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NURS3016: Professional Practice Experience

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  • Course Code: NURS3016
  • University: The University Of Sydney
  • Country: Australia

Question:

Discuss about the NURS3016: Professional Practice Experience.
 
 

Answer:

Introduction:

Medical-surgical ward has emerged out as one of the most important ward in the healthcare units in the present generation. The main scope for the nursing service in this ward is to provide total care for both the medical as well as the surgical adult patients (Arnold & Boggs, 2015). The daily comprehensive interdisciplinary healthcare team mainly provides the service in this setting. This team remains dedicated extensively in serving the different types of needs of the patients in this ward (Sonke et al., 2015. Effective communication is extremely important in this ward in order to ensure patient safety and prevention of adverse events (Yngman et al., 2016). This assignment will show how ineffective communication affects patient health status and the ways by which it can be overcome.

Medical surgical ward:

The nurses in this ward needs to provide care that is not only evidence based but should support the patient as well as family centered care. The teams are mainly seen to provide care to a wide variety of the patients who are experiencing cardiac, gastro-intestinal, respiratory as well as neurological disorders (Weller, Boyd & Cumin, 2014). They also care for various types of surgical procedures that mainly require monitoring and caring during the procedural phases. Different examples of their work might include administration of medication to acute and chronic disorder patients change the dressing of wounds as well as starting a new line IV and help someone with pain (Arnold & Boggs, 2015).

Effective communication between the healthcare professionals within the teams and that between the healthcare experts and the patients are important factors. These aspects lead to patient safety as well as patient care quality (Arnold & Boggs, 2015). One of the studies relating effective communication with patient safety in the medical surgical ward has put forward an important analysis of the situations occurring in the ward (Austin & Pinkleton, 2015). Often nursing professionals in the ward has the duty of educating patient regarding the medication procedures he needs to follow or the lifestyle interventions that they need to follow. This education is mainly given to the patient when the nurses discharge them from the medical-surgical ward to their homes (O’Hagan et al., 2014). Studies are of the opinion that how well a patient understands the information provided by the professionals can also affect the healthcare decisions that they might make in the future. Researchers have pointed out that if the patients are not able to understand the information that they receive, there might be increased risk of the instructions being followed by them incorrectly. This might in turn lead to occurring of different types of adverse events (Quilligan, 2015).

Medical-surgical nurses are seen to manage care for adult patients of all ages with both acute as well as chronic conditions, whether they are surgical patients or not. These wards are mainly seen to be comprising of patients with a variety of diagnoses. Often different inter-disciplinary teams also treat such patients and an example can be provided to explain the importance of such teams (Yngman et al., 2016).  A patient who is waiting for appendectomy might be also under the treatment of cardiac condition as well as Chron’s disorder.  Therefore, it becomes very important for the medical surgical nurses to coordinate, organize and thereby prioritize complex multiple patient assignments (Stanyon et al., 2016). Often huge number of patients often gets admitted who suffer from various com-morbid disorders and requires the collaborative working and effective communication to ensure that all the needs of the patients are me (Austin & Pinkleton, 2015). They need to provide interventions, therapies, education and guide patients and their families through complex healthcare systems. They need to advocate for the patient treatment and use current researches to provide care for the complex needs of the patients. They need to discuss within the team members about the complex differences in medication and allocation of medicines that would not cause any form of medication errors to the patients (Walczak et al., 2016). All these aspects require effective communication to achieve the best results which otherwise might being out adverse patient outcomes.

 

Ethical and legal aspects:

In the medical surgical ward, effective communication between the interdisciplinary teams and the patients as well as within the team-members is extremely important to ensure patient safety (Stanyon et al., 2016). Studies are of the opinion that effective and efficient communication can help in development of the culture of excellence and this factor in turn delivers the value for the patients, fellow caregivers as well as the families (Austin & Pinkleton, 2015). This value enhances outcomes, safety as well as efficiency of care. Beneficence is the ethical principle which states that every nurse need to provide care to the patient, which is safest and evidence based and provides the best outcomes (Sonke et al., 2015). Effective communication helps patients in going home with a plan that would help him in restoration of the health and thereby result in lessening the chances of repeat visits and readmission of the patients in the medical-surgical wards thereby maintaining their beneficence. Beneficence can only be followed when team members show proper teamwork and communicates about patients among themselves proactively (Sonntag et al., 2016). Studies have shown how effective communication can ensure patient safety and beneficence and results in reduction in adverse events on patients. Firstly, effective communication help in improvement of the perception of teamwork between the members of the team members who work with patients with complex needs in the medical-surgical wards. Secondly, effective communication helps in allowing the ability to give authentic as well as constructive feedback. This feedback is extremely significant for creating a learning environment and safety culture in the medical-surgical ward. Third, effective communication can also help in fostering psychological safety and even help sin promoting the willingness to speak in constructive ways.

