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PRESIDENT'S MESSAGE

Communication

McMahon, Maria Faillace MSN, RN, PNP-AC/PC, TCRN

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doi: 10.1097/JTN.0000000000000588
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I believe the effects of communication are essential to relationships, both professional and private. Communication itself may seem simple, but there is always the chance that a misunderstanding will lead to mistrust, negativity, poor interpersonal relationships, or action errors. Successful communication is far more than sharing information. It can build relationships, avoid conflicts, and contribute to better decision-making (Smarp, 2020).

When reflecting on situations where successful communication skills were either used effectively or not displayed at all, the results were equally memorable. Whether during virtual peer-review meetings or communicating with the trauma team when caring for an injured patient, communication is important for good outcomes. Almost 200,000 patients die annually in the United States because of adverse medical events. Most of these are related to miscommunications among health care teams (Martin & Ciurzynski, 2015). I am fortunate to be a facilitator during crisis resource management simulation sessions, where each member of the multidisciplinary trauma team participates monthly. During this activity, we address our program's five core principles: communication, role clarity, personnel support, resources, and global awareness. Examples of good communication skills during a crisis, such as closing the loop, speaking up, using the right tone, and asking for help, are discussed and practiced during high acuity patient scenarios. These case scenarios provide an opportunity for participants to examine their communication skills and behaviors exhibited when stressed.

There are several skills that are necessary for successful communication. Listening is important for developing trust. Someone who feels safe expressing their ideas or observations may help solve a problem or impact a patient's outcome. Another skill is the ability to communicate in an honest and direct way. A person who does this is not afraid to share their opinion or point of view on a subject. It is also someone who is willing to admit they made a mistake or can ask for help when they don't know something.

Nonverbal communication, such as body language, facial expressions, and gestures, can say more than words. This can often make face-to-face communication confusing. Whether it's an attendee's perplexed look during a presentation or the abrupt change in facial expression during an interaction, developing the ability to address nonverbal signals and be open to feedback will meet challenging situations head-on and ultimately build better relationships. In today's world of virtual prerecorded presentations and truncated text messages, it's not surprising that there can be an added layer of uncertainty about the meanings conveyed in these formats, which could possibly result in disastrous misunderstandings. Tone is also another important example of nonverbal communication. It's the condescending tone of an experienced clinician during a stressful trauma resuscitation that affects the confidence of a novice, who may, in turn, not speak up when they have valuable clinical information that can impact a patient's outcome.

Managing stress, especially during difficult or crisis situations, is thought to be helpful for successful communication. Normal physiological responses during stressful situations are restrictive thinking and behavior (Staw, Sandelands, & Dutton, 1981). The former may result in fixation performing a task or diagnosis, and the latter an increased reliance on leaders. Both of these responses may contribute toward the inability to think outside the box or a lack of confidence to speak up when something is seen or identified during an event. Debriefing or reflection after an event helps with self-awareness of one's behaviors when stressed. Stress management techniques such as taking a mental pause, or taking a series of deep breaths either prior to or during high anxiety situations, facilitate the development of reflexive strategies needed to perform successfully during a crisis.

Relationship building that happens with successful communication may also improve team performance. For instance, it was observed during a high-level trauma activation resuscitation when a surgical resident and an emergency medicine fellow displayed several examples of good communication and teamwork skills. They performed as if they had worked together often despite the surgical resident having just started his rotation. Curiosity had me ask about the ease of their collaboration. After a thoughtful minute, they said that before the patient arrived, a passing comment made them realize they had graduated from the same university and had several other things in common. This friendly conversation allowed a trusting relationship to quickly develop, which was displayed by their notable teamwork.

When the decision was made to write about communication for this message, I knew how the importance and vastness of the topic. Focusing on the key components related to developing and achieving successful communication techniques critical to the effective delivery of trauma care and optimal outcomes was the goal. Ultimately, successful communication skills are vital tools for so many facets of life. Most importantly, it is essential in the health care setting, where it could be a matter of life or death.

REFERENCES

Martin H., Ciurzynski S. (2015). Situation, background, assessment, and recommendation–guided huddles improve communication and teamwork in the emergency department. Journal of Emergency Nursing, 41(6), 484–488. doi:10.1016/j.jen.2015.05.017
Smarp. (2020). Top 5 communication skills and how to improve them. Retrieved from https://blog.smarp.com/top-5-communication-skills-and-how-to-improve-them
Staw B., Sandelands L., Dutton J. (1981). Threat rigidity effects in organizational behavior: A multilevel analysis. Administrative Science Quarterly, 26(4), 501–524. doi:10.2307/2392337
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