Introduction and Problem Identification
It is impossible to imagine a competent medical system without adequate communication. Medical institutions whose leaders promote effective communication among their followers find it easier to solve emerging challenges and improve patient outcomes. Thus, the purpose of this project is to explain how to achieve effective communication between nurses, patients, and their family members, leading to better outcomes. The project will present background information on the issue, literature review, and proposed action plan.
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The problem statement is articulated with the help of the Johns Hopkins Question Development Tool as the guide (Johns Hopkins Hospital, n.d.). Effective communication is significant because it allows nurses to provide their patients with information on their health, treatment methods, and preventive measures. Furthermore, nurses should also address family members to contribute to better outcomes. If a medical establishment does not have effective communication strategies, possible issues are likely to emerge. It is a clinical problem with an educational focus that can result in effectiveness concerns, unsatisfactory patients, and variation in practice. The challenge of ineffective communication still remains a significant problem in different units. Thus, it is necessary to formulate a PICO question and conduct a literature search to identify the most suitable solutions. The initial EBP question is whether effective communication between nurses, patients, and their family members can make a difference regarding the length of stay.
When individuals are unable to cooperate and pursue a common goal, the chances are high that they will ignore the effectiveness of the established care procedures and create room for medication errors. Portney (2020) argues that poor communication remains one of the major causes of poor health outcomes and preventable deaths in different medical facilities. Furthermore, Tulsky et al. (2017) admit that “poor communication by health care professionals contributes to physical and psychological suffering in patients” (p. 1361).
This project involves several stakeholders whose roles can be instrumental in changing the situation. The first category of stakeholders is that of all medical professionals whose goals and experiences depend on the nature of communication. The second group is comprised of patients and community members who expect to receive high-quality services from their respective health units. Finally, medical units can also suffer from ineffective communication because unsatisfied patients can create a negative image of the health care establishment.
The PICO(T) question formulated for the project is clear and concise. In hospitalized patients suffering from infection diseases (P), does creating regular simulation and role modeling rounds to contribute to communication excellence between nurse, patient, and family to discuss patient health status and progress (I), compared with irregular patient status reports (C), allow for better communication and increase the quality of care by reducing the length of stay (O) within the admission period (T)? This articulation stipulates that the proposed search terms include nursing, patient, and communication. The terms and the year of publication form the basis of a search strategy to use. The given question reflects the current evidence because it addresses a topical issue. Finally, the PICO(T) question shows that the project is aimed at determining how and whether education communication can contribute to a shorter duration of stay among hospital patients.
Review of Literature
At this stage, it is necessary to find literature that can answer the question above. It was decided to look for the articles in the ScienceDirect, PubMed, Springer Link, and NCBI databases, and ten suitable studies have been found. The Johns Hopkins Individual Evidence Summary Tool demonstrates the analysis and the reliability of the sources (Johns Hopkins Hospital, n.d.). The following information will show how it is possible to address the problem under consideration.
On the one hand, one should state that ineffective communication between nurses and relatives of patients can result in sadness, anger, and anxiety (Chan, 2017). Furthermore, Crawford et al. (2017) argue that cultural differences resulting in communicating inefficiencies can lead to adverse outcomes. At the same time, numerous patients admit that they appreciate the attention paid to them by nurses Chan et al. (2018). On the other hand, Curtis et al. (2016) stipulate that communication facilitators decrease family distress and reduce hospital length of stay. Furthermore, Wocial et al. (2017) also mention that effective communication is associated with reduced length of stay. That is why the following articles will explain how it is possible to improve nurses’ communication skills.
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Blake and Blake (2019) and Bussard and Lawrence (2019) mention that nursing lab simulation and role modeling are a sufficient way to increase nurses’ communication skills. Donovan and Mullen (2019) stipulate that simulation programs result in higher nurses’ confidence while working with patients. In addition to that, Bullington et al. (2019) state that a phenomenologically-based communication training approach helps nurses train communication skills. Finally, Dittman and Hughes (2018) also say that nursing participation in multidisciplinary patient rounds increases communication proficiency.
The proposed intervention is to organize regular simulation and role modeling rounds to contribute to communication excellence among nurses. It is necessary to develop a learning plan that will guide the rounds above. They will teach nurses how to include their patients and encourage family members in communication to offer proper support. This intervention will go further to allow key stakeholders to be involved in improving the level of communication.
The targeted setting for the proposed study is a healthcare unit. The hospital will have caregivers, practitioners, nurse leaders, and health managers. The facility will also identify patients who are expected to participate throughout the study period and benefit from effective communication. In this setting, it is necessary to make sure that patient length of stay is decreased, and their satisfaction can be an additional positive outcome.
Several barriers have the potential to disorient or affect the success of the proposed project. Firstly, the introduction of the new educational program means that a change model will be necessary. Secondly, the issue of time might affect the nature and success of the proposed project. This outcome is possible since most stakeholders will be involved in critical processes aimed at improving the experiences and results of the targeted patients.
The given project is going to result in a few essential outcomes. Firstly, it is likely to increase the quality of care by reducing the length of stay. Secondly, patients and their family members will be satisfied with the work of nurses, which will combine their efforts to recover. Finally, it is more likely that improved communication between nurses and patients will result in better health outcomes of the latter.
