A GUIDE TO GETTING THE BEST HEALTHCARE: Understanding the System and Communicating Your Needs

People who have known each other for many years, if not all of their life, will feel as if some albeit important discussions are no longer worth having as they always seem to end in the same way. Not responding in the same way they always have can help others to be more tolerant and to try to reach new ground. For those that have avoided communicating so far, this is confronting and enormously challenging. Communication about difficult issues is much easier if the small steps have been taken first.

Try to use the valuable time you have now to open discussion slowly. Be Assertive When You Need to. I feel pretty tired most days. I want you to help around at home by making your own lunches. Communication evolves and there are nearly always other opportunities to talk. Be realistic in your expectations — set realistic goals for communication and be patient, yet motivated, to create even small changes. Communicate Without Words Loving and supportive communication does not need to revolve around words.

Importance of Communication in Nursing

Simply being there, holding hands, smiling, sharing meaningful eye contact and showing physical affection are all meaningful ways of demonstrating respect, concern and support. Technically, the only one with the rights to patient information is the next of kin. Large families, though, pose a problem as there may be a number of next of kin. It is simple and easy to turn someone down under those circumstances. That number can very easily be disseminated to numerous people, and this means the nurse has to spend a great deal of time explaining the same information to ten or twelve different people.

It takes time to make non-medical persons understand the situation, and the problem can get quickly out of hand. In large family situations, someone should be appointed the main contact. This way, the nurse only has to explain the situation once. Ideally, it should be the next of kin; but some families may want a member with a medical background to handle updates and check-ins.

Another possible management tool is to tell the next of kin to guard the privacy number closely. Explain to them that it takes away from the care of their family member to have several people with the privacy number. Even though you are not in charge of the family, you will have to step in and make suggestions that they may or may not comply with. However, even in the best of situations, it may be difficult to get the amount of contacts down to one.

Mrs Jones is an year-old woman who has come into the intensive care unit with an acute stroke. She is the proud mother of five children, all of whom are married, and a grandmother of ten. Some of these grandchildren are old enough to have spouses of their own. The relationship between Lisa and her siblings is complicated, and all of them have insisted on obtaining the security code for themselves. Lisa, not wanting to start an argument, has given it to her brothers and sisters, who in turn, gave it to a few grandchildren.

Although the nurse tries to be concise, often these conversations can take up to twenty minutes. It is decided that all information will flow through Lisa, although this does not make everyone happy. In the end, you will inevitably engender bad feelings, even in small families. Even those without the privacy code may try to bully you into telling them something, and your assertiveness as a nurse has to override that impulse to please. There are no easy answers in cases like this, and the nurse has to make a judgment on a case-by-case basis.

You can help minimise bad feelings by actively listening, keeping your cool and assuring callers that you understand they are concerned about the patient. If you have someone who is angry with you, that may be necessary for the good of the patient. If that person goes to your manager, be sure to back up your actions so that you can prove you are merely respecting privacy laws and protecting your ability to care for the patient. Sometimes, despite our best intentions, things can get a little out of hand and patients may demand to speak to a higher authority — your nurse manager for example. Families in crisis may react in ways that they normally would not.

The stress and worry over a patient in danger can cause them to say and do things that are offensive, violent, loud, and intimidating. A great deal of the attention will be focused on you because you are at the bedside, caring for their family member.

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As in most communication situations, it is important to remain calm in the face of whatever the family may present. In that case, you need to work on calming the relative. Once you have established that they are privy to the details, tell them the truth about what is going on with their loved one. Be prepared for a wide range of reactions. Some will react with anger, but most will react with neutrality or sadness.

In some cases, this can be more difficult to deal with than hostility.

Communication Skills for Nurses

Offer yourself as a sounding board for the relative. Make it a point to be there for them, a presence of peace and understanding. Comfort them and do not betray their trust in you. Patients have the right to competent care, protection from reasonable risks, and advocacy from their nurse. If the relatives are disturbing the patient, working them up, or causing more stress, the nurse has to step in and remove the family.

It is a difficult situation to be put in because no one wants to separate a family from their loved one. Is this helping them or hurting them? Most families will not cause stress, but sometimes even the most laid back family may cry, focus only on the negative, or in other ways upset the patient. In these cases, it is important to talk to the patient and the family member. Ask the patient if they are comfortable with their family and if they would like the family to have restricted access to them. Most will decline, but at least you are offering the opportunity to the patient.

