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Executive Summary

This paper has focused on the importance of communication between nurses and patients, and the patient’s family members. Certainly, communication between the nurses and the patients is important for secure medication management. Efficient communication in all matters relating to the patients is very important as it prevents misinterpretation of information and, besides, it helps the patients to make appropriate decisions regarding their care. Miss-communication, which has also been discussed in this paper, may sway the number of re-visits patients make to their physicians and the significance of communication between nurses and the patients family members. It can result in negative consequences and, therefore, it is vital to offer comprehensive report regarding the patients, the failure to do this means that essential information is not communicated, thus, medications and treatments can be overlooked. According to some scholars, the patients and their families make conclusions regarding a certain hospital through observing the interactions of the nurse and the rest of the workers as well as the patients and as a result, it may affect such an organization either positively and negatively. Other factors including Quantum Leadership, legal issues and management principles have also been discussed in this paper. By ensuring that nurses are given some autonomy in their practices will help them offer the best care required in addition to helping them communicate effectively to their patients. This as a result would reduce some of the errors experienced in communication, including transcribing of medication orders and care provisions.

Introduction

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Effective communication is a major factor that should be considered in all organizations. In nursing care, there exists continuous communication between the patients and the nurse, the nurse and the supervisors, the patient’s family and the core workers. Such information including medication and care are very essential and must be communicated by the nurses to the patients or the patients’ family. Research shows that in nursing, communication may be a multifaceted procedure, and there habitually subsists the likelihood of receiving or sending wrong information (Caress, 2003). For this reason, nurses are recommended to be aware of the important elements of the communication procedure, the skills required and the possible predicaments that subsist with communication inaccuracies.

In the nursing practice, nurses are necessitated to communicate frequently with their patients regarding medications and to do this efficiently; they must understand the various factors that may sway how the patients interpret their messages. Such factors as the communication setting, personal perceptions, past experiences as well as communication timing among other factors should be put into consideration (Barrere, 2007).

Communication breakdown or miss-communication can result in negative consequences. It is vital to offer comprehensive report regarding the patients and failure to do this means that the essential information is not communicated, thus, medications and treatments can be overlooked. It is clear to us that for nurses to offer efficient nursing care, trust from the patients’ family and the patients themselves is a very significant element (Caress, 2003). Lack of trust signifies that the patients may disregard any communication conveyed to them. There are a number of steps that nurses can take to make sure that they are trusted by their patients. First the nurses should be honest with their patients and this is believed to be the initial steps for effective communication. Other significant factors are responsiveness and availability. If the patients and families consider that the nurses are ignoring them, they become irritated. Such complaint, if encountered, requires the communication procedure and the timing of the communication between the nurses and their patients to be looked at (Barrere, 2007).

Issues to be Addressed in the Paper

This paper will address the importance of communication between nurses and patients particularly in terms of medications. Certainly, communication between the nurses and the patients is important for secure medication management. The paper will also discuss how miss-communication may sway the number of re-visits patients make to their physicians and the significance of communication between nurses and the patients family members. Other factors such as legal issues, Quantum Leadership and management principles will also be discussed in the paper.

Section 2

Literature Review

Introduction

Basically, on the surface, communication would appear to be a simple idea in the health care sector. The patients get talking to their nurses and doctors and the nurses communicating with the families of the patients as well as between the nurses themselves in an attempt to get the best for the patient (Caress, 2003). Nevertheless, this is not always the case as many hindrances frequently get in the way of quality and effective communication. Lacking quality communication often restricts the service quality which can be offered to the patient. According to studies, some of these problems are mainly within the design of the health care system, whereas others are as a result of unsuitable services being offered to the patients (Kimberly, 2009). Due to the limitations in communication the visits of the patient to his physician gets frustrating as well as unpleasant. This section of the paper aims at exploring the relevant literature in relation to nurse patient communication so as to place the study in relation to what has previously been studied on the subject.

