Improving Communication for Patient Safety

Improving Communication for Patient Safety Abstract: Communication is a very important aspect of medical training. Poor communication is the root cause for the majority of complaints against the National Health Service (NHS) (Pincock S. , 2004). Communication is especially important at handover to ensure continuity of appropriate medical care and to ensure safety of patients. The added constraint in medical handovers is that the process is limited by time. The SBAR (Situation, Background, Assessment and Recommendation) tool is intended for effective transfer of information between health professionals in a concise, factual and standardised structure. This article assesses the importance of teaching communication in medical education with particular emphasis on handover, the available literature on SBAR and the authors view on SBAR as a communication tool for medical students and trainee doctors. Introduction Communication lies at the heart of good medical practice. The General Medical Council has mandated the need for good communication skills to ensure that patients are kept informed of their condition, progress, investigations, treatment and progress. Good communication skills are also necessary to ensure continuity of patient care and to ensure patient safety. The introduction of the shift system has made effective communication more important (General Medical Council). Poor communication is the root cause for the majority of complaints in the National Health Service. Poor communication between health professionals, failure to take informed consent and improper handling of complaints are the major reasons and effective communication could have reduced the disputes and complaints (Pincock S. , 2004). Teaching communication to medical students in UK medical schools The UK council of communication skills in undergraduate medical education was established in 2005 with the aim of raising awareness, to improve current teaching, to improve and to develop consensus on the communication training provided to medical students (The UK council of communication skills in undergraduate medical education). This in the authors opinion represents a major step towards recognition of the need for training medical students in communication skills training. In addition to the benefits which better communication has in relation to patient safety and reducing complaints, research has indicated that teaching communication skills to medical students improved their overall performance (Smith, Hanson, Tewskbury, 2007). The medical handover: communication is vital The National patient safety agency (NPSA), London has defined handover as The transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis (National Patient Safety agency, 2007). Medical handover is one of the most important procedures and has the potential for causing errors and harm if done improperly. It is also a very frequent occurrence with the advent of the shift system of working. The General Medical Council has also recognised the importance of a good handover and explained that keep colleagues well informed when sharing the care of patients (General Medical Council). Benefits of a good handover Good handover has several benefits both for the doctor and the patient. For the doctor the handover session can be used to improve communication skills and can also be used to teach clinical medicine. A good handover also makes working less stressful as the doctors on the shift have will have good knowledge about the patients and their management plans. The British Medical Association has also opined that clear communication at handover will protect the doctor against blame for errors (British Medical Association, 2004). Good handover also benefits the patient by providing continuity of care, providing safety, decreasing repetition and in providing better service satisfaction. There are several critical incidents of patient safety being compromised because of the lack of clear handover between teams (British Medical Association, 2004). Constraints to good handover There are several constraints to a detailed handover. In the authors own experience of handover in an intensive care area, the time allocated for handover is often insufficient to handover all details of patient care. Although the morning handover is led by the consultant on call and attended by a multidisciplinary team involving the physiotherapist and the in charge nurse, evening handover often involves only the junior doctors on call. Because of the complex problems which most patients on intensive care have, the handover often extends beyond the allocated time of 30 minutes. This means that the doctors who are leaving are unable to do so on time and those who are starting are not able to get on with their duties on time; both these situations lead to a sense of dissatisfaction with the job. The handover venue varies from the patients bedside to the doctors office and therefore lacks uniformity and continuity. Further the handover can be interrupted by non-emergency calls from dif ferent parts of the hospital. On some occasions handover is taken by one team while the other team is setting up the ventilator and this results in an unsatisfactory handover. Because of the presence of personnel from paediatric, intensive care, anaesthetic, nursing and other allied health back grounds at the morning handover, there are significant differences in the style, length and the importance which different people place on different aspects of the handover. Also the experience levels of the different trainees are variable and they vary in the ability to highlight important aspects of patient care and in their ability to summarise the progress of a patient in a concise way. Need for a structure to handover One of the criticisms of handover among healthcare professionals is the hint and hope approach where one person hints at what might be going on without giving any specific details and hopes to get a specific response or action (Featherston, 2005). The handover process needs to be streamlined to allow transfer of a large amount of information regarding very sick patients with complex needs in a time limited manner. This means that there is a need for a system of handover which is structured, complete, relevant and concise to ensure uniformity of the process and to ensure continuity of patient care. Literature of handover in other hospital settings A study of handover of clinical care from ambulance crew to the emergency department personnel showed that there were concerns regarding the quality and quantity of handover, the staff perception of handover and staff education. This study also identified the need for a standardised handover process which would enable smooth transfer of patient care and also provide opportunity for the receiving team to assess and prioritise their work (Bost, Crilly, Wallis, 2010). The British Medical Association (British Medical Association, 2004), The General Medical (General Medical Council) and the National patient safety agency (National Patient Safety agency, 2007) have all emphasised the need to develop a system of effective handover. SBAR SBAR (Situation, background, assessment, recommendation) is a communication technique that provides a structure for communication between healthcare professionals. SBAR was developed by Dr. Leonard and colleagues in 2006. It is useful for handover from nurse to nurse, doctor to doctor and doctor to nurse. SBAR enables healthcare professionals to communicate in a specific framework. When applied to handover communication, S stands for situation which is a short description of the problem, its severity and when it started. B stands