Communication in the Healthcare Environment – It’s all About the Behavior

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Communication in the healthcare environment can be very challenging amongst healthcare providers especially in the high tech world that is now commonplace. Clear, effective, timely communication and teamwork is essential to provide quality, safe patient care, for better outcomes. One might ask why communication plays such an important role in providing safe care. Well, when the interdisciplinary, multidisciplinary teams (for example, nurses, doctors, therapists, and pharmacists) do not communicate effectively patient safety is at risk. There are many factors that affect communication in the healthcare environment. What is the link between communication, behavior, and patient safety?

Patient safety is vital, the patient is at the center of and central to everything we do in healthcare and any risk factors must be mitigated, eliminated. Many believe that communication is more verbal than non-verbal and that is not the case. Verbal communication accounts for approximately seven percent of communication with non-verbal the remaining ninety three percent. What we convey with our body language and expression tells more of a story than the verbal aspect. How we carry on a conversation is shaped by many factors including our cultural upbringing, education, personal and professional experiences, the situation at hand or topic of conversation, recipient, and most of all our behavior. As well, how we are feeling, our attitudes and behavior, the many work stresses, and external distractions can make navigating the channels of communication even more difficult. These distractions come in the form of cell phones ringing, pings of text messages, monitors beeping, patient call lights, equipment alarms, and multiple conversations and interruptions around us as we multi-task in this busy environment. With the increased use of electronics and technology the art of clear effective communication, the person to person verbal conversation seems to be lost. So how do we converse clearly, communicate effectively in the healthcare environment?  How do we get the message across the way it is intended in this dynamic environment?

First, we should do a “self-check” of our behavior, how are we feeling today.  Perception is the key. If we are upset, anxious, tense, angry, rushed, or distracted it will manifest in how we communicate, our body language, and the message being conveyed, how it is received. The intended message may be unclear and/or misconstrued by the recipient. If we come to work upset, then the start to our day will be rocky, we are unable to pay attention to the details that is key in recognizing a change or potential change in patient condition. We must be fully present, gather our thoughts, refocus and think about the situation at hand. What is it that you are trying to communicate to the other person(s)? Shift your focus on delivering your intended message clearly and concisely and be prepared to answer clarifying questions.  Taking a few moments to “self-check” and refocus on the situation, person, or task at hand will be beneficial in delivering the “right” message at the “right” time with the “right” (best) outcomes.

A seasoned nurse mentor shared this advice a long time ago and this was to leave my home issues, personal stresses and challenges at the door before entering my work environment and practice being fully present for my patient. Essentially, when I enter my work-place and clocked in I was ready mentally and emotionally for my work day, whatever that day may turn out to be. Starting your shift off on the “right note,” being fully present means you will actually “hear” what is being verbally communicated to you in bedside shift report. Being fully present will facilitate being able to “see” your patient and the surroundings, the lines, tubes, drips, and medical equipment, conducting your quick safety check to ensure patient safety.  Own your practice and exercise full responsibility for the patients being entrusted in your care. I have taught nursing students this strategy as paying attention to details, asking clarifying questions, validating and verifying what is communicated in hand-off report and performing a quick initial safety check so there are no surprises (patient safety risks). The reality is if you are working on a busy medical/surgical or specialty unit it may be thirty minutes to an hour later by the time you get back to your patient. This strategy supports patient safety, quality of care initiatives, and better outcomes that we must strive to achieve one hundred percent of the time. This is all learned behaviors that will get easier because the more it is practiced the better you will be and it becomes part of your daily routine. 

A long time ago, I also learned as a critical care nurse that de-stressing on my way home from work was beneficial, the journey (whether driving or taking public transportation) allowed me to be in a better frame of mind to assume my role as wife and mother. I used reflection, what is known in the evidence-based literature and encouraged as reflective practice, a strategy for learning from your practice which also builds our internal resilience, enhances our coping skills. I think about my shift, mull over the events, what went wrong, what went right, what I could have done better if I had the time and staffing assistance. This is my version of “self-debriefing” of my day or night-shift. I used to “beat up on myself” all the time and had to learn to come to terms with the things I did not do “right,” had no control over, or could have done better.  By doing this I am giving myself permission to learn and to let it go, tomorrow is a new day to get it right or better. As nurses we have all done this at some point in time and I am sure many still do.

Secondly, think about your style of communication. I think of communication as individual, it is all about the behavior and level of emotional intelligence. There are many different styles of communication and the styles will vary according to the situation, person(s), actions, perceptions, and reactions of all involved. You will not converse with your boss the same way as your peer, friend, patient or family member. Take some time to explore how you are at baseline when all things are calm and going well at work (quiet days), then think about your reactions to the constantly changing situations in the work environment. This also requires considering the recipient’s level of education and understanding. How do you react to your co-workers, members of the interdisciplinary and multidisciplinary team? What are your expectations of team members for example, involved in multidisciplinary patient care rounds? If we have too high expectations, we need to be considerate of the environment, persons, situation and compromise in order to collaborate effectively as a team.  This is when we need to remind ourselves who is important here, it is the patient, and leave our high expectations and ego out of the equation. If you find you are annoyed by others’ behavior during meetings or rounds, take a moment to do a mental self-check, perhaps it is you, your expectations that may need readjusting to fit with the team or situation around you in order for collaboration to work. How you communicate and what is being communicated should be tailored according to the situation and persons involved. Effective, clear communication is said to be achieved when the message is received, understood by the recipient the way it is intended.

As healthcare givers we are accountable and responsible for the care we provide. How we deliver that safe care is dependent largely on our behaviors, practice, communication, thought processes, and decision-making, as well as collaborative teamwork with the interdisciplinary and multidisciplinary teams. We are expected to perform and behave respectfully and professionally at all times regardless of the situation. Try to school your personal (home) issues into the background (recesses of your mind) so that when you enter your work environment you are ready to give your full attention. Try to bring the best version of yourself to work every day.  All you can do is try, make a conscious effort and soon this commitment will become habit. None of us are perfect and we should view every day as a new day to keep trying, an opportunity to do better, in providing the best possible safe nursing care to our patients.

By Dr. Reezena H. Malaska, DNP, MSN, RN, CCRN

Critical Care Educator, Instructor, Author, Mentor, Coach

Jan 15, 2019

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