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Table 2 indicates some common barriers to interprofessional collaboration that we have learned from our research and focus groups with hospitals across the country. Common Barriers to Interprofessional Communication and Collaboration. The barriers indicated in Table 2 can occur within disciplines, most notably between physicians and residents, surgeons and anesthesiologists, and nurses and nurse managers.
Even though doctors and nurses interact numerous times a day, they often have different perceptions of their roles and responsibilities as to patient needs, and thus different goals for patient care. One barrier compounding this issue is that because the United States is one of the most ethnically and culturally diverse countries in the world, many clinicians come from a variety of cultural backgrounds. In all interactions, cultural differences can exacerbate communication problems. As a result, it is very difficult for nurses from such cultures to speak up if they see something wrong.
In cultures such as these, nurses may communicate their concern in very indirect ways. Culture barriers can also hinder nonverbal communication. For example, some cultures ascribe specific meaning to eye contact, certain facial expressions, touch, tone of voice, and nods of the head. Issues around gender differences in communication styles, values, and expectations are common in all workplace situations.
In the health care industry, where most physicians are male and most nurses are female, communication problems are further accentuated by gender differences. A review of the organizational communication literature shows that a common barrier to effective communication and collaboration is hierarchies. Communication is likely to be distorted or withheld in situations where there are hierarchical differences between two communicators, particularly when one person is concerned about appearing incompetent, does not want to offend the other, or perceives that the other is not open to communication.
In health care environments characterized by a hierarchical culture, physicians are at the top of that hierarchy. Consequently, they may feel that the environment is collaborative and that communication is open while nurses and other direct care staff perceive communication problems. Hierarchy differences can come into play and diminish the collaborative interactions necessary to ensure that the proper treatments are delivered appropriately.
When hierarchy differences exist, people on the lower end of the hierarchy tend to be uncomfortable speaking up about problems or concerns. Intimidating behavior by individuals at the top of a hierarchy can hinder communication and give the impression that the individual is unapproachable. Staff who witness poor performance in their peers may be hesitant to speak up because of fear of retaliation or the impression that speaking up will not do any good.
Relationships between the individuals providing patient care can have a powerful influence on how and even if important information is communicated. Research has shown that delays in patient care and recurring problems from unresolved disputes are often the by-product of physician-nurse disagreement. Reasons for this include intimidation, fear of getting into a confrontational or antagonistic discussion, lack of confidentiality, fear of retaliation, and the fact that nothing ever seems to change. Many of these issues have to deal more with personality and communication style.
Our research has shown that 17 percent of respondents to our survey research in — knew of a specific adverse event that occurred as a result of disruptive behavior. A quote from one of the respondents illustrates this point: Leaders in both medicine and nursing have issued ongoing initiatives for the development of a cooperative rather than a competitive agenda to benefit patient care.
The fact that most health professionals have at least one characteristic in common, a personal desire to learn, and that they have at least one shared value, to meet the needs of their patients or clients, is a good place to start. A large body of literature shows that because of the complexity of medical care, coupled with the inherent limitations of human performance, it is critically important that clinicians have standardized communication tools and create an environment in which individuals can speak up and express concerns.
This literature concurs that when a team needs to communicate complex information in a short period of time, it is helpful to use structured communication techniques to ensure accuracy. Structured communication techniques can serve the same purpose that clinical practice guidelines do in assisting practitioners to make decisions and take action.
Research from aviation and wilderness firefighting is useful in health care because they all involve settings where there is a huge variability in circumstances, the need to adapt processes quickly, a quickly changing knowledge base, and highly trained professionals who must use expert judgment in dynamic settings. Research shows that in these disciplines, the adoption of standardized tools and behaviors is a very effective strategy in enhancing teamwork and reducing risks.
Experts in aviation have developed safety training focused on effective team management, known as Crew Resource Management CRM. Improvements in the safety record of commercial aviation may be due, in part, to this training. Realizing that 70 percent of commercial flight accidents stemmed from communication failures among crew members, CRM sought to standardize communication and teamwork. The concept originated in , in response to a NASA workshop that examined the role that human error plays in air crashes.
CRM emphasizes the role of human factors in high-stress, high-risk environments. This represents a major change in training, which had previously dealt with only the technical aspects of flying. It considers human performance limiters such as fatigue and stress and the nature of human error, and it defines behaviors that are countermeasures to error, such as leadership, briefings, monitoring and cross-checking, decisionmaking, and review and modification of plans.