for pertinent background describing the admission diagnosis, results of investigations and other clinical information. Details of current resuscitation status could also be included in this. A stands for the handing over team assessment of the patient status and R stands for recommendation on how the patient should be managed. Recommendation can also be used to update the team receiving the handover on how quickly a patient needs to be seen and this can help them prioritise their tasks. Literature on use of SBAR SBAR is relatively new and there have only been a few studies looking into its impact on communication and patient safety. One study demonstrated that staff found SBAR tool helpful in team and individual communication. As a result of this the study team using SBAR perceived an improvement in patient safety culture. The study group also showed an improvement in reporting of incidents and near misses in the team and in the institution where study was done (Velji, Baker, Fancott, 2008). Another study found fewer missed information at handover and suggested that this improved patient safety. The authors of this study opined that this was the result of information transfer in a concise and organised format (Haig Sutton, 2006). Other studies have reported mixed results. A study from Texas found no or slightly negative impact on the nurse confidence while talking to physicians, safety on the unit and satisfaction with working on the unit. However there was some benefit on communication openness and in feedback about errors. It must be noted that this study was based on a comparison of key outcome measures following a four hour classroom training on SBAR which the authors themselves describe as inadequate. The authors have advised caution regarding the widespread use of SBAR despite the lack of evidence of its effectiveness (Carroll, 2006). The SBAR collaborative communication evidence based practice study (SBAR EBP) showed that use of SBAR resulted in transfer of evidence, knowledge and clinical skills. The second outcome from this study was the benefits noted in communication, teamwork and safety environment. However as the authors of this study note, there are no studies so far which demonstrate benefits in patient outcomes or patient collaboration. This study also noted that no physicians participated in the SBAR collaborative-communication education. The authors also noted that physicians felt that SBAR teaching was meant for nurses and that doctors do not need to attend nursing classes (Beckett Kipnis, 2009). Summary of the evidence and opinion It is the authors view that SBAR as a tool for handover will act as a uniform model around which staff can communicate at handover. It also encourages critical thinking around the time of handover. It allows precise, complete and concise transfer of information at handover. This is likely to improve better team working and ultimately improve patient safety. However there are likely to be impediments to the implementation of SBAR for handover. Doctors especially at more senior levels are likely to ask for evidence regarding the positive effects of SBAR on patient safety before they support its implementation on a wider basis. Therefore there is a need for large well designed studies to demonstrate a significant benefit from use of SBAR not only on the staff perceptions and communication skills but also on patient safety. Teaching SBAR to medical students and trainee doctors It is authors opinion that communication models on medical handover should be taught from medical school days. The transition from student to doctor is huge and medical students should be trained to have the skills to make this transition as smooth as possible. There is limited literature available on teaching SBAR to medical students. One study using a simulated clinical setting found that medical students who went through 40 minute training on a modified SBAR model (ISBAR), performed significantly better than controls on a content and clarity global rating score (Marshall, Harrison, Flanagan, 2009). There is literature available on teaching SBAR to nursing students and the benefits it has had (Thomas, E, Johnson, 2009), (Wood, 2008) (Kesten Karen, 2011). The uptake of SBAR seems to be more robust amongst the nursing professionals than the medical professionals. As the uptake of SBAR increases it would become more important that medical professionals also become proficient in the use of SBAR as a model of communication. Therefore there is a need for both doctors in training and medical students to be trained in the use of SBAR. Recommendations on training in SBAR for use in medical handover Based on the experience of handover in an intensive care setting and after review of the above literature, it is the authors opinion that systems for handover need a radical overhaul to ensure patient safety and to improve communication within teams. One of the steps is a structure to the handover progress in the form of the SBAR. As a first step junior doctors need training in the use of SBAR for handover. Prior to the intervention, a baseline assessment of communication skills using an appropriate tool would help monitor progress. This can be in the form of an interactive small group discussion where the process of SBAR is fully explored. It is also important to present the available evidence on SBAR and how it can improve communication outcomes and potentially patient outcomes. A simulation exercise at the end of the discussion will also help doctors understand the skills needed. This teaching session needs to be done on several days and at times and location which facilitate and encourage junior doctor participation. The aim is to ensure that all the junior doctors in the particular unit or institution have the opportunity to attend this session. A separate session needs to be organised for the consultants who will be supervising the junior doctors as they implement SBAR. Consultants will need to play a major role in enforcing the use of this tool and also to monitor the effectiveness of this tool. Consultant supervision is essential to support the handover process using SBAR and also to facilitate the involvement of multidisciplinary teams at the handover. Handover based on SBAR should also be accompanied by robust changes like having a dedicated time and place for the morning and night handovers, making sure that the handover is not interrupted for non-emergency reasons and to ensure the availability of electronic resources which can facilitate handover. After a pre-defined period where SBAR process is implemented, there needs to be an evaluation of the effect SBAR has had on the handover process in particular and communication in general. Evidence of improvement in the handover process will encourage staff to improve further on their skills. The process of implementation should be dynamic and continuous until the process becomes a part of the working culture. Summary and conclusions Inadequate handover poses significant risks to the personnel involved, their organization and their patients. Handover therefore needs to be complete, specific, concise and structured to allow effective transfer of information. Use of SBAR will provide a structure to the handover progress. There is evidence that use of SBAR has positive benefits on team working and communication and it is likely that this has a positive effect on patient safety. The process of implementation of SBAR will involve training of staff with supervision and mentoring from senior members of the team. There is also a need to conduct well designed studies to assess the impact of SBAR on medical handover and to determine potential benefits to patient safety.