Significance of Communication between the Nurses and the Patients

It is apparent that the relationship between the patient and the nurse has a fundamental role in ensuring customer satisfaction. Moreover, it also sets the tone of the health care experience. According to the experts, the patients and their families make conclusions regarding a certain hospital through observing the interactions of the nurse and the rest of the workers (Susie, Anita & Aldridge, 1998). This in turn can affect the relationship of the patient with the nurse and the frequency with which the patient visits the hospital for the help of a physician. 

Effective communication is a major factor within the health care sector. This is due to the fact that communication is not only essential for accurate diagnosis and treatment but also because it is an essential factor in the patient satisfaction survey.  In a survey carried out by Jarrett and Payne (1995) on the importance of nurse-patient communication, a few factors were identified in relation to the topic. They included:

  • The need for the nurses to acquire relevant interviewing skills for them to be in a position to identify the problem accurately
  • Attending the patient individually, which heightens the significance of psychological factors and, hence, communication in nursing.
  • Research indicates substantial impacts of delivering information for instance the treatment regimes, stress, pain as well as anxiety reduction and heightening the compliance with drugs
  • Inappropriate communication as well as the lack of information result in patient complaints
  • Positive clinical outcomes are characterized by good communication (Gunther & Alligood, 2002).
  • Communication itself actually constitutes the care or nursing action in some instances (Barclay & Schmied, 2001).

From literature, it is apparent that there exists a strong trend in the communication between the patients and the health professionals. As highlighted by Hinckley et al (1990), those in support of patient consumerism have encouraged a more active participation by the patients as well as the activities aimed at enhancing question asking. Clearly, the medical profession is ensuring to address the needs and demands of the patients and their families. However, the physicians overestimated the patients desire to make decisions as well as underestimated their desire for information (Hinckley et al, 1990).

Similarly, these findings were echoed by Simpson et al., (1991), who argued that dissatisfaction and anxiety in patients was highly linked to uncertainty and inappropriate communication to include explanation and feedback from the physician. This is a clear indication that the medical professions have realized and addressed the patients’ desire to take part in decision making but they have not provided sufficient information to the patients yet for them to base their choice. In most instances, delivering information is both beneficial and essential.

The majority of patients have very little knowledge regarding the multifaceted medical processes (Susie, Anita & Aldridge, 1998). Some are demoralized by a medical situation and confused on what is taking place around them. To solve this issue, nurses should have good communication skills as this would assist in reassuring patients that care is being provided as required. Effective communication between patients and nurses is essential as it ensures that the patients are treated successfully whilst at the same time it ensures that the patients have the peace of mind necessitated in order to get well. Patients necessitate being aware of what is needed of them when they are at the hospital/medical facility and after leaving. To ensure that the patient-nurse communication is a success, it should be a two-way traffic; the nurse should both educe important information from his/her patients in addition to supplying them with pertinent medical information (Kimberly, 2009).

Studies have proven that every time information regarding medication is conveyed to the patients, there is likelihood for blunder. Generally, communication mistakes take place when a nurse computer generates or handwrites a medication order. Errors also occur while writing down an order; communicating a medication order via telephone, in person or by computer; while labeling the medicine container, whilst administering the medication, or whilst educating the patients regarding their medications (Hinckley et al, 1990). Normally, these errors occur due to communications errors although some are linked to the employment of acronyms, abbreviations and dose descriptions that the patients can misinterpret.

Nurses in medical facilities may be prescribing medication orders to the patients, writing down medication orders as well as educating patients regarding their medication. Knowledge of the likelihood for errors while communicating the medication orders and awareness concerning suitable terms may serve as a fundamental safety aspect of safeguarding the patients from probable harm.

Health care givers attempts to achieve more in reduced amount of time and this has various consequences, for instance, the association between the care givers and the patients is affected negatively (Kimberly, 2009). Pressure and stress caused by time constraints generally result in miscommunication, reduced patient and employee satisfaction, flawed postulation, and non-existent or poor care synchronization. Although ‘to error is human’, the Institute of Medicine reports that good and efficient communication between the patients and the nurses is vital to making certain consistent and safe care (Kimberly, 2009). Medical facilities are presently challenged by the need to establish a setting that is characterized by transparent and open communication. This can be achieved by implementing strategies to accomplishing the same. These strategies can be those adopted and being triumphant in other organizations.

