Communication

Today we're talking about communication.

It's one of the most important skills for ensuring safety and

strong outcomes for our patients and your team. And so to walk us through why it matters and how to do it well, I'd like to welcome Ashton and Brad from our Quin team. Hi, guys. Welcome.

Hi, Melissa. Hi.

Hi. Thank you guys so much for joining today.

Yes. Thanks for having us.

Of course. Alright. So go ahead, please. Please tell us what co how communication works and what it means for a nurse in the US.

Absolutely, Melissa. Thank you. Communication in nursing isn't just helpful.

It's It's really, really important. And so, you know, when that breaks down, you know, it can lead to really serious misunderstandings, safety issues, poor patient outcomes. So when it is done well, communication becomes one of those most powerful tools, that we have for delivering safe, coordinated, and compassionate.

As Ashton was saying, when communication is done well, it is a powerful tool that helps us deliver the safe and coordinated care that is needed.

To set the stage, let's take a look at some of the core foundations that support strong communication.

Some of these foundations is the role of empathy, consistency in communication, nonverbal cues, culture competency, transparency and honesty, confidentiality, and interdisciplined communication.

As nurses, empathy is a large part of our role, caring for patients day in and day out and wanting to do what is best for those patients.

In caring for those patients, you want to inform those patients through consistency in your communication on what's happening with them and what the plan is.

At times, you may see your patients react in nonverbal ways and being attentive attentive to those nonverbal cues is important.

That also plays into the cultural competencies. Different cultures express themselves in different ways and being in tune to those non verbal cues or verbal cues when it comes to communications is it's very important.

Making sure that you are delivering clear and honest information that the patients understand. At times, you may have to reword or change things to help them understand confidentiality.

HIPAA is a big thing here in the US where private health information cannot be shared outside of the healthcare setting. Being aware of that is important. And then lastly the interdisciplinary communication.

You are working with many members of a medical team and have to be able to communicate with them effectively and efficiently through your time.

Yep. Absolutely. And we're gonna touch on all of these points throughout this entire segment. So, you know, the first part we'll review is nurse to nurse, right, and even other colleagues, like nurse aides, like, Brad was just saying, that interdisciplinary communication.

So, you know, nursing is a team sport. Right? I don't know how many times, I have that conversation with our our nurses.

You just have to be able to rely on your team, the other nurses you're working with, but they also need to rely on you. Right? So, you know, you have to be able to work well together and communicate during your entire shift.

And so without communication, you know, the team could completely fall apart, and that's not what we want for our our patients.

So building those relationships can take some time.

You know? So you could do things like offering to help others. Right? And thank others for helping you. Right? Communication in is two way street.

Avoid interrupting. Take accountability. Apologize when necessary, and have have manners. Right? Please, thank you. You know, those things go a long way.

Respond to phone calls and call lights, you know, relatively, you know, quickly, right, in a respectful amount of time.

Speak up. No one can read your mind, and you can't read theirs. Right? That's why verbal communication is really, really crucial.

Participate in unit or department events. Sometimes, I know in my experience, and I know Brad and I have talked about it, I mean, our team now also has food days. Right? Everyone brings in something, and it's just a really great bonding experience. And so and you get to have fun while at work. Right? So it's really, really important to participate in those kinds of things.

And be professional. Right? The language and behaviors should remain professional at all times while you are on the job.

So have personal conversations privately. Right? Don't have your personal phone out in the nursing station in front of patients, families, even other colleagues. Right?

And conflict. Right? Conflict is inevitable. Right? We're humans.

And but there's a professional way to manage conflicts and have those difficult conversations, in a professional manner.

It can even happen with physicians. And so, Brad, you know, I know you're gonna touch on nurse to physician, and I'm sure we've we've each, in our experiences, have had some some run ins with some physicians.

Yep. Thanks, Ash. This is great points in the nurse to nurse communication. Now let's talk about nurse to physician communication. Many international nurses come from areas where the hierarchy of the hospital setting looks much different than the US health care system.

Many times, physicians are the drivers of the work that needs to be done here in the US. Nurses have a lot of autonomy and expectations but still work very closely with the with the physicians, physicians and nurse practitioners aren't always physically on the units or in the building. So, it's critical to be able to speak through them through various ways. Some of those ways may be from paging them, sending them messages through an internal system or phone calls. Remember, you are a critical part of the health care team and they can't do what they do without the nurses. Collaboration between the provider and nurse leads to a better patient outcomes.

One good way to speak with physicians when you're needing to contact them is to use the SBAR format. Ashley, can you tell us a little bit about the SBAR?