From a practical standpoint, CRM programs typically include educating crews about the limitations of human performance. Trainees develop an understanding of cognitive errors and how stressors such as fatigue, emergencies, and work overload contribute to the occurrence of errors.
Knowing yours can help you to find ways around them. Without the commitment and support of senior-level leadership, even the best intended projects are at great risk of not being successful. They view these warning signals as indicators of routine repetitions of poor communication rather than unusual, worrisome indicators. The successful work of these strategies was dependent upon having motivated 80 and empowered teams. Although the nurse tries to be concise, often these conversations can take up to twenty minutes. Blumenthal D, Kilo CM. Nurses teach and help patients communicate their needs, but something about silence is therapeutic too.
Operational concepts stressed include inquiry, seeking relevant operational information, advocacy, communicating proposed actions, conflict resolution, and decisionmaking. CRM is now required for flight crews worldwide. The development and implementation of CRM in aviation over the last 25 years offers valuable lessons for medical care.
Sexton and colleagues 51 compared flight crews with operating room personnel on several measures, including attitudes toward teamwork. This landmark study included more than 30, cockpit crew members captains, first officers, and second officers and 1, operating room personnel attending surgeons, attending anesthesiologists, surgical residents, anesthesia residents, surgical nurses, and anesthesia nurses.
Questionnaires were sent to crew members of major airlines around the world over a year period. The operating room participants were mailed an analogous questionnaire, administered over a period of 3 years at 12 teaching and nonteaching hospitals in the United States, Italy, Germany, Switzerland, and Israel. The Sexton study and other analyses suggest that safety-related behaviors that have been applied and studied extensively in the aviation industry may also be relevant in health care.
Study results show successful CRM applications in several dynamic decisionmaking health care environments: In anesthesiology, 65—70 percent of safety problems accidents or incidents have been attributed at least in part to human error. Collected data from the comparison periods and were statistically analyzed using the chi-square test. This study indicates that, since the implementation of MTM, there has been a statistically significant increase in the number of reports filed at Eglin USAF Regional Hospital and a decline in the severity of incidents.
These findings suggest that since the implementation of MTM, there have been changes in the patterns of error reporting, and with training, staff are able to prevent more serious incidents. Table 3 highlights the application of a CRM model to medicine. Doctors and nurses often have different communication styles in part due to training.
Nurses are taught to be more descriptive of clinical situations, whereas physicians learn to be very concise. Standardized communication tools are very effective in bridging this difference in communication styles. This technique has been implemented widely at health systems such as Kaiser Permanente.
It allows for an easy and focused way to set expectations between members of the team for what will be communicated and how, which is essential for information transfer and cohesive teamwork.
Not only is there familiarity in how people communicate, but the SBAR structure helps develop desired critical-thinking skills. The person initiating the communication knows that before they pick up the telephone, they need to provide an assessment of the problem and what they think an appropriate solution is. Their conclusion may not ultimately be the answer, but there is clearly value in defining the situation. The guidelines use the physician team member as the example; however, they can be adapted for use with all other health professionals.
Forest Service to give direction to firefighters. The literature reviewed shows that effective teams are characterized by common purpose and intent, trust, respect, and collaboration. Team members value familiarity over formality and watch out for each other to make sure mistakes are not made. Health care teams that do not trust, respect, and collaborate with one another are more likely to make a mistake that could negatively impact the safety of patients. One of the first crucial steps is organizational commitment and willingness to address the situation.
Commitment needs to come from the top down and bottom up, making a statement about the way the organization does business. The rallying point should be around behavioral standards and their relationship to patient safety. Clinical and administrative leaders must set the tone by establishing and adhering to behavioral standards that support agreed-upon code of conduct practices backed by a nonpunitive culture and zero-tolerance policy. The next step in the process is recognition and self-awareness. Organizations must be able to assess the prevalence, context, and impact of behaviors to identify potential opportunities for improvement.
Doing an internal assessment will help pinpoint the seriousness of the situation and provide clues to areas that need to be addressed. Assessment information can be gained from formal methods such as incident reports, survey tools, focus groups, department meetings, task forces or committees, direct observation, suggestion boxes, and hot lines. Informal methods such as casual meetings and gossip can also provide valuable surface information and should be evaluated more deeply as to the source, relevance, and significance of the events to determine next steps. In many organizations there are still remnants of reluctance to address the issue head on for fear of antagonizing a prominent surgeon or staff member.
