Abstract:
It is difficult to find in Spanish a word that can translate the meaning of Counselling and encompassing all those elements and nuances that you are your own. The translations more frequently used are "assisted advice" and/or "aid relationship" and/or advice, it also includes all the skills that are necessary to establish that interpersonal relationship.
Although the communication skills, and in particular communication of bad news and the relationship with users are currently not part of the university education within the degree in Medicine, Nursing, Physiotherapy or Psychology if it has been of concern on the part of practitioners in these areas present sufficient levels of training in this core competency. In fact, we presented/displayed a communication where the little information received in the own hospital on the part of parents with children with Syndrome of Down is reflected in particular on this genetic alteration before making decisions referred to the birth from the boy. Thus, just as the curative art is learned can be learned the abilities of communication referred the unexpected news, which will help to diminish the psychological cost for the professional and the own patient.
Abstract:
It is difficult to find in Spanish a word that can translate the meaning of Counselling and encompassing all those elements and nuances that you are your own. The translations more frequently used are "assisted advice" and/or "aid relationship" and/or advice, it also includes all the skills that are necessary to establish that interpersonal relationship.
Although the communication skills, and in particular communication of bad news and the relationship with users are currently not part of the university education within the degree in Medicine, Nursing, Physiotherapy or Psychology if it has been of concern on the part of practitioners in these areas present sufficient levels of training in this core competency. In fact, we presented/displayed a communication where the little information received in the own hospital on the part of parents with children with Syndrome of Down is reflected in particular on this genetic alteration before making decisions referred to the birth from the boy. Thus, just as the curative art is learned can be learned the abilities of communication referred the unexpected news, which will help to diminish the psychological cost for the professional and the own patient.
A prominent nursing center in the mid-size East South Central city in the South has come under the fire due to a major challenge of shortage in the nursing staff. An increase in the health care expenses led to a temporary reduction in the staff’s earning that led them to decrease in the number of nurses. Decreasing the nursing staff is the only logical way to combat the increased health costs, however, it partly kills the working enthusiasm of the staff.
But, the decreased staff is birthing more problems, as there is an array of patients that come to this center for care and cure and the decreased number of nurses cannot put up with all of them.
Wessex AHSN is pleased to announce the publication of a short report on the evaluation of how people feel when they experience new models of care. The report has been produced in partnership with R-Outcomes and the Centre for Implementation Science (University of Southampton) and responds to local evaluation guidance, published by NHS England in June 2017, that calls for a strengthened focus on capturing and evaluating patient and residents’ experience of transformed services.
Measuring “Culture of Safety” Tawam’s Experience
Discovery:
Tawam Hospital’s Executive leadership realized the need to establish a “Culture of Safety” within the organization and implemented the Johns Hopkins Medicine “Comprehensive Unit based Safety Program” (CUSP). CUSP was introduced as a pilot project in the Intensive Care Unit (ICU), Neonatal Intensive Care Unit (NNU) and Paediatric Oncology Unit (Peds Onc).
Prior to implementation the leadership decided to measure staff perception of safety using evidence based tool.
Solution:
Tawam partnered with Pascal Metrics to implement the Safety Attitude Questionnaire survey. The SAQ was administered to all Tawam Hospital staff in three phases (2008, 2010 and 2011). In 2010 the pilot CUSP units were also resurveyed to determine the status of safety culture since its introduction in 2008.
An email from the CEO was sent to the participants encouraging them to participate in the SAQ survey.
Physicians, nurses, ward-clerks; respiratory therapist, physiotherapist, dieticians etc were included in the survey.
Those who spent at least 50% of their time in the identified units were only included to participate in the survey.
Survey was administered during departmental meetings to increase response rate.
Conducted separate sessions of physicians.
Staff dropped the completed surveys in an envelope.
82% of staff in the patient care areas of the whole hospital participated in the overall 3 phases of SAQ Survey.
The three CUSP pilot units were re-surveyed in 2010.
Anonymity, privacy and confidentiality were maintained from the beginning till the end.
Outcome:
The survey results were graded against percentage positive responses. Responses that were less than 60% mark were graded in the danger zone and anything above the 80% mark were graded in the goal zone. Teamwork climate and Safety climate scale scores are considered to be primary dependent variables, because they are important in preventing patient harm.
