Abstract
Communication between a patient and a physician is crucial in the healthcare field. According to Gooch, “A CRICO Strategies study indicated communication failures were linked to 1,744 patient deaths in five years and $1.7 billion in malpractice costs.” (2014, p.3) This paper discusses the importance of patient-physician communication, and family-physician communication, and its crucial role in the treatment decision making process, maintaining self- care, and understanding treatment costs.
INTRODUCTION “I wish someone would have told me what was going on.” (Rolek, 2017) These were few, but powerful words spoken by Ms. Joanna Rolek during a Foundations of Interprofessionalism class at Rosalind Franklin
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As stated in the introduction Ms. Rolek’s spoke of her husband’s rapid decline in health, and how he was placed in a medically induced coma without her consent or knowledge. (Rolek, 2017) There was no communication in regards to her husband’s state of health or any discussion of end-of-life care. Communication is key to ensuring the family is informed of the patient’s care. As stated in an article by Visser et all, “End-of-life care in ICUs is often inadequate because of factors such as a lack of communication between patients and health care providers and lack of patient and family-centered care. As a result of inadequate communication ICU physicians are unable to provide treatment according to a patient’s wishes when the goals of care and treatment preferences of the patient are not clear and treatment decisions are not shared with the patient and the patient’s family.”(2014 p.2) As a result, the patient’s quality of life may be harmed and the patient’s family may be left feeling uninvolved as was described by Ms. Rolek. Visser et all 2014, discusses ways that communication can be improved between, the patient, the family and the physician. One way to improve communication is to meet as an interprofessional team. During this meeting discussions may be held in regards to patient condition and clarifying goals of treatment. The team may also clarify patient and family needs and preferences. Another important meeting directly involves the family to review the patient’s status and answer any residual questions. Recognizing the patient and family as a unit of care, and recognizing their role in the patient’s treatment and long-term care plan will assure better quality of care and avoid
Communication is cited as a contributing factor in 70% of healthcare mistakes, leading to many initiatives across the healthcare settings to improve the way healthcare professionals communicate. (Kohn, 2000.)
Charalambous, A. (2010). Good communication in end of life care. Journal of Community Nursing, 24(6), 12-14. Retrieved from EBSCOhost.
“Medical futility is a complex concept as there is no universally accepted definition.” (Chow, RN, ANP-BC, 2014) Futility was found among the group of colleagues on the ICU floor to mean a considerable use of resources without hope for recovery. The most common answers as to why medically futile care was provided were due to demands from family members and disagreements among team members regarding their plan of action. A major concern in these situations is that family members are left to make decisions without any health care knowledge. Communication is key here; critical care team members and family members have to try to overcome the difficult situation they have been placed in to figure out what is the best plan. The palliative care team should have been brought in sooner in L.J.’s case because on top of the lack of communication, “the case happened at the beginning of an academic year when new medical residents and fellows were just becoming oriented in the hospital system.” (Chow, RN, ANP-BC,
“Physicians and other health care professionals all agree on the importance of effective communication among the members of a health care team. However, there are many challenges associated with effective interprofessional (between physicians and other health care providers) communication, and these difficulties sometimes lead to unfavourable patient outcomes” (Canadian Medical Protection Association, 2011 p. 11).
Effective communication between patient and clinician is an important aspect to patient care. Proper communication has a direct positive impact on patient care and adversely poor communication has a direct negative impact on patient care. I will define the seven principles of patient-clinician communication and how I apply these communications with my patients. I will also describe the three methods currently being used to improve interdisciplinary communication and the one method that my area of practice currently uses. Then, I will explain the ethical principles that can be applied to issues in patient-clinician communication. And Lastly, the importance of ethics in communication and how patient safety is influenced by good or bad team communication.
Communicating with someone who has a life-altering illness is not an easy task. A person needs to have compassion, patience, and listening skills. I have seen firsthand how a caring healthcare provider and having an attitude of optimism can prolong a person’s life.