Essay --

Background: Office ergonomics as is the case with other disciplines in ergonomics all emerged in the 1940s during the world war (McCormick and Saunders 1993). Difficulties arouse from soldiers inability to handle technical equipment produced for the war due to physical incompatibility or lack of understanding of the equipment and when the advancements in technology was transferred to the civilian populous after the war, the same problems in human-machine system incompatibility were observed. This led to a study by military personnel, academics psychologists and physiologist all researching on solutions to the complications arising from the operation of the machines (Kumar and Cohn, 2013). In the year 1949 the term ergonomics was coined from the Greek words â€Å"ergo† meaning work and â€Å"nomos† meaning law in a meeting attended by distinguished psychologist and physiologist. The same group later formed the ergonomic research society (ERS) which was the first body in the world to study on ergonomics. ERS then evolved to the ergonomics society (ES) and then to the current Institute of Ergonomics and Human Factors (IEHF) (Omerley, 2103). Office ergonomics is part of this generalized evolution of ergonomics with it being a recognized discipline among the domains of ergonomics. Office ergonomics deals mainly in the office setting or environment and helps in averting injuries and adapting the work to the person rather than the person to the work. Development of office ergonomics Office ergonomics was developed in a bid to better the already good working environment (Lauren, 2006). This helps individuals operating machines give their best job results as well as maximizing production. As production is increased, risks of injury are greatly red... ...lementation of the solution by the committee. Worker compensation cost also reduced by 10%. This saved Quad graphics money that would be used in compensation and valuable days that would have been lost due to worker absence (Lauren, 2006). Conclusion/opinion Ergonomics is a great tool in increasing worker productivity and improving working conditions in work stations. Any organization that encompasses ergonomics in its operations is saving lots of money from time wastage and worker compensation. Organizations should not wait until their workers become injured or ill so that they introduce ergonomics. They should instead adopt it from the word go. By doing so, workers have confidence in the organization as they feel cared for thus will give their best while at work. The moment ergonomics becomes a way of life in all organizations, everything changes for the better.