The overall hospital score on all the domain scores were in the danger zone, less than 60%. 20 clinical locations in 2010 and 7 clinical locations in 2011 had less than 60% scores in the primary dependent variables.
The SAQ results were disseminated department wise in the presence of a hospital Senior Executive. Every department did an action plan using the SAQ de-briefer tool. The hospital administrators to bring about the change played a facilitators role and helped the departments to come up with their actionable plans.
The hospital leadership in their pursuit to continuing the culture of safety journey, identified six more units for CUSP implementation based on the Phase 2 SAQ scores of 2010. Accordingly the Medical 1, Medical 2, Surgical 1, Surgical 2, Day Case and OBGYN Units were identified for the CUSP roll out. Senior Executive leaders were assigned to each of these new CUSP units to ensure leadership commi
OVERVIEW -- Care by Design - Putting Care back into healthcare the University of Utah experience in building PCMH level care over the decade of 2001 to . 2011
Patient’s experience, improve the quality health3zsaddique
Putting patients first requires more than world-class clinical care – it requires care that addresses every aspect of a patient’s encounter with Hospital, including the patient’s physical comfort, as well as their educational, emotional, and spiritual needs. A team of professionals should serves as an advisory resource for critical initiatives across the Hospital health system. In addition, it should provide resources and data analytics; identify, support, and publish sustainable best practices; and collaborate with a variety of departments to ensure the consistent delivery of patient-centered care.
Taking Efficiency to Scale: Spread of a Delegate Model in an FQHCJSI
A large rural federally qualified health center (FQHC) in Maine seeks to increase access to and quality of care through decreasing variability in efficiency and panel sizes among its primary care teams across 5 of 17 sites through spread of a "delegate model." Secondary objectives are to enhance provider and team job satisfaction, increase team function, and decrease provider and staff burnout.
A prominent nursing center in the mid-size East South Central city in the South has come under the fire due to a major challenge of shortage in the nursing staff. An increase in the health care expenses led to a temporary reduction in the staff’s earning that led them to decrease in the number of nurses. Decreasing the nursing staff is the only logical way to combat the increased health costs, however, it partly kills the working enthusiasm of the staff.
But, the decreased staff is birthing more problems, as there is an array of patients that come to this center for care and cure and the decreased number of nurses cannot put up with all of them.
Wessex AHSN is pleased to announce the publication of a short report on the evaluation of how people feel when they experience new models of care. The report has been produced in partnership with R-Outcomes and the Centre for Implementation Science (University of Southampton) and responds to local evaluation guidance, published by NHS England in June 2017, that calls for a strengthened focus on capturing and evaluating patient and residents’ experience of transformed services.
Measuring “Culture of Safety” Tawam’s Experience
Discovery:
Tawam Hospital’s Executive leadership realized the need to establish a “Culture of Safety” within the organization and implemented the Johns Hopkins Medicine “Comprehensive Unit based Safety Program” (CUSP). CUSP was introduced as a pilot project in the Intensive Care Unit (ICU), Neonatal Intensive Care Unit (NNU) and Paediatric Oncology Unit (Peds Onc).
Prior to implementation the leadership decided to measure staff perception of safety using evidence based tool.
Solution:
Tawam partnered with Pascal Metrics to implement the Safety Attitude Questionnaire survey. The SAQ was administered to all Tawam Hospital staff in three phases (2008, 2010 and 2011). In 2010 the pilot CUSP units were also resurveyed to determine the status of safety culture since its introduction in 2008.
An email from the CEO was sent to the participants encouraging them to participate in the SAQ survey.
Physicians, nurses, ward-clerks; respiratory therapist, physiotherapist, dieticians etc were included in the survey.
Those who spent at least 50% of their time in the identified units were only included to participate in the survey.
Survey was administered during departmental meetings to increase response rate.
Conducted separate sessions of physicians.
Staff dropped the completed surveys in an envelope.
82% of staff in the patient care areas of the whole hospital participated in the overall 3 phases of SAQ Survey.
The three CUSP pilot units were re-surveyed in 2010.
Anonymity, privacy and confidentiality were maintained from the beginning till the end.
