospital system comparing perceived subjective communication with… Modrijan, Marjeta Marija 1977

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COMMUNICATION EFFECTIVENESS WITHIN A HOSPITAL SYSTEM COMPARING PERCEIVED SUBJECTIVE COMMUNICATION WITH OBSERVED OBJECTIVE COMMUNICATION by MARJETA MARIJA MODRIJAN B.S.N., U n i v e r s i t y o f B r i t i s h C olumbia, 1973 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING i n THE SCHOOL OF NURSING We a c c e p t t h i s t h e s i s as c o n f o r m i n g t o t h e r e q u i r e d s t a n d a r d THE UNIVERSITY OF BRITISH COLUMBIA A p r i l , 1977 © M a r j e t a M a r i j a M o d r i j a n , 1977 In presenting th i s thes is in pa r t i a l fu l f i lment of the requirements for an advanced degree at the Un ivers i ty of B r i t i s h Columbia, I agree that the L ibrary sha l l make i t f ree ly ava i lab le for reference and study. I further agree that permission for extensive copying of th i s thesis for scho lar ly purposes may be granted by the Head of my Department or. by his representat ives. It is understood that copying or pub l i ca t ion of th is thes is fo r f inanc ia l gain sha l l not be allowed without my writ ten permission. Department of NURSING The Univers i ty of B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 pate 9^1 as t r n -ACKNOWLEDGEMENTS -I w i s h t o thank and e x p r e s s my g r a t i t u d e t o my committee, Dr. J u l i a Q u i r i n g , Dr. Vance F. M i t c h e l l , and E l i z a b e t h McCann f o r t h e i r t i m e , guidance and encouragement t h r o u g h o u t t h e c o u r s e o f t h i s s t u d y . S p e c i a l thanks a r e extended t o Dr. C h a r l e s A. L a s z l o , Dr. Ruth L. Z i t n i k , and B r i a n Muth f o r t h e i r a d v i c e and h e l p w i t h the a n a l y s i s o f d a t a . I am g r a t e f u l t o Dr. E l i z a b e t h M. M c G i l l who p r o v i d e d t h e o b j e c t i v e d a t a f o r t h i s s t u d y . I a l s o want t o extend my thanks t o my f r i e n d s w i t h o u t whose m o r a l s u p p o r t t h i s s t u d y would n ot have been completed. ABSTRACT T h i s s t u d y i n v o l v e s an e x a m i n a t i o n o f h o s p i t a l p e r s o n n e l ' s s e l f - p e r c e i v e d a b i l i t y t o communicate w i t h each o t h e r . I n t h e p r o c e s s o f p u r s u i n g t h i s i n v e s t i g a t i o n , i n f o r -m a t ion on t h e p e r c e i v e d and ob s e r v e d a b i l i t y t o communicate was g a t h e r e d t o a l l o w comparisons. The purpose o f t h e s t u d y was t o add t o the e x i s t i n g body o f knowledge r e g a r d i n g p e r -c e p t i o n and communication i n a h o s p i t a l o r g a n i z a t i o n . The st u d y was p l a n n e d t o t e s t t h e f o l l o w i n g h y p o t h e s i s : There i s no s i g n i f i c a n t d i f f e r e n c e between h o s p i t a l p e r s o n n e l ' s s e l f r a t i n g s o f t h e i r com-m u n i c a t i o n e f f e c t i v e n e s s as measured by means o f an I n t e r s t a f f Communication Q u e s t i o n n a i r e , and t h e i r o b s e r v e d communication a c t s c o r e s w h i c h were o b t a i n e d t h r o u g h B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . Data on the s e l f - p e r c e p t i o n o f h o s p i t a l p e r s o n n e l ' s a b i l i t y t o communicate was sec u r e d by means o f a q u e s t i o n n a i r e . Data on the observed e f f e c t i v e n e s s o f communication came from a n o t h e r r e s e a r c h e r , ( M c G i l l ) who u t i l i z e d B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . Both s t u d i e s were conducted s i m u l t a n e o u s l y on t h e same p o p u l a t i o n . The st u d y p o p u l a t i o n i n c l u d e d 165 members o f d i f f e r e n t s t a f f c a t e g o r i e s who were c o n s i d e r e d major communicators w i t h i n t h e h o s p i t a l o r g a n i z a t i o n . A n a l y s i s of d a t a i n c l u d e d f r e q u e n c y t a b l e s c o n v e r t e d i n t o r e l a t i v e v a l u e s e x p r e s s e d i n p e r c e n t a g e s . These r e s u l t s were d e p i c t e d i n bar graphs t o f a c i l i t a t e comparison between t h e p e r c e i v e d and o b s e r v e d a b i l i t y t o communicate. The f i n d i n g s o f t h e s t u d y showed t h a t no h o s p i t a l s t a f f group i s a b l e t o a c c u r a t e l y a c c e s s o r e v a l u a t e i t s own com-m u n i c a t i o n e f f e c t i v e n e s s . Thus, the f i n d i n g s f a i l t o s u p p o r t t h e h y p o t h e s i s o f the s t u d y . The s t u d y recommends t h a t h e a l t h team members p r o g r e s s i n t h e i r u n d e r s t a n d i n g s o f what c o n s t i t u t e s a c c u r a t e p e r c e p t i o n and e f f e c t i v e communication. F u r t h e r m o r e , s i n c e 40-50% o f some c a t e g o r i e s o f h o s p i t a l s t a f f t h i n k t h a t no communication t a k e s p l a c e , f u r t h e r i n v e s t i g a t i o n o f t h i s a r e a o f h e a l t h team com-m u n i c a t i o n s h o u l d be i n i t i a t e d . i v TABLE OF CONTENTS Page LIST OF FIGURES v i CHAPTER I - INTRODUCTION TO THE STUDY 1 Problem Statement 4 Purpose o f t h e Study 4 R e l e v a n c e o f t h e Study t o N u r s i n g 5 Assumptions o f t h e Study 7 D e f i n i t i o m o f Terms 7 N u l l H y p o t h e s i s 8 L i m i t a t i o n s o f t h e Study 8 Overview o f t h e Methodology 9 Overview o f Remaining C h a p t e r s 11 CHAPTER I I - SELECTED REVIEW OF THE LITERATURE . . . . 12 I n t r o d u c t i o n 12 COMMUNICATION PROCESS IN GENERAL 12 We L i v e i n Two Worlds 13 Some D e f i n i t i o n s o f Communication 13 The T e c h n i c a l P r o c e s s o f Communication 15 Communication System and Human L i m i t a t i o n s . . . . 16 Human P r o c e s s o f Communication 17 Types o f t h e P e r s o n - C e n t e r e d Communicative P r o c e s s 18 The V i t a l P r o c e s s o f Communication 19 v Page PROCESS OF PERCEPTION 21 Some D e f i n i t i o n s of the P e r c e p t u a l P r o c e s s 21 We Connect t h e Two Worlds We L i v e i n 2 3 S e l f - C o n c e p t , P e r c e p t i o n and Communication 23 P h y s i o l o g i c a l A s p e c t of the P e r c e p t u a l P r o c e s s . . . 25 I n t e r p r e t a t i o n by P e r c e p t i o n 29 PATTERNS OF COMMUNICATION IN THE HOSPITAL SYSTEM . . . 32 Bu r e a u c r a c y and Communication 32 Bu r e a u c r a c y and P e r c e p t i o n 34 Communication, C o o r d i n a t i o n and N u r s i n g 3 6 Communication as a T h e r a p e u t i c T o o l i n t h e H o s p i t a l System 37 Why the A c t o f Communication and P e r c e p t i o n F a i l s i n an O r g a n i z a t i o n 39 How t o O b t a i n and S u s t a i n E f f e c t i v e Communication f o r A c c u r a t e P e r c e p t i o n and E f f i c i e n t H o s p i t a l F u n c t i o n i n g . . . . 42 E f f e c t s o f Communication on P a t i e n t W e l f a r e and L e v e l o f Care 48 Summary 52 CHAPTER I I I - METHODOLOGY 54 I n t r o d u c t i o n 54 The S e t t i n g 5 4 The P o p u l a t i o n 5 4 PART A - The Q u e s t i o n n a i r e 5 5 The P r e t e s t 5 6 Data C o l l e c t i o n P r o c e d u r e 5 7 v i -Page .PART B - Data f o r Observed O b j e c t i v e Communication. . . 58 B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s 59 Method o f A d o p t i n g M c g i l l ' s Data f o r t h e P r e s e n t Study 61 Methodology o f Observed O b j e c t i v e Communication. . . 62 Type o f Data R e s u l t i n g 62 The A n a l y s i s Used t o T e s t t h e H y p o t h e s i s 63 CHAPTER IV - ANALYSIS OF THE DATA 64 A n a l y s i s o f P a r t A and B o f t h e Study 66 PART A - A n a l y s i s o f Comparison o f P e r c e i v e d Communication E f f e c t i v e n e s s Between N u r s i n g and A l l Other C a t e g o r i e s o f H o s p i t a l S t a f f and Between A l l Other C a t e g o r i e s o f H o s p i t a l S t a f f and N u r s i n g 66 PART B - A n a l y s i s o f Comparison o f P e r c e i v e d Communication E f f e c t i v e n e s s ( I n t e r -s t a f f Communication Q u e s t i o n n a i r e ) and Observed Communication E f f e c t i v e -ness ( B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s 77 A d d i t i o n a l Comments on P a r t B 91 Summary 91 CHAPTER V - SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS . . 92 SUMMARY 92 CONCLUSIONS 93 RECOMMENDATIONS 94 v i i Page BIBLIOGRAPHY 97 APPENDICES A. (a) Letter of Introduction presented to s t a f f members 105 (b) Information and General Instructions for completion of Int e r s t a f f Communication Questionnaire 106 (c) I n t e r s t a f f Communication Questionnaire . . . . 107 B. Absolute frequency count of Responses of the Self-Assessed Perception of Communication Effectiveness between Nursing and Non-Nursing Personnel on the Int e r s t a f f Communication Questionnaire, Questions 1 to 8 112 C. Relative frequency count of Responses (in per ceritages) of the Self-Assessed Perception of Communication Effectiveness between Nursing and Non-Nursing Personnel on the Int e r s t a f f Communication Questionnaire, Questions 1 to 8 121 D. Grouped absolute frequency d i s t r i b u t i o n of Responses showing Perceived Subjective Effectiveness of Communication between Nursing and Non-Nursing Personnel 130 E. Grouped r e l a t i v e frequency d i s t r i b u t i o n of Responses (in percentages) showing Perceived Subjective Effectiveness of Communication between Nursing and Non-Nursing Personnel . . 139 v i i i -Page F. A b s o l u t e f r e q u e n c i e s o f P e r c e i v e d O b j e c t i v e Data O b t a i n e d by the e i g h t h q u e s t i o n o f t h e I n t e r s t a f f Communication Q u e s t i o n n a i r e . . 148 G. A b s o l u t e f r e q u e n c i e s o f the Observed O b j e c t i v e Data O b t a i n e d u s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s 150 H. R e l a t i v e f r e q u e n c i e s o f P e r c e i v e d S u b j e c t i v e Data ( i n p e r c e n t a g e s j O b t a i n e d by t h e e i g h t h q u e s t i o n o f t h e I n t e r s t a f f Communication Q u e s t i o n n a i r e 152 I . R e l a t i v e f r e q u e n c i e s o f t h e Observed O b j e c t i v e Data ( i n p e r c e n t a g e s ) O b t a i n e d u s i n g 'Bales' I n t e r a c t i o n P r o c e s s A n a l y s i s 154 i x LIST OF FIGURES Figure Page 1. Bales' System of Categories Used i n Observation and t h e i r Major Relations 60 2. Bales' System Matched with L i k e r t Scale of the Questionnaire 61 3. Comparison of Self-perception of Communication Effectiveness: Nursing to Non-nursing Personnel and Non-nursing to Nursing Personnel on Question 1 68 4. Comparison of Self-perception of Communication Effectiveness: Nursing to Non-nursing Personnel and Non-nursing to Nursing Personnel on Question 2 69 5. Comparison of Self-perception of Communication Effectiveness: Nursing to Non-nursing Personnel and Non-nursing to Nursing Personnel on Question 3 70 6. Comparison of Self-perception of Communication Effectiveness: Nursing to Non-nursing Personnel and Non-nursing to Nursing Personnel on Question 4 71 7. Comparison of Self-perception of Communication Effectiveness: Nursing to Non-nursing Personnel and Non-nursing to Nursing Personnel on Question 5 72 8. Comparison of Self-perception of Communication Effectiveness: Nursing to Non-nursing Personnel and Non-nursing to Nursing Personnel on Question 6 73 9. Comparison of Self-perception of Communication Effectiveness: Nursing to Non-nursing Personnel and Non-nursing to Nursing Personnel on Question 7 74 10. Comparison of Self-perception of Communication Effectiveness: Nursing to Non-nursing Personnel and Non-nursing to Nursing Personnel on Question 8 75 x F i g u r e Page 11. Comparison o f D i e t a r y S t a f f ' s S e l f - p e r c e p t i o n U s i n g I n t e r s t a f f Communication Q u e s t i o n n a i r e and Observed Communication U s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s 79 12. Comparison o f Housekeeping s t a f f ' s s e l f - p e r c e p t i o n U s i n g I n t e r s t a f f Communication Q u e s t i o n n a i r e and Observed Communication U s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s 8 0 13. Comparison o f M e d i c a l Records S t a f f ' s S e l f -p e r c e p t i o n U s i n g I n t e r s t a f f Communication Q u e s t i o n n a i r e and Observed Communication U s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . . 81 14. Comparison o f N u r s i n g S t a f f ' s S e l f - p e r c e p t i o n U s i n g I n t e r s t a f f Communication Q u e s t i o n n a i r e and Observed Communication U s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s 82 15. Comparison o f Ward C l e r k S t a f f ' s S e l f - p e r c e p t i o n U s i n g I n t e r s t a f f Communication Q u e s t i o n n a i r e and Observed Communication U s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . . 83 16. Comparison o f O c c u p a t i o n a l Therapy S t a f f ' s S e l f -p e r c e p t i o n U s i n g I n t e r s t a f f Communication Q u e s t i o n n a i r e and Observed Communication U s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . . 84 17. Comparison o f Pharmacy S t a f f ' s S e l f - p e r c e p t i o n U s i n g I n t e r s t a f f Communication Q u e s t i o n n a i r e and Observed Communication U s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s 85 18. Comparison o f P h y s i c a l Therapy S t a f f ' s S e l f -p e r c e p t i o n U s i n g I n t e r s t a f f Communication Q u e s t i o n n a i r e and Observed Communication U s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . . 8 6 19, Comparison o f P h y s i c i a n s S t a f f ' s S e l f - p e r c e p t i o n U s i n g I n t e r s t a f f Communication Q u e s t i o n n a i r e and Observed Communication U s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s 87 x i F i g u r e Page 20. Comparison o f P o r t e r s ' S t a f f ' s S e l f - p e r c e p t i o n U s i n g I n t e r s t a f f Communication Q u e s t i o n n a i r e and Observed Communication U s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . . . . . . . . . 88 21. Comparison o f S o c i a l S e r v i c e S t a f f ' s S e l f -p e r c e p t i o n U s i n g I n t e r s t a f f Communication Q u e s t i o n n a i r e and Observed Communication U s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . . 89 x i i 1 CHAPTER I INTRODUCTION TO THE STUDY Communication i s becoming i n c r e a s i n g l y i m p o r t a n t i n the h o s p i t a l system w i t h i n c r e a s e d p r o f e s s i o n a l s p e c i a l i z a t i o n a t a l l l e v e l s . Each s p e c i a l t y i n t r o d u c e s new methods, o r i e n t a -t i o n and t e r m i n o l o g y . C o n s e q u e n t l y , i n d i v i d u a l p e r c e p t i o n s about t h e e f f e c t i v e n e s s o f communication w i t h o t h e r s i n t h e h o s p i t a l system are h i g h e r than t h e a c t u a l u n d e r s t a n d i n g o f the i n f o r m a t i o n exchanged. The h o s p i t a l f u n c t i o n s f o r t h e c a r e o f the p a t i e n t s . In t h i s system the nurse i s the c e n t r a l l a i s o n t o communicate the needs o f her p a t i e n t s t o o t h e r p e r s o n n e l . Thus t h i s com-m u n i c a t i o n becomes o f utmost d i r e c t i mportance t o p a t i e n t c a r e . F u r t h e r m o r e , poor communication a t any l e v e l has d i r e c t n e g a t i v e r e p e r c u s s i o n s on p a t i e n t c a r e . Communication i s a l s o v i t a l t o p e o p l e s i n c e i t i s a means o f o b t a i n i n g s o c i a l s a t i s f a c t i o n w h i l e c a r r y i n g o u t j o b expec-t a t i o n s e f f e c t i v e l y . The communication p r o c e s s i s t h e b a s i s f o r m o t i v a t i n g and i n f l u e n c i n g p e o p l e thus s a t i s f y i n g b o t h human and i n s t i t u t i o n a l needs. Kron d e s c r i b e s t h e f o r m a l f l o w o f communication t h r o u g h the h o s p i t a l h i e r a r c h y as moving i n b o t h v e r t i c a l and h o r i z o n t a l d i r e c t i o n s . " ' " Downward communication t i e s t he d i f f e r e n t l e v e l s o f t h e o r g a n i z a t i o n t o g e t h e r as i t conveys i n f o r m a t i o n , o b j e c t i v e s , Thora Kron, Communication i n N u r s i n g (Toronto: W. B. Saunders Co., 1972), pp. 47-49. 2 p o l i c i e s , procedures, and d i r e c t i v e s from the top to the person next and down the l i n e . Upward communication keeps the superior person informed about the a c t i v i t i e s of the subordinates. The free flow of upward communication i s important to s a t i s f y the natural desire of the employees to pa r t i c i p a t e and to express ideas. Lack of e f f e c t i v e upward communication leads to em-ployees' f r u s t r a t i o n and loss of s i g n i f i c a n t information. Hori-zontal communication occurs between departments and i s ess e n t i a l for e f f i c i e n t functioning and e f f e c t i v e coordination of the organization as a whole. The knowledge explosion i n medical science and techno-logy has further increased the need for good communication, and caused the process to be examined i n numerous studies i n general. Yet, studies i n p a r t i c u l a r about the functions, qual i t y , quantity, and significance of communication i n the hospital system are rare. I t has been stated by many authors writing on hospital communi-9 3 4 5 cation (Wall^, Skipper and Leonard , Greben , Feldman ) that the greatest number of weak lin k s i n the chain of patient care stems from poor communication. A second problem evolves from trouble-some personal feelings among the occupational groups i n the ^S i s t e r Clare Dolores Wall, "How to Bridge the Communi-cation Gap," Hospital Progress, (April , 1973), p. 30. 3 James K. Skipper and Robert C. Leonard, Social Inter- action and Patient Care (Toronto: J. B. Lippincott Co., 1965), p. 51. 4 S. E. Greben and others, "Patient Care Conferences Means Communication," Dimensions i n Health Service ( A p r i l , 1975), p. 45. 5 Saul Feldman, "Mental Health Under the Umbrella," Hospi- t a l and Community Psychiatry, Vol. 27, No. 1, (January, 1976), p. 25. 3. - h o s p i t a l i n r e l a t i o n t o one a n o t h e r . A c o l l e c t i o n o f p r o f e s -s i o n a l s coming t o g e t h e r does n o t mean t h a t t h e y w i l l be a b l e t o work t o g e t h e r c o - o p e r a t i v e l y and s u p p o r t i v e l y . P r o f e s s i o n a l j e a l o u s y o f t e n d e v e l o p s r e s u l t i n g i n poor communication and f r u s t r a t i o n . P a t i e n t c a r e s u f f e r s , and as a r e s u l t , p a t i e n t s become u n d e r s t a n d a b l y s k e p t i c a l about m e d i c a l advancement. P e r c e p t i o n has a v e r y s i g n i f i c a n t r o l e i n communication. S i n c e p e r c e p t i o n i s a h i g h l y s u b j e c t i v e s t a t e o f a f f a i r s , i t o f t e n causes communication t o be d i s t o r t e d . C o n s e q u e n t l y , th e p r o c e s s o f b r i n g i n g t o g e t h e r t h e e f f o r t s o f groups o f p e o p l e i n a h o s p i t a l system t o a c h i e v e one u n i f i e d r e s u l t i s a d i f f i c u l t one, s i n c e each department w i l l s t r e s s i t s own o p i n i o n and i n - , t e r e s t i n what t h e y see as t h e b e s t p o s s i b l e p a t i e n t c a r e and how i t i s t o be a t t a i n e d . Each department f a v o r s one way o v er the o t h e r depending on t h e i r p a r t i c u l a r f u n c t i o n and e x p e r i e n c e . Thus, due t o p e r c e p t u a l d i f f e r e n c e s departments d e v e l o p d i f f e r i n g v i e w p o i n t s about q u a l i t y p a t i e n t c a r e . The d i v e r g e n t o p i n i o n s on t h i s c r i t i c a l s u b j e c t f r e q u e n t l y reduce the q u a l i t y o f p a t i e n t c a r e . I t has been r e c o g n i z e d t h a t e f f e c t i v e i n t r a d e p a r t m e n t a l communication r e s u l t s i n improved f u n c t i o n i n g o f d i f f e r e n t groups 7 and improved s e l f esteem of s t a f f . C o n s e q u e n t l y , a more complete approach t o t h e p a t i e n t and h i s f a m i l y i s a c h i e v e d . The c o o r d i n a -A l b e r t H. H a s t o r f , D. S c h n e i d e r , and J . P o l e f k a , P e r s o n  P e r c e p t i o n (Don M i l l s , O n t a r i o : Addison-Wesley P u b l i s h i n g Co., 1970), pp. 93-96. 7 G e r t r u d e M. Brown and C. A. Robert "A Group Approach t o P a t i e n t Care," Dimensions i n H e a l t h S e r v i c e , ( F e b r u a r y , 1974), p. 37. n a t i o n o f s e r v i c e s o f groups above, below, and l a t e r a l t o each de-partment r e q u i r e s t h o u g h t f u l n e s s , c o - o p e r a t i v e a t t i t u d e s , s e l f -a d j u s t m e n t and u n d e r s t a n d i n g . These can be g r e a t l y a i d e d by e f f e c t i v e communication. Problem Statement In the h o s p i t a l system communication t r a n s m i t t e d by the sender may not be p e r c e i v e d i n t h e same manner by the r e c e i v e r , he q u e s t i o n was r e v i s e d whether o r not t h e r e i s a s i g n i f i c a n t d i f -f e r e n c e between h o s p i t a l p e r s o n n e l ' s p e r c e i v e d s u b j e c t i v e and ob-s e r v e d o b j e c t i v e communication e f f e c t i v e n e s s . Purpose o f the Study The purpose of the p r e s e n t s t u d y was t o compare the p e r c e i v e d s u b j e c t i v e communication e f f e c t i v e n e s s o f h o s p i t a l p e r -s o n n e l o f v a r i o u s c a t e g o r i e s , o b t a i n e d by an I n t e r s t a f f communi-c a t i o n u e s t i o n n a i r e , w i t h the o b s e r v e d o b j e c t i v e communication e f f e c t i v e n e s s , as measured u s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . O f t e n a n u r s e p e r c e i v e s h e r s e l f as a good communicator but she i s p e r c e i v e d by o t h e r h o s p i t a l p e r s o n n e l as communicating p o o r l y , and as f a i l i n g t o t r a n s m i t i n f o r m a t i o n m e a n i n g f u l l y . Due t o m i s u n d e r s t a n d i n g s f e e l i n g s a r e h u r t , c o - o p e r a t i o n c e a s e s and p a t i e n t c a r e s u f f e r s . The q u a l i t y o f p a t i e n t c a r e o f t e n depends on e f f e c t i v e i n t e r - p r o f e s s i o n a l communication and u n d e r s t a n d i n g . I t has become i n c r e a s i n g l y r e c o g n i z e d i n the l i t e r a t u r e t h a t p r e s e n t communication p r a c t i c e s among the d i f f e r e n t c a t e g o r i e s o f h o s p i t a l s t a f f are n o t c o m p l e t e l y f u n c t i o n a l . Because o f the l a r g e number of p e r s o n n e l i n v o l v e d w i t h the p a t i e n t c a r e , c a r e becomes fragmented. E f f e c t i v e communication i s seen as one o f the methods f a c i l i t a t i n g the i n t e g -r a t i o n o f p a t i e n t c a r e as i t e n a b l e s the c o o r d i n a t i o n o f a c t i v i t i e s . 5 An i n d i v i d u a l ' s p e r c e p t i o n o f p e r s o n a l e f f e c t i v e n e s s i n communication between h e a l t h team members i n f l u e n c e s t h e a c t u a l communication p r o c e s s . O f t e n t h e i n d i v i d u a l s ' p e r s o n a l i d e a o f one '.s a b i l i t y t o communicate d i f f e r s from a c t u a l a b i l i t y . T h i s o i s e v i d e n c e d i n S t e i n ' s d e s c r i p t i o n o f the "Doctor-Nurse Game." The o b j e c t o f the game i s t o a v o i d open disa g r e e m e n t among n u r s e s and d o c t o r s a t a l l c o s t . T h e r e f o r e the nurse must communicate t o the d o c t o r her recommendations r e g a r d i n g p a t i e n t c a r e w i t h o u t making i t appear t h a t he has asked f o r them. P r a c t i c e s such as t h e s e g i v e i n d i v i d u a l s f a l s e p e r c e p t i o n s o f t h e i r communication a b i l i t y . Awareness of poor communication p a t t e r n s i s a b e g i n -n i n g f o r c o r r e c t i n g the s i t u a t i o n . R e l evance o f the Study t o N u r s i n g The h o s p i t a l cannot o p e r a t e e f f e c t i v e l y w i t h o u t adequate communication. The e f f o r t s and s k i l l s o f the o r g a n i z a t i o n a l members from the d i f f e r e n t s p e c i a l i z e d , but i n t e r d e p e n d e n t , departments w h i c h make up t h e h o s p i t a l work f o r c e must be c o -o r d i n a t e d i f t h e system i s t o f u n c t i o n as a u n i f i e d whole and a c c o m p l i s h i t s o b j e c t i v e s . B a s i c t o t h i s e f f e c t i v e c o o r d i n a t i o n i s e f f e c t i v e communication. The nurse becomes c e n t r a l t o t h i s communication as she monitors, p a t i e n t c a r e 24 hours a day. C o n f i r m a t i o n o f t h e key r o l e o f t h e nurse i n r e l a t i o n t o p a t i e n t 9 c a r e i s s u p p l i e d by the f i n d i n g s o f Georgopoulos and Mann. T h e i r s t u d y i n d i c a t e s t h a t the q u a l i t y o f p a t i e n t c a r e i s r e l a t e d Leonard S t e i n , "The D o c t o r - N u r s e Game," A r c h i v e s o f  G e n e r a l P s y c h i a t r y , V o l . 16, (1967), p. 699. 9 B a s i l S. Georgopoulos and F l o y d C. Mann, The Community  G e n e r a l H o s p i t a l (New York: The M a c M i l l a n Co., 1962), p. 344. 6 t o t h e N u r s i n g Department . s k i l l s i n c o o r d i n a t i n g , w h i c h i n t u r n r e s t s on communication between t h e v a r i o u s l e v e l s and between nurse p e e r s . Lysaught p o i n t e d o u t t h a t advances i n t e c h n o l o g y w i l l have an e f f e c t on the r o l e s and f u n c t i o n s o f n u r s e s . I n 1970 he proposed t h a t the nurse i n her unique r o l e w i l l occupy a c r u c i a l p o s i t i o n as she w i l l be the one t o ensure t h a t communi-c a t i o n s between h e a l t h p r o f e s s i o n a l s a r e u n d e r s t o o d and c a r r i e d o u t . I n 1972 Kron wrote t h a t i n the N u r s i n g Department the p r o f e s s i o n a l nurse must be p a r t i c u l a r l y concerned about her r o l e i n e f f e c t i v e communication. She i s i n v o l v e d w i t h many p e o p l e b e s i d e s p a t i e n t s , such a s , p a t i e n t s ' r e l a t i v e s , f r i e n d s , o t h e r h o s p i t a l p e r s o n n e l , and the o t h e r n u r s i n g s t a f f i n her a r e a o f f u n c t i o n i n g . E q u a l l y i m p o r t a n t t o p a t i e n t c a r e i s what and how the L i c e n s e d P r a c t i c a l Nurse o r the Nurse's A i d e communicates t o t h e s e same p e o p l e . The a t t a i n m e n t o f q u a l i t y p a t i e n t c a r e w i t h a minimum o f s t r a i n depends not o n l y on mutual u n d e r s t a n d i n g w i t h i n the n u r s i n g s t a f f p o s i t i o n s , but a l s o communication between n u r s i n g and o t h e r d e partments. Thus the a b i l i t y o f t h e n u r s i n g s t a f f t o p r o v i d e e x c e l l e n t c a r e t o t h e p a t i e n t depends upon n u r s i n g competence and a l s o upon a network of r e l a t i o n s h i p s among n u r s e s a t many l e v e l s and between n u r s e s and o t h e r d e p artments. Such r e l a t i o n -1 0 J e r o m e P. L y s a u g h t , An A b s t r a c t f o r A c t i o n (Toronto: M c G r a w - H i l l Co., 1970), p. 98. "'""''Kron, op. c i t . , p. 44. 7 • s h i p s form a common base f o r s h a r i n g o f e x p e c t a t i o n s and work a c t i v i t i e s i n the d a i l y o p e r a t i o n s o f the h o s p i t a l . E f f e c t i v e communication among a l l groups o f a h o s p i t a l work f o r c e w i l l f a c i l i t a t e t h e development o f a common base upon w h i c h t o b u i l d . T h i s base o f u n d e r s t a n d i n g o f g o a l s and o b j e c t i v e s w i l l i n t u r n f o s t e r a h i g h l e v e l o f n u r s i n g c a r e . Assumptions o f t h e Study The assumptions o f t h i s s t u d y were: 1. S t a f f c a t e g o r i e s communicate as a group t o o t h e r s t a f f c a t e g o r i e s w i t h i n d i v i d u a l d i f f e r e n c e s absorbed t o a g r e a t e x t e n t i n t o a group s t e r e o t y p e . 2. Each s t a f f c a t e g o r y w i l l t e n d t o sh a r e c o n s i s t e n t p e r s o n a l p e r c e p t i o n s and o b s e r v a b l e b e h a v i o r . D e f i n i t i o n o f Terms Communication: F a c e - t o - f a c e v e r b a l and o v e r t n o n v e r b a l t r a n s m i s s i o n o f i n f o r m a t i o n from one pe r s o n t o a n o t h e r . E f f e c t i v e Communication: A message s e n t and r e c e i v e d w h i c h has components o f (a) u n d e r s t a n d i n g , (b) w o r t h , and (c) s e l f - e s t e e m . H o s p i t a l S t a f f C a t e g o r y : Any group o f p e r s o n n e l who f u n c t i o n i n a s p e c i a l i z e d manner t o meet needs o f the H o s p i t a l System. H o s p i t a l System: A management system i n c l u d i n g a l l h o s p i t a l c a t e g o r i e s whose combined f u n c t i o n i s t o meet p a t i e n t s ' needs. N u r s i n g P e r s o n n e l : I s d e f i n e d f o r t h i s s t u d y as 8 A s s i s t a n t D i r e c t o r o f N u r s i n g o r S u p e r v i s o r , C e r t i f i e d N u r s i n g A s s i s t a n t , I n - S e r v i c e E d u c a t i o n , Nurse A t t e n d a n t , R e g i s t e r e d N u rse, and Ward C l e r k . Non-Nursing P e r s o n n e l : I s d e f i n e d f o r t h i s s t u d y as D i e t a r y , Housekeeping, M e d i c a l R e c o r d s , O c c u p a t i o n a l Therapy, Pharmacy, P h y s i c a l Therapy, M e d i c i n e , P o r t e r i n g , and S o c i a l S e r v i c e . Observed O b j e c t i v e Communication: Data o b t a i n e d on observed communication a c t s as measured u s i n g B a l e s ' I n t e r -a c t i o n P r o c e s s A n a l y s i s . P e r c e i v e d S u b j e c t i v e Communication: Data o b t a i n e d by s e l f - r e p o r t s as r e s p o n s e s t o an I n t e r s t a f f Communication Ques-t i o n n a i r e . P e r c e p t i o n : S e l f - e x p e r i e n c e d and s e l f - d e r i v e d i n t e r n a l f e e l i n g s and meanings from and about t h e w o r l d o u t s i d e of o u r -s e l v e s . N u l l H y p o t h e s i s There i s no s i g n i f i c a n t d i f f e r e n c e between h o s p i t a l p e r s o n n e l ' s s e l f r a t i n g s o f t h e i r communication e f f e c t i v e n e s s as measured by means o f an I n t e r s t a f f Communication Q u e s t i o n -n a i r e , and t h e i r o b s e r v e d communication a c t s c o r e s w h i c h were o b t a i n e d t h r o u g h B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . L i m i t a t i o n s o f t h e Study 1. The s t u d y was conducted i n o n l y one h o s p i t a l . How-e v e r , the employee c a t e g o r i e s s t u d i e d a r e r e p r e s e n t a t i v e o f a l l g e n e r a l h o s p i t a l s . Thus a c e r t a i n degree o f g e n e r a l i z a t i o n may be p o s s i b l e . 9 2. The s t a f f were grouped i n t o c a t e g o r i e s r a t h e r t h a n a t t e m p t i n g t o s t u d y i n d i v i d u a l s t r e n g t h s and l i m i t a t i o n s . T h i s method was c o n s i d e r e d u s e f u l i n d e t e r m i n i n g d i f f e r e n c e s between p e r c e i v e d and a c t u a l communication r a t h e r t h a n e x a g g e r a t i n g i n d i v i d u a l g r i e v a n c e s o r problems. 3. A p e r s o n a l p e r c e p t i o n communication q u e s t i o n n a i r e was r e p l i e d t o by a l l p e r s o n n e l i n v o l v e d , whereas t h e o b s e r v a -t i o n s o f communication b e h a v i o r t h r o u g h B a l e s ' I n t e r a c t i o n P r o -c e s s a n a l y s i s were o b t a i n e d by random s a m p l i n g . 