Professional & Therapeutic Communication Lecture 6 PDF

NUSC 1P10 | Fall 2023 Lecture 6 Class Objectives • Describe principles of safe communication • Discuss standardized communication tools as a strategy for safe communication • Describe principles of communication at discharge and transfer of care • Explore concepts of team-based, inter- and intra-...

NUSC 1P10 | Fall 2023 Lecture 6 Class Objectives • Describe principles of safe communication • Discuss standardized communication tools as a strategy for safe communication • Describe principles of communication at discharge and transfer of care • Explore concepts of team-based, inter- and intra-professional collaboration • Describe barriers and facilitators in team-based communication NUSC 1P10 | Fall 2023 Communication for Safety Today’s Objectives • Describe principles of safe communication • Discuss standardized communication tools as a strategy for safe communication • Apply SBAR method of providing information to team members • Describe principles of communication at discharge and transfer of care • Analyze and apply safe communication principles to a nurse-to-nurse shift report scenario • Explore concepts of team-based, inter- and intra-professional collaboration • Describe barriers and facilitators in team-based communication • Describe the RN’s role in coordination of care and in collaboration and how this impacts on patient safety Communication for Safety • The number of deaths in Canada due to avoidable medical incidents ranks as 3rd = three jumbo jets crashing every month (CPSI, 2020) • Miscommunication à 60 -70% of reported errors (The Joint Commission, 2008) What is patient safety? “the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. An acceptable minimum refers to the collective notions of given current knowledge, resources available and the context in which care was delivered weighed against the risk of non-treatment or other treatment” (WHO, 2009) What makes communication safe? Sufficiency—the extent to which care participants convey, extract, and exchange a sufficient amount of information in order to arrive at a shared understanding. Accuracy—the extent to which care participants convey correct information, interpret information correctly, and utilize their communication with each other to validate the accuracy of their communicated message content. Clarity—the extent to which care participants express and interpret verbal and nonverbal messages clearly (i.e. unambiguously) and utilize their interaction with each other to reduce uncertainty. (Hannawa, 2018) What makes communication safe? Contextualization—the extent to which care participants frame their interaction within local interactional circumstances such as hierarchies, time pressure, or discrepant goals that either facilitate or create barriers to shared understanding. Interpersonal Adaptation—the extent to which participants respond to implicitly (i.e. nonverbally) and explicitly (i.e. verbally) expressed needs and expectations to maximize the likelihood of shared understanding. (Hannawa, 2018) Barriers to Safe Communication Fragmentation Underreporting Fatigue Fostering Safe Communication Communication clarity Collaboration & Cooperation – standardized communication – teamwork Standardized Communication • Avoids incomplete or misleading messages • Requires consistent adoption and implementation (system à clinician) • Leads to clear communication à prevents harm to patients Standardized Communication Check lists • Structured list of evidence-based actions to be performed in a clinical setting or situation • If every step is completed the possibility of miscommunication is reduced Verbal communication tools • Structured format for communication • SBAR • IPASS SBAR IPASS • Structured patient hand-off • Leads to reduction in hand-off related errors I – Illness Severity P – Patient Summary A – Action Items S – Situation Awareness & Plan S – Synthesis by Receiver Handoff • A handoff – sometimes handover or transfer of accountability (TOA) is the transfer of information during transitions in care across the continuum • includes the opportunity to ask questions, clarify, and confirm • A handoff consists of: • • • • • transfer of responsibility and accountability clarity of information verbal communication of information acknowledge by receiver opportunity to review (TeamSTEPPS Canada) Tips for Safe Hand-offs Focus on critical information Standardize tools/methods Don’t rely solely on paper or electronic communication Combine/collaborate Include important minimum information Distraction free Interprofessional + patient-centred Use electronic records to enhance the hand-off Continuity of Care • A multidimensional longitudinal process in health care emphasizing seamless provision and coordination of quality care across settings • Refers to patients experiencing their care as being connected and coordinated as they move between health-care providers and through the health-care system (CPSO, n.d.) Continuity of Care What it means for patients: • Knowing when