Importance of Communication between Nurses and the Patient’s Family Members

It is important for the nurses to communicate effectively to the patient’s family all matters relating their patients. This occurs in cases whereby the patient is in a critical condition or has mental problems, thus, his medical information can only be conveyed to his/her family. In such cases, the nurse should communicate efficiently to the family members regarding the patients’ care and medications. Properly communicating such information as medication orders and how to administer them to the patient’s family members will ensure that the patient is in good and reliable hands, thus, the probability of harm is avoided (Patak et al., 2009).

Let’s take for instance a patient who has a history of bipolar disorder for the past ten years. As a requirement the patient’s nurse has a responsibility to ensure that the patient is taken care of in and out of the hospital. This can only happen when the relevant information is communicated to the family members. In some cases, such a patient may not comply with the medical prescription which means that his/her state will continue worsening if actions are not taken (Patak et al., 2009).

In other instances, patients are not in a position to make various medical decisions relating to their care. It is apparent that individual’s capacity to make certain decisions is compromised by certain illnesses or other factors. The Australian Code of Ethics requires nurses to accept individual’s rights to make their own decisions and choices relating to their care (Coady and Bloch, 1996). However, in cases where patients cannot be able to make such decisions, the nurse should communicate efficiently all the information relating to the patients to his/her family members in order to help them make correct decisions. Nurses have a role of informing individuals regarding the nursing care which is available to them, and individuals are at liberty to either reject or accept such a care (Fry and Johnstone, 2002). Thus nurses should ensure that the patients are provided with significant and ample information to enable them make informed decisions regarding their care, diagnosis, and treatment in order to sustain an optimum level of self determination and self direction (Fry and Johnstone, 2002).

Apart from the medication information, the nurses should also convey other vital information to the family members as this assists in relieving anxiety. Family members usually rely on the nurses to convey them with the patient’s information and link them with the physicians or other care providers (Barrere, 2007). Besides, the nurses have the responsibility of listening to them, relieving their anxiety as well as protecting their patients. The high expectations of the patients or the patients’ families to their nurses mean that the nursing performance, particularly the relationship between the nurses and the patients is very important as it ensures that both the patients and their family members are satisfied in addition to ensuring that quality care is offered (Barrere, 2007).

How Miss-Communication Can Affect Many Re-Visits

Communication breakdowns can sway everything from personal relationships, politics, businesses or military operations. Miss-communication is an issue that is evident and in many cases, it has resulted to problems between the sender and the receiver. In medical facilities, inefficient communication between the patients and the nurses may be particularly risky, resulting in bitterness, distrust as well as serious errors swaying patients’ mortality or recovery period (Patak et al. 2009). As a result, efficient communication is very important to patient safety and in order to attain this, nurses can make use of various practices.

Miss-communication has been evidenced to sway the number of re-visits made by patients to their physicians. In cases where there are poor communications regarding the administering of a certain medication, there may be severe effects to the patient and this may increase the number of re-visits patients make to their physicians for consultations (Erinn, Janice and Kitko, 2008). On the other hand, studies have proven that the patients and their families make conclusions regarding a certain hospital through observing the interactions of the nurse and the rest of the workers or the patient’s family. This in turn can affect the relationship of the patient with the nurse and the frequency with which the patient visits the hospital for the help of a physician. Due to the limitations in communication the visits of the patient to his physician gets frustrating as well as unpleasant. Communication breakdown or miss-communication can result to negative consequences. It is vital to offer comprehensive report regarding the patients and failure to do this means that essential information is not communicated thus medications and treatments can be overlooked (Barrere, 2007).

The Joint Commission requires the medical organizations to enhance communication efficiency amongst care providers and also with their patients (The Joint Commission, 2005). This can be done by reading unwritten orders, reporting important tests on a timely manner, establishing a catalog of abbreviations that should not be used and ensuring that handoff communications are well managed. Nevertheless, up to now, these aspects are a struggle for the majority of care providers and especially the nurses.

