Impact of Environment on Critically Ill Patient - Literature review Example

IMPACT OF ENVIRONMENT ON CRITICALLY ILL PATIENT Name Course Tutor University Date Communication between patients, their family members and physicians is one of the most important factors in providing quality care in the emergency departments and intensive care units. It is also consistently named as one of the least accomplished factors in the provision of quality intensive care due to the increased demands of the intensive care unit environment (Alasad & Ahmad 2005, p. 357). According to Arrington, Bavare and Williams (2013, p. 352), more than five hundred thousand people die yearly in ICU or during the last hospital admission after treatment in ICU due to altered communication. Less than five percent times, patients admitted in ED or ICU do not have direct directives and have the capability to be involved in their “own end of life discussions” (Arrington, Bavare & Williams 2013, p. 353). Health care providers in the departments therefore turn into surrogates. The family members who in this case are biologically or emotionally connected to the patient act as surrogate decision makers. Ineffective communication between health care providers has led to various medical errors that harm the patients and their family members (Kessler et al. 2013, p. 48). Sentinel events represented by over seventy percent have implicated communication failures as the root causes and nurses asked to name the contributing factors to errors in patient care stated bad communication with physicians as one of the two major causes. This essay discusses how the environment of the intensive care unit and emergency department contributes to altered communication, ways in which altered communication impacts patients in the intensive care unit and emergency department and the role of physicians and nurses in reducing its impact. Altered communication between medical staff leads to an unhealthy work environment in the intensive care unit and emergency departments, which causes a devastating impact to the patients. Arrington, Bavare and Williams (2013, p. 352) and Kessler et al. (2013, P. 48) state that when team members have insufficient or ineffective communication, there is the risk of adverse events, in emergency departments and intensive care units. Communication failures increase the risks of patient harm, increase use of resources, length of stay, rapid turnover and dissatisfaction of intense caregivers (Seung-Chul 2000, p. 200). Intimidation has been consistently named as one of the causes of medical errors, with some of the nurses reporting to have felt pressured to administer a medication, despite the fact that they questioned its safety, but due to feelings of intimidations, were unable to communicate their concerns effectively (Loiselle, 2012, p. 33). For example, in a busy intensive care unit environment, a nurse prepares to give insulin to a patient with high blood sugar levels at 3 am. The physician order sheet is not clear on the dose of insulin to be administered and from experiences; the nurse knows that late night calls to the physician will result to demeaning slurs and verbal outbursts, despite the fact that the inquiry is valid. The nurse decides to make a judgment of the appropriate dose and refuses to make a confirmation with the physician, to avoid a harassing encounter. Hours after administering the insulin, the patient becomes unresponsive and despite calling emergency help and attempts to restore the consciousness of the patient, his brain fails to function normally again. This example highlights the issue of poor collaborative communication between physicians and nurses in an intensive care unit environment, which led to brain damage of a patient. Loiselle et al. (2012, p. 33) analyzed four hundred and twenty one communication events in an operating room and discovered that thirty percent of team exchanges had communication failures, which increases tensions in the operation room environment. Consequently, there was the increase of routine interruptions, increased tension and increased cognitive load in the operating room setting (Curtis et al. 2012, 588). Altered communication in intensive care units and emergency departments leads to medical errors that harm the patients and their family members. Altered communication leads to a work environment that encourages unhealthy and ineffective interpersonal relationships (Kohn 2013, p. 1645). There is an inadequacy of communication between physicians and family members in the intensive care unit (Kozub et al. 2013, p. 210). According to a study done by Kim et al. (2013, p 34), half of the family members did not understand the most basic information concerning the patients’ prognosis, diagnosis and treatment, forty-eight hours after admission. Meriläinen, Kyngäs and Ala-Kokko (2013, p. 78) conducted interviews with one hundred and twenty three family members of patients who had died during treatment in the intensive care unit and seventeen percent of the interviewees reported to have received unclear and insufficient information about the diagnosis of their loved ones. Altered communication magnifies anxiety and depression among family members and patients during the intensive care unit stay (Watson, Hewett & Gallois 2012, p. 294). During family meetings with physicians about the progress of a patient, Shannon, Long‐Sutehall and Coombs (2011, p. 125) found out that physicians use a directive approach and