Reflection

  • Category:
    Nursing
  • Document type:
    Essay
  • Level:
    Undergraduate
  • Page:
    3
  • Words:
    2191

10REFLECTIVE ESSAY

REFLECTING ON ISSUES IN CLINICAL PRACTICE

Name of Lecturer

Current Communication Issues in Nursing and Recommendations

Introduction

This essay reflects on a case of communication and its impact in nursing practice as it happened during my placement. The core feature in this context is the fact that communication is a key attribute in the nursing profession. The reflection based on the Gibbs Model will be carried leading to an action plan crucial in my future career practice, as well as to other aspiring professional nurses. The Gibbs Reflective Cycle involves description, feelings evaluation, analysis, and conclusions, as well as an action plan in respect to the clinical issues at hand (Gibbs, 1988). Reflective practice helps provide a good way of dealing with or putting sense into occurrences in our workplaces and therefore allows us to build courage in our work so as to act competently (Ghaye, 2000). Based on happenings in a ward setting and the behaviour a newly posted charge nurse lacking flexibility in the leadership and inefficient communication skills, the encounter gave me the impetus to understand the necessity of effective communication and supple leadership. The critical analysis will provide an action plan that entails various recommendations to be embraced by nursing professionals to enhance communication in their professional practice.

Description

Effective communication in the healthcare practice is of much importance to the wellbeing of patients. Ineffective team communication is frequently the root of medical error leading to inefficiency and team tension (Lingard et al., 2002). During my placement practice, I remember a situation that I had to take orders from a newly posted charge nurse in the clinical ward working alongside five other nurses. The charge nurse developed an authoritative model of leadership where no one was to question his authority, and the orders were to be followed to the latter. At one instance, I happened to be holding a patient who had suffered burn wounds, and I was entirely responsible for nursing his injuries. Apparently the charge nurse ordered me to dress the wounds without explicitly stating whether to have the necessary medication applied before covering the wounds. The situation was compelling and dictating, and I felt my opinion or little experienced was of less importance and had to follow the given orders. After the dressing, it happened that the patient’s wounds deteriorated to a bad state, a sentinel event that would not have happened had there been an environment that calls for collaboration between the charge nurse and me in ensuring the patient wellbeing.

Feelings

From the experience, I felt a lack of effective communication and disregarding the juniors in the ward setting is not crucial for the quality of care to be given. The leadership methodology of the charge nurse made me feel like I was working in an environment that did not accommodate giving ideas and suggestions on a patient’s healthcare. Evidence-based practice and experience are critical in nursing care and are effectively shared among nurses through effective communication. Teamwork and collaboration are provided for in an organisation that allows for an interdisciplinary approach that recognises, and treasures expertise and ideas of a large number of different healthcare providers (Orchard, Curran and Kabene, 2005).

The patient also had to be listened to so that he could participate in the healing process, but the charge nurse failed to listen to the patients complain of wound infections. The future of the health system is dependent on health care practitioners working out on ways they practice together. Collaborative patient-centred care should be encouraged in nursing care as it brings about improved care, enhances evidence-based practice and promotes working relations in health systems (Joint Commission on Accreditation of Healthcare Organisations, 2004). Generally, with effective communication among nursing professionals, improved well-being of patients is realised.

Evaluation

Lack of effective communication negatively impacts on the nursing practice, with competency being a fundamental aspect of nurses in their professional practice. Maguire and Pitceathly (2002) highlight the necessary skill that allows for doctors to understand their patients so as to be able to perform essential tasks. To elicit the patient’s problems, the charge nurse has to establish a rapport with the patient at the beginning of the consultation and maintain this rapport throughout the healthcare process. By establishing eye contact, the charge nurse shows the need to be involved in the betterment of the patient’s well-being this way the patient is encouraged to give out information on the sequence in which difficulties occurred, their emotional situation concerning their state and also dates of occurrences. Active listening methods are beneficial in understanding problems and distress on the patient’s part (Maguire and Pitceathly, 2002).

