SSU NURS 300 - Improving Patient-Provider Communication

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JONAVolume 39, Number 9, pp 372-376Copyright B 2009 Wolters Kluwer Health |Lippincott Williams & WilkinsImproving Patient-ProviderCommunicationA Call to ActionLance Patak, MD, MBA, RNAmy Wilson-Stronks, MPP, CPHQJohn Costello, MA, CCC-SLPRuth M. Kleinpell, PhD, RN, FAANElizabeth A. Henneman, PhD, RNColleen Person, MMA, BSN, RNMary Beth Happ, PhD, RNPatients who are communicationimpaired are at greater risk ofmedical error and poorer outcomes.Contributing factors that perpet-uate ineffective patient-providercommunication include the lackof a systematic method for nursingassessment, evaluation, and mon-itoring of patient-provider commu-nication needs and interventionsand a lack of standardized trainingof healthcare providers. We pro-pose a call to action for nursingadministrators to position patient-provider communication as apatient safety-care quality prior-ity within the healthcare orga-nization and incorporate bedsidepractices that achieve effective pa-tient communication, especiallywith those most vulnerable toimpaired communication. Effec-tive patient-provider communica-tion is an essential component ofpatient care, and for communica-tion to be effective, the informa-tion must be complete, accurate,timely, unambiguous, and under-stood by the patient.1By formallyimplementing the assessment of372 JONAVol. 39, No. 9September 2009Spotlight OnAuthors’ Affiliations: AnesthesiologyResident, University of Michigan, AnnArbor (Dr Patak); Director, the Joint Com-mission, Chicago, Illinois (Ms Wilson-Stronks); Speech Language Pathologist,Children’s Hospital Boston, Massachusetts(Mr Costello); Director and Professor, RushUniversity Medical Center and Our Lady ofthe Resurrection Medical Center, Chicago,Illinois (Dr Kleinpell); Assistant Professor,University of Massachusetts-Amherst Schoolof Nursing (Dr Henneman); Vice President,Creative Health Care Management, Minne-apolis, Minnesota (Ms Person); AssistantProfessor, University of Pittsburgh School ofNursing, Pennsylvania (Dr Happ).Disclosure: Dr Patak is the Presidentand CEO for Vidatak, LLC, a for-profitcompany that focuses on research anddevelopment for evidence-based patientcommunication products and resources.Mrs Wilson-Stronks is principal inves-tigator for a national study funded by theCalifornia Endowment titled, ‘‘Hospitals,Language, and Culture: A Snapshot of theNation,’’ a cross-sectional qualitative studyinvestigating how hospitals are addressingthe healthcare needs of diverse patient popu-lations (grant numbers 20032851 and20062218). She is also coinvestigator for aproject funded by the Commonwealth Fundto develop standards for culturally competentpatient-centered care in hospitals (grantnumber 20080055).Mr Costello, Drs Kleinpell andHenneman, and Mrs Person have no con-flicts of interest.Dr Happ is principal investigator for aclinical trial funded by the National Insti-tute of Child Health and Human Develop-ment, the SPEACS study, testing an educa-tional program, SLP consultation and AACstrategies (R01-HD043988, ‘‘ImprovingCommunication with Nonspeaking ICUPatients’’). She is coauthor of a copyrightededucational program for ICU nurses used inthe SPEACS study. Her research on patient-caregiver communication is currentlysupported by a grant from NINR K24-NR010244, ‘‘Symptom Management,Patient-Caregiver Communication, andOutcomes in ICU.’’Corresponding author: Dr Patak,Department of Anesthesiology, Universityof Michigan, 1H247 UH, SPC 5048, 1500East Medical Center Dr, Ann Arbor, MI48109-5048 ([email protected]).Supplemental digital content is avail-able for this article. Direct URL citationsappear in the printed text and are providedin the HTML and PDF versions of thisarticle on the journal’s Web site (www.jonajournal.com).9Copyright @ 200 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.patient communication needs intoroutine care, nursing administra-tors will create a sense of account-ability among bedside nurses tomeet the needs of patients whoare communication vulnerable.A patient’s right to effectivepatient-provider communicationis supported by accreditation stan-dards,2regulatory guidelines,3,4andpatient rights declarations.5,6Pa-tients have the right to be informedabout the care they receive, makeeducated decisions about theircare, and have the right to be lis-tened to by their providers. How-ever, patient communication needsoften go unmet or are addressedinappropriately.7-10In the case ofnonYEnglish-speaking patients,language access services such as theprovision of in-person, telephone,or video interpreters and translateddocuments are either not avail-able or infrequently used.8-11Manyhealthcare institutions rely on adhoc interpreters such as family,friends, or administrative and cus-todial staff to communicate andfacilitate patient-provider com-munication, despite the fact thatresearch has shown that the useof ad hoc interpreters can lead tomiscommunication and medicalerrors.12For critically ill or nonspeak-ing patients, nonverbal behaviors,such as mouthing words, gestures,and head nods, are the principalmeans of communication; how-ever, these methods have beenshown to be ineffective, fatiguing,and inciting frustration.13-18Often,communication is attempted bysimply asking yes/no questions,and more appropriate communi-cation interventions are not used.Limiting the patient’s communi-cation to yes/no answers restrictsthe patient’s responses to predict-able messages only or messagesthat meet the a priori expectationof the patient’s need as determinedby the clinician.The absence of effective patient-provider communication has beencited as a significant factor con-tributing to adverse outcomes.19,20In a 2007 public policy paper fo-cused on health literacy, the JointCommission recommended thathealthcare organizations ‘‘make ef-fective communication an organi-zational priority to protect thesafety of patients’’ and to ‘‘incorpo-rate strategies to address patient’scommunication needs across thecontinuum of care.’’21Effectivepatient-provider communicationis a vital component of this trans-formation and must be priori-tized to improve patient safety.Call to ActionConduct an AssessmentPatient communication assessmentshould include a thorough initialassessment of literacy, linguistic,cultural, behavioral, and physicalbarriers (eg, patient wears glassesor uses hearing aids) at the pointof care. It should also include re-ferrals


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