Molly Melton

BACKGROUND:

 

I have learned in my Evolution of Nursing Science (NURS 212) class that communication is the interactive sharing of information. As was stated in my second key insight, “Overcoming Your Fear of Speaking,” having good communication skills are essential in both completing an education and succeeding in a career. As I go into the medical profession, I understand it is essential to be able to communicate with patients, patients’ families, and my health care team. This skill is very important in a hospital setting where more than one physician and nurse are caring for one patient. In addition, if a patient has to stay in the hospital for a long period of time, there are multiple shift changes leading to more than one team providing for a patient during the duration of the stay. According to Joseph Catalano (2015), successful communication is recognized as the foundation of the medical practice. Effective communication is fundamental for developing patient relationships leading to more accurate patient evaluations and diagnoses. Communication is also an important aspect of patient treatment and patient safety. A nursing professor of mine stated that she believes the power of communication can heal a patient more than medicine sometimes. A medical professional’s ability to communicate with, explain to, listen to, and empathize with a patient can have a great effect on patient satisfaction and quality of care.

 

 

 

 

 

 

 

 

THE ISSUE: POOR COMMUNICATION IN A HOSPITAL SETTING:

 

Published research from CRICO Strategies found that poor communication contributed to 7,149 of the 23,000 medical malpractice claims filed between the years of 2009 and 2013 including 1,744 deaths (Budryk, 2016). Why has poor communication between health care professionals become such a big problem?

 

My town’s hospital is Piedmont Medical Center (PMC). I have had numerous experiences in this hospital and have had four women in my family work for Piedmont as well. PMC has never had a great reputation in Rock Hill, SC, because of a number of errors that have occurred. For example, in March of 2007, when a 73-year-old man was in the operating room for cardiac surgery, miscommunication between a surgeon and one of his assistants resulted in the man being given the wrong medication. He died soon after on the operating table (“SC Wrongful Death”, 2007). Piedmont could improve its quality of care immensely by improving the communication used by health care professionals. My mother, who was an emergency room nurse at PMC, stated that she does believe that communication in Piedmont is improving but there is still much improvement needed. 

 

According to the book Nursing Now!, a major factor of poor communication in the medical field is the environment (Catalano, 2015). Hospitals have in-groups, groups of people that closely associate themselves with the people in their groups. The in-groups can lead to in-group bias which sociologists describe as a group of people who consider themselves superior to all others (Schaefer, 2013). According to an emergency room nurse at PMC, an in-group bias between the intensive care unit (ICU) and the critical care unit (CCU) nurses has always existed. She stated that ICU nurses have always considered themselves better and more qualified than the CCU nurses, which created a negative environment at Piedmont. Not only does a negative environment create a distraction from proper medical care, but it leads to poor communication between the workers as well.

 

A problem I have encountered myself is some college nursing programs do not emphasize the importance of communication in health care and do not educate college nursing students on proper health care communication. Being in the four-year nursing program at USC Lancaster, I was required to take a public communication course where I was taught proper speaking skills to use during presentations and debates. Even though I did develop useful skills and confidence in my speaking abilities, I did not learn specifics to help me in the health care field. Furthermore, starting fall of 2017, the nursing curriculum at USC Lancaster will no longer require a speech course. Speaking with a professor of the four-year nursing program about the issue, she stated that years ago at USCL there was a communication course that offers students the opportunity to understand closed-ended questions and open-ended questions and how to establishing a good rapport among the nurse and patient. She stated that communication is the key to healthcare and that the previous communication course was very beneficial to the nursing program.

 

According to Joseph Catalano (2015), poor communication can develop from a person’s fear of change. This relates to another factor contributing to poor communication at Piedmont, the transition from paper to technology. Previously, all patients had paper charts, in which all medical information were written on these papers. Now Piedmont uses COWs, computers on wheels, as patients’ new “charts”. All medical information is now stored on these computers. When speaking to a nurse from PMC, she stated that converting to COWs has helped communication because you are not having to depend on handwriting. The problem with COWS is that many Piedmont hospital employees did not grow up in the age of technology, including my mother, and have a hard time understanding how the COWs operate. If medical professionals do not understand how to use the technology then he or she cannot input the proper medical code or may not input the correct information in the computer for doctors. According to a survey given to nurses by the West Health Institute, 71 percent of the nurses who participated would not go back to paper records and 72 percent of nurses feel that this technology reduces medical errors. But approximately one out of every two nurses who participated stated that they notice medical errors that occurred due to poor integration of the technology systems (“Misuse of EHR systems,” 2015). If health care providers do not like change and do not like technology then he might be hesitant to input the proper medical procedures. This incorrect information could lead to miscommunication between care providers and cause medical errors. 