4. The independent v a r i a b l e " P e r s o n a l P e r c e p t i o n o f Communication" i s a t t i t u d i n a l and thus i s d i f f i c u l t t o t e s t by any o b j e c t i v e means. 5. P r o t e c t i o n o f i n d i v i d u a l r e s p ondent anonymity p r e -v e n t e d m atching s u b j e c t s ' s p e c i f i c o b s e r v e d communication b e h a v i o r w i t h t h e i r own p e r c e p t i o n s o f t h e i r communication b e h a v i o r . 6. I n o r d e r t o compare B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s w i t h the I n t e r s t a f f Communication Q u e s t i o n n a i r e i t was n e c e s s a r y t o c o l l a p s e B a l e s ' 12 c a t e g o r i e s t o 5. The 12 B a l e s ' c a t e g o r i e s were grouped t o c o r r e s p o n d w i t h t h e 5 I n t e r s t a f f Communication Q u e s t i o n n a i r e c a t e g o r i e s . Overview o f the Methodology The p r e s e n t s t u d y was conducted i n a 230 bed r e h a b i l -i t a t i o n h o s p i t a l i n a P r a i r i e P r o v i n c e . A l l t h e n u r s i n g and s u p e r v i s o r y s t a f f on two s e l e c t e d h o s p i t a l u n i t s p a r t i c i p a t e d i n t h e s t u d y . A l l o t h e r h o s p i t a l s t a f f p e r s o n n e l i n d i c a t e d i n c a t e g o r i e s o t h e r t h a n n u r s i n g were a l s o i n c l u d e d i n t h e s t u d y . 10 The s t u d y was e x p l o r a t o r y i n d e s i g n . A p r o f i l e was dev e l o p e d o f communication e f f e c t i v e n e s s as p e r c e i v e d by the i n d i v i d u a l s c o m p r i s i n g each s t a f f c a t e g o r y . Comparison o f th e s e p r o f i l e s was made between v a r i o u s c a t e g o r i e s o f h o s p i t a l p e r s o n n e l . These c o m p a r a t i v e d e s c r i p t i v e d a t a d i s c l o s e d t o the r e s e a r c h e r t h e p e r c e i v e d e f f e c t i v e n e s s o f communication between groups. Communication e f f e c t i v e n e s s was s t u d i e d from a s t r a t i -f i e d sample t a k e n from a h o s p i t a l system. Each p a r t i c i p a n t completed a q u e s t i o n n a i r e w h i c h s u b j e c t i v e l y measured how th e y p e r s o n a l l y p e r c e i v e d t h e i r a b i l i t y t o communicate w i t h o t h e r s . S i m i l a r l y each p a r t i c i p a n t was ob s e r v e d and e v a l u a t e d on B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s t o o b j e c t i v e l y measure t h e i r a c t u a l performance when communicating w i t h o t h e r s . The q u e s t i o n n a i r e o b t a i n e d i n f o r m a t i o n r e g a r d i n g t h e independent v a r i a b l e - t h a t i s the s u b j e c t i v e p e r c e p t i o n o f how peo p l e see them s e l v e s and f e e l about t h e i r a b i l i t i e s t o communi-c a t e . The B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s p r o v i d e d a method of a n a l y s i n g t h e dependent v a r i a b l e w h i c h i s t h e o b s e r v a b l e o b j e c t i v e human b e h a v i o r o f t h e p a r t i c i p a n t s as t h e y communi-c a t e d w i t h o t h e r s . The independent v a r i a b l e f o r s p e c i f i c h o s p i t a l s t a f f c a t e g o r i e s o f how p e o p l e p e r c e i v e and f e e l about o b s e r v e d b e h a v i o r was compared w i t h t h e i r group's p e r c e p t i o n o f t h e i r communication b e h a v i o r . The f i n d i n g s were a n a l y s e d t o d e t e r m i n e t h e degree o f congruence between the s u b j e c t i v e and t h e o b j e c t i v e measures o f communication u t i l i z e d t o e v a l u a t e the e f f e c t i v e n e s s o f t h e 11 i n t r a - d e p a r t m e n t a l communication o c c u r r i n g on t h e two s t u d y u n i t s . S t a t i s t i c a l a n a l y s i s was employed t o compare the sub-j e c t s ' o b s e r v e d and p e r c e i v e d communication. Overview of Remaining C h a p t e r s C h a p t e r I I w i l l d e a l w i t h a s e l e c t e d r e v i e w o f t h e l i t e r a t u r e i n c l u d i n g the b a s i c communication p r o c e s s , p r o c e s s o f p e r c e p t i o n , p a t t e r n s o f communication w i t h the h o s p i t a l system, and e f f e c t s o f communication on p a t i e n t w e l f a r e and l e v e l o f c a r e . I n C h a p t e r I I I methodology o f t h e s t u d y w i l l be o u t -l i n e d . C h a p t e r IV w i l l p r e s e n t the a n a l y s i s o f d a t a and r e p o r t s i g n i f i c a n t f i n d i n g s . Summary, c o n c l u s i o n s and recommendations f o r f u r t h e r s t u d y w i l l be c o n c l u d e d i n C hapter V. 12 CHAPTER I I SELECTED REVIEW OF THE LITERATURE I n t r o d u c t i o n I n r e v i e w i n g the l i t e r a t u r e i t was noted t h a t t h e r e was an abundance o f r e s e a r c h r e l a t e d t o the t o p i c o f communi-c a t i o n and p e r c e p t i o n . D i r e c t l y r e l e v a n t s o u r c e s have been s e l e c t e d t o i l l u s t r a t e communication as p e r c e i v e d i n t h e h o s p i t a l s e t t i n g . F o r t h e purposes o f t h i s s t u d y i t was de-c i d e d t o f o c u s on the communication p r o c e s s i n g e n e r a l , p r o c e s s o f p e r c e p t i o n , p a t t e r n s o f communication w i t h i n the h o s p i t a l system, and e f f e c t s o f communication on p a t i e n t w e l f a r e and l e v e l o f c a r e . COMMUNICATION PROCESS IN GENERAL A l t h o u g h communication has been r e c o g n i z e d as one o f the most complex human p r o c e s s e s i t was not u n t i l 1948 t h a t the f i r s t e x p e r i m e n t s d e a l i n g w i t h human exchange o f i n f o r m a -t i o n took p l a c e . 1 " The r e v i e w o f t h e l i t e r a t u r e i n d i c a t e s t h a t 2 man has an i n b o r n need t o communicate. John P a r r y , The P s y c h o l o g y o f Human Communication (New York: American E l s e v i e r P u b l i s h i n g Company, 19 6 8 ) , p. 15. J . Reusch and G. B a t e s o n , Communication: The S o c i a l  M a t r i x o f P s y c h i a t r y (New York: N o r t o n , 1951), p. 314. He e x p r e s s e s h i m s e l f f o r h i m s e l f i n i n t r a p s y c h i c terms. The p l a c e he o c c u p i e s might be c a l l e d h i s t e r r i t o r i a l space. T h i s 3 he commands by v e r b a l and n o n - v e r b a l t y p e s of b e h a v i o r . We L i v e i n Two Worlds Research p o s t u l a t e s t h a t we l i v e i n two w o r l d s , namely an e m p i r i c a l ( r e a l i t y ) and a s y m b o l i c (language) w o r l d . The e m p i r i c a l w o r l d i s t h e w o r l d o f o b j e c t s , p e r s o n s , e v e n t s , and s i t u a t i o n s which we encount e r e x t e r n a l l y and e x p e r i e n c e i n t e r -n a l l y t h r o u g h our senses. Man's s y m b o l i c w o r l d i s t h e w o r l d of language w h i c h we use t o t r a n s l a t e and d e s c r i b e our sensa-t i o n s and f e e l i n g s about t h e e m p i r i c a l w o r l d we p e r c e i v e p e r -4 s o n a l l y t o the e m p i r i c a l w o r l d of o t h e r s . The i n t e r n a l p e r s o n a l i t y must always f u n c t i o n w i t h i n t h e g r e a t e r e x t e r n a l c u l t u r e and s o c i e t y , f o r c u l t u r e and s o c i e t y always precede an 5 i n d i v i d u a l . Some D e f i n i t i o n s o f Communication T h e o r i s t s and r e s e a r c h e r s have used the term "communi-c a t i o n " t o denote many d i f f e r e n t t h i n g s . Nord c l a i m s i n h i s i n f o r m a t i o n t h e o r y o f communication t h a t communication i s "the degree o f o v e r l a p between t h e message s e n t and t h e message J G a i l E. Myers and M i c h e l e T o l e t a Myers, The Dynamics  of Human Communication (Toronto: M c G r a w - H i l l Book C o . , 1 9 7 3 ) , p. 3. 4 I b i d . , p. 29. ~*P. W a t z l a w i c k , J . H. B e a v i n , and D. D. J a c k s o n , P r a g m a t i c s o f Human Communication (New York: W. W. N o r t o n & Co., I n c . , 1967), pp. 257-270. 14 r e c e i v e d . " Thayer equates communication w i t h t h i n k i n g . He f e e l s t h a t t h e two p r o c e s s e s a r e i n s e p a r a b l e , s t a t i n g ..."as a man t h i n k s , so does he communicate; as he communicates, so 7 must he t h i n k . " Shannon and Weaver d e s c r i b e t h e term com-m u n i c a t i o n i n t h e m a t h e m a t i c a l t h e o r y o f communication t o i n -g e l u d e a l l t h e p r o c e d u r e s by w h i c h one mind a f f e c t s a n o t h e r . Ruesch and B a t e s o n s u p p o r t Thayer's d e f i n i t i o n o f communication but add a f e e l i n g a s p e c t t o i t . They t h e o r i z e t h a t a p e r s o n ' s i n t e r n a l o r g a n i z a t i o n o f components, such as i d e a l s , images, f a n t a s i e s , o r s e n t i m e n t s , i s communication. I t i s e x p e r i e n c e d 9 by t h e i n d i v i d u a l n ot o n l y as t h i n k i n g b u t a l s o as f e e l i n g . The h e l p i n g p r o f e s s i o n s do not negate t h a t communi-c a t i o n i s the p r o c e s s o f p a s s i n g m e a n i n g f u l i n f o r m a t i o n from one p e r s o n t o a n o t h e r as acknowledged by Haimann"'"^ i n h i s w r i t i n g s on h o s p i t a l s u p e r v i s i o n . They do, however, make the d e f i n i t i o n even more e x p l i c i t by s a y i n g t h a t communication i s a b a s i c s o c i a l p r o c e s s by w h i c h p e o p l e exchange meanings and W a l t e r Nord, Concepts and C o n t r o v e r s y i n O r g a n i z a t i o n a l  B e h a v i o r ( C a l i f o r n i a : Goodyear P u b l i s h i n g Co., 1970), p. 364. 7 Lee O. Thayer, A d m i n i s t r a t i v e Communication (Homewood: I l l i n o i s : R i c h a r d D. I r w i n , I n c . , 1961), p. v i i i . Q C. A. Shannon and W. Weaver, The M a t h e m a t i c a l Theory  of Communication (Urbana: U n i v e r s i t y o f I l l i n o i s P r e s s , 1949), p. 117. q Ruesch and B a t e s o n , op. c i t . , p. 314. "^Theo Haimann, S u p e r v i s o r y Management f o r H e a l t h  I n s t i t u t i o n s ( S t . L o u i s , M i s s o u r i : The C a t h o l i c H o s p i t a l A s s o c i a t i o n / 1973), p. 39. v a l u e s among themselves."'""'" F o r r e s t r e c o n f i r m s t h i s by sug-g e s t i n g t h a t communication can a l s o be seen as an i n t e r p e r s o n a l r e l a t i o n s h i p . "*"^  The T e c h n i c a l P r o c e s s o f Communication Communication r e s e a r c h e r s have attempted t o u n d e r s t a n d , and t h e r e b y d e f i n e t h e communication p r o c e s s . C o n s e q u e n t l y , the communication p r o c e s s i s viewed by some i n v e s t i g a t o r s i n a r a t h e r m e c h a n i c a l way. Fabun d e s c r i b e s communication as a t r a n s a c t i o n . The p a r t s o f t h i s t r a n s a c t i o n a r e (a) something t a k e n i n , i . e . sound; (b) something t r a n s f o r m e d , i . e . sound waves a r e t r a n s f o r m e d i n t o c h e m i c a l - e l e c t r i c a l codes; (c) some-t h i n g r e t a i n e d , i . e . code f o r sound i s r e t a i n e d i n the memory bank of t h e b r a i n ; (d) something exchanged, i . e . sound code i s changed o r t r a n s f o r m e d i n t o muscle r e a c t i o n and (e) something t r a n s m i t t e d , i . e . movement o f t h e muscle i s t r a n s m i t t e d t o o t h e r s . T h i s p r o c e s s o f communication c o n s i s t s o f i n p u t , p r o -c e s s i n g , and o u t p u t . I t i s a c l o s e d c i r c u i t w i t h the elements of a sender, a message, and a receiver."*"^ R ichelman s t u d i e d n u r s e - p a t i e n t i n t e r a c t i o n by the above t y p e o f communication t h e o r y a n a l y z i n g t h e elements o f communi-c a t i o n t o i n c l u d e a sender, a r e c e i v e r , a message, as w e l l as "''"''Skipper and L e o n a r d , op. c i t . , p. 51. 1 2 E l l i o t t B. F o r r e s t , " P e r c e p t i o n and Human Communi-c a t i o n , " American J o u r n a l of Optometry and A r c h i v e s o f American  Academy of Optometry, (August, 1970), pp. 640-643. Don Fabun, Communications: The T r a n s f e r o f Meaning ( C a l i f o r n i a , B e v e r l y H i l l s : The Glencoe P r e s s , 1968), pp. 32-33 16 a c h a n n e l o f t r a n s m i s s i o n , and a response o r e f f e c t . S i m i l a r l y Grom r e f e r s t o the communication p r o c e s s as b e i n g made up of the communicator, the message, the medium, the 15 a u d i e n c e , and feedback. Approaches such as t h o s e noted above have a r e d u c t i o n i s t i c q u a l i t y i n which communication becomes a mechanized measurable q u a n t i t y . Haney p u r p o r t s t h a t t h e communication p r o c e s s model o f man c o n s i s t s o f a p r o b l e m - s o l v i n g sequence. He d e s c r i b e s t h e sequence as e n c o d i n g and d e c o d i n g w h i l e p e r c e i v i n g and formu-l a t i n g e n c o u n t e r e d e x p e r i e n c e s . He becomes v e r y g r a p h i c when d e s c r i b i n g a i r moving a i r . S p e a k i n g , i s t r a n s m i t t i n g a message by a i r v i b r a t i o n s r e p r e s e n t a t i v e o f words, t h o u g h t s , f e e l i n g s and i d e a s . These a i r v i b r a t i o n s t r a v e l l i n g t h r o u g h a i r even-t u a l l y become e l e c t r o c h e m i c a l - n e u r o l o g i c a l i m p u l s e s w h i c h a r e 16 decoded i n t o symbols w i t h meaning. To c a p t u r e t h e f e e l i n g s t h a t r e p r e s e n t t h e e x p e r i e n c e s , t h e y a r e s t o r e d as encoded sym-b o l i c memories. We can c o n c l u d e t h a t our memories a r e f e e l i n g s . Communication System and Human L i m i t a t i o n s The communication system o f a man i s l i m i t e d i n i t s c a p a c i t y . The o r g a n i s m i s a b l e t o h a n d l e incoming and o u t g o i n g Bonnie L. R i c h e l m a n , "A C o n c e p t u a l Approach t o N u r s e - P a t i e n t I n t e r a c t i o n , " N u r s i n g R e s e a r c h , V o l . 20, No. 5, (September-October, 1971), p. 398. 15 H e l l e n a Smejda Grom, " U n r a v e l l i n g the M y s t e r y o f t h e Communication P r o c e s s , " H o s p i t a l F i n a n c i a l Manager, (December, 1973), pp. 8-12. 16 W i l l i a m V. Haney, Communication and O r g a n i z a t i o n a l  B e h a v i o r (Georgetown, O n t a r i o : I r w i n - D o r s e y L i m i t e d , 1973), pp. 179-195. 17 messages ( s i g n a l s , s i g n s , o r symbols) on the b a s i s o f man's a n a t o m i c a l and p h y s i o l o g i c a l make-up and h i s a c q u i r e d s k i l l s . The communication system o f a man w i l l d i s i n t e g r a t e i f i t i s tax e d beyond i t s t h r e s h o l d and i t w i l l a t r o p h y i f i t i s not employed."*"7 A t b e s t the c o m m u n i c a t o r - t r a n s m i t t e r can o n l y attempt t o r e p r e s e n t h i s f e e l i n g s and i d e a s w i t h symbols, words o r 18 a c t s . March and Simon r e p o r t t h a t a man as "a c h o o s i n g , d e c i s i o n - m a k i n g , problem s o l v i n g o r g a n i s m can do o n l y one or 19 a few t h i n g s a t a t i m e . " Thus we choose and d e c i d e what we e x p e r i e n c e o r encode from the environment. F o r example, Haney's i n f o r m a t i o n t h e o r y r e v e a l s t h a t a l t h o u g h the eye can e x t r a c t 5 m i l l i o n p i e c e s o f i n f o r m a t i o n per second, the human b r a i n can 2 0 d e c i p h e r o n l y 500 o f them. C o n s e q u e n t l y the s e l e c t i o n o f i n f o r m a t i o n i s u n a v o i d a b l e . T h i s i n t r o d u c e s t h e human a s p e c t o f communication as c o m p l e t e l y d i v o r c e d from any m e c h a n i s t i c e x p l a n a t i o n . Human P r o c e s s o f Communication A l t h o u g h t h e communication p r o c e s s i s a h i g h l y complex e n t i t y i t i s n o t a m e c h a n i c a l t h i n g but a pe r s o n c e n t e r e d p r o -21 cess as Rogers s t a t e s . F o r r e s t d i s t i n g u i s h e s t h a t the most 1 7 J . Ruesch, D i s t u r b e d Communication (New York: N o r t o n , 1957), p. 337. 18 Haney, op. c i t . , p. 181. 1 9 J . G. March and H. A. Simon, O r g a n i z a t i o n s (New York: John W i l e y & Sons, I n c . , 1958), p. 11. 2 0 Haney, op. c i t . , p. 57. 2 1 C a r l R. Rogers, C l i e n t - C e n t e r e d Therapy (Boston: Houghton M i f f l i n Co., 1965), pp. 351 T355. 18 i m p o r t a n t r e q u i r e m e n t f o r t h e communication p r o c e s s t o o c c u r i s the c o n s c i o u s n e s s o r degree o f awareness o f a p e r s o n t h a t 22 makes him r e a c h o u t and be p a r t o f a communication p r o c e s s . More i m p o r t a n t the w r i t e r s on communication denote t h a t com-m u n i c a t i o n has n o t o c c u r r e d u n l e s s the meaning o f messages has 2 3 24 been conveyed from one p e r s o n t o a n o t h e r . ' One p e r s o n can hear what another i s s a y i n g i f he has h e a r i n g a b i l i t y , b ut un-l e s s the meaning o f t h e i n f o r m a t i o n i s t r a n s m i t t e d as w e l l , he has n o t r e c e i v e d the message - o n l y the words. However, f o r the communication t o be s u c c e s s f u l b o t h p e r s o n s i n v o l v e d do not n e c e s s a r i l y have t o agree. I n f a c t , communication i s o f t e n h e i g h t e n e d by di s a g r e e m e n t . The c l a r i f i c a t i o n and d i s c u s s i o n t o b r i n g about agreement i s o f t e n o f a v e r y i n f o r m a t i v e and m e a n i n g f u l n a t u r e . ^ Types o f the P e r s o n - C e n t e r e d Communicative P r o c e s s Ruesch and Bateson d i s t i n g u i s h t h r e e t y p e s o f p e r s o n -c e n t e r e d communication. These a r e i n t r a p s y c h i c , i n t e r p e r s o n a l , and group communication. I n t r a p s y c h i c communication i s t h e memory o f i n t e r p e r s o n a l communication t h a t t a k e s p l a c e w i t h i n the mind o f an i n d i v i d u a l . I n t e r p e r s o n a l communication o c c u r s when t h e r e i s e v i d e n c e t h a t s y m b o l i c words o r a c t i o n s were 22 F o r r e s t , op. c i t . , p. 642. 23 K r o n , op. c i t . , p. 27. 24 C h a r l e s B. S m i t h , "Communication - An E s s e n t i a l o f R e a l i t y , " P e r s o n n e l J o u r n a l , (August, 1974), p. 605. 25 Haimann, op. c i t . , pp. 34-54. 19 c o n s c i o u s l y o r u n c o n s c i o u s l y p e r c e i v e d by one o r many. I n t e r -p e r s o n a l communication can be ob s e r v e d when t h e p e r c e p t i o n o f s y m b o l i c words o r a c t i o n s i s p e r c e i v e d by an o u t s i d e o b s e r v e r , i . e . p e r c e p t i o n o f p e r c e p t i o n . Group communication i s a form of i n t e r p e r s o n a l communication t h a t t a k e s p l a c e when one r e l a t e s t o many, many r e l a t e t o one, o r many r e l a t e t o many. The d i f -f e r e n c e i s t h a t o f numbers. I n group communication meanings a r e o f t e n much more d i f f u s e d , feedback may be d e l a y e d and p e r i -2 6 p h e r a l meaning and u n d e r s t a n d i n g may be p r e v a l e n t . The V i t a l P r o c e s s of Communication I n t h i s v i t a l p r o c e s s o f e f f e c t i v e communication one of the b i g g e s t d i f f i c u l t i e s we f a c e i s how t o co n n e c t our sym-b o l i c w o r l d w i t h our e m p i r i c a l w o r l d f o r t r a n s m i s s i o n o f meaning. U n q u e s t i o n a b l y , i f a message i s t o be of any s i g n i f i c a n c e , t h e i n t e r n a l r e a c t i o n s o f one p e r s o n have t o be i n t e r p r e t e d t o c o i n -27 c i d e i n t h e same manner by an o t h e r p e r s o n . Our s y m b o l i c w o r l d , w h i c h a r i s e s from our i n t e r a c t i o n w i t h o t h e r s , i s a t t h e d i s p o s a l o f our p e r c e p t i o n , thus our communication w h i c h r e f l e c t s our p e r c e p t i o n may not be based on the f a c t s o f r e a l i t y . The r e a l i t y we p e r c e i v e i s s t r a i n e d t h r o u g h our b e l i e f s , a t t i t u d e s , and v a l u e s . A d m i t t e d l y , we respond t o s i t u a t i o n s as C. B. Smith d e s c r i b e s , t h r o u g h t h i n g s t h a t i n t e r a c t i n s i d e o f us as w e l l as 2 8 t o the e x t e r n a l p a r t o f a s i t u a t i o n . Ruesch and B a t e s o n , op. c i t . , p. 314. 27 J . Ruesch and W. Kees, N o n v e r b a l Communication ( B e r k e l e y and Los A n g e l e s : U n i v e r s i t y o f C a l i f o r n i a P r e s s , 1956), p. 205. 2 8 C. B. Sm i t h , op. c i t . , p. 602. 20 2 9 3 0 C h e r r y and Q u a s t l e r advance t h e n o t i o n t h a t t h e communi-c a t i o n p r o c e s s c o n t r o l s a l l human a c t i o n , as i t e n a b l e s a p e r s o n t o p r e d i c t e v e n t s , c o r r e c t b e h a v i o r , i n f l u e n c e and c o n t r o l the environment. The i n f o r m a t i o n s t o r e d i n memory can a l s o be r e -31 f e r r e d t o as t h e knowledge o f r e l a t i o n s h i p s . H a s t o r f , S c h n e i d e r , and P o l e f k a c o n c l u d e : How you c a t e g o r i z e and p e r c e i v e me w i l l i n f l u e n c e how you behave towards me, and your b e h a v i o r , i n t u r n , w i l l i n f l u e n c e how I b e h a v e . ^ C l e a r l y t h e n , when one i s communicating one i s commu-n i c a t i n g something about o n e s e l f , as one makes one's p e r s o n a l v iews p u b l i c , and one r e a c t s t o the environment the way one p e r -c e i v e s i t . F e e l i n g s a re ar o u s e d and energy spent. T h i s means t h a t one responds w i t h p s y c h o l o g i c a l as w e l l as p h y s i o l o g i c a l r e a c t i o n t o the sensory, s t i m u l i . 29 C. C h e r r y , On Human Communication (New York: W i l e y , 1957), p. 333. "^0H. Q u a s t l e r , ed. , I n f o r m a t i o n Theory i n P s y c h o l o g y (Glencoe: F r e e P r e s s , 1955), p. 438. 31 T. I b i d . 32 H a s t o r f , S c h n e i d e r , and P o l e f k a , op. c i t . , p. 13. 21 PROCESS OF PERCEPTION I know you believe you understand what you think I said, but I am not sure you r e a l i z e that what you heard i s not what I meant.3 3 Why i s i t that two people perceive the same thing d i f f e r e n t l y ? Does one hear or see things the way they r e a l l y are? What i s one r e a l l y communicating when one communicates? One needs to look at the process of perception to begin to answer these questions. Some d e f i n i t i o n s of the Perceptual Process The process of perception has been variously defined. Webster's Dictionary explains perception as "awareness of the elements of the environment through physical sensation i n t e r -34 preted i n the l i g h t of experience." Nord interprets i t as the process by which a person gives meaning to the environ-35 ment. Fergus claims that perception i s information extracted 3 6 from the world from sources within and outside of ourselves. Hastorf, Schneider and Polefka declare that the process of perception i s the process of problem solving. The search i s for s t a b i l i t y , structure, and meaning to provide r e l a t i o n s h i p 33 Author unknown. 3 4Webster's Seventh New Collegiate Dictionary (Toronto, Ontario: Thomas Allen & Sons Limited, 1969), p. 626. 35 Nord, op. c i t . , p. 19. 3 fi R. H. Fergus, Perception (New York: McGraw-Hill Book Co., 1966), p. 1. 22 37 bonds between our s y m b o l i c and e m p i r i c a l w o r l d s . C h o d i l and W i l l i a m s d e s c r i b e t h e s e n s o r y p r o c e s s as t h e a b i l i t y o f an o r g a n i s m t o p e r c e i v e , r e c e i v e , and o r g a n i z e s t i m u l i . We r e g i s t e r the w o r l d t h r o u g h r e c e p t i o n , t h e b i o -l o g i c a s p e c t o f s e n s o r y p r o c e s s , and we o r g a n i z e and s e l e c t s t i m u l i t h r o u g h p e r c e p t i o n , t h e p s y c h o l o g i c a s p e c t o f s e n s o r y 3 8 p r o c e s s . P e r c e p t i o n , t h e p s y c h o l o g i c a s p e c t o f s e n s o r y p r o -39 c e s s , r e q u i r e s a t t e n t i o n t o s e l e c t and o r g a n i z e t h e s t i m u l i . S t i m u l i a r e s e l e c t e d and o r g a n i z e d as i n f l u e n c e d by s i z e , change, r e p e t i t i o n , i n t e n s i t y , p a s t e x p e r i e n c e , knowledge, a t t i t u d e s , v a l u e s , and f e e l i n g s . A f t e r t h e o r g a n i z a t i o n o f t h e w o r l d t h r o u g h our senses we r e c o g n i z e i t i n terms o f an 40 o b j e c t , group, d e p t h , o r d i s t a n c e . Thus the c o n c e p t of p e r c e p t i o n i s based on a p e rson's awareness, i n t e r p r e t a t i o n , and e v a l u a t i o n o f s t i m u l i . Awareness i s an i n t e g r a l p a r t o f the p e r c e p t i o n o f t h e e x t e r n a l w o r l d . W i t h o u t i t a p e r s o n would e x p e r i e n c e h a l l u c i -n a t i o n s . H a l l u c i n a t i o n i s the term t h a t was f i r s t i n t r o d u c e d by E s q u i r o l t o d e s c r i b e h e a r i n g and s e e i n g t h i n g s as t h e r e -s u l t o f pseudosensory d i s t u r b a n c e s . These are n o t f a l s e 37 H a s t o r f , S c h n e i d e r , and P o l e f k a , op. c i t . , pp. 4-10. 38 J u d i t h C h o d i l and B a r b a r a W i l l i a m s , "The Concept o f Sensory D e p r i v a t i o n , " C l i n i c s o f N o r t h A m e r i c a , 5 (September, 1970), pp. 453-455. 39 C. D a v i d Mortensen, Communication: The Study Of Human  I n t e r a c t i o n (New York: M c G r a w - H i l l Book Co., 1972), pp. 83-89. 40 • John W. K e l t n e r , Elements of I n t e r p e r s o n a l Communication (Belmont, C a l i f o r n i a : Wadsworth Co., 1973), pp. 128-136. 23 p e r c e p t i o n s o f t h e r e a l w o r l d , t h e s e a re the p e r c e p t i o n s t h a t happen i n the p e r s o n w i t h o u t e x t e r n a l s t i m u l i . I n h a l l u c i n a -t i o n s t h e p e r c e p t i o n i s c r e a t e d and p r o j e c t e d t o t h e r e a l w o r l d , A p e r s o n does not r e a l i z e t h e d i f f e r e n c e between c r e a t e d and r e a l perception. 4"'" We Connect t h e Two Worlds We L i v e I n Many i n v e s t i g a t o r s have t r i e d t o u n d e r s t a n d t h e r e -l a t i o n s h i p between t h e e m p i r i c a l and s y m b o l i c language w o r l d . For. Nord the r e l a t i o n s h i p between t h e t w o - w o r l d s - d e s c r i b e d can be equated t o the energy spent when a t t e m p t i n g t o o b t a i n meaning from t h e environment. He s a y s : Most t h e o r i e s agree t h a t t h e p s y c h o l o g i c a l meaning g i v e n t o an energy so u r c e i s d e t e r m i n e d by t h e i n t e r a c t i o n o f p r e v i o u s e x p e r i e n c e s , c u r r e n t s t a t e s o f the organism, t h e c o n t e x t i n wh i c h t h e p e r c e i v e d o b j e c t e x i s t s , and t h e unique s e n s i n g system of an i n d i v i d u a l . 4 2 Thus t h e r e l a t i o n s h i p between t h e two w o r l d s i s i n t h e meaning. T h i s c o n c e p t , as one o f the most s i g n i f i c a n t c o n c e p t s i n t h e t h e o r i e s o f communication, i s b e i n g s u p p o r t e d . K e l t n e r s t a t e s , "meaning i s t h e e x p e r i e n c e p e o p l e p e r c e i v e as response 43 t o symbols." S e l f - C o n c e p t , P e r c e p t i o n , and Communication The s e l f - c o n c e p t i s t h e i n t e r n a l p o i n t o f v i e w we have 41 R. H. Shulman, Essays i n S c h i z o p h r e n i a ( B a l t i m o r e : W i l l i a m s and W i l k e n s , Co., 1968), p. 184. 42 Nord, op. c i t . , p. 20. 43 K e l t n e r , op. c i t . , p. 65. 24 44 o f o u r s e l v e s ; i t i s what we t h i n k we a r e , not n e c e s s a r i l y 45 what we a r e . We behave as we b e l i e v e we s h o u l d , o r as we a r e 46 i n f l u e n c e d by the feedback of o t h e r s . "Our b e h a v i o r s a r e a 47 t e s t i n g p r o c e d u r e we use on o t h e r s , " as we seek t o c r e a t e a r esponse i n communicators. Haney summarizes the r e l a t i o n s h i p between s e l f - c o n c e p t and e m p i r i c a l w o r l d by s a y i n g : The s e l f - c o n c e p t t h e n i s the fundamental d e t e r m i n a n t of a l l our b e h a v i o r . Indeed, s i n c e i t i s an o r g a n i -z a t i o n o f our p a s t e x p e r i e n c e s and p e r c e p t i o n s as w e l l as o f our v a l u e s and g o a l s , i t d e t e r m i n e s th e c h a r a c t e r o f the r e a l i t y we s e e . 4 8 F u r t h e r m o r e , our b e h a v i o r i s t o a g r e a t e x t e n t con-49 50 t r o l l e d by our e motions, as man i s an i r r a t i o n a l human b e i n g . S i n c e communication i s the t r a n s f e r o f meaning our b e h a v i o r i s a r esponse t o the meaning o f s i g n s , symbols, and s i g n a l s embedded i n our emotions. T h e r e f o r e , communication i s d i s t o r t e d by 51 i n t e n t i o n , t h e consequence o f s e l f - i n t e r e s t . Rogers j u s t i f i -44 Myers and Myers, op. c i t . , p. 105. 45 Haney, op. c i t . , p. 200. ^ K e l t n e r , op. c i t . , p. 41. 47 Edward C. C a r t e r e t t e and Morton P. Friedman, Handbook  o f P e r c e p t i o n , V o l . 1 (London: Academic P r e s s , 1974), p. 112. 48 Haney, op. c i t . , p. 200. 49 H. R. S m i t h , "Communication by A m b i g u i t y , " i n Readings  i n I n t e r p e r s o n a l & O r g a n i z a t i o n a l Communication, eds. R. C. Huseman, D. M. Logue, D. L. F r e s h l e y (Boston: H o l b r o o k P r e s s , I n c . , 1974), p. 175. 50 B a s i l S. Georgopoulos, "The H o s p i t a l System and N u r s i n g : Some B a s i c Problems and I s s u e s , " N u r s i n g Forum, V o l . 5, No. 3, (1966), pp. 8-11. 51 H. R. S m i t h , op. c i t . , p. 175. 25 a b l y i n d i c a t e s t h a t everyone l i v e s i n a h i g h l y p e r s o n a l i z e d 52 w o r l d o f w h i c h he i s t h e c e n t e r . P h y s i o l o g i c a l A s p e c t o f P e r c e p t u a l P r o c e s s We p e r c e i v e i n f o r m a t i o n t h r o u g h the r e c e p t i o n c e n t e r s 53 o f our f i v e senses as t h e y a r e s t i m u l a t e d by the environment. Our human nervous system i s b u i l t i n such a way t h a t we cannot p e r c e i v e a l l the i n f o r m a t i o n t h a t i s i n t h e environment. F o r example, we do n o t hear t h e sounds above 2 0,000 and below 2 0 c y c l e s p e r second. S i m i l a r l y , no two i n d i v i d u a l s a r e a l i k e as sen s o r y "equipment" v a r i e s w i t h each one. C o n s e q u e n t l y , we do not p e r c e i v e t h i n g s t h a t we a r e not b u i l t t o e x p e r i e n c e , and as i n d i v i d u a l s we d i f f e r i n what we s e l e c t t o pay a t t e n t i o n t o . 54 i n our environment. H a s t o r f , S c h n e i d e r and P o l e f k a ' s r e s e a r c h i n p e r c e p t i o n i n d i c a t e s t h a t v e r b a l and n o n v e r b a l a c t s t o be u n d e r s t o o d a r e s e p a r a t e d i n t o u n i t s o f e f f e c t . What we ob s e r v e i s t h e r e s u l t o f a p r o c e s s as a p e r s o n p e r f o r m s c a u s a l a n a l y s i s o f an e v e n t , 55 a c t i v e s e l e c t i o n , and p r o c e s s i n g o f t h e s t i m u l u s . P s y c h o l o g i c a l A s p e c t o f P e r c e p t u a l P r o c e s s We g i v e meaning t o what we p e r c e i v e . We d i s t o r t o r mold 52 Rogers, op. c i t . , p. 48 3. 53 K e l t n e r , op. c i t . , p. 125. 54 Myers and Myers, op. c i t . , p. 16. 