Outcome:
The survey results were graded against percentage positive responses. Responses that were less than 60% mark were graded in the danger zone and anything above the 80% mark were graded in the goal zone. Teamwork climate and Safety climate scale scores are considered to be primary dependent variables, because they are important in preventing patient harm.
The overall hospital score on all the domain scores were in the danger zone, less than 60%. 20 clinical locations in 2010 and 7 clinical locations in 2011 had less than 60% scores in the primary dependent variables.
The SAQ results were disseminated department wise in the presence of a hospital Senior Executive. Every department did an action plan using the SAQ de-briefer tool. The hospital administrators to bring about the change played a facilitators role and helped the departments to come up with their actionable plans.
The hospital leadership in their pursuit to continuing the culture of safety journey, identified six more units for CUSP implementation based on the Phase 2 SAQ scores of 2010. Accordingly the Medical 1, Medical 2, Surgical 1, Surgical 2, Day Case and OBGYN Units were identified for the CUSP roll out. Senior Executive leaders were assigned to each of these new CUSP units to ensure leadership commi
OVERVIEW -- Care by Design - Putting Care back into healthcare the University of Utah experience in building PCMH level care over the decade of 2001 to . 2011
Patient’s experience, improve the quality health3zsaddique
Putting patients first requires more than world-class clinical care – it requires care that addresses every aspect of a patient’s encounter with Hospital, including the patient’s physical comfort, as well as their educational, emotional, and spiritual needs. A team of professionals should serves as an advisory resource for critical initiatives across the Hospital health system. In addition, it should provide resources and data analytics; identify, support, and publish sustainable best practices; and collaborate with a variety of departments to ensure the consistent delivery of patient-centered care.
Taking Efficiency to Scale: Spread of a Delegate Model in an FQHCJSI
A large rural federally qualified health center (FQHC) in Maine seeks to increase access to and quality of care through decreasing variability in efficiency and panel sizes among its primary care teams across 5 of 17 sites through spread of a "delegate model." Secondary objectives are to enhance provider and team job satisfaction, increase team function, and decrease provider and staff burnout.
Comment 1Development of an evidence-based practice project musJeniceStuckeyoo
Comment 1
Development of an evidence-based practice project must include the direct and indirect impact that will be encountered through implementation. Staff retention of newly hired nurses specific to the night shift is the focus of my project and its impact on the nurses, facility and community that is served. According to published reports, a supportive work environment, especially between managers and employees, creates a strong deterrent to nurses leaving an organization by improving perception of organizational support, employee engagement, team cohesion, and connection to the mission of the health-care setting (Kurnat-Thoma, Ganger, Peterson, & Channell, 2017).
Financial aspect
– staffing cost/turnover cost
Hospital staffing turnover is projected to 5% to 5.8% of total hospital annual operating budget and is largely driven by the loss and necessary replacement of qualified nurses according to Waldman, J., Kelly, F., Arora, S., Smith, H. (2010).
Proposal direct impact
– hospital revenue/staffing costs,
Proposal indirect impact
– patient outcomes, positive healing environment perception by staff/patients
Quality Aspect
– High turnover in any industry can be a concern, especially those that are customer-centric. Industries that deal with people’s health are in an even more precarious position. Institutions with high attrition must consider how a “revolving door” of care providers affects the quality of care an institution is able to provide, and the satisfaction of patients with their overall experience according to Arena (2018).
Proposal direct impact
–
Separation Costs – Continued benefits, temporary labor, overtime to existing employees
• Recruitment Costs – Job description, posting on job boards, screening candidates, interviewing candidates, assessing candidates
• Onboarding Costs – Orientation and training of new hire
Proposal indirect impact
–
Loss of productivity
• Lack of staff while positions are being filled
• Increased pressure on existing staff to cover and pick up the extra work often leading to burnout
• Patients receiving less attention
• Pressure on current staff to train and then gel with the new employees
• Lack and lag of knowledge with new employees concerning institutional practices, workplace norms, team behaviors, and patient knowledge, familiarity, and care experience
Clinical aspect
– unit cohesiveness/patient care
Many nurses leave their positions because of negative experiences with heavy or unrealistic workloads and due to feeling unheard and undervalued. Clinical nurses' sense of disempowerment can be related to lack of leadership interventions. Clinical nurses may feel that managers are insensitive to their staffing needs, don't support employee well-being, and don't invest enough in staff education or clinical advancement according to Linnen and Rowley (February 2014).