Quantum Leadership

Quantum Leadership is one of the theories in the nursing leadership that mostly applies to a novel nurse. The other theories include dynamic leader-follower and transformational leadership. Quantum Leadership is an appealing theory and particularly as it embraces leadership in all stages. According to Porter- O’Grady (1999), the modifying medical facilities necessitates novel leadership skills, roles and characteristics. According to him, the development of technology has modified the traditional way of leadership. In the old days when technology was still young, the top leaders were the only ones with technological knowledge. Normally information base amplifies as one moves to a higher position. Currently, leadership as well as the knowledge linked with it has modified. Porter-O’Grady, (1997) puts forth that technology has enabled nurses entering the nursing profession to have ever expanding skills in leadership. Nurses spend most of their time with the patients and at the front line meaning that they posses unique power to sway sustainable results and productivity. In fact, the nurses are at the initial decision making level. By allowing some sovereignty in decision making although small, we lay the basis of leadership. Nurses may decide on the suitable time to call a doctor, decide on important interventions and appropriate care plans and these are taken as initial sovereign steps, which act as the basis of leadership.

Nurses can be trained in this way by assessing their decisions with related patient results. As put forth by Porter-O’Grady (1999), managers should stimulate leadership from the lower employees to the higher employees. This can be done by developing employee self direction instead of providing direction. This, as mentioned earlier, will enable nurses to improve on their leadership traits and skills. Apparently, giving the nurses some autonomy is one step of improving care and communication with their patients. Nurses will feel appreciated and more responsible with some tasks, thus, will go a step further in order to offer their best. This is also a way of assisting nurses to converse expertly to their patients and associate at an emotional and personal level in less time and through this they are able to accomplish their tasks, characterized by endless multiple priorities, without making errors (Porter-O’Grady, 1997).

In nursing care, leaders should avoid intrusion, eliminate barriers and establish the conditions required by the nurses in order to serve and care for the patients and the patients’ families with kindness and attentive care. Besides, leaders should also engage the minds and hearts of nurses in order to strengthen their communication with families as well as the patients, thus, necessitating to make certain follow-through and follow-up. Strengthening leadership and communication skills amongst the nurses and backing the use of the same in patient-nurse relationship necessitates long-lasting investment.

Improving the linkage between nurses and their patients will assist nurses to improve communication with their patients and families as well as their care and passion for work (Gunther &Alligood, 2002). This is advantageous to the patient, the nurse and to the entire organization. Leaders in fact require adopting the core priority of assisting their nurses to renew and maintain their passion to work.

Legal Issues

It is apparent that the legal and ethical issues in the field of nursing are continuously increasing in scope in addition to importance as the profession tussles with the sophisticated technology, the effects of nursing shortages in all practice settings as well as the demands of the customers (American Nurses Association, 2001). Therefore, the need for relevant and up to date information remains a critical issue. The nursing standards of care are based on the recent scientific information from the nursing literature (Guido, 2006). There are about seven legal principles that should be followed by the nurses to ensure patient safety. They include;

Administering Medication Appropriately

Wrong medication can jeopardize the safety of the patient. Moreover, they are all frequent, costly in that they lead to expensive follow up care and litigation (American Nurses Association, 2001). Within the nursing standard of practice for medication knowing the type of drugs you give to the patient is an essential element. It is required that the medical practitioner understands the purpose and actions of the medication, the right dosage for the condition of the patient, how it is administered and any possible adverse reactions or any contradictions. Additionally, at the ultimate line of defense before the error gets to the patient, the medical practitioner ought to remain vigilant of the issues at the points of administration, labeling as well as dispensing the medication (American Nurses Association, 2001). This also entails observing the five rights of medication which are the right patient, right medication, right dose, right time and right route.

Monitor for and Report Deterioration

According to the nursing procedure, a patient should continually be observed. After diagnosing the patient and administering the medication a follow up evaluation, should be done to assess the effectiveness of the medication and communicate effectively. Failure to do this can endanger the patient and leaving open to liability (American Nurses Association, 2001).