55 H a s t o r f , S c h n e i d e r , and P o l e f k a , op. c i t . , p. 11. 26 what we see a t our c o n v e n i e n c e . ^ C o n s c i o u s l y o r s u b c o n s c i o u s l y we s e l e c t , o r g a n i z e , and i n t e r p r e t s e n s o r y s t i m u l i i n t o our p i c t u r e o f t h e w o r l d t o a c h i e v e s t r u c t u r e , s t a b i l i t y , and 57 meaning. C a n t r i l s t a t e s : "Any p e r c e p t i o n i s an awareness t h a t emerges as a r e s u l t o f a most c o m p l i c a t e d w e i g h i n g p r o c e s s an i n d i v i d u a l goes t h r o u g h as h i s mind t a k e s i n t o a c count a whole h o s t o f f a c t o r s o r c u e s . " 5 8 We p e r c e i v e what i n t e r e s t s us and what we l i k e . We t e n d • • 59 t o p e r c e i v e i n accordance w i t h our needs, m o t i v e s , and a t t i t u d e s . A c a r mechanic w i l l v i ew t h e c a r a c c i d e n t d i f f e r e n t l y t h a n a h e a l t h p r o f e s s i o n a l . The f i r s t one w i l l see more d e t a i l s o f the c o n d i t i o n o f t h e c a r , whereas th e second w i l l f o c u s a t t e n t i o n on the c o n d i t i o n o f t h e p e r s o n . Both w i l l p e r c e i v e a c c o r d i n g t o each one's demographic c h a r a c t e r i s t i c s , namely, v a l u e s , knowledge and p e r s o n a l i t y . ^ 0 To p e r c e i v e s e l e c t i v e l y i s the r e s u l t o f our p a s t ex-p e r i e n c e and p a s t l e a r n i n g . We s e l e c t from the environment th e d e t a i l s t h a t a r e s i g n i f i c a n t t o us and we r e c o g n i z e t h e d e t a i l s by t h e e x p e r i e n c e s we have had w i t h them. ^ H a s t o r f , S c h n e i d e r , P o l e f k a , p. 8. 57 I b i d . , pp. 3-10. 5 8 Hans Toch and Henry C l a y Smith (eds.) S o c i a l P e r c e p t i o n (Toronto: D. Van N o s t r a n d Company, I n c . , 1966), p. 5. 59 R. C. Huseman, D. M. Logue, D. L. F r e s h l e y ( e d s . ) , Readings i n I n t e r p e r s o n a l & O r g a n i z a t i o n a l Communication, (2nd ed. B o s t o n : Holbrook P r e s s , I n c . , 1974), p. 51. 60,, • , I b i d . 27 K e l l e y , i n 1950, s u p p o r t e d the f i n d i n g s o f B r u n n e r ^ who noted t h a t one o f the most i m p o r t a n t s u b j e c t i v e f a c t o r s i n f l u e n c i n g t h e p r o c e s s of p e r c e p t i o n (the way we p e r c e i v e ) i s " s e t " . K e l l e y 1 s f i n d i n g s were t h a t p e o p l e behave d i f f e r e n t l y and form d i f f e r e n t i n f e r e n c e s about a "warm" as opposed t o a " c o l d " p e r s o n , 6 2 i n s p i t e of the f a c t t h a t they are s e e i n g the same p e r s o n . Another s t u d y by S t r i c k l a n d i n 1958 c o n f i r m e d the importance of " s e t " on t h e b a s i s of p r i o r e x p e c t a t i o n s o f a s u p e r v i s o r . T h e i r f i n d i n g was t h a t a l t h o u g h t h e performance of two s u b o r d i n a t e s 6 3 was the same, one was more t r u s t e d t h a n the o t h e r . Haney sup-p o r t s t h e hypotheses t h a t we have a c q u i r e d i n t e r n a l " s e t s " w h i c h 64 make us see what we see. March and Simon c o n t i n u e t h a t a s t i m u l u s w i l l t r i g g e r " s e t s " , and w i t h i t a h o s t of elements a s s o c i a t e d w i t h the " s e t " due t o i t s l e a r n i n g p r o c e s s . ^ How a c c u r a t e are we? Myers and Myers note t h a t whenever we a r e t a l k i n g about something we a r e , i n f a c t , t a l k i n g about o u r s e l v e s - our l i k e s or d i s l i k e s . When we are t a l k i n g we are d e s c r i b i n g our f i l t e r s . ^ Haney d e s c r i b e s t h e s e f i l t e r s as 61 J . S. Bruner and A. T a g u i r i , "The P e r c e p t i o n o f P e o p l e , Ch. X VII i n G. L i n d z e y (ed.) Handbook of S o c i a l P s y c h o l o g y (Cam-b r i d g e , Mass., 1954). C p H. H. K e l l e y , "The Warm-Cold V a r i a b l e i n F i r s t Impres-s i o n s o f P e r s o n s , J o u r n a l o f P e r s o n a l i t y , V o l . 18 (1950), pp. 431-439. ft L. H. S t r i c k l a n d , " S u r v e i l l a n c e and T r u s t , J o u r n a l o f  P s y c h i a t r y , V o l . 26 (1958), p. 200-215. 64 Haney, op. c i t . , p. 60. ^ 5 J . G. March and H. A. Simon, O r g a n i z a t i o n s , (New York: John W i l e y & Sons, I n c . , 1958), p. 11. 6 6 Myers and Myers, op. c i t . , p. 19. 28 u n c o n s c i o u s i n t e r n a l s t a t e s which a r e t h e p r o d u c t o f our l e a r n i n g 6 7 p r o c e s s from t h e c u l t u r e and s o c i e t y from w h i c h we come. Thus, we f i l t e r s e n s o r y s t i m u l i t h r o u g h t h e s e n e t s o f p a s t l e a r n i n g , m o t i v e s , f e a r s , d e s i r e s , and i n t e r e s t s . How w e l l do we p e r c e i v e ? S m i t h p o i n t s o u t t h a t we t e n d t o a p p l y a c h a r a c t e r i s t i c o r e x p e r i e n c e we have had w i t h one p e r s o n t o a group o f p e r s o n s o f the same c l a s s c a t e g o r y . F o r example, a l l d o c t o r s a r e demanding. S i n c e p r e s e n t p e r c e p t i o n i s based upon our memory of p r e v i o u s e x p e r i e n c e s we may g i v e i t 68 the wrong meaning. O r g a n i z a t i o n o f P e r c e p t i o n s Not o n l y do we s e l e c t , we a l s o o r g a n i z e what we have s e l e c t e d . T h e r e f o r e what we see i s our c o n f i g u r a t i o n and o r g a n i -z a t i o n o f s e l e c t e d s t i m u l i . Mason was a b l e t o show t h a t we i g n o r e the f a c t s and we see what we e x p e c t t o see. I n h i s s t u d y "Judgments o f L e a d e r s h i p Based Upon Physiognomic Cues" he found no r e l a t i o n s h i p between th e a c t u a l c h a r a c t e r i s t i c s t h e l e a d e r s 69 p o s s e s s e d and the ones th e p e o p l e f e l t t h e y must have. We a l s o s t r i v e f o r c l o s u r e . I f we see a gap we complete 70 i t . I n r e l a t i o n t o t h i s A l l p o r t t h e o r i z e d t h a t we p e r c e i v e a 6 7 Haney, op. c i t . , pp. 60-61. 6 8 C. B. Smith, op. c i t . , p. 605. 6 9 D. J . Mason,"Judgments of L e a d e r s h i p Based Upon P h y s i o g -nomic Cues," J o u r n a l of Abnormal and S o c i a l P s y c h o l o g y , V o l . 54, (.1958) , pp. 431-439. 7 0 P. F. Secord and E. B e r s c h e i d , " S t e r e o t y p i n g and t h e G e n e r a l i t y o f I m p l i c i t P e r s o n a l i t y Theory," J o u r n a l o f P e r s o n a l i t y , V o l . 31, (1963), pp. 65-78. 29 p e r s o n as a u n i t almost i n s t a n t a n e o u s l y . I n a few seconds, we make judgment o f a p e r s o n t h a t we have never seen b e f o r e as t o h i s age, s i z e , n a t i o n a l i t y , f r i e n d l i n e s s , n e a t n e s s , s o c i a l c l a s s , 71 temperament, and even i n t e g r i t y . D a i l e y f u r t h e r documented t h a t n o t o n l y i s our f i r s t i m p r e s s i o n t h e l a s t i n g one b u t t h a t 72 most o f t e n i t i s i n c o r r e c t i f n o t s u p p o r t e d w i t h r e l e v a n t d a t a . I n t e r p r e t a t i o n o f P e r c e p t i o n As we s e l e c t and o r g a n i z e , so we i n t e r p r e t . T h i s i n t e r -73 p r e t a t i o n i s seldom c o n s c i o u s . The a m b i g u i t y xs always p r e s e n t , and t h e danger t o p e r c e i v e i n c o r r e c t l y i s g r e a t when we c o n s i d e r t h a t we p e r c e i v e on the b a s i s o f our emotions. I n 1944 Johnson r e s e a r c h e d o b j e c t p e r c e p t i o n w h i c h l e d him t o t h e o r i z e t h a t r e g i s t r a t i o n o f a c t u a l phenomena and our judgment are i n f l u e n c e d by e m o t i o n a l f a c t o r s . We may p e r c e i v e elements t h a t we l i k e more r e a d i l y , and we a c c e p t t h e elements t h a t we r e s p e c t as 74 c o r r e c t . Emotions, o r the way we f e e l about something, t h e n 75 w i l l d e t e r m i n e our memories and c o n s e q u e n t l y our a c t i o n . Rogers c o n f i r m s t h i s by s a y i n g t h a t emotions do e n t e r i n t o e v e r y t h i n g . They t r i g g e r t h e management o f communication and d i s t o r t i t by i n t e n t i o n as an i n d i v i d u a l s t r i v e s t o a c t u a l i z e , 71 G. W. A l l p o r t , P e r s o n a l i t y , (Boston: H o u g h t o n - M i f f l i n , 1937), p. 55. 72 C. A. D a i l e y , "The E f f e c t s o f Premature C o n c l u s i o n upon the A c q u i s i t i o n o f U n d e r s t a n d i n g o f a P e r s o n , " J o u r n a l o f Psy- c h o l o g y , V o l . 33, (1952), pp. 133-152. 73 Myers and Myers, op. c i t . , p. 14. 7 4 D. M. Johnson, "A S y s t e m a t i c Treatment o f Judgment," P s y c h o l o g i c a l B u l l e t i n , V o l . 42, (1945), pp. 193-224. 75 Grom, op. c i t . , p. 9. 3 0 7 6 m a i n t a i n and enhance h i m s e l f . We i n t e r p r e t on t h e b a s i s o f our emotions and r e a c t t o the meaning the s t i m u l i have f o r us. S m i t h , i n h i s s t u d y " S i z e -D i s t a n c e Judgments o f Human Fac e s , " r e p o r t e d t h a t s u b j e c t s p e r -c e i v e d photographs o f p l e a s a n t and f r i e n d l y f a c e s t o be c l o s e r and l a r g e r t h a n t h o s e of u n f r i e n d l y f a c e s , a l t h o u g h a c t u a l l y 7 7 the photographs were shown from the same d i s t a n c e . S i m i l a r l y , we respond t o cues t h a t may not be r e p r e s e n t a t i v e o f t h e o t h e r p e r s o n ' s c h a r a c t e r i s t i c s . F o r example Johnson, i n h i s s t u d y "A S y s t e m a t i c Treatment o f Judgment," showed t h a t an i n d i v i d u a l 7 8 may be p e r c e i v e d as honest on the b a s i s o f h i s s m i l e . B a s i c t o t h e n a t u r e o f man i s man's d e s i r e and need t o 7 9 communicate. We do not l i v e i n a vacuum and we need o t h e r s t o h e l p us d e t e r m i n e th e d i f f e r e n c e between the e m p i r i c a l / r e a l w o r l d and our s y m b o l i c / l a n g u a g e w o r l d . As Grom c o n t e n d s , t r u t h 8 0 i s n o t s e l f - e v i d e n t — we a l l see r e a l i t y i n our own terms. S e l f i s manufactured whenever we communicate, thus our i n n e r w o r l d has s e l e c t i v e and s u b j e c t i v e d i m e n s i o n s and our a c t i o n s a r e based on our f e e l i n g s . I s t h e r e a d i f f e r e n c e between p e r c e p t i o n and communication? F o r r e s t c l a i m s t h a t p e r c e p t i o n and communication a r e one and t h e 7 6 Rogers, op. c i t . , p. 4 8 3 . 7 7 G. H. S m i t h , " S i z e - D i s t a n c e Judgments o f Human F a c e s , " The J o u r n a l o f G e n e r a l P s y c h o l o g y , V o l . 4 9 , ( 1 9 5 3 ) , pp. 4 6 - 6 4 . 7 8 Johnson, op. c i t . 7 9 Reush and B a t s o n , op. c i t . 8 0 Grom, op. c i t . , p. 8. 31 same. They b o t h r e q u i r e the a b i l i t y t o encode and decode a 81 message m e a n i n g f u l l y . F o r Myers and Myers, p e r c e p t i o n p r ecedes communication. They say t h a t o n l y a f t e r we have p e r c e i v e d can 8 2 we communicate about the o b j e c t o f t h a t p e r c e p t i o n . As we can r e c r e a t e f o r o t h e r s , t h r o u g h t h e medium o f language, t h e p e r c e p t i o n t h a t we have c r e a t e d f o r o u r s e l v e s and a c h i e v e t h e same c o n c l u s i o n , w e can say t h a t we have communicated s u c c e s s f u l l y . ^ 3 F o r r e s t , op. c i t . , p. 643. 2 Myers and Myers, op. c i t . , p. 26. 3 I b i d . , pp. 23-24. 32 PATTERNS OF COMMUNICATION IN THE HOSPITAL SYSTEM B u r e a u c r a c y and Communication Most h o s p i t a l o r g a n i z a t i o n a l s t r u c t u r e s can be c h a r a c -t e r i z e d as t r a d i t i o n a l ; t h i s means t h a t a b u r e a u c r a c y i s p r e s e n t . Georgopoulos d e s c r i b e s a b u r e a u c r a c y as h a v i n g t h r e e p r i n c i p a l e l ements; f i x e d o f f i c i a l d u t i e s , r u l e s about a u t h o r i t y and c o e r s i o n , and m e t h o d i c a l p r o v i s i o n f o r t h e f u l f i l l m e n t o f d u t i e s 84 and t h e e x e r c i s e o f r i g h t . The c h a i n o f a u t h o r i t y , r e s p o n s i -b i l i t y , and a c c o u n t a b i l i t y e x t e n d s from t h e a d m i n i s t r a t o r down t h r o u g h t h e department head t o t h e p e r s o n n e l o f each s p e c i a l i z e d department. I n t h e b u r e a u c r a c y each p o s i t i o n i n the o r g a n i z a t i o n has i t s own j o b d e s c r i p t i o n o u t l i n i n g how t h a t p o s i t i o n r e l a t e s 85 t o each o f the o t h e r s . O r g a n i z a t i o n a l c h a r t s f u r t h e r i l l u s -t r a t e the l i n e s o f r e s p o n s i b i l i t y , a u t h o r i t y , and a c c o u n t a b i l i t y . The t r a n s m i s s i o n o f i n f o r m a t i o n i s e x p e c t e d t o f o l l o w t h e s e l i n e s . The p e r s o n i n charge o f a h o s p i t a l ward i s r e s p o n s i b l e f o r p a t i e n t c a r e . I f t h e charge p e r s o n cannot p e r f o r m a l l the f u n c t i o n s o f an o f f i c e , some r e s p o n s i b i l i t i e s a r e d e l e g a t e d t o s t a f f n u r s e s who i n t u r n d e l e g a t e r e s p o n s i b i l i t i e s t o o t h e r s t a f f members, such as n u r s e s ' a i d e s . I n t h i s p r o c e s s o f d e l e g a t i o n , 8 6 communication i s a v i t a l l i n k . Georgopoulos a f f i r m s t h e Op. c i t . , pp. 8-11. 8 5 M a r j o r i e Beyers and C a r o l e P h i l l i p s , N u r s i n g Management  f o r P a t i e n t Care (Boston: L i t t l e , Brown and Company), pp. 6-7. I b i d . 33 i mportance o f communication as he p o i n t s out t h a t t h e o r g a n i -8 7 z a t i o n i s as e f f e c t i v e as i t s c o m m u n i c a t i o n a l system. P a t i e n t s e n t e r a h o s p i t a l t h r o u g h th e a d m i t t i n g d e p a r t -ment, hence t o t h e n u r s i n g u n i t , and from t h e r e move from one department t o a n o t h e r t o r e c e i v e c a r e . M e e t i n g each p a t i e n t ' s u nique needs i s d i f f i c u l t , B e yers and P h i l l i p s o b s e r v e , when each department i s o r g a n i z e d s e p a r a t e l y t o u t i l i z e t h e i r p e r -s o n n e l f o r s p e c i a l i z e d f u n c t i o n s . A l s o such an o r g a n i z a t i o n o f i ndependent s e r v i c e s means t h e s p e c i a l i z e d p e r s o n n e l i d e n t i f y w i t h each o t h e r more th a n w i t h t h e o t h e r p e r s o n n e l who a r e p r o -8 8 v i d i n g c a r e t o t h e p a t i e n t . C h r i s t m a n s u g g e s t s t h a t o r g a n i z a t i o n i n t h e h o s p i t a l 89 system i s a m a t t e r of g i v i n g c a r e t h r o u g h o t h e r s . O r g a n i z a -t i o n a l e f f e c t i v e n e s s , however, i s not p r e s e n t when no one knows 90 what has o r has not been done f o r t h e p a t i e n t . Mathew e l a b o -r a t e s upon t h i s c o n c e p t when he d e c l a r e s , "...each department seems t o f u n c t i o n as an independent s e r v i c e and not as p a r t o f some c o h e s i v e and p r e d i c t a b l e method f o r i n s u r i n g h i g h q u a l i t y ,.91 ' c a r e , The b u r e a u c r a t i z a t i o n i s i l l u s i v e as i t i s n o t p o s s i b l e 8 7 G eorgopoulos, op. c i t . , p. 10. 88 Beyers and P h i l l i p s , I b i d . 89 L u t h e r C h r i s t m a n , "The R o l e of N u r s i n g i n O r g a n i z a -t i o n a l E f f e c t i v e n e s s , " I n t e r n a t i o n a l N u r s i n g Review, V o l . 16, No. 4 (1968), p. 250. I b i d . 91 B. H. Mathew, " S o c i a l O r g a n i z a t i o n o f H o s p i t a l s and P h y s i c i a n s , " J o u r n a l o f N u r s i n g A d m i n i s t r a t i o n , (September-O c t o b e r , 1971), pp. 25-31. 34 t o s p e c i f y the c o n t e n t and b o u n d a r i e s o f e v e r y s p e c i a l i z e d p o s i t i o n . T h i s r e s u l t s i n t h e f a c t t h a t t h e c h a n n e l s o f h o r i -z o n t a l communication a r e n o t always open, nor do they convey 92 complete i n f o r m a t i o n . I t i s a l s o t r u e t h a t d o c t o r s who p e r c e i v e t h e newer groups i n t h e h o s p i t a l system as t h e i r a s s i s t a n t s r e t a r d t h e 93 f l o w o f v e r t i c a l communication. B u r e a u c r a c y and P e r c e p t i o n The l i t e r a t u r e c o n s i s t e n t l y d i s c l o s e s t h a t the s e t o f p e r c e p t i o n s t h a t a group s t a f f c a t e g o r y has about each o t h e r and o t h e r group c a t e g o r i e s i n t h e h o s p i t a l system f i l t e r s t h e i r 94 communication and d i s r u p t s t h e q u a l i t y o f p a t i e n t c a r e . Georgopoulos and Mann, i n t h e i r s t u d y "The Community G e n e r a l H o s p i t a l , " found t h a t s t a f f i n d i f f e r e n t o r g a n i z a t i o n a l p o s i t i o n s p e r c e i v e and behave towards t h e work s i t u a t i o n d i f -f e r e n t l y because they h o l d d i f f e r e n t a t t i t u d e s , p o i n t s o f v i e w and v a l u e s o f each o t h e r . The n o n - s u p e r v i s o r y r e g i s t e r e d n u r s e s , l i k e t h e t e c h n i c i a n s , e v a l u a t e work s i t u a t i o n s more c r i t i c a l l y 95 than s u p e r v i s o r y n u r s e s and p h y s i c i a n s do. Brown and R o b e r t s 92 S a u l G e l l e r m a n , The Management o f Human R e l a t i o n s (New York: H o l t , R i n e h a r t and W i n s t o n , 1966), p. 60. 93 S k i p p e r and L e o n a r d , op. c i t . , p. 15. 94 S k i p p e r and L e o n a r d , op. c i t . , pp. 11-14. 95 B a s i l S. Georgopoulos and F l o y d C. Mann, The Community  G e n e r a l H o s p i t a l (New York: The M a c M i l l a n Co., 1962), pp. 148, 152. 35 a s s e r t t h a t the n u r s i n g group s t a f f c a t e g o r y i s p e r c e i v e d by o t h e r s as the c a t e g o r y t h a t has a s p e c i a l r e l a t i o n s h i p w i t h t h e p a t i e n t . Such p e r c e p t i o n g i v e s them a u t h o r i t y o v e r th e n u r s i n g u n i t as w e l l as o v e r t h o s e who come t o f u r n i s h s e r v i c e s 96 f o r t h e p a t i e n t i n t h a t u n i t . How a s e n i o r h o s p i t a l a d m i n i s t r a t o r p e r c e i v e s t h e needs o f d i f f e r e n t departments, and how d i f f e r e n t departments com-municate t h e i r needs, w i l l d e t e r m i n e r e l e a s e o f t e n s i o n and ease 97 of c o o p e r a t i o n and f u n c t i o n i n g . The o p e r a t i o n o f t h e c o n c e p t o f p e r c e p t i o n i s e v i d e n t when, f o r example, m e d i c a l men want t o p a r t i c i p a t e i n t h e d e c i s i o n making of t h e h o s p i t a l but f e e l e x c l u d e d . The a d m i n i s t r a t o r may want t o i n v o l v e t h e s e same m e d i c a l men, but p e r c e i v e s them as l a c k i n g i n t e r e s t i n b e i n g i n v o l v e d . Each h o s p i t a l department i s engaged i n a power s t r u g g l e t o d e f i n e how t h e i r f u n c t i o n i s t o be performed. The p h y s i c i a n , by the v i r t u e o f h i s m e d i c a l a u t h o r i t y , may p e r c e i v e h i m s e l f as "The Manager" o f p a t i e n t c a r e , but he i s not l i k e l y t o f i l l t h e 99 m a n a g e r i a l r o l e . Bax s t a t e s t h a t not o n l y a r e d o c t o r s poor communicators w i t h one a n o t h e r and w i t h o t h e r g r o u p s , but t h e y do n o t pay a t t e n t i o n t o t h e i r own p a t i e n t s by g i v i n g them n e c e s s a r y f e e d b a c k . 1 ' 0 0 On t h e o t h e r hand, m e d i c a l - l e g a l 97 " Brown and R o b e r t s , op. c i t . , p. 50. 98 I b i d . , p. 51. 9 9 Mathew, op. c i t . , p. 26. ^ " 0 0 M a r t i n Bax, " D o c t o r s as Communicators," The L a n c e t , ( J u l y 24, 1971), P. 206. 36 r e s p o n s i b i l i t y f o r t h e p a t i e n t i s o f t e n p r e s c r i b e d by l e g i s -l a t i v e r e q u i r e m e n t s ; such s t i p u l a t e d g u i d e l i n e s a r e e a s i e r t o d e f i n e and work w i t h i n . Communication, C o o r d i n a t i o n and N u r s i n g I t has been r e p o r t e d by many t h a t n u r s e s a r e t h e key p e r s o n n e l who i n s u r e adequate c o o r d i n a t i o n i n t h e l i n e s o f h o r i z o n t a l and v e r t i c a l communication f l o w . Mayhew s t a t e s t h a t c o o r d i n a t i o n o f t h e a c t i v i t i e s i s not handled by t h e a d m i n i s t r a t o r or p h y s i c i a n . "Nurses i n i t i a t e most o f t h e p a t i e n t - p r o c e s s i n g sequences. They do more th a n p e r s o n n e l i n o t h e r subsystems t o a c h i e v e i n t e r d e p a r t m e n t a l coordination.""'"^''" Greben e t a l . , i n d i c a t e s t h a t as communi-c a t o r s " . . . n u r s e s a r e the main t h r e a d o f c o n t i n u i t y i n t h e l i f e 102 o f the ward...." "The head nurse i s the key p e r s o n on the ward who s e t s the tone w h i c h d e t e r m i n e s the q u a l i t y o f p a t i e n t 103 c a r e and t h e openness o f communication." E l a b o r a t i n g upon t h i s c o n c e p t Beyers and P h i l l i p s c o n c l u d e : ...because p a t i e n t s o f t e n p e r c e i v e t h e h o s p i t a l o r g a n i z a t i o n t h r o u g h t h e i r e x p e r i e n c e s on a n u r s i n g u n i t , p r o f e s s i o n a l n u r s e s a r e key p e r s o n s among m e d i c a l p r o f e s s i o n a l s . 1 0 4 However, i n an o r g a n i z a t i o n as complex as a h o s p i t a l system, no d i s c i p l i n e can f u n c t i o n on i t s own. F a c i l i t a t i o n o f 1 0"Slayhew, op. c i t . , p. 27. 1 0 2 G r e b e n , e t a l . , op. c i t . , p. 46. I b i d . 1 0 4 B e y e r s and P h i l l i p s , op. c i t . , p. 12. each o t h e r ' s work and c o o r d i n a t i o n o f e f f o r t happens when t h e r e i s mutual u n d e r s t a n d i n g of each o t h e r ' s i m p o r t a n t c o n t r i b u t i o n s t o t o t a l p a t i e n t c a r e and when t h e c h a n n e l s o f communication 105,106,107 a r e open. Communication as a T h e r a p e u t i c T o o l i n the H o s p i t a l System Georgopoulos and Mann s p e c i f i e d t h a t we can t a l k about an o r g a n i z a t i o n as b e i n g e f f e c t i v e when i t c o n t a i n s a w e l l -f u n c t i o n i n g communication system and meets t h e d i v e r s e m o t i -108 v a t i o n a l needs o f the employees. He r z b e r g noted i n h i s r e s e a r c h on work and m o t i v a t i o n t h a t an employee has needs such a s : e n v i r o n m e n t a l s a f e t y , economic s e c u r i t y , s t a t u s , o r i e n t a t i o n , j o b s e c u r i t y o r j o b 109 s t a b i l i t y . Maslow p e r c e i v e d t h e worker's m o t i v a t i o n needs as ego needs f o r growth, r e s p o n s i b i l i t y and recognition." 1"" 1" 0 Each p e r s o n i n a h o s p i t a l system can and must f e e l t h a t t h e i r c o n t r i b u t i o n t o t o t a l p a t i e n t c a r e i s m e a n i n g f u l . A l l t h e s e needs can and s h o u l d be s a t i s f i e d t h r o u g h work; i f n o t met, th e y w i l l be the cause of o r g a n i z a t i o n a l m a l f u n c t i o n i n g . T h i s knowledge i s most s i g n i f i c a n t , as Dr u c k e r p o i n t s o u t , i n an 1 0 5 I b i d . 1 0 6 C h r i s t m a n , op. c i t . , p. 148. Brown and R o b e r t s , op. c i t . , p. 50. 1 0 8 G e o r g o p o u l o s and Mann, op. c i t . , p. 10. 1 0 9 F . H e r z b e r g , Work and the N a t u r e of Man ( C l e v e l a n d : The World P u b l i s h i n g Co., 1966), pp. 71-79. 1 1 0 A . H. Maslow, "A Theory o f M o t i v a t i o n , " P s y c h o l o g i c a l  Review, V o l . 50 (1943), pp. 370-396. 38 organization. Communication must involve that which i s common to sender as well as receiver. He states: . . . i t (communication) must be focussed on the motivation of the intended r e c i p i e n t . I t must, from the beginning, be formed by his values, b e l i e f s , and aspirations.m People i n the hospital system r e l a t e , impart and receive information. This information i s and must be made useful. The major communication networks i n the hospital system are a group category to patient, group category to another group category, group category to superior, and group category to agencies i n the community. Any communication network must have depth to be ef f e c t i v e . Depth means the communicator possesses the s k i l l s to see beneath the surface of s u p e r f i c i a l communication to per-ceive and fin d additional meaning and implication i n the i n f o r -mation conveyed. Rogers c a l l s such a s k i l l empathy, p o s i t i v e regard, and a non-judgmental attitude that permits reaching the depth of the other person's reactions and supports that person's 112 adjustment and adaptation. Beyers and P h i l l i p s also claim that a l l communications, nurse-patient or s t a f f - s t a f f , must have depth to be e f f e c t i v e . S u p e r f i c i a l i n t e r a c t i o n i s not s u f f i c i e n t to develop innovative methods for giving health care or for 113 f a c i l i t a t i n g the growth of s t a f f categories. Communication, 1 1 1 P e t e r F. Drucker, Technology, Management and Society (New York: Harper & Row, 1970), p. 21. 112 Rogers, op. c i t . Beyers and P h i l l i p s , op. c i t . , p. 183. 39 t h e t h e r a p e u t i c t o o l , as viewed by Ruesh does n ot and s h o u l d not p e r t a i n o n l y t o p a t i e n t s , but t o a l l p e o p l e w o r k i n g t o -1 1 4 g e t h e r . Examining i n t e r p e r s o n a l r e l a t i o n s h i p s , Georgopoulos and Mann l o o k a t c o o r d i n a t i o n as t h e concept t h a t t i e s t o g e t h e r d i f f e r e n t departments as they f u n c t i o n t o f u l f i l l t he demands o f o t h e r p a r t s o f t h e t o t a l h o s p i t a l system. They s t u d i e d t e n h o s p i t a l s and found t h a t c o o r d i n a t i o n c o r r e l a t e d p o s i t i v e l y w i t h s h a red e x p e c t a t i o n s , awareness o f problems, s o l v i n g o f problems, ease o f communication, and absence o f i n t r a o r g a n i -115 z a t i o n a l t e n s i o n . P a t i e n t c a r e needs s e n s i t i v i t y , and so do the p e o p l e i n an o r g a n i z a t i o n . V e n i n g a , a s p e c i a l i s t i n communication, i n d i c a t e s t h a t t h r o u g h h i s p e r s o n a l e x p e r i e n c e as a p a t i e n t he has found t h a t p e o p l e a t e v e r y l e v e l o f t h e h o s p i t a l h i e r a r c h y must p o s s e s s s e n s i t i v i t y and awareness i f a h o s p i t a l i s t o be more than a s t e r i l e factory. 1""'"^ Why t h e A c t o f Communication and P e r c e p t i o n F a i l s i n an O r g a n i z a t i o n . ; Groups o f p e o p l e a r e the l i n k between the i n d i v i d u a l 117 and s o c i e t y . P e r s o n s i n a group i n t e r a c t o r communicate t o share a purpose o r g o a l . T h i s bond between p e o p l e i n v o l v e d i n 114 Ruesh, op. c i t . , p. 451. 115 Georgopoulos and Mann, op. c i t . 116 R o b e r t V e n i n g a , "Communications: A P a t i e n t ' s Eye View," American J o u r n a l of N u r s i n g , ( F e b r u a r y , 1973), p. 322. 117 Glen H. Vernon, Human I n t e r a c t i o n (New York: The Ronald P r e s s Company, 1965), p. 4. 40 118 communication B a l e s c a l l s " p s y c h o l o g i c a l awareness." The c o m p l e x i t y o f t h e p e r c e p t u a l p r o c e s s i s ever p r e s e n t y e t each i n d i v i d u a l has h i s own unique way o f e x t r a c t i n g meaning 119 f u l i n f o r m a t i o n from the environment. The o b s e r v a t i o n s a p e r s o n makes i n t h i s p r o c e s s o f a b s t r a c t i n g , o r g a n i z i n g and d e v e l o p i n g a p i c t u r e o f a n o t h e r a r e r e l a t e d t o one's own b e l i e f s v a l u e s , needs, and e x p e c t a t i o n s . T h i s p r o c e s s may r e s u l t i n c r e a t i n g i n d i v i d u a l o r group s t e r e o t y p e , a t the expense o f a c c u r a c y , as i t r e s t r i c t s our awareness t o o t h e r a s p e c t s o f t h e , , , 120 p e r son's b e h a v i o r . Why d i f f e r e n t p e o p l e form d i f f e r e n t i m p r e s s i o n s o f o t h e r s a l s o depends on i n d i v i d u a l d i f f e r e n c e s i n s e n s i t i v i t y i n u t i l i z a t i o n of, and i n f o r m a t i o n about o t h e r s . These d i f f e r e n c e s i n p e r c e p t i o n a r e due t o p e r s o n a l i n t r a p s y c h i c f u n c t i o n . S t u d i e have shown t h a t the same s o c i a l s t i m u l u s produces d i f f e r e n t r e -sponses i n d i f f e r e n t p e o p l e due t o t h e i r d i f f e r e n t i a l s u s c e p t i -121 b i l i t y t o o p t i c a l i l l u s i o n ( W i t t r e i c h ) , ' s e l e c t i v e a t t e n t i o n 122 ( H a s t o r f and C a n t r i l ) , and d i f f e r e n c e s i n memory ( W i t r y o l and 118 R. F. B a l e s , I n t e r a c t i o n P r o c e s s A n a l y s i s (Cambridge, Mass.: Addison-Wesley P r e s s , 1950), p. 33. 119 Haney, op. c i t . , p. 200. 120 H a s t o r f , op. c i t . , p. 17. 121 Warren J . W i t t r e i c h , "The Horn Phenomenon: A Case of S e l e c t i v e P e r c e p t u a l D i s t o r t i o n , " The J o u r n a l o f Abnormal and  S o c i a l P s y c h o l o g y , V o l . 47, (1952), pp. 705-712. 122 A. H. H a s t o r f and Hadley C a n t r i l , "They Saw a Game: Case Study," J o u r n a l o f Abnormal and S o c i a l P s y c h o l o g y , V o l . 49, (1954), pp. 129-234. 41 123 K a e s s ) . Toch a l s o p o i n t s o u t t h a t i n t e r p r e t a t i o n or under-s t a n d i n g o f a group s t e r e o t y p e i s shaped by our needs. Our needs i f unmet cause t e n s i o n i n us and reduce a c c u r a c y i n our p e r c e p t i o n . H a s t o r f and C a n t r i l demonstrated t h a t an event has v a l u e f o r an i n d i v i d u a l t o t h e e x t e n t i t f u l f i l l s h i s needs o r purpose. T h i s i s t o say t h a t p e r c e p t i o n o f an event i s d e t e r -mined by the g a i n i t r e p r e s e n t s t o t h e i n d i v i d u a l p e r c e i v i n g 124 i t . " T h i s i m p l i e s t h a t our p e r c e p t i o n i s shaped by our f e e l i n g s about th e s i t u a t i o n . As we observe and e v a l u a t e the b e h a v i o r o f o t h e r s , we a r e o n l y i n f e r r i n g w i t h a c e r t a i n degree of p r o b a b i l i t y , what i s happening i n s i d e o f t h a t p e r s o n . How w e l l we i n f e r depends on t h e q u a l i t y o f t h e c u e s , our knowledge of t h e p e r s o n , and our a b i l i t y as e v a l u a t o r s . I n an o r g a n i z a t i o n t h e a c t o f communication f a i l s t o be s u c c e s s f u l as a consequence o f a number o f f a c t o r s . A l b r e c h t i d e n t i f i e d t h e f o l l o w i n g f i v e a r e a s : snap r e a c t i o n s , the " a l l n e s s o r i e n t a t i o n " , " e i t h e r / o r " t h i n k i n g , u n j u s t i f i e d a s s u m p t i o n s , and 12 5 i n f e r e n c e s . Snap r e a c t i o n s i m p l y t h a t a p e r s o n responds 12 6 i n s t a n t a n e o u s l y t o a s t i m u l u s w i t h o u t t h i n k i n g . " A l l n e s s 123 Sam L. W i t r y o l and W a l t e r A. Kaess, "Sex D i f f e r e n c e s i n S o c i a l Memory Tasks," The J o u r n a l o f Abnormal and S o c i a l P s y - c h o l o g y , V o l . 54, (1957), pp. 343-346. 124 H a s t o r f and C a n t r i l , op. c i t . , p. 129-234. 125 K a r l G. A l b r e c h t , " F i v e Ways t o S h o r t - C i r c u i t Your Communication," S u p e r v i s o r y Management, (June, 1974), pp. 2-7. " ' " ^ I b i d . , p. 2-3. 