Proposal direct impact
– nurses will see themselves as stewards for their unit. “Nurses are leaders by virtue ...
Discussion 1 GeorgeIntroduction Teamwork is a significant aVinaOconner450
Discussion 1 George
Introduction
Teamwork is a significant aspect of health care delivery. With the increasing complexity and specialization of clinical care, healthcare workers have
to learn more complicated methods and procedures to achieve the desired patient outcomes. Teamwork is associated with reduced medical errors and
improve patient safety. Additionally, teamwork reduces staff burnout since a healthcare professional team is responsible for patient welfare (Zajac et al.,
2021). Various strategies are key to ensuring effective teamwork for better patient outcomes.
Strategies for effective teamwork during patient care
Effective communication across staff members of a clinical team increases teamwork efficacy, leading to improved patient outcomes. Working
towards a common goal, effective communication expands the traditional roles of each member to make decisions as a team (Zajac et al., 2021). One
particular strategy that worked for my clinical team is goal setting at the beginning of the scheduled activities so that each member has a clear purpose
for their roles for the day. Several studies also agree that goal setting provides the direction for implementing procedures and coordinated care.
Organizing regular meetings and using digital communication platforms such as emails and WhatsApp groups to convey information relating to patient
care to team members and debate suggestion is key to improving performance and, ultimately, patient outcomes.
Another effective team strategy is collaboration. By definition, health care involves multiple disciplines- nurses, doctors, and health care specialists
in different fields, working together, communicating often, and sharing resources (Zajac et al., 2021). A clinical team is made up of professionals of
different health specialities and responsibilities. Cumulatively, these differences contribute to the overall patient well-being and safety. The different
teams contribute to patient outcomes by understanding the patient presenting illness, asking them probing questions regarding their situation, making
an initial evaluation, discussing, and providing a recommendation based on their findings.
Strategies for ineffective teamwork during patient care
It is common for challenges to arise during teamwork. According to Hendrick et al. (2017), some of the most common challenges that impede a
team’s efforts to improve patient care include a lack of commitment of team members, different individual team members’ goals, and conflict
about how the team members individually relate to the patient. The input of individual members is vital to realizing the overall team’s goal. Therefore,
each member must demonstrate full commitment to the course of the team. Also, if the goals of the individual members do not align with the team’s
goal, then they might be less committed to achieving the team’s goal (Rawlinson et al., 2021). The healthcare team should help the patient understand
that their care is multidisci ...
Acute hospitals end of life care best practiceNHSRobBenson
Delivering reliable best practice in an acute hospital setting for patients whose recovery is uncertain. Including details of the AMBER care bundle. Presentation from Anita Hayes and colleagues from England's National End of Life Care Programme as part of the Department of Health's QIPP end of life care workstream seminar series at Healthcare Innovation Expo 2011
Part 6 Disseminating Results Create a 5-minute, 5- to 6-sli.docxsmile790243
Part 6: Disseminating Results
Create a 5-minute, 5- to 6-slide narrated PowerPoint presentation of your Evidence-Based Project:
· Be sure to incorporate any feedback or changes from your presentation submission in Module 5.
· Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
Points Range: 81 (81%) - 90 (90%)
The narrated presentation accurately and completely summarizes the evidence-based project. The narrated presentation is professional in nature and thoroughly addresses all components of the evidence-based project.
The narrated presentation accurately and clearly explains in detail how to disseminate the results of the project to an audience, citing specific and relevant examples.
The narrated presentation accurately and clearly provides a justification that details the selection of this dissemination strategy that is fully supported by specific and relevant examples.
The narrated presentation provides a complete, detailed, and specific synthesis of two outside resources related to the dissemination strategy explained. The narrated presentation fully integrates at least two outside resources and two or three course-specific resources that fully support the presentation.
Written Expression and Formatting—Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.
Points Range: 5 (5%) - 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.
Written Expression and Formatting—English Writing Standards:
Correct grammar, mechanics, and proper punctuation.
