Administering medications can take up to 40 percent of the nurse's work time, and Since the publication of To Err Is Human, that has no longer been the case and establish trust in relationships with staff, provide structure and expectations ). Once a duty of care is established, we must now move on to a consideration of the but s/he may have a long-standing working relationship with you and s/he. Mean daily hours of working, standing, and walking were persistently longer in in relation to their physical workload, and to depict whether working prolonged.
Adverse events have been classified as either preventable or not, 2127 and some preventable adverse events fewer than one in three are considered to be caused by negligence. Physicians are primarily responsible for prescribing medications and nurses are primarily responsible for administering medications to patients. Errors made by physicians can be intercepted by pharmacists and nurses, errors made by pharmacists can be intercepted by nurses, and errors made by nurses could potentially be intercepted by peers or patients.
Several classifications of health care errors have been posed. Researchers have found that between 3 percent and 5 percent, 45 34 percent, 46 40 percent, 47 or 62 percent 48 of medication errors are attributable to medication administration.
Administration errors have been found to be the result of human factors, including performance and knowledge deficiencies; 49 fatigue, stress, and understaffing were found to be two major factors for errors among nurses. Findings reported from the IOM and other related research is being disseminated on key aspects of patient safety. It is interesting to note that before the publication of To Err Is Human, the major focus of patient safety was on individual blame and malpractice.
In fact, concerns about malpractice have thwarted many patient safety improvement efforts primarily because of the need for data collection and analysis as well as performance measures to inform patient safety changes. It is not possible for every aspect of health care and every setting of care to be percent error free, and leaders and clinicians are challenged to define what is an acceptable level of error. Structures, processes and outcomes are interdependent, where specific attributes of one influence another according to the strength of the relationship.
When teams function well and organization structure factors support their work, outcomes are better, even at institutions that have a high intensity of specialized care for those particular needs. These organizations are engaged in continuous improvement to improve outcomes. Yet, many organizations do not meet the standards of high-reliability organizations HROs. An indicator of the presence of work environment vulnerabilities and patient safety improvements could be whether or not an organization has Joint Commission accreditation.
Healthy work environments are also places where safe and high-quality nursing care is expected and rewarded. Healthy work environments also need to foster effective communication, collaborative relationships, and promote decisionmaking among all nurses.
Applying the theory behind high reliability organizations and normal accident theory e. HROs have a 1 preoccupation with avoiding failure, 2 reluctance to simplify interpretations, 3 sensitivity to operations, 4 commitment to resilience, and 5 deference to expertise.
- Communication Skills for Nurses
A reluctance to simplify interpretations is supported by thoroughly examining situations. Being sensitive to operations involves being constantly concerned about the unexpected and recognizing that active errors result from latent errors in the system. Committing to resilience involves being able to identify, control, and recover from errors, as well as developing strategies to anticipate and responds to the unexpected.
Having deference to expertise means that everyone is involved and decisions are made on the front line. Postal Service, 219495 to apply their lessons learned to health care. HROs are known to approach safety from a systems perspective, involving both formal structures and informal practices, such as open inquiry and deep self-understanding that complement those structures.
Mindfulness speaks to the interrelationships among processes of perception and cognition that stimulate a rich awareness of and hypervigilance for emerging factors and issues that could threaten the quality of care and enable the identification of actions that might be taken to deal with the threats to quality.
Changes in health care work environments are needed to realize quality and safety improvements. Because errors, particularly adverse events, are caused by the cumulative effects of smaller errors within organizational structures and processes of care, focusing on the systemic approach of change focuses on those factors in the chain of events leading to errors and adverse events. Transforming the Work Environment of Nurses, 1 was to emphasize the dominant role of the work environment within health care organizations and the importance of the work environment in which nurses provide care to patients.
Research reviewed by the IOM committee reported that nurses were dissatisfied with their work and wanted better working conditions and greater autonomy in meeting the needs of patients.
After the release of that report, the American Association of Critical-Care Nurses AACN expanded upon these concepts and put forth the following standards for establishing and sustaining healthy work environments: Researchers have found that nurses may experience greater professional fulfillment when strategies are implemented that promote autonomous practice environments, provide financial incentives, and recognize professional status.