In a situation where doctors use communication skills effectively, there is improved care and practice satisfaction resulting in a two-way benefit for both the nurse and patient. Nurses are expected by the NMBA Competency Standards to identify their patient’s problems accurately, accommodate the patient’s treatment options and work towards reducing patient’s distress and their susceptibility to anxiety (Thompson and Pascal, 2012). Nurse-patient communication ensures that physicians obtain ample information on the patient’s perceptions about their problems or about the issue’s impact on the physical and emotional state of the patient. By evaluating my situation I realised that had the charge nurse followed on the emotional status of the patient who was complaining of possible wound infection due to the way in which his wounds were being handled, then the sentinel event would have been avoided.

The structural organisation as I noted from my experience also plays a significant part in facilitating or impeding communication flow among healthcare practitioners. Orchard, Curran, and Kabene (2005) argue that sources of conflict among healthcare professionals can be caused by failure to recognise the authority of other disciplines, poor communication among members of a different department, inflexible leadership attitude, mistrust and lack of confidence in other disciplines. Leaders within the nursing practice may feel as though they are superior to the other nurses and thus, creating a communication channel for giving orders only, rather for collaborative efforts to realise adequate healthcare (Knox, Simpson and Garite, 1999). Such an organisational structure can create barriers to interdisciplinary collaboration in the healthcare practice.

Analysis

Decision-making processes utilised within the healthcare organisation should allow for the provision of supportive environment whereby consultation and innovate ideas flow with no barriers between various disciplines in a health facility. To ensure collaborative practice health, professional ought to accept the boundaries and work out ways to relay information and show trust to other discipline members in the handling of patient care process (Lingard, et al., 2004). An organisation where clarity of roles is evident shows a healthy collaborative environment. Role clarification ensures for an understanding of duties to be taken by all members in the varying disciplines, as well as their ability to perform the tasks
(Orchard et al., 2005).

Lingard et al. (2004) stipulate that sentinel events resulting from error are mostly caused or prone to happen in settings with insufficient communication among members of the health care team. In situations where communication errors are prevalent, the negative implications are highly noticeable and may include procedural errors, waste of resources, patient inconveniences and even delay of treatment (Reflective Practice, 2014). I would recommend utilisation of research so as to study the effect of communication failure on both the system and the health outcomes of patients. By understanding these failures, the information may then be utilised to prevent other occurrences or to call for the change necessitated in the structural organisation that impedes information flow.

Action Plan

The medical practitioner ought to discuss treatment issues with the patient where they adequately inform patients on different options of treatment since it’s evident that patients who are involved in decision making regarding their wellbeing are more adhering to treatment plans; here the patient’s perspective is put into consideration. Empathy should be utilised by the nurse to show the patient that their problems are well understood and being worked on to ensure the patients wellbeing (Maguire and Pitceathly, 2002).To improve safety in a progressively more complex healthcare environment the standardised tools and behaviours should be embedded and this adds value to the wellbeing of the patients. Cultural change is relevant for this quest where expert physicians adopt a more truly collaborative team environment (Knox et al., 1999).

Conclusion

In conclusion, communication failure among nurses negatively impacts on the overall quality of care to patients. The need for effective communication and interactive practices among nurses is imperative to promote quality of care, as well as share critical-evidence based practices to solve impending clinical issues. Similarly, effective communication patterns should exist between the nurse and patient so as to accommodate the patient’s involvement in his or her healing process. Further, ensure the nurse understand the emotional state of the patient concerning the patient’s current health state. This gives assurance to the patient that they are being care for promoting the recovery process. Collaborative efforts among all nurses, as well as with the physicians important enhance effective communication for the betterment of the patients’ wellbeing.

