Executive Summary
Purpose: The purpose of this project was to discover a way to facilitate effective communications between nurses, patients, and their family members, leading to better outcomes. To that end, it was decided to implement an educational program that would improve nurses’ communication skills through role modeling and simulation rounds. The improvements sought included shortened length of stay and higher patient satisfaction.
Project Location: Due to the lockdown measures introduced in response to the COVID-19 pandemic, this project was conducted at a virtual hospital. This hospital was a comprehensive multidisciplinary health care unit incorporating primarily U.S.-based medical professionals. The participating patients were treated and monitored remotely using telemedicine.
Synthesis of Literature and Evidence: The existing literature is unanimous on the role of successful communications in patient outcomes. In particular, the quality of nurse-patient communications has been demonstrated to influence the length of stay and patient satisfaction. This project’s findings add to the body of evidence for the effectiveness of role modeling and simulations in training nurse communication skills.
Implementation: This project used the Johns Hopkins Nursing Evidence-Based Practice model to implement a learning change. Instructors developed an educational program based on role modeling and simulations. Nurses were assigned weekly 30-minute simulation rounds followed by debriefings. Results were assessed based on the length of stay changes and patient feedback.
Dissemination: The project results were disseminated among its stakeholders, including nurses, other medical professionals, and the public. Findings were communicated to health care practitioners, managers, and advocates through a formal presentation with an online version. The highlights of the research were relayed to the public through a poster presentation.
Data Collection to Support Outcomes
Correctly assessing the effectiveness of the chosen approach requires evaluating the relevant data before and after the intervention. The two critical data sets for this project are lengths of stay and patient satisfaction. The length of stay statistics for the patient test and control groups will be gathered from hospital records. Patient satisfaction will be measured using surveys consisting of ranking and open-ended questions focused on the quality of nurse interactions. The surveys and collected data will be entirely anonymous to protect the patients’ privacy, allowing the rest of the information to be shared (Portney, 2020). By triangulating quantitative length of stay data with qualitative patient feedback, the researchers should be able to form a comprehensive picture of the problem’s scale before the intervention (Polit & Beck, 2017). Similarly, the changes in those data sets by the end of the project will be used to gauge its success.
Evaluation
After the end of the three-month intervention, the project’s effectiveness was assessed based on the relevant criteria. Due to the proven influence of communications interventions on that metric, length of stay indicators provided the principal quantifiable criterion for evaluating the project’s effects (Wocial et al., 2017). The patient test group has shown a significant reduction in the average length of stay over the intervention period compared to the rest of the hospital’s patients. This result reflects superior nurse-patient communications leading to more rational decision-making by patients and family members and more effective treatment by the staff. Furthermore, ranking surveys of the test group have demonstrated a marked improvement in patient satisfaction with the level of care received, especially the quality of patient-nurse communication. The elevated sense of patient satisfaction stems from objective improvements of care on top of better subjective experiences with nurses. It can be seen that the intervention has fully reached its goals.
Incorporating the feedback of stakeholders such as patients, their family members, nurses, and other health care system participants has been essential for attaining this outcome. Patient surveys have the additional function of providing actionable input on the effectiveness of the programs. Nurse feedback has been collected through discussions during round debriefings and at the project’s end. The opinions of other hospital staff and patients’ family members have also been solicited throughout the intervention. A critical finding from this input, consistent with prior evidence, has been the insufficiency of role modeling for improving communications (Feraco et al., 2016). It caused a change of strategy to place a greater emphasis on the specific learning needs of nurses and evidence-based simulations. Patient feedback also helped nurses identify and overcome cultural obstacles to effective communications (Crawford et al., 2017). By utilizing input from different sources, it was possible to adjust the intervention in real-time.
The effects of the project’s success extend beyond the original problem of nurse-patient communications to the functioning of the hospital’s health care system and future nursing research. Communication improvements made nurse-patient interactions more efficient, directly improving patient outcomes such as length of stay and patient costs (Curtis et al., 2016). By fostering productive relationships based on mutual trust, they also had a notable effect on both patient satisfaction and nurse job satisfaction, further enhancing nurse performance (Dittman & Hughes, 2018). The hospital as a whole benefits from increased efficiency, decreased strain on resources, and improved patient satisfaction leading to a higher number of repeat and referred customers. Avenues for further research suggested by the project include more in-depth studies on different simulation methods and the feasibility of their closer integration with systematic role modeling. It may also be possible to extend the experience gained from this intervention to other areas of nurse communications, such as interactions with other health care professions.