With growing concerns about workforce shortages, staff satisfaction and retention, hospital reputation, liability and patient safety, and the need for compliance to the latest Joint Commission proposed standards addressing disruptive behaviors, organizations can no longer afford to take a passive approach to the situation. Creating opportunities for different groups to just get together is a highly effective strategy for enhancing collaboration and communication. These group interactions can be either formal or informal.
Encouraging open dialogue, collaborative rounds, implementing preop and postop team briefings, and creating interdisciplinary committees or task forces that discuss problem areas frequently provides an upfront solution that reduces the likelihood of disruptive events. When a disruptive event does occur, some organizations have implemented a time-out, code white, or red light policy that addresses the issue in real time to prevent any further serious consequences.
Developing and implementing a standard set of behavior policies and procedures is vital. 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. 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.
When communicating with patients , communicating with children is probably the most difficult. 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. 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. 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. 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. She helped them to understand what would happen, explaining the procedure, the heart-lung machine, and the estimated time of the surgery.
When the nurse prepared to leave after half an hour of talking, both Daniel and his parents were much more at ease. Although all of them were still afraid of the surgery, it helped to know a little bit about what would happen so not everything would come as a shock. Finally, it is important to include the child when talking about procedures or their health.
It is so much easier to talk to the parents that you may have a tendency to ignore the child. Children are very sensitive to this, and they do not appreciate being ignored. You should address the child at the beginning of your explanation and try to focus your talk on them and their needs.
At the end, you should also ask the child if he or she has any questions. They may not, but it helps them to feel included if you treat them like more than just a parcel to be taken here and there. Talk to the child as much as possible, and then take the parents out of the room for more adult conversation, if needed.
Among the most difficult scenarios that can arise for caregivers when communicating with patients is talking with a patient who is dying. It is challenging and often awkward to face the person. You might be too professional and distant, or you may go the other way, and be more emotional and connected than you should be. Remember, you have a roster of patients, and the wear and tear from becoming too emotionally involved can lead to burnout. How do you successfully balance all of the emotional roadblocks that can arise when dealing with a patient who has a poor prognosis?
It is important for you to be mentally healthy when working as a nurse, but especially when working with a population of patients who are in the process of dying. This means taking care of yourself and having ways to de-stress and unwind. When you go home you need to leave the sadness and emotion of the job at work.
If you take it home you could end up becoming a victim of compassion fatigue—a syndrome that can lead to anger, depression, substance abuse, and other problems. Communicating with dying patients is difficult and taking care of yourself emotionally should always come first. Most people who are dying are aware of what is happening. However, if you enter the room tongue tied and sad the patient could feel as if you pity them. Neither of these approaches will make your patient feel supported through this difficult time. Instead, you should approach the patient with neutrality.
You are an open, loving caregiver. You tend to their needs and answer their questions with honesty. It can be challenging to be open. When a patient asks a difficult question you may be tempted to pass the buck to other caregivers or to gloss over it. However, your patients have the right to know what their condition is.
That is part of ethical nursing. Your patient may also need to open up to someone and trusts you because you are their nurse. Although it may be difficult, always tell your patient the truth when they ask questions. Sometimes, in this situation the best communication is not saying anything at all. This is not always easy; one part of you may want to draw the person out to explore their feelings while another part of you would just like the distraction of talking to avoid awkwardness.
Neither of these approaches is helpful to a dying person. You just need to be present. In some cases, silence is more helpful than talking.
Feel unsure about whether or not you actually need to see a healthcare provider ? Consider putting together a notebook or filing system to maintain all of your records in an orderly fashion. Even better, create an online personal health record. Even with routine examinations or check-ups, be sure you understand the. Demands of the healthcare and public health systems. • Demands of the Plain language is communication that users can understand the first time they read or.
Maybe your patient has been talked to so much that the quiet helps to finally give them a chance to talk. They could also be tired of talking because everyone wants to know everything about what they are feeling. Families of dying patients are also suffering, and it can be challenging to communicate with them as well. Honesty is always the best course of action to take with families.
They will know you are hiding the truth and may resent you for telling them something false. One of the best ways to talk to families is through active listening. Since these people may be highly emotional they have the need to be heard as much as the patient. Active listening means that you reflect back to the person what they are communicating to you. Can you tell me more about that? Is that what you are trying to say? This can help with any emotional situation from anger to sorrow to apathy.
