NURSE-PATIENT COMMUNICATION, AND PATIENT SAFETY
The principle of Patient-Clinician Communication
Effective and consistent communication between patients and clinicians has been associated with improved patient safety and satisfaction, lower costs and better health outcomes. Poor communication and disregard for patient context, preferences, and understanding have been attributed to disparities in health care and other counterproductive differences in health care utilization rates. To build a trusting relationship with patients, it is paramount that healthcare professionals foster effective and respectful communication, which also promotes informed consent (Forensic Healthcare, 2012). In fostering good patient-clinician communication, seven basic principles are applied. In this paper all seven principles will be discussed in depth, their application defined, methods of improving interdisciplinary communication and ethical tenets addressed.
Principles of Communication
The number one principle of patient-clinician is mutual respect. Paget et al. (2011) provide that every party involved, in this case, patients and clinicians, should be engaged as full decision makers. Communication between these parties should support the growth of a partnership connection that is built on trust and focused on the patient. Paget et al. further provides that both parties should exchange information through active and respectful listening, inquiry and facilitation. The information should include the patient’s preferences, ideas, and values.
The second principle of patient-clinician communication is the creation of harmonized goals. Both the patient and clinician, after exchanging information, should have a common goal. Both should agree on a care plan after considering its costs, benefits, risks involved, patient expectations, preferences, lifestyle, health, health literacy and cultural differences.
The third principle of patient-clinician communication is the need for a supportive environment. Both parties need environments that nurture and allow for the provision of quality services and sound decision making. A good environment allows for the required attention to be given to the patient and for the care to be implemented. It also allows for the patient and clinician to speak and communicate openly.
The fourth principle of patient-clinician communication is the availability and presence of appropriate decision partners such as specialists and patient’s agents. All parties need to be understanding and competent in arriving at proper decisions. Today, sophisticated problems are arising, and the availability of specialists is essential. Communication between all clinicians and the patient should be fostered to ensure the patient gets the best .
The fifth principle is the provision of the right information. Clinicians should offer their opinions, choices, and trade-offs while the patient should share their perceptions, personal practices, and symptoms. While parties are sharing information, they should be transparent and offer full disclosure, which is the sixth principle. The clinician should fully disclose the benefits, risks, costs and any other information that will aid the patient in decision making, while the patient should fully disclose to the clinician all relevant preferences, medical history, and circumstances.
Lastly, continuous learning is necessary and is the last principle. Regular feedback between clinician and patient on progress, status and challenges are fundamental in the development of a learning connection that is flexible and adaptable to the changing situations and needs. This is achieved through regular assessments that help in changing strategies as needs change.
As a nurse, I apply these principles in my work. I actively and respectfully listen, inquire from and facilitate my patients when they are letting me know how they are feeling. After listening to them and making notes, I repeat, in my understanding, what they said to ensure we are on the same page. I like nursing my patients in an environment they are comfortable in, one that is not noisy and an environment they can freely talk. I also try to make them feel at home and urge them not to hold back any information.
In some cases, when a patient needs specialized treatment, we come together as nurses and doctors from different fields to help the patient. It is paramount that the patient receives the care they need, and we ensure this by sharing and exchanging information on the patient and treatment as well. During these times, we, the medical professionals, share useful and right information with the patient and also urge the patient to share the correct information with us. Some patients tend to give false information in cases where they are feeling ashamed of their conditions. At all times, I encourage transparency and full disclosure. Sometimes it is painful and hard to share sensitive information, but I do it because the patient deserves to know it. I just have to be careful how I deliver it. Lastly, I schedule assessments and collect feedback from my patients. The assessments help keep me up to date on my patients’ statuses and progress.
Methods to improve interdisciplinary communication.
We have already established that communication between patients and clinicians is essential. Patients receive better care when members of a healthcare team work in collaboration, where they put their different skill sets, professional identities, and knowledge in their work. However, barriers such as perceived power differences, inter-professional cultural competence, and profession-centered role models hinder the provision of good quality care (Keller et al., 2013). In the quest to improve interdisciplinary communication, three methods are used. One way is the use of multidisciplinary rounds and using daily goal sheets. Multidisciplinary rounds involve different health care professionals such as nurses, physicians, social workers, therapists and pharmacists among others discussing in real time a patient’s care plan, daily goals, potential discharge or transfer. These rounds are attended by any healthcare professional helping care for a patient in one way or the other. During the rounds, every participant in the care team fills the daily goals sheet. This method enhances patient satisfaction, reduces the length of stay and readmissions.
