Patient Empowerment Discussion


Question Description

For this discussion, you will answer the following questions:

  • What factors should be considered when dealing with decisions where the nurse and patient hold differing values?
  • Give one example of a situation where patient empowerment might pose an ethical dilemma for you.
  • If you feel a patient is making an unwise decision, how would you respond?
  • Should there be limits on patient empowerment?

Your initial post must be posted before you can view and respond to colleagues, must contain minimum of two (2) references, in addition to examples from your personal experiences to augment the topic. The goal is to make your post interesting and engaging so others will want to read/respond to it. Synthesize and summarize from your resources in order to avoid the use of direct quotes, which can often be dry and boring. No direct quotes are allowed in the discussion board posts.


  • Initial Post: Minimum of two (2) total references: one (1) from required course materials and one (1) from peer-reviewed references.

Words Limits

  • Initial Post: Minimum 200 words excluding references (approximately one (1) page)

Unformatted Attachment Preview

CPD CONTINUING PROFESSIONAL DEVELOPMENT Effective communication and teamwork promotes patient safety NS805 Gluyas H (2015) Effective communication and teamwork promotes patient safety. Nursing Standard. 29, 49, 50-57. Date of submission: March 15 2015; date of acceptance: May 14 2015. Abstract Aims and intended learning outcomes Teamwork requires co-operation, co-ordination and communication between members of a team to achieve desired outcomes. In industries with a high degree of risk, such as health care, effective teamwork has been shown to achieve team goals successfully and efficiently, with fewer errors. This article introduces behaviours that support communication, co-operation and co-ordination in teams. The central role of communication in enabling co-operation and co-ordination is explored. A human factors perspective is used to examine tools to improve communication and identify barriers to effective team communication in health care. This article aims to inform the reader about effective teamwork and communication. The behaviours required for effective teamwork, the key elements of effective communication and common tools that support successful communication within a team are discussed. After reading this article and completing the time out activities you should be able to: Explain the pivotal role of effective teamwork in promoting patient safety and quality care. Describe the behaviours that are required for effective teamwork. List the barriers to effective communication in health care. Describe common tools that can be used to improve team communication. Relate effective communication to your own practice. Develop your communication skills in your team environment. Author Heather Gluyas Associate professor, School of Health Professions, Murdoch University, Mandurah, Western Australia. Correspondence to: Keywords Communication, co-operation, human factors, patient safety, revalidation, structured communication tools, team briefing, teamwork Review All articles are subject to external double-blind peer review and checked for plagiarism using automated software. Revalidation Prepare for revalidation: read this CPD article, answer the questionnaire and write a reflective account. Go to Online For related articles visit the archive and search using the keywords above. To write a CPD article: please email Guidelines on writing for publication are available at: Introduction Teamwork involves a group of people working together to achieve a common purpose (St Pierre et al 2011). Teamwork requires co-operation, co-ordination and communication between members of a team to achieve desired outcomes. In industries where there is high risk, such as health care, effective teamwork has been shown to achieve team goals successfully and efficiently, with fewer errors. Conversely, poor teamwork has been shown to result in errors and suboptimal outcomes (Walker 2008, Donohue and Endacott 2010, Lee et al 2012, Lyons and Popejoy 2014). This article introduces behaviours that support communication, co-operation and co-ordination in teams, and explores the central role of communication in enabling 50 august 5 :: vol no 49 :: 2015 STANDARD Downloaded from by ${individualUser.displayName} on Jun 01, 2017. For personal use only. NoNURSING other uses without permission. Copyright © 2017 RCN Publishing Company Ltd co-operation and co-ordination. A human factors perspective is used to identify barriers to effective team communication in health care and to examine tools that improve communication. Complete time out activity 1 In health care, teamwork is integral to providing safe and effective care to patients. The importance of effective teamwork in response to the growing complexity of care involving chronic conditions and associated comorbidities is increasingly recognised (St Pierre et al 2011). Most patient encounters involve more than one healthcare professional and may involve many people, depending on the type of healthcare problem. These individuals may include doctors, nurses, allied health professionals and other specialist professionals. Teams from different healthcare sectors, such