42 o r i e n t a t i o n " a r e words l i k e nobody, a l w a y s , and never t h a t convey an i m p r e s s i o n o f t o t a l i t y t h a t b l o c k s the l i s t e n e r from p a y i n g a t t e n t i o n t o t h e d i f f e r e n c e s . A s u p e r v i s o r may say, "You NEVER l i s t e n " o r "EVERYTHING you do f a i l s " . 1 2 7 " E i t h e r / o r " t h i n k i n g i m p l i e s a f e e l i n g o f o p p o s i t e s , p r e v e n t s a compromise 128 and d i s c r e d i t s room f o r an a l t e r n a t i v e . A l s o , we do not pay at-t e n t i o n f o r we assume t h a t we a l r e a d y know a l l about t h e s u b j e c t . The p o s s i b i l i t y o f l e a r n i n g something new about something t h a t we know does not come t o us U n j u s t i f i e d assumptions a r e a cause o f communication m a l f u n c t i o n when a p e r s o n a c t s on an assumption w i t h o u t c h e c k i n g t h e f a c t s . I n f e r e n c e s b l o c k commu-n i c a t i o n s when they a r e a c t e d upon as though t h e y were an a c t u a l 129 o b s e r v a t i o n . How t o O b t a i n and S u s t a i n E f f e c t i v e Communication f o r A c c u r a t e P e r c e p t i o n and E f f i c i e n t H o s p i t a l F u n c t i o n i n g .  Any o r g a n i z a t i o n i n which the c h i e f aim i s t o r e n d e r p e r s o n a l s e r v i c e s t o i n d i v i d u a l s , needs e f f e c t i v e communication t o f a c i l i t a t e a c c u r a t e p e r c e p t i o n o f b o t h p a t i e n t s and s t a f f . Communication between p e o p l e i n an o r g a n i z a t i o n t a k e s two forms. One i s c o n t e n t and the o t h e r i s p r o c e s s communication. They a r e a l s o c a l l e d " t a s k and s o c i o e m o t i o n a l " o r " t a s k and maintenance" communication. We f o c u s on c o n t e n t when we o b s e r v e what p e o p l e a re t a l k i n g about. We f o c u s on p r o c e s s when we ob-s e r v e how p e o p l e a r e t a l k i n g t o each o t h e r . 1 3 0 1 2 7 I b i d . , p. 3-4. 1 2 8 I b i d . , p. 4-5. 12 9 I b i d . , p. 6-7 130 Myers and Myers, op. c i t . , p. 131. 43 P r o c e s s communication i s p r e s e n t i n a l l communications, and an u n d e r s t a n d i n g o f i t i s u s e f u l i n d i a g n o s i n g and d e a l i n g e f f e c t i v e l y w i t h i n t e r p e r s o n a l problems. To be s e n s i t i v e t o a group p r o c e s s means t o be p e r c e p t i v e o f t h e f e e l i n g s t h a t d e v e l o p 131 i n a group as a r e s u l t o f t h e i r i n t e r a c t i o n . McGregor d e s c r i b e s a w e l l - f u n c t i o n i n g group as the one t h a t can be c h a r a c t e r i z e d by h a v i n g a warm, f r i e n d l y , and con-g e n i a l atmosphere. U n p l e a s a n t f e e l i n g s a r e suppressed and t h e r e i s no p r o v o c a t i o n . Disagreement i s r e s o l v e d by d e c i s i o n making p r o c e s s and not by the d o m i n a t i o n o f one over t h e o t h e r . P e o p l e l i s t e n and e x p r e s s t h e i r f e e l i n g s and i d e a s . L e a d e r s h i p s h i f t s depending upon t h e c i r c u m s t a n c e s . There i s l i t t l e o r no power 132 s t r u g g l e o n l y the t a s k o r o b j e c t i v e t o g e t t h e j o b done. To be a s u c c e s s f u l communicator one must p o s s e s s commu-n i c a t i o n s k i l l s . I t i s err o n e o u s t o assume t h a t good communica-133 t i o n j u s t happens. I t r e q u i r e s h ard work and p a i n s t a k i n g 134 a t t e n t i o n t o d e t a i l s . Zima r e a f f i r m s t h i s i n h i s " S e l f - A n a l y s i s I n v e n t o r y : An I n t e r p e r s o n a l Communication E x e r c i s e " when he i n d i c a t e s t h a t p e o p l e do need t r a i n i n g and e x p e r i e n c e i n d e v e l o p i n g s k i l l s . These s k i l l s a l s o make i t p o s s i b l e f o r t h e p e r s o n t o 131 I b i d . , p. 133. 132 D. McGregor, The Human S i d e o f E n t e r p r i s e (New York: M c G r a w - H i l l Book Company, 1960), pp. 227-242. 133 A l b r e c h t , op. c i t . , p. 2. 1 3 4 C . G. Ron a l d , "Very, V e r y I m p r e c i s e " , J o u r n a l o f t h e American M e d i c a l A s s o c i a t i o n , V o l . 2 03, No. 8, (Fe b r u a r y 19, 1968), pp. 141-142. 44 - s t r u c t u r e t h i n k i n g about h i m s e l f and t o t e s t t h a t s e l f - p e r c e p t i o n 135 a g a i n s t t h e p e r c e p t i o n o f o t h e r s . E f f e c t i v e communication can happen when t h e communi-c a t o r s a r e i n t o u c h w i t h f e e l i n g s as much as w i t h words. Beyers and P h i l l i p s w r i t e : " . . . f e e l i n g has i t s s o u r c e i n emo t i o n s , and emotions a re the most p o t e n t c a t a l y s t o f a c t i o n . F e e l i n g s , i f n ot a l l o w e d t o escape, can d e v e l o p i n t o f o r c e s o f a n x i e t y and f r u s t r a t i o n t h a t erode morale and e f f i c i e n c y and produce incompetency."136 S k i p p e r and Leonard s t a t e t h a t communication i s 137 b a s i c a l l y a s o c i a l p r o c e s s . Thus, the e f f e c t i v e n e s s o f com-m u n i c a t i o n depends on t h e r e l a t i o n s h i p between s u p e r i o r and s u b o r d i n a t e s o r between d i f f e r e n t group c a t e g o r i e s i n t h e h o s p i t a l system. When s t a f f f e e l r e c o g n i z e d and r e s p e c t e d as i n d i v i d u a l s a n o n - t h r e a t e n i n g environment i s c r e a t e d . I n t h i s manner s t a f f w i l l d e v e l o p i n accordance w i t h a s e l f - f u l f i l l i n g prophecy. K o r z y b s k i saw i n h i s s t u d i e s on mental i l l n e s s how the s e l f - f u l f i l l i n g prophecy i s f u n c t i o n a l i n the w o r l d we 138 c r e a t e . Our e x p e c t a t i o n s and a t t i t u d e s a r e t r a n s m i t t e d t h r o u g h our b e h a v i o r . M yles LaGrange r e p o r t s : "...your a d m i n i s t r a t i v e s u c c e s s w i l l be i n d i r e c t p r o p o r t i o n t o t h e 1 3 5 J o s e p h P. Zima, " S e l f - A n a l y s i s I n v e n t o r y : An I n t e r -p e r s o n a l Communication E x e r c i s e , " Speech Therapy, V o l . XX, (March, 1971), pp. 108-114. 1 O f Beyers and P h i l l i p s , op. c i t . , p. 111. 137 S k i p p e r and Leo n a r d , op. c i t . , p. 118. 138 Haney, op. c i t . , p. 205. 45 13 9 s u b o r d i n a t e ' s b e l i e f o f your b e l i e f i n him." The g r e a t e s t s e n s i t i v i t y s k i l l t h a t makes communication 140 e f f e c t i v e and r e w a r d i n g i s l i s t e n i n g . M a r n e f f e s u p p o r t s t h i s c o n c e p t i n s a y i n g t h a t a s u p e r i o r i n an o r g a n i z a t i o n must l i s t e n t o know what o t h e r s t h i n k and f e e l , and t o make d e c i s i o n s 141 and t o t a k e a c t i o n . " Rogers a s s e r t s t h a t e f f e c t i v e l i s t e n i n g i s l i s t e n i n g a c t i v e l y t o t h e t o t a l meaning of t h e message and r e s p o n d i n g t o t h e f e e l i n g . I t i s not j u s t h e a r i n g a p e r s o n ou t . He a l s o i n d i c a t e s t h a t m e r e l y by l i s t e n i n g we communicate t h a t 142 t h e o t h e r p e r s o n i s o f w orth. T h i s r e c o g n i t i o n o f w o r t h w i l l f o s t e r growth, i n c r e a s e d s e l f - e s t e e m , c a p a c i t y f o r s e l f -d i r e c t i o n and a d j u s t m e n t , development, and i n t e g r a t i o n o f d i f -f e r e n t s t a f f c a t e g o r i e s i n t h e h o s p i t a l system. I t i s i m p o s s i b l e f o r one t o be i n t o u c h w i t h one's own and the o t h e r ' s r e a l i t y a l l t h e t i m e . Haney d e c l a r e s t h a t t h e r e a r e j u s t t o o many d i f f e r e n t i n t e r r e l a t e d v a r i a b l e s o f s t i m u l i , p a s t e x p e r i e n c e s , i n t e r n a l s t a t e s and evoked s t a t e s t h a t i n t e r v e n e between p e r c e p t i o n and r e a l i t y w i t h i n o u r s e l v e s 139 Mace Myles LaGrange, The Growth and Development o f  E x e c u t i v e s (Boston: D i v i s i o n o f R e s e a r c h , Graduate S c h o o l of B u s i n e s s A d m i n i s t r a t i o n , H a r v a r d U n i v e r s i t y , 1950), p. 131 "^^Myers and Myers, op. c i t . , p. 182-193. 141 F r a n c i s de M a r n e f f e , " L i s t e n i n g Generates T r u s t , " H o s p i t a l s , J.A.H.A., (March 16, 1973), pp. 86-90. 142 C a r l Rogers, "Communication: I t s B l o c k i n g and F a c i -l i t a t i n g , " N o r t h w e s t e r n U n i v e r s i t y I n f o r m a t i o n , V o l . 20, (1952), pp. 9-15. 46 143 and betwe en o t h e r s . Thus t h e r e s p o n s e , a feedback i n a p e r c e i v a b l e manner i s n e c e s s a r y f o r a p e r s o n o r group t o gauge the e f f e c t s produced. I f t h e response i s as the message i n -144 tended,a p e r s o n e x p e r i e n c e s g r e a t s a t i s f a c t i o n . W i t h f e e d -back, s a t i s f y i n g o r e f f e c t i v e communication becomes a d r i v i n g f o r c e f o r an i n d i v i d u a l t o seek out f u r t h e r human r e l a t i o n s . N o n - s a t i s f y i n g communication causes an i n d i v i d u a l t o w i t h d r a w 145 from the communication network. F i n a l l y , t h e f a c t t h a t t h e h o s p i t a l system i s a network of p e o p l e means t h a t we can do much t o improve communication, but we must be aware of t h e p r o c e s s e s i n v o l v e d . I n communications w i t h s u b o r d i n a t e s , p e e r s , s u p e r i o r s and o t h e r s we can h e l p t o e l i m i n a t e some of the communication breakdowns by b e i n g more aware of our own r e a c t i o n s and p a y i n g a t t e n t i o n t o our v i e w o f r e a l i t y . T h i s i n c l u d e s l e a r n i n g and making a c o n s c i o u s e f f o r t t o a v o i d " a l l o r none" and " e i t h e r / o r " t h i n k i n g , assuming t h a t your communication i s u n d e r s t o o d , and t r e a t i n g i n f e r e n c e s as 146 o b s e r v a t i o n s . I n c o n t r a s t , we can c r e a t e a c l i m a t e o f non-judgmental a t t i t u d e and warmth so t h a t p s y c h o l o g i c a l b a r r i e r s t o the e f f e c t i v e i n t e r p e r s o n a l r e l a t i o n s h i p s can be broken , 1 4 7 down. To shape t h e s t a f f ' s m o r a l e , t o enhance c o o p e r a t i o n , and t o a c h i e v e g o a l s o f the o r g a n i z a t i o n we must u n d e r s t a n d our 1 4 3 H a n e y , op. c i t . , p. 63. 14 4 J . Ruesch, D i s t u r b e d Communication (New York: N o r t o n , 1957), p. 337. 1 4 ^ I b i d . 1 4 ^ A l b r e c h t , op. c i t . , p. 1-2 147 Rogers, (1965), op. c i t . 47 own f e e l i n g s and pro b l e m s , and must a c c e p t and work t h r o u g h r e l a t i o n s h i p s w i t h o t h e r s . The utmost importance o f t h i s i s u n d e r l i n e d by Feldman and G o l d s t e i n ' s work w h i c h i n d i c a t e d i n an o v e r v i e w o f m e n t a l h e a l t h c e n t e r s i n t h e U.S.A., t h a t no t h e o r y i s o f any v a l u e i f p e o p l e cannot r e l a t e t o each o t h e r 148 m e a n i n g f u l l y . D r u c k e r a s s e r t s t h a t e f f e c t i v e communication i s c r i t i c a l t o o r g a n i z a t i o n a l development. He s t a t e s , "...com-m u n i c a t i o n s i n an o r g a n i z a t i o n a r e not a means o f o r g a n i z a t i o n 149 b u t a mode o f o r g a n i z a t i o n . " 148 S. Feldman and H. G o l d s t e i n , "Community M e n t a l H e a l t h C e n t e r s i n the U.S.A.: An Overview," I n t e r n a t i o n a l  J o u r n a l o f N u r s i n g S t u d i e s , V o l . 8, No. 4, (1971), pp. 247-257 149 D r u c k e r , op. c i t . 48 EFFECTS OF COMMUNICATION ON PATIENT WELFARE AND LEVEL OF CARE The need f o r e f f e c t i v e communication has been s t u d i e d and s t a t e d c o n s i s t e n t l y i n the l i t e r a t u r e . I n v e s t i g a t i o n s have been done t o s u b s t a n t i a t e t h i s need by e x a m i n i n g v a r i o u s a s p e c t s of p a t i e n t c a r e . I n a c o n f e r e n c e on t h e "Problems o f Communication," Bax r e p o r t e d t h a t i n s p i t e o f advanced t e c h n o l o g y and t h e computer age, p a t i e n t c a r e s u f f e r s due t o i n a d e q u a t e i n f o r m a t i o n . He proposed t h a t t h e p h y s i c i a n s h o u l d c o n c e n t r a t e l e s s on h i s p e r c e p t i o n o f , f o r example, the computer as a t h r e a t t o h i s d o c t o r image and more on t h e human a s p e c t of d o c t o r - p a t i e n t r e l a t i o n s h i p . I n t h i s way, the a t t e n t i o n would be where i t s h o u l d be - the p a t i e n t would n o t o n l y r e c e i v e feedback t o h i s q u e s t i o n s but h i s r i g h t s as a human b e i n g would be a t t e n d e d t o as w e l l . M i n t y a l s o l o o k e d a t t h e e f f e c t s o f communication i n a h o s p i t a l system on p a t i e n t c a r e . I f t h e communication i s a "two-151 way s t r e e t " the r i g h t k i n d o f i n f o r m a t i o n r e a c h e s t h e appro-p r i a t e end. Such communication p l a y s a major r o l e i n an o r g a n i z a t i o n f o r i t c o n n e c t s , i n t e g r a t e s , e n e r g i z e s and a l l o w s 152 f o r p l a n n i n g , d i r e c t i n g , o r g a n i z i n g and c o n t r o l l i n g i n t h e d e c i s i o n making p r o c e s s . 1 5 0 M a r t i n Bax, D o c t o r s as Communicators," The L a n c e t , ( J u l y 24, 1971), p. 206. •] c i A b d u l M i n t y , "Democracy and Communication," The  L a n c e t , ( J u l y 24, 1971), p. 207. A l b e r t K. W i c k e s b e r g , Management O r g a n i z a t i o n (New York: A p p l e t o n - C e n t u r y - C r o f t s , 1966), pp. 72-97. 49 L i t e r a t u r e i s abundant on how team c o n f e r e n c e s l e a d t o improvement o f communication s k i l l s and improved p a t i e n t c a r e . Radtke and W i l s o n emphasize t h a t i n m e e t i n g i n c r e a s e d h e a l t h demands, n u r s i n g must s u p p o r t t h e concept o f t o t a l p a t i e n t c a r e . T h i s can be a c c o m p l i s h e d when we a r e s e n s i t i v e t o t h e f e e l i n g s o f p e o p l e w i t h whom we work. By examining our own f e e l i n g s and r e a c t i o n s we i n c r e a s e our powers o f o b s e r v a t i o n and u n d e r s t a n d i n g 153 of p a t i e n t ' s b e h a v i o r s . T r a d i t i o n a l l y , i t was t h o u g h t t h a t t h e team c o n f e r e n c e was e f f e c t i v e i f i t was p a t i e n t c e n t e r e d . Greben acknowledges t h a t c o n f e r e n c e s h e l p p a t i e n t s d i r e c t l y , and i n -d i r e c t l y h e l p t h e h o s p i t a l , as group c a t e g o r i e s v e n t i l a t e t h e i r 154 f e e l i n g s about p a t i e n t s and each o t h e r . I n 197 4 Brown and R o b e r t s p r e s e n t e d a paper i n an ongoing r e v i e w of t h e o r g a n i z a t i o n o f h o s p i t a l s i n w h i c h t h e y s u g g e s t a group approach as one o f t h e methods t o meet t h e demand f o r more e f f e c t i v e communication. Group approach meant t h e r e q u e s t s f o r s e r v i c e s were d i r e c t e d t o p r o p e r c h a n n e l s , so t h e w a i t i n g l i s t f o r a d m i s s i o n was r e d u c e d , and t h e p a t i e n t s i n need o f emergency 155 c a r e were a t t e n d e d t o i m m e d i a t e l y . Burns examined communication from the p o i n t o f b e i n g "the t e c h n i q u e f o r s t r e n g t h e n i n g i n t r a and i n t e r - d e p a r t m e n t a l c o o p e r a t i o n and c o o r d i n a t i o n . " To him, o n l y communication t h a t 153 Maxine Radtke and A l a n W i l s o n , "Team C o n f e r e n c e s That Work," American J o u r n a l o f N u r s i n g , (March, 1973), pp. 506-508. 154 Greben e t a l . , op. c i t . , p. 46. 155 Brown and R o b e r t s , op. c i t . , p. 49. 50 i s on the l e v e l o f f e e l i n g s , r a t h e r than m e r e l y f a c t s , produces improvements i n p a t i e n t c a r e p r o g r a m s . I n th e h o s p i t a l h e a l t h c a r e system, C h r i s t m a n f u r t h e r s u g g e s t s t h a t where t h e r e i s a m i x t u r e o f w o r k e r s w i t h g r e a t d i v e r s i t i e s o f s p e c i a l t i e s , p r o b -lems of communication a r e bound t o happen. The i n t e r p r e t a t i o n s o f one message can be as numerous as t h e number of i n d i v i d u a l s t r a n s m i t t i n g i t . Thus the competence of a s t a f f group o f p r o f e s -s i o n a l s may n o t be conveyed and t h e t h e r a p e u t i c g o a l o f the p a t i e n t 157 may be d i s p l a c e d . S t i t e l y r e i n f o r c e s t h e i m p o r t a n c e o f e f f e c t i v e communication by r e p o r t i n g t h a t the i n p u t from a l l l e v e l s o f h e a l t h c a r e w o r kers i s e s s e n t i a l i f we a r e t o i n s t i -t u t e p o l i c i e s , p r o c e d u r e s , and management g u i d e s t h a t w i l l be r e a l i s t i c f o r h o s p i t a l o p e r a t i o n and i n t h e b e s t i n t e r e s t s o f the p a t i e n t . Communication w i t h open c h a n n e l s g i v e s each h o s p i t a l d i s c i p l i n e an o p p o r t u n i t y t o p a r t i c i p a t e . Such p a r t i c i p a t i o n c a l l s f o r an i n v o l v e m e n t t h a t l e a d s t o an u n d e r s t a n d i n g o f t h e management p r o c e s s e s and an awareness of f i n a n c i a l and o t h e r a d m i n i s t r a t i v e a c t i o n s . The u n d e r s t a n d i n g o f c o s t and e f f e c t r e s u l t s i n more sound d e c i s i o n s i n t h e outcome of p a t i e n t 159 c a r e . W i t h open c h a n n e l s of communication and i n v o l v e m e n t , R o b e r t K. Burns, "Techniques f o r S t r e n g t h e n i n g I n t r a and I n t e r - d e p a r t m e n t a l C o o p e r a t i o n and C o o r d i n a t i o n , " H o s p i t a l  T o p i c s , ( M a r c h / A p r i l , 1975), p. 31. 157 C h r i s t m a n , op. c i t . , p. 252. 158 D. M. S t i t e l y , "The R o l e of the D i v i s i o n Head i n a D e c e n t r a l i z e d N u r s i n g S e r v i c e System," The N u r s i n g C l i n i c s o f  N o r t h A m e r i c a , (June, 1973), p. 253. 159 Brown and R o b e r t s , op. c i t . , p. 51. 51 i n e f f i c i e n c y , due t o i g n o r a n c e and/or m i s i n t e r p r e t a t i o n o f how o t h e r d i s c i p l i n e s f u n c t i o n i s redu c e d . A l s o d i f f e r e n t h o s p i t a l s t a f f c a t e g o r i e s d i s c o v e r when t h e y have an o p p o r t u n i t y t o e x p r e s s and s hare t h e i r f e e l i n g s t h a t t h e y have s i m i l a r c o n c e r n s , aims, and g o a l s . A t the p e r s o n a l l e v e l , t h e i n v o l v e m e n t a l l o w s f o r i n c r e a s e d knowledge and w o r t h , and h e i g h t e n e d s e l f - e s t e e m and c o n f i d e n c e as t o t h e a b i l i t y and s k i l l s o f t h e o t h e r s t a f f c a t e -161 g o r i e s . Beyers d e c l a r e s t h a t each s t a f f c a t e g o r y i n t h e h o s p i t a l s e t t i n g a c c e p t s h i s p e r s o n a l r e s p o n s i b i l i t y t o f u l f i l l t h e e x p e c t a t i o n s o f h i s j o b r e q u i r e m e n t . Thus, t h e r o l e o f t h e p r o f e s s i o n a l p e r s o n means t h a t we a r e r e s p o n s i b l e t o work on our communication s k i l l s and t o g e t a l o n g i n t h e b e s t p o s s i b l e 162 manner so t h a t t h e p a t i e n t w i l l r e c e i v e t h e optimum c a r e . I f t h e h o s p i t a l group f u n c t i o n s t o g e t h e r as a team, t h e f l o w o f communication becomes f r e e r . P r o f e s s i o n a l s become l e s s concerned w i t h t h e i r s t a f f c a t e g o r y r o l e and have more time and energy t o c o n t r i b u t e t o p a t i e n t c a r e . D i f f i c u l t d e c i s i o n s a r e made b e t t e r because t h e y o c c u r i n a p e r s o n a l and s u p p o r t i v e c l i m a t e . Such d e c i s i o n s a r e based on knowledge and s k i l l as t h e y a r e p e r t a i n i n g t o p a t i e n t w e l f a r e and w e l l - b e i n g r a t h e r than who has t h e a u t h o r i t y o ver whom. Open and f r a n k communica-t i o n a l s o means t h a t new team members e x p e r i e n c e t h a t t h e i r Haimann, op. c i t . , p. 34. Brown and R o b e r t s , op. c i t . , p. 51. B e y e r s , op. c i t . , p. 5. 52 contributions toward meeting the patient's needs are as essen t i a l as those of any other team member. This leads to proper u t i l i z a t i o n and concentration of s k i l l s , e f f e c t i v e and e f f i c i e n t hospital functioning and less anxiety and confusion for the patient. SUMMARY Communication i s a v i t a l l i n k i n an organization. It i s e s s e n t i a l for coordination of a l l the e f f o r t s of the person-nel, and for the e f f e c t i v e , e f f i c i e n t , and economic functioning of the hospital system. The communication of people i n the hospital system i s affected by the type of work they do, t h e i r experiences, and their needs. When communicating people are constantly checking t h e i r communicative pattern with t h e i r perception of the re-actions of others. This feedback t e l l s them about t h e i r own and others perceptions, and how the communication i s progressing. Feelings enter into everything. As we communicate we connect the two worlds, empirical and symbolic through meaning. Meaning i s based on our feelings which are our memories. When we com-municate we communicate as we perceive the external r e a l i t y , the r e f l e c t i o n of our int e r n a l world - s e l f . E f f e c t i v e communication re s u l t s i n e f f e c t i v e work as people enjoy s a t i s f a c t o r y job rel a t i o n s h i p s . It can be said that at the base of a l l personal relationships i s the matrix of communication which can be seen and f e l t through the process of 53 p e r c e p t i o n . As the p r o c e s s o f p e r c e p t i o n p r e s e n t s an e n d u r i n g problem i n f o r m i n g s a t i s f a c t o r y i n t e r - p e r s o n a l r e l a t i o n s h i p s a s t u d y i n t h i s a r e a seemed j u s t i f i e d . E f f e c t i v e communication i s deemed n e c e s s a r y w i t h i n t h e h o s p i t a l system. 54 CHAPTER I I I METHODOLOGY I n t r o d u c t i o n The f i r s t a s p e c t o f t h i s s t u d y , ( P a r t A ) , d e a l s w i t h s u b j e c t i v e p e r c e p t i o n s o f how h o s p i t a l group c a t e g o r i e s see and f e e l about t h e i r a b i l i t i e s t o communicate. These d a t a were o b t a i n e d by means o f a q u e s t i o n n a i r e . The second a s p e c t , ( P a r t B ) , d e a l s w i t h o b j e c t i v e l y o b s e r v e d communication be-h a v i o r s s e c u r e d by means o f B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . A comparison between the p e r c e i v e d and t h e ob s e r v e d e f f e c t i v e n e s s o f communication was made. The S e t t i n g The s t u d y was conducted on two n u r s i n g u n i t s o f a 23 0 bed r e h a b i l i t a t i o n h o s p i t a l i n a P r a i r i e P r o v i n c e o f Canada. One u n i t was c l a s s i f i e d as an a d u l t p h y s i c a l r e h a b i l i t a t i o n ward, t h e o t h e r as an extended c a r e ward. A l s o i n c l u d e d i n t h i s s t u d y were s t a f f c a t e g o r i e s who p r o v i d e d i r e c t o r i n d i r e c t p a t i e n t c a r e . These a r e d e s c r i b e d below. The P o p u l a t i o n A l l t he p o p u l a t i o n o f t h e two s e l e c t e d wards were i n c l u d e d i n the s t u d y . The p o p u l a t i o n o f t h e a d u l t r e h a b i l i -t a t i o n u n i t c o n s i s t e d of 12 r e g i s t e r e d n u r s e s p l u s a ward c l e r k , whereas the extended c a r e u n i t had 14 r e g i s t e r e d n u r s e s , 19 nurse a t t e n d a n t s , 7 c e r t i f i e d n u r s i n g a s s i s t a n t s p l u s a ward c l e r k . Each u n i t had c o n t a c t w i t h 5 d i e t a r y s t a f f , 3 p o r t e r s , 3 s o c i a l 5 5 w o r k e r s , 5 s t a f f from t h e pharmacy, 5 s t a f f i n m e d i c a l r e c o r d s , 3 i n i n - s e r v i c e e d u c a t i o n , 4 n u r s i n g s u p e r v i s o r s o r a s s i s t a n t d i r e c t o r s o f n u r s i n g , 3 p h y s i c i a n s and 2 m e d i c a l s p e c i a l i s t s , 6 o c c u p a t i o n a l w o r k e r s , 8 housekeeping s t a f f , and 1 7 p h y s i c a l t h e r a p i s t s . These s t a f f c a t e g o r i e s a r e a l s o i n c l u d e d i n the st u d y . No new s t a f f member was i n v o l v e d i n the p o p u l a t i o n . PART A The Q u e s t i o n n a i r e The q u e s t i o n n a r e u t i l i z e d i n the p r e s e n t s t u d y (see Appendix A, page 1 0 4 ) , was a m o d i f i e d v e r s i o n o f the t o o l de-v e l o p e d by Georgopoulos and Mann i n t h e i r 1 9 6 2 s t u d y i n M i c h i g a n . The q u e s t i o n n a i r e c o v e r e d e i g h t b a s i c components o f communication w h i c h a f f e c t d i r e c t o r i n d i r e c t p a t i e n t c a r e . These i n c l u d e d communications r e l e v a n t t o p a t i e n t c a r e , s u p e r v i s i o n , team work, programme development, p e r s o n a l e v e n t s , s o l v i n g problems - d i f -f e r e n c e s o f o p i n i o n , and o v e r a l l h o s p i t a l communication. A d a p t a t i o n o f t h e Georgopoulos and Mann q u e s t i o n n a i r e was a c c o m p l i s h e d by h a v i n g each q u e s t i o n r e v i e w e d f i r s t by t h e p e r s o n i n charge o f each s p e c i a l i z e d h o s p i t a l s t a f f c a t e g o r y and s e c o n d l y by each s t a f f member i n c l u d e d i n a f i r s t and second p r e t e s t . These p r o c e d u r e s were conducted t o i n c r e a s e t h e c o n t e n t v a l i d i t y o f the q u e s t i o n n a i r e . A measure o f i n t e r n a l v a l i d i t y o f the q u e s t i o n n a i r e was o b t a i n e d by q u e s t i o n #8 w h i c h measured o v e r a l l p e r c e p t i o n s o f h o s p i t a l communication, i . e . , how p e o p l e p e r c e i v e t h e o v e r a l l Georgopoulos and Mann, op. c i t . , pp. 6 3 7 - 6 7 0 . 5 6 e f f e c t i v e n e s s o f t h e i r own communication s k i l l s . The P r e t e s t R e l i a b i l i t y and c l a r i t y o f the q u e s t i o n n a i r e were e s t a b l i s h e d as f o l l o w s . The q u e s t i o n n a i r e was a d m i n i s t e r e d t w i c e t o two groups o f h o s p i t a l s t a f f c a t e g o r i e s . The f i r s t group c o n s i s t e d o f 5, t h e second group o f 20 s t a f f members. The sample f o r p r e t e s t was o b t a i n e d t h r o u g h s t r a t i f i e d random s a m p l i n g . T h i s s a m p l i n g p r a c t i c e was used t o a s s u r e t h a t the f i n d i n g s were r e p r e s e n t a t i v e o f the p o p u l a t i o n under s t u d y . The t o t a l p o p u l a t i o n o f the h o s p i t a l system was grouped i n t o s t r a t a o f departments. The Department o f N u r s i n g was f u r t h e r grouped a c c o r d i n g t o the c l a s s i f i c a t i o n ; f o r example, r e g i s -t e r e d n u r s e , nurse a t t e n d a n t , ward c l e r k . The demographic d a t a c o n s i d e r e d when p l a n n i n g the q u e s t i o n n a i r e were e d u c a t i o n a l background - p r o f e s s i o n a l ( i . e . n u r s i n g ) v e r s u s n o n - p r o f e s s i o n a l ( i . e . d i e t a r y a i d s ) , , l e v e l o f comprehension - ( n o n - p r o f e s s i o n a l p o p u l a t i o n i n t h e s t u d y had grade V I I I e d u c a t i o n ) , and under-s t a n d i n g o f the E n g l i s h language ( s e v e r a l o f t h e s t u d y p o p u l a t i o n spoke U k r a i n i a n as t h e i r f i r s t language w i t h E n g l i s h as a second). F o l l o w i n g the c o m p l e t i o n o f the f i r s t p r e t e s t each of the 5 members were i n t e r v i e w e d and a l t e r a t i o n s made. The ques-t i o n n a i r e was p r e t e s t e d a g a i n and r e a c t i o n s a s s e s s e d . One hour was a l l o t t e d w i t h each respondent f o r c l a r i f i c a t i o n o f w o r d i n g , i n s t r u c t i o n s , r e l e v a n c e and p r e c i s i o n o f c o n t e n t . The q u e s t i o n -n a i r e was r e v i s e d t o i n c l u d e suggested changes. These i n c l u d e d e m p h a s i z i n g the s u b j e c t i v e p e r s o n a l communication by w r i t i n g s i g n i f i c a n t words i n c a p i t a l l e t t e r s and u n d e r l i n i n g . I n 57 a d d i t i o n , t h e term "my" was used i n q u e s t i o n #7. The i n i t i a l q u e s t i o n #2, " I n the a r e a o f d i r e c t i o n . . . . " was c o n v e r t e d i n t o two q u e s t i o n s t o r e a d "When I GIVE d i r e c t i o n . . . . " and "When I RECEIVE d i r e c t i o n . . . . " A l s o q u e s t i o n #1, " I n w o r k i n g r e l a t i o n s was m o d i f i e d t o " I n communications between m y s e l f and t h e f o l l o w i n g departments...." The q u e s t i o n measuring s t a f f m o rale o r j o b s a t i s f a c t i o n was d e l e t e d . The p a r t i c i p a n t s e x p r e s s e d t h e f e e l i n g t h a t t h i s i s an i s s u e w i t h i n r a t h e r t h a n between d e p a r t -ments. F u r t h e r m o r e , t h e response t o t h i s same q u e s t i o n would i n d i c a t e t h a t the communication happens but i t would n o t show whether t h e communication was p o s i t i v e o r n e g a t i v e i n a f f e c t . The i n i t i a l t h r e e p o i n t L i k e r t S c a l e used t o measure s u b j e c t i v e p e r c e p t i o n s o f h o s p i t a l group c a t e g o r i e s was expanded t o a f i v e p o i n t s c a l e t o c a p t u r e t h e f e e l i n g tone from the most to t he l e a s t e f f e c t i v e communication as p e r c e i v e d by r e s p o n d e n t s . F u r t h e r , use o f t h e f i v e p o i n t s c a l e p e r m i t t e d more d e f e n s i b l e use o f p a r a m e t r i c c o r r e l a t i o n a l a n a l y s i s o f t h e d a t a o b t a i n e d . F o r t h e same r e a s o n the p e r c e n t a g e s c a l e was added t o the f i v e p o i n t L i k e r t S c a l e . The p r e t e s t was a l s o u s e f u l t o d e t e r m i n e t h a t the p a r t i c i p a n t s c o u l d complete the q u e s t i o n n a i r e i n 2 0 m i n u t e s , the time a l l o c a t e d by the a d m i n i s t r a t i v e c o o r d i n a t o r of the h o s p i t a l system. S u b j e c t s t h a t were i n v o l v e d i n b o t h p r e t e s t s were e x c l u d e d from the s t u d y p o p u l a t i o n . Data C o l l e c t i o n P r o c e d u r e The purpose o f t h e s t u d y was d i s c u s s e d w i t h each d e p a r t -ment head i n charge o f each s p e c i a l i z e d s t a f f c a t e g o r y . Anonymity of t h e re s p o n d e n t s was emphasized f i r s t i n the " I n f o r m a t i o n and 58 G e n e r a l I n s t r u c t i o n s f o r C o m p l e t i o n o f Q u e s t i o n n a i r e " (see Appendix A, page 104) and by p r o v i d i n g each p a r t i c i p a n t w i t h an e n velope i n wh i c h t o s e a l the completed q u e s t i o n n a i r e . The q u e s t i o n n a i r e was d i s t r i b u t e d t o some group c a t e -g o r i e s a t a s c h e d u l e d meeting and t o o t h e r s as t h e y came on d u t y . The c a t e g o r i e s s t u d i e d were t h e major s p e c i a l i z e d f u n c -t i o n a l a r e a s i n t h e i n t e r l o c k e d h o s p i t a l system s u p p o r t i n g p a t i e n t c a r e . W i t h each s t a f f c a t e g o r y i n v o l v e d i n the s t u d y i t was e x p l a i n e d how much t h e i r p a r t i c i p a t i o n was o f v a l u e and t h a t w i t h o u t t h e i r i n v o l v e m e n t t h e s t u d y would n ot be as m e a n i n g f u l t o the h o s p i t a l . Any s t a f f members who were n o t p r e s e n t i n t h e h o s p i t a l a t t h e time o f t h e stu d y were m a i l e d a q u e s t i o n n a i r e o r i t was l e f t w i t h t h e i r p e e r s t o be completed when they r e t u r n e d t o work. PART B Data f o r Observed O b j e c t i v e Communication The same s i t e and p o p u l a t i o n was a l s o u t i l i z e d by an o t h e r 2 r e s e a r c h e r , M. E. M c G i l l . B oth s t u d i e s took p l a c e s i m u l t a n e o u s l y i n t h e summer o f 197 5. The purpose of t h e M c G i l l s t u d y was t o o b t a i n means o f h e l p i n g h o s p i t a l s t a f f u n d e r s t a n d how t h e y com-municate and t h e o b j e c t i v e o f her stu d y was t o adapt the Rob e r t B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s t o a more r e f i n e d r e s e a r c h M. E. M c G i l l , " O b s e r v a t i o n o f Communication B e h a v i o r : The Development o f a Res e a r c h Method f o r use i n H e a l t h Care O r g a n i z a t i o n s " ( u n p u b l i s h e d D o c t o r ' s d i s s e r t a t i o n , U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1976), pp. I I - I I I . method f o r s t u d y i n g i n t e r a c t i o n o f s m a l l groups. B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s I.P.A. i s a s e t o f 12 m u t u a l l y e x c l u s i v e c a t e g o r i e s of communicative b e h a v i o r w h i c h e n a b l e s i d e n t i f i c a t i o n o f t h e c h a r a c t e r i s t i c s o f communication between i n d i v i d u a l s and groups. The 12 c a t e g o r i e s a r e a r r a n g e d i n 2 p o l a r h i e r a r c h i e s i l l u s t r a t e d i n F i g u r e 1. C a t e g o r i e s a s s o c i a t e d w i t h s t r o n g p o s i t i v e and n e g a t i v e f e e l i n g tone a r e on e i t h e r end of the h i e r a r c h i e s whereas n e u t r a l a f f e c t i s i n t h e m i d d l e . T h i s s e t o f 12 mutu-a l l y e x c l u s i v e c a t e g o r i e s , when p l a c e d i n a who-to-whom m a t r i x e n a b le the c o n s t r u c t i o n o f a p r o f i l e o f i n t e r a c t i o n . 