speak two thirds of the time, giving family members less time to voice out the preferences of their patient. In twenty percent of the meetings, physicians do not find time to listen and address the emotions of the surrogate decision makers, nor do they explain the role of surrogate decision makers, examine the preferences of the patients and address the concerns of the family members about non-abandonment (Arnold 2012, p. 37). Most families report conflicts with medical staff due to poor communication. Ninety days after a patient has been discharged from intensive care unit, most of them show stress related symptoms and post-traumatic depressions because they were given incomplete information about their health (Joint Commission 2011, p. 345). Family members of the patients who die in intensive care units, also display stress related symptoms and report that their loved ones died due to physicians’ lack of good communication skills (Joint Commission 2011, p. 345). Clinicians fail to prepare family members of patients in the intensive care unit of the kind of environment to expect after notifying them of their transfer to the unit, which leads to anxiety and depression to both the patient and their family members (Sole, Klein & Moseley 2012, p. 65). Sole, Klein and Moseley (2012, p. 65), in their studies, explains how it was shocking for Kosai, the wife of a patient diagnosed with chronic Lyme disease, to find him hooked to all kinds of machines after she was notified that his husband had been transferred to the intensive care unit. Miller et al. (2011, p. 31) states that more than seventy percent of clinicians report conflicts with family members of patients in the intensive care unit and other stuff, mostly concerning elements of decision making for patients who face the risk of dying. While some clinicians worry about the feeling of futility with family members, others worry about the overwhelming demands from the family members. The overwhelming demands from the family members cause the medical practitioners’ job environment to be unbearable, and can cause medical errors (Kessler et al. 2013, p. 48). Family members are assumed to have the knowledge of the preferences of the patient and are presumed to act in the best interest of the patient (Kessler et al. 2013, p. 48). It is the role of the intensive caregivers to inform the patient or the surrogate decision makers of the diagnosis, prognosis and treatment (Seung-Chul 2000, p. 200). They are also expected to assist the surrogate decision makers to make decisions concerning the goals of the patient. Failure of the physicians and the nurses to communicate effectively with family members may lead to the passage of inaccurate information leading to the making of wrong treatment decisions. Arrington, Bavare and Williams (2013, p. 352) state that the ability of physicians to communicate effectively is an inborn talent, while Kessler et al. (2013, P. 48) claims that if evidence based methods are used; physicians can learn good communication skills. Bad communication from physicians due to strained work environment increases the anxiety and distress of patients, leading to worsening of their symptoms (Wattanapanom 2014, p. 45). Furthermore, a physician who does not make clear enquires from the patient’s family members is not able to elicit the feelings of the patient and may not be able to communicate bad news. The environment of emergency department and intensive care unit may increase the level of stress for patients, due to lower number of nurses as compared to increased number of patients and increased communication needs, leading to most patients feeling abandoned. Seung-Chul (2000, p. 200) states that elderly people aged above sixty five years tend to fall sick more often and may need the emergency department more regularly than younger patients. Curtis et al. (2012, 588) conducted a study in 2011 and discovered that approximately twenty percent of the people aged from sixty five to seventy four years and twenty seven percent of those aged above seventy five years had visited the emergency department at least once. While forty percent of the elderly patients who visit the emergency departments are admitted in hospitals, six percent of them are admitted to the intensive care unit (Curtis et al. 2012, 588). Some of the elderly may substitute their primary care by using emergency department due to inadequate care and attention from their personal physicians. Lack of good communication between the patients’ personal physician and physicians in the emergency departments and intensive care units may lead to the wrong diagnosis, treatment and ailment management plans. Emergency department physicians have the role of enquiring from the personal physicians of the elderly patients, about the basic information of the patients, including reports of simple injuries, for example, ankle sprains and wrist fractures because such information can affect the independence and the functional ability of the patient. Some of the emergency department visits by elderly patients may be because of the failed social structure, such as, failure of caregivers to give appropriate care, which result in people calling ambulances instead of visiting the physicians’ offices (Curtis et al. 2012, 588). Consequently, some of the visits to emergency departments are true emergencies while others are not. Due to pressure and work related stress; some emergency department physicians may fail to recognize which