COMS0002 : Foundations of Communication : Inter-Professional Communica

1. Identify the patient-centred and inter-professional communication opportunities available in the case study and explain how the identified opportunities can be used to maintain an effective process of patient care. 

2. Using the ISBAR (Identify, Situation, Background, Assessment and Recommendation) format, outline how you would verbally execute a clinical handover to one relevant multidisciplinary team member identified within the context of this case study. 

3. Using the Gibbs reflective cycle), outline how you would apply your nursing communication skills in the role of being a leader within the Interdisciplinary health care team. 

Introduction:

Inter-professional communication in healthcare is a process where care providers, trainers, nurses communicate with each other as well as transmitting information to families, and communities in a collaborative and responsible manner (Stein-Parbury, 2014). Interpersonal communication works as an effective process or tool to implement patient-centred communication in healthcare because patient care is at the centre point of this communication process. The occurrence of inter-professional miscommunication leading to bad patient outcomes is a commonly occurring phenomenon in healthcare (McCabe & Timmins, 2013). The provided case study is one example of this phenomenon. Therefore, present study works to identify and overcome these inter-professional and patient communication defects promising better patient outcomes in a provided case study.

Identification of patient-centres and inter-professional communication opportunities and their utilization to maintain the effective process of patient care in provided case

Advocacy for the patient for improving care services

According to Liaw et al. (2014) studies, speaking-up for the patient is a first, foremost and personal approach to communication that every healthcare professional should adopt for healthy patient-centred communication. In the provided case, there is mismanagement, disruptive behaviour and negligence noticed in the patient care process. Mr. Smith is reporting continuous worsening of condition after his admission to hospital indicating mismanagement. Mr. Smith has even informed ward Nurse Unit Manager about his condition since morning but there was no avail from the side of a nurse is a sign of disruptive behaviour towards the patient. Further, he has no knowledge about his care plan, no family member visit (his son living far away is not informed about his condition) and no visit by the specialist (chest physiotherapist) indicate a clear situation of negligence towards the patient.

As a professional nurse, this situation is an opportunity to implement patient advocacy by speaking-up about defects in patient care and communication. These care service issues are required to be informed in the healthcare system for proper improvement of mismanaged, negligence and disruptive behaviour occurring with the patient (Matziou et al., 2014).

Improving inter-professional communication within the team

Delunas & Rouse (2014) opine that inter-professional communication within the team is the soul of patient care process that is usually interrupted by issues like lacking organization, structural hierarchies, personal issues among team etc. In the provided case there is a lacking proper inter-professional communication within team members that requires improvement. Mr. John is facing critical symptoms of high heart rate and blood pressure having past history of congestive heart failure. He is describing his condition to be worse after admission to the hospital, yet no chest physiotherapist has attended him even after the doctor’s order. Further, Mr. Smith personally informed about his unstable condition toward Nurse Unit Manager but no response was initiated from her side. Further, no information about Mr. Smith condition is shared with his family. This indicates a situation of lacking communication with the healthcare team member. Improving the process to share information with the patient. This opportunity can be used to improve the defects in the structural hierarchy of healthcare inter-professional communication (Arnold & Boggs, 2015).

Implementing Patient education

There is lacking communication of information to Mr. Smith in the provided case because he is not even aware of his treatment plan. He is diagnosed with pneumonia still no information about treatment is communicated to him. Further, he is not able to perform his daily living activities. Mr. Smith is a chain smoker and an alcoholic even after having a history of congestive heart failure. Therefore, this situation is an opportunity to implement patient education process for improving patient –centred communication process in the healthcare setting. Patient education helps to improve transmission of better information from professional to patients implementing better living habits of the patient for better treatment process (Davis Boykins, 2014).

Clinical handover for verbal execution of patient situation using ISBAR format to one relevant multidisciplinary team member in the context of this case study 

This clinical handover involves the minimum set of information that requires attention and action by higher professionals within the inter-professional team for better care of Mr. Smith. This ISBAR format is applicable in all clinical scenario as per studied by De Meester et al. (2013) in their work.