Points Range: 5 (5%) - 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
Evidenced Based Change
Leslie Hill
Walden University
Introduction/PurposeChange is inevitable.Health care organizations need change to improve.There are challenges that need to be addressed(Baraka-Johnson et al. 2019).Challenges should be addressed using evidence-based research.These changes enhance professionalism therefore improving quality of care and quality of life.The purpose of this paper is to identify an existing problem in health care and suggest a change idea that would be effective in addressing the problem. The paper also articulates risks associated with the change process, how to distribute the change information and how to implement change successfully.
Organizational CultureThe Organization is a hospice facilityOffers end of life care for pain and symptom managementThe health care providers cu.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
2. NURSING CORE COMPETENCIES:
FOR INTERDISCIPLINARY DISCHARGE PLANNING
Communication
“The Nurse of the Future will interact effectively with patients,
families, and colleagues, fostering mutual respect and shared
decision making to enhance patient satisfaction and health
outcomes” (Masters, 2014, p.78).
Teamwork
“The Nurse of the Future will function effectively within nursing
and interdisciplinary teams, fostering open communication,
mutual respect, shared decision making, team learning, and
development” (Masters, 2014, p.78)
3. WHAT IS COMMUNICATION?
A process that includes 5 factors:
SENDER – encodes a message to be transmitted;
MESSAGE – the ideas, symbols, signals being transmitted;
CHANNEL/MEDIUM – the means by which a message travels;
RECEIVER – receives and decodes the message; and
FEEDBACK – Receiver provides feedback to Sender to signal
effective reception of intended message (Oxford University Press,
2014; Communication Models and Theories, n.d.).
5. NURSE-PATIENT
COMMUNICATION:
SUCCESSFUL INTERACTION
Scenario: During Admission Intake, Nurse Hope Soeiltry would like to
obtain a medication list from Patient Will U. Listinclose for a safe medication
reconciliation.
Sender (Nurse: Hope) – encodes her message with words by asking a question
Message (The Question) – what medications do you take at home? Can you tell
me and write them down on this paper to include the name, dose, and time you
take them?
Channel/Medium (Verbal/Written) – both verbal and written responses
Receiver (Patient Will) – decodes the message; begins to tell Nurse Hope his
medications from home while writing them down
Feedback (Patient: Will) - asks if he should write down his over-the-counter
medications while showing Nurse Hope his medication list in progress. Nurse
Hope nods in agreement while saying, “absolutely correct!”.
Outcome of Communication: SUCCESS!
6. EFFECTIVE COMMUNICATION:
BARRIERS TO SUCCESS
Noise or Interference – ambient noise, alarms, bells, televisions,
radios;
Medium chosen poorly – incompatible language, incompatible
medium i.e. hearing impaired (chose verbal transmission), visually
impaired or illiterate (chose written transmission);
Message – unclear, inappropriate, incongruent, lacks context;
Receiver – emotionally/psychologically compromised (angry,
anxious, sad, fearful, uncooperative/unreceptive); physically
compromised (pain, fatigue, altered mental status);
Feedback – Receiver did not provide feedback to ensure
successful communication occurred; Sender did not request for
feedback (Communication Models and Theories, n.d.).
7. STRATEGIES TO OVERCOME
BARRIERS:
EFFECTIVE COMMUNICATION
Sender – is clear, concise, and congruent during message
transmission process;
Reduce or Eliminate – sources of interference with a calm, quiet,
and timely delivery environment for the communication to take
place;
Select Appropriate Medium – relative to the age, ethnic/cultural,
and language determined to be compatible with the receiver;
Assess the Receiver – for readiness i.e. Alert, oriented, well
rested, with a reasonable mood disposition; and
Request Feedback – ask the receiver if they understood the
message delivered; exercise a repeat-back and verify process to
ensure successful delivery.
8. DISCHARGE PLANNING AND
EFFECTIVE COMMUNICATION: WHAT &
WHEN
Definition:
“Preparation for moving a patient from one level of care to
another within or outside the current health care agency”
(Bulechek, Butcher, Dochterman, & Wagner, 2013, p.150).
When:
“Planning for discharge begins during the initial contact with
the client by establishing the expected outcomes and
anticipating follow-up care that may be needed”
(Harkreader, 2007, p.206).