case is a true emergency and which is not (Curtis et al. 2012, 588). The environment of emergency departments can be stressful to elderly patients because there is no special accommodation for them as compared to private wings, such as lower beds, quiet rooms, indirect sunlight and extra pillows (Wattanapanom 2014, p. 45). There are fewer nurses to attend to them, due to the great demand of attending emergency care patients and consequently, if the physicians and nurses do not communicate clearly about the differences of the emergency department and other departments, patients and their family members may feel that they are being abandoned (Wattanapanom 2014, p. 45). Consequently, this may strain patient to health care professional relationship affecting some of the treatment decisions. To address the issue of altered communication in the intensive care unit and emergency departments and reduce its impacts, it is important to understand some of the challenges that health care professional face in the intensive care unit environment that lead to lack of good communication. Firstly, due to the complexity and unpredictability of health care, professionals from different disciplines located in different areas are expected to give health care, facing the disadvantage of limited interactions with their counterparts (Wattanapanom 2014, p. 45). Secondly, health care professionals may have different views of the patients determined by their disciplines, and therefore, may act independently (Miller et al. 2011, p. 31). Thirdly, hierarchical organizational structures may lead to strained communication between physicians and other health care professionals (Miller et al. 2011, p. 31). Educational curricula is the fourth factor because more focus is given to technical skills and little or no attention is given to communication and teamwork skills, which are equally important in the provision of quality health care (Seung-Chul 2000, p. 203). Finally, there is a lack of cultural competency with health care practitioners, thus, straining the relationships with patients from diverse cultures. Nurses and other health care professionals have a big role to play to make sure that there is effective communication between patients, relatives of the patients and their professional colleagues. Effective communication is an important clinical skill in emergency departments, intensive care units and the general medical practice (Kozub et al. 2013, p. 216). Communication between an intensive caregiver and the patient or the family members serves as the bedrock of the therapeutic relationship (Kozub et al. 2013, p. 210). There are two models that intensive caregiver can utilize to communicate with the patient or surrogate decision maker effectively. The collaborative and facilitative models fit in the health care setup because they enable the health care professional in clarifying the values of the patients with the family members (Ala-Kokko 2013, p. 78). Nurses can use the collaborative model to help in the decision-making and to make recommendations to the family. The collaborative model can also be used by the health care professionals to share their ideas and to conclude about the treatment of a patient in the intensive care unit (Joint Commission 2011, p. 345). The nurses can also use the ask-and-tell approach to improve communication in intensive care units. The nurses can ask the family members to explain their understanding of the issue and from this information, a nurse can rate the level of knowledge of the family (Joint Commission 2011, p. 345). Furthermore, asking the patient or the family permission to pass on to them some information shows that one respects them. The ask-and-tell approach can be used to prevent situations where a nurse makes the wrong treatment decisions such as administering the wrong dose of medicine simply because she did not seek confirmation from the physician in charge (Joint Commission 2011, p. 345). In conclusion, altered communication in the intensive care units and emergency departments caused by strained work environment and poor staffing, leads to negative impacts to the lives of patients and their family members. For nurses and other health care providers to ensure that the issue of altered communication is addressed to reduce its impacts on the patients in intensive care units, standards for establishing a healthy work environment have to be implemented (Kohn 2013, p. 1645). Nurses need to be given regular communication skills training so that they can be as competent in communicating as they are in clinical skills (Kohn 2013, p. 1645). They also have to pursue and foster true collaboration with their patients and colleagues. Nurses also have to be engaged in making policies, making evaluations of clinical care and lead organizational operations for them to feel valued and to make them more committed. In emergency departments and intensive care units, appropriate staffing is necessary to ensure an effective match between the competencies of the nurses and patients need (Watson, Hewett & Gallois, 2012 p. 295). References Alasad, J & Ahmad, M 2005, ‘Communication with critically ill patients’, Journal of advanced nursing, 50(4), pp. 356-362. Arnold, RM, Prendergast T, Emlet, L, Weinstein, E, Barnato, A, Back A 2012, Educational modules for the critical care communication (C3) course-a communication skills training program for intensive care fellows. 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