Communication & Collaboration

Pivotal Landmark Publications:
- 1998 Institute of Medicine report: To Err is Human: Building a Safer Health System
- 2001 IOM Report: Crossing the Quality Chasm

A safety culture necessitates:
- Strong, committed leadership
- Engagement and empowerment of all employees
Essential elements of a culture of safety include:
- Teamwork
- Patient involvement
- Openness and transparency
- Accountability
- References: Barnsteiner (2011), Lamb, Studdert, Bohmer, Berwick & Brennan (2003)

Effective functionality within nursing and interprofessional teams is achieved through:
- Open communication
- Mutual respect
- Shared decision-making
Goals: Achieve quality patient care (QSEN, 2013)
Benefits of working on a nursing team:
- Higher job satisfaction: Leads to less turnover/burnout
- Better patient satisfaction: Enhances patient outcomes
- Resource management: More efficient use of resources, leading to less cost

Mindfulness: Recognizing the importance of team contributions
Understanding that collaboration leads to better care in complex and specialized interprofessional teams

Interdisciplinary simulation initiatives occurring in March involve:
- Nursing (BSN, CNL, APN)
- Medical school students
- Medical dieticians
- Occupational therapy
- Physical therapy
- Respiratory therapy
- Social work
- Speech Therapy
- Pharmacy

Definition: Communication involves using words and behaviors to:
- Construct and send messages
- Receive and interpret messages
Process: It is a dynamic interaction where one individual can influence another through written, verbal, and nonverbal channels.
- In simpler terms, it is the interactive process of transmitting a message or idea.

Model includes:
- Noise
- Sender/Receiver: Provider A and Provider B
- Contexts (A's and B's context)
- Encoding/Decoding messages
- Channels used for communication

Impact of nonverbal communication:
- 55% - Our appearance (Facial expressions, body language, dress/grooming)
- 38% - The way we speak (Tone, speed, formality)
- 7% - The words we use (Informal vs. formal)

Almost all sentinel events are linked to communication failures (Joint Commission, 2016)
Approximately 80% of serious medical errors are attributed to poor communication, especially during shift changes.
Consequences of substandard handoffs include:
- Delays in treatment
- Inappropriate treatment
- Omissions in care
- Increased inefficiency due to rework
- Adverse events
- Increased costs

A nurse failed to inform a surgeon about a patient's post-operative abdominal pain and drop in red blood cell levels, leading to the patient's hemorrhage and death.
A nurse did not relay messages from a diabetic patient to the primary care provider, resulting in the patient's collapse and death from diabetic ketoacidosis.
A woman’s desire for sterilization after a C-section was not conveyed to the on-duty obstetrician, leading to an unwanted pregnancy.

Obtain a mental “image” of patient conditions upon entering their room:
- Anticipate patient appearance and accessories
- Expectation of level of consciousness
- Project potential patient needs
- If clarity is lacking, actively ask questions!

S: Identify self (name, position, location) and the patient (name, age, sex, location)
Situation: Clearly state the purpose of the communication, especially if urgent.
Background: Provide relevant history, current problems, and pertinent test results.
Assessment: State concerns, including vital signs and current management.
Request: Communicate what assistance or opinion is needed, stressing urgency if applicable.

CUS is a tool for conflict resolution and patient advocacy:
- C – I am concerned
- U – I am uncomfortable
- S – This is a safety issue
Two-Challenge Rule: A strategy for when a team member disagrees with a decision-maker regarding safety issues (AHRQ, 2013).

Definition: Delegation is the process of a nurse directing another person to perform nursing tasks and activities.
According to the National Council of State Boards of Nursing (NCSBN), this involves transferring authority, while the ANA emphasizes transferring responsibility. Both uphold that accountability remains with the nurse.

Right Task: Ensure it aligns with policies and procedures.
Right Circumstance: Check that the patient is stable.
Right Person: Confirm the delegatee is appropriately trained and competent.
Right Directions and Communication: Ensure two-way communication is established.
Right Supervision and Evaluation: The licensed nurse retains accountability while the delegatee is responsible for the delegated tasks (NCSBN, 2016).

Assess when and what tasks to delegate.
Communicate expectations and provide guidance.
Be available for inquiries.
Follow up after tasks are completed to:
- Review performance and outcomes
- Address any issues
- Offer feedback for improvement

Delegation and Assignments: Nurses must supervise and monitor the performance to ensure compliance with practices, policies, and standards.
Consider:
- Required level of supervision
- Frequency of check-ins
- Methods to verify completion and adequacy of tasks
- How nursing team members report concerns or changes in patient status.

RNs may delegate components of care but not the nursing process itself.
- RNs conduct assessments, develop care plans, and initiate patient teaching and discharge planning, evaluating responses to plans.
- Implementation of certain tasks can be delegated, but RNs are accountable for the nursing process.

LPNs cannot engage in nursing practice without direction from an RN or authorized health care provider.
They are prohibited from administering IV push medication, teaching nursing practices, supervising nursing practice, and assessing health status for nursing care provision.
LPNs contribute by communicating with RNs or healthcare providers regarding patient status and needs (OBN, 2015).