60 FIGURE 1 BALES' SYSTEM OF CATEGORIES USED IN OBSERVATION AND THEIR MAJOR RELATIONS Posi t i v e : 1. Shows s o l i d a r i t y / raises other's status, gives help, reward; 2. Shows tension release, jokes, laughs, shows s a t i s f a c t i o n ; 3. Agrees, shows passive acceptance, understands, concurs, complies; Neutral: 4. Gives suggestion, d i r e c t i o n , implying autonomy for other; 5. Gives opinion, evaluation, analysis, expresses f e e l i n g , wish; 6. Gives orientation, information, c l a r i f i e s , confirms; 7. Asks for orientation, information r e p e t i t i o n , confirmation; 8. Asks for opinion, evaluation, analysis, expression of f e e l i n g ; 9. Asks for suggestion, d i r e c t i o n , possible ways of action; Negative: 10. Disagrees, shows passive r e j e c t i o n , formality, withholds help; 11. Shows tension, asks for help, with-draws out of f i e l d ; 12. Shows antagonism, deflates other's status, defends or asserts s e l f . R. F. Bales, Interaction Process Analysis (Cambridge, Mass.: Addison-Wesley Press, 1950), p. 9. 61 Method o f A d a p t i n g M c G i l l ' s Data f o r t h e P r e s e n t Study B a l e s ' 12 c a t e g o r i e s o f p o s i t i v e , n e u t r a l , and n e g a t i v e f e e l i n g tone were somewhat a r b i t r a r i l y d i v i d e d i n t o s e c t i o n s f o r comparison w i t h t h e L i k e r t S c a l e of t h e I n t e r s t a f f Communication Q u e s t i o n n a i r e , d e s c r i b e d i n P a r t A. See F i g u r e 2. FIGURE 2 BALES' SYSTEM MATCHED WITH LIKERT SCALE OF THE QUESTIONNAIRE Observed Communication as p e r B a l e s ' 12 c a t e g o r i e s S e l f P e r c e i v e d E f f e c t i v e n e s s o f Communication as p e r q u e s t i o n n a i r e 1. Shows s o l i d a r i t y 2. Shows t e n s i o n r e l e a s e Most e f f e c t i v e 3. Agrees 4. G i v e s s u g g e s t i o n V e r y e f f e c t i v e 5. G i v e s o p i n i o n 6. G i v e s o r i e n t a t i o n M o d e r a t e l y e f f e c t i v e 7. Asks f o r o r i e n t a t i o n 8. Asks f o r o p i n i o n 9. Asks f o r s u g g e s t i o n Somewhat e f f e c t i v e 10. D i s a g r e e s 11. Shows t e n s i o n 12. Shows antagonism Not e f f e c t i v e 62 Methodology of Observed O b j e c t i v e Communication M c G i l l and her r e s e a r c h a s s i s t a n t assumed t h e r o l e o f n o n - p a r t i c i p a n t o b s e r v e r s . They f o c u s e d on how t h e s t a f f com-municated w i t h each o t h e r and t h e p a t i e n t s i n t h e d i f f e r e n t l o c i of t h e two s p e c i f i e d wards. T h e i r o b s e r v a t i o n s were r e c o r d e d and coded, phrase by p h r a s e , a c c o r d i n g t o t h e 12 c a t e g o r i e s o f B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . A l l o v e r t n o n - v e r b a l and f a c e - t o - f a c e d y a d i c v e r b a l i n t e r a c t i o n s were p l a c e d i n a who-to-whom B a l e s ' m a t r i x o f communication. S t a f f A were i d e n t i f i e d by t h e t i t l e o f t h e i r p o s i t i o n . Type o f Data R e s u l t i n g The raw d a t a o f who speaks t o whom and how was c o l l e c t e d and p u t i n t o a communication p r o f i l e . Such p r o f i l e i s a graph o f t h e c o n v e r s a t i o n o f a dyad. F o r example, a d o c t o r s p e a k i n g t o a nurse and a n u r s e s p e a k i n g t o a d o c t o r and showing t h e pe r c e n t a g e o f communication a c t s from each o f B a l e s ' 12 c a t e -g o r i e s o f communicative b e h a v i o r c o n s t i t u t e s a n u r s e - d o c t o r p r o f i l e . Data o f any p a i r o f s t a f f p o s i t i o n s were combined t o 5 a l l o w f o r an o v e r a l l communication p a t t e r n p r o f i l e . M c G i l l , op. c i t . , pp. 66-72 5 I b i d . , pp. 85-99. 63 The A n a l y s i s used t o T e s t t h e H y p o t h e s i s A n a l y s i s o f the I n t e r s t a f f Communication Q u e s t i o n n a i r e l o o k e d a t n u r s i n g p e r s o n n e l communicating w i t h n o n - n u r s i n g p e r -s o n n e l and the r e v e r s e . From the d a t a , a b s o l u t e f r e q u e n c y t a b l e s were d e r i v e d and c o n v e r t e d i n t o r e l a t i v e f r e q u e n c i e s e x p r e s s e d i n p e r c e n t a g e s . These r e s u l t s were f i n a l l y compared by means of b a r graphs. R e s u l t s o f t h e I n t e r s t a f f Communication Q u e s t i o n n a i r e measuring p e r c e i v e d communication a b i l i t y were a l s o compared w i t h the r e s u l t s o f B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s measuring o b s e r v e d communication a c t s o r a b i l i t y . Once a g a i n , a b s o l u t e response f r e q u e n c y t a b l e s were c o n v e r t e d i n t o r e l a t i v e v a l u e s e x p r e s s e d i n p e r c e n t a g e s . These were then d e p i c t e d i n bar graphs showing a comparison between p e r c e i v e d and obse r v e d communication a b i l i t y . 64 CHAPTER IV ANALYSIS OF THE DATA T h i s c h a p t e r p r e s e n t s the d a t a o b t a i n e d by t h e method d e s c r i b e d i n Chapter I I I . The d e t a i l s a v a i l a b l e from t h e q u e s t i o n n a i r e and a v a i l a b l e power o f computer a n a l y s i s p e r -m i t t e d t h e e v a l u a t i o n o f s e l f p e r c e p t i o n o f the e f f e c t i v e n e s s o f communication o f h o s p i t a l groups w i t h each o t h e r . Conse-q u e n t l y the d a t a a r e aggregated showing t h e p e r c e p t i o n o f n u r s i n g communicating w i t h n o n - n u r s i n g p e r s o n n e l , and non-n u r s i n g communicating w i t h n u r s i n g p e r s o n n e l . T h i s a n a l y s i s w i l l be r e p o r t e d i n P a r t A. In terms o f t h e h y p o t h e s i s the p e r c e i v e d s u b j e c t i v e d a t a and ob s e r v e d o b j e c t i v e d a t a were compared. The p e r c e i v e d s u b j e c t i v e d a t a were o b t a i n e d by t h e e i g h t h q u e s t i o n o f t h e I n t e r s t a f f Communication Q u e s t i o n n a i r e ; t h e ob s e r v e d o b j e c t i v e d a t a were o b t a i n e d from the r e s u l t s o f a n o t h e r s t u d y u s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . T h i s p a r t o f t h e s t u d y w i l l be r e p o r t e d i n P a r t B o f t h i s c h a p t e r . The non-aggregated, d e t a i l e d r e s u l t s o f b o t h p a r t s A and B a r e g i v e n i n Appendices B t o I . F i r s t , t h e p e r c e i v e d e f f e c t i v e n e s s o f t h e n u r s i n g group communicating w i t h the n o n - n u r s i n g group was compared. The 8 q u e s t i o n s d e v e l o p e d f o r t h i s s t u d y from the work o f Georgopoulos and Mann d e s c r i b e the v a r i o u s a s p e c t s o f h o s p i t a l communication. The f i r s t p a r t o f the a n a l y s i s d i v i d e s the p o p u l a t i o n i n t o two groups; n u r s i n g and n o n - n u r s i n g , and shows the d i f f e r e n c e s o f t h e s u b j e c t i v e i m p r e s s i o n s o f n u r s i n g p e r s o n n e l ' s a b i l i t y t o communicate t o o t h e r s t a f f c a t e g o r i e s w i t h i n t h e h o s p i t a l system. T h i s p e r c e p t i o n i s compared w i t h the o t h e r n o n - n u r s i n g c a t e g o r i e s ' p e r c e i v e d a b i l i t y t o communicate w i t h n u r s i n g . The r e s u l t s a r e summarized by bar graphs. I n a l l c a s e s , n u r s i n g p e r s o n n e l p e r -c e i v e t hemselves t o be more e f f e c t i v e communicators w i t h o t h e r s than o t h e r groups p e r c e i v e t hemselves as b e i n g a b l e t o communi-c a t e w i t h n u r s i n g . As d e s c r i b e d i n Ch a p t e r I I I (p.58 ) , a s i m u l t a n e o u s s t u d y on t h e same p o p u l a t i o n u t i l i z i n g B a l e s ' I n t e r a c t i o n P r o -c e s s A n a l y s i s t o e v a l u a t e o b j e c t i v e l y t h e observed communication e f f e c t i v e n e s s o f the v a r i o u s s t a f f c a t e g o r i e s was performed by ano t h e r r e s e a r c h e r . A p p r o x i m a t e l y 7000 communication a c t s were r e c o r d e d . Q u e s t i o n 8 from t h e I n t e r s t a f f Communication Q u e s t i o n -n a i r e , w h i c h a d d r e s s e d p e r c e i v e d o v e r a l l communication e f f e c -t i v e n e s s p e r c a t e g o r y was compared w i t h o b s e r v e d o v e r a l l e f f e c t i v e n e s s p e r c a t e g o r y o f t h e same p o p u l a t i o n . The 12 B a l e s ' r e s ponse c a t e g o r i e s were c o l l a p s e d i n t o 5 c a t e g o r i e s t o c o r r e s -pond w i t h t h e 5 c a t e g o r i e s o f t h e L i k e r t S c a l e used i n t h e q u e s t i o n n a i r e . From t h i s , an o v e r a l l c o m parison o f p e r c e i v e d v e r s u s o b s e r v e d communication was made. N u r s i n g was grouped as a c a t e g o r y and compared w i t h o t h e r c a t e g o r i e s s t u d i e d . Each h o s p i t a l s t a f f c a t e g o r y was a n a l y s e d f o r p e r c e i v e d and obser v e d communication e f f e c t i v e n e s s w i t h t h e o t h e r 10. To o b t a i n sub-j e c t i v e d a t a 165 q u e s t i o n n a i r e s were d i s t r i b u t e d and a l l were r e t u r n e d . 66 A n a l y s i s o f P a r t A and B o f t h e Study F o r comparison the raw s c o r e s o f t h e I n t e r s t a f f Com-m u n i c a t i o n Q u e s t i o n n a i r e , (the s e l f - e v a l u a t e d a b i l i t y t o com-municate) , and t h e s c o r e s o b t a i n e d by means o f B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s , (the o b s e r v e d a b i l i t y t o communicate), were c o n v e r t e d from a b s o l u t e f r e q u e n c i e s i n t o r e l a t i v e f r e q u e n c i e s e x p r e s s e d i n p e r c e n t a g e s . Bar graphs show t h e degree o f c o r -r e l a t i o n between p e r c e i v e d s u b j e c t i v e communication and o b s e r v e d o b j e c t i v e communication e f f e c t i v e n e s s . The aim o f t h e s t u d y was t o g i v e d e p t h t o t h e d e s c r i p t i v e i n f o r m a t i o n , not t o d i s -c o v e r c a u s a l r e l a t i o n s h i p s . The t a b l e s o f raw d a t a a r e p r e s e n t e d i n Appendices B t o I . PART A A n a l y s i s o f Comparison o f P e r c e i v e d Communication E f f e c t i v e n e s s  Between N u r s i n g and A l l Other C a t e g o r i e s o f H o s p i t a l S t a f f and  Between A l l Other C a t e g o r i e s o f H o s p i t a l S t a f f and N u r s i n g . The s u b j e c t i v e d a t a were c o l l e c t e d as d e s c r i b e d i n C h a p t e r I I I . A f r e q u e n c y count was done o f the r e s p o n s e s on the I n t e r s t a f f Communication Q u e s t i o n n a i r e and c o n v e r t e d i n t o r e l a t i v e f r e q u e n c i e s e x p r e s s e d i n p e r c e n t a g e s . Comparison d a t a i n c l u d e d n u r s i n g v e r s u s n o n - n u r s i n g , and n o n - n u r s i n g v e r s u s n u r s i n g p e r s o n n e l . D e t a i l e d and aggregated d a t a a r e shown i n the A p p e n d i c e s : ( i ) Appendix B, a b s o l u t e f r e q u e n c y t a b l e s ; ( i i ) Appendix C, f r e q u e n c y t a b l e s e x p r e s s e d i n r e l a t i v e p e r c e n -t a g e s ; ( i i i ) Appendix D, n u r s i n g c a t e g o r i e s and n o n - n u r s i n g c a t e g o r i e s grouped i n a b s o l u t e f r e q u e n c y t a b l e s ; and ( i v ) Appendix E, n u r s i n g c a t e g o r i e s and n o n - n u r s i n g c a t e g o r i e s grouped i n r e l a t i v e p e r c e n t a g e s . F i g u r e s 3 t o 10 summarize the r e s u l t s i n b a r graphs. 68 FIGURE 3*-COMPARISON OF SELF-PERCEPTION OF COMMUNICATION EFFECTIVENESS: NURSING TO NON-NURSING PERSONNEL AND NON-NURSING TO NURSING PERSONNEL ON QUESTION 1** C O •H -P fd u •H 3 O U m o Q) t7> rtJ +J CJ 0) u u <u 50 40 h 30 U 20 10 h 0 1 2 3 4 5 6 P e r c e i v e d E f f e c t i v e n e s s o f Communication F i g u r e 3 shows the r e s p o n s e s t o Q u e s t i o n 1 on t h e t o p i c o f p a t i e n t c a r e . The g r a p h i n d i c a t e s t h a t on an average t h e n u r s i n g group p e r c e i v e t h e i r a b i l i t y t o communicate w i t h o t h e r p e r s o n n e l as b e i n g more e f f e c t i v e t h a n t h a t o f n o n - n u r s i n g p e r -s o n n e l t o n u r s i n g . The " U s u a l l y No Communication" column on t h e g r a p h i s h i g h e r f o r t h e n o n - n u r s i n g group t h a n f o r t h e n u r s i n g group. T h i s p r o b a b l y i n d i c a t e s t h a t n u r s i n g p e r s o n n e l i n i t i a t e c ommunication w i t h o t h e r d e p a r tments more o f t e n about p a t i e n t c a r e t h a n any o t h e r group. *For Legend, p l e a s e see f o l d - o u t , page 76 * * Q u e s t i o n 1: " I n communications between m y s e l f and t h e f o l l o w i n g d e p a r t ments o r p o s i t i o n s r e g a r d i n g DIRECT o r IN-DIRECT PATIENT CARE, I would r a n k t h e e f f e c t i v e n e s s as: FIGURE 4* 69 COMPARISON OF SELF-PERCEPTION OF COMMUNICATION EFFECTIVENESS: NURSING TO NON-NURSING PERSONNEL AND NON-NURSING TO NURSING PERSONNEL ON QUESTION 2** O • H •P a u • H c 0 o u m o a> Ln (0 4-> C u <D ft 50 40 30 20 10 0 1 2 3 4 5 6 Perceived Effectiveness of Communication Figure 4 i l l u s t r a t e s responses to Question 2 on the subject of giving information. The responses indicate that nursing personnel judge themselves as being more e f f e c t i v e com-municators with non-nursing personnel than non-nursing personnel perceive themselves to be with nursing department. *For Legend, please see the fold-out, page 76. **Question 2: "When I GIVE d i r e c t i o n , i n s t r u c t i o n or advice to the following departments or pos i t i o n s , I would rank the effectiveness of the communication as:" FIGURE 5* 70 COMPARISON OF SELF-PERCEPTION OF COMMUNICATION EFFECTIVENESS: NURSING TO NON-NURSING PERSONNEL AND NON-NURSING TO NURSING PERSONNEL ON QUESTION 3** ' O -H +J fd u •H 0 O U o d) tn -P « O P4 50 40 30 20 10 0 1 2 3 4 5 6 P e r c e i v e d E f f e c t i v e n e s s o f Communication F i g u r e 5 d e m o n s t r a t e s t h e r e s p o n s e s t o Q u e s t i o n 3. The n u r s i n g groups' r e s p o n s e i n d i c a t e s t h e y a r e more e f f e c t i v e r e c e i v e r s o f i n f o r m a t i o n , t h e t o p i c o f Q u e s t i o n 3, t h a n non-n u r s i n g p e r s o n n e l . T h i s s u g g e s t s t h a t n o n - n u r s i n g p e r s o n n e l f u n c t i o n more i n d e p e n d e n t l y w i t h o u t r e c e i v i n g i n f o r m a t i o n from o t h e r departments t h a n n u r s i n g p e r s o n n e l . T h i r t y p e r c e n t o f n u r s i n g p e r s o n n e l f e e l t h e y n e v e r r e c e i v e i n f o r m a t i o n . . *For Legend, p l e a s e see t h e f o l d - o u t , page 76. * * Q u e s t i o n 3: "When I RECEIVE d i r e c t i o n , i n s t r u c t i o n o r a d v i c e from t h e f o l l o w i n g d e p a r tments o r p o s i t i o n s , I would rank t h e e f f e c t i v e n e s s o f t h e communication FIGURE 6* 71 COMPARISON OF SELF-PERCEPTION OF COMMUNICATION EFFECTIVENESS NURSING TO NON-NURSING PERSONNEL AND NON-NURSING TO NURSING PERSONNEL ON QUESTION 4** o •H 4J o -H c 50 0 0 40 CJ m 30 o <D 20 tn (0 nt 10 rc 0 CD 1 2 3 4 5 6 P e r c e i v e d E f f e c t i v e n e s s o f Communication F i g u r e 6 r e v e a l s t h e r e s p o n s e s on Q u e s t i o n 4, t h e e f f e c t i v e n e s s o f communication i n t h e a r e a o f team c o n f e r e n c e s . The n u r s i n g group p e r c e i v e s t h e m s e l v e s as more e f f e c t i v e communi-c a t o r s t o non-nurses t h a n t h e n o n - n u r s i n g group does t o n u r s e s . N e v e r t h e l e s s 40 p e r c e n t o f t h e n u r s i n g group do n o t c o n s i d e r t h e m s e l v e s members o f t h e team c o n f e r e n c e s , and an even h i g h e r p e r c e n t a g e o f n o n - n u r s i n g members p e r c e i v e t h e m s e l v e s i n t h e same manner as n o t e d by t h e " U s u a l l y No Communication" column. * F o r Legend, p l e a s e see t h e f o l d - o u t , page 76. * * Q u e s t i o n 4: " I n h e a l t h team a c t i v i t i e s (such as team c o n f e r e n c e s , c l i n i c s , o r s t a f f m e e t i ngs) I would r a n k t h e e f f e c t i v e n e s s o f t h e communication between m y s e l f and t h e f o l l o w i n g d e p a r t m e n t s o r p o s i t i o n s a s : " FIGURE 7* 72 COMPARISON OF SELF-PERCEPTION OF COMMUNICATION EFFECTIVENESS: NURSING TO NON-NURSING PERSONNEL AND NON-NURSING TO NURSING PERSONNEL ON QUESTION 5** o • H +J o •H 3 O CJ u-i O <u 0-1 -p CD u u o ft 50 40 30 20 10 0 1 2 3 4 5 6 P e r c e i v e d E f f e c t i v e n e s s o f Communication F i g u r e 7 d i s c l o s e s t h e r e s p o n s e s on Q u e s t i o n 5, t h e t o p i c o f p e r s o n a l e v e n t s . The n o n - n u r s i n g group p e r c e i v e s t h a t t h e y communicate more e f f e c t i v e l y t h a n n u r s i n g g r o u p s , a l t h o u g h t h e d i f f e r e n c e between t h e two groups i s s m a l l . Thus, when n o t com-m u n i c a t i n g on h e a l t h m a t t e r s t h e n o n - n u r s i n g group p e r c e i v e t h e i r communication w i t h t h e n u r s i n g department t o be as e f f e c t i v e as t h a t o f t h e n u r s i n g group w i t h t h e n o n - n u r s i n g group. I t i s i n t e r e s t i n g t o note t h a t a l a r g e number o f b o t h n u r s i n g (43.79%) and n o n - n u r s i n g (44.90%) p e r s o n n e l f e e l t h e y do n o t communicate on a p e r s o n a l l e v e l a t a l l . * F o r Legend, p l e a s e see t h e f o l d - o u t , page 76. * * Q u e s t i o n 5: "When I am t a l k i n g w i t h s t a f f members about p e r -s o n a l a c t i v i t i e s o r e v e n t s n ot a s s o c i a t e d w i t h t h e h o s p i t a l ( f o r example: f a m i l y o r s p o r t s ) , I would rank the. e f f e c t i v e n e s s o f t h e communication a s : " FIGURE 8* 73 COMPARISON OF SELF-PERCEPTION OF COMMUNICATION EFFECTIVENESS: NURSING TO NON-NURSING PERSONNEL AND NON-NURSING TO NURSING PERSONNEL ON QUESTION 6** C O •H 4-> rd u -.-I C g o u o CD Cr> rd - P c CD O U CD p-l 50 40 30 20 10 0 P e r c e i v e d E f f e c t i v e n e s s o f Communication F i g u r e 8 d e m o n s t r a t e s t h e r e s p o n s e s on Q u e s t i o n 6, t h e t o p i c o f s o l v i n g d i f f e r e n c e s o f o p i n i o n . The r e s p o n s e s o f b o t h n u r s i n g and n o n - n u r s i n g p e r s o n n e l i s about t h e same. A g a i n , t h e " U s u a l l y No Communication" column on t h e b-ir g r a p h i n d i c a t e s t h a t 40-50% o f b o t h groups t h i n k t h a t no communication t a k e s p l a c e . * F or Legend, p l e a s e see t h e f o l d - o u t , page 76. * * Q u e s t i o n 6: " I n r e s o l v i n g d i f f e r e n c e s o f o p i n i o n s o r m i s -u n d e r s t a n d i n g s i n w o r k i n g s i t u a t i o n s , I would rank t h e e f f e c t i v e n e s s o f t h e communication between m y s e l f and t h e f o l l o w i n g d e p a r tments o r p o s i t i o n s a s : " FIGURE 9* 74 COMPARISON OF SELF-PERCEPTION OF COMMUNICATION EFFECTIVENESS: NURSING TO NON-NURSING PERSONNEL AND NON-NURSING TO NURSING PERSONNEL ON QUESTION 7** " C O •H -U (d o •H c 3 o o m o 0) Cn rd -P (U u n <u PH 50 40 30 20 10 0 1 2 3 4 5 6 P e r c e i v e d E f f e c t i v e n e s s o f Communication F i g u r e 9 r e p r e s e n t s t h e r e s p o n s e s on Q u e s t i o n 7. t h e a r e a o f e x p r e s s i n g i d e a s o r o p i n i o n s . The d i f f e r e n c e o f r e s -ponses on t h i s q u e s t i o n between t h e n o n - n u r s i n g and n u r s i n g group i s s m a l l . B u t , 39.05% o f t h e n u r s i n g group and 48.63% o f t h e n o n - n u r s i n g group p e r c e i v e t h e m s e l v e s as n o t e x p r e s s i n g any s u g g e s t i o n s o r i d e a s . *For Legend, p l e a s e see t h e f o l d - o u t , page 76. * * Q u e s t i o n 7: "When I e x p r e s s MY i d e a s o r s u g g e s t i o n s t o t h e f o l l o w i n g d epartments o r p o s i t i o n s , I would r a n k th e e f f e c t i v e n e s s o f t h e communication a s : " FIGURE 10* 75 COMPARISON OF SELF-PERCEPTION OF COMMUNICATION EFFECTIVENESS: NURSING TO NON-NURSING PERSONNEL AND NON-NURSING TO NURSING PERSONNEL ON QUESTION 8** 50 -40 _ 20 -10 _ 0 t 1 I I I I 1 2 3 4 5 6 P e r c e i v e d E f f e c t i v e n e s s o f Communication F i g u r e 10 r e p o r t s t h e r e s p o n s e s on Q u e s t i o n 8, m e a s u r i n g t h e o v e r a l l p e r c e i v e d e f f e c t i v e n e s s o f communication w i t h i n t h e h o s p i t a l system. The n u r s i n g and n o n - n u r s i n g groups' r e s p o n s e s were a l m o s t i d e n t i c a l . A number o f b o t h groups see t h e m s e l v e s as n o t communicating w i t h o t h e r s a t a l l . * F o r Legend, p l e a s e see t h e f o l d - o u t , page 76. * * Q u e s t i o n 8: "As a summary, i n g e n e r a l I f e e l t h a t t h e OVERALL e f f e c t i v e n e s s o f t h e communication between m y s e l f and t h e f o l l o w i n g d epartments o r p o s i t i o n s i s : " '1 76 % • F 0 R F I G U R E S 3 - 1 1 T H E L E G E N D G I V E N BELOW I S A P P L I C A B L E : L e g e n d S e l f p e r c e p t i o n o f c o m m u n i c a t i o n e f f e c t i v e n e s s f r o m n u r s i n g t o n o n -n u r s i n g p e r s o n n e l S e l f p e r c e p t i o n o f c o m m u n i c a t i o n e f f e c t i v e n e s s f r o m n o n - n u r s i n g t o n u r s i n g p e r s o n n e l 1 M o s t E f f e c t i v e 2 V e r y E f f e c t i v e 3 M o d e r a t e l y E f f e c t i v e 4 S o m e w h a t E f f e c t i v e 5 N o t E f f e c t i v e 6 U s u a l l y No C o m m u n i c a t i o n 77 A d d i t i o n a l F i n d i n g s Noted i n Frequency T a b l e s I n r e f e r e n c e t o t h e f r e q u e n c y t a b l e s w i t h t h e n u r s i n g group i n Appendix C, i t can be shown t h a t w i t h t h e e x c e p t i o n o f T a b l e 15, the h i g h e r the p o s i t i o n , t h e h i g h e r t h e s e l f r a t i n g of p e r c e p t i o n o f communication e f f e c t i v e n e s s . I n s h o r t , a n u r s i n g a t t e n d a n t sees h e r s e l f as l e s s a b l e t o e f f e c t i v e l y com-municate t h a n a s u p e r v i s o r sees h e r s e l f , whether o t h e r s p e r c e i v e them i n t h e same manner o r n o t . A l t h o u g h o t h e r i n f e r e n c e s may be drawn from t h e f r e q u e n c y t a b l e s i n Appendix C, t h i s i s not w i t h i n the scope o f t h i s s t u d y . PART B A n a l y s i s o f Comparison o f P e r c e i v e d Communication E f f e c t i v e n e s s  ( I n t e r s t a f f Communication Q u e s t i o n n a i r e ) and Observed Communication  E f f e c t i v e n e s s ( B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s ) I n t h e second p a r t o f t h i s s t u d y , t h e e l e v e n h o s p i t a l s t a f f c a t e g o r i e s ' r e s p o n s e s o f p e r c e i v e d communication w i t h o b s e r v e d communication u s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s were compared. F o r r e l e v a n t a s p e c t o f methodology the r e a d e r i s r e f e r r e d t o C h a p t e r I I I . Each o f t h e e l e v e n major groups were e v a l u a t e d i n terms of t h e i r communication w i t h t h e r e s t w h i c h were combined i n one ag g r e g a t e group. To e v a l u a t e t h e h y p o t h e s i s , t h e p e r c e i v e d and observed communication o f one department i s compared w i t h t h e p e r c e i v e d and o b s e r v e d communication o f a l l o t h e r groups i n t h e h o s p i t a l system. The r e s u l t s o f t h e s e comparisons a r e p r e s e n t e d s i m i l a r l y as i n P a r t A. Appendices F t o I c o n t a i n t h e t a b l e s o f . 78 t h e s c o r e s . F i g u r e s 11-21 summarize th e r e s u l t s by b a r graphs. FIGURE 1 1 * COMPARISON OF DIETARY STAFF'S SELF-PERCEPTION USING INTERSTAFF COMMUNICATION QUESTIONNAIRE AND OBSERVED COMMUNICATION USING BALES' INTERACTION PROCESS ANALYSIS ' c O •H U) +J W flj CO > a u 0) o > m - r i o o \ CD m m cu M-l in w a o c o< o w -H CD -P « (0 o o c <D g tn g fti o +> u c cu m u o M CD ft 90 80 70 60 50 -4*0 -30 20 -10 -0 N=10 1 2 3 4 5 L i k e r t C a t e g o r i e s o f Communication E f f e c t i v e n e s s F i g u r e 11 i l l u s t r a t e s t h e D i e t a r y p e r s o n n e l ' s p e r c e p t i o n . They p e r c e i v e d t h e m s e l v e s as l e s s e f f e c t i v e communicators t h a n t h e y were o b s e r v e d t o be. A c c o r d i n g t o t h e d a t a , none p e r c e i v e d t h e m s e l v e s as most e f f e c t i v e , a l t h o u g h 25% o f them were ob s e r v e d as b e i n g most e f f e c t i v e , and none p e r c e i v e d t h e m s e l v e s as b e i n g n o n - e f f e c t i v e , y e t 7.76% were o b s e r v e d t o be n o n - e f f e c t i v e com-m u n i c a t o r s . *For Legend, p l e a s e see t h e f o l d - o u t , page 90. 80 FIGURE 1 2 * COMPARISON OF HOUSEKEEPING STAFF'S SELF-PERCEPTION USING INTER-STAFF COMMUNICATION QUESTIONNAIRE AND OBSERVED COMMUNICATION USING BALES' INTERACTION PROCESS ANALYSIS co C O •H CO +J cn rd cu > C U CU CD > CO -H XI +J O O \ a> CO M-l cu m co W o c A o CO -H <U 4J u o G CL) g t n g rd o -P u C cu m u o u CU P4 N=16 60 50 40 30 20 10 0 L i k e r t C a t e g o r i e s o f Communication E f f e c t i v e n e s s F i g u r e 12 d e m o n s t r a t e s t h e v a l u e l a d e n Housekeeping group's p e r c e p t i o n o f t h e e f f e c t i v e n e s s o f t h e i r c o mmunication. Housekeeping p e r s o n n e l a l s o p e r c e i v e t h e m s e l v e s as l e s s e f f e c t i v e communicators t h a n t h e o b s e r v a t i o n i n d i c a t e s . None o f them p e r -c e i v e d t h e m s e l v e s as most e f f e c t i v e , and y e t 2 8 . 8 7 % were o b s e r v e d t o be most e f f e c t i v e communicators. T h i r t y - t w o and o n e - h a l f p e r -c e n t p e r c e i v e d t h e m s e l v e s t o be n o n - e f f e c t i v e and 1 4 . 0 8 % were ob s e r v e d t o be n o n - e f f e c t i v e . * F o r Legend, p l e a s e see f o l d - o u t , page 90-81 FIGURE 13* COMPARISON OF MEDICAL RECORDS STAFF'S SELF-PERCEPTION USING INTERSTAFF COMMUNICATION QUESTIONNAIRE AND OBSERVED COMMUNICATION USING BALES' INTERACTION PROCESS ANALYSIS N=10 80 |-70 60 50 40 30 20 10 0 1 2 3 4 5 L i k e r t C a t e g o r i e s o f Communication E f f e c t i v e n e s s F i g u r e 13 d e m o n s t r a t e s t h a t t h e M e d i c a l Records group's p e r c e p t i o n , f o r t h e c a t e g o r y "Most E f f e c t i v e " , i n d i c a t e d t h a t 14.7% p e r c e i v e d t h e m s e l v e s t o be most e f f e c t i v e b u t 48.94% were o b s e r v e d t o be most e f f e c t i v e . None p e r c e i v e d t h e m s e l v e s as non-e f f e c t i v e communicators, however, 12% were o b s e r v e d t o be non-e f f e c t i v e communicators. * F o r Legend, p l e a s e see f o l d - o u t , page 90. 82 FIGURE 14* COMPARISON OF NURSING STAFF'S SELF-PERCEPTION USING INTERSTAFF COMMUNICATION QUESTIONNAIRE AND OBSERVED COMMUNICATION USING BALES' INTERACTION PROCESS ANALYSIS N=68 10 C 0 -H 10 +> to a CD > d u CD CD > W -H o U CD to m CD >W CO W o d ft 0 to • H CD - P ffj O •H o d CD t n td 0 -t-> o d CD 0 0 n CD 40 30 20 10 0 1 2 3 4 5 L i k e r t C a t e g o r i e s o f Communication E f f e c t i v e n e s s F i g u r e 14 r e v e a l s t h a t t h e N u r s i n g group i s f a i r l y a c c u r a t e i n t h e i r p e r c e p t i o n o f t h e e f f e c t i v e n e s s o f t h e i r c ommunication. F i f t e e n p e r c e n t p e r c e i v e d t h e m s e l v e s t o be most e f f e c t i v e communicators. Two and t h r e e - t e n t h s p e r c e n t f e l t t h e y communicated i n e f f e c t i v e l y , and 8.72% were o b s e r v e d t o communicate i n e f f e c t i v e l y . *For Legend, p l e a s e see t h e f o l d - o u t , page 90. 83 FIGURE 1 5 * COMPARISON OF WARD CLERK STAFF'S SELF-PERCEPTION USING INTER-STAFF COMMUNICATION QUESTIONNAIRE AND OBSERVED COMMUNICATION USING BALES' INTERACTION PROCESS ANALYSIS co C o •H - P > u CD CO O \ co CD co CI o co CD & m o CD Ln (C - P C CD O M 0) P-i CO CO CD C CD > •H •P O CD m W 80 7 0 60 50 o 40 o o 30 20 10 N=2 L i k e r t C a t e g o r i e s o f Communication E f f e c t i v e n e s s F i g u r e 15 d i s c l o s e s t h a t t h e Ward C l e r k s , as a gro u p , p e r c e i v e t h e m s e l v e s t o be b e t t e r t h a n t h e o b s e r v a t i o n i n d i c a t e s . S i x t y - n i n e and t w o - t e n t h s p e r c e n t p e r c e i v e d t h e m s e l v e s as b e i n g most e f f e c t i v e communicators, b u t o n l y 2 4 . 5 6 % were o b s e r v e d t o be most e f f e c t i v e . None p e r c e i v e d t h e m s e l v e s as n o n - e f f e c t i v e , a l t h o u g h 9.42% were o b s e r v e d t o be n o n - e f f e c t i v e . * F or Legend, p l e a s e see t h e f o l d - o u t , page 9 0 . 