Nurses teach and help patients communicate their needs, but something about silence is therapeutic too. Once again, openness and the willingness to be with the patient will either help them to talk or give them a much-needed rest. That is the best therapeutic gift you can give your patient. Chances are, this strategy of communicating with doctors is not going to get you far. You have a very busy, often impatient, person listening to you. You have to make the most of your time, and the best way to do that is with organisation.
It stands for identify , situation , background , assessment , and recommendation. Merely having this structure in your head when picking up that phone to the doctor can make the call flow a bit more smoothly. The doctor on the other end will get a clear picture, you will get all of your information out concisely, and the patient will get the treatment they need. The situation part of ISBAR seems self-explanatory, but it can often throw you off when dealing with a patient you are not sure about or just have a bad feeling about. Knowing who your audience is makes it possible to plan your communication logically.
There are many different ways to think about your audience and the ways they could best be contacted. You can group people according to a number of characteristics:. Another aspect of the audience to consider is whether you should direct your communication to those whose behavior, knowledge, or condition you hope to affect, or whether your communication needs to be indirect.
Sometimes, in order to influence a population, you have to aim your message at those to whom they listen — clergy, community leaders, politicians, etc. Ultimately, the company agreed to change its practices. Ads that described the difficulties of adults with poor reading, writing, and math skills attracted potential volunteers. Both ads were meant to make the same points — the importance of basic skills and the need for literacy efforts — but they spoke to different groups.
You should craft your message with your audience in mind; planning the content of your message is necessary to make it effective. The mood of your message will do a good deal to determine how people react to it. It may take some experience to learn how to strike the right balance. Keeping your tone positive will usually reach more people than evoking negative feelings such as fear or anger.
There are two aspects to language here: The second language issue is more complicated. You should use plain, straightforward language that expresses what you want to say simply and clearly. What does your intended audience read, listen to, watch, engage in? Several interactive theater groups in New England, by stopping the action and inviting questions and comments, draw audiences into performances dramatizing real incidents in the lives of the actors, all of whom are staff members and learners in adult literacy programs.
They have helped to change attitudes about adult learners, and to bring information about adult literacy and learning into the community. What do you have the money to do? Do you have the people to make it possible? Who will lose what, and who will gain what by your use of financial and human resources? You may also be able to get materials, air time, and other goods and services from individuals, businesses, other organizations, and institutions.
Any number of things can happen in the course of a communication effort. Someone can forget to e-mail a press release, or forget to include a phone number or e-mail address. A crucial word on your posters or in your brochure can be misspelled, or a reporter might get important information wrong. Worse, you might have to deal with a real disaster involving the organization that has the potential to discredit everything you do.
Crisis plans should include who takes responsibility for what — dealing with the media, correcting errors, deciding when something has to be redone rather than fixed, etc. It should cover as many situations, and as many aspects of each situation, as possible.
You have to make personal contacts, give the media and others reasons to want to help you, and follow through over time to sustain those relationships in order to keep communication channels open. The individuals that can help you spread your message can vary from formal community leaders — elected officials, CEOs of important local, businesses, clergy, etc.
Institutions and organizations, such as colleges, hospitals, service clubs, faith communities, and other health and community organizations all have access to groups of community members who might need to hear your message. Now the task is to put it all together into a plan that you can act on.
By the time you reach this point, your plan will already be essentially done. You know what your purpose is and whom you need to reach to accomplish it, what your message should contain and look like, what you can afford, what problems you might face, what channels can best be used to reach your intended audience, and how to gain access to those channels.
And finally, you'll evaluate your effort so that you can continue to make it better. It will keep getting more effective each time you implement it. Developing a Communication Plan will guide the user through the steps of developing a communication plan, starting with figuring out the aim of the communication plan, developing objectives, acknowledging key messages as well as a target audience, planning tasks, and timelines to evaluation of the communication plan.
Developing a Communication Plan , by the Pell Institute and Pathways to College Network, is an excellent, simple resource providing information on how the communication plan should be designed as well as questions to be answered in order to develop a working and effective plan. How to Develop a Communication Plan. Newsworthy elements , from the Berkeley Media Studies Group, includes a checklist of questions by category to help you prepare and focus your story.
Planning for Effective Communication. Planning Before You Communicate. This helpful tool developed by the Public Health Foundation will help you to address and organize essential factors of communications planning, execution, and evaluation. Doing this preparation work before you communicate will save you valuable time and resources when and where they are needed most.