It is important to know the different types of adverse patient events that occur due to poor ineffective communication. Non-maleficence is the ethical principle that shows that nurses should never conduct any actions which harms or causes suffering to the patient (Walczak et al., 2016). Current researchers are of the opinion that infective communication in the medical-surgical ward among the healthcare professionals is one of the leading causes of the medical errors and harm of the patients thereby causing breaching of the principle of non-maleficence. Data has suggested that failures in communication contribute to about 70% of the sentinel events. Two important contributors to errors in patient care in the medical-surgical ward can be found in the different literatures (Constand et al., 2014). One of the concerns revealed by nurses in a qualitative research paper was the communication issues that they have when interacting with the doctors. Another concern is the intimidation that is suggested by many healthcare professionals as the root cause of the medical harm. Half of the respondents in the study had reported feeling pressured into giving a medication, for which they had questioned the safety but had felt intimidated and unable in communicating their concerns effectively (Alsheri et al., 2015). Ineffective and insufficient communication among the members of the team is an important contributor for different adverse events. In the acute care settings, failures in communication can lead to increase in the patient harm, preventable deaths of patients, length of the stay as well as resource use and even to more intense caregiver dissatisfaction and more rapid turnover. All these are examples of breaches of non-maleficence and care should be taken to prevent them (Brunero et al., 2017).

 

Apart from the medical errors, poor ineffective communication results in other adverse events in the medical-surgical nursing. Breakdown of communication between the experts working in the healthcare team might result in long waiting times of the patients. Often situations arise where patients are confirmed by one healthcare professional that other experts would visit them on a particular time (Yngman et al., 2016). However, often other experts do not visit the patients on time making them wait. They come late making the patient wait making them nervous and anxious about the situation and about their health (Hsu et al., 2015).. Although, it does not result in adverse patient outcomes but affects the dignity and autonomy of the patients making them feel powerless, unattended and uncared.  Ineffective communication can also cause workplace conflict (Stanyon et al., 2016). Disagreements and differences of the opinion among the healthcare members in the medical-surgical ward came also cause escalation to serious conflicts in the workplace. In such situations, communication should be always promoted as it will allow the misunderstandings to get over helping in the working out and solving of the different problems (Brunero et al., 2017).

In many situations, ineffective communication between the patients and the healthcare professionals in the medical-surgical ward can cause poor decision-making. This issue mainly occurs   when not all the details regarding care, interventions, disorder, protocols and others are discussed with the patients for helping them to make a sound or rational decisions (Harkanen et al., 2015). The decision making procedures are mainly seen to require a clear vision of the missions, goals, values and others in order to accurately identify the possible, issue or need of improvement, possible solutions, alternatives and consequences as well as strengths and weakness. Studies have shown that managers in the medical-surgical ward cannot identify the information alone. They need to depend on the communication from the entire staffs for making effective decisions. Encouraging the staffs for speaking up about their concerns by effective feedback sharing in positive and productive ways can help in making decisions (Davis et al., 2014). These aspects would be helpful in the improvement of the working procedures of the medical-surgical ward and ensure patient safety. Many of the studies have also suggested that lack of stress can also result in unnecessary worries and concerns over the workplace issues which might be real as well as perceived (Hsu et al., 2015).. Increased stress among the healthcare professionals in this ward can directly affect the patient care with poor quality services and more chances of medication errors and missed interventions. All these can lead to patient harm and nurses might be held under legal obligation for providing wrong and poor quality care (Brunero et al., 2017).

 

Best strategies and nursing practices:

In order to develop effective strategies for betterment of effective communication, it is very important to analyze closely the source of tensions that occur among the team members who provide service to the patients (Schorr et al., 2016). Healthcare is very complex as well as unpredictable. In the medical-surgical ward, professionals come to treat patients from a variety of disciplines to provide care at the different times throughout the day. This might take place often being dispersed over several locations along with the creation of the spatial gaps with limited opportunities for regular synchronous interaction in the busy wards (Walczak et al., 2016). Another study had stated that care providers have their own disciplinary view of what the patient needs with each of the providers prioritizing the activities in which he or she acts independently. Therefore, this might result in creation of issues and conflicts among the team members if effective communication is not carried on. The third issue is that like every healthcare unit, the medical-surgical ward also has a hierarchical organizational structure. Significant power distances are found between the physicians and the other healthcare professionals (Sacks et al., 2015). This factor results in the development of the culture of inhibition as well as the restraints in the communication, rather than the sense of open, safe communication ensuring psychological safety (Hsu et al., 2015). Therefore, this might affect the morale of the workers and might make them with withdrawn from the safe and quality care of the patients. This might lead to occurrence of errors in the patient care.