84 FIGURE 1 6 * COMPARISON OF OCCUPATIONAL THERAPY STAFF'S SELF-PERCEPTION USING INTERSTAFF COMMUNICATION QUESTIONNAIRE AND OBSERVED COMMUNICATION USING BALES' INTERACTION PROCESS ANALYSIS cn a o • H CO J J to rd CD > 'C U CD CD > 10 - H ,Q 4J O O • X CD to m CD 4-1 CO W a o a ft o CO -H CD -P & rd o o a CD § Cn g rd O +J U C CD m U O U CD 60 50 40 h 30 20 [-10 k 0 N=12 1 2 3 4 5 L i k e r t C a t e g o r i e s o f Communication E f f e c t i v e n e s s F i g u r e 16 i n d i c a t e s t h a t t h e O c c u p a t i o n a l Therapy group a l s o p e r c e i v e t h e m s e l v e s t o be l e s s e f f e c t i v e communicators. S i x and t w o - t e n t h s p e r c e n t p e r c e i v e d t h e m s e l v e s t o be most e f f e c t i v e , and 1 5 . 5 7 % were o b s e r v e d as b e i n g most e f f e c t i v e . Three and o n e - t e n t h p e r c e n t p e r c e i v e d t h e m s e l v e s as n o n - e f f e c t i v e , and 7.7 0% were o b s e r v e d as n o n - e f f e c t i v e . * F o r Legend, p l e a s e see t h e f o l d - o u t , page 9 0 . 85 FIGURE 17* COMPARISON OF PHARMACY STAFF'S SELF-PERCEPTION USING INTERSTAFF COMMUNICATION QUESTIONNAIRE AND OBSERVED COMMUNICATION USING BALES' INTERACTION PROCESS ANALYSIS to O •H tfl +J tfl (d CD > C 1^ CU CU > CO -rH X) -P O O \ CU co m <u m co w C O G ft o CO -H CU -P <d o m -H o d P cu g en g cd o •p u CU iH u o CD CU 60 50 40 30 20 h 10 0 t -N=10 1 2 3 4 5 L i k e r t C a t e g o r i e s o f Communication E f f e c t i v e n e s s F i g u r e 17 s u g g e s t s t h a t t h e Pharmacy, as a grou p , a l s o p e r c e i v e t h e m s e l v e s as b e i n g l e s s e f f e c t i v e communicators. O n l y 13.0% p e r c e i v e d t h e m s e l v e s as b e i n g most e f f e c t i v e , a l t h o u g h 25.51% were o b s e r v e d as b e i n g most e f f e c t i v e . None p e r c e i v e d t h e m s e l v e s as n o n - e f f e c t i v e , y e t 8.21% were o b s e r v e d as b e i n g n o n - e f f e c t i v e . * F o r Legend, p l e a s e see t h e f o l d - o u t , page 90. 86 FIGURE 1 8 * COMPARISON OF PHYSICAL THERAPY STAFF'S SELF-PERCEPTION USING INTERSTAFF COMMUNICATION QUESTIONNAIRE AND OBSERVED COMMUNICATION USING BALES' INTERACTION PROCESS ANALYSIS o -H 10 4-> 10 Cd CD > c U CU CD > to -H Xi 4-> O U \ <D to m to w o c ft o tO -r-i CD -p C< rd u o c ' CD g tn g rd O -P U (D m o o u CD PH N=34 60 50 40 30 20 10 0 1 2 3 4 5 L i k e r t C a t e g o r i e s o f Communication E f f e c t i v e n e s s F i g u r e 18 r e v e a l s t h a t t h e P h y s i c a l Therapy p e r s o n n e l a r e f a i r l y a c c u r a t e i n t h e i r p e r c e p t i o n o f t h e i r c ommunicative a b i l i t i e s . Twenty and t w o - t e n t h s p e r c e n t p e r c e i v e d t h e m s e l v e s as b e i n g most e f f e c t i v e and 2 0 . 6 7 % were o b s e r v e d as b e i n g most e f f e c t i v e communicators. One and o n e - h a l f p e r c e n t p e r c e i v e d t h e m s e l v e s as b e i n g n o n - e f f e c t i v e , and 7 . 9 5 % were o b s e r v e d as b e i n g n o n - e f f e c t i v e communicators. *For Legend, p l e a s e see t h e f o l d - o u t , page 9 0 . 87 FIGURE 19* COMPARISON OF PHYSICIANS STAFF'S SELF-PERCEPTION USING INTER-STAFF COMMUNICATION QUESTIONNAIRE AND OBSERVED COMMUNICATION USING BALES' INTERACTION PROCESS ANALYSIS tO O •H tfl -P tfl <d 0) > a u 0) CD > tfl -H A -P o u \ CD Cfl H-t o m tfl w £ o £ ft o tfl -H a) -p o o c a) g t?i B tcf O •P u CD ip u o u <D N=10 80 70 60 50 40 30 20 10 0 1 2 3 4 5 L i k e r t C a t e g o r i e s o f Communication E f f e c t i v e n e s s F i g u r e 19 i n d i c a t e s t h a t t h e P h y s i c i a n s , as a group, p e r c e i v e t h e m s e l v e s a l s o as b e i n g l e s s e f f e c t i v e communicators. E l e v e n p e r c e n t p e r c e i v e d t h e m s e l v e s as b e i n g most e f f e c t i v e , and 14.90% were o b s e r v e d as most e f f e c t i v e . Two and t w o - t e n t h s p e r c e n t p e r c e i v e d t h e m s e l v e s as b e i n g n o n - e f f e c t i v e , and 4.73% were o b s e r v e d t o be n o n - e f f e c t i v e . F o r Legend, p l e a s e see t h e f o l d - o u t , page 90. FIGURE 20* 88 COMPARISON OF PORTERS STAFF'S SELF-PERCEPTION USING INTERSTAFF COMMUNICATION QUESTIONNAIRE AND OBSERVED COMMUNICATION USING BALES' INTERACTION PROCESS ANALYSIS N=6 to c 0 •H to 4-> to rd CO > c U cu > to XX -P O o \ CO to m 0) m to w a o a ft 0 to •H o -p « rd u m o 0) g tn cd 0 •P CJ C o 0 M (1) CM 60 50 40 30 20 10 h 0 , " j " 1 2 3 4 5 L i k e r t C a t e g o r i e s o f Communication E f f e c t i v e n e s s F i g u r e 20 r e p o r t s t h a t t h e P o r t e r s , as a gro u p , p e r c e i v e t h e m s e l v e s as b e t t e r communicators. T h i r t y - s e v e n and n i n e - t e n t h s p e r c e n t p e r c e i v e d t h e m s e l v e s as b e i n g most e f f e c t i v e , and 30.55% were o b s e r v e d as b e i n g most e f f e c t i v e . None p e r c e i v e d t h e m s e l v e s as n o n - e f f e c t i v e , a l t h o u g h 7.49% were o b s e r v e d as b e i n g non-e f f e c t i v e . * F o r Legend, p l e a s e see t h e f o l d - o u t , page 90. 89 FIGURE 21* COMPARISON OF SOCIAL SERVICE STAFF'S SELF-PERCEPTION USING INTERSTAFF COMMUNICATION QUESTIONNAIRE AND OBSERVED COMMUNICATION USING BALES' INTERACTION PROCESS ANALYSIS CO C o •H CO -P CO (d CD > U CD CD > co •rH X) -P O U \ CD CO m CD M-l CO w c 0 P-< o CO •H CD -p (d u in •H o C CD g tn id 0 -P CJ a CD U-! u 0 n CD ft N=6 60 40 1 2 3 4 5 L i k e r t C a t e g o r i e s o f Communication E f f e c t i v e n e s s F i g u r e 21 shows t h a t t h e S o c i a l S e r v i c e group p e r c e i v e t h e m s e l v e s as b e i n g b e t t e r communicators. Twenty-nine and two-t e n t h s p e r c e n t p e r c e i v e d t h e m s e l v e s as b e i n g most e f f e c t i v e , b u t o n l y 17.35% were o b s e r v e d as b e i n g most e f f e c t i v e communicators. None p e r c e i v e d t h e m s e l v e s as b e i n g n o n - e f f e c t i v e , a l t h o u g h 8.84% were o b s e r v e d as b e i n g n o n - e f f e c t i v e . *For Legend, p l e a s e see t h e f o l d - o u t , page 90. FOR FIGURES 11 - 21 THE LEGEND GIVEN BELOW IS APPLICABLE Legend Observed Communication U s i n g B a l e s ' I.P.A. S e l f P e r c e i v e d Communication U s i n g I n t e r s t a f f Communication Q u e s t i o n n a i r e 1 Not E f f e c t i v e 2 Somewhat E f f e c t i v e 3 M o d e r a t e l y E f f e c t i v e 4 V e r y E f f e c t i v e 5 Most E f f e c t i v e 9 ! A d d i t i o n a l Comments on P a r t B R e s u l t s o f the second a s p e c t o f t h e s t u d y , P a r t B, i n d i c a t e t h a t h o s p i t a l groups' p e r c e p t i o n i s p r o b a b l y n o t a c c u r a t e . These f i n d i n g s f a i l t o s u p p o r t t h e n u l l h y p o t h e s i s t h a t t h e r e i s no d i f f e r e n c e between t h e p e r c e i v e d and ob s e r v e d communication e f f e c t i v e n e s s o f h o s p i t a l p e r s o n n e l c a t e g o r i e s . A l l p r o f e s s i o n a l g r o u p s , namely, m e d i c a l r e c o r d s , n u r s i n g , o c c u p a t i o n a l t h e r a p y , pharmacy, p h y s i c a l t h e r a p y , and m e d i c i n e , w i t h t h e e x c e p t i o n o f s o c i a l s e r v i c e , p e r c e i v e t h e m s e l v e s as l e s s e f f e c t i v e communicators t h a n t h e y were obse r v e d t o be. N o n - p r o f e s s i o n a l h o s p i t a l g r o u p s , namely, ward c l e r k s and p o r t e r s , w i t h t h e e x c e p t i o n of d i e t a r y and ho u s e k e e p i n g , p e r -c e i v e t h e m s e l v e s as more e f f e c t i v e t h a n t h e y were observed t o be. Summary P a r t A o f t h e s t u d y f o c u s e d on t h e comparison o f t h e e f f e c t i v e n e s s o f t h e communication o f n u r s i n g v e r s u s n o n - n u r s i n g p e r s o n n e l , and the reverse-, u t i l i z i n g a l l e i g h t q u e s t i o n s o f the I n t e r s t a f f Communication Q u e s t i o n n a i r e . P a r t B o f t h e st u d y examined p e r c e i v e d communication e f f e c t i v e n e s s ( q u e s t i o n -n a i r e ) v e r s u s the obser v e d communication ( B a l e s ' I.P.A.) o f each h o s p i t a l group i n r e l a t i o n t o a l l o t h e r s . Bar graphs were used f o r the comparison on b o t h P a r t A and B o f t h e s t u d y . 92 CHAPTER V SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS SUMMARY The purpose o f t h i s e x p l o r a t o r y s t u d y was t o compare the p e r c e i v e d s u b j e c t i v e p e r c e p t i o n o f communication e f f e c t i v e -ness o f h o s p i t a l p e r s o n n e l o f v a r i o u s c a t e g o r i e s , o b t a i n e d by an I n t e r s t a f f Communication Q u e s t i o n n a i r e , w i t h o b s e r v e d ob-j e c t i v e communication e f f e c t i v e n e s s , as measured u s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . T h i s s t u d y was d e s i g n e d t o e l i c i t i n f o r m a t i o n about h o s p i t a l group c a t e g o r i e s ' p e r c e p t i o n o f t h e i r a b i l i t y t o communicate w i t h o t h e r h e a l t h team members w i t h i n t h e h o s p i t a l system. The f o l l o w i n g h y p o t h e s i s was examined i n the s t u d y : "There i s no s i g n i f i c a n t d i f f e r e n c e between h o s p i t a l p e r s o n n e l ' s s e l f r a t i n g s o f t h e i r communication e f f e c t i v e n e s s as measured by means o f an I n t e r s t a f f Communication Q u e s t i o n n a i r e , and t h e i r o b served communication a c t s c o r e s w h i c h were o b t a i n e d t h r o u g h B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . A r e v i e w of s e l e c t e d l i t e r a t u r e , C h a p t e r I I , p r o v i d e d the p e r t i n e n t i n f o r m a t i o n on communication and p e r c e p t u a l p r o -c e s s e s i n g e n e r a l , and w i t h i n t h e h o s p i t a l system i n p a r t i c u l a r . The l i t e r a t u r e r e v e a l s t h e complex and s i g n i f i c a n t r o l e o f p e r c e p t i o n i n the communication p r o c e s s . I t d e f i n e s the im-p o r t a n c e o f c o n d i t i o n s w h i c h a r e c o n s i s t e n t w i t h t h e i n d i v i d u a l ' s s e l f c o n c e p t , e l i m i n a t e a n x i e t y and use o f de f e n s e mechanisms. 93 A c l i m a t e o f warmth and p o s i t i v e r e g a r d enhance human r e l a t i o n s and s u p p o r t the m a t r i x o f communication. I n s t r u m e n t s used t o o b t a i n r e l e v a n t d a t a f o r t h i s s t u d y were the I n t e r s t a f f Communication Q u e s t i o n n a i r e and B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . The q u e s t i o n n a i r e p r o v i d e d the d a t a o f s e l f - a s s e s s e d a b i l i t y o f h o s p i t a l p e r s o n n e l t o communi-c a t e . F i r s t e i g h t q u e s t i o n s on t h e v a r i o u s t o p i c s o f h o s p i t a l communication were a n a l y z e d and t h e n summarized on bar graphs t o show the c o m p a r i s o n of s e l f p e r c e p t i o n o f communication e f f e c t i v e n e s s between n u r s i n g t o n o n - n u r s i n g p e r s o n n e l and n o n - n u r s i n g t o n u r s i n g p e r s o n n e l . T h i s c o n s t i t u t e s P a r t A, the f i r s t a s p e c t o f t h e s t u d y . I n P a r t B, d a t a from o b j e c t i v e communication were used t o compare w i t h s u b j e c t i v e communication t o t e s t the h y p o t h e s i s o f t h i s s t u d y . The o b j e c t i v e d a t a came from a n o t h e r r e s e a r c h p r o j e c t t h a t u t i l i z e d B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s . The t i m e , s i t e , and p o p u l a t i o n f o r b o t h s t u d i e s were t h e same. The raw s c o r e s o f b o t h s t u d i e s were a n a l y z e d by t r a n s -l a t i n g a b s o l u t e f r e q u e n c i e s t o r e l a t i v e p e r c e n t a g e s and com-p a r i n g t h e v a l u e s o b t a i n e d oh p e r c e i v e d v e r s u s o b s e r v e d communication e f f e c t i v e n e s s . CONCLUSIONS The r e s u l t s o f t h e f i r s t a s p e c t o f t h i s s t u d y ( P a r t A) showed t h a t t h e more s e n i o r the n u r s i n g p e r s o n n e l , the more e f f e c t i v e t hey p e r c e i v e t h e i r a b i l i t y t o communicate. N u r s i n g 94 personnel perceived t h e i r a b i l i t y to communicate to non-nursing personnel as higher than the reverse. This symbolically repre-sents a communication breakdown because the nursing group rates themselves higher than other groups who are tryin g to communicate with nursing. The most alarming finding i n one sense i s the fac t that both groups indicate that i n the majority of situations they made no attempt to communicate. This i s contradictory to the generally held assumption that communication i s an int e g r a l part of good patient care. The re s u l t s of the second aspect of the study (Part B) disclosed that the hospital personnel's per-ception of the effectiveness of th e i r communication i s not i n accord with the findings of the observers. RECOMMENDATIONS The following recommendations are made for further follow-up i n view of the findings: 1. Regarding Research (a) Since 40-50% of a l l hospital s t a f f categories believe there i s no communication (Part A of thi s study) i t would be of int e r e s t to further investigate t h i s area of communication. (b) What i s the reason that nursing as a group perceive themselves as being more e f f e c t i v e communicators than a l l others? Examining the personality t r a i t s of d i f f e r e n t h ospital s t a f f categories might provide the answer. (c) The reason for professional groups' perceived low a b i l i t y to communicate versus non-professional groups' perceived high a b i l i t y to communicate might also be further explored. 95 2. R e g a r d i n g E d u c a t i o n (a) I n - s e r v i c e e d u c a t i o n i s recommended t o a s s i s t h o s p i t a l s t a f f t o improve t h e e f f e c t i v e n e s s o f communication. (b) The importance o f e s t a b l i s h i n g and m a i n t a i n i n g s a t i s f a c t o r y r e l a t i o n s h i p s among d i f f e r e n t s t a f f s h o u l d be emphasized t o improve th e q u a l i t y o f p a t i e n t c a r e w i t h i n the h o s p i t a l system. (c) The a b i l i t y t o communicate more e f f e c t i v e l y s h o u l d i n c r e a s e as t h e a n a l y s i s o f r e s e a r c h f i n d i n g s l e n d i n s i g h t t o communication. (d) C ourses s h o u l d be e s t a b l i s h e d t o h e l p employees u n d e r s t a n d t h e o r g a n i z a t i o n a l s t r u c t u r e , o r g a n i z a t i o n a l b e h a v i o r , and human performance w i t h i n t h e i n s t i t u t i o n . (e) E d u c a t i o n a l c o u r s e s s h o u l d aim t o i n c r e a s e communi-c a t i o n e f f e c t i v e n e s s among the h e a l t h team members. 3. R e g a r d i n g N u r s i n g and Other H o s p i t a l S t a f f C a t e g o r i e s (a) Nurses s h o u l d g a i n g r e a t e r u n d e r s t a n d i n g o f o t h e r h o s p i t a l p e r s o n n e l ' s i n t e r n a l and e x t e r n a l w o r l d o f r e a l i t y . (b) N u r s i n g as w e l l as o t h e r h o s p i t a l p e r s o n n e l s h o u l d be aware t h a t e f f e c t i v e communication means b e i n g s e n s i t i v e t o p e o p l e and t h e i r needs, and a l e r t t o t h e environment and f e e l i n g s . They must be f r e e t o r e c e i v e as w e l l as i n i t i a t e messages. The a b i l i t y t o meet each o t h e r s ' needs, p r o v i d e s feedback and i n c r e a s e s j o b s a t i s f a c t i o n . (c) H o s p i t a l p e r s o n n e l ' s knowledge and s k i l l s a r e b e s t u t i l i z e d i f t h o s e p e r s o n n e l a r e a l e r t t o g i v e as w e l l as r e c e i v e feedback. (d) As h o s p i t a l p e r s o n n e l p r o g r e s s i n t h e i r under-s t a n d i n g o f b e h a v i o r t h e y w i l l be l e s s l i k e l y t o r e a c t t o o t h e r s i n the p r o b l e m a t i c a l l y e m o t i o n a l way, t h u s c a u s i n g communication breakdown and m i s u n d e r s t a n d i n g . The o v e r a l l message o f t h i s s t u d y i s the seeming a b i l i t y o f i n d i v i d u a l s t o a c c u r a t e l y e v a l u a t e t h e i r own communication e f f e c t i v e n e s s . 97 BIBLIOGRAPHY BOOKS A l l p o r t , G.W. 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F o r r e s t , E l l i o t t B., " P e r c e p t i o n and Human Communication," American J o u r n a l o f Optometry and A r c h i v e s o f American  Academy o f Optometry, August, 1970, pp. 640-643. Georgopoulos, B a s i l S., "The H o s p i t a l System and N u r s i n g : Some B a s i c Problems and I s s u e s , " N u r s i n g Forum, v o l . V, no. 3, 1966, pp. 8-11. Greben, S.E., and o t h e r s , " P a t i e n t Care Co n f e r e n c e Means Communi-c a t i o n , " Dimensions i n H e a l t h S e r v i c e , A p r i l , 1975, p. 45. Grom, H e l l e n a Smejda, " U n r a v e l l i n g the M y s t e r y o f t h e Communication P r o c e s s , " H o s p i t a l F i n a n c i a l Manager, December, 1973, pp. 8-12. H a s t o r f , A.H., and C a n t r i l , H a d ley, "They Saw a Game: A Case Study," J o u r n a l o f Abnormal and S o c i a l P s y c h o l o g y , v o l . 49, 1954, pp. 129-234. Johnson, D.M., "A S y s t e m a t i c Treatment o f Judgment," Psycho- l o g i c a l B u l l e t i n , v o l . 42, 1945, pp. 193-224. K e l l e y , H.H., "The Warm-Cold V a r i a b l e i n F i r s t I m p r e s s i o n s o f P e r s o n s , " J o u r n a l o f P e r s o n a l i t y , v o l . 18, 1950, pp. 431-439. K e l l e r , Nancy S., "Care W i t h o u t C o o r d i n a t i o n , " N u r s i n g Forum, v o l . 6, no. 3, 1967. 102 Mason, D.J., "Judgements o f L e a d e r s h i p based upon Physiognomic Cues," J o u r n a l o f Abnormal and S o c i a l P s y c h o l o g y , v o l . 5 1958, pp. 431-439. Mathew, B.H., " S o c i a l O r g a n i z a t i o n o f H o s p i t a l s and P h y s i c i a n s , " J o u r n a l o f N u r s i n g A d m i n i s t r a t i o n , September/October, 1971, pp. 25-31. M i n t y , A b d u l . "Democracy and Communication," The L a n c e t , J u l y 24, 1971, p. 207. Maslow, A.H. "A Theory o f M o t i v a t i o n , " P s y c h o l o g i c a l Review, v o l . 50, 1943, pp. 370-396. Radtke, Maxine, and W i l s o n , A l a n , "Team C o n f e r e n c e s t h a t Work," American J o u r n a l o f N u r s i n g , March, 1973, pp. 506-508. Richelman, Bonnie L., "A C o n c e p t u a l Approach N u r s e - P a t i e n t I n t e r a c t i o n , " N u r s i n g R e s e a r c h , v o l . 20, no. 5, September/ O c t o b e r , 1971, p. 398. Rogers, C a r l . "Communication: I t s B l o c k i n g and F a c i l i t a t i n g , " N o r t h w e s t e r n U n i v e r s i t y I n f o r m a t i o n , v o l . 20, 1952, pp. 9-15. Ron a l d , C.G., "Very, V e r y I m p r e c i s e , " J o u r n a l o f t h e American M e d i c a l A s s o c i a t i o n , v o l . 203, no. 8, F e b r u a r y 19, 1968, pp. 141-142. S e c o r d , P a u l F., and B e r s c h e r d , E l l e n S., " S t e r e o t y p i n g and t h e G e n e r a l i t y o f I m p l i c i t P e r s o n a l i t y Theory," J o u r n a l o f  P e r s o n a l i t y , v o l . 31, 1963, pp. 65-78. Shoenberg, E l i z a b e t h , " B l o c k i n g Communications," The L a n c e t , J u l y 24, 1971, p. 206. Smi t h , C h a r l e s B., "Communication - An E s s e n t i a l o f R e a l i t y , " P e r s o n n e l J o u r n a l , August, 1974, pp. 601-625. Sm i t h , G.H., " S i z e - D i s t a n c e Judgements o f Human Fac e s , " The J o u r n a l o f G e n e r a l P s y c h o l o g y , v o l . 49, 1953, pp. 46-64. Smoyak, S h i r l e y A., "The C o n f r o n t a t i o n P r o c e s s , " American J o u r n a l o f N u r s i n g , v o l . 74, no. 9, September, 1974, pp. 1632-1635. S t e i n , L eonard, "The Doctor-Nurse Game," A r c h i v e s o f G e n e r a l  P s y c h i a t r y , v o l . 16, 1967, p. 699. S t i t e l y , D.M., "The Rol e o f the D i v i s i o n Head i n a D e c e n t r a l i z e d N u r s i n g S e r v i c e System," The N u r s i n g C l i n i c s o f N o r t h  A m e r i c a , June, 1973, p. 253. 103 S t r i c k l a n d , L.H., " S u r v e i l l a n c e and T r u s t , " J o u r n a l o f Psy- c h i a t r y , v o l . 26, 1958, pp. 200-215. V e n i n g a , R o b e r t , "Communications: A P a t i e n t ' s Eye View," American J o u r n a l o f N u r s i n g , F e b r u a r y , 1973, p. 322. W i t r y o l , Sam L., and Kaess, W a l t e r A., "Sex D i f f e r e n c e s i n S o c i a l Memory Tasks," The J o u r n a l o f Abnormal and  S o c i a l P s y c h o l o g y , v o l . 54, 1957, pp. 343-346. W i t t r e i c h , Warren J . , "The Honi Phenomenon: A Case o f S e l e c t i v e P e r c e p t u a l D i s t o r t i o n , " The J o u r n a l o f Abnormal and  S o c i a l P s y c h o l o g y , v o l . 47, 1952, pp. 705-712. W a l l , S i s t e r C l a r e D o l o r e s , "How t o B r i d g e t h e Communication Gap," H o s p i t a l P r o g r e s s , A p r i l , 1973, p. 30. Zima, Joseph P., " S e l f - A n a l y s i s I n v e n t o r y : An I n t e r p e r s o n a l Communication E x e r c i s e , " Speech Therapy, v o l . 20, March, 1971, pp. 108-114. UNPUBLISHED WORKS M c G i l l , E l i z a b e t h M., " O b s e r v a t i o n o f Communication B e h a v i o r : The Development o f a Res e a r c h Method f o r use i n H e a l t h Care O r g a n i z a t i o n s , " u n p u b l i s h e d D o c t o r ' s d i s s e r t a t i o n , U n i v e r s i t y o f B r i t i s h C o lumbia, 1976. 104 APPENDIX A \ (a) L e t t e r o f I n t r o d u c t i o n p r e s e n t e d t o s t a f f members » (b) I n f o r m a t i o n and G e n e r a l I n s t r u c t i o n s f o r c o m p l e t i o n o f I n t e r s t a f f Communication Q u e s t i o n n a i r e 5 (c) I n t e r s t a f f Communication Q u e s t i o n n a i r e * 105 THE UNIVERSITY OF BRITISH COLUMBIA VANCOUVER 8, CANADA ICHOOL OF NURSINC August, 1975. Dear S t a f f Member: This i s to introduce Marjeta Modrijan, a nursing student i n our Master's Program. She i s interested i n exploring d e t a i l s related to hospital communication emphasizing the e f f e c t s related to planning patient care. During the month of August she w i l l be p a r t i c i p a t i n g with Betty McGill and Peter Bowman to gather information regard-ing communication on your ward. Since they have begun a related study i n t h i s area, Miss Modrijan w i l l be coordina-t i n g her project with theirs in order to maxmize the outcome f o r both studies. Miss Modrijan's study deals with hospital personnel's feelings related to the effectiveness o f t h e i r communication. On behalf of the School o f Nursing we would l i k e to thank you f o r your p a r t i c i p a t i o n i n t h i s study. Sincerely, . JIHIA QUIRING. R.N., Ph.D., Graduate Program Advisor. MURIEL UPRICHARD, Director, Sr-hool of Nursing. 106 JNFORMATIC1I AND GENERAL INSTRUCTIONS FOR COMPLETION OP QUESTIONNAIRE Most of us spend at least part of our time on the job talking with other members of the hospital staff. While we talk about a wide variety of things we can roughly group our conversations into three broad categories. The first of these categories is conversations directly concerning patient care. The second is conversations about other things directly related to our Job such as asking for or receiving instructions about hospital policies, coordinating with others, problem solving, and so on. Finally, we talk about a lot of things that have no direct relationship to our work, such as our fanily,friends, the weather and griping about particular people, etc. A questionnaire dealing with these general areas has been developed. Various hospital staff categories have been identified. Vfe would like you first to identify the category to which you belong by checking the appropriate place in the listing at the top of the next page. As you proceed with the questionnaire in completing sections 1-8, please consider your conrnmications on the ward where you are working, and indicate how effective you feel these are as you communicate with the other staff members in each of the categories listed. You are to evaluate the effectiveness of your communication with other departments or staff positions by whether or not i t produces the  results you desire. For example, i f you are a registered nurse and you feel your coinnunicaticn related to patient care is usually very effective when you talk with dietary personnel, put a check mark (>/ ) in the "Very Effective" column. . Continue like this for each of the categories indicated. If you feel you have no communication with a particular category put a ( \zO in that column labelled "No CcOTiunicationn. When you have completed the questionnaire please place i t in the envelope provided, seal i t , and return i t to the specified box in your nursing unit or department. You are requested not to sign i t or give any information about yourself except to indicate the general classification of your job category and the ward(s) or program(s) cn which you are now working. Tnank you for completing the questionnaire. Findings will be available to you upon conpletion of the study. If you have any questions regarding the questionnaire please contact Mar j eta Jbdrfjan. 1 f)7 r i e a s c check ( \ / ) the category which app l ies to your department or p o s i t i o n : D ie tary * C .S .R . Housekeeping X-Iiay Medical Records Nurs ing Ass is tan t D i rec to r of Nursing (A,D.N.) or Superv isor C e r t i f i e d Nursing Ass is tan t (C.1J.A.) In -Serv ice Education Nurse Attendant , Registered Nurse , Ward Clerk Occupat ional Iherapy ITiurmncy P h y s i c a l Tterapy Phywician Porte r i ng S o c i a l Serv ice Please check ( V) the ward(s) or program(o) o r both on which you are now working;: Main west l 'alj i East , Second Wast Second East S ta t i on F ive S ta t i on S i x . Outpat ients Department Workers' Coirpensation Boarel Please p lace a check { V ) i n the colurni which most c l e a r l y descr ibes how you f e e l about the 1C-SULTS of your verbal coi;;:!unication w i th each o f the o t te r s t a f f ca tegor ies pertalj- i ing to each of the top ics s p e c i f i e d . I f you usua l l y do not contnunicate wi th that category on the v.ard(s) where you are work ing, check the "No Comnunlcatlcn" colurrn. 1. In cornrirjnications between myself and the f o l l ow ing departments o r pos i t i ons recording DT.KECT or IND11CCT PATIENT CAPE, I would rank t)» e f f ec t i veness a s ; .00? 15% 50% 25% 0? • H O • P C) W ^ -t &ti f> •H j' o > W a> r> l-> -H cO J-> S< <' <U c ) <.., at .<: JJ \< o $ W fi J J o o S i H I s -H P '\ n ii in o a. 0) (J 0- m Dietary housekeeping Medica l Hv cords Nurs ing - A.D.N, or Superv isor C.N.A. • In -Serv ice Education Nurse Attendant — Kep.i.slciv.d Nurse Ward Clerk Occupat ional Therapy Itinrmnc.y I l w s l c a l 'Jherap.v l l i y s l c l a n V o r t c r l n g — S o c i a l Serv ice Conntnts: 108 2. Vshen I GIVE d i r e c t i o n , i ns t ruc t i on or advice to the fo l l ow ing departncnta o r p o s i t i o n s , I would rank the ef fec t iveness of the co i imn ica t lon as : I.OO.5; 752 5055 25* . 02 Most • Effective S 4-> O &e .0) C-l > w >, >H p ( S j-> r-i 0 O (0 • Q 4-1 > r,l - w J-'. 4-> 0 g«s 0 <.-. si 0 a; W s O .).:> 11 to O 1 3 O Si a> "3 -S ft) c O a j r - i i-l Dietal-y Housekeeping Medical He cords Nursing - A.D.N, or Supervisor C.N.A. I n - Service Education Nurse Attendant Registered Nurse Ward Clerk Occupational Therapy Pharmacy Phys i ca l Therapy Phys ic ian Por te r ing S o c i a l Service Courrents: 3. VJhen I RECEIVE d i r e c t i o n , i n s t r uc t i on or advice from the fo l l ow ing departments or p o s i t i o n s , I would rank the ef fec t iveness of the corrmunication a s : 1003 752 50? 25% 0% Most Effective 1 O Moderately Effective Effective Not Effective c 0 • H 10 0 » 0 Please Leave Blank D ietary Housekeeping Medical Records Nursing - A.D.N, or Supervisor C.N.A. ' In-Serv ice Education Nurse Attendant Registered Nurse Ward Clerk Occupational Iherany Pham-acy Phys i ca l Therapy Physic ian Por te r ing S o c i a l Serv ice -I Contents: 109 l\. In hea l th team a c t i v i t i e s (such a s : team conferences, c l i n i c s , or s t a f f i ieetiJiEs) I would rank th> e f fec t iveness of the comironication between r e s e l l end the fo l low ing departments or pos i t i ons a s : loo? Dietary Housekeeplnf; I fedical Records Nurs ing - A. P.N. o r Supervisor C.N.A. In-Soi 'vice Education Nurse Attendant Rorr.1 s tered Nurse Ward Clerk Occupa t lo : ia 1 'i'nerapy _ Pharmacy Phys i ca l '.Therapy Ph.ysicJ.an  Porterlnp; S o c i a l Service Pi •r-t 1> t> 10 <M O 'M 75? iO? 0 1 P (Vi 4> i - i O C) o is?, 25? 0% O In IS W Corroents: 5. When I am t a l k i n g wi th s t a f f refers about personal a c t i v i t i e s °£ f ^ t s not associated w i th the hosp i t a l ( fo r example: fami ly o r s p o r t s ) , I would rank the e f fec t iveness of the communication as : 100? 4-> O in <^t is w 75? o> I 4 J o > t - i 25? 4J > X - . - P 4-> O si Dietary '• Housekeeping Medical Records FJursinp; - A .P .M. or Supervisor CJi._A. In-Serv ice Education Nurse Attendant  )<cp;istered Nurse Ward Clerk  Occupational Therapy  Pharmacy Phys i ca l Therapy  Phys ic ian  P o r t e r l n g  S o c i a l Serv ice Comments: 110 6. In reso lv ing d i f ferences of opinions or misunderstnndinES i n working s i t u a t i o n s , I would rank the ef fec t iveness of the coirarajnication between nt/self and t lx; fo l low ing departments or pos i t i ons a s : 10.02 752 502 252 02 i l Very Effective | | i f Not ! Effective 6 o 11 a H tu no Dietary Housekee j lng Medical records Nurs ing - A.D.M. or Suocrv isor C.H.A. In-Serv ice Education Nurse Attendant Refi istered Nurse V.'ard Cic-x-k Occupational Therapy Pharmacy Phys i ca l Therapy Phys ic ian Por te r ing S o c i a l Service Comrents: 7. When I express MY ideas o r suggestions to the fo l l ow ing departments or p o s i t i o n s , I would rank the e f fec t i veness o f the communication a s : 1002 752 502 252 02 J in Very Effective Moderately Effective 5 Not Effective Usually No Communication Please Leave Blank D ie tary Housekeeping Medical Records Nurs ing - A.D .N, o r Supervisor C.N.A. In-Serv ice Education Nurse Attendant Registered Nurse V.'ard Clerk Occupational Therapy Pharmacy Phys i ca l Therapy Phys ic ian Por ter Vr.g S o c i a l Serv ice ConrTCTJ'.s: I l l 8. As a summary, in general I feel that the OVERALL effectiveness of the communication between myself and the following departments or positions is: 1002 752 502 252 02 O 4^> , o P <M ' ?>' • H 01 <•-< > M Q) > •)-•• - H u o 0,1 CJ ' Q <.-• o <.-< 4-> > a ! - H . C 4> O %X O ;l> • H JJ o 0) 4-> <M O s 1-t O 4-' E C a l o >> - H Pi s 3 ; w o ;-> o a t t, 3 . ' 1 Dietary Housekeeping Medical Records Nursing - A.D.N, or Supervisor C.N.A. In-Service Education Nurse Attendant Registered Nurse l.v'ird Clerk Occupational Tneraoy Pharnacv Fnysical 'fherapy Physician Portering Social Service Conrc-nts: Thank You v. - APPENDIX B s o l u t e f r e q u e n c y count o f r e s p o n s e s o f t h e e l f - A s s e s s e d P e r c e p t i o n o f Communication E f f e c t i v e n e s s between N u r s i n g and Non-Nursing P e r s o n n e l on t h e i I n t e r s t a f f Communication Q u e s t i o n n a i r e , Q u e s t i o n s 1 t o 8. TABLE I 113 Q u e s t i o n 1. " I n communications between m y s e l f and t h e f o l l o w i n g departments o r p o s i t i o n s r e g a r d i n g DIRECT o r INDIRECT PATIENT CARE, I would rank t h e e f f e c t i v e n e s s a s : " N u r s i n g S t a f f C a t e g o r i e s S e l f - A s s e s s e d P e r c e p t i o n o f Communication E f f e c t i v e n e s s between th e m s e l v e s and Non-N u r s i n g P e r s o n n e l N D i e t a r y 10 5 26 11 5 1 19 1 Housekeeping 16 10 24 9 7 1 15 2 M e d i c a l Records 10 4 9 6 2 - 39 8 N u r s i n g - A.D.N, o r S u p e r v i s o r 24 21 12 7 - 1 3 C.N.A. 17 21 10 2 - 15 3 I n - S e r v i c e E d u c a t i o n 68 15 29 10 6 1 5 2 Nurse A t t e n d a n t 18 26 14 2 - 6 2 R e g i s t e r e d Nurse 21 36 9 - - 1 1 Ward C l e r k 26 29 4 1 1 6 1 O c c u p a t i o n a l Therapy 12 6 14 15 2 4 18 3 Pharmacy 10 13 17 9 1 4 16 8 P h y s i c a l Therapy 34 8 16 14 10 1 15 3 P h y s i c i a n 10 8 18 10 3 1 21 6 P o r t e r i n g 6 8 16 16 11 - 15 2 S o c i a l S e r v i c e 6 8 17 12 7 2 18 4 >i CD CD rH CD > > CD > •H •H -P -H •P •P <d-P O O 5-1 O -P CU >iCD <D CD wm T3»4H om CDHH OMH _ S H •H •H -P O-P CD o -P > CD o >1 <d-H MH > i H rH .C-P m rH G CU 15 O W rH 3 CD CD CD (0 | em -P 0 CO O o COW z Non-Nursing S t a f f C a t e g o r i e s S e l f - A s s e s s e d P e r c e p t i o n o f Communication E f f e c t i v e n e s s between themselves and N u r s i n g P e r s o n n e l .  