as primary care, acute care, mental health or chronic care, may also be involved. Effective communication – both verbal and written – between team members and between different teams is essential to ensure co-operation and co-ordination of care. Ineffective communication, which leads to poor co-operation and co-ordination of care, is a major cause of errors and adverse events in patient care (World Health Organization 2009). Communication errors occurring at handover, either between team members or between different teams, may lead to inaccurate diagnosis, incorrect treatment and/or medication errors (Wong et al 2008). Poor communication in teams leads to team members having different perceptions of situations and of what is required to manage them (Brady and Goldenhar 2014). Such differing perceptions of a situation among team members may be viewed as the lack of a shared mental model, and this has been shown to contribute to serious safety events (Gluyas and Morrison 2013, Brady and Goldenhar 2014). Moreover, a lack of effective team communication has been shown to contribute to delayed response to deteriorating patients (Endacott et al 2007). Patient safety in surgical interventions may be compromised if there is poor team communication (Lyons and Popejoy 2014). This may result in serious adverse events such as wrong patient, procedure and/or site; retained instruments; infections; and unanticipated blood loss (Treadwell et al 2014). Thomas et al (2013) examined data from 459 patient safety incidents relating to clinical handover in acute care settings. They found that 28.8% of incidents (n=132) involved transfer of patients without adequate handover, 19.2% of incidents (n=88) involved omissions of critical information about the patients’ condition and 14.2% of incidents (n=65) involved omission of critical information in patients’ care plans. Poor communication is not limited to incidents in the acute sector. It may also be a factor in poor outcomes when transferring care between sectors, such as from primary care to the acute sector and back again (Russell et al 2013). There is a convincing case for investing time and resources in improving communication and teamwork in health care to improve patient safety. Complete time out activity 2 Teamwork behaviours Teams are composed of individuals with different knowledge, skills and attributes, who all contribute particular characteristics to team performance. However, for a team to perform successfully, individuals must share an understanding of what is required to achieve the desired goal (Endsley 2012). This means team members must work individually to carry out their duties while maintaining an awareness of the need for the collective contribution of team members (Gluyas and Morrison 2013). The skills that contribute to successful teamwork include team leadership, mutual support, situation monitoring and effective communication (Baker et al 2012). Table 1 indicates the knowledge and behaviours that are required to demonstrate these skills. Communication Communication is necessary in each of the skills team members require to contribute to an effective team (Table 1) and may be considered as the basis for effective teamwork. It may involve spoken communication, non-verbal (gestures, facial expression) and/or written language. It involves one person initiating a message, along with receipt of this message by another person or persons (St Pierre et al 2011). However, the powerful effect of cognitive processes on the communication process should be understood and recognised, since this is central to promoting effective communication. A human factors perspective provides a framework for understanding these effects and considers the 1 Before completing this article, recall a time when you were part of a team that did not work well together. Write down the factors and behaviours that may have contributed to this. Once you have completed the article and reviewed Table 1, add any factors you may have omitted from this list. 2 Read the case study in Box 1. Draw a diagram indicating the different teams that may have been involved in Mary’s care in the community and in hospital. Identify specific points where effective teamwork and communication were required between team members and teams. NURSING STANDARD :: voluses 29 no 49 ::permission. 2015 51 Downloaded from by ${individualUser.displayName} on Jun 01, 2017. For personal useaugust only. No5other without Copyright © 2017 RCN Publishing Company Ltd CPD communication effect of systems, environments, equipment and processes on human cognitive abilities and limitations (Catchpole 2013). Human cognition is a dynamic process that allows people to perceive, interpret and make decisions about required actions (Gluyas and Morrison 2013). The cognitive load is relatively low when undertaking well-known tasks in familiar situations. In such instances, humans are able to carry out tasks in a somewhat automatic manner with little conscious thought. However, in unfamiliar or complex situations, humans must use increased conscious attention to process what is going TABLE 1 Teamwork skills and required behaviours Skill Required behaviours Leadership  Communicate awareness and understanding of the desired outcome.  Communicate understanding of purpose, team roles, responsibilities, task requirements and plan.  