Yes, absolutely. I feel like in nursing school, that's like all we we heard is like, use SBAR, use SBAR and so, for those that aren't aware, so SBAR is an acronym that stands for situation, background, assessment, and recommendation. And so it is designed to just standardize communication between providers and nurses to improve accuracy and efficiency with that communication. And so just fun fact.

So the SBAR was actually created by the US Navy and was later adapted in the nineteen nineties from the by the health care system. So I thought that was kinda cool. And it is widely used all over the US in any health care system. It's very well known, and so it is and will be expected for you guys to adapt this version of communication.

And so here on the screen, you'll see an example, a great example, that we found from the Institute of Healthcare Improvement. And so as you can see so situation. So, basically, what what are you calling about? Right?

You wanna ID yourself, the unit you're calling from, the patient you're calling for, and room number, and briefly state the problem. Right? When it happens when it started and how severe. So in the example, it shows that, you know, doctor Jones, this is Sharon Smith calling from the CCU.

I have mister Holloway in room two seventeen, a fifty six year old man who, looks pale, sweaty, see feels confused and weak, and is complaining of chest pressure. Right? So great background there, or situation. So background.

So this is when you wanna include the patient history related to the situation. The admitting diagnosis, when they were admitted, current meds, including, you know, the PO meds, IV meds, any meds that they're on, the their allergies, and recent lab results, including the date and time they were done, recent vital signs assessment details, any relevant, you know, clinical info. So in the example, the background states he has a history of hypertension, was admitted for a GI bleed, received two units.

His last, crit two hours ago was thirty one, and the vital signs were a blood pressure of ninety over fifty and a pulse of one twenty. So great background there.

The the assessment. Right? Your assessment of the situation. Right? So in the example, I think he's got an active bleed, and we can't rule out an MI, but we don't have a troponin or a recent H and H.

So that's kind of leads into the recommendation. Right? So what do you recommend is needed for the patient and what the patient or what the patient wants?

And so an example, the recommendation that the nurse would be providing to the physician is I like to get an EKG in labs, and I need you to evaluate him right away. Right? So that's what Brad was mentioning about the autonomy. Right? Our physicians aren't on-site all the time.

And so they really do rely on the nurses to be their their senses. Right? Their hands, eyes, ears, even nose sometimes. Right? So they really do depend on us for them to do their job well. Right? So we need to do well so they can do well.

Ashton, I think that's a great example of how to use SBAR appropriately. One thing that I often think about for individuals that are unfamiliar with SBAR is I go back twenty years ago when I started my nursing profession and I was uncomfortable with using this and and speaking with physicians, I often times would write out the SBAR before I would approach the physician to make sure I had all that information together.

Some other information that you might want to ask yourself, hey, is this pertinent to the SBAR?

Have you seen and assessed the patient before calling the physician?

Has the situation been discussed with other team members, maybe more senior nurses or the charge nurse? Have you had the opportunity to review the patient's chart and make sure that the physician that you're reaching out to is the appropriate provider knowing that that admitting diagnosis and when they are admitted, most recent notes from both the provider and maybe previous nurses and when you are reaching out to that physician, you wanna make sure that you have the chart available to you and open. You know what the current meds are. If they're, they have allergy, recent labs, changes in those recent layups, as well as vital signs and code status.

Yes. Absolutely. There's a lot of things to gather to prepare for the call. Right? So now we're gonna talk about, you know, you make you gather all this information.

You made the call. Right? You went through to your SBAR, and, let's say that the physician didn't answer. Right?

You had to leave a message, or you had to just page them because, you know, that's kind of their preferred method. You know, the next step would be, hey. Now you have to wait for them to call you back. Right?

So you want to be ready for that return call. So you wanna be available. Right? Communicate with, the administrator that's running the front desk, charge nurse, whoever it may be, that kind of manages when the unit phone rings.

Right? Because that's the number that you're gonna give them for them to call back. So inform them, like, hey. I called so and so for this patient.

You know, please let me know when they return my call.

So that way, they know just to automatically send it to your phone or just find you.

You know, like, all the stuff that Brad went over needs to be ready. Right? Be able to if you can, get to a computer quickly too.

Make it quick. Right? That's when when they return your page or your message, that's when you go through the SBAR. Right? So you already you should already have that prepared. Right?

Expect to take new orders. Right? That's kind of what you're reaching out for, right, to give them the information you have, and the recommendation is typically a new order.

And so, you know, they can give nurses a verbal order. Right? So that requires you to be able to be at a computer to put that order in for them. Right? So, really important to be able to have a pen ready, piece of paper, be by a computer, you know, just be ready. Be prepared.

That's great, Ashton. So we've covered nurse to nurse communication, and we've covered nurse physician or nurse practitioner communication. So, now, we're going to talk about nurse to patient communication. So, HCaPs is a it's called the Hospital Consumer Assessment of Healthcare Providers and big thing in the US healthcare system.