The other two methods used in improving interdisciplinary communication are team huddles and implementation of situational briefings. Team huddles are quick interdisciplinary meetings between team members before the beginning of a shift. Team huddles enhance communication between team members because they outline the work that needs to be done, prioritizes work, identify issues and address the problems. Team huddles have been said to lead to immediate clarification of issues and fewer interruptions during shifts. Situational briefings, on the other hand, involve the use of the SBAR, that is, situation, background, assessment, and recommendation method. This method gives the involved staff information about the patient’s status. It helps them know the patient’s current situation, their clinical context or background, what the problem is and the recommendation to give to the patient. The SBAR method allows all members to be on the same train thus bridges communication differences. (Dingley et al., 2008)
As a licensed practical nurse, the multidisciplinary rounds and gaily goals sheets would apply best to my practice. Working with different patients who require different specialists to attend to them, this method is applicable best. During the rounds, every professional who is working with a particular patient gets to offer their input on the patient, which helps in giving all-round care to the patient. Every practitioner present also gets to hear and consider the contribution of other members of the team.
Ethical principles and communication.
In the nursing profession, ethics govern nurses’ code of conduct and are highly upheld. There are four ethical principles namely; autonomy, justice, beneficence, and non-maleficence (Bhanji, 2013). The ethical principle of autonomy emphasizes the freedom of the patient to make decisions about their treatment. The nurse or clinician requires to be truthful to their patients and respect the patients’ choices on their treatment plan. To make right decisions the patient requires to be equipped with accurate, complete and comprehensive information by the healthcare professional. The ethical principle of beneficence provides that health care professionals treat their patients in such a way that offers the patient the full benefits.
The principle of nonmaleficence requires that nurses should ensure they avoid causing harm to their patients. Lastly, the ethical principle of justice requires that equality and fairness are held in the distribution of resources and offering care to patients (Povar et al., 2004). Justice is also rights-based, in that the rights of the patients need to be respected. Also, all patients have equal rights when seeking for health care. In patient-clinician communication, the patient has the freedom to communicate their decision, has the right to receive truthful information from healthcare professionals and thehave the duty to protect the patient from harm and treat the patient such that they receive the most benefits.
Ethics govern communication between patients and clinicians. They ensure that transparency is upheld therefore withholding of information is avoided. Ethical communication also enhances trustworthiness and respect between the involved parties. It also provides patient safety in that nurses get to acquire correct information from the patient and also keep accurate records. Patient safety is also upheld because the patient can speak up and point out mistakes, mainly because they are informed.
Patient safety is upheld when patient-clinician communication is effective. The patient can benefit from quality care provided by the professionals while the professionals can make better treatment decisions through information provided by the patient. Both parties should be ethical in communication and be respectful of either parties’ opinion.
Bhanji, S. M. (2013). Health Care Ethics. Journal of Clinical Research and Bioethics, 4 (1):142. doi: 10.4172/2155-9627.1000142
Dingley, C., Daugherty, K., Derieg, M. K. and Persing, R. (2008). Improving Patient Safety Through Provider Communication Strategy Enhancements. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK43663/
Forensic Healthcare. (2012). Patient-Clinician Communication: Basic Principles and Expectations. Retrieved from: https://www.forensichealth.com/2012/02/02/patient-clinician-communication-basic-principles-and-expectations/
Keller, K. B., Eggenberger, T. L., Belkowitz, J., Sarsekeyeva, M. and Zito, A. R. (2013). Implementing Successful Interprofessional Communication in Health Care Education: A . International Journal of Medical Education, 4, 253-259. doi: 10.5116/ijme.5290.bca6
Paget, L., Han, P., Nedza, S., Kurtz, P., Racine, E., Russell, S., … Kohorn, V. I. (2011). Patient-Clinician Communication: Basic Principles and Expectations. Institute of Medicine. Retrieved from: http://iom.edu/Global/Perspectives/2012/PatientClinician.aspx
Povar, G. J., Blumen, H., Daniel, J., Daub, S., Evans, L., Holm, R. P., … Campbell, A. (2004). Ethics in Practice: Managed Care and the Changing Health Care Environment: Medicine as a Profession Managed Care Ethics Working Group Statement. Annals of Internal Medicine, 2004, 141 (2), 131-136. doi: 10.7326/0003-4819-141-2-200407200-00012