Identification

Patient Information – Name – Mr. John Smith, Age- 72years

Staff – Registered Nurse

Situation

Mr. Smith John admitted three days ago to the emergency department is not feeling clinical attended and well. He is not getting proper attention from professionals, carers and physicians. The physiotherapist has not attended Mr. Smith even after doctor’s order. The ward Nurse Unit Manager and other attending nurse in the morning are not paying attention to patient communications. Mr. Smith is dealing with worsening condition even after three days of admission. As per observations and clinical assessment details his condition really seems to be worsening with time without any serious medical attention provided by healthcare professionals (Hagemeier et al., 2014).

Background

Mr. Smith is a 72-years old widower, living alone, chain smoker and alcoholic. His family member (only son) lives 800km away from the patient and is not informed about his condition. Mr. Smith had a history of congestive heart failure, hypercholesterolemia and hypertension. Mr. Smith is allergic to dairy products getting with severe diarrhea and vomiting. He is presently diagnosed with pneumonia (Sharma & Klocke, 2014).

Assessment

As per clinical assessment performed on Mr. Smith, he is having an increased heart rate (118beats per minute) and high blood pressure (164/90). The physical assessment indicates a productive cough with greenish sputum, low tolerance of food and fluids, incapable to perform daily activities and a slight increase in body temperature (38 degree Celsius) (De Meester et al., 2013).

Recommendation

Risks

There is a clear risk of another heart failure, fall, severe pneumonia.

Action required after the handover

There is an urgent requirement for chest physiotherapist (as per doctor’s order) and cardiologist (risk of heart failure) to make an urgent visit for Mr. Smith. He also needs a 24-hour helper for his daily activities to prevent the risk of fall. Further, an occupational therapist is required for Mr. Smith as per his request for home modifications (Hagemeier et al., 2014).

Individual responsibility

The helper needs to provide 24-hours help to Mr. Smith, chest physiotherapist needs to identify the risk of pneumonia and cardiologist need to identify any risk to further heart failure in case of Mr. Smith as his blood pressure and heart rate is very high (De Meester et al., 2013).

Using Gibbs reflective for applying nursing communication skills as a leader within the interdisciplinary team 

Description

The medical ward patient Mr. Smith was diagnosed with pneumonia having the history of heart failure, hypertension and hypercholesterolemia. As a ward nurse, I went to John room he informed me that no physiotherapist or any other specialist came to see him. His complaint toward Nurse Unit Manager was ignored and he was unaware of his treatment plan as well. The patient complains about worsening condition and no family member of Mr. Smith was present with him. Further, no other healthcare professional was present in the room to attend him. As per diagnosis his heart rate and blood pressure were quite high along with mild fever. He was producing cough with green sputum and low tolerance to food and fluid (Dube & Ducharme, 2015).

Feelings

As per personal viewpoint, I obtained a mixed feeling for this situation because the present situation (pneumonia) of the patient was under control but his all over condition was not perfect enough. I felt that either the management is unaware of Mr. Smith condition or care providers are completely ignoring him, especially the ward Nurse Unit Manager. Further, no physiotherapist made a visit even after the doctor’s order highlights complete negligence (Husebo, O'Regan & Nestel, 2015).

Evaluation

As per personal and professional perception, the present case study is an incidence of patient mismanagement, disruptive behaviour and negligence in healthcare scenario. In this case patient, Mr. Smith was not attended by professionals as scheduled neither his complain was entertained by professionals. Further, as per patient assessment details his heart rate and blood pressure was very high. Mr. Smith had a history of congestive heart failure, therefore, assessment results signal an emergency situation (Dube & Ducharme, 2015).