One of the most important strategies that should be taken up by the healthcare organization to develop communication in the medical-surgical ward is allocating stalwart leaders and mangers in the wards. Effective leaders would be helpful in transforming the safety culture in the medical-surgical ward (Schorr et al., 2016). Transformational leaders would enable the nursing professionals to understand the importance of effective communication and its association with patient safety. Through inspirational motivation, the leaders would motivate the nurses to communicate effectively with all the embers keeping aside their ego and complexes (Sacks et al., 2015). This would help them to provide safe care to the patients without the occurrences of medication errors, missed interventions, poor documentations and others. They would also adopt the traits of idealized influence where they would be acting as role models and exhibit the ways by which effective communication can be carried on (Brunero et al., 2017).

 


The nursing professionals in the wards can follow them and develop the skills helping to prevent adverse situations. The leaders should also adopt the attribute of individualized consideration. Here the leaders would be interacting with the members working in the medical-surgical ward and solve the concerns of each of them regarding communication issues individually. These aspects would help the members feel that they are cared and respected in the organization and accordingly they would abide by the suggestions developed by the leaders (Schorr et al., 2016).

Development of the culture of safety is important and hence the organizational heads should introduce initiatives by which important strategies can be suggested to the professionals. One of the strategies would be arrangement of training and workshop sessions where the experienced nursing professionals of the medical-surgical ward would be explaining the significance of cultural safety to the professionals (Sacks et al., 2015). Accordingly, they would be also allocating workshop session to the professionals where they would be learning about the different important communication skills like active listening, feedback exchange and many others. Moreover, the professionals should be also taught the significance of therapeutic communication and ways by which the therapeutic communication can be developed between the professionals and patients. For developing a safety culture in the organization, effective team working is also important and proper communication can help in development if better teams. The better the emotional intelligence, communication skill and interpersonal skills, better teamwork can be ensured (Walczak et al., 2016). Effective communication can overcome misunderstanding among the processionals, help in development of bonding and relationship among the members who provide service in the medical-surgical ward (Hsu et al., 2015). Better, the communication among the members, there will be development of trust and mutual respect with each other’s and hence teamwork would be more effective (Haines et al., 2015). Development of stress would not take place due to sharing of emotional, financial and physical concerns among the member due to both formal and informal communication among the professionals that would lessen the work burden.

Conclusion:

Effective communication is one of the most important components of healthcare. It ensures patient safety and prevents adverse events and accidents. In the medical surgical wards, nurses have to provide both pharmacological and non-pharmacological treatment to patients. As patients suffer from co-morbid situations both from acute and chronic disorder, inter-disciplinary teams members are mainly seen to act together to provide care. In such situation, ineffective communication can lead to medication error, missed interventions, long waiting times of patients and may create power struggles, ego clashes and others. Professional might commit mistakes and errors sue to miscommunications, and many others. Hence, to ensure beneficence, non-maleficence and confidentiality of patients, the healthcare sectors need to develop proper organizational cultures and policies promoting effective communication.

 

References:

Alshehri, B., Ljungberg, A. K., & Rüter, A. (2015). Medical-surgical nurses’ experiences of calling a rapid response team in a hospital setting: A literature review. Middle East Journal of Nursing, 9(3), 3-23. https://www.researchgate.net/profile/Badryah_Alshehri/publication/280570975_Medical-Surgical_Nurses'_Experiences_of_Calling_a_Rapid_Response_Team_in_a_Hospital_Setting_A_Literature_Review/links/55bac3ba08ae092e965db024/Medical-Surgical-Nurses-Experiences-of-Calling-a-Rapid-Response-Team-in-a-Hospital-Setting-A-Literature-Review.pdf

Arnold, E. C., & Boggs, K. U. (2015). Interpersonal Relationships-E-Book: Professional Communication Skills for Nurses. Elsevier Health Sciences. https://books.google.co.in/books?hl=en&lr=&id=7DAxBgAAQBAJ&oi=fnd&pg=PP1&dq=effective+communication+in+healthcare&ots=uYuER4yBZo&sig=fiP_EbLlSZG-YoQYHstJyb47G6s#v=onepage&q=effective%20communication%20in%20healthcare&f=false

Austin, E. W., & Pinkleton, B. E. (2015). Strategic public relations management: Planning and managing effective communication campaigns. Routledge. https://content.taylorfrancis.com/books/download?dac=C2011-0-16798-X&isbn=9781317625308&format=googlePreviewPdf

Brunero, S., Buus, N., & West, S. (2017). Categorising patients mental illness by medical surgical nurses in the general hospital ward: A focus group study. Archives of psychiatric nursing. https://doi.org/10.1016/j.apnu.2017.09.003

Constand, M. K., MacDermid, J. C., Dal Bello-Haas, V., & Law, M. (2014). Scoping review of patient-centered care approaches in healthcare. BMC health services research, 14(1), 271. https://doi.org/10.1186/1472-6963-14-271

