Evidenced-Based Communication among Health Professionals - Research Paper Example

?Evidenced Based Research Communication among medical professional: Developing the Matrix Evidenced Based Research Communication among medical professional: Developing the Matrix Evidenced Based Research Communication among medical professional: Developing the Matrix Burning question The hospice patients constitute the population for my clinical question. Care in the hospice incorporates a variety of facets which must be instituted together to achieve the best medical care that can be provided to a patient in his terminal days. The goals of care are to “provide relief from pain and other physical symptoms, maximize the quality of life, provide psychosocial and spiritual care and provide support to help the family during the patient’s illness and bereavement” (IAPHC, 2004). The care should invariably include the medical therapy and the nursing attention supported by catering to the social, cultural and spiritual calls of the patient (IAPHC, 2004). Brown et al has also spoken about the influences of society, cultures, politics and economics in the encounters in the health care system. (2006). The holistic approach had been the principal idea behind Madam Florence Nightingale’s endeavor. Hospice care is the place to demonstrate this essential aspect of nursing care. The caring attitude, commitment of the staff, consideration of the patient, cultural leanings and consent of the patient govern the attitude of the nurse towards the care of the patient. Communication among the health professionals like the nurse, doctor, social worker, psychologist, spiritual leaders and family members constitute a strong factor for the provision of the best care. History shows that opinions have varied and evolved over the years about the necessary communication among the professionals but as yet, the appropriate and reliable method of instituting and measuring communications between the staff and the comparable levels of improvement has not yet been achieved. Having selected effective communication as the best manner to improve patient care in the hospice, I am embarking on evaluating available researches to discover how to go about it. “Shaping the Future of Public Health” in the US Department of Health, set up in 2005, speaks about empowering communities. The theory of health care communications keeps changing. Our present aim is to improve the system of communication in a hospital or in a hospice so that the best possible care is provided to the inmates of a hospice. The American Association of Critical Care nurses have identified six essential behaviors of a healthy working environment: “skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition and authentic leadership” (2007). Boyle and Kochinda have defined collaboration as the “process of joint decision-making among independent parties, involving joint ownership of decisions and collective responsibility for outcomes (2004). The intervention for communication could be an instrument which is highly informative or a training program or an education program. Comparison may be made among the three by evaluating evidence-based studies available. The outcomes may also be compared to determine which method is the best for producing the best possible medical care and outcomes in hospice patients. EBP and the two models “Evidence-based practice (EBP) is the conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions” (Hughes, 2008). Three stages are involved. Knowledge is created and distilled according to the requirements of the patients. Then it is diffused and spread among the policy makers and health care systems (Hughes, 2008). Adoption of the new information and implementing it in society is the last step. The best and newest evidence obtained from research is slowly adopted into the health care system. EBP is advocated by media, leaders, change champions and experts (Hughes, 2008). The new information is unearthed by research using different methods, a range of interventions and different sets of variables. Decision–making in the operational and clinical systems use the evidence-based practices elicited by research and this is translational science (Hughes, 2008). The following EBP studies have different models. First study The care of patients in the hospice is mostly care of the family too as expressed by Oliver et al (2007). The significance of improving the communication between the patient and physician is based on this fact and this has led to the interdisciplinary theory. Provision of good care and a peaceful death requires able management of the environment by the multi-disciplinary team in close contact with the patient including the nurses, doctors, social workers and the family. Traditional roles which divided the team were to be intermingled as collective responsibility. This study by Oliver et al created a tool for measuring various perceptions which promoted collaboration by modifying the Index for Interdisciplinary Collaboration which had been developed by Bronstein (2002). The new instrument exhibited high reliability for the original instrument and its subscales. Oliver et al (2007) have defined interdisciplinary collaboration thus: “Interdisciplinary collaboration is defined here as an interpersonal process leading to the attainment of specific goals that are not achievable by any one team member alone”. The conceptual framework in Oliver’s study had recognized features of collaboration. In essence the focus was on interdependence for goal-setting and achieving. Success was not possible without the colleagues. The Modified Index for Interdisciplinary Collaboration consisted of 42 items and was a questionnaire of self-report. The instrument had good reliability with Cronbach ? of 0.92 and Cronbach ? of 0.75 for each subscale. Interdependence and flexibility was one subscale. Newly created professional activities came under another. Collective ownership of goals constituted another. Reflection on process was the fourth. Participants were hospice staff members from 5 hospices who did so voluntarily. Staff members were given letters of introduction to the study and the questionnaire. They had to fill it and hand in the sealed envelope to the research team. Spss 13.0 was used to identify missing data and normality. 