More important, clinicians in practice will need new skills and empowerment to work effectively with colleagues within their work environments. Nurses also need to possess certain competencies that reflect the nature of nursing in improving patient and systems outcomes, including evidence-based practice, patient-centered care, teamwork and collaboration, safety, quality improvement, and informatics. For this recommendation to be realized, the IOM asserted that health care would have to achieve six aims: The IOM also asserted that health care for the 21st century would need to be redesigned, ensuring that care would be based on a continuous healing relationship, customized inclusion of patient needs and values, focused on the patient as the source of control, and based on shared knowledge and the free flow of information.
Patient-centered care would improve health outcomes and reduce or eliminate any disparities associated with access to needed care and quality. Patients seek care from competent and knowledgeable health professionals to meet their physical and emotional needs.
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It follows then that an effective clinician-patient partnership would include informed, shared decisionmaking and development of patient knowledge and skills needed for self-management of chronic conditions. Patients and families have been and are becoming more involved in their care. Findings from several studies have indicated that patients who are involved with their care decisions and management have better outcomes than those patients who are not,although some researchers indicate that the evidence concerning the impact of patient-centered care is variable.
Patient-centeredness is increasingly recognized as an important professional evolution and holds enormous promise for improving the quality and safety of health care. Yet, patient-centered care has not become the standard of care throughout care systems and among all clinicians as recommended by the IOM.
Teamwork and Collaboration It is nonsensical to believe that one group or organization or person can improve the quality and safety of health care in this Nation. In that patient safety is inextricably linked with communication and teamwork, 6 there is a significant need to improve teamwork and communication. The Joint Commission has found communication failures to be the primary root cause of more than 60 percent of sentinel events reported to the Joint Commission.
Interprofessional and intraprofessional collaboration, through multidisciplinary teams, is important in the right work environments. Skills for teamwork are considered nontechnical and include leadership, mutual performance monitoring, adaptability, and flexibility. Conversely, lack of effective teamwork—such as poor communication and collaboration within and between disciplines—was found to have negative effects on patient outcomes e. The relationship between Lisa and her siblings is complicated, and all of them have insisted on obtaining the security code for themselves.
Lisa, not wanting to start an argument, has given it to her brothers and sisters, who in turn, gave it to a few grandchildren. Although the nurse tries to be concise, often these conversations can take up to twenty minutes. It is decided that all information will flow through Lisa, although this does not make everyone happy.
Juggling Bad Feelings In the end, you will inevitably engender bad feelings, even in small families. Even those without the privacy code may try to bully you into telling them something, and your assertiveness as a nurse has to override that impulse to please. There are no easy answers in cases like this, and the nurse has to make a judgment on a case-by-case basis.
You can help minimise bad feelings by actively listening, keeping your cool and assuring callers that you understand they are concerned about the patient. If you have someone who is angry with you, that may be necessary for the good of the patient.
If that person goes to your manager, be sure to back up your actions so that you can prove you are merely respecting privacy laws and protecting your ability to care for the patient. What to Do When Things Escalate Sometimes, despite our best intentions, things can get a little out of hand and patients may demand to speak to a higher authority — your nurse manager for example. Crisis Management Families in crisis may react in ways that they normally would not.
The stress and worry over a patient in danger can cause them to say and do things that are offensive, violent, loud, and intimidating. A great deal of the attention will be focused on you because you are at the bedside, caring for their family member. As in most communication situations, it is important to remain calm in the face of whatever the family may present.
In that case, you need to work on calming the relative. Once you have established that they are privy to the details, tell them the truth about what is going on with their loved one.
Be prepared for a wide range of reactions. Some will react with anger, but most will react with neutrality or sadness. In some cases, this can be more difficult to deal with than hostility.
Offer yourself as a sounding board for the relative. Make it a point to be there for them, a presence of peace and understanding. Comfort them and do not betray their trust in you. Patient Rights v Family Rights Patients have the right to competent care, protection from reasonable risks, and advocacy from their nurse.
Nurses at the “Sharp End” of Patient Care - Patient Safety and Quality - NCBI Bookshelf
If the relatives are disturbing the patient, working them up, or causing more stress, the nurse has to step in and remove the family.
It is a difficult situation to be put in because no one wants to separate a family from their loved one. Is this helping them or hurting them? Most families will not cause stress, but sometimes even the most laid back family may cry, focus only on the negative, or in other ways upset the patient.
In these cases, it is important to talk to the patient and the family member. Ask the patient if they are comfortable with their family and if they would like the family to have restricted access to them.
Most will decline, but at least you are offering the opportunity to the patient.