And they are one of the four determinants of reimbursement or how hospitals are paid for their services with the three other areas are the outcomes, the efficiency, and the clinical process of care. So this survey is designed to produce data about the patient's perspective of the care that allow the objectives and meaningful comparison of hospitals on topics that are important to consumers like communication. That's one of the biggest. They will they will rate you low if you don't provide effective and clear communication on this H cap score and therefore then the hospital will not receive as much reimbursement as they could have. Another area of this is public reporting of a survey as a result in new incentives for hospitals to improve quality of care. If a hospital is scoring low on HCAP in a consistent area, then the hospital knows that they need to work on that area to develop a better, effective plan to have that improved.

The public reporting system serves to enhance accountability in the health care by increasing that transparency of the quality of the hospital care provided in return to the public investment.

Every single day here in the US, over six thousands of these surveys are completed and they are viewed.

Yeah. And you know, just thinking about just how many patients we we have in, you know, on one unit, in one hospital, in one city total. Right? You know, it's really great that our patients do fill these out.

And so they, you know, during their stay in the hospital, right, they're anxious, they're worried, concerned, even families, right, are feeling those things. So it's really, really important to communicate with the patients and families, to help them better understand what's going on. Right? Because many of them, like, we have medical background education, they may not.

So it's really important that we're able to educate them, right, on what's going on. Sometimes the doctors or nurse practitioners kinda get in their their mindset and just speak medical terminology. Right?

But they forget that sometimes their patients aren't at that level. They don't understand that. And so it's really important for the nurse to, you know, be sure to educate and kinda break it down in layman terms. Right? In at a level that your patient and families can understand. Very, very important.

You know? And even so, at times, the patients may feel embarrassed or not asked questions with their providers. And so that's another reason that, you know, you guys as nurses spend a lot of time with the patient. Right? So they probably feel more comfortable with you and confident in your ability to to support them and and educate them. So, you know, they are able to be vulnerable, right, with their nurse. And so it's really crucial that you're able to, you know, speak to them.

And in addition to educating in that way, you know, it's really important that you can explain, right, what you're doing. So, you know, it's one thing to, you know, again, have a patient where you're you're putting in an IV. Right?

They may not have ever got an IV in their lifetime, never even seen one. Right? So they don't know what you're doing. You're taking their arm and poking it.

And so it's really important that you explain, you know, you know, I'm I'm cleaning your spot for your your IV. This is where your medication's gonna come through, and that's how it enters, right, your body. You know, explaining what you're doing as you're doing it and even a little bit before. Right?

Letting them know as soon as you into the room, hey. I'm gonna get some lab work from you, instead of just walking in the room and grabbing their arm and shoving a needle in there. Right?

You wanna be sure that you ease their anxieties and worries and concerns.

And listening. Right? So I know today we talked a lot about talking. Right? But listening is just as important from in all areas that we've talked about today.

So it's a really crucial and critical life skill. You have to be able to listen, to be able to be a good communicator. And so avoid finishing sentences for others, interrupting.

So changing the subject, looking elsewhere other than the person speaking to you. Right? So just make sure you are active listening. Right? And this goes to anyone that you speak to in life. Right? Really important.

So Ashton and Brad, I just wanted to ask a quick question because, know communication does seem like a vital role for a nurse. You said nurse to nurse, nurse to patient, nurse to physician. But earlier Brad mentioned something about you know the healthcare professionals are coming from a different country that has different set of rules. So what I'm hearing, it's a cultural thing as well, not only in the hospital, but it also could be like their regular lifestyle, how it is in their country.

And so sometimes it's a little hard to get out of what you're used to. And I believe this segment is very important for that. But it also I'm more asking like about practical ways. So do we provide any training or courses where they could do simulation of these things so that they can get into it before they get here or after they arrive?

Mhmm. Yeah. Yeah. Great question. Yes. So our health care professionals do complete modules related and related to and surrounding communication in various, you know, settings and individuals.

Right? So, we do support our international health care professionals, in that sense, and that's just part of our, you know, full circle of support, in terms of making sure our, you know, health care professionals are ready, right, prepared, and know what to expect.

I think that you said that very well, Ashton.

All right, so we're gonna go over key takeaways from our talk on communication.

Communication in nursing is crucial for safety of the staff and the patients. The healthcare team must communicate to each other for the patients to have the best outcomes possible for their hospitalization.

Utilizing SBAR format when communicating with your provider for your patient is the best way to give them all the information they need accurately and efficiently. Having your information prepared before calling them and paging them is important.

Communication and customer skills are a must when speaking with the patients and their loved ones. You are your patients.

You are with your patients more than anyone else in the facility. They rely on you in so many ways.

So communications is extremely important so they feel safe in your

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