Communication Skills for Nurses - 10 Tips for Improvement| Ausmed

Next, talk with the family. Explain that their behaviours are upsetting the patient and that a different approach is needed. There is no reason to be falsely happy, but tell them to simply be with the patient instead of focussing on the negative. In the end, talking to a patient may be easier than talking to their family. Patients may not understand what is going on with them, and their relatives are basically in the same position.

However, they also have the added stress of not knowing if their loved one will make it through. Acknowledge the fear they are feeling and offer them the same compassion you would offer your patients. Nurses encounter many older people in the course of their careers. This makes sense, because as a person ages they may require more frequent care. Communicating with patients is a skill that you need to practice.

Memory and cognitive disturbances can also make talking to this population challenging. One of the most important considerations when talking with older people is time. It is hard to dedicate the time necessary to talk properly to an older person, but this is the way to open the communication channel.

It is only over time that you get the whole story. This is especially true of doctors, but they may feel the same reticence when talking to nurses. If you are there and available for their concerns, they may be more willing to talk to you than to the doctor who might only spend five minutes in the room.

You may find out something that is vital to the care and comfort of that patient just by spending an extra few minutes with them. Yes, nurses are busy, but older people need time to express their pain, fear, and questions, and you need to allow for that in your schedule. As with children, it is best to avoid medical jargon when speaking with older people. It is a fine line to walk, and you need to base your language on the questions and cognitive ability of the patient you are speaking with.

Try to use language that is simple, clear, and non-threatening. You should also strive to be as honest as possible. Some older patients need to write down what you are telling them so that they will remember it.

Be prepared to repeat yourself and express concepts in different ways so that your patient can grasp what you are trying to say. One of the most important parts of helping your elderly patients is acting as a kind of interpreter for the doctor. Try to be on hand when the doctor talks to the patient so you can explain later what they said. They will wait and ask you later to get a better understanding. Although she is forgetful, she is still able to live a relatively independent life.

She experienced an episode of fainting that was witnessed by several people at church, and she was taken to her primary care physician. It took a great deal of talking to her to help her understand that the fainting spell was, in fact, a major problem that needed to be investigated. In addition to restricting her driving privileges, Carolyn needed several tests to rule out different probable causes of her fainting spell.

Each test needed to be carefully explained to Carolyn and the information repeated so that she could grasp what each one required. She wrote down all the key information in a system that she had developed to keep herself from forgetting important points.

It takes careful reminding to keep her from driving her car or performing other actions that may put her in danger. Our research has shown that 17 percent of respondents to our survey research in — knew of a specific adverse event that occurred as a result of disruptive behavior. A quote from one of the respondents illustrates this point: Leaders in both medicine and nursing have issued ongoing initiatives for the development of a cooperative rather than a competitive agenda to benefit patient care. The fact that most health professionals have at least one characteristic in common, a personal desire to learn, and that they have at least one shared value, to meet the needs of their patients or clients, is a good place to start.

A large body of literature shows that because of the complexity of medical care, coupled with the inherent limitations of human performance, it is critically important that clinicians have standardized communication tools and create an environment in which individuals can speak up and express concerns. This literature concurs that when a team needs to communicate complex information in a short period of time, it is helpful to use structured communication techniques to ensure accuracy.

Structured communication techniques can serve the same purpose that clinical practice guidelines do in assisting practitioners to make decisions and take action. Research from aviation and wilderness firefighting is useful in health care because they all involve settings where there is a huge variability in circumstances, the need to adapt processes quickly, a quickly changing knowledge base, and highly trained professionals who must use expert judgment in dynamic settings.

Research shows that in these disciplines, the adoption of standardized tools and behaviors is a very effective strategy in enhancing teamwork and reducing risks. Experts in aviation have developed safety training focused on effective team management, known as Crew Resource Management CRM. Improvements in the safety record of commercial aviation may be due, in part, to this training.

Realizing that 70 percent of commercial flight accidents stemmed from communication failures among crew members, CRM sought to standardize communication and teamwork. The concept originated in , in response to a NASA workshop that examined the role that human error plays in air crashes. CRM emphasizes the role of human factors in high-stress, high-risk environments.

This represents a major change in training, which had previously dealt with only the technical aspects of flying. It considers human performance limiters such as fatigue and stress and the nature of human error, and it defines behaviors that are countermeasures to error, such as leadership, briefings, monitoring and cross-checking, decisionmaking, and review and modification of plans. From a practical standpoint, CRM programs typically include educating crews about the limitations of human performance.