 

Texting is another technological issue leading to improper communication at Piedmont. The younger generations, including me, have become “addicted” to their cells phones. I know personally when I forget my phone at home I panic and have the worst day. I also prefer texting over calling someone. I have become so accustomed to texting that I do not feel comfortable talking to some people face-to-face. Being reluctant to talk to someone could lead to major problems in the hospital setting. Cell phones and texting are discouraging communication with other health professionals. Piedmont even has cell phones for their faculty to use specifically for work. If a care provider uses “text speech” in a message sent to a doctor and he does not understand what the provider is saying, a medical error could potentially occur.

 

 

 

 

GENERAL RECOMMENDATIONS:

 

An early solution to help improve communication skills at PMC is education. A lot of new Piedmont employees come from USC Lancaster because the Lancaster campus has the closest four-year nursing program and Piedmont is a major clinical site for USCL. If the importance of communication skills are taught and emphasized throughout the college years, students are more likely to practice the skills during labs, clinical, and even in classes between fellow nursing students. Eventually, the skills will become habitual and common practice. As more nurses graduate and begin their professional careers, more nurses will know proper health care communication and can teach their colleagues.

 

A college nursing student can be taught proper health care communication, but if he works in an environment where workers do not practices proper communication, the skills might be quickly lost. PMC’s medical faculty is required to complete continuing education classes (CECs) every year to stay up-to-date on their medical knowledge. If the professionals are required to take classes to stay up to date on health care, they should also be required to complete a set number of health care communication specific CECs yearly to stay up to date with medical communication. The CECs should demonstrate to the medical professionals how communication can greatly improve health care environments and the quality of health care. The classes should include appropriate medical terms to use in a hospital so professionals use a common language and will understand each other. The classes should also include terms to use when communicating with patients and patients’ families so this information is better understood.

 

Another way to improve communication between the Piedmont employees is to create gatherings for the faculty to bond and interact with each other. Piedmont has group exercises that take place in their facilities but sometimes the exercises can feel forced and some people want to go home to get away from work. Gatherings outside of the hospital would be more effective for improving bonding. Many workplaces, including USC Lancaster, have evenings where the professors go have dinner with each other for the purpose of being social. I have heard from professors how the gatherings have helped professors in STEM majors develop stronger relationships with the Humanities faculty at USC Lancaster. Despite teaching in very different disciplines, the professors are able to learn about and respect each other’s scholarly work and gain positive relationships between them through this bonding. I was having a conversation with a former Piedmont registered nurse and she explained to me her experience where a doctor at Piedmont invited her and some other hospital faculty out to dinner every week. She stated that this experience was very enjoyable and she felt that she really bonded with and got to know her co-workers on a more personal level. If Piedmont employees were required to attend scheduled bonding times, they will have the opportunity to interact with each other and get to know each other in a more positive and relaxing environment, leading positive relationships. The positive bonds made can help diminish in-groups and the bias that comes with them. Diminishing the in-groups will lead to a better work environment and make communication easier and more effective for all of the professionals.

 

 

 

 

THE IMPLEMENTATION: 

 

1. I interviewed two of the nursing professors and advisors at USC Lancaster about integrating communication classes into the USC Lancaster nursing program. Both professors spoke about how beneficial a health care communication class would be. In order to try and persuade the USC school system that the nursing curriculum should include a health care specific communication class I will present a proposal.

 

In my proposal I will include:

• The issue of improper health care communication by using examples from Piedmont Medical Center. I can even expand by using examples from hospitals such as Springs Hospital and Carolinas Medical Center.

• Testimonies from Piedmont medical professionals and USC Lancaster professors about their views on communication and the problems with it.

• An explanation of how introducing health care specific speech classes will help address problems with health care communication and the curriculum that should be included in these classes. For example, students will learn the importance of communication, how it can affect the quality of care and satisfaction for a patient, and how it can affect the work environment in general. The students will also learn how to properly speak to a physician or co-worker and the proper terms that should be used. In addition, the students will learn how to speak to patients and patient families as well in terms that are professional but are clearly understood by those not in the health care field.

• Suggested changes to the Nursing curriculum. For my coursework, I was required to take a fine arts elective credit which is not necessary for the nursing curriculum. I will propose taking the art requirement out of the curriculum and adding a health care speech class. The current nursing professors would be eligible to teach this course.

 

I will present my proposal to the professors, advisors, nursing directors and coordinators, and anyone included in the nursing program in the USC system at a large gathering. I will hold the gathering in Hubbard Hall at USC Lancaster in a room that allows 2-way video so other faculty who cannot make it to Lancaster can still interact in the meeting.

 

2. Based on an interview with an employee at PMC, employees are required to take continuing education courses but none of the courses are communication specific. I did some research online trying to find the best site for continuing education courses strictly on communication. I found a website called Medline University. Medline is a continuing education website for medical professionals that offers over 250 free online courses.

 

Some of the courses include:

 

• Handoff Communication

• Create a Safer Patient Environment through Communication and Team Building

• Communications: The Process and Between Generations

• Communications: Nurse-Patient Relationships

• Understanding Communications in a Culture of Change

 

 

The courses above are just a few of the many courses Medline offers. Each course takes about an hour to complete.

