Communication is the act of conveying information through ideas, feelings, attitudes, expectations, or perceptions by speech, gestures, writings, or behavior (Gifu, Dima, & Teodorescu, 2014).  Ineffective communication in the healthcare setting can lead to serious medical errors. Continuity of patient care occurs through clear and concise communication between healthcare professionals during handoff (Shahid, & Thomas, 2018). The writer used to work in an inpatient psychiatric unit where handoff was done quickly between shifts at the nurse’s station. There was no protocol or standard in place for patient handoff, and only verbal communication took place.  The writer experienced many occasions where the report writer received would not correlate with the patient’s actual condition. The unit was a high acuity unit meaning we had patient’s that were suicidal, homicidal, a flight risk, manipulative, and violent. Effective communication is critical in these situations to ensure the safety of the patient and employees (Marquis, & Huston, 2015).  An incident occurred regarding ineffective communication where a patient swallowed her eating utensils and had a history of consuming random items. The writer was given a verbal report about the patient at the beginning of my shift and was told that she was calm, cooperative, stable, and there are no issues to report.  The writer was not told about her history of swallowing items and that the writer needed to monitor her food tray to remove plastic silverware. The patient had to have surgery to remove the items. This situation could have been prevented with effective communication. Within the communication process, both the sender and the receiver of the message had different thoughts, ideas, and information that was exchanged (Marquis, & Huston, 2015).

Barriers to Communication

The barriers to communication in this scenario were emotional barriers and interpersonal barriers. As a new nurse, the writer was not confident in communicating with my colleagues, who were more experienced and challenging their expertise. I did not have the self-confidence and the emotional intelligence to question authority and the processes in place. Another barrier was a loss of situational awareness in which we did not understand the patient’s current condition because we were not at the bedside during handoff. The formal organizational structure is also a barrier to communication because people at lower levels of the hierarchy do not feel that they have a voice to make a difference within the organization (Marquis, & Huston, 2015).

Strategy to Improve Communication

Improving communication is critical to quality patient care and a reduction of errors (Marquis & Huston, 2015). After many mistakes due to ineffective handoffs, the psychiatric unit decided to implement the SBAR (Situation, Background, Assessment and Recommendation) as a communication tool for handoff at the Bedside. Performing the SBAR significantly reduced medication errors, falls, moreover, increased patient/employee safety and utilizing this tool created effectively communication between staff members and patients and created a sense of confidence to be able to take care of that patient without any doubts. Employees were required to walk in the patient’s room together to assess the patient and go over pertinent issues. The SBAR provides a structured format and standardized process for effective communication (Shahid, & Thomas, 2018).

References

Gifu, D., Dima, I. C., & Teodorescu, M. (2014). New communication approaches vs. Traditional communication. International Letters of Social and Humanistic Sciences, (20), 46-55.

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Shahid, S., & Thomas, S. (2018). The situation, Background, Assessment, Recommendation (SBAR) Communication Tool for Handoff in Health Care – A Narrative Review. Safety in Health,4(1). doi:10.1186/s40886-018-0073-1