and where to seek care; • Having a family doctor or primary care provider • Only using walk-in clinics or emergency rooms when necessary • Having information shared between all health-care providers • Understanding what role each health-care provider has in your care; • Making sure transitions between parts of the healthcare system are smooth Dimensions of Continuity of Care Relational Continuity • interpersonal elements across time and care settings. Stronger relationships = quality-coordinated care Informational Continuity • accurate record sharing and technology to facilitate data sharing between providers, patients, and systems Management Continuity • consistent, coherent patient-specific care approach to management of a health condition Essential Elements of Relational Continuity Patient Centeredness Collaboration Coordination Informational Continuity – Transitional Care • Changeovers between care settings are associated with a larger number of “avoidable adverse events” and “near misses.” • “Care transitions shouldn’t be an abrupt end of care previously provided, but rather considered to be a coordinated changeover for the patient to a new team of involved caregivers.” (Carr, 2008, p. 26) Transitional Care – Nurses Role • Early planning for transition is essential. • Discharge planning provides the level and information patients/families need to secure their recovery and/or maintain health status. • Begins with a careful review of initial admission data and continues as a thread with each subsequent review. • Specific instructions for post-discharge care and contact with external care providers should be shared with patients and families. • Medication reconciliation • Identify primary support person and/or specific post-hospital arrangements. • Caregivers need specific instruction to successfully self-manage recovery and chronic health problems. Transitional Care Communication - PODS • Challenge of traditional discharge summary: • • • • Patients do not understand medical terms might not be fluent in English/French cannot memorize verbal instructions or are too stressed at time of illness to absorb information • Patient-oriented Discharge Summary (PODS) • Increase patient satisfaction related to discharge • Gives structure to discharge conversations • Did not add to provider workload NUSC 1P10 | Fall 2023 Interprofessional Collaboration Fostering Safe Communication Communication clarity Collaboration & Cooperation – standardized communication – teamwork Interprofessional Collaboration Interprofessional Competency Framework (CIHC, 2010) - Goal = Interprofessional collaboration - 6 domains: - interprofessional communication - patient/client/family /community-centred care - role clarification - team functioning - collaborative leadership - interprofessional conflict resolution Interprofessional Collaboration Interprofessional collaboration is the process of developing and maintaining effective interprofessional working relationships with learners, practitioners, patients/clients/ families and communities to enable optimal health outcomes. elements of collaboration include respect, trust, shared decision making, and partnerships (CIHC, 2010) Interprofessional Collaboration – Domains • Role Clarification – learners/ practitioners understand their own role and the roles of those in other professions, and use this knowledge appropriately to establish and achieve patient/client/ family and community goals; e.g., • describe own role and role of others • recognize and respect diversity of other health and social care roles • integrate competencies/roles seamlessly (CIHC, 2010) Nursing knowledge and skills • CNA Code of Ethics • CNO Nursing Practice Standards • CNO/CNA Entry-to-practice competencies • Nursing process • Nursing theories • Nursing Professional Ways of Knowing • Interprofessional competencies Interprofessional Collaboration – Domains • Patient/Client/Family/ Community-Centred Care – learners/ practitioners seek out, integrate and value, as a partner, the input and the engagement of the patient/client/ family/community in designing and implementing care/ services; e.g., • support participation • share information • listen respectfully (CIHC,2010) Interprofessional Collaboration – Domains • Team Functioning - learners/ practitioners understand the principles of teamwork dynamics and group/team processes to enable effective interprofessional collaboration; e.g., • be respectful of all members’ participation in collaborative decision-making • regularly reflect on team functioning • maintain effective and healthy working relationships with learners/ practitioners, patients/clients, and families (CIHC,2010) Interprofessional Collaboration – Domains • Collaborative leadership – learners/ practitioners understand and can apply leadership principles that support a collaborative practice model; e.g., • work with others to enable effective patient/ client outcomes • facilitation of effective team processes • facilitation of effective decision making (CIHC,2010) Interprofessional