Plan and allocate tasks. Mutual support  Provide feedback to other team members when required.  Provide and request assistance when required.  Trust in other team members and have confidence in their actions and intentions. Situation monitoring  Review ongoing team performance.  Adjust, adapt and reallocate tasks and responsibilities as required. Communication  Share information with other team members.  Communicate clearly using objective language, correct terminology and structured processes or tools, where available.  Acknowledge communication and check for correct interpretation (closed loop communication). (Miller et al 2009, Baker et al 2012, Gluyas and Morrison 2013) BOX 1 Case study 1: Mary Mary presented to the GP feeling unwell, with pain in her right leg of several days’ duration. On examination the GP identified that Mary had tenderness and swelling in her right calf; she denied any falls or other incidents that may have caused this. Since Mary had recently taken a flight overseas, the GP suspected a deep vein thrombosis (DVT). The GP ordered an ultrasound scan and blood test, which were positive for DVT, and Mary was commenced on oral anticoagulation therapy. Later that day, she presented to the emergency department with acute shortness of breath and was admitted with a diagnosis of pulmonary embolus. She was commenced on parenteral anticoagulation and respiratory support. After several days, Mary improved and was discharged into the care of the GP for monitoring of ongoing anticoagulation therapy, and the community nursing service, which would provide home visits and support during the recovery phase. on around them and what actions are required. Cognitive overload may occur if the situation is complex, for example where constantly changing circumstances require intense cognitive attention to process what is happening (Endsley 2012). Several cognitive processing failures may then arise, including attentional tunnelling, confirmation bias, memory failures (slips and lapses) and inaccurate mental models (Endsley 2012) (Table 2). These limitations in cognitive processing may be precipitated or exacerbated by workload pressures, time pressures, stress, anxiety, fatigue, poor team relationships, constant interruptions and changing situational requirements (St Pierre et al 2011). The cognitive load of the individuals involved in the communication may affect their processing of the information. Communication failures may occur if an individual is in a situation where there is cognitive overload, for example because of the volume of data they are trying to process. Transmission failures may arise from incomplete, incorrect, ambiguous or unclear messages, while reception failures may arise because the message is misinterpreted, disregarded or not processed and retained in memory (Endsley 2012). Therefore, it is important to recognise the context of communication and the individual stresses that might affect the communication process. The communication process itself is only one aspect of effective communication; there are additional barriers that may lead to communication failures. Barriers to effective communication General factors that can increase the likelihood of communication failures in any setting include differences in gender, culture, ethnicity, education and styles of communication. Also, there are contextual and cultural issues specific to healthcare settings that may affect communication in healthcare teams. One major difference between health care and many other environments is the existence of a hierarchical system, both among different health professional groups and among senior and junior staff in the same professional group (Nugus et al 2010). This hierarchy results in an authority gradient; those further down the hierarchy may be hesitant to challenge those further up the hierarchy, raise concerns or ask questions. In a situation where one member of the team feels there may be a patient safety issue, or has concerns of some kind, they may not feel comfortable raising this or discussing their concerns with the team (Makary et al 2006, Reid and Bromiley 2012). 52 august 5 :: volfrom 29 no 49 :: 2015 STANDARD Downloaded by ${individualUser.displayName} on Jun 01, 2017. For personal use only. NoNURSING other uses without permission. Copyright © 2017 RCN Publishing Company Ltd An example that illustrates this authority gradient is provided in Reynard et al (2009). A child experienced facial burns from a dry swab that caught fire from the diathermy machine during maxillofacial surgery. The surgeon immediately changed his practice to using wet swabs, but ascertained from colleagues that they previously changed to this practice because the risk of using dry swabs had already been identified. When the surgeon asked nursing staff why they did not inform him of this practice, they indicated that he had discouraged suggestions in the past, so they did not feel comfortable raising issues about his surgical practice (Reynard et al 2009). Other studies confirm that reluctance to speak up about possible patient risk is an important factor in communication errors (Leonard et al 2004, Makary et al 2006, Mackintosh and Sandall 2010, Carayon 2012, Lyndon et al 2012, Okuyama et al 2014). Lyndon et al (2012) reported that 12% of staff were unlikely to speak up even when