9. DISCHARGE PLANNING AND
EFFECTIVE COMMUNICATION:
RATIONALES
Poor Planning and Discharge Communication is Costly:
“Poor communication can endanger patients’ lives and waste
fiscal and human resources” (Lattimer, 2011).
“Delays, omissions, and inaccuracy of discharge information are
common at hospital discharge and put patients at risk for adverse
outcomes” (Harlan, 2010).
“It’s often poor communication, coupled with an expectation that
patients or caregivers will remember and relate critical
information, which can lead to dangerous, even life-threatening,
situations” (Lattimer, 2011).
10. RN DISCHARGE ACTIVITIES:
OVERVIEW
NURSING INTERVENTIONS CLASSIFICATION (NIC) SUMMARY
Assist patient/family/significant others to prepare for discharge;
Collaborate with interdisciplinary team/patient/family/significant
others;
Coordinate with other providers for a timely discharge;
Identify patient / caregiver knowledge or skills required for
discharge;
Identify patient teaching required for post-discharge care;
Communicate patient discharge plans as appropriate;
Monitor readiness for discharge;
Formulate discharge maintenance plan;
Arrange post-discharge evaluation; and
Discharge to next level of care (Bulechek et al., 2013 p.150).
11. CASE MANAGEMENT: OVERVIEW
DISCHARGE ACTIVITIES
Screening and Intake – identify discharge disposition / placement and
destination;
Assess needs – financial resources, treatment plans coordinated with
physician, patient and family for smooth discharge transitions;
Service planning – initiate plan of care, identify barriers to outcomes
achievement, post-discharge service need identification, setting mutual goals
with family/patient;
Link patient to what they need – resource utilization, appropriate length of
stay planning, evaluation of expected outcomes progress;
Implement Interdisciplinary Treatment Plan – monitor expected outcomes,
begin arranging post-discharge arrangements, re-evaluate discharge
destination if needed; and
Evaluate Patient Care Outcomes – based on plan of care progress towards
achieving outcomes; round with the attending physician to obtain progress
feedback (Cesta, 2013).
12. DISCHARGE COMMUNICATION:
INTERDISCIPLINARY STRATEGIES
Team Approach:
Discharge Planning Teams (Rose & Haugen, 2010).
Standardizing Communication:
“S-B-A-R” (Bengasco et al., 2013).
Evidence-Based Discharge Education:
“Teach-Back” (Kornburger et al., 2013).
13. DISCHARGE PLANNING TEAMS:
MULTIDISCIPLINARY INTERVENTION
STUDY
Based on a study conducted in a Progressive Care Unit (PCU) in a
Midwestern Hospital (Rose & Haugen, 2010):
Problem – Current Discharge Process Concerns
Incomplete / Inaccurate Discharge Summaries
Incomplete Prescriptions
Inconsistent Discharge Education
Communication Gaps regarding: Discharge dates, time, and disposition
Intervention – Formation of Discharge Planning Teams
Possible Outcomes – Effective Discharge Planning
Decreases Re-admissions
Promotes Cost-effective Use of Inpatient Beds
Increased Patient / Staff Satisfaction
15. DISCHARGE PLANNING TEAMS:
ACTIVITIES PER DISCIPLINE
Physician & P.A.:
Education on pathology and surgical reports,
Writes discharge prescriptions the night before discharge, and
Completion of discharge summaries;
Registered Nurse:
Education on post-discharge care requirements night before
discharge and on the day, and
Coordinate follow up for outstanding discharge items to be
completed;
Pharmacist:
Fills prescriptions at Hospital Outpatient Pharmacy; and
Verifies insurance information as soon as possible to fill script
promptly (Rose & Haugen, 2010).
16. DISCHARGE PLANNING TEAMS:
JOINT ACTIVITIES –SURVEY, AUDIT &
RESULTS
Pre-implementation of Discharge Planning Teams:
Discharge Summaries – 60% completion rate,
Prescriptions Written – 45% completed night before discharge,
Nursing Staff Satisfaction – 37% contentment with discharge process, and
Patient Satisfaction – 93% perceived a smooth process;
Post-implementation of Discharge Planning Teams:
Discharge Summaries – 91% completion rate by 2007,
Prescriptions Written – 88% completed night before discharge by 2007,
Nursing Staff Satisfaction – 91% contentment with discharge process by
2007, and
Patient Satisfaction – 100% perceived a smooth process by 2007 (Rose &
Haugen, 2010).