12 questions were recorded inversely. Recoding was done for the score of these 12 questions. As the sample size was insufficient and small, values were compared to the original instrument. On analysis, 95 hospice staff including the nurse, doctor, social worker, therapist, chaplain, aide, secretary and team leader, had participated. The study was focused on the perceptions of collaboration by the participants. This study had limitations in that the sample was small and results could not be generalized. The future studies needed to reduce the number of items. The findings of such a questionnaire provided scope for developing new feasible strategies and new interventions for strengthening the interdisciplinary team work. The study has laid the groundwork and calls for more research and quantification of collaborative actions later. Second study McCaffrey and her colleagues conducted another study in the form of an education program to foster appropriate communication between the nurses and other healthcare professionals especially medical residents (2011). The program was implemented to demonstrate that patient outcomes were improved by the communication and collaborative efforts of the health team. The job satisfaction of the nurses simultaneously grew. The education program was aimed at the nurses, physicians and house officers. It was to find out the level of collaboration and the patient outcomes. Collaboration skills were to be developed. Cultural differences were discussed. Role playing was an integral part of the education. Follow-up meetings assessed the better communication skills. Several admirable changes became obvious. Earlier tension melted away with the education program. The number of stat tests was reduced to make the phlebotomist available for emergencies. Issues were explained thoroughly further adding viewpoints. Sharing of thoughts and solutions were more common now. General respect for the other person and compromise on issues were a new finding. Solutions were readily agreed upon by colleagues. Improved patient outcomes were worked for on a collective basis. The team approach helped to identify patients who were in real need of care. The nurses became more dedicated and had more job satisfaction. An education program was a positive means of improving collaborative communication in the health care system. In the comparison of the two EBP studies, the first study of Oliver’s has produced an excellent instrument to study collaboration. However the post-study period did not show the persistence of the changes which was seen during the study. McCaffrey’s study used an education program which produced persistent good results in that the behaviours of the nursing staff and the physicians changed completely. The continuation of the follow-up meetings produced the favorable effect. Burning Clinical Question How can lasting improved communication be possible among the nurses and doctors and other stakeholders in a hospice so that the quality of care in terminal patients is increased and satisfactory to the dying patient and family, providing in turn job satisfaction to the nurse? Evidence-based tools: Literature results Database Date searched Search strategies Hits Medscape 11/10/2011 1.Communication in Nursing 2.Communication between nurses and physicians 3. Communication in hospice care 1759 hits 1593 hits 162 hits Ebscohost 11/10/2011 1.Communication in Nursing 2.Communication between nurses and physicians 3. Communication in hospice care 2009 1824 153 The reviewed matrix has been added in the next five pages in a landscape format Summary The information gathered from my search has provided valuable ideas. The feasibility of using a tool like the ISBAR handover tool has to be maintained by more advanced research (Thompson et al, 2011). Research should also siphon out the types of patients needing handing over. Training needs to be provided by senior clinicians. Education programs appear to be the best and most cost-effective method of improving handovers. Communication is proved to be just one of the causes for adverse outcomes in patients, but the other causes have yet to be evaluated. A longitudinal study in different geographical regions is more preferable than a cross-sectional study (Manojlovic et al, 2009). Institutions selected must show good response to study. Ample research of high quality is to be done. Effectiveness of interventions is to be evidenced. Research must conform to standardized recommendations for patient safety and quality initiatives like the SQUIRE guidelines (Riesenberg et al, 2009). Research should focus on systems factors, human performance, and the effectiveness of protocols and interventions. Effective communication is an essential skill in patient care in both nurses and physicians. Collaboration has improved patient outcomes (Tschannen, 2011). It also lessened fragmentation of care. Communication is highly significant in patient care. Inadequate communication can cause errors and inadequate patient care. A broken communication system can produce a poor quality of patient care. A code of conduct must be in place in every institution of patient care. Inter-professional education must be part of the curriculum (Tschannen, 2011). The teaching of effective communication must be part of the hospital agenda. A team-centered culture must be supported. References:. Boyle, D., & Kochinda, C. (2004). Enhancing collaborative communication of nurse and physician leadership in two ICUs. Journal of Nursing Administration, 34(2), 60-70. Bronstein LR. A model for interdisciplinary collaboration. Soc Work. 2003;48:297-306. Brown, B. Crawford, P. and Carter, R. (2006). Evidence-based health communication, McGraw-Hill, Open University Press. Hughes, R.B. (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses: Vol.1, AHRQ Publications. International Association for Hospice and Palliative Care (2004). I. Principles and Practice of Palliative Care. The IAHPC Manual of Palliative Care. (2nd). Retrieved from http://www.hospicecare.com/manual/principles-main.html Manojlovich, M., Antonakos, C.L., Ronis, D.L. (2009). Intensive Care Units, Communication Between Nurses and Physicians, and Patients' Outcomes. American Journal of Critical Care. 2009;18(1):21-30. © 2009 American Association of Critical-Care Nurses McCaffrey, R.G., Hayes, R., Stuart, W., Cassel, A., Farrell, C., Miller-Reyes, S and Donaldson, A. (2011). An Educational Program to Promote Positive Communication and Collaboration Between Nurses and Medical Staff. Journal for Nurses in Staff Development & Volume 27, Number 3, 121-127 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Oliver, D.P., Wittenberg-Lyles, E.M. and Day, Michele. (2007). Measuring Interdisciplinary Perceptions of Collaboration on Hospice Teams. American Journal of Hospice & Palliative Medicine, Volume 24 Number 1, February/March 2007 49-53 © 2007 Sage Publications 10.1177/1049909106295283 Riesenberg, L.E., Leitzsch, J., Massucci, J.L., Jaeger, J., Rosenfeld, J.C., Patow, C. et al, (2009). Residents' and Attending Physicians' Handoffs: A Systematic Review of the Literature. Academic Medicine. 2009;84(12):1775-1787. Lippincott Williams & Wilkins Thompson, J.E., Collett, L.W., Langbart, M.J., Purcell, N.J., Boyd, S.M., Yuminaga, Y. et al. (2011). Using the ISBAR Handover Tool in Junior Medical Officer Handover: A Study in an Australian Tertiary Hospital. Postgrad Med J. 2011;87(1027):340-344. Tschannen, D., Keenan, G., Aebersold, M.,Kocan, M.J., Lundy, F., Averhart, V. (2011). Implications of Nurse-physician Relations: Report of a Successful Intervention. Nurs Econ. 2011;29(3):127-135. 2011 Jannetti Publications, Inc. Read More