Collaboration – Domains • Interprofessional Communication – learners/ practitioners from different professions communicate with each other in a collaborative, responsive and responsible manner. ; e.g., • establish teamwork communication principles • actively listen • develop trusting relationships (CIHC,2010) Intra-professional Teams • Nurses need to function effectively as a team to deliver quality care • Communication issues can compromise patient/client care • Nurses need to promote open, honest and transparent communication by: • promoting a culture of effective communication, and • establishing processes for verbal, written and electronic communication • Nurses also support intra-professional team practice by creating supportive learning environments for students (RNAO, 2016) Interprofessional Teams • The link between miscommunication and poor patient outcomes is well documented (The Joint Commission, 2015) • team communication breakdowns are related to preventable safety events • deliberate and mindful strategies to improve communication is part of a nurse’s job • There are differences in communication styles between groups and frustrations can surface. Interprofessional Communication 1. Level the playing field – understand the rules of communication and apply them 2. Get to the point – clear, concise communication is recommended; use SBAR where appropriate 3. Use powerful terms or phrases – avoid phrases such as “I’m not sure” and “maybe” as this comes across as unsure or tentative 4. Exude expertise – speak confidently; your unique nursing knowledge of the patient is important 5. Expect respect – begin all interactions expecting respect and believing that what you have to say is important Interprofessional Collaboration – Domains • Interprofessional Conflict Resolution – learners/practitioners actively engage self and others, including the client/patient/family, in positively and constructively addressing disagreements as they arise; e.g., • see potential positive nature of conflict • take constructive steps to address conflict • identify common situations that are likely to lead to disagreements or conflicts e.g., • role ambiguity • power gradients • differences in goals • understand strategies to deal with conflict (CIHC,2010) Sources of Conflict Different expectations • e.g., being asked to do something you know would be irresponsible of unsafe Threats to self • e.g., target of disruptive behaviours such as harassment Differences in role hierarchy • e.g., difference in education or experience Clinical situation constraints • e.g., stressful workload Reminder – Problem Solving/Collaboration • Negotiate so that goals and relationships are maintained Negotiation 1. Describe what you want 2. Describe how you feel 3. Exchange the reasons for your positions 4. Understand the other person’s perspective 5. Initiate options for mutual gain 6. Reach a constructive agreement (Johnson, 2013, cited in Stein-Parbury, 2018) Disruptive Behaviours Disruptive behaviour - a lack of civility or lack of respect which occurs within professional relationships as frequently as weekly, and is repeated over time • rudeness, verbal abuse, intimidation, put-downs • angry outbursts, yelling, blaming, criticizing • sexual harassment, threatening physical confrontations • passive-aggressive communication, withholding information, withholding help, refusals, impatience or reluctance to answer questions, speaking in a condescending tone Eliminating Disruptive Behaviours à Collaboration Collaboration – working will all members of the health team to achieve maximum health outcomes for a mutual patient. Collaboration includes: 1. A common goal – e.g., culture of safety 2. Open, safe communication – e.g., assertiveness & cooperation 3. Mutual respect – e.g., appreciation for each team member 4. Shared decision making – all team members as full partners in decision making 5. Role clarity – e.g., knowing own role and when to call on the expertise of others 6. Message clarity – e.g., tools to increase clear communication Responses to Address Harassment and Bullying Verbal afront Non-verbal innuendo Withholding information Sabotage Undermining activities Infighting Backstabbing What do you mean by that comment? I see from your expression … I feel you are not telling me everything I need to know I feel this should not have happened. We need to talk about this privately I feel that you do not trust me. Will you tell me why? We need to stop this behaviour and learn to work together I don't feel comfortable talking about (person's name) when they are not present Broken confidences This is information that should have remained confidential Scapegoating We can't blame one person for everything that goes wrong Gossiping This is inappropriate conversation (Fehr & Seibel, 2016) To be continued in Lab • Practicing safe communication • Complete TeamSTEPPS essentials course • Shift-to-shift communication game • Final Lab evaluation – same as midterm bring selfevaluation + blank copy to evaluate a peer NUSC 1P10 | Fall 2023