The final assessment of the intervention’s effectiveness must factor in a cost-benefit analysis. Although simulation training programs can be costly, much of the expenditure goes towards equipment and regular procedures repeated over a long period (Hippe et al., 2020). A one-off three-month training program focused on communication skills should cost approximately $225 per participant (including development and implementation). Paper surveys cost approximately $12 per patient, whereas electronic surveys, preferable for most patients in the virtual hospital setting, cost $9 (Mukasa et al., 2017, p. 5). This estimate includes the costs of material development, testing, data entry, and personnel salaries. Making the program ongoing or involving more participants would increase costs in accordance with the scale of the change. Since simulation rounds will only take an hour a week for each participant, their drain on overall nurse work efficiency should be negligible. The benefits of heightened efficiency in nurse-patient communications, treatment, resource use, and patient turnover should be more than compensate for the intervention’s costs.
Dissemination
The sustainability of the evidence-based improvement hinges on the use of effective dissemination practices. Upon the project’s completion, its results will be communicated to key stakeholders through a conference presentation. A formal oral presentation aimed at health care professionals, advocates, and managers, will be followed by a poster session relaying the highlights to the general public, including patients and their families. The findings will also be publicized through an open-access online article for ease of referencing and continuous dissemination (Polit & Beck, 2017). Special care must be taken to clearly communicate the intervention’s concept, goal, methods, stages, and results to all interested parties (Hailemariam, 2019). If this is done, it will be possible to implement similar programs at other health care units while repeating it at the original hospital. Given the low costs of the intervention, it appears feasible to expand it to cover other nurses at the health care unit and repeat it on an annual basis. Annual three-month training would prevent skill decay and ensure that new nurses will also benefit from the intervention.
Conclusions and Contributions to the Profession of Nursing
The project was meant to determine whether regular simulation and role modeling rounds could improve nurse-patient communications, leading to a reduction of length of stay. Evidence shows that effective communications can lead to better patient outcomes (Wocial et al., 2017). The intervention’s results have demonstrated the efficacy of simulation training and role modeling for enhancing nurse communication skills (Blake & Blake, 2019; Bussard & Lawrence, 2019). While role modeling alone may have been insufficient, it has proven more effective within a systematic framework focused on simulation (Feraco et al., 2016). The relatively low requirements of the intervention have ensured the feasibility of its initial implementation and subsequent expansion (Hippe et al., 2020). The long-term sustainability of the project’s results depends on the clear and accessible dissemination of its parameters, along with the creation of an annual training program (Hailemariam et al., 2019). The project has thus confirmed the effectiveness of its simulation-based approach to nurse communication skill training, paving the way for this strategy’s further elaboration and use in different scenarios.
References
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Bussard, M. E., & Lawrence, N. (2019). Role modeling to teach communication and professionalism in prelicensure nursing students. Teaching and Learning in Nursing, 14(3), 219-223. Web.
Crawford, T., Candlin, S., & Roger, P. (2017). New perspectives on understanding cultural diversity in nurse-patient communication. Collegian, 24(1), 63-69.
Curtis, R., Treece, P. D., Nielsen, E. L., Gold, J., Ciechanowski, P. S., Shannon, S. E., Khandelwal, N., Young, J. P., & Engelberg, R. A. (2016). Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care. American Journal of Respiratory and Critical Care Medicine, 193(2), 154-162. Web.
Dittman, K., & Hughes, S. (2018). Increased nursing participation in multidisciplinary rounds to enhance communication, patient safety, and parent satisfaction. Critical Care Nursing Clinics of North America, 30(4), 445-455. Web.
Feraco, A. M., Brand, S. R., Mack, J. W., Kesselheim, J. C., Block, S. D., & Wolfe, J. (2016). Communication skills training in pediatric oncology: moving beyond role modeling. Pediatric blood & cancer, 63(6), 966-972.
Hailemariam, M., Bustos, T., Montgomery, B., Barajas, R., Evans, L. B., & Drahota, A. (2019). Evidence-based intervention sustainability strategies: a systematic review. Implementation Science, 14(1), 57.
Hippe, D. S., Umoren, R. A., McGee, A., Bucher, S. L., & Bresnahan, B. W. (2020). A targeted systematic review of cost analyses for implementation of simulation-based education in healthcare. SAGE Open Medicine, 8, 2050312120913451. Web.
Mukasa, O., Mushi, H. P., Maire, N., Ross, A., & de Savigny, D. (2017). Do surveys with paper and electronic devices differ in quality and cost? Experience from the Rufiji Health and demographic surveillance system in Tanzania. Global health action, 10(1), 1387984.
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Wolters Kluwer.
Portney, L. (2020). Foundations of clinical research: Applications to evidence-based practice. F.A. Davis Company.
Wocial, L., Ackerman, V., Leland, B., Benneyworth, B., Patel, V., Tong, Y., &Nitu, M. (2017). Pediatric ethics and communication excellence (PEACE) rounds: Decreasing moral distress and patient length of stay in the PICU. HEC Forum, 29, 75-91.