Nursing Preceptor Program - Professional and effective communication

communication in preceptorship course

1. Professional & effective communication (aidet & Isbar )

2. Objectives By the end of the training session you will be able to: Understand interpersonal communication skills in workplace Define AIDET. Use AIDET framework with patients, families, visitors and staff visiting the department at all times. Define ISBAR. Explain ISBAR steps. Explore why, when and how to use ISBAR.

3. Introduction

4. Interpersonal skills at work directly impact the whole organization. A strong approach to improve communication between people and break such barriers will go a long way in assuring the efficiency of the workplace. Cooperation with others and supporting them is very important. It improves communication and leads to a better understand of the situation and the emotional disposition of people. Interpersonal communication skills

5. Interpersonal communication skills Verbal communication Non-verbal communication Listening skills Negotiation Problem-solving Decision-making Assertiveness

6. What does it effect when we don’t get communication right? Patient safety Patient & family satisfaction Management of care Compliance with treatment Level of anxiety Job satisfaction Efficiency Teamwork

7. Well structured communication frameworks will help us getting the communication right

8. Definition of AIDET What is AIDET? It is a framework to communicate with patients and their families as well as with each other. It is a simple acronym that represents a very powerful way to communicate with people who are often nervous, anxious and feeling vulnerable. It can also be used as we communicate with other staff and colleagues, especially when we are providing an internal service. What does AIDET stand for? A cknowledge I ntroduce D uration E xplanation T hank You

9. How to use AIDET framework Acknowledge Greet people with a smile and use their names if you know them. Attitude is everything so create a lasting impression. E.g. OPD nurse to a patient: "Good morning Ms. Lina. We've been expecting you and we're glad you are here. Introduce Introduce yourself to others politely. Tell them who you are and how you are going to help them. Escort people where they need to go rather than pointing or giving directions. E.g. MSW nurse to a patient: "My name is Ali, I am a registered nurse and I am assigned to take care of you today. If you need my help at any time, please let me know. "

10. How to use AIDET framework Duration Keep in touch to ease waiting times. Let others know if there is a delay and how long it will be. E.g. OBGYN nurse to a patient: "Dr. Amina had to attend an emergency. She was concerned about you and wanted you to know that it may be 30 minutes before she can finish your discharge summery. Am sorry for the inconvenience and I will keep you updated.” Explanation Advise others what you are doing, how procedures work and whom to contact if they need assistance. Communicate any steps they may need to take. Make words work. Talk, listen and learn. Make time to help. E.g. phlebotomist to a patient: "The test takes about 30 minutes. The first step is drink this solution and then we will have you wait 20 minutes before we take a blood sample. Would you like to read while waiting?"

11. How to use AIDET framework Thank you Thank people. Foster an attitude of gratitude. E.g. Pediatric: "Thank you for choosing SKGH. It has been a privilege to care for your child."

12. Enjoy watching the following https://www.youtube.com/watch?v=EP_hYBro_Qw

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14. The cost of communication (So what….?) In 2015 a study was undertaken which examined 7,149 negligence claims filed between 2009 and 2013. The study examined cases in which facts, figures, or findings got lost between the individuals who had that information and those who needed it across the spectrum of healthcare services and settings. Of those 7,149 claims: 30% What percentage do you think were in relation to communication breakdown? What percentage do you think were in relation to communication failure? In addition: 37%

15. Ineffective hand-off communication is recognized as a critical patient safety problem in health care; in fact, an estimated 80% of serious medical errors involve miscommunication between caregivers during the transfer of patients. The hand-off process involves “senders,” those caregivers transmitting patient information and transitioning the care of a patient to the next clinician, and “receivers,” those caregivers who accept the patient information and care of that patient. In addition to causing patient harm, defective hand-offs can lead to delays in treatment, inappropriate treatment, and increased length of stay in the hospital. ( Joint Commission Perspectives, August 2012, Volume 32, Issue 8). Handover Communication

16. Definition of ISBAR? It is a structured framework for communicating critical information that requires immediate attention and action. It improves communication, effective escalation and increased patient safety. ISBAR is a standard mnemonic to improve clinical communication. ISBAR use is well established and structured in different settings such as military and not only limited to health care organizations only.

17. What does ISBAR stands for? A B S I R Recommendation Assessment

18. Five Steps of ISBAR IDENTIFY: Who you are and what is your role? And identify patient using two identifiers. SITUATION : What is the current situation, concerns, observations, EWS etc. BACKGROUND : What is the relevant background? This helps to set the scene and to interpret the situation above accurately. ASSESSMENT : What do you think the problem is? This requires the interpretation of the situation and background information to make an educated conclusion about what is going on. RECOMMENDATION : What do you have to do? What do you recommend should be done to correct the current situation? Moving to interventions.

19. When to use ISBAR For Inpatient or outpatient. Urgent or non urgent communications. Conversations with a physician, either in person or over the phone. - Particularly useful in nurse to doctor communications. - Also helpful in doctor to doctor consultation. Discussions with allied health professionals.         - e.g. Respiratory therapy         - e.g. Physiotherapy Conversations with peers.         - e.g. Change of shift report Handover from an ambulance crew to hospital staff.