Vark: Educational Psychology and Learning Styles

VARK Analysis Grand Canyon University VARK Analysis VARK refers to a specific style of learning, visual, auditory, reading and writing and kinesthetic leaners. (Fleming & Mills, 1992) VARK assessment questions alert people to the variety of different approaches to learning. (VARK: A Guide to Learning Styles, 2011) For those struggling with learning the VARK analysis can develop a new learning approach or enhance your current learning style by identifying your learning style to more effectively store and recall information. Knowing our own learning style also can help you to realize that other people may approach the situation different from your own. (Connor, 2009) â€Å"Everyone has a certain amount of each learning style, but one learning type will be more dominant that than other. †(Smith, 2011) Throughout our journey of childhood education we are introduced to kinesthetic learning in the early years, JR high visual and read and write and higher learners experience more auditory. (Smith, 2011) Each individual is exposed to different learning approaches however we develop a preference to a specific learning style. Whichever type a person is, will be how they view life and comprehend situations. This is their own, unique personal filtering system. Obviously each of us will become automatically drawn to our same type, and those who filter the same information the way we do. But having diverse relationships will increase our own happiness throughout our lives† (Smith, 2011) â€Å"VARK is a bout learning, not leisure activities. The read/write learners prefer information displayed as words. This learning style emphasizes text based-input and output. People who prefer this modality are often addicted to Power Points, the internet, lists diaries and words, words, words. †(VARK: A Guide to Learning Styles, 2011) Upon taking this test, it reinforced the learning strategies I currently utilize the read and write learning preference. Read and write learners need writing materials to take down points the think are important from what the read, hear and see. (Smith, 2011) The advantage for read write learners they are very independent with learning and can self-teach. A disadvantage to this style of learning preference if a presentation is audio or visual with no opportunities to take notes, this type of learner will struggle with comprehending the content. With a presentation that is more visual and audio, the read write learner must convert this content to a style of words in their head that will help them commit this to memory. (VARK: A Guide to Learning Styles, 2011) Read and Write learners prefer to take information by making list, headings or utilizing book, handouts, essays and manuals. To make their intake of information a learnable package a read and write learner must convert their â€Å"notes† by 3:1 for studying. † (VARK: A Guide to Learning Styles, 2011) These read/write learner to utilize the information they gather often organizes their written words into diagrams, graphs, charts and read their notes and rewrite the principals into other words. The successful output of this information is when they can perform well on a test or assignment. VARK: A Guide to Learning Styles, 2011) Completing the VARK analysis at the beginning of my BSN program reinforced the strengths of my read write learning preference. This learning preference style analysis also gave suggestions if a read and write learner is put in a situation where they must utilize the other learning styles. The suggestion to convert that information into the preferred â€Å"word† method read/ write learners like is an excellent suggestion rather than focusing on the fact one is uncomfortable with the presentation of the material in a non-preferred learning method. University Education is ideal for a read and write learner due to the comfort of reading text, writing notes and essays. † (VARK: A Guide to Learning Styles, 2011) This style learning preference does well with self-teach /learning which a benefit in the online classroom environment. The challenge a read/ write learner might face in the online classroom is the need to l isten to online tutorials, this is a time they would need to convert the information into a preferred â€Å"word† method to process the needed information in a way they better comprehend. The read write learner has a â€Å"AH HA’ moment which is the point the words they intake help them comprehend the topic and process the information long term. (Smith, 2011) References Connor, M. (2009). Ageless Learners: What’s your Learning Style? Retrieved January 20, 2012, from http://agelesslearner. com/assess/learningstyle. html Fleming, N. , & Mills, C. (1992). Helping Students Understand How They Learn [Journal]. The Teaching Professor, 7(). Retrieved from www. vark-learn. com Smith, C. (2011, June). Understanding Every Personality Type: Audio, Visual and Kinesthetic [Discussion Group comment]. Retrieved from http://applecsmith. hubpages. com/hub/Being-Successful-With-Every-Personality-Type-Audio-Visual-Kinesthetic Smith, D. (2011, June 26). Advantages and Disadvantages to different learning styles [Discussion Group comment]. Retrieved from http://www. ehow. com/info_8651838_advantages-disadvantages-different-learning-styles. html VARK: A Guide to Learning Styles. (2011). www. vark-learn. com

Anorexia Nervos A Group Of Eating Disorders - 1696 Words

Anorexia nervosa is psychiatric condition that is part of a group of eating disorders. It is associated with abnormally low body weight, extreme fear of gaining weight and a distorted perception of body image. Those with the disorder place a high value on controlling their weight to produce certain image. However, those suffering from the disorder more than likely use extreme efforts that tends to significantly interfere with their health and even normal activities or occupations in their lives. There is two forms of Anorexia, Anorexia Nervosa Binge is the type where an individual will purge when he or she eats. Restrictive Anorexia Nervosa is the form of anorexia nervosa where the individual will aggressively limit the quantity of food†¦show more content†¦Men with anorexia sometimes display other psychological problems. While affected women tend to be more perfectionistic and displeased with their body. Children and adolescents who suffer from anorexia are at risk for a sl ow growth and development.â€Å"Anorexia tends to affect the middle and upper socioeconomic classes and Caucasians more often than less advantaged classes and ethnic minorities in the United States† (Stockwell, 1990). â€Å"People with anorexia lean towards compulsive behaviors, obsession with food, and or addiction characteristics in efforts to overly control their food intake and weight† (Harries, 1992). According to ANAD, statistics show that â€Å"0.9% of American women suffer from anorexia in their lifetime.1 in 5 anorexia deaths is by suicide†. (Carney, 2009) Surprisingly, someone with anorexia thinks about food a lot and limits the food she or he eats, even though she or he is too thin. â€Å"Anorexia is more than just a problem with food. It s a way of using food or starving oneself to feel more in control of life and to ease tension, anger, and anxiety† (Harries, 1992). However, this is a very unhealthy and even life threatening reaction. When yo u have anorexia, you often associate slenderness with self-esteem. â€Å"The extreme dieting and weight loss of anorexia can lead to a potentially fatal degree of malnutrition. Other possible complications of anorexia include heart-rhythm disturbances, digestive abnormalities, bone density loss,