17. DISCHARGE PLANNING TEAMS:
KEYS TO SUCCESSFUL
IMPLEMENTATION
Communication Remains Open – Across all disciplines
must be open to facilitate acceptance of changes in processes;
Multidisciplinary Involvement – input from various
disciplines facilitated the efficiency of workflow by identifying
barriers related to other departments/services; and
Continuous Improvement Process – teams must be
cognizant of the changes in health care environment: Payer
systems, regulatory agencies, and processes, ready to adapt to
changing conditions (Rose & Haugen, 2010).
18. STANDARDIZING COMMUNICATION:
RATIONALES FOR IMPLEMENTATION
Good Communication is characterized by:
Timeliness,
Standardization of Content, and
Well coordinated between disciplines (Reilly, Marcotte, Berns, & Shea,
2013).
Errors in Communication results in:
Adverse Events with Negative Patient Outcomes,
Negative Emotional Impacts for Patients & Caregivers,
Increased associated Costs,
Increased Length of Hospital Stay,
Loss of Patient Trust, and
Increased Risk for Litigation (Bagnasco et al., 2013; Reilly et al., 2013).
19. STANDARDIZED COMMUNICATION:
PROPOSED METHODS
S.B.A.R – Situation, Background, Assessment, &
Recommendations:
Recommended as a Standardized Communication Tool, and
Has Written and Verbal components for Communication at Patient
Hand-off and Transfer (Bagnasco et at., 2013).
Proposed Benefits – S.B.A.R Implementation:
Mitigation of Risk associated with poor Communication during Patient
Hand-off and Transfer i.e. Memory Failures,
Standardizes Communication Styles of various healthcare workers to
create uniformity, and
Optimizes communication timing via Standardized reporting
procedure (Bagnasco et al., 2013).
20. DISCHARGE EDUCATION:
EVIDENCE-BASED STRATEGIES
“Teach-Back” Process – “a comprehensive, interdisciplinary, evidence-
based strategy which can empower nursing staff to verify understanding,
correct inaccurate information, and reinforce medication teaching and
new home care skills with patients and families” (Kornburger et al., 2013).
Proposed Benefits – “Teach-Back”: Implementation
Provides opportunity to Verify Understanding, Correct Inaccurate Information,
and Reinforce Medication Education and Home Care Skills;
Valuable, Easily Implemented and Understood, and Cost-effective Education
Strategy;
Engages Patients and Families in learning activities;
Patient and Family-centered Education Strategy (Kornburger et al., 2013).
21. DISCHARGE EDUCATION:
TEACH-BACK PROCESS
“Teach-Back” Goal – Effective Family / Patient Self-Management:
Step 1: Teach a New Concept or Skill,
Step 2: Clarify or Correct Misunderstandings,
Step 3: Acknowledge any Questions Patient/Family may Have, and
Step 4: Continue the Process until Concept or Skill is Understood (Kornburger
et al., 2013).
Nurse Competencies – Understand Health Literacy Principles:
Encourage Patient/Family Questions,
Use Plain Language,
Limit Teaching to 3-5 Concepts, and
Document “Teach-Back” education in the approved form (Kornburger et al.,
2013).
22. SUMMARY & CONCLUSION
Communication Highlights:
Is a vital function to ensure Patient Safety;
Failures occur mostly during points of Transfer of Care;
Failures carry a significant potential for Adverse Patient Events;
Standardized Communication methods optimize outcomes;
Discharge Planning Highlights:
Requires an Integrated, Multidisciplinary & Team Approach;
Begins at Admission, is ongoing, and is constantly re-evaluative in nature;
Is Patient and Family-centered; anticipating needs constantly;
Requires effective communication between patients, family, and Healthcare
Team; and
Requires pre-emptive, evidence-based discharge Education from entire team
(Bagnasco et al., 2013; Kornburger et al., 2013; Reilly et al., 2013; Rose &
Haugen, 2010).
23. REFERENCES
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