Communication Skills for Nurses - 10 Tips for Improvement| Ausmed
Next, talk with the family. Explain that their behaviours are upsetting the patient and that a different approach is needed. There is no reason to be falsely happy, but tell them to simply be with the patient instead of focussing on the negative. In the end, talking to a patient may be easier than talking to their family. Patients may not understand what is going on with them, and their relatives are basically in the same position. However, they also have the added stress of not knowing if their loved one will make it through.
Acknowledge the fear they are feeling and offer them the same compassion you would offer your patients. This makes sense, because as a person ages they may require more frequent care. Communicating with patients is a skill that you need to practice. Memory and cognitive disturbances can also make talking to this population challenging. It is hard to dedicate the time necessary to talk properly to an older person, but this is the way to open the communication channel.
It is only over time that you get the whole story. This is especially true of doctors, but they may feel the same reticence when talking to nurses. If you are there and available for their concerns, they may be more willing to talk to you than to the doctor who might only spend five minutes in the room.
You may find out something that is vital to the care and comfort of that patient just by spending an extra few minutes with them. Yes, nurses are busy, but older people need time to express their pain, fear, and questions, and you need to allow for that in your schedule. Explain Things Simply As with children, it is best to avoid medical jargon when speaking with older people.
It is a fine line to walk, and you need to base your language on the questions and cognitive ability of the patient you are speaking with. Click To Tweet Try to use language that is simple, clear, and non-threatening. You should also strive to be as honest as possible. Some older patients need to write down what you are telling them so that they will remember it. Be prepared to repeat yourself and express concepts in different ways so that your patient can grasp what you are trying to say.
One of the most important parts of helping your elderly patients is acting as a kind of interpreter for the doctor. Try to be on hand when the doctor talks to the patient so you can explain later what they said. They will wait and ask you later to get a better understanding. Although she is forgetful, she is still able to live a relatively independent life.
She experienced an episode of fainting that was witnessed by several people at church, and she was taken to her primary care physician. It took a great deal of talking to her to help her understand that the fainting spell was, in fact, a major problem that needed to be investigated. In addition to restricting her driving privileges, Carolyn needed several tests to rule out different probable causes of her fainting spell.
Each test needed to be carefully explained to Carolyn and the information repeated so that she could grasp what each one required. She wrote down all the key information in a system that she had developed to keep herself from forgetting important points.
It takes careful reminding to keep her from driving her car or performing other actions that may put her in danger. Include Family in the Conversation Finally, including family is a big part of communicating with older people. You should always try to keep your older patient in the conversation, although not much of it may be understood. Often children, spouses and family friends can help the older person understand what is needed from them.
Family and friends can help you to communicate with an older patient because they know how that person thinks. It may help to have a three-way conversation between the patient, their caregiver, and yourself. When everyone works together to help the patient understand, you stand a much better chance of putting him or her at ease with all that is happening around them.
Not only are you trying to explain a difficult situation to a child, but you are trying to include the parents in the conversation as well. It is natural for a child to be scared, unreasonable and resistant to medical treatment, and it takes a skilled nurse to work through these roadblocks to achieve understanding. As with most communication, listening and allowing the patient to be heard will serve you well in talking to children.
Communicating with Children When talking to children you want to avoid medical jargon. For very young children, you have to use words that are as simple as possible. Even then, you may not get them to understand because their fear response is overriding everything else. However, you have to use care when talking to older children. You have to make a mental note of the age of the patient and their level of understanding, and tailor your speech to meet their needs.
You need to moderate your language, get down on the level of the child, and use a soft tone of voice. Sometimes, though, you need to do something that will cause them discomfort, and you must explain this with honesty and using straightforward language.
Talking to Parents Part of communicating with children is communicating with their parents. Again, you are likely to be dealing with someone who is in a great deal of distress and fear. It is helpful to try to allay their fears, answering all their questions as honestly as possible.
Some parents may get emotional and you need to be aware of possible outbursts of anger or sorrow. Either of these can upset your patient and that can go against what you are trying to accomplish. Try talking to parents away from the child and use active listening techniques, as you would for any other patient, family and relatives.
Case Study Daniel was a two-year-old heart patient who was preparing for his second open-heart surgery. Already, starting the IV line had been a traumatic event. Then one of the nurses from the OR came into the room the night before the operation with a bag of items.
She got down on her knees with Daniel and showed him the hairnet he would wear, the tubes that would come out of him, and the mask that would be placed over his face. Instead of being afraid, Daniel was fascinated with the new toys in front of him and played with them all. During this time, the nurse took the time to talk to the parents about their concerns. Employment, family roles, and mental ill health in young married women.
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