Trainees develop an understanding of cognitive errors and how stressors such as fatigue, emergencies, and work overload contribute to the occurrence of errors. Operational concepts stressed include inquiry, seeking relevant operational information, advocacy, communicating proposed actions, conflict resolution, and decisionmaking.

CRM is now required for flight crews worldwide. The development and implementation of CRM in aviation over the last 25 years offers valuable lessons for medical care. Sexton and colleagues 51 compared flight crews with operating room personnel on several measures, including attitudes toward teamwork.

This landmark study included more than 30, cockpit crew members captains, first officers, and second officers and 1, operating room personnel attending surgeons, attending anesthesiologists, surgical residents, anesthesia residents, surgical nurses, and anesthesia nurses. Questionnaires were sent to crew members of major airlines around the world over a year period. The operating room participants were mailed an analogous questionnaire, administered over a period of 3 years at 12 teaching and nonteaching hospitals in the United States, Italy, Germany, Switzerland, and Israel.

The Sexton study and other analyses suggest that safety-related behaviors that have been applied and studied extensively in the aviation industry may also be relevant in health care. Study results show successful CRM applications in several dynamic decisionmaking health care environments: In anesthesiology, 65—70 percent of safety problems accidents or incidents have been attributed at least in part to human error. Collected data from the comparison periods and were statistically analyzed using the chi-square test. This study indicates that, since the implementation of MTM, there has been a statistically significant increase in the number of reports filed at Eglin USAF Regional Hospital and a decline in the severity of incidents.

These findings suggest that since the implementation of MTM, there have been changes in the patterns of error reporting, and with training, staff are able to prevent more serious incidents. Table 3 highlights the application of a CRM model to medicine. Doctors and nurses often have different communication styles in part due to training. Nurses are taught to be more descriptive of clinical situations, whereas physicians learn to be very concise.

Standardized communication tools are very effective in bridging this difference in communication styles. This technique has been implemented widely at health systems such as Kaiser Permanente. It allows for an easy and focused way to set expectations between members of the team for what will be communicated and how, which is essential for information transfer and cohesive teamwork. Not only is there familiarity in how people communicate, but the SBAR structure helps develop desired critical-thinking skills. The person initiating the communication knows that before they pick up the telephone, they need to provide an assessment of the problem and what they think an appropriate solution is.

Their conclusion may not ultimately be the answer, but there is clearly value in defining the situation. The guidelines use the physician team member as the example; however, they can be adapted for use with all other health professionals. Forest Service to give direction to firefighters.

The literature reviewed shows that effective teams are characterized by common purpose and intent, trust, respect, and collaboration. Team members value familiarity over formality and watch out for each other to make sure mistakes are not made. Health care teams that do not trust, respect, and collaborate with one another are more likely to make a mistake that could negatively impact the safety of patients. One of the first crucial steps is organizational commitment and willingness to address the situation.

Commitment needs to come from the top down and bottom up, making a statement about the way the organization does business. The rallying point should be around behavioral standards and their relationship to patient safety. Clinical and administrative leaders must set the tone by establishing and adhering to behavioral standards that support agreed-upon code of conduct practices backed by a nonpunitive culture and zero-tolerance policy.

The next step in the process is recognition and self-awareness. Organizations must be able to assess the prevalence, context, and impact of behaviors to identify potential opportunities for improvement. Doing an internal assessment will help pinpoint the seriousness of the situation and provide clues to areas that need to be addressed.

Assessment information can be gained from formal methods such as incident reports, survey tools, focus groups, department meetings, task forces or committees, direct observation, suggestion boxes, and hot lines. Informal methods such as casual meetings and gossip can also provide valuable surface information and should be evaluated more deeply as to the source, relevance, and significance of the events to determine next steps. In many organizations there are still remnants of reluctance to address the issue head on for fear of antagonizing a prominent surgeon or staff member.

With growing concerns about workforce shortages, staff satisfaction and retention, hospital reputation, liability and patient safety, and the need for compliance to the latest Joint Commission proposed standards addressing disruptive behaviors, organizations can no longer afford to take a passive approach to the situation.

Creating opportunities for different groups to just get together is a highly effective strategy for enhancing collaboration and communication. These group interactions can be either formal or informal.

