Nursing CommunicationNursing Communication

CommunicationCommunication

From 1995-2005 JCAHO reviewedover 2537 sentinel events in General Hospital and Emergency Departments.

Found…Ineffective communication is a root cause of nearly 66 percent of all sentinel events reported

(The Joint Commission Root Causes and Percentages for Sentinel Events (All Categories) January 1995 December 2005)−

CommunicationCommunication

Communication can be defined as the process by which people share ideas, experience, knowledge and feelings through the transmission of symbolic messages.

Key Elements of Key Elements of CommunicationCommunication

•Message•Source•Channel•Receiver•Filter•Feedback

Standards of Standards of communicationcommunication

•Complete-Communicate all relevant information

•Clear-Convey information that is plainly understood

•Brief-Communicate the information in a concise manner

•Timely-Offer and request information in an appropriate timeframe

-Validate authenticity or acknowledge information 

Communication Communication Chain of CommandChain of Command

• One of the most common areasleading to OB claims. 

• Lack of policies on chain of command.• Chain of command was not followed according

to policy.

Communication Communication Chain of CommandChain of Command

• Chain of command protocols meant to empower nurses

• Nurses hesitate to use chain of command

Communication Chain of CommandCommunication Chain of Command

Chain of commandChain of command

Delegation and downsizing◦ Nurse responsible for own act of negligence.◦ Hospital is legally accountable to provide an adequate number of staff.

◦ Hospital is legally accountable that unlicensed professionals are qualified.

◦ Nurse has legal duty to communicate with administration if there are concerns.

◦ Administrator is responsible for solving problem and continuing up the chain of command.

The Association of Women's Health, Obstetrics and Neonatal Nurses (AWHONN) published the following statement related to the chain of command:

"The nurse must initiate an appropriate course of action when, after careful deliberation, the issue is determined to be a matter of maternal/fetal well being...”

(Association of Women's Health, Obstetrics and Neonatal Nurses, 2003, p. 232).

S.B.A.R.S.B.A.R.

• Framework for communicating.• Universal way of addressing issues

within healthcare.• Helps create an environment where individauls can

expression their concern.• Helps ensure that patient’s get what the need, when

the need.

S.B.A.R.S.B.A.R.

Situation – What is happening?

Background – What is the background?

Assessment – What do I think the problem is?

Recommendation – What would I recommend?

S.B.A.R.S.B.A.R.

• Assess patient yourself• Discuss situation with another colleague• Organize information before with physician.• Chart• Allergies• Medication list • Current list of IV meds and fluids• Pertinent lab results• Primary physician name  • Code status

SituationSituation

• State you name and unit.• Identify the person you are

talking to• “I am calling about (state

patient and room).• State the problem you are

calling about

BackgroundBackground

• State admission diagnosis and date of admission.

• State any other pertinent diagnosis or medical problems.

• State medical history• State brief synopsis of current

treatment

AssessmentAssessment

• Analysis of the situation• What is you clinical impression?• Severity of the patient• Metal Status any neurological changes• Vital signs of mother• Fetal heart rate• Contractions• Discharge• Pain level

RecommendationRecommendation

• Explanation of what you are requiring.• Change in treatment• Ask for consultation• What test you believe is needed.• Clarification of how urgent the action needs to

occur.• If changes have occurred need follow plans• How often for vital signs• If no improvement what next?• Document change in condition• Document physician notification

CommunicationCommunication

• The Joint Commission has set a

standard for communication.

• The nurse transferring care must give the nurse taking responsibility for the patient all appropriate information about his condition.

• The nurse transferring care must give the nurse taking responsibility for the patient all appropriate information about his condition.

Two-Way Two-Way CommunicationCommunication

• The objective is to engage in a two way flow with responses to questions.

Two-Way Two-Way CommunicationCommunication

• In 2011the U.S. Department of Health and Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ) launched an initiative to encourage clinicians and patients to engage in effective two-way communication.

• Better communication with patients shown to increase compliance with treatment plans.

Low Health Low Health LiteracyLiteracy

“It is likely the almost everyone has been, at some time, put off by densely worded forms, and confused by complex medical regimens, conflicting health care advice, poorly worded instructions, and medical speak that few on the receiving side of health care can understand.”

What Did the Doctor Say?: Improving Health Literacy to Protect Patient Safety, The Joint Commission, 2007 www.jointcommission.org

Low Health Low Health LiteracyLiteracy

“The communications gap between the abilities of ordinary citizens, and especially those with low health literacy and low English proficiency, and the skills required to comprehend everyday health care information must be narrowed.”

What Did the Doctor Say?: Improving Health Literacy to Protect Patient Safety, The Joint Commission, 2007 www.jointcommission.org

Low Health Low Health LiteracyLiteracy

•Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Institute of Medicine, 2004)•Health literacy is dependent on both individual and systemic factors

Communication skills of lay people and professionalsKnowledge of lay people and professionals of health topicsCultureDemands of the healthcare and public health systemsDemands of the situation/context

Teach BackTeach Back

• Nurses have an ethical and legal duty to validate a patients understanding of the treatment offered.

• A health literacy tool to ensure patient understanding• Asking patients to repeat in their own words what

they need to know or do, in a non-shaming way. • NOT a test of the patient, but of how well you

explained a concept.• A chance to check for understanding and, if necessary,

re-teach the information.

Non-English Non-English Speaking patientSpeaking patient

• Joint Commission Guidelines promote care that is culturally and linguistically sensitive.

• Nurses must provide patients with resources necessary to communicate with their healthcare providers.

• All hospital should ensure non-English patients are offered translation services.

• On admission patient’s preferred language must be identified for discussing healthcare.

• Patients need to be notified of their right for an interpreter.• Free services