D i e t a r y 10 9 9 5 3 2 66 3 Housekeeping 16 3 4 10 8 4 65 3 M e d i c a l Records 10 11 17 7 2 7 49 4 N u r s i n g - A.D.N, o r S u p e r v i s o r 6 19 17 10 2 34 9 C.N.A. - 10 18 3 3 50 13 I n - S e r v i c e E d u c a t i o n 68 4 18 11 3 - 53 8 Nurse A t t e n d a n t 1 17 18 4 2 46 9 R e g i s t e r e d Nurse 11 33 31 7 1 11 3 Ward C l e r k 18 33 23 1 1 18 3 O c c u p a t i o n a l Therapy 12 11 27 13 6 3 32 5 Pharmacy 10 11 13 7 4 3 52 7 P h y s i c a l Therapy 34 21 31 8 1 1 26 9 P h y s i c i a n 10 5 26 14 3 3 37 9 P o r t e r i n g 6 2 12 14 10 4 49 6 S o c i a l S e r v i c e 6 8 24 5 3 - 48 9 >1 CD CD rH CD > > CD > •H •rH -P -H -P •P m-p O O u o •P CD >i(D CD CD mm SHMH Tim OMH CDMH om >w S H CD c > 0 •H •iH -P O-P CD O -p > CD o >1 m rH .CP m rH C ft £ o w rH 3 CD CD CD flJ | DH gUH •P 3 § OMH O tfl 0 o CO W D O TABLE 2 114 Q u e s t i o n 2. "When I GIVE d i r e c t i o n , i n s t r u c t i o n o r a d v i c e t o t h e f o l l o w i n g departments o r p o s i t i o n s , I would rank t h e e f f e c t i v e -ness o f the communication a s : " N u r s i n g S t a f f C a t e g o r i e s CD >i rH CD CD CD NO ation S e l f - A s s e s s e d P e r c e p t i o n > •H > -H CD > - P - H -P > rd-H > •H o >i rH o f Communication -P •P (d -P .C -P -P rH a OJ E f f e c t i v e n e s s between O -P CD O >iCD 5-1 O CD CD S 'O <D CD O CD rH 3 id g CD PS themselves and Non- (flip Om 5-14-1 CDMH T3 4H om E ' H OMH - P m om d g W O o N u r s i n g P e r s o n n e l . N= SW >W CO W D i e t a r y 10 6 22 16 2 1 18 3 Housekeeping 16 12 22 12 4 2 13 3 M e d i c a l Records 10 4 10 6 - 1 43 4 N u r s i n g - A.D.N, o r S u p e r v i s o r 16 21 11 5 2 8 5 C.N.A. 16 20 10 - - 20 2 I n - S e r v i c e E d u c a t i o n 68 10 25 8 8 - 13 4 Nurse A t t e n d a n t 17 26 12 2 - 8 3 R e g i s t e r e d Nurse 19 33 5 2 - 5 4 Ward C l e r k 22 30 4 1 - 8 3 O c c u p a t i o n a l Therapy 12 7 10 10 9 1 28 3 Pharmacy 10 9 15 10 4 1 26 3 P h y s i c a l Therapy 34 6 12 11 6 - 29 4 P h y s i c i a n 10 5 13 10 4 - 32 4 P o r t e r i n g 6 8 16 13 5 - 21 5 S o c i a l S e r v i c e 6 5 13 10 6 1 30 3 O •H >i O - P CD CD i—1 CD CD CD Non-Nursing S t a f f C a t e g o r i e s > •H > •H CD > - P - H •P > td-H > •H o > r H >i rH S e l f - A s s e s s e d P e r c e p t i o n o f Communication E f f e c t i v e n e s s - P CJ •P CD -p u >i(D cd-P 5H O CD CD . C - P &o CD CD -P O CD rH C rH 0 id g a, CD « between themselves and mm om 5-m CDMH T3 m om gm om -pm om 3 g m o 0 N u r s i n g P e r s o n n e l . N= £w > W £ W cow iz w 13 D i e t a r y 10 8 9 3 2 1 65 8 Housekeeping 16 3 10 5 3 2 65 9 M e d i c a l Records 10 4 15 10 2 3 47 16 N u r s i n g - A.D.N, o r S u p e r v i s o r 5 20 12 3 2 41 14 C.N.A. 1 6 16 4 4 54 12 I n - S e r v i c e E d u c a t i o n 68 6 15 3 6 3 52 12 Nurse A t t e n d a n t 4 13 12 7 4 44 13 R e g i s t e r e d Nurse 12 22 25 7 4 16 11 Ward C l e r k 16 23 16 6 1 24 11 O c c u p a t i o n a l Therapy 12 11 23 11 3 3 33 13 Pharmacy 10 8 7 3 5 4 54 16 P h y s i c a l Therapy 34 20 21 11 - 3 27 15 P h y s i c i a n 10 3 28 15 1 5 29 16 P o r t e r i n g 6 4 15 10 7 6 44 11 S o c i a l S e r v i c e 6 5 25 8 1 3 43 12 TABLE 3 115 Q u e s t i o n 3. "When I RECEIVE d i r e c t i o n , i n s t r u c t i o n o r a d v i c e from t h e f o l l o w i n g departments o r p o s i t i o n s , I would rank t h e e f f e c -t i v e n e s s o f t h e communication a s : " N u r s i n g S t a f f C a t e g o r i e s cu >i r-l CU cu cu No ation S e l f - A s s e s s e d P e r c e p t i o n > -H > -rH CU > - P - H -p > > •H o >i r-H o f Communication -P -p rrj -P X I - P •P rH c Ot E f f e c t i v e n e s s between O •P CU o >iCU M O CU CU S o cu cu O CU ca | CU themselves and Non- CflH-l 04-1 s w M4-I CU4-4 >w M-l 0 M-l S W 04-1 cn w 4-> M-l 04-1 s w 3 e CO 0 PCJ o N u r s i n g P e r s o n n e l . . N= D i e t a r y 10 10 23 9 3 2 21 -Housekeeping 16 10 21 10 5 - 22 -M e d i c a l Records 10 4 11 7 2 - 39 5 N u r s i n g - A.D.N, o r S u p e r v i s o r 30 24 8 3 1 1 1 C.N.A. 18 21 7 - - 20 2 I n - S e r v i c e E d u c a t i o n 68 23 27 8 5 - 4 1 Nurse A t t e n d a n t 19 24 8 - - 15 2 R e g i s t e r e d Nurse 24 31 7 1 - 4 1 Ward C l e r k 22 27 7 - 1 9 2 O c c u p a t i o n a l Therapy 12 13 17 12 6 - 18 2 Pharmacy 10 12 18 8 3 - 22 5 P h y s i c a l Therapy 34 11 21 11 4 - 19 2 P h y s i c i a n 10 17 18 7 1 - 21 4 P o r t e r i n g 6 8 14 14 10 - 20 2 S o c i a l S e r v i c e 6 9 13 14 6 - 24 2 O •H >i O - P C U C U r H C U C U C U S r d Non-Nursing S t a f f C a t e g o r i e s > ><u>-P> > o > i S e l f - A s s e s s e d P e r c e p t i o n o f +j ^ ( 0 ^ ^ ^ 4 J r - i c c u Communication. E f f e c t i v e n e s s +) 8 oJ xo § 8 8 ^ 1 S between themselves and COM-I g>w +JM-I • T . , „ O 4-1 CU4-I OM-I 04-1 04-1 wo o N u r s i n g P e r s o n n e l . N= S;H > H S;H cnw g H P U ^ D i e t a r y 10 6 9 4 1 2 70 5 Housekeeping 16 6 10 3 3 1 68 6 M e d i c a l Records 10 12 9 5 3 2 55 11 N u r s i n g - A.D.N, o r S u p e r v i s o r 11 27 11 1 - 40 7 C.N.A. 1 12 12 2 2 60 8 I n - S e r v i c e E d u c a t i o n 68 7 18 10 4 3 44 11 Nurse A t t e n d a n t 3 15 15 2 2 50 10 R e g i s t e r e d Nurse 13 43 15 - 2 17 7 Ward C l e r k 17 34 12 4 - 21 9 O c c u p a t i o n a l Therapy 12 11 30 10 3 2 33 8 Pharmacy 10 10 11 3 4 2 53 14 P h y s i c a l Therapy 34 21 26 9 2 3 27 9 P h y s i c i a n 10 11 31 6 3 3 32 11 P o r t e r i n g 6 3 19 12 3 3 50 7 S o c i a l S e r v i c e 6 7 23 9 1 2 47 8 TABLE 4 116 Q u e s t i o n 4. " I n h e a l t h team a c t i v i t i e s (such a s : team c o n f e r e n c e s , c l i n i c s , o r s t a f f meetings) I would rank t h e e f f e c t i v e n e s s o f t h e communication between m y s e l f and t h e f o l l o w i n g departments o r po-s i t i o n s a s : " c o • H N u r s i n g S t a f f C a t e g o r i e s CD CD >i r H CD CD CD 0 4 - ) 3rd S e l f - A s s e s s e d P e r c e p t i o n > • H > • H CD > 4->-H -P > ( 0 - H > - H O > i H >i r H o f Communication -P •P tO-P .C-P -P r H C Ck E f f e c t i v e n e s s between o -P CD V >iCD M O CD CD S o CD CD o CD r H 3 rdg CD Pi themselves and Non-N= com om Mm cDm t S M H om gm om 4->m om dg cn o O N u r s i n g P e r s o n n e l . sw >w CO W DO D i e t a r y 10 6 13 10 6 - 28 5 Housekeeping 16 6 11 8 3 - 34 6 M e d i c a l Records 10 1 10 5 1 1 44 6 N u r s i n g - A.D.N, o r S u p e r v i s o r 18 23 5 7 - 11 4 C.N.A. 14 15 8 1 - 26 4 I n - S e r v i c e E d u c a t i o n 68 11 23 9 7 - 14 4 Nurse A t t e n d a n t 14 19 9 2 - 20 4 R e g i s t e r e d Nurse 19 30 5 1 - 9 4 Ward C l e r k 16 25 6 - - 17 4 O c c u p a t i o n a l Therapy 12 5 14 15 6 1 24 4 Pharmacy 10 7 16 6 1 2 31 5 P h y s i c a l Therapy 34 6 15 12 4 2 25 4 P h y s i c i a n 10 5 15 10 2 — 29 7 P o r t e r i n g 6 5 9 6 5 1 37 5 S o c i a l S e r v i c e 6 7 16 10 5 — 26 4 >i 0 • H O-P CD CD r H CD CD CD 3rd Non-Nursing S t a f f C a t e g o r i e s > • H > - H CD > 4 - l - H -P > rd-H > - H O > i H >i r H S e l f - A s s e s s e d P e r c e p t i o n o f 4-1 -P (0 4-> , C 4 - > 4-> r H C a, Communication E f f e c t i v e n e s s o 4->CD O >tCD u o CD CD £ O CD CD O CD r H 3 cdg CD between themselves and N= com om Mm com T3m om gm om 4->m om 3g COO 0 N u r s i n g P e r s o n n e l . sw >w SH CO w £ W p u & D i e t a r y 10 4 7 4 4 69 9 Housekeeping 16 4 2 3 4 1 70 13 M e d i c a l Records 10 2 4 4 2 — 70 15 N u r s i n g - A.D.N, o r S u p e r v i s o r 5 13 11 - - 54 14 C.N.A. - 7 8 2 - 66 14 I n - S e r v i c e E d u c a t i o n 68 2 7 4 2 - 67 . 15 Nurse A t t e n d a n t 2 7 9 1 - 62 16 R e g i s t e r e d Nurse 8 28 11 1 - 37 12 Ward C l e r k 3 7 11 1 1 60 14 O c c u p a t i o n a l Therapy 12 6 28 5 3 1 42 12 Pharmacy 10 7 6 9 4 2 52 17 P h y s i c a l Therapy 34 18 22 7 3 — 34 13 P h y s i c i a n 10 11 20 10 3 2 37 14 P o r t e r i n g 6 2 3 7 2 - 69 14 S o c i a l S e r v i c e 6 10 21 5 3 - 45 13 TABLE 5 117 Q u e s t i o n 5. "When I am t a l k i n g w i t h s t a f f members about p e r s o n a l a c t i v i t i e s o r ev e n t s n o t a s s o c i a t e d w i t h t h e h o s p i t a l ( f o r ex-ample: f a m i l y o r s p o r t s ) , I would rank t h e e f f e c t i v e n e s s o f t h e communication a s : " N u r s i n g S t a f f C a t e g o r i e s cu >i r H CU cu cu NO ation S e l f - A s s e s s e d P e r c e p t i o n > - H > • H CU > - P - H -p > rd-H > - H 0 > 1 - H > i r H o f Communication • P - P <d - P .C-P - P r H c CU E f f e c t i v e n e s s between O 4 J CD O > i C U U O CU CU £ O CU cu o CU r H 3 rd § CU OH themselves and Non- com om nm cum TJ m om em om -pm om 3 BCO o O N u r s i n g P e r s o n n e l . N= a w > w a w D CJ is D i e t a r y 10 7 9 10 2 — 34 6 Housekeeping 16 7 12 11 3 - 30 5 M e d i c a l Records 10 5 6 3 - - 47 7 N u r s i n g - A.D.N, o r S u p e r v i s o r 16 25 7 7 - 8 5 C.N.A. 11 19 11 5 - 17 5 I n - S e r v i c e E d u c a t i o n 68 12 21 9 6 - 16 4 Nurse A t t e n d a n t 15 21 13 5 - 10 4 R e g i s t e r e d Nurse 17 30 11 4 - 2 4 Ward C l e r k 17 21 11 5 - 11 3 O c c u p a t i o n a l Therapy 12 7 12 7 4 - 32 6 Pharmacy 10 8 14 8 5 - 27 6 P h y s i c a l Therapy 34 7 16 7 3 - 30 5 P h y s i c i a n 10 5 11 5 4 - 36 7 P o r t e r i n g 6 7 14 7 3 - 32 5 S o c i a l S e r v i c e 6 7 13 7 3 - 31 7 o - H >i O-P cu cu r H CU cu cu 2 fd Non-Nursing S t a f f C a t e g o r i e s > - H > - H CU > •P-H -p > rd-H > - H o >rH > i r H S e l f - A s s e s s e d P e r c e p t i o n o f -P -P rd -P X5-P -P r H CCommunication E f f e c t i v e n e s s O •P CU O > i C U U U CU CU S O CU cu O CU r H 3 rd i cu between themselves and com om r-im cum •am O m em om -Pm om 3 eco 0 o N u r s i n g P e r s o n n e l . N= aw > w a w WW £> U D i e t a r y 10 3 12 4 5 — 66 7 Housekeeping 16 4 15 5 13 1 50 9 M e d i c a l Records 10 9 10 6 5 - 58 9 N u r s i n g - A.D.N, o r S u p e r v i s o r 3 14 12 3 1 54 10 C.N.A. - 14 7 4 1 62 9 I n - S e r v i c e E d u c a t i o n 68 4 12 6 5 - 60 10 Nurse A t t e n d a n t 4 16 8 4 - 55 10 R e g i s t e r e d Nurse 7 26 17 6 - 32 9 Ward C l e r k 7 23 15 4 1 40 7 O c c u p a t i o n a l Therapy 12 5 26 16 5 - 36 9 Pharmacy 10 9 14 6 5 - 49 14 P h y s i c a l Therapy 34 11 29 10 4 1 33 9 P h y s i c i a n 10 1 14 7 8 5 53 9 P o r t e r i n g 6 3 16 13 6 1 47 11 S o c i a l S e r v i c e 6 2 24 7 6 - 49 9 TABLE 6 118 Q u e s t i o n 6. " I n r e s o l v i n g d i f f e r e n c e s o f o p i n i o n s o r m i s u n d e r s t a n d i n g s i n w o r k i n g s i t u a t i o n s , I would rank t h e e f f e c t i v e n e s s o f t h e com-m u n i c a t i o n between m y s e l f and t h e f o l l o w i n g departments o r p o s i t i o n s >i 0 -H O 4-) N u r s i n g S t a f f C a t e g o r i e s S e l f - A s s e s s e d P e r c e p t i o n Cl) > •H CU > -H rH CU CU > -P-H CU -p > m-H CU > •H S3 rd O >rH >t rH o f Communication 4-> u P O rd-P M O £,+> 13 O 4-1 O rH C rH 3 Cu CU E f f e c t i v e n e s s between -P CU >iCU CU CU CU CU CU rd g themselves and Non- com OM-J Mm cum Tim om gm om -P m o m ^ g CQ O o N u r s i n g P e r s o n n e l . N= SW > w 2W CO w 3 w S3 D i e t a r y 10 6 17 11 7 2 20 5 Housekeeping 16 7 20 9 6 1 21 4 M e d i c a l Records 10 2 9 6 2 - 44 5 N u r s i n g - A.D.N, o r S u p e r v i s o r 12 29 11 7 2 4 3 C.N.A. 7 25 10 4 - 18 4 I n - S e r v i c e E d u c a t i o n 68 8 27 10 10 - 10 3 Nurse A t t e n d a n t 10 24 17 4 1 9 3 R e g i s t e r e d Nurse 15 29 17 2 - 3 2 Ward C l e r k 14 29 10 2 1 9 3 O c c u p a t i o n a l Therapy 12 7 12 11 10 1 24 3 Pharmacy 10 8 16 11 3 2 23 5 P h y s i c a l Therapy 34 6 12 11 6 3 25 5 P h y s i c i a n 10 3 14 7 6 - 33 5 P o r t e r i n g 6 6 15 8 9 1 26 3 S o c i a l S e r v i c e 6 4 16 9 4 - 30 5 >i c 0 -H 04J CU CU rH CU CU CU S3 td >i rH Non-Nursing S t a f f C a t e g o r i e s > -H > •H CU > 4-1-H 4-1 > td-H > -H U >rH S e l f - A s s e s s e d P e r c e p t i o n o f -P O -p o rd4-l M O Xi 4-1 & O -P O rH C rH 3 04 CU Communication E f f e c t i v e n e s s 4-1 CU >iCU CU CU CU 0 CU rd g between themselves and cnm om Mm cum Tim om gm om 4-) m o m 3 g CO 0 0 N u r s i n g P e r s o n n e l . N= s w > w S B CO w S3 H DU S3 D i e t a r y 10 1 12 6 3 2 67 6 Housekeeping 16 3 9 9 4 - 65 7 M e d i c a l Records 10 5 8 8 2 4 60 10 N u r s i n g - A.D.N, o r S u p e r v i s o r 6 19 16 3 3 41 9 C.N.A. 1 10 17 2 2 57 8 I n - S e r v i c e E d u c a t i o n 68 1 19 6 2 2 60 7 Nurse A t t e n d a n t 1 15 15 4 2 52 8 R e g i s t e r e d Nurse 6 32 22 10 2 19 6 Ward C l e r k 11 25 21 4 2 27 7 O c c u p a t i o n a l Therapy 12 6 27 20 6 2 30 6 Pharmacy 10 5 8 5 8 2 57 12 P h y s i c a l Therapy 34 15 26 16 3 2 26 9 P h y s i c i a n 10 3 22 19 3 5 38 7 P o r t e r i n g 6 2 12 12 8 7 48 8 S o c i a l S e r v i c e 6 5 23 9 - 2 52 6 TABLE 7 1 Q u e s t i o n 7. "When I e x p r e s s MY i d e a s o r s u g g e s t i o n s t o t h e f o l l o w i n g departments o r p o s i t i o n s , I would rank the e f f e c t i v e n e s s o f t h e communication a s : " o •H N u r s i n g S t a f f C a t e g o r i e s CD CD >i rH CD CD CD O - P 3 rd S e l f - A s s e s s e d P e r c e p t i o n > > CD > •P > > O >. o f Communication -H 4-> -H -P • P - H rrj -P rrJ-H . C - P •H -P >TH rH a rH a, E f f e c t i v e n e s s between o -P CD O >iCD M O CD CD & O CD CD o CD rH 3 rd S CD themselves and Non- 104-1 M4-I TJ4-I £4-1 -P4H 3 s N u r s i n g P e r s o n n e l . N= 04-1 SW CD 4-1 >W 04-1 S H 04 - J . W W 0 4 H 3 H to O DU 0 3 D i e t a r y 10 5 18 11 6 6 17 5 Housekeeping 16 7 15 15 5 4 17 5 M e d i c a l Records 10 1 9 5 2 - 44 7 N u r s i n g - A.D.N, o r S u p e r v i s o r 11 22 17 8 3 2 5 C.N.A. 10 2 0 14 2 - 18 4 I n - S e r v i c e E d u c a t i o n 68 7 24 15 9 1 8 4 Nurse A t t e n d a n t 13 23 14 3 1 10 4 R e g i s t e r e d Nurse 13 29 17 2 1 2 4 Ward C l e r k 14 24 17 1 - 8 4 O c c u p a t i o n a l Therapy 12 4 10 13 7 1 28 5 Pharmacy 10 3 17 13 3 2 23 7 P h y s i c a l Therapy 34 4 9 12 8 2 28 5 P h y s i c i a n 10 2 14 9 6 1 29 7 P o r t e r i n g 6 3 14 13 6 2 25 5 S o c i a l S e r v i c e 6 5 13 12 3 1 28 6 o -H >i O - P CD CD rH CD CD CD 3 rd Non-Nursing S t a f f C a t e g o r i e s > •H > -H CD > • P - H - P > rd-H > -H O > r H rH S e l f - A s s e s s e d P e r c e p t i o n o f -P O - P O rd - P U O Xi -P £ o - P O rH fi rH 3 Q< CD Communication E f f e c t i v e n e s s •P CD >iCD CD CD CD CD CD rd § on between themselves and tO 4-1 04-1 rH4-4 CD 4-4 TJ4-J 04-1 £4-1 04-1 -P4-I 04-1 0 e to O O N u r s i n g P e r s o n n e l . N= sw >W S H Ul W 3 W DU 3 D i e t a r y 10 1 12 4 4 3 68 5 Housekeeping 16 6 5 10 6 1 65 4 M e d i c a l Records 10 3 10 5 3 3 65 8 N u r s i n g - A.D.N, o r S u p e r v i s o r 1 21 17 9 - 42 7 C.N.A. - 7 15 1 3 64 7 I n - S e r v i c e E d u c a t i o n 68 2 18 9 4 2 57 5 Nurse A t t e n d a n t 1 15 15 3 2 57 4 R e g i s t e r e d Nurse 6 28 24 9 2 24 4 Ward C l e r k 6 27 11 9 2 39 3 O c c u p a t i o n a l Therapy 12 6 26 21 5 2 34 3 Pharmacy 10 7 11 3 8 3 53 12 P h y s i c a l Therapy 34 13 25 17 3 2 32 5 P h y s i c i a n 10 6 24 20 2 3 37 5 P o r t e r i n g 6 2 12 13 9 4 51 6 S o c i a l S e r v i c e 6 3 23 8 . 2 2 54 5 TABLE 8 120 Q u e s t i o n 8. "As a summary, i n g e n e r a l I f e e l t h a t t h e OVERALL e f f e c -t i v e n e s s o f t h e communication between m y s e l f and th e f o l l o w i n g departments o r p o s i t i o n s i s : " o •H N u r s i n g S t a f f C a t e g o r i e s CU CU >i rH CU CU CU O - P 53 rd S e l f - A s s e s s e d P e r c e p t i o n > •H > -H CU >•P-H •P > rd-H > •H O >rH >i rH o f Communication -P O 4-1 CU 4-> O >iCU rd 4-> M O CU CU S O CU CU 4-1 O CU rH G rH 3 rd | cu CU OJ E f f e c t i v e n e s s between themselves and Non- com om Mm cum •cm om gMH om 4->m om 3 g CO O Qi N u r s i n g P e r s o n n e l . N= SH > w CO w 53 w D C J D i e t a r y 10 5 22 15 6 3 15 2 Housekeeping 16 7 23 15 6 1 15 1 M e d i c a l Records 10 1 11 7 4 - 41 4 N u r s i n g - A.D.N, o r S u p e r v i s o r 17 25 13 7 2 - 4 C.N.A. 11 21 14 2 - 17 3 I n - S e r v i c e E d u c a t i o n 68 16 25 13 6 1 3 4 N u r s i n g A t t e n d a n t 14 24 16 3 - 7 4 R e g i s t e r e d Nurse 16 34 11 2 1 1 3 Ward C l e r k 20 30 9 1 1 5 2 O c c u p a t i o n a l Therapy 12 8 11 16 8 2 20 3 Pharmacy 10 7 22 10 3 - 21 5 P h y s i c a l Therapy 34 7 14 14 7 2 21 3 P h y s i c i a n 10 4 19 12 3 - 25 5 P o r t e r i n g 6 8 16 15 7 1 19 2 S o c i a l S e r v i c e 6 5 19 12 5 - 22 5 >i c o •H 04-> CU cu rH CU cu cu 53 rd Non-Nursing S t a f f C a t e g o r i e s > •H > •H CU > 4-1-H 4-1 > rd-H > •H O > f H >i rH S e l f - A s s e s s e d P e r c e p t i o n o f -P 4-> td 4-1 •C.4-1 4-1 rH a CU Communication E f f e c t i v e n e s s V 4-> CU O >i 0) M O CU CU £ O CU CU O CU rd g CU « between themselves and N= com om Mm cum tim om gm om 4-im om 3 g co 0 0 N u r s i n g P e r s o n n e l . SW >H •a w CO w 53 H O O 53 D i e t a r y 10 7 13 4 4 3 63 3 Housekeeping 16 9 8 9 7 1 59 4 M e d i c a l Records 10 14 12 11 3 4 46 7 N u r s i n g - A.D.N, o r S u p e r v i s o r 4 30 17 4 - 35 7 C.N.A. 1 12 16 7 2 52 7 I n - S e r v i c e E d u c a t i o n 68 3 22 11 3 1 50 7 Nurse A t t e n d a n t 6 20 14 5 2 45 5 R e g i s t e r e d Nurse 13 36 27 3 2 12 4 Ward C l e r k 18 29 18 7 - 21 4 O c c u p a t i o n a l Therapy 12 12 30 15 5 2 30 3 Pharmacy 10 10 17 7 7 2 44 10 P h y s i c a l Therapy 34 18 23 15 4 3 28 6 P h y s i c i a n 10 4 27 18 3 2 36 7 P o r t e r i n g 6 3 13 13 8 6 46 8 S o c i a l S e r v i c e 6 11 21 9 2 2 47 5 APPENDIX C R e l a t i v e f r e q u e n c y count o f r e s p o n s e s ( i n p e r c e n t s ) o f the S e l f - A s s e s s e d P e r c e p t i o n o f Communication E f f e c t i v e n e s s between N u r s i n g and Non-Nursing P e r s o n n e l on t h e I n t e r s t a f f Communication Q u e s t i o n n a i r e , Q u e s t i o n s 1 t o 8. T A B L E 9 Q u e s t i o n 1. " In c o m m u n i c a t i o n s b e t w e e n N u r s i n g S t a f f C a t e g o r i e s ' S e l f - A s s e s s e d m y s e l f and t h e f o l l o w i n g P e r c e p t i o n o f C o m m u n i c a t i o n E f f e c t i v e n e s s d e p a r t m e n t s o r p o s i t i o n s r e - b e t w e e n t h e m s e l v e s a n d N o n - N u r s i n g P e r s o n n e l . g a r d i n g DIRECT o r INDIRECT  P A T I E N T C A R E , I w o u l d r a n k c t h e e f f e c t i v e n e s s a s : " .2 >1 O-P 0> ( D r H C D 0> 01 £; <d > > 01 > -P > > O >i •H -H 4-> -H tO -H -rH >,-H r-4. V U S - I U SO O H 3 01 •P(l) >i 01 0) 01 0)01 (1) (flE P4 mm Tj.m 4-1 44 3 E M _ O 44 01 4-1 O 44 OM-I O 44 WO O N - E W >W SW WH 2W DU 2 D i e t a r y 10 7 . 35 3 8 . 24 1 6 . 18 7 . 35 1. 47 2 7 . 94 1. 47 H o u s e k e e p i n g 16 14 . 71 3 5 . 29 1 3 . 24 1 0 . 29 1. 47 2 2 . 06 2 . 94 M e d i c a l R e c o r d s 10 5 . 88 1 3 . 24 8 . 82 2 . 94 0. 0 5 7 . 35 1 1 . 76 N u r s i n g - A . D . N , o r S u p e r v i s o r 3 5 . 29 3 0 . 88 1 7 . 65 1 0 . 29 0 . 0 1. 47 4. 41 C . N . A . 2 5 . 00 3 0 . 88 14 . 71 2 . 94 0. 0 2 2 . 06 4 . 41 I n - S e r v i c e E d u c a t i o n 68 2 2 . 06 4 2 . 65 1 4 . 71 8. 82 1. 47 7 . 35 2 . 94 N u r s e A t t e n d a n t 2 6 . 47 3 8 . 24 2 0 . 59 2 . 94 0 . 0 8 . 82 2 . 94 R e g i s t e r e d N u r s e 3 0 . 88 5 2 . 94 1 3 . 24 0. 0 0 . 0 1 . 47 1. 47 Ward C l e r k 3 8 . 24 4 2 . 65 5. 88 1. 47 47 . 8. 82 1. 47 O c c u p a t i o n a l T h e r a p y 12 8 . 82 2 0 . 59 2 2 . 06 1 1 . 76 5 . 88 2 6 . 47 4 . 41 P h a r m a c y ' 10 1 9 . 12 2 5 . 00 1 3 . 24 1 . 47 5. 88 2 3 . 53 1 1 . 76 P h y s i c a l T h e r a p y 34 1 1 . 76 2 3 . 53 2 0 . 59 14 . 71 2 . 94 2 2 . 06 4. 41 P h y s i c i a n 10 1 1 . 76 2 6 . 47 1 4 . 71 4 . 41 2 . 94 30 . 88 8 . 82 P o r t e r i n g 6 1 1 . 76 2 3 . 53 2 3 . 53 1 6 . 78 0 . 0 2 2 . 06 2 . 94 S o c i a l S e r v i c e 6 1 1 . 76 2 5 . 00 1 7 . 65 1 0 . 29 2 . 94 2 6 . 47 5 . 88 N o n - N u r s i n g S t a f f C a t e g o r i e s ' S e l f - A s s e s s e d P e r c e p t i o n o f C o m m u n i c a t i o n E f f e c t i v e n e s s b e t w e e n t h e m s e l v e s a n d N u r s i n g P e r s o n n e l . c o •rH N = >i 0 -P 0) H oi 01 0) Z ffl > > o > •P > > 0 >1 • H 4-1 - H <rj - H • r - l >1-H +J -P rrj -P Xi 4J -M r-4 C O O U O 3 U O .-1 D W S 0) 4-> tt) 0> 01 01 0) 01 « 01 44 u 44 73 44 e u-i •P 4-1 3 e 0 m 01 44 0 m 0 4-1 O 4-1 10 0 0 s a > w S W 2 W 3 U 10 9. ,28 9 . 28 5. ,15 3 . 09 7 . 06 68 . 04 3 . 09 16 4. 12 8. 25 10. 31 4 . 12 3 . 09 6 7 . 01 3 . 09 10 1 1 . 34 1 7 . 53 7. 22 2. 06 7 . 22 50 . 52 4 . 12 , 6 . 19 1 9 . 59 17 . 53 1 0 . 31 2 . 06 3 5 . 05 9 . 28 1 0 . 31 18 . 56 3 . 09 3 . 09 0. 0 5 1 . 55 1 3 . 40 68 4. 12 1 8 . 56 1 1 . 34 3 . 09 0 . 0 54 . 64 8 . 25 1. 03 1 7 . 53 18 . 56 4 . 12 2 . 06 4 7 . 42 9 . 28 1 1 . 34 34 . 02 31 . 96 7 . 92 1 . 03 1 1 . 44 3 . 09 1 0 . 56 34 . 02 2 3 . 71 1. 03 1. 03 1 8 . 56 3 . 09 12 1 1 . 34 2 7 . 84 13 . 40 6 . 19 3 . 09 3 2 . 99 5 . 15 10 1 1 . 34 1 3 . 40 7 . 22 4 . 12 3 . 09 5 3 . 61 7 . 22 34 2 1 . 65 3 1 . 96 8. 25 1. 03 1 . 03 2 6 . 80 9 . 28 10 5. 15 2 6 . 80 14 . 43 3 . 09 3 . 09 3 8 . 14 9 . 28 6 2 . 06 1 2 . 37 14. 43 1 0 . 31 4 . 12 5 0 . 52 6. 19 6 8 . 25 2 4 . 74 5 . 15 3 . 09 0 . 0 4 9 . 48 9 . 28 TABLE 10 Q u e s t i o n 2 . "When I GIVE d i r e c t i o n , i n s t r u c t i o n o r a d v i c e t o t h e f o l l o w i n g d e p a r t m e n t s o r p o s i t i o n s , I w o u l d r a n k t h e e f f e c t i v e n e s s o f t h e commu-n i c a t i o n a s : " N u r s i n g S t a f f C a t e g o r i e s ' S e l f - A s s e s s e d P e r c e p t i o n o f C o m m u n i c a t i o n - E f f e c t i v e n e s s b e t w e e n t h e m s e l v e s a n d N o n - N u r s i n g P e r s o n n e l . 0> > •H 4-> U •P 0) Ul MH N= S W 0> > •P o >i 0> U MH 0> MH > W rH d) 0) > 4-> -H rd -P n o (1) 01 rO MH O <+H s w c 0 •H O -P 01 01 Z rd -p > > 0 >i rd -H •H >i-H rH .C 4-> -p rH C a S O O rH 3 01 01 QJ 0) rd § a; e 4-) •P MH 3 e O <4H O m 01 O 0 . w w s w D U D i e t a r y 10 8 . 8 2 3 2 . 35 2 3 . 53 2 . 94 1. 47 26 . 47 4 . 41 H o u s e k e e p i n g 16 1 7 . 65 3 2 . 35 1 7 . 65 5 . 88 2 . 94 .19 . 12 4 . 41 M e d i c a l R e c o r d s u 1 0 5 . 88 8 . 82 14 . 71 1. 47 63 . 24 5 . 88 N u r s i n g - A . D . N , o r S u p e r v i s o r 2 3 . 53 30 . 88 1 6 . 18 7 . 35 2 . 94 1 1 . 76 7 . 35 C . N . A . 2 3 . 53 2 9 . 41 14 . 71 2 9 . 41 2. 94 I n - S e r v i c e E d u c a t i o n 68 1 4 . 7 1 3 6 . 76 1 1 . 76 1 1 . 76 1 9 . 12 5 . 88 N u r s e A t t e n d a n t 2 5 . 0 0 3 8 . 24 1 7 . 65 2 . 94 1 1 . 76 4 . 41 R e g i s t e r e d N u r s e 2 7 . 9 4 4 8 . 53 7 . 35 2 . 94 7 . 35 5 . 88 Ward C l e r k 3 2 . 3 5 44 . 12 5 . 88 1. 47 - 1 1 . 76 4 . 41 O c c u p a t i o n a l T h e r a p y 12 1 0 . 2 9 1 4 . 71 14 . 71 1 3 . 24 1. 47 4 1 . 18 4 . 41 P h a r m a c y 10 1 3 . 2 4 2 2 . 06 14 . 71 5 . 88 1. 47 38 . 24 4 . 41 P h y s i c a l T h e r a p y 34 8 . 8 2 1 7 . 65 1 6 . 18 8 . 82 - 4 2 . 65 5 . 88 P h y s i c i a n 10 7 . 3 5 1 9 . 12 1 4 . 71 5 . 88 - 4 7 . 06 5 . 88 P o r t e r i n g 6 1 1 . 7 6 2 3 . 53 1 9 . 12 7 . 35 - 3 0 . 88 7 . 35 S o c i a l S e r v i c e 6 7 . 3 5 1 9 . 12 14 . 71 8 . 82 1 . 47 44 . 12 4 . 41 N o n - N u r s i n g S t a f f C a t e g o r i e s ' S e l f - A s s e s s e d . P e r c e p t i o n o f C o m m u n i c a t i o n E f f e c t i v e n e s s b e t w e e n t h e m s e l v e s and N u r s i n g P e r s o n n e l . >! o •H O 4-1 0) rH 0) o> Z rd > > 0) > 4-> > > 0 >i •H •H •P -H rd -H •H >vH rH •P -P cd 4-1 X 4J 4-1 rH C OJ O O u 0 3 O O rH O 0) -p D >i 0) 0) 01 0) 0> 0) rd E a in <*4 U MH T) lP e t-i -P MH 3 e N= O *4H 01 <4H O MH O MH 0 W Ul O o w > W s w w a Z H z 10 8 25 9 . 28 '3.09 2 . 06 2 . 06 6 7 . 01 8 . 2 5 16 3 09 1 0 . 3 1 5 .15 3 . 0 9 2. 06 6 7 . 01 9 . 28 10 4 12 1 5 . 4 6 1 0 . 3 1 2 . 0 6 3 . 0 9 4 8 . 45 16 . 4 9 5. 15 20 . 62 12 .37 3 . 0 9 2 . 06 4 2 . 2 7 14 . 43 1 03 6 .19 16 .49 4 . 1 2 4 . 1 2 5 5 . 67 12 .37 68 6. 19 1 5 . 4 6 3 .09 6 . 1 9 3 . 0 9 5 3 . 61 12 . 37 4. 12 1 3 . 4 0 12 .37 7 . 2 2 4 . 1 2 4 5 . 3 6 13 . 4 0 12 . 37 2 2 . 68 25 .77 7 . 2 2 4 . 1 2 1 6 . 4 9 11 . 34 1 6 . 49 2 3 . 7 1 16 .49 6 . 1 9 1 .03 2 4 . 7 4 11 .34 12 1 1 . 34 2 3 . 7 1 11 .34 3 . 0 9 3 . 0 9 3 4 . 0 2 13 . 4 0 10 8 . 25 7 .22 3 .09 5 . 1 5 4 . 1 2 5 5 . 6 7 16 . 4 9 34 2 0 . 62 2 1 . 6 5 11 .34 - 3 . 0 9 2 7 . 8 4 15 .46 10 3 . 09 2 8 . 8 7 1 5 . 4 6 1 .03 5 . 1 5 2 9 . 90 16 . 49 6 4 . 12 1 5 . 4 6 10 .31 7 . 2 2 6 . 1 9 4 5 . 3 6 11 . 3 4 6 5 . 15 2 5 . 7 7 8 .25 1 .03 3 . 0 9 12 . 37 to co T A B L E 11 Q u e s t i o n 3 . "When I R E C E I V E d i r e c t i o n , i n s t r u c t i o n o r a d v i c e f r o m t h e f o l l o w i n g d e p a r t m e n t s o r p o s i -t i o n s , I w o u l d r a n k t h e e f f e c t i v e n e s s o f t h e c o m m u n i -c a t i o n a s : " N u r s i n g S t a f f C a t e g o r i e s ' S e l f - A s s e s s e d P e r c e p t i o n o f C o m m u n i c a t i o n E f f e c t i v e n e s s b e t w e e n t h e m s e l v e s and N o n - N u r s i n g P e r s o n n e l 0> > • H 4-1 O 4 J 0) U l t-l O M H s w 01 > • H 4 J O >. 01 U <U 01 M - l > W r H 0) 0) > 4-1 -rH ra 4-1 u o 0) 01 O > H s w c 0 • H O 4 J 01 a ra -p > > u >i ra - H • H > i - H r H £ 4 J 4-1 r H C S 0 u r H 3 0) 01 0) 01 ro E « E > M 4-1 I H 3 E O M H 0 m U l O 0 CO w S W D CJ 2 D i e t a r y 10 14 . 71 3 3 . 82 1 3 . 24 4 .41 2 . 94 30 . 88 H o u s e k e e p i n g 16 14 . 71 3 0 . 88 14 . 71 7 . 3 5 - 32 . 35 M e d i c a l R e c o r d s 10 5. 88 16 . 18 1 0 . 29 2 .94 - 5 7 . 35 7 . 35 N u r s i n g - A . D . N , o r S u p e r v i s o r 44 . 12 3 5 . 29 1 1 . 76 4 .41 1. 47 1. 47 1. 47 C . N . A . 2 6 . 47 3 0 . 88 1 0 . 29 - 2 9 . 41 2 . 94 I n - S e r v i c e E d u c a t i o n 68 3 3 . 82 3 9 . 71 1 1 . 76 7 . 3 5 - 5. 88 1. 47 N u r s e A t t e n d a n t 2 7 . 94 3 5 . 29 1 1 . 76 - 22 . 06 2 . 94 R e g i s t e r e d N u r s e 3 5 . 29 4 5 . 59 1 0 . 29 1 .47 - 5. 88 1. 47 Ward C l e r k 3 2 . 35 3 9 . 71 1 0 . 29 1. 47 1 3 . 24 2 . 94 O c c u p a t i o n a l T h e r a p y 12 1 9 . 12 2 5 . 00 1 7 . 65 8 .82 - 2 6 . 47 2 . 94 P h a r m a c y 10 1 7 . 65 2 6 . 47 1 1 . 76 4 .41 - 32 . 35 7 . 35 P h y s i c a l T h e r a p y 34 1 6 . 18 3 0 . 88 1 6 . 18 5 .88 - 2 7 . 94 2 . 94 P h y s i c i a n 10 2 5 . 00 2 6 . 47 1 0 . 29 1 .47 - 3 0 . 88 5. 88 P o r t e r i n g 6 1 1 . 76 2 0 . 59 2 0 . 59 14 .71 - 2 9 . 41 2 . 94 S o c i a l S e r v i c e 6 1 3 . 24 1 9 . 12 2 0 . 59 8 .82 - 3 5 . 29 2 . 94 N o n - N u r s i n g S t a f f C a t e g o r i e s ' S e l f - A s s e s s e d P e r c e p t i o n o f C o m m u n i c a t i o n E f f e c t i v e n e s s be tween t h e m s e l v e s and N u r s i n g P e r s o n n e l . • H > 1 O 4 J 0) • 01 r H Q) 0 01 2 rd > > 01 > 4-1 > > o • H • H 4-1 - H rd - H • H > i - H r H +1 4-1 rd 4-1 . C - P 4 J r H C & V O M O ? u O r H 3 01 4 J fl) >! 0) 0) 0) 01 0) 01 rd g K ui m U M H T3 4 4 E '4H 4-1 M H 3 e O 4 H 01 !*4 O U H O >w O t-J ul O O S H > w s w CO w •z a D U 2 10 6. 19 9 . 28 4.. 12 1 . 03 2 . 06 7 2 . 16 5 . .15 16 6 . 19 1 0 . 31 3 . 09 3 . 09 1 . 03 7 0 . 10 6. 19 10 1 2 . 37 9 . 28 5 . 15 3 . 09 2 . 06 5 6 . 70 1 1 . 34 1 1 . 34 27 . 84 1 1 . 34 1 . 03 4 1 . 24 7 . 22 1. 03 1 2 . 37 1 2 . 37 2 . 06 2 . 06 6 1 . 86 8. 25 63 7 . 22 18 . 56 1 0 . 31 4 . 12 3 . 09 4 5 . 36 1 1 . 34 3 . 09 1 5 . 46 1 5 . 46 2 . 06 2 . 06 5 1 . 55 1 0 . 31 1 3 . 40 44 . 33 1 5 . 46 2 . 06 1 7 . 53 7 . 22 1 7 . 53 3 5 . 05 1 2 . 37 4 . 12 2 1 . 65 9 . 28 12 1 1 . 34 30 . 93 1 0 . 31 3 . 09 2 . 06 3 4 . 02 8. 25 10 1 0 . 31 1 1 . 34 3 . 09 4 . 12 2 . 06 54 . 64 1 4 . 43 34 2 1 . 65 2 6 . 80 9 . 28 2 . 06 3 . 09 2 7 . 84 9 . 28 10 1 1 . 34 3 1 . 96 6 . 19 3 . 09 3 . 09 3 2 . 99 1 1 . 34 6 3 . 09 1 9 . 59 1 2 . 37 3 . 09 3 . 09 5 1 . 55 7 . 22 6 7 . 22 2 3 . 71 9 . 28 1 . 03 2 . 06 4 8 . 45 8 . 25 to TABLE 12 Q u e s t i o n 4 . " In h e a l t h team a c t i v i t i e s ( s u c h a s : team c o n f e r e n c e s , c l i n i c s , o r s t a f f m e e t i n g s ) I w o u l d r a n k t h e e f f e c t i v e n e s s o f t h e c o m m u n i c a t i o n b e t w e e n m y s e l f a n d t h e f o l l o w i n g d e -p a r t m e n t s o r p o s i t i o n s a s : " N u r s i n g S t a f f C a t e g o r i e s ' S e l f - A s s e s s e d P e r c e p t i o n o f C o m m u n i c a t i o n E f f e c t i v e n e s s b e t w e e n t h e m s e l v e s and N o n - N u r s i n g P e r s o n n e l . c o •rH >1 • O-P 0) ( U r H O I 0) 01 Z rd > > 0) > 4-> > > O > i • H - H 4J - H rd - r H - H > i - H r-4 4-> 4J (04-1 . C 4 J 4 J H C OH O O H U S O O r H p CJ) 4->0> >H0> 010) 010) 0 ) ( T J § « M m Mm t( m g m +)l*4 „ om o> m om om om wo o N = S W > W S H WK a H DO 3 " N o n - N u r s i n g S t a f f C a t e g o r i e s ' S e l f - A s s e s s e d P e r c e p t i o n o f C o m m u n i c a t i o n E f f e c t i v e n e s s b e t w e e n t h e m s e l v e s and N u r s i n g P e r s o n n e l . c o • H > i O 4-1 0) O l r - 1 0 1 O ) 0 ) 2 ( 8 > > . 0 ) > 4 J > > O >1 • H - r l 4-1 ' r H ( S - r H - H > ! - H r H 4-1 4-1 (0 4-> . C 4-> J-> r H OH O O r H O S O O H 3 0) 4Joi >, o> oioi ooi o roe r±! in m r i < r i >om Em J J m p g vi_ om oim om om om uio O " SW > H Spq WW 2; H D u 2 D i e t a r y 10 8 . 82 1 9 . 12 14 . 71 8 . 82 - 4 1 . 18 7 . 35 10 4 . 12 7 . 22 4 . 12 4 . 12 - 7 1 . 13 9 . 28 H o u s e k e e p i n g 16 8. 82 1 6 . 18 1 1 . 76 4 . 41 - 5 0 . 00 8 . 82 16 4 . 12 2 . 06 3 . 09 4 . 12 1 .03 7 2 . 16 1 3 . 40 M e d i c a l R e c o r d s 10 1. 47 1 4 . 71 7 . 35 1 . 47 1 .47 64 . 71 8 . 82 10 2 . 06 4 . 12 4 . 12 2 . 06 - 7 2 . 16 1 5 . 46 N u r s i n g - A . D . N , o r S u p e r v i s o r 2 6 . 47 3 3 . 82 7 . 35 1 0 . 29 - 16 . 18 5. 88 5 . 15 1 3 . 40 1 1 . 34 - 5 5 . 67 14 . 43 C . N . A . 20 . 59 2 2 . 06 1 1 . 76 1 . 47 - 3 8 . 24 5 . 88 7 . 22 8. 25 2 . 06 - 6 8 . 04 1 4 . 43 I n - S e r v i c e E d u c a t i o n 68 1 6 . 18 3 3 . 82 1 3 . 24 1 0 . 29 - 2 0 . 59 5 . 88 68 2 . 06 7 . 22 4 . 12 2 . 06 - 6 9 . 07 1 5 . 46 N u r s e A t t e n d a n t 2 0 . 59 2 7 . 94 1 3 . 24 2 . 94 - 2 9 . 41 5 . 88 2 . 06 7 . 22 9 . 28 1 . 03 - 6 3 . 92 16 . 49 R e g i s t e r e d N u r s e 2 7 . 94 44 . 12 7 . 35 1. 47 - 1 3 . 24 5 . 88 8 . 25 2 8 . 87 1 1 . 34 1 . 03 - 3 8 . 14 1 2 . 37 Ward C l e r k 2 3 . 53 3 6 . 76 8 . 82 - 2 5 . 00 5 . 88 3 . 09 7 . 22 1 1 . 34 1 . 03 1 .03 6 1 . 86 14 . 43 O c c u p a t i o n a l T h e r a p y 12 5 . 88 2 0 . 59 2 2 . 06 8 . 82 1 .47 3 5 . 29 5 . 88 12 6 . 19 28 . 87 5 . 15 3 . 09 1 .03 4 3 . 30 1 2 . 47 P h a r m a c y 10 1 0 . 29 2 3 . 53 8 . 82 1. 47 2 .94 4 5 . 59 7 . 35 10 7 . 22 6. 19 9 . 28 4 . 12 2 . 06 53. 61 1 7 . 53 P h y s i c a l T h e r a p y 34 8. 82 2 2 . 06 1 7 . 65 5 . 88 2 .94 3 6 . 76 5. 88 34 1 8 . 56 2 2 . 68 7 . 22 3 . 09 - 3 5 . 05 1 3 . 40 P h y s i c i a n 10 7 . 35 2 2 . 06 14 . 71 2 . 94 - • 4 2 . 65 1 0 . 29 10 1 1 . 34 20 . 62 1 0 . 31 3 . 09 2 . 0 6 3 8 . 14 1 4 . 43 P o r t e r i n g 6 7 . 35 1 3 . 24 8 . 82 7 . 35 1 .47 54 . 41 7 . 35 6 2 . 06 3 . 09 7 . 22 2 . 06 - 7 1 . 13 1 4 . 43 S o c i a l S e r v i c e 6 1 0 . 29 2 3 . 53 1 4 . 71 7 . 35 - 3 8 . 24 5 . 88 6 1 0 . 31 2 1 . 65 5 . 15 3 . 09 - 4 6 . 39 1 3 . 