Pardon me while I climb on my soapbox. The topic? Communication. It should be easy, right? Communication simply involves giving and receiving information. It's the foundation of patient safety and it's crucial in transitions between caregivers and healthcare settings. We know communication breakdown is often the root of poor patient outcomes. Myriad good tools such as SBAR, electronic devices, and training programs are widely available to facilitate communication. So, what's the problem? It boils down to the quality of the human interaction...how information is given and how it's received. Personality, stress, knowledge, biases, and past experiences influence both the delivery and the receipt of the message.
Here's an example: A nurse communicates that a patient may be exhibiting early signs of X (insert a complication). However, that information didn't fit the provider's perspective. Pick a reason: The provider didn't expect the patient's condition to change, the provider questions the nurse's competence, the provider's interpretation differs from the nurse's, the provider is busy and downplays the concern, the condition change doesn't fit neatly into the provider's preordained plan, ego or anger impede an effective response. The nurse could react in several ways: second-guess the concern and feel foolish, be (perhaps falsely) reassured, or pursue the issue up the chain of command—and then prepare to deal with the backlash.
Rather than focus on whether the nurse is right or wrong, what matters most is that a concern about a patient's welfare exists—a warning of a possible problem that should prompt timely reevaluation by the provider or qualified designee without the unnecessary drama of a bad interaction. In reality, a “thank you” is in order for the opportunity to address the concern and intervene early. It's also a good time for a collaborative conversation to acquire a shared mental model of the situation.
The patient's outcome can hang on the perils and pitfalls of communication. Being a patient advocate takes courage and knowledge, including knowing when to get help from experienced colleagues and how to invoke the chain of command to activate needed resources. Don't let patients fall victim to poor communication. Embrace a culture that adamantly supports patient safety and accepts nothing less.
Until next time—
Linda Laskowski-Jones, MS, RN, ACNS-BC, CEN, FAWM
Editor-in-Chief, Nursing2014 Vice President: Emergency & Trauma Services Christiana Care Health System, Wilmington, Del.