Communicate Effectively

Other than informing the medical practitioner of the present condition of the patient the nurse is expected to communicate both with the patient and the fellow staff at all, the stages of the patient care. Appropriate communication skills are vitally important especially when:

  • Educating your patient
  • Interacting or speaking with the relatives of the patient

Delegate Responsibly

This is so as to ensure that the right qualified person takes care of a patient. While performing the delegation the five rights of delegating need to be followed. They include; right person, right task, right circumstances, right direction, and right supervision (American Nurses Association, 2001).

Document in an Accurate and Safe Manner

Safe documentation entails understanding and following the documentation policies and procedures of your facility. Failure to comply with the procedures of the facility leads to inconsistencies which may jeopardize the safety of the patient.

Use Equipment Properly

A nurse has the responsibility of ensuring that they have acquired the right training on the use of the equipment meant to provide patient care.

Management Principles

In the nursing field the term management principles is used to the theoretical and practical experiences, which offers a rich blend of content, integrating management skills and concepts appropriate for the nurse manager to use in daily practice (Gullatte, 2005). Additionally, the management principles in nursing are meant to help the nurse managers to meet the sophisticated demands and needs of patients as well as their families (Gullatte, 2005).

Section Three

Explanation of Potential Outcomes, Impact or Benefit to the Organization

Efficient communication between the nurses and the patients or their patients’ family has a number of benefits. Firstly, the potential for harm is prevented thus making certain that the patient’s safety is guaranteed (Susie, Anita & Aldridge, 1998). Errors may occur when the nurse is writing down medication orders, while administering the medication to the patient or whilst educating the patient regarding his/medication. Besides, where the correct acronyms and abbreviations of medications are not correctly written or interpreted to the patient, there may be possibility of misinterpretation (Susie, Anita & Aldridge, 1998). As a result, this may cause harm to the patient as a result of taking the wrong drugs or dosage or where patients do not report to follow-up clinics. This may have a negative effect on the organization as the patients or patients’ family may lose faith in such an organization and prefer visiting an alternative medical facility for care.

When the nurses communicate efficiently with their patients or the patients’ family members they build trust with the patients’ family and the patients themselves and this may be an extremely significant element. Lack of trust signifies that the patients may disregard any communication conveyed to them. An organization in this case benefits in that it is able to build patient loyalty and it will always be considered as the best care medical facility. In fact, research has put forth that the patients and their families make conclusions regarding a certain hospital through observing the interactions of the nurse and the rest of the workers or the patient’s family (Jarrett & Payne, 1995). This in turn can affect the relationship of the patient with the nurse and the frequency with which the patient visits the hospital for the help of a physician

The ‘Name Differentiation Project’, commenced by the FDA in 2001, was aimed at assisting nurses avoid errors, while transcribing drugs to the patients. It aimed at promoting the employment of ‘Tall Man’ letters on drug labeling. A number of hospitals have implemented the use of these letters and apparently, research show that errors related to patients medication errors have reduced and the nurses have a better knowledge regarding the drug and communicates the same either verbally or in writing to the patient (FDA, 2008).

The probability of recommending a medical facility and its general rating are the global factors that are identified by CAHPS research. According to the Press Ganey and CAHP Survey, nurse-patient communication is a key factor that has the highest effect on patients’ general rating of their experiences in hospital. Quality and efficiency of communication between nurses and their patients as well has the greatest effect on the probability of the patient to recommend a medical facility. Nursing communication is believed to be a main factor that assists in personalizing care, building family and patients’ cooperation and trust, lessens patients anxiety linked with their sicknesses and enhances the nurse-patient association (Hinckley, Craig & Anderson, 1990).

Although nurses are caring and they aim at ensuring that their communication with the patients is efficient, the current pressurized working conditions, characterized by endless multiple priorities and multitasking, has made it difficult for their care to come out efficiently as expected by the patients and the patients’ families (Simpson et al. 1991). The extreme work loads and never ending tasks have resulted to stress, which in turn has affected the patient-nurse communication. This, in addition to provoking anxiety to the patients is also draining for the organization and the nurses themselves.