Communicating with Patients

Encouraging open dialogue, collaborative rounds, implementing preop and postop team briefings, and creating interdisciplinary committees or task forces that discuss problem areas frequently provides an upfront solution that reduces the likelihood of disruptive events. When a disruptive event does occur, some organizations have implemented a time-out, code white, or red light policy that addresses the issue in real time to prevent any further serious consequences.

Developing and implementing a standard set of behavior policies and procedures is vital. These policies need to be consistent and universally applied. There should not be a separate policy for any one particular discipline or service. For the medical staff, the policies should become part of the medical staff bylaws with signed agreements to abide by these policies at the time of appointment and recredentialing.

Included in the policies should be a standardized protocol outlining expected standards and the process for addressing disruptive behavior issues, recommendations, followup plans, and actions to be taken in the face of individual resistance or refusal to comply. Prior to implementation, make sure all employees are familiar with the existence, purpose, and intent of the policies and procedures.

For the process to unfold, the organization needs to encourage its employees to report disruptive behaviors. The organization needs to address issues related to confidentiality, fear of retaliation, and the common feelings that there is a double standard and that nothing ever gets done. Reporting mechanisms should be made easy and must be supported by the presence of a nonpunitive environment. The ideal vehicle for reporting is to address the situation in real time, but concerns about position, appropriateness, receptiveness, fear, hostility, and retaliation are significant impediments.

Responses should be timely, appropriate, consistent, and provide necessary feedback and followup.

Establishing Good Communication

Taking action though appropriate intervention strategies is next. On one level, generic educational programs can do a lot to spread the message and teach basic skills necessary to promote effective communication. Appropriate topics should include sessions on team dynamics, communication skills, phone etiquette, assertiveness training, diversity training, conflict management, stress management, and any other courses necessary to foster more effective team functioning and communication flow.

Courses should be offered to all staff and employees at the organization: For individuals who have consistently exhibited disruptive behavior, education may need to be supported by more focused sessions and specific counseling. Another important strategy is to promote and assure competency training at all levels of the health care team.

This is a key factor affecting trust and respect, which have such a strong influence on team collaboration. Focused team training programs have been of particular value. One of the newer approaches to improving team collaboration and patient safety is through the principles learned from the aviation industry. Fostering an environment of trust and respect, accountability, situational awareness, open communication, assertiveness, shared decisionmaking, feedback, and education, interdisciplinary CRM training has brought significant improvements to communication flow in the perioperative setting.

Having a clinical champion or early adopter who actively promotes the importance of appropriate behavior, communication, and team collaboration can be an extremely valuable asset. Champions can come from the executive ranks or through the voluntary interest and enthusiasm of other staff members. Co-champions may be even more effective. Some organizations have reported that having a nurse and physician or other health care professional go through a joint training program will help foster mutual cooperation and collaboration between the different disciplines.

Due to the important clinical, emotional and psychological benefits for nurses and patients, many online RN to BSN programs are now incorporating communication training into their curricula. Coursework in professional interpersonal communication — including written and verbal techniques — can help prepare nurses for the workplace. While the significance of verbal communication is well understood, the necessity to use clear and concise written communication is often underestimated.

With the rise of electronic medical records, malpractice lawsuits and insurance denials, it has become increasingly important for nurses to fully document patient encounters and treatment plans. Those who study the role of communication and its effects on interpersonal relationships are expected to have a distinct advantage upon entering the field. Students should have the opportunity to evaluate various techniques and apply those in the classroom and clinical settings. Nurse-patient interactions must be handled with care, and students need to learn how to approach different scenarios.

For example, nurses should refrain from overwhelming the patient with irrelevant details or complex language. Learning to communicate at the level of the listener, whether a patient, caregiver, or another nurse or healthcare provider, is a crucial concept. Nurses have a multitude of responsibilities when it comes to patient care.

Arguably, communication tops the list. Nurses act as the hub of communication, relaying and interpreting information between physicians, caregivers, family members and patients. The ability to establish effective communication in nursing is imperative to providing the best care and patient outcomes possible. Developing these skills starts in the classroom, where students can study techniques in more depth.

Coursework covering professional interpersonal communication, including both verbal and written, is ideal. Many online RN to BSN programs offer this training as part of their curricula now due to the growing impact that effective communication has on patients, nurses, and their coworkers. Communication in Nursing Practice.