Analysis 

The present case situation of Mr. Smith senses a requirement of emergency to look after his serious symptoms. Although, the quick response from Ward Nurse Manager about patient complaint shall have helped to control the situation in a better manner. But, as per my analysis, right now the present stage of the patient requires quick medical attention as he is complaining about the worsening of his health (Beam, O'brien & Neal, 2010).

Conclusion:

The case study patient Mr. Smith requires a proper attention from professionals regarding his health issues. The situation highlights that negligence, disrupted behaviour and mismanagement in patient care can lead to serious health issues and even risk of life for the patient (Dube & Ducharme, 2015).

Action plan 

The action plan for handling present situation requires proper attention from the higher management of healthcare to look into the issues of this situation. Firstly, there is a need to manage the present situation of the patient followed by establishing individual responsibility to avoid such mismanagement, disrupted behaviour and negligence in future cases.

The action plan involves checking individual duties, managing negligent behaviour towards patient, special team to check emergency situations and patient follow-up system (Beam, O'brien & Neal, 2010).

Conclusion:

The detailed study on the provided case study indicates this to be a clear situation of negligence, disrupted behaviour and mismanagement in healthcare. The identified opportunities for improving communication are the requirement of patient advocacy, patient education and improving inter-professional team communications. Further, the ISBAR format is used to develop handover clinical information about a provided case and Gibbs reflective cycle is used to develop personal reflection as a nurse dealing with the situation as a leader in the interdisciplinary healthcare team.

References:

Books

Arnold, E. C., & Boggs, K. U. (2015). Interpersonal Relationships-E-Book: Professional Communication Skills for Nurses. Elsevier Health Sciences.

McCabe, C. & Timmins, F. (2013). Communication skills for nursing practice (2nd ed.). Hampshire: PalgraveMcMillan.

Stein-Parbury, J. (2014). Patient & person: Interpersonal skills in nursing (5th ed.). Chatswood: Churchill Livingstone Elsevier.

Journals

Beam, R. J., O'brien, R. A., & Neal, M. (2010). Reflective practice enhances public health nurse implementation of nurse?family partnership. Public Health Nursing, 27(2), 131-139.

Davis Boykins, A. (2014). Core communication competencies in patient-centered care. ABNF Journal, 25(2), 67-69.

De Meester, K., Verspuy, M., Monsieurs, K. G., & Van Bogaert, P. (2013). SBAR improves nurse–physician communication and reduces unexpected death: A pre and post intervention study. Resuscitation, 84(9), 1192-1196.

Delunas, L. R., & Rouse, S. (2014). Nursing and medical student attitudes about communication and collaboration before and after an interprofessional education experience. Nursing Education Perspectives, 35(2), 100-105.

Dube, V., & Ducharme, F. (2015). Nursing reflective practice: An empirical literature review. Journal of Nursing Education and Practice, 5(7), 91.

Hagemeier, N. E., Hess Jr, R., Hagen, K. S., & Sorah, E. L. (2014). Impact of an interprofessional communication course on nursing, medical, and pharmacy students’ communication skill self-efficacy beliefs. American Journal of Pharmaceutical Education, 78(10), 186.

Husebo, S. E., O'Regan, S., & Nestel, D. (2015). Reflective practice and its role in simulation. Clinical Simulation in Nursing, 11(8), 368-375.

Liaw, S. Y., Zhou, W. T., Lau, T. C., Siau, C., & Chan, S. W. C. (2014). An interprofessional communication training using simulation to enhance safe care for a deteriorating patient. Nurse Education Today, 34(2), 259-264.

Matziou, V., Vlahioti, E., Perdikaris, P., Matziou, T., Megapanou, E., & Petsios, K. (2014). Physician and nursing perceptions concerning interprofessional communication and collaboration. Journal of interprofessional care, 28(6), 526-533.

Sharma, U., & Klocke, D. (2014). Attitudes of nursing staff toward interprofessional in-patient-centered rounding. Journal of interprofessional care, 28(5), 475-477.