Recommendations

From the reflection, I would recommend for setting up of training sessions that equip nurse leaders on interactive ways with other nurses to promote collaborative working and sharing of evidence-based practice. Courses should be used to ensure the deficiency in nurse-patient communication is dealt with amicably (Lingard et al., 2004). The reasons for this shortcoming, as well as the effect they have on the nurse and patient should be studied to come up with effective measures to counter. Evidence-based research methods should come up with skills needed to overcome the communication deficiencies. Maguire and Pitceathly (2002) argue that doctors who attend workshops to improve their communication skills have an advantage of receiving feedback about how they communicate in real consultations and therefore, boost their confidence to communicate more with their patients.

Another recommendation would be to consider training resident nurses how to communicate effectively using standardised educational programs. This emphasises the effectiveness of face to face communication while giving orders or handing off patients to other care practitioners. The utilisation of incident analysis and peer evaluations is a good way of training and improving resident sign-out (Patterson et al., 2004). Further, it is worth recommending for developing a tailored teamwork research to identify communication skills and behaviours crucial for maintaining safety. This research may be done with the utilisation of a range of techniques which may include cognitive interviews, hierarchical task analysis, and observation during performance and root cause analyses methods (Lucas, 1997).

Effective verbal communication is essential in ensuring transmission of important information around the healthcare environment, and I would, therefore, recommend the use of more structured communication systems such as read backs during wire calls concerning critical clinical issues (Volpp and Grande, 2003). This reduces errors in telephone laboratory reporting thus improving the wellbeing of patients. Finally, information from the communication audit should be used to improve communication tools and policies that augur well for staff needs and have the ability to meet organisational goals (Steadham, 1980). Regardless of whether the tool is given orally or written it should be user-friendly, utilise minimum time and effort to use, limit the possibility of error and encourage multidisciplinary cooperation.

References

Ghaye, T. (2000). Into the reflective mode: Bridging the stagnant moat. Reflective Practice, 1(1) 5-9.

Gibbs, G (1988). Learning by doing: A guide to teaching and learning methods. Oxford: Oxford Polytechnic Further Education Unit.

Joint Commission on Accreditation of Healthcare Organizations (2004). Sentinel event statistics, Accessed April 29, 2016 <www.jcaho.org>.

Knox, G.E. Simpson, K.R. and Garite, T.J. (1999) High reliability perinatal units: an approach to the prevention of patient injury and medical malpractice claims. Health Risk Manag, 19, 24–32

Lingard, L., Espin, S., Whyte, S., Regehr, G., Baker, G.R., Reznik R., Bohnen, J., Orser, B. and Doran, D. (2004). Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care, 13(5), 330-334.

Lingard, L., Reznick, R. and Espin, S., (2002). Team communications in the operating room: talk patterns, sites of tension, and implications for novices. Acad Med, 77, 37–42

Lucas, D. (1997). The causes of human error. In R. Redmill, Human factors in safety critical systems, (37-65). Oxford: Butterworth Heinemann.

Maguire, P. and Pitceathly, C. (2002). Key communication skills and how to acquire them. BMJ, 325(7366), 696-700.

Orchard, C.A. Curran, V. and Kabene, S. (2005). Creating a culture for interdisciplinary collaborative professional practice. Medical Education Online, 10(11), 1-13

Patterson, E.S., Roth, E.M. and Woods, D. (2004). Handoff strategies in settings with high consequences for failure: lessons for health care operations. Int J Qual Health Care, 16(2), 125-32.

Reflective Practice (2014). A practice guide for personal development. Dental Nursing, 10(9), 516-519.

Steadham, S.V. (1980). Learning to select a needs assessment strategy. Train Dev J. 34(1), 56–61.

Thompson, N. and Pascal, J. (2012). Developing critically reflective practice. Reflective Practice: International and Multidisciplinary Perspectives, 13(2), 311-325.

Volpp, K.G. and Grande, D., (2003) Residents’ suggestions for reducing errors in teaching hospitals. N Engl J Med, 348, 851–5.

Appendix

Reflection

Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. Oxford Polytechnic Further Education Unit: Oxford, England.