there was high risk; this reluctance was related to previous rudeness or intimidation from other staff. Other factors that contribute to this hesitancy include poor leadership and relationships in the healthcare team, fear of the responses of others, and concerns about appearing incompetent in ambiguous or complex clinical situations (Okuyama et al 2014). Differing communication styles between doctors and nurses may exacerbate authority gradients that exist in health care. Doctors are educated on a scientific basis that emphasises cure and treatment in the management of patient care. This results in a communication style that tends to be succinct, with a focus on scientific facts. Nurse education is informed by science but has a holistic focus on caring linked to treatment and management. Nurses’ communication style differs from that of doctors in that it tends to be more narrative, rather than concisely factual (Wachter 2012). Communication between different professional groups can lead to misunderstanding and misinterpretation of the message being communicated, because different professional staff have expectations of others that are not explicitly communicated (Donohue and Endacott 2010). Implicit expectations, or those not explicitly communicated, may also be described as a ‘hint and hope’ dialogue. This can result in the sender and receiver failing to communicate, with the sender hinting at what is required and the receiver completely missing their message. One example of this is the case of Elaine Bromiley, a patient who died following a failed intubation for a surgical procedure (Reid and Bromiley 2012, Bromiley 2014). During the emergency situation, the medical staff involved were focused on continuing to try to intubate; the patient became severely hypoxic, resulting in her death 13 days later (Walker 2008). The authority gradient discouraged any direct assertion by the nurses that the situation was an emergency. When a nurse brought in the tracheostomy tray (without being asked) and stated that it was ready, the implicit message was: ‘I have brought in the tracheostomy tray because you need to look at alternative airway access for oxygenation.’ This was not the message received by the medical staff, who remained focused on the task of intubating the patient and ignored the interruption (an example of attentional tunnelling, Table 2). A second nurse was also ignored when she stated that she had contacted the intensive care unit (ICU) for a bed. The implied message was: ‘I have contacted ICU because this is an emergency and I am worried about the patient’s deteriorating observations.’ However, the nurse’s comments were not interpreted in this way. The communication failures were a result of differing communication styles, as well as the authority gradient and the cognitive overload of the medical staff attempting to manage the situation. TABLE 2 Cognitive processes to manage challenging situations Cognitive process Description Attentional tunnelling Focusing cognitive attention on one aspect of a situation that is proving challenging in terms of understanding or task completion, while ignoring other information from the environment or context. Confirmation bias A tendency to consider only confirming evidence and to disregard evidence that does not confirm. Memory failures (slips and lapses) Memory failures are associated with automatic behaviour, where we intend to do something but our attention is focused elsewhere. We either forget to carry out an action (lapse), or undertake steps of an action in the wrong order or leave out a step entirely (slip). Inaccurate mental models Erroneous mental models of events and what decisions or actions are required, resulting from flawed perception or comprehension of a situation. (Adapted from Endsley 2012) NURSING STANDARD :: voluses 29 no 49 :: permission. 2015 53 Downloaded from by ${individualUser.displayName} on Jun 01, 2017. For personal useaugust only. No5 other without Copyright © 2017 RCN Publishing Company Ltd CPD communication In health care, teams are often not fixed or established, but have come together for a specific purpose. They have not had time to establish roles and responsibilities or to articulate clearly the apparent objectives of the team (Wachter 2012). This can lead to different perceptions or mental models of the situation and the required outcomes. Shift work, long hours leading to fatigue, and other common factors in health care, such as distractions, interruptions, workload and time pressures, add to these different perceptions. Therefore, it is not surprising that poor communication within teams contributes to errors and poor patient outcomes. It is imperative to develop strategies that decrease the likelihood of communication f ...
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School: UC Berkeley

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Navigating the diverse backgrounds within the healthcare realm can be unnerving for
nurses. Often, nurses interact with patients from unique backgrounds with differing personal,
religious and cultural beliefs and values. Such differences can create a moral challenge putting a
strain on the nurse-patient relationship.
Various factors must be considered when a caregiver`s beliefs and values do ...

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