 

To introduce Medline to PMC I will write a proposal including:

 

• An explanation of the problems related to poor communication skills at Piedmont and give examples and statistics to prove my point.

• An introduction to Medline’s FREE course and even take the audience partially through a course so they can experience the course for themselves.

• A suggestion that PMC employees take Medline communication courses at least once a year, if not twice, and observe if the courses help with communication in the work field.

 

After completing my proposal I will schedule two different meetings at Piedmont so as many faculty as possible are able to attend, including board members. At the meeting, I will then propose the courses as solutions to poor communication skills.

 

3. Piedmont should provide their employees with a survey that asks questions regarding their preferences for team building activities. The surveys should include a comments section where employees can list specific places and give restaurants that they prefer or recommend. The surveys should also ask questions about how he or she feels about the current work environment, their relationships with co-workers, and other co-worker relationships that he or she has observed. The administration at Piedmont should carefully review the results of the surveys and begin to consider how improvements can be made. I would suggest that PMC plan two different group bonding experiences a month based on survey suggestions and require all hospital employees to attend at least one gathering per month. The bonding experiences will help build relationships between co-workers and help create a more positive environment in the hospital. With positive relationships and a positive environment, co-workers are more likely to speak to each other and have better communication patterns. The workers are also more likely to be in better moods and be more willing to communicate more effectively. 

 

4. Lastly, I will propose that PMC creates a form for hospital employees to address their concerns with workplace stress, communication, and the general environment. The form should include a space to voice the problem and a space for possible solution suggestions. There should be a locked box in the break room with these forms to give the Piedmont faculty a private opportunity to voice their concerns. Managers should unlock and check the box weekly while also being confidential of all information. If these concerns can be addressed immediately, it might improve the work environment which will also create more positive communication.

 

 

 

 

EVALUATION:

 

1. Surveys will be a major part of my evaluation. If my proposal for health care specific communication courses in the USC system goes through, hopefully, courses would be implemented in the fall of 2019 nursing curriculum. I would like for juniors to take the course because the students will have had some nursing education in their first two years of college. On the first day of class, surveys will be given to both professors and students.

 

The student survey will include things such as:

 

• On a scale of one to ten, how do you feel about your ability to explain a medical diagnosis to a patient in a way the patient would understand?

• On a scale of one to ten, how do you feel about your ability to educate a patient on his or her treatment in a way the patient would understand?

• On a scale of one to ten, how do you feel about your ability to communicate properly with health professionals?

• And ask multiple choice questions such as medical terms to determine if they know the proper medical terminology.

 

The professor survey will include questions such as:

 

• On a scale of one to ten, are nursing students educated enough to communicate properly with other medical professionals?

• On a scale of one to ten, are nursing students educated enough to communicate properly with patients?

• Do you think a communication course will be or was beneficial to nursing students?

 

At the end of the course semester, I will pass out the same surveys to both the students and the professors teaching. I will compare the pre-course surveys and post-course surveys to determine if the class was beneficial. I will gather the student's contact information and after a 4 year run through of requiring the communication course, I will email all the USCL students involved to ask if he or she feel as if the class was beneficial in their medical career thus far. 

 

2. If my proposal for requiring communication CECs at Piedmont was approved, I will require all faculty take two different communication courses, one every six months. I will require the employees to print out forms of completion to be put on file. After a year of taking the required courses, I would give the involved employees a survey.

 

The survey would include questions such as:

 

• Do you believe the communication CECs program was successful?

• Did you learn skills you did not know before?

• Should the program stay a requirement?

• Do you have any comments or suggestions?

 

I would give the survey out every year and after a four year period, determine if it was successful or should be discontinued.

 

3 & 4. After a year of Piedmont, employees attend monthly group bonding experiences I will again hand out surveys to the employees involved. 

 

The survey would include questions such as:

 

• Do you feel that having bonding experiences with employees outside of work has improved your relationships with co-workers? 

• Do you feel more comfortable communicating and interacting with coworkers, specifically during shifts?

• Have you noticed a change in the work environment and communication between personnel after a few months of the required bonding experiences? Has it become more positive? No change?

• Do you believe the bonding experiences should continue to be required or discontinued?

• Do you have any comments or suggestions regarding the gatherings?

• Does having a lock box in the break room encourage you to speak up more about work environment problems?

• Do you feel comfortable contributing to the lock box?

• Do you believe that it has helped the working environment and made it easier to communicate with co-workers?

• Do you have any comments or suggestions regarding the lock box?

 

After a four year period of requiring the bonding experiences and having a lock box, I will decide if they were successful or should be discontinued.

 

After just a year of surveys, communication is not going to be greatly improved but will be a gradual process. That is why I decided to survey at the end of each year and have each solution be a four year run through. If the implemented solutions are successful in improving communication at Piedmont Medical Center then I will create a presentation to present to other hospitals and surrounding colleges. I will explain to the audience the process I went through to suggest the changes, how the changes were implemented, how the changes were evaluated, and the success.