Davis Boykins, A. (2014). Core communication competencies in patient-centered care. ABNF Journal, 25(2). https://web.a.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=10467041&AN=95591070&h=FX4dUlH5mDpdc%2fzts4dy0zUhP4XWcVdBPIlzqeTegDreaZEq97Fpyt02luhu%2f2Mbl1asMPk2ojqIKAZwu6cJEQ%3d%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d10467041%26AN%3d95591070

Haines, T. P., O’Brien, L., Mitchell, D., Bowles, K. A., Haas, R., Markham, D., ... & Lescai, D. (2015). Study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder-driven model for acute medical/surgical patients versus no weekend allied health services. Trials, 16(1), 133. https://dx.doi.org/10.1136/bmjqs-2014-003764

Härkänen, M., Ahonen, J., Kervinen, M., Turunen, H., & Vehviläinen?Julkunen, K. (2015). The factors associated with medication errors in adult medical and surgical inpatients: a direct observation approach with medication record reviews. Scandinavian journal of caring sciences, 29(2), 297-306. https://doi.org/10.1111/scs.12163

Hsu, L. L., Chang, W. H., & Hsieh, S. I. (2015). The effects of scenario-based simulation course training on nurses' communication competence and self-efficacy: a randomized controlled trial. Journal of Professional Nursing, 31(1), 37-49. https://doi.org/10.1016/j.profnurs.2014.05.007

O'hagan, S., Manias, E., Elder, C., Pill, J., Woodward?Kron, R., McNamara, T., ... & McColl, G. (2014). What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients. Journal of advanced nursing, 70(6), 1344-1355. https://doi.org/10.1111/jan.12296

O'Halloran, R., Worrall, L., & Hickson, L. (2015). Environmental factors that influence communication between patients and their healthcare providers in acute hospital stroke units: an observational study. International journal of language & communication disorders, 1-18. https://www.tandfonline.com/doi/abs/10.3109/13682821003660380

Quilligan, S. (2015). Learning clinical communication on ward-rounds: An ethnographic case study. Medical teacher, 37(2), 168-173. https://doi.org/10.3109/0142159X.2014.947926

Sacks, G. D., Shannon, E. M., Dawes, A. J., Rollo, J. C., Nguyen, D. K., Russell, M. M., ... & Maggard-Gibbons, M. A. (2015). Tea https://dx.doi.org/10.1136/bmjqs-2014-003764

Schorr, C., Odden, A., Evans, L., Escobar, G. J., Gandhi, S., Townsend, S., & Levy, M. (2016). Implementation of a multicenter performance improvement program for early detection and treatment of severe sepsis in general medical–surgical wards. Journal of hospital medicine, 11, S32-S39. https://doi.org/10.1002/jhm.2656

Sonke, J., Pesata, V., Arce, L., Carytsas, F. P., Zemina, K., & Jokisch, C. (2015). The effects of arts-in-medicine programming on the medical-surgical work environment. Arts & health, 7(1), 27-41. https://doi.org/10.1080/17533015.2014.966313

Sonntag, O., Plebani, M., Della, P., Jones, D., Steward-Wynne, E., Walsh, J., ... & Lee, M. (2016). Effective communication in clinical handover: from research to practice(Vol. 15). Walter de Gruyter GmbH & Co KG. https://books.google.co.in/books?hl=en&lr=&id=JJrUCwAAQBAJ&oi=fnd&pg=PR5&dq=effective+communication+in+healthcare&ots=tsQVu2V0OX&sig=lCy36GUylP48zFAIl5C0hH6USXQ#v=onepage&q=effective%20communication%20in%20healthcare&f=false

Stanyon, M. R., Griffiths, A., Thomas, S. A., & Gordon, A. L. (2016). The facilitators of communication with people with dementia in a care setting: an interview study with healthcare workers. Age and ageing, 45(1), 164-170. https://doi.org/10.1093/ageing/afv161

Walczak, A., Butow, P. N., Bu, S., & Clayton, J. M. (2016). A systematic review of evidence for end-of-life communication interventions: who do they target, how are they structured and do they work?. Patient education and counseling, 99(1), 3-16. https://doi.org/10.1016/j.pec.2015.08.017

Weller, J., Boyd, M., & Cumin, D. (2014). Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgraduate medical journal, 90(1061), 149-154. https://pmj.bmj.com/content/90/1061/149?utm_source=trendmd&utm_medium=cpc&utm_campaign=pmj&utm_content=consumer&utm_term=0-A

Yngman?Uhlin, P., Klingvall, E., Wilhelmsson, M., & Jangland, E. (2016). Obstacles and opportunities for achieving good care on the surgical ward: nurse and surgeon perspective. Journal of nursing management, 24(4), 492-499. https://doi.org/10.1111/jonm.12349

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