End of life care in the Intensive Care Unit (ICU) can be very stressful for ICU nurses due their need to rapidly transition from curative care to end of life care, therefore the interventions they choose are very important. The qualitative study “A Study of the Lived Experiences of Registered Nurses who have Provided End-of-Life Care Within an Intensive Care Unit,” by Holms (2014), explores the experiences of ICU nurses who have provided end of life care to dying patients and their families in the ICU. End of life care according to Radbruch and Payne, is “synonymous with palliative care yet it is more specific to acutely unwell patients who require palliative care in the last few hours, days or weeks of their lives” (As cited in Homs, 2014, p. 549). Sadly, patients in the ICU are critically or terminally ill, and most are unable to plan their own end of life care. Therefore, nurses in the ICU are needed to help guide patients and family members through this process. According to Wright, “95% of patients within the ICU may not have the ability to make informed decisions” (As cited in Holms, 2014, p. 549). The discussion of end of life care in the ICU continues to be a very controversial because care is highly inconsistent due to conflicting opinions on what to base the care for the patient.
The purpose for this research study was to develop a communication strategy for family members of patients dying in the ICU by evaluating a format consisting of a proactive end-of-life conference and brochure to see whether the intervention could minimize the effects of bereavement for the families left behind. This research provided the family members with more opportunities to discuss the patient wishes, to express emotions, to alleviate feelings of guilt, and to understand the goals of care.
Communication involves the exchange of information between two or more people. Whether verbal or nonverbal, communication serves as the bridge that allows people to share ideas and thoughts. Clinical professionals converse with patients, relatives, and other professionals daily. Conversely, despite having multiple encounters with patients every day, physicians fail to enact the necessary communication and interpersonal skills to effectively listen, instill confidence, and promote following medical advice in patients.
Cypress discusses a study on how one ICU unit developed interpersonal relationships between the patient and their loved ones. The Roy Adaptation model was used to provide the best quality care for the patient. The staff encouraged families to talk and assist in care of their loved ones. ICU patients are sometimes unable to speak due to oral intubation and alteration in level of consciousness or neurological changes related to medications and acute critical condition (Cypress, 2011, 4). This often affects communication and relationships with family members and friends. Family members were kept updated on any changes with the patient. The nurses, physicians, therapist and families all worked together for the benefit of the
The care of patients at the end of their live should be as humane and respectful to help them cope with the accompanying prognosis of the end of their lives. The reality of this situation is that all too often, the care a patient receives at the end of their life is quite different and generally not performed well. The healthcare system of the United States does not perform well within the scope of providing the patient with by all means a distress and pain free palliative or hospice care plan. To often patients do not have a specific plan implemented on how they wish to have their end of life care carried out for them. End of life decisions are frequently left to the decision of family member's or physicians who may not know what the patient needs are beforehand or is not acting in the patient's best wishes. This places the unenviable task of choosing care for the patient instead of the patient having a carefully written out plan on how to carry out their final days. A strategy that can improve the rate of care that patients receive and improve the healthcare system in general would be to have the patient create a end of life care plan with their primary care physician one to two years prior to when the physician feels that the patient is near the end of their life. This would put the decision making power on the patient and it would improve the quality of care the patient receives when they are at the end of their life. By developing a specific care plan, the patient would be in control of their wishes on how they would like their care to be handled when the time of death nears. We can identify strengths and weakness with this strategy and implement changes to the strategy to improve the overall system of care with...
Communication plays a major role in preventing and resolving behavior problems and enhancing your patient’s quality of life by allowing them to feel, even when they no longer know or recognize those around them that they are in the midst of people who care about them and are concerned about their physical and emotional well being.
These conversations allow us as healthcare professionals to align patients’ goals of cares involving decisions on quality of life versus quantity of life and plan medical interventions accordingly based on their medical preferences. I believe far too often it is a conversation that is put off by patients, families, and health care providers alike until it is a “better” time or when it is dire to have the conversation as death proves to be imminent for the patient. A survey from the Conversation Project reported that 90% of people surveyed think that talking with their loved ones about end-of-life-care is important, yet only 27% of them have actually done it (“The Conversation Project”, 2018, p. 2). This goes to show how much room for improvement there is for us to advocate for our patients and explain the importance of having advanced directives. The lack of patients actually having advanced directives filed and documented may be partially to blame on providers being caught up in the other time-consuming tasks, hoping another provider addresses this problem, or just a general lack of knowledge on how to initiate such a difficult conversation, especially with a relatively healthy individual where death seems far off.
Street, Richard, MD. (1992). “Analyzing Communication in Medical Consultations: Do Behavioral Measures Correspond to Patient’s Perceptions?”. Medical Care, 30, 976 - 987
Family medicine are doctor that provides basic health care to all the members of a family and patients, Family medicine treat and diagnose diseases and stop the immediate abnormal growth, family medicine care for all ages, sexes, each organ system. Family medicine also provides personal care for the individual in the community.