20. Escalating a concern – RED FLAG - Sudden or gradual change in the patient’s condition - Change in the plan of care made at shift change - Physician change/handover of care When to use ISBAR

21. Why to use ISBAR? To reduce the barrier to effective communication across different disciplines and levels of staff. SBAR creates a shared mental model around all patient care handover and situations requiring escalation, or critical exchange of information (handovers). SBAR is a memory prompt; easy to remember and encourages prior preparation for communication. SBAR reduces the incidence of missed communications.

22. How does it help? Easy to remember Clarifies what information needs communicating quickly Points to action IT PREVENTS “HINTING & HOPING”

23. How to use the framework ISBAR Before making the call: Assess the patient/situation (physiological parameters) Read the most recent notes/information/results Have the information in front of you

24. How to use SBAR? I dentify Identify yourself the site/unit you are calling from. Identify the patient using two identifiers For example: "This is Leena Ali, a registered nurse on MSW wing B. I am calling in regards to Mrs Muna Ahmad, MRN: U 10478 who is in room 16 and under the care of Dr. Adel Internal Medicine consultant

25. How to use SBAR? S ituation Identify the reason for your report. Describe your concern. Firstly, describe the specific situation about which you are calling, including the resuscitation status, and vital signs. For example: “Mrs. Ahmed becomes suddenly short of breath, her oxygen saturation has dropped to 88 % on room air, her respiration rate is 24 per minute, her heart rate is 110 bpm and her blood pressure is 85/50 mmHg.”

26. B ackground Give the patient's reason for admission. Explain significant medical history. Overview of the patient's background: admitting diagnosis, date of admission, prior procedures, current medications, allergies, pertinent laboratory results and other relevant diagnostic results. For this, you need to have collected information from the patient's chart, flow sheets and progress notes. For example: "Mrs. Ahmad is a 69-year-old woman who was admitted from home three days ago with a community acquired chest infection. She has been on intravenous antibiotics and appeared, until now, to be doing well. She is normally fit, well and independent.”

27. A ssessment Vital signs and EWS Clinical impressions, concerns For example:   You need to think critically when informing the doctor of your assessment of the situation. This means that you have considered what might be the underlying reason for your patient's condition. If you do not have an assessment, you may say: "Mrs. Ahmad’s vital signs have been stable from admission but deteriorated suddenly. She is also complaining of chest pain and there appears to be blood in her sputum. She has not been receiving any venous thromboembolism prophylaxis.” “I’m not sure what the problem is, but I am worried.”

28. R ecommendation Explain what you need - be specific about request and time frame. Make suggestions. Clarify expectations. Finally, what is your recommendation? That is, what would you like to happen by the end of the conversation with the physician? Remember telephone orders can only be taken if the doctor cannot attend immediately and assess the patient. In this step you may say: " I would like you to come immediately”

29. Enjoy watching the following https://www.youtube.com/watch?v=haurNwYB8Ak Think Talk Write ISBAR

30. Remember … Focusing on the problem and avoiding the issue of who’s ‘‘right ‘‘and who’s ‘‘wrong’’ is quite important and a major success factor. We often ask or require nurses to provide an objective argument to convince a physician to see a patient. Nurses have license to say: ‘‘I need you to come now and see this patient’’ “Something’s wrong, I’m not sure what it is, but I need you here now’’ “I am worried, concerned, scared” Coupling this with SBAR helps ensure that communication becomes progressively clearer

31. Key messages Effective teamwork and communication can help prevent these inevitable mistakes from becoming consequential, and harming patients and providers. Embedding standardized tools and behaviours such as ISBAR along with appropriate assertion, and critical language can greatly enhance safety. Communication failures account for the overwhelming majority of unanticipated adverse events in patients. Medical care is extremely complex, and this complexity coupled with inherent human performance limitations, even in skilled, experienced, highly motivated individuals, can lead to mistakes .

32. References Amato-Vealey, E.J., Barba, M.P., & Vealey, R.J.(2008). Hand-off communication: A requisite for perioperative patient safety. AORN Journal , 88(5), 763-774. Beckett, C.D. & Kipnis , G. (2009). Collaborative communication: integrating SBAR to improve quality/patient safety outcomes. Journal for Healthcare Quality, 31(5). Clark, E., Squire, S., Heyme , A.,Mickle , M.E., & Petrie, E.(2009). The PACT project : Improving communication at handover. MJA, 190(11), S125-S127. Denham, C.R. (2008). SBAR for patients. Journal of Patient safety, 4(1). Field, T. S. et al.,(2011). Randomized trial of a warfarin communication protocol for nursing homes: An SBAR-based approach. AJM, 124(2), 179.e1~e7. JCAHO(2005). The SBAR technique : Improves communication, enhances patient safety. Joint Commission Perspectives on Patient Safety , 5(2), 1-2,8. Leonard,M.,Graham,S.,& Bonacum,D .(2004). Thehuman factor: The critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care, 13( Suppl 1), i85–90. Retrieved September 11, 2006, from www.inti-qhc.bmijournals.com Mikos , K.(2007). Monitoring handoffs for standardization. Nursing Management , 38(12),16-20. Powell, S.K.(2007). SBAR-It’s not just another communication tool. Professional Case Management . 12(4), 195-196. Pothier , D., Monteiro, P., Mooktiar , M., & Shaw, A.(2005), Pilot study to show the loss of important data in nursing handover, British Journal of Nursing, 14(20), 1090-1093. Studer, Q., (2003). Hardwiring for Excellence . Fire Starter Publishing.

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