40 •J TABLE 13 Q u e s t i o n 5. "When I am t a l k i n g w i t h s t a f f members a b o u t p e r s o n a l a c t i v i t i e s o r e v e n t s n o t a s s o c i a t e d w i t h t h e h o s p i t a l ( f o r e x a m p l e : f a m i l y o r s p o r t s ) , I w o u l d r a n k t h e e f f e c t i v e n e s s o f t h e c o m -m u n i c a t i o n a s : " N u r s i n g S t a f f C a t e g o r i e s ' S e l f - A s s e s s e d P e r c e p t i o n o f C o m m u n i c a t i o n E f f e c t i v e n e s s b e t w e e n t h e m s e l v e s a n d N o n - N u r s i n g P e r s o n n e l . " N o n - N u r s i n g S t a f f C a t e g o r i e s ' S e l f - A s s e s s e d P e r c e p t i o n o f C o m m u n i c a t i o n E f f e c t i v e n e s s b e t w e e n t h e m s e l v e s and N u r s i n g P e r s o n n e l . > i 01 CO r H 01 01 01 > > 0) > •P > > - r l • H •P - H rd - H • H -P -P rcj 4J .C -P 4-) o O U O IS O O •P 01 >i 0) 01 01 0) 01 0> oi m U 44 •a MH E 44 •4-1 UH 0 4H 01 M-l 0 4H 0 44 0 44 s a > W a w CO W z w c o • H O -P 2 rd O > 1 - r l H C r H 3 rd e 3 e ui O O U a 0) K o 2 0) > • H •P O 4-> 01 cn m O 44 a w 01 > • H •P O > i 0) r4 4-1 oi m > w C o • r H >1 •0 -P r H 11 01 01 2 rd 0) > •P > > 0 > i -P - H rd - r i • H > i - H r H rd -P s: 4-i -p r H C 04 (4 0 2 o 0 r H 3 0) 0) 01 0) 0) 01 rd E K T3 44 E 44 •P 44 3 E 0 4H 0 44 0 44 oi o 0 2 S W w w 2 W 3 U D i e t a r y 10 1 0 . 29 1 3 . 24 14 . 71 2 . 94 - 5 0 . 00 8 .82 10 3 . 09 1 2 . 37 4. 12 5 . 15 - 68 . 04 7 . 22 H o u s e k e e p i n g 16 1 0 . 29 1 7 . 65 1 6 . 18 4. 41 - 44 . 12 7 .35 16 4 . 12 1 5 . 46 5. 15 1 3 . 40 1 .03 5 1 . 55 9 . 28 M e d i c a l R e c o r d s 10 7 . 35 8 . 82 4. 41 - 6 9 . 12 10 .29 10 9 . 28 1 0 . 31 6. 19 5 . 15 - 5 9 . 79 9 . 28 N u r s i n g - A . D . N , o r S u p e r v i s o r 2 3 . 53 3 6 . 76 1 0 . 29 10 . 29 - 1 1 . 76 7 .35 3 . 09 14 . 43 12 . 37 3 . 09 1 .03 5 5 . 67 1 0 . 31 C . N . A . 16 . 18 2 7 . 94 1 6 . 18 7 . 35 - 2 5 . 00 7 .35 14 . 43 7. 22 4 . 12 1 .03 6 3 . 92 9 . 28 I n - S e r v i c e E d u c a t i o n 68 1 7 . 65 3 0 . 88 1 3 . 24 8 . 82 - 2 3 . 53 5 .88 68 4 . 12 12 . 37 6. 19 5 . 15 - 6 1 . 86 1 0 . 31 N u r s e A t t e n d a n t 2 2 . 06 3 0 . 88 1 9 . 12 7 . 35 - 14 . 71 5 .88 4 . 12 16 . 49 8. 25 4 . 12 - 5 6 . 70 1 0 . 31 R e g i s t e r e d N u r s e 2 5 . 00 44 . 12 1 6 . 18 5 . 88 - 2 . 94 5 .88 7 . 22 2 6 . 80 1 7 . 53 6 . 19 - 32 . 99 9 . 28 Ward C l e r k 2 5 . 00 3 0 . 88 1 6 . 18 7 . 35 - 1 6 . 18 4 .41 7 . 22 2 3 . 71 1 5 . 46 4 . 12 1 .03 4 1 . 24 7 . 22 O c c u p a t i o n a l T h e r a p y 12 1 0 . 29 1 7 . 65 1 0 . 29 5. 88 - 4 7 . 06 8 .82 12 5 . 15 2 6 . 80 16 . 49 5 . 15 - 3 7 . 11 9 . 28 P h a r m a c y 10 1 1 . 76 2 0 . 59 1 1 . 76 7 . 35 - 3 9 . 71 8 .82 10 9 . 28 1 4 . 43 6. 19 5 . 15 - 5 0 . 52 1 4 . 43 P h y s i c a l T h e r a p y 34 1 0 . 29 2 3 . 53 1 0 . 29 4 . 41 - 4 4 . 12 7 . 3 5 34 1 1 . 34 2 9 . 90 1 0 . 31 4 . 12 1 .03 3 4 . 02 9 . 28 P h y s i c i a n 10 7 . 35 1 6 . 18 7 . 35 5. 88 - 5 2 . 94 10 .29 10 1 . 03 14 . 43 7 . 22 8 . 25 5 . 1 5 54 . 64 9 . 28 P o r t e r i n g 6 1 0 . 29 2 0 . 59 1 0 . 29 4 . 41 4 7 . 06 7 . 3 5 6 3 . 09 16 . 49 1 3 . 40 6 . 19 1 .03 4 8 . 45 1 1 . 34 S o c i a l S e r v i c e 6 1 0 . 29 1 9 . 12 1 0 . 29 4 . 41 - 4 5 . 59 10 .29 6 2 . 06 24 . 74 7 . 22 6 . 19 - 5 0 . 52 9 . 28 T A B L E 14 Q u e s t i o n 6. " In r e s o l v i n g d i f f e r e n c e s o f o p i n i o n s o r m i s u n d e r -s t a n d i n g s i n w o r k i n g s i t u a t i o n s , I w o u l d r a n k t h e e f f e c t i v e n e s s o f t h e c o m m u n i c a t i o n b e t w e e n m y s e l f and t h e f o l l o w i n g d e p a r t m e n t s o r p o s i t i o n s a s : " N u r s i n g S t a f f C a t e g o r i e s ' S e l f - A s s e s s e d P e r c e p t i o n o f C o m m u n i c a t i o n E f f e c t i v e n e s s b e t w e e n t h e m s e l v e s and N o n - N u r s i n g P e r s o n n e l . c o • H 0 -P 2 rrj U >i . r H c a H 3 <D 3 E N_ U ' H l U S - i U M H U M H U M H U l O O - y H ^ TTI r T 1 r n M ^ r.-< 3 C J 2 N o n - N u r s i n g S t a f f C a t e g o r i e s ' S e l f - A s s e s s e d P e r c e p t i o n o f C o m m u n i c a t i o n E f f e c t i v e n e s s b e t w e e n t h e m s e l v e s and N u r s i n g P e r s o n n e l . > 1 o> 0 ) r H (1) 0 ) Q ) > > 0 1 > •P > > • H • H •P - H rd - H • H +) 4-> rd 4-1 x: +> •P 0 O u u 3 o 0 4-> 0 ) > 1 0> tt) (1) 0 1 d ) 0 ) 0 ) 4-1 U 4 4 TJ 4 4 E 4 4 •P 4 4 0 4 4 0 ) 4 4 0 4 4 0 4 4 O 4 4 S W > W S W to w 2 Ko •P o U l U J O 4 4 s w 0 ) > • H 4-> O u 4H 0 ) 4 4 > w C 0 - H O -P H 0) 0) 0) 2 rd 0) > • p > > O > i -P - H rd - H > i - H r H rd 4-> 4 J - p r H C a U 0 3 o 0 r H 3 a 0) 0) 0) 0) 0) ro E « 1 3 4-1 E 4 4 4-1 4 H 3 E O 4 4 O 4 4 O 4 4 ui o 0 2 a co a 2 W 3 U 2 D i e t a r y 10 8 . 82 25 . 00 1 6 . 18 1 0 . 29 2 . 94 2 9 . 41 7 . 35 10 1 .03 12 . 3 7 6. 19 3 . 09 •2. 06 6 9 . 07 6 . 19 H o u s e k e e p i n g 16 1 0 . 29 29 .41 1 3 . 24 8 . 82 1. 47 3 0 . 88 5 . 88 16 3 .09 9 .28 9 . 28 4 . 12 6 7 . 01 7 . 22 M e d i c a l R e c o r d s 10 2 . 94 13 .24 8 . 82 2 . 94 64 . 71 7 . 35 10 5 .15 8 . 2 5 8. 25 2 . 06 4 . 12 6 1 . 86 1 0 . 31 N u r s i n g - A . D . N , o r S u p e r v i s o r 1 7 . 65 42 £ 5 1 6 . 18 1 0 . 29 2 . 94 5 . 88 4 . 41 6 .19 19 .59 16 . 49 3 . 09 3 . 09 4 2 . 27 9 . 28 C . N . A . 1 0 . 29 36 .76 1 4 . 71 5 . 88 26 . 47 5. 88 1 .03 10 .31 1 7 . 53 2 . 06 2 . 06 5 8 . 76 8 . 25 I n - S e r v i c e E d u c a t i o n 68 1 1 . 76 39 .71 14 . 71 14 . 71 14 . 71 4 . 41 68 1 .03 19 .59 6. 19 2 . 06 2 . 06 6 1 . 86 7 . 22 N u r s e A t t e n d a n t 14 . 71 35 . 29 2 5 . 00 5 . 88 1. 47 13 . 24 4 . 41 1 .03 15 .46 1 5 . 46 4 . 12 2 . 06 5 3 . 61 8. 25 R e g i s t e r e d N u r s e 2 2 . 06 42 . 6 5 2 5 . 00 2 . 94 4 . 41 2 . 94 6 .19 32 .99 22 . 68 1 0 . 31 2 . 06 1 9 . 59 6. 19 Ward C l e r k . 2 0 . 59 42 . 6 5 1 4 . 71 2 . 94 1. 47 1 3 . 24 4 . 41 11 .34 25 .77 2 1 . 65 4 . 12 2 . 06 2 7 . 84 7 . 22 O c c u p a t i o n a l T h e r a p y 12 1 0 . 29 17 .65 1 6 . 18 14 . 71 1. 47 3 5 . 29 4. 41 12 6 .19 27 .84 20 . 62 6 . 19 2 . 06 3 0 . 93 6. 19 P h a r m a c y 10 1 1 . 76 23 .53 1 6 . 18 4 . 41 2 . 94 3 3 . 82 7 . 35 10 5 .15 8 . 2 5 5 . 15 8 . 25 2 . 06 5 8 . 76 1 2 . 37 P h y s i c a l T h e r a p y 34 8 . 82 17 . 65 1 6 . 18 8 . 82 4. 41 36 . 76 7 . 35 34 1 5 . 4 6 26 .80 16 . 49 3 . 09 2 . 06 2 6 . 80 9 . 28 P h y s i c i a n 10 4 . 41 20 . 59 1 0 . 29 8 . 82 48 . 53 7 . 35 10 1 0 9 22 .68 1 9 . 59 3 . 09 5 . 15 3 9 . 18 7 . 22 P o r t e r i n g 6 8 . 82 22 .06 1 1 . 76 1 3 . 24 1. 47 38 . 24 4 . 41 6 2 .06 12 .37 1 2 . 37 8 . 25 7 . 22 4 9 . 48 8 . 25 S o c i a l S e r v i c e 6 ' 5 . 88 23 . 53 1 3 . 24 5 . 88 44 . 12 7 . 35 6 5 .15 23 .71 9 . 28 - 2 . 06 5 3 . 61 6. 19 T A B L E 15 Q u e s t i o n 7 . "When I e x p r e s s MY i d e a s o r s u g g e s t i o n s t o t h e f o l -l o w i n g d e p a r t m e n t s o r p o s i t i o n s , I w o u l d r a n k t h e e f f e c t i v e n e s s o f t h e c o m m u n i c a t i o n a s : " N u r s i n g S t a f f C a t e g o r i e s ' S e l f - A s s e s s e d P e r c e p t i o n o f C o m m u n i c a t i o n E f f e c t i v e n e s s b e t w e e n t h e m s e l v e s and N o n - N u r s i n g P e r s o n n e l . c o •H >i O - P 0 1 0 1 r H o> 0> 0 ) 2 r d > > O) > 4-1 > > O > 1 • H - H - P - r H r d - r l - r - j > , . H r H - P - P r d - P x\ - P - P M C Q i u o M O S o O r H p a) - P 0> > i 0 1 0 ) 0 ) 0 1 0 ) 0 1 r d S e x t i l 4 4 M 4 4 t ) 4 J g 4 H J J L H p 3 0 4 - 1 0 ) 4 - 1 0 4 - 1 O 4 4 O 4 4 0 1 O O E H > W S W W H 2 W D U 2 D i e t a r y 10 7 . 35 2 6 . 47 1 6 . 18 8 . 82 8 . 82 2 5 . 00 7 . 35 H o u s e k e e p i n g 16 1 0 . 29 2 2 . 06 2 2 . 06 7 . 35 5 . 88 2 5 . 00 7 . 35 M e d i c a l R e c o r d s 10 1 . 47 1 3 . 24 7 . 35 2 . 94 64. 71 10 . 29 N u r s i n g - A . D . N , o r S u p e r v i s o r 1 6 . 18 3 2 . 35 2 5 . 00 1 1 . 76 4 . 41 2 . 94 7 . 35 C . N . A . 1 4 . 71 2 9 . 41 2 0 . 59 2 . 94 2 6 . 47 5 . 88 I n - S e r v i c e E d u c a t i o n 68 1 0 . 29 3 5 . 29 2 2 . 06 1 3 . 24 1 . 47 1 1 . 76 5 . 88 N u r s e A t t e n d a n t 1 9 . 12 3 3 . 82 2 0 . 59 4 . 41 1 . 47 14 . 71 5 . 88 R e g i s t e r e d N u r s e 1 9 . 12 4 2 . 65 2 5 . 00 2 . 94 1 . 47 2 . 94 5 . 88 Ward C l e r k 2 0 . 59 3 5 . 29 2 5 . 00 1 . 47 1 1 . 76 5 . 88 O c c u p a t i o n a l T h e r a p y 12 5 . 88 1 4 . 71 1 9 . 12 1 0 . 29 1. 47 4 1 . 18 7 . 35 P h a r m a c y 10 4 . 41 2 5 . 00 1 9 . 12 4 . 41 2 . 94 3 3 . 82 1 0 . 29 P h y s i c a l T h e r a p y 34 5 . 88 1 3 . 24 1 7 . 65 1 1 . 76 2 . 94 4 1 . 18 7 . 35 P h y s i c i a n 10 2 . 94 2 0 . 59 1 3 . 24 8 . 82 1 . 47 4 2 . 65 1 0 . 29 P o r t e r i n g 6 4 . 41 2 0 . 59 1 9 . 12 8 . 82 2 . 94 3 6 . 76 7 . 35 S o c i a l S e r v i c e 6 7 . 35 1 9 . 12 1 7 . 65 4 . 41 1. 47 4 1 . 18 8 . 82 N o n - N u r s i n g S t a f f C a t e g o r i e s ' S e l f - A s s e s s e d P e r c e p t i o n o f C o m m u n i c a t i o n E f f e c t i v e n e s s b e t w e e n t h e m s e l v e s and N u r s i n g P e r s o n n e l . c o • r H >1 O - P 0 1 CU i - H O ) 0 1 0 ) 2 ffl > > 0 I > - P > > " 0 • H - H P - H r d - H - r l > i - i H + J 4-1 <fl 4 J J C - P - P r - I C o o >HO S O ' j r - i p j j o i > i O coo) o>a> oi rag U ) 4 H ( 4 4 4 r 0 l | _ | E 4 H - P 4-1 P g O 4 4 0 ) 4 - 1 0 4 H 0 4 H 0 4 H B I O S= SW > W £ H W W 2 W » U 10 1. 03 1 2 . 37 4. 12 4 . 12 3 . 09 7 0 . 10 5 . 15 16 6 . 19 5 . 15 10 . 31 6 . 19 1. 03 6 7 . 01 4 . 12 10 3 . 09 1 0 . 31 5. 15 3 . 09 3 . 09 6 7 . 01 8 . 25 1. 03 2 1 . 65 17 . 53 9 . 28 4 3 . 30 7 . 22 7 . 22 1 5 . 46 1 . 03 3 . 09 6 5 . 98 7 . 22 68 2. 06 18 . 56 .9. 28 4 . 12 2 . 06 5 8 . 76 5 . 15 1. 03 1 5 . 46 1 5 . 46 3 . 09 2 . 06 5 8 . 76 4 . 12 6 . 19 2 8 . 87 24 . 74 9 . 28 2 . 06 2 4 . 74 4 . 12 6. 19 2 7 . 84 1 1 . 34 9 . 28 2 . 06 4 0 . 21 3 . 09 12 6. 19 2 6 . 8 0 2 1 . 65 5 . 15 2 . 06 3 5 . 05 3 . 09 10 7 . 22 1 1 . 34 3 . 09 8 . 25 3 . 09 54 . 64 1 2 . 37 34 1 3 . 40 2 5 . 77 17 . 53 3 . 09 2 . 06 3 2 . 99 5 . 15 10 6 . 19 2 4 . 74 20 . 62 2 . 06 3 . 09 3 8 . 14 5 . 15 6 2 . 06 .12. 37 1 3 . 40 9 . 28 4 . 12 5 2 . 58 6. 19 6 3 . 09 2 3 . 71 8. 25 2 . 06 2 . 06 5 5 . 67 5 . 15 >1 r H a. 0) a o 2 INJ CO T A B L E 16 Q u e s t i o n 8 . " A s a summary , i n g e n e r a l I f e e l t h a t t h e OVERALL e f f e c t i v e n e s s o f t h e c o m m u n i -c a t i o n b e t w e e n m y s e l f and t h e f o l l o w i n g d e p a r t m e n t s o r p o s i t i o n s i s : " N u r s i n g S t a f f C a t e g o r i e s ' S e l f - A s s e s s e d P e r c e p t i o n o f C o m m u n i c a t i o n E f f e c t i v e n e s s b e t w e e n t h e m s e l v e s and N o n - N u r s i n g P e r s o n n e l . >i rH 0) a) > > 0> > •p > > •H •rH -P -H rd -H •H -P •P rd -P .c -p 4-1 O 0 U 0 3 o o 4-1 o> >i 0) 0> 01 01 to 44 U 44 T3 44 E 4H 4-> 4-1 0 44 0) 44 0 4-1 O 4-1 O 44 aw > W s w CO W 2 W c o •H O -P 2 rd O >i-H H C rH P rd £ P E Ul O D CJ D4 0 ) « O 2 D i e t a r y 10 7 . 3 5 3 2 . 3 5 2 2 . 0 6 8 .82 4 . 4 1 2 2 . 0 6 2 .94 H o u s e k e e p i n g 16 1 0 . 2 9 3 3 . 8 2 2 2 . 0 6 8 .82 1 . 4 7 " 2 2 . 0 6 1 .47 M e d i c a l R e c o r d s 10 1 .47 1 6 . 1 8 1 0 . 2 9 5 .88 - 6 0 . 2 9 5 .88 N u r s i n g - A . D . N , o r S u p e r v i s o r 2 5 . 0 0 3 6 . 7 6 1 9 . 1 2 1 0 . 2 9 2 . 9 4 - 5 .88 C . N . A . 1 6 . 1 8 3 0 . 8 8 2 0 . 5 9 2 .94 - 2 5 . 0 0 4 .41 I n - S e r v i c e E d u c a t i o n 68 2 3 . 5 3 3 6 . 7 6 1 9 . 1 2 8 .82 1 .47 4 . 4 1 5 .88 N u r s e A t t e n d a n t 2 0 . 5 9 3 5 . 2 9 2 3 . 5 3 4 . 4 1 - 1 0 . 2 9 5 .88 R e g i s t e r e d N u r s e 2 3 . 5 3 5 0 . 0 0 1 6 . 1 8 2 . 9 4 1 .47 1 .47 4 . 4 1 Ward C l e r k 2 9 . 4 1 4 4 . 1 2 1 3 . 2 4 1 .47 1 .47 7 . 3 5 2 .94 O c c u p a t i o n a l T h e r a p y 12 1 1 . 7 6 1 6 . 1 8 2 3 . 5 3 1 1 . 7 6 2 .94 2 9 . 4 1 4 . 4 1 P h a r m a c y 10 1 0 . 2 9 3 2 . 3 5 1 4 . 7 1 4 . 4 1 - 30 .88 7 . 3 5 P h y s i c a l T h e r a p y 34 1 0 . 2 9 2 0 . 5 9 2 0 . 5 9 1 0 . 2 9 2 .94 3 0 . 8 8 4 . 4 1 P h y s i c i a n 10 5 .88 2 7 . 9 4 1 7 . 6 5 4 . 4 1 - 3 6 . 7 6 7 .35 P o r t e r i n g 6 1 1 . 7 6 2 3 . 5 3 2 2 . 0 6 1 0 . 2 9 1 .47 2 7 . 9 4 2 .94 S o c i a l S e r v i c e 6 7 . 3 5 2 7 . 9 4 1 7 . 6 5 7 . 3 5 - 2 2 . 3 5 7 . 3 5 N o n - N u r s i n g S t a f f C a t e g o r i e s ' S e l f - A s s e s s e d P e r c e p t i o n o f C o m m u n i c a t i o n E f f e c t i v e n e s s b e t w e e n t h e m s e l v e s a n d N u r s i n g P e r s o n n e l . >. c o •H O 4-1 01 0) rH 01 01 2 rd > > 01 > •P > > o >i •H •H 4-1 -H rd -H •H rH •P 4-1 rd -P X -P 4-1 rH C 04 U U U 0 3 O O rH P 01 4-i o> >i <D 01 0) 01 0) 0) <o i « 0) 44 U 44 -a 44 E 44 -P 44 P E N= O 44 0) 44 O 44 O 44 0 44 Ul O 0 S H > H s w CO 64 2 W D U 2 10 7 .22 1 3 . 4 0 4 . 1 2 4 . 1 2 3 . 0 9 64 . 95 3 . 09 16 9 .28 8 . 2 5 9 . 2 8 7 .22 1 .03 6 0 . 82 4 . 1 2 10 1 4 . 4 3 1 2 . 3 7 1 1 . 3 4 3 . 0 9 4 . 1 2 4 7 . 4 2 7 . 2 2 4 .12 3 0 . 9 3 1 7 . 5 3 4 .12 - 3 6 . 0 8 7 . 2 2 1 .03 1 2 . 3 7 1 6 . 4 9 7 .22 2 .06 5 3 . 61 7 . 2 2 68 3 . 0 9 2 2 . 6 8 1 1 . 3 4 3 . 0 9 1 .03 5 1 . 55 7 .22 6 .19 2 0 . 62 1 4 . 4 3 5 . 1 5 2 . 0 6 4 6 . 3 9 5 . 1 5 1 3 . 4 0 3 7 . 1 1 2 7 . 8 4 3 . 0 9 2 . 0 6 1 2 . 37 4 . 1 2 1 8 . 5 6 2 9 . 9 0 1 8 . 5 6 7 .22 - 2 1 . 65 4 . 1 2 12 1 2 . 3 7 3 0 . 9 3 1 5 . 4 6 5 . 1 5 2 . 0 6 3 0 . 9 3 3 . 0 9 10 1 0 . 3 1 1 7 . 5 3 7 . 2 2 7 .22 2 . 0 6 4 5 . 3 6 1 0 . 3 1 34 18 . 56 2 3 . 7 1 1 5 . 4 6 4 . 1 2 3 . 0 9 2 8 . 8 7 6 . 1 9 10 4 . 1 2 2 7 . 8 4 1 8 . 5 6 3 . 0 9 2 . 0 6 3 7 . 1 1 7 . 2 2 6 3 . 0 9 1 3 . 4 0 1 3 . 4 0 8 . 2 5 6 . 1 9 4 7 . 4 2 8 . 2 5 6 1 1 . 3 4 2 1 . 6 5 9 . 3 8 2 . 0 6 2 . 0 6 4 8 . 4 5 5 . 1 5 10 APPENDIX D Grouped a b s o l u t e f r e q u e n c y d i s t r i b u t i o n o f r e s p o n s e s showing p e r c e i v e d s u b j e c t i v e e f f e c t i v e n e s s o f communication between: (a) N u r s i n g P e r s o n n e l w i t h N u r s i n g P e r s o n n e l . (b) N u r s i n g P e r s o n n e l w i t h Non-Nursing P e r s o n n e l . (c) Non-Nursing P e r s o n n e l w i t h N u r s i n g P e r s o n n e l . (d) Non-Nursing P e r s o n n e l w i t h Non-Nursing P e r s o n n e l . TABLE 17 S e l f - A s s e s s e d P e r c e p t i o n o f Communication E f f e c t i v e n e s s Q u e s t i o n 1. " I n communications between m y s e l f and the f o l l o w i n g departments o r p o s i t i o n s r e g a r d i n g DIRECT o r INDIRECT PATIENT CARE, I would rank the e f f e c t i v e n e s s a s : " N u r s i n g P e r s o n n e l w i t h : -(a) N u r s i n g P e r s o n n e l (N=68) (b) Non-Nursing P e r s o n n e l (N=97) Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y 121 70 162 157 59 102 18 54 16 •34 176 12 37 Non-Nursing P e r s o n n e l w i t h : -Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (c) N u r s i n g P e r s o n n e l (N=68) (d) Non-Nursing P e r s o n n e l (N=97) 40 82 130 167 118 83 28 36 26 212 424 45 55 TABLE 18 S e l f - A s s e s s e d P e r c e p t i o n o f Communication E f f e c t i v e n e s s Q u e s t i o n 2. "When I GIVE d i r e c t i o n , i n s t r u c t i o n o r a d v i c e t o the f o l l o w i n g departments o r p o s i t i o n s , I would rank t h e e f f e c t i v e n e s s o f the communication a s : " N u r s i n g P e r s o n n e l w i t h : -Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (a) N u r s i n g P e r s o n n e l (N=68) (b) Non-Nursing P e r s o n n e l (N=97) 100 44 155 99 50 84 18 33 18 62 231 21 73 Non-Nursing P e r s o n n e l w i t h : -Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (c) N u r s i n g P e r s o n n e l (N=68) (d) Non-Nursing P e r s o n n e l (N=97) 62 66 133 153 98 76 40 24 31 240 407 32 116 t—1 U) to TABLE 19 S e l f - A s s e s s e d P e r c e p t i o n o f Communication E f f e c t i v e n e s s Q u e s t i o n 3. "When I RECEIVE d i r e c t i o n , i n s t r u c t i o n o r a d v i c e from the f o l l o w i n g departments o r p o s i t i o n s , I would rank t h e e f f e c t i v e n e s s o f the communication a s : " N u r s i n g P e r s o n n e l w i t h : -Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (a) N u r s i n g P e r s o n n e l (N=68) (b) Non-Nursing P e r s o n n e l (N=97) 136 52 154 149 45 75 13 53 232 52 Non-Nursing P e r s o n n e l w i t h : -Most Very M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (c) N u r s i n g P e r s o n n e l (N=68) (d) Non-Nursing P e r s o n n e l (N-97) 94 87 156 168 92 61 40 23 20 206 435 22 79 u> TABLE 2 0 S e l f - A s s e s s e d P e r c e p t i o n o f Communication E f f e c t i v e n e s s Q u e s t i o n 4. "I n h e a l t h team a c t i v i t i e s (such a s : team c o n f e r e n c e s , c l i n i c s , o r s t a f f m eetings) I would rank t h e e f f e c t i v e n e s s o f the communication between m y s e l f and t h e f o l l o w i n g departments o r p o s i t i o n s a s : " N u r s i n g P e r s o n n e l w i t h : ' Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (a) N u r s i n g P e r s o n n e l (N=68) (b) Non-Nursing P e r s o n n e l (N-97) 92 20 135 69 42 54 18 97 346 24 85 Non-Nursing P e r s o n n e l w i t h : -Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (c) N u r s i n g P e r s o n n e l (N=68) (d) Non-Nursing P e r s o n n e l (N=97) 47 64 119 113 82 54 33 28 278 488 46 120 TABLE 21 S e l f - A s s e s s e d P e r c e p t i o n o f Communication E f f e c t i v e n e s s Q u e s t i o n 5. "When I am t a l k i n g w i t h s t a f f members about p e r s o n a l a c t i v i t i e s o r e v e n t s n o t a s s o c i a t e d w i t h the h o s p i t a l ( f o r example: f a m i l y o r s p o r t s ) , I would rank t h e e f f e c t i v e n e s s o f the communication as:" N u r s i n g P e r s o n n e l w i t h : -Most Very M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (a) N u r s i n g P e r s o n n e l (N=68) (b) Non-Nursing P e r s o n n e l (N=97) 88 25 137 105 62 65 32 26 64 55 25 303 Non-Nursing P e r s o n n e l w i t h : -Most Very M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication Re p l y (c) N u r s i n g P e r s o n n e l (N=68) (d) Non-Nursing P e r s o n n e l (N=97) 53 45 94 136 58 67 24 148 68 268 392 47 77 U) TABLE 2 2 S e l f - A s s e s s e d P e r c e p t i o n o f Communication E f f e c t i v e n e s s Q u e s t i o n 6. " I n r e s o l v i n g d i f f e r e n c e s o f o p i n i o n s o r m i s u n d e r s t a n d i n g s i n w o r k i n g s i t u a t i o n s , I would rank t h e e f f e c t i v e n e s s o f t h e communication between m y s e l f and t h e f o l l o w i n g departments o r p o s i t i o n s a s : " N u r s i n g P e r s o n n e l w i t h : -(a) N u r s i n g P e r s o n n e l (N=68) (b) Non-Nursing P e r s o n n e l (N=97) Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y 66 26 163 120 75 97 29 25 13 53 256 18 45 Non-Nursing P e r s o n n e l w i t h : -(c) N u r s i n g P e r s o n n e l (N=68) (d) Non-Nursing P e r s o n n e l (N=97) Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y 49 45 131 147 83 104 53 37 10 26 246 443 40 71 CO cn TABLE 23 S e l f - A s s e s s e d P e r c e p t i o n o f Communication E f f e c t i v e n e s s Q u e s t i o n 7. "When I e x p r e s s MY i d e a s o r s u g g e s t i o n s t o the f o l l o w i n g departments o r p o s i t i o n s , I would rank t h e e f f e c t i v e n e s s o f the communication as:" N u r s i n g P e r s o n n e l w i t h : -Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (a) N u r s i n g P e r s o n n e l (N=68) (b) Non-Nursing P e r s o n n e l (N=97) 68 16 142 116 94 91 25 35 11 48 283 25 30 Non-Nursing P e r s o n n e l w i t h : -Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (c) N u r s i n g P e r s o n n e l (N=68) (d) Non-Nursing P e r s o n n e l (N=97) 34 47 119 148 103 101 46 42 19 23 239 459 52 53 TABLE 24 S e l f - A s s e s s e d P e r c e p t i o n o f Communication E f f e c t i v e n e s s Q u e s t i o n 8. "As a summary, i n g e n e r a l I f e e l t h a t t h e OVERALL e f f e c t i v e n e s s o f t h e communi-c a t i o n between m y s e l f and the f o l l o w i n g departments o r p o s i t i o n s i s : " N u r s i n g P e r s o n n e l w i t h : -Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (a) N u r s i n g P e r s o n n e l (N-68) (b) Non-Nursing P e r s o n n e l (N-97) 94 45 159 149 76 103 21 29 33 215 20 34 Non-Nursing P e r s o n n e l w i t h : -Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (c) N u r s i n g P e r s o n n e l (N=68) (d) Non-Nursing P e r s o n n e l (N=97) 52 88 157 164 116 101 49 43 25 199 399 30 53 (JO CO APPENDIX E G r o u p e d . r e l a t i v e f r e q u e n c y d i s t r i b u t i o n o f r e s p o n s e s ( i n p e r c e n t s ) showing p e r c e i v e d s u b j e c t i v e e f f e c t i v e n e s s o f communication between: (a) N u r s i n g P e r s o n n e l w i t h N u r s i n g P e r s o n n e l . (b) N u r s i n g P e r s o n n e l w i t h Non-Nursing P e r s o n n e l . (c) Non-Nursing P e r s o n n e l w i t h N u r s i n g P e r s o n n e l . (d) Non-Nursing P e r s o n n e l w i t h Non-Nursing P e r s o n n e l . TABLE 25 Self-Assessed Perception of Communication Effectiveness Question 1. "In communications between myself and the following departments or positions regarding DIRECT or INDIRECT PATIENT CARE, I would rank the effectiveness as:" Nursing Personnel with:-Most Very Moderately Somewhat Not Usually No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication Reply (a) Nursing Personnel (N=68) (b) Non-Nursing Personnel (N=97) 29.66 11.44 39.71 25.65 14.46 16.67 4.41 8. 82 4.9 2.61 8.3 28.76 2. 94 6.05 Non-Nursing Personnel with:-Most Very Moderately Somewhat Not Usually No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication Reply (c) Nursing Personnel (N=68) (d) Non-Nursing Personnel (N=97) 6.87 9.39 22.34 19.13 20.27 9.51 4.81 4.12 1.55 2.98 36.43 48.57 7.73 6.30 TABLE 26 Self-Assessed Perception of Communication Effectiveness Question 2. "When I GIVE d i r e c t i o n , i n s t r u c t i o n or advice to the following departments or positions, I would rank the effectiveness of the communication as:" Nursing Personnel with:-Most Very Moderately Somewhat Not Usually No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication .Reply (a) Nursing Personnel (N=68) (b) Non-Nursing Personnel (N=97) 24.51 10.13 37.99 21.73 12.25 16.01 4.41 6.54 .49 1.14 15.20 39.22 5.15 5.23 Non-Nursing Personnel with:-Most Very Moderately Somewhat Not Usually No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication Reply (c) Nursing Personnel (N=68) (d) Non-Nursing Personnel (N=97) 7.56 7.56 17.01 17.53 14.43 8.71 5.67 7.75 3.09 3.55 39.69 46.62 12.54 13.29 TABLE 27 Self-Assessed Perception of Communication Effectiveness Question 3. "When I RECEIVE d i r e c t i o n , i n s t r u c t i o n or advice from the following departments or positions, I would rank the effectiveness of the communication as:" Nursing Personnel with:-Most Very Moderately Somewhat Not Usually No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication Reply (a) Nursing Personnel (N=68) (b) Non-Nursing Personnel (N-97) 33.33 15. 36 37.75 25.49 11.03 15.3 2.21 6.54 49 43 12.99 33.66 2.21 3.59 Non-Nursing Personnel with:-Most Very Moderately Somewhat Not Usually No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication Reply (c) Nursing Personnel (N=68) (d) Non-Nursing Personnel (N=97) 8.93 9. 97 25.60 19.24 12.89 6.99 2.23 2.63 1.55 2.29 39.86 49.83 8.93 9. 05 INJ TABLE 2 8 S e l f - A s s e s s e d P e r c e p t i o n o f Communication E f f e c t i v e n e s s Q u e s t i o n 4. " I n h e a l t h team a c t i v i t i e s (such as: team c o n f e r e n c e s , c l i n i c s , o r s t a f f m eetings) I would rank the e f f e c t i v e n e s s o f the communication between m y s e l f and t h e f o l l o w i n g departments o r p o s i t i o n s a s : " N u r s i n g P e r s o n n e l w i t h : -Most Very M o d e r a t e l y Somewhat . Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (a) N u r s i n g P e r s o n n e l (N=68) (b) Non-Nursing P e r s o n n e l (N=97) 22.55 7.68 33.09 19.44 10.29 13. 40 4.41 5.39 0.00 1.14 23.77 45.42 5.88 7.52 Non-Nursing P e r s o n n e l w i t h : -Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (c) N u r s i n g P e r s o n n e l (N=68) (d) Non-Nursing P e r s o n n e l (N=97) 3.44 7.33 11.86 12.94 9.28 6.19 1.20 3.21 1.17 .69 59.45 55.90 14.60 13.75 TABLE 2 9 S e l f - A s s e s s e d P e r c e p t i o n o f Communication E f f e c t i v e n e s s Q u e s t i o n 5. "When I am t a l k i n g w i t h s t a f f members about p e r s o n a l a c t i v i t i e s o r e v e n t s n ot a s s o c i a t e d w i t h t h e h o s p i t a l ( f o r example: f a m i l y o r s p o r t s ) I would rank t h e e f f e c t i v e n e s s o f t h e communication as:" N u r s i n g P e r s o n n e l w i t h : -Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (a) N u r s i n g P e r s o n n e l (N=68) (b) Non-Nursing P e r s o n n e l (N=97) 2 1 . 5 7 8.66 3 3 . 5 8 1 5 . 3 6 1 5 . 2 0 9.48 7.84 3.92 0.0 1 1 . 1 1 1 5 . 6 9 4 3 . 7 9 6.13 7.68 Non-Nursing P e r s o n n e l w i t h : -Most Very M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (c) N u r s i n g P e r s o n n e l (N=68) (d) Non-Nursing P e r s o n n e l (N-97) 4.30 5.15 1 8 . 3 0 1 5 . 5 8 1 1 . 1 7 7.67 4.47 1 6 . 9 5 52 .92 5 2 . 06 4 4 . 9 0 9.45 8.82 TABLE 3 0 Self-Assessed Perception of Communication Effectiveness Question 6. "In resolving differences of opinions or misunderstandings i n working si t u a t i o n s , I would rank the effectiveness of the communication between myself and the following departments or positions as:" Nursing Personnel with:-Most Very Moderately Somewhat Not Usually No No Ef f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication Reply (a) Nursing Personnel (N=68) (b) Non-Nursing Personnel (N=97) 16.18 8. 01 39.95 21.41 18.38 13.56 7.11 8.66 .98 1.63 12.99 40. 20 4.41 6.94 Non-Nursing Personnel with:-Most Very Moderately Somewhat Not Usually No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication Reply (c) Nursing Personnel (N=68) (d) Non-Nursing Personnel (N=97) 4.47 5.15 20. 62 16.84 16.67 11.91 4.30 4.24 2.23 2.98 43.23 50.74 7.73 8.13 TABLE 31 Self-Assessed Perception of Communication Effectiveness Question 7. "When I express MY ideas or suggestions to the following departments or positions, I would rank the effectiveness of the communication as:" Nursing Personnel with:-Most Very Moderately Somewhat Not Usually No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication Reply (a) Nursing Personnel (N=68) (b) Non-Nursing Personnel (N=97) 16. 67 5.56 34.80 19.44 23.04 18.83 6.13 7.52 .1.47 3.10 11.76 39. 05 6.13 8.50 Non-Nursing Personnel with:-Most Very Moderately Somewhat Not Usually No No Ef f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication Reply (c) Nursing Personnel (N=68) (d) Non-Nursing Personnel (N=97) 2.75 5.38 19.93 16.95 15.67 11.57 6.01 4.81 1.89 2.63 48.63 52.58 5.15 6. 07 TABLE 32 S e l f - A s s e s s e d P e r c e p t i o n o f Communication E f f e c t i v e n e s s Q u e s t i o n 8. "As a summary, i n g e n e r a l I f e e l t h a t the OVERALL e f f e c t i v e n e s s o f t h e communication between m y s e l f and t h e f o l l o w i n g departments o r p o s i t i o n s i s : " N u r s i n g P e r s o n n e l w i t h : -Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y (a) N u r s i n g P e r s o n n e l (N=68) (b) Non-Nursing P e r s o n n e l (N=97) 23.04 8.50 38.97 25.65 18.63 18. 95 5.15 8.01 1.23 1.47 8.09 32.52 4.09 4.90 Non-Nursing P e r s o n n e l w i t h : -(c) N u r s i n g P e r s o n n e l (N=68) (d) Non-Nursing P e r s o n n e l (N-97) Most V e r y M o d e r a t e l y Somewhat Not U s u a l l y No No E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e E f f e c t i v e Communication R e p l y 7.73 10. 08 25.60 18.79 17.70 11.57 4.98 4.93 1.20 2.86 36.94 45.70 5.84 6.07 APPENDIX F A b s o l u t e f r e q u e n c i e s o f p e r c e i v e d s u b j e c t i v e d a t a o b t a i n e d by the e i g h t h q u e s t i o n o f t h e I n t e r s t a f f Communication Q u e s t i o n n a i r e 149 TABLE 33 LIKERT CATEGORIES OF COMMUNICATION EFFECTIVENESS H o s p i t a l S t a f f C a t e g o r i e s grouped and compared w i t h o t h e r e l e v e n grouped c a t e g o r i e s Not Effective Somewhat Effective Moderately Effective Very Effective Most Effective 1. D i e t a r y N=10 0 2 6 23 0 2. Housekeeping N=16 25 19 22 11 0 3. M e d i c a l Records N=10 0 0 7 22 5 4. Nurses N-68 10 50 125 184 65 5- Ward C l e r k s N=2 0 0 0 4 9 6. O c c u p a t i o n a l Therapy N=12 2 11 33 15 4 7. Pharmacy N=10 0 12 21 27 9 8. P h y s i c a l Therapy N=34 3 15 46 94 40 9. P h y s i c i a n s N=10 2 4 18 57 10 10. P o r t e r s N=6 0 0 6 12 11 11. S o c i a l S e r v i c e N=6 0 0 3 14 7 150 APPENDIX G A b s o l u t e f r e q u e n c i e s o f t h e o b s e r v e d o b j e c t i v e d a t a o b t a i n e d u s i n g B a l e s * I n t e r a c t i o n P r o c e s s A n a l y s i s TABLE 3 4 LIKERT CATEGORIES OF COMMUNICATION EFFECTIVENESS H o s p i t a l S t a f f C a t e g o r i e s grouped and compared w i t h o t h e r e l e v e n grouped c a t e g o r i e s Not Effective Somewhat Effective Moderately Effective Very Effective Most Effective 1. D i e t a r y N=10 25 59 103 57 78 2. Housekeeping N=16 40 43 74 45 82 3. M e d i c a l Records N=10 6 1 10 7 23 4. Nurses N=68 519 913 2144 1082 1297 5. Ward C l e r k s N=2 295 491 1014 562 769 6. O c c u p a t i o n a l Therapy N=12 48 92 261 125 97 7. Pharmacy N=10 28 53 128 45 87 8. P h y s i c a l Therapy N=34 90 151 478 179 234 9. P h y s i c i a n s N=10 47 155 410 233 148 10. P o r t e r s N=6 26 40 126 49 106 11. S o c i a l S e r v i c e N=6 80 120 386 162 157 APPENDIX H R e l a t i v e f r e q u e n c i e s o f p e r c e i v e d s u b j e c t i v e d a t a ( i n p e r c e n t s ) o b t a i n e d by t h e e i g h t h q u e s t i o n o f the I n t e r s t a f f Communication Q u e s t i o n n a i r e TABLE 35 H o s p i t a l S t a f f C a t e g o r i e s grouped and compared w i t h o t h e r e l e v e n grouped c a t e g o r i e s LIKERT CATEGORIES OF COMMUNICATION EFFECTIVENESS >i CD CU rH CU CU CU > 4-1 > CU > > > -H rd -H 4-1 -H •H •H 4-> Xi 4-1 rd 4-1 -P 4-> 0 S o H O O O CU CU CU CU CU >i CU 4-1 CU 4-> m S «w TJ 44 54 44 CO 44 o 4H 0 4-1 O 44 CU 44 O 44 a w en w a W > W a w 1. D i e t a r y N=10 2. Housekeeping N=16 3. M e d i c a l Records N=10 4. Nurses N=68 5. Ward C l e r k s N=2 6. O c c u p a t i o n a l N=12 Therapy 7. Pharmacy N=10 8. P h y s i c a l N=34 Therapy 9. P h y s i c i a n s N=10 10. P o r t e r s N=6 11. S o c i a l S e r v i c e N=6 0. 6.5 19.4 74.2 0. 32.5 24.7 28.6 14.3 0. 0. 0. 20.6 64.7 14.7 2.3 11.5 28.8 42.4 15. 0. 0. 0. 30.8 69.2 3.1 16.9 50.8. 23.1 6.2 17.9 30.4. 39.1 13.0 23.2 47.5 20.2 19.8 62.6 11. 0. 1.5 7.6 2.2 4.4 0. 0. 20.7 41.4 37.9 0. 0. 12.5 58.3 29.2 APPENDIX I R e l a t i v e f r e q u e n c i e s o f the o b s e r v e d o b j e c t i v e d a t a ( i n p e r c e n t s ) o b t a i n e d u s i n g B a l e s ' I n t e r a c t i o n P r o c e s s A n a l y s i s TABLE 36 H o s p i t a l S t a f f C a t e g o r i e s grouped and compared w i t h o t h e r e l e v e n grouped c a t e g o r i e s LIKERT CATEGORIES OF COMMUNICATION EFFECTIVENESS >i (U rH CJJ cu CU > -P > CU > > > -rl rd - H -P -H •H -rl -P Xi -P rd 4-> •p -P O & U U 0 o U CU CU cu (U cu >i cu -P CU •P 4-1 6 4-1 4H !H 4H cn 4H O 4-1 0 4-J O 4H CU 4H O 4H IS H CO H s w > W a w 1. D i e t a r y N=10 2. Housekeeping N=16 3. M e d i c a l Records N=10 4. Nurses N=68 5. Ward C l e r k s N=2 6. O c c u p a t i o n a l N=12 Therapy 7. Pharmacy N=10 8. P h y s i c a l N=34 Therapy 9. P h y s i c i a n s N=10 10. P o r t e r s N=6 11. S o c i a l S e r v i c e N=6 7.76 18.32 31.99 17.70 24.22 14.08 15.14 26.06 15.85 28.87 12.77 2.13 21.28 14.89 48.94 8.72 15.33 36.00 18.17 21.78 9.42 15.68 32.39 17.95 24.56 7.70 14.77 41.89 20.06 15.57 8.21 15.54 37.54 13.20 25.51 7.95 13.34 42.23 15.81 20.67 4.73 15.61 41.29 23.46 14.90 7.49 11.53 36.31 14.12 30.55 8.86 13.26 42.65 17.90 17.35 

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