Recommendation for Changes, Additions or Action

In order to prevent the various communication errors, which come about while the nurses converse with their patients, regarding different issues, a number of recommendations have been provided. Most of these recommendations aim at ensuring that there exists good and effective communication that guards the patients from any harm that may result from miscommunication. It is also clear that patients have the tendency of misinterpreting acronyms and abbreviations as communicated to by the nurses, thus, recommendations have also been offered for this.

The Joint Commission on Accreditation of Healthcare Organizations’ has come up with the National Patient Safety Goals which deal with a broad array of issues particularly designed for enhancing the safety of patients in all categories of medical facilities (TJC, 2005). Standardizing acronyms, abbreviations and symbols employed in accredited organizations and developing a list of symbols, acronyms and abbreviations, which should not be employed in any medication linked records or order was one of the objectives. Through this, such problems as misinterpretation of drugs prescribed by the care givers could be avoided.

The Food and Drug Administration (FDA) and Institute for Safe Medication Practices (ISMP) have dealt with the employment of dosing terms that are prone to error. In the year 2006, these institutions started an educational campaign intended to lessen the employment of probably risky terms in medical communication (FDA, 2006). Dosing terms that are easily flawed may be the basis of harm to the patients thus nurses are offered with recommendations for decreasing the probability for linked errors.

There is also the possibility of confusion of the drug name. This may occur when the care giver uses acronyms and abbreviations for appropriate drug names. The patients may misinterpret the acronyms and the abbreviations and in order to solve this problem, nurses are recommended to use complete names of drugs whilst writing down medication orders to prevent probable errors in filling, recording, labeling or educating patients (ISMP, 2007). Some examples of the acronyms and abbreviations that can be misinterpreted include:

  • CPZ: aimed to mean prochlorperazine may be misinterpreted as chlorpromazine
  • AZT: aimed to mean zidovudine may be misinterpreted as aztreonam or azathioprine
  • DPT: aimed to mean demerol-phenergan-thorazine may be misinterpreted as diphtheria-pertussis-tetanus

In some instances, even though the nurses employ complete medicine names, this may not be sufficient to avoid errors since two drugs might have the same names, thus, are simply confused for each other. The FDA commenced a Name Differentiation Project in 2001 that was aimed at promoting the employment of Tall Man letters on drug labeling. A number of hospitals have implemented the use of these letters and this is aimed at helping to administer the drug, while prescribing and writing down medication orders for the patients (FDA, 2008; Turkoski, Lance, & Bonfiglio, 2008).

This paper has focused on the importance of communication between nurses and patients. Certainly, in all organizations, efficient communication has proven to be very essential. Dealing with patients is not an easy task and explaining the medical procedures to them is also a difficult task. This means that there should be efficient communication between the nurses and the patients. Nurses usually communicate such information as medications and care to the patients and the patients’ family. For this reason, nurses are recommended to be aware of the important elements of the communication procedure, the skills required and the possible predicaments that subsist with communication inaccuracies in order to avoid the same. Be it written or verbal communication, studies have shown that there occur errors whilst nurses are conveying medication messages to their patients. Generally, communication mistakes take place when a nurse computer generates or handwrites a medication order. Errors also occur while writing down an order; communicating a medication order via telephone, in person or by computer; while labeling the medicine container, whilst administering the medication, or whilst educating the patients regarding their medications.

Ensuring efficient communication is very important for the safety of the patient. When there is miss-communication, the patients may misinterpret the information conveyed and this may cause harm as the patient may take the wrong drugs or doses. Communicating with the patient’s family efficiently is also very important especially in cases where the patient is in a critical condition.

Although such institutions as the ISMP, FDA and the TJC have primarily focused on formulating guidelines to ensure safety in medication, the nurses and other care givers who are concerned with drug orders should make modifications that may lessen the probability for errors. In most cases, nurses are concerned in the communications with the patients from transcribing a drug order to educating and giving the drugs to the patients. When nurses understand the importance of efficient communication and the effects of miscommunication and embark on actions to integrate remedial procedures is a way of amplifying the safety of the patients.

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