1. Patient and Caregiver Communication: The Cornerstone of Patient Safety
Jane Englebright, PhD, RN
Chief Nursing Officer &
Vice President Clinical Services Group
June 2012

2. Objectives
Discuss the importance of effective patient communication to patient safety
Compare and contrast patient and caregiver perceptions of effective communication
Apply specific communication techniques to improve the patient’s perception of effective communication

4. Effective Communication is Fundamental to Clinical Practice
First skill check-off in Fundamentals of Nursing
Everyone knows how important effective communication is
Accurate history
Full explanation of symptoms
Evaluation of effectiveness of treatment
Relieving anxiety and pain
Assuring adherence to treatment plan
Preventing readmissions
Preventing or identifying errors

5. HCAHPS Results Point to a National Communication Problem
Patient perceptions of their hospitalization are collected through a national survey called HCAHPS
Patients are asked about the frequency (always, sometimes, occasionally, never) with which their needs were met
Eight different dimensions of care are assessed
Clinical dimensions are tied to likelihood of relapse
Hospital results are published on public website:
Consider presenting your hospital results here. Discussion: How do our patients perceive our nursing care?

6. HCAHPS Performance Linked to Communication Effectiveness
HCAHPS Dimensions
US Top Box %
NY Top Box %
Communication with nurses 77 72
Communication with physicians 80 76
Medication communication 61 57
Discharge information 83 81
Staff responsiveness 65
Pain management 70
Quietness of the environment 59 49
Cleanliness of the environment 67
Spring 2012 Report,
July 2010 – June 2011 Discharges

7. Conclusions
6 of 8 HCAHPS dimensions reflect communication effectiveness
Survey items distinguish between “customer service” and “therapeutic communication”
“Treated with courtesy and respect” vs
“Explained things in a way you could understand”
Patients are not perceiving communication in the hospital to be effective

8. Do patients evaluate communication effectiveness differently from clinicians?
When you are the patient, do you tell your caregivers that you are a healthcare professional?

9. Differences in Patient & Nurse Perceptions Regarding Communication
Communication Needs in the Emergency Department
Patient Rank Order “very important”
Nurses Rank Order “very important”
Keep you informed about what tests and treatments are done 1
Answer your questions 2 8
Listen to your concerns 3 7
Show you respect 4
Show compassion and genuine concern 5
Speak in a way that meets your language needs 6
Use terms you can understand
Give you frequent updates on what is happening 18
Appear as if they have time to listen to what you have to say 9 14
Provide comfort 10
Pytel C, Fielden NM, Meyer KH, Albert N.
Journal of Emergency Nursing,

10. Effective Communication is a Team Effort
The collective acts of the clinical team that have important consequences for patients and create the patient’s perception of effective communication.
Communication from each member of the clinical team is
Consistent in content, avoiding confusion and encouraging trust
Reinforcing of learning at each stage of care
Respectful and courteous, encouraging openness to further communication and learning
Keeping the clinical team aligned takes additional work and tools
Educational materials
Communication checklists
Discuss importance of being able to rely on caring behaviors of colleagues. Example: Telling family that nurse will come get them after patient is settled in a new room and knowing that it will happen.

11. Lauren’s List Checklist for consistent communication
Developed by a chronically ill hospitalized child and her mother
While communication techniques are basic to nursing education, all to often, we fail our patients. This list of behaviors was developed by a chronically ill hospitalized child and her mother. The story is that the first caregiver that encountered the sign, tore it down, and told them not to tell him how to do his job.

12. The Caring Model is a bundle of 5 evidence-based behaviors that, when practiced consistently by nurses and other caregivers, create a perception of being cared for and about among patients.

13. Intentional Communication Checklist
Communication Element
Intended Effect
Introduce yourself and explain your role in care
Convey courtesy and respect
Decrease anxiety
Establish your role
Call the patient by preferred name
Establish patient identity
Use touch appropriately
Personalizes communication
Conveys caring
Review care plan daily sitting at eye level for at least 5 minutes
Acknowledges patient as individual in charge of plan of care
Demonstrates active listening
Reduces power gradient
Patient perceives more time with the clinician
Each day compliment another caregiver to the patient
Reduce anxiety
Improve team communication

14. Effective Patient Teaching
&
Narrating each care activity with explanation of what is being done and why it is important
Coordinated teaching plan with shared educational tools and materials
Ask participants to recall the reasons they became nurses. Write the reasons on the paper. How many have something about caring in their list of reasons?

15. Every patient interaction . . .
no matter how brief. . .
is an opportunity for communication that is both courteous and therapeutic
is an opportunity for asking questions and listening to the patient
is an opportunity for narrating care activities and providing the patient with information about their status, their treatment, and their progress
Jean Watson, the founder of Caring Theory, describes the concept of “therapeutic presencing”. Are we cognizant of making a therapeutic contribution to the patient every time we enter the room?

16. Evaluating Effectiveness of Communication
Criteria
Good
Not So Good
Who speaks?
Patients, family members and all professional team members
Only the professional team members
Who is silent?
No one
Patient or family
What is said?
Content is about the patient
Content is about the caregiver
How is message given?
Language patient can understand
Medical jargon
What is the body language?
Eye-level, eye contact, open body position
Standing over the patient or talking from the doorway
Which aspects of the patient’s care are prioritized?
Elements most important to the patient are addressed first
Elements most important to the professional team are addressed first

17. Why Focus on Communication?
It is fundamental to a caregiving relationship
It is important to patients
It must be coordinated across the entire team
It takes effort
It produces results

18. References
Dingman SK, Williams M, Fosbinder D, Warnick M. (1999). Implementing a caring model to improve patient satisfaction. Journal of Nursing Administration, 29:12,
Doss A, DePascal, P, Hadley K. Patient-Nurse Partnerships. Nephrology Nursing Journal : 38(2),
Hemsley B, Balandin S, Worrall L. Nursing the patient with complex communication needs: time as a barrier and a facilitator to successful communication in hospital. Journal of Advanced Nursing
Manias E. Medication communication: a concept analysis. Journal of Advanced Nursing,
Pytel C, Fielden NM, Meyer KH, Albert N. Journal of Emergency Nursing,
Watson, J. (1985). Nursing human science and human care. Norwalk, CT: Appleton-Century.
Watson, J. (1988). New dimensions of human caring theory. Nursing Science Quarterly, 1(4),