It is reasonable to take some action to improve the situation, which implies a few milestones. Thus, Milestone 1 means that it is necessary to find general information and develop educational programs. Milestone 2 refers to organizing the educational environment, including the necessity to make sure that all nurses attend simulation and role modeling rounds that will occur once a week over a 3-month period. When it comes to Milestone 3, a critical task is to present the materials to the attendees. The rounds will explain the potential to improve communication skills to reduce patient length of stay and offer role modeling exercise to develop these skills. Finally, the assessment of knowledge is performed at Milestone 4, which is necessary to check whether nurses are ready to implement the theoretical information in practice. The details of this action plan are presented by the John Hopkins Action Planning tool (Johns Hopkins Hospital, 2017).
John Hopkins Nursing Evidence-Based Practice Model
Introduction to Model
This practicum project uses the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model as the basis for all activities. The process of this model has 19 steps, which are conducted in three phases abbreviated as PET, as shown in Figure 1.
The initial stage, Practice Question, includes steps from 1 to 6:
- The first activity is to “recruit [an] interprofessional team” (Dang & Dearholt, 2017, p. 46). It is vital to invite members who are directly related to the problem. This implies the participation of nurses and physicians as frontline workers, as well as patients and families, pharmacists, and local committee members.
- The next step is to define the problem – this stage does not imply that the solution is already known to the team; members discuss the issues with each other and other stakeholders to see how the problem should be formulated.
- The third step is to develop the EBP question – it can be focused on learning, operational, or clinical change. Moreover, the project often benefits from a foreground question more than a background question (Dang & Dearholt, 2017). The latter does not offer any solutions, while the former outlines possible ways of improvement. The established way of creating an effective question is PICO(T) mnemonic (Dang & Dearholt, 2017).
- After developing the question, the team should identify relevant stakeholders. Many people are involved in the improvement of clinical practice, and they should be informed about the project and its steps. Stakeholders include staff, managers and leaders, discipline representatives, patients, families, policymakers, advocates, and organizations.
- The fifth step is to determine who is the leader of the project; this position implies responsibility for facilitation and communication. The leader should have experience in the field of the problem and EBP question as well as in working with interprofessional teams and understanding the organizational structure.
- The final step in the first part of the process is to schedule team meetings. The team should pick and reserve a room with adequate space, ask members to bring calendars, choose a way to record information, and establish a timeline. Project resources and files should also be considered to keep track of all data.
The second phase, Evidence, covers steps 7-11 and deals with data:
- During this step, the team determines the type of evidence to use and members responsible for the process. Then, such sources as the librarian (or a health information specialist), experts, practice guidelines, standards, organizational data, quality improvement data, patient surveys, and more are utilized.
- The collected evidence is appraised – each piece is investigated to determine the level and quality of information. In the PET process, the evidence is rated on a 5-level scale, where level I is the highest (Dang & Dearholt, 2017). It is necessary to discard evidence pieces that are low both in quality and level.
- The remaining information is summarized, distributing data by level of evidence. The findings that are relevant to the EBP question are recorded in a table with an appropriate level.
- Next, the evidence is investigated on each level to determine the quality and strength of findings in each group. The team looks at the overall volume of data and whether it is enough to make a strong argument for change.
- After appraising the evidence, the team develops recommendations for change based on the final synthesis of evidence. The advice can be compelling, good and consistent, good but inconsistent, and insufficient or nonexistent; it is recorded on the Synthesis Process and Recommendation Tool (Dang & Dearholt, 2017). As a result, the decision is made to either recommend a change or investigate further.
The final phase of the project is Translation, which includes steps 12-19:
- The twelfth step is to decide whether the recommendations are fit for translating into the selected setting. In some situations, change, although positive for patient outcomes or other quality measurements, is not possible for the organization due to time, money, or other constraints.
- If the recommendation is a good fit for the setting, the team needs to create an action plan. It may include the development of a new standard, system, pathway, or process, implementation timeline, feedback channels, and other details.
- The team needs to secure support for the project, working with department leaders and organizations to gather financial, human, and material resources.
- The implementation of the developed action plan is the following step. Here, communication with stakeholders and education are vital to ensure adherence and understanding.
- Next, outcomes of the implementation must be evaluated, using the information from the Question Development Tool.
- The team has to report the findings to stakeholders to disseminate new knowledge and ensure that all valuable members of the community are informed of successes, problems, and barriers.
- After considering the outcomes of the project, team members can identify new steps for change. These can incorporate new EBP questions, lessons, calls for additional research, training, new tools, and information dissemination.
- Finally, the team needs to disseminate findings to the organization as well as sources of knowledge, such as clinical journals and conferences.
Use of Model to Support Project
The step-by-step explanation of the model and its attention to detail makes the JHNEBP process extremely useful to clinical change projects. The model has been implemented in this project on all stages, including the formation of the problem and the EBP question. In this case, the PICO(T) tool described in the third step was used for the project. Moreover, evidence gathering was also conducted following the model’s steps – the literature review appraising the knowledge about simulation and role modeling rounds corresponds to steps 7-11. As a result, the project’s authors proposed the intervention for the chosen setting and found barriers to change as well as milestones for completion. The JHNEBP process will guide the project in the next chapters, helping to create an action plan and assess its outcomes. These steps allow the researchers to see which activities are the most important on each stage of the intervention – the JHNEBP defines the roles of the interprofessional team and the importance of information analysis and feedback.
Based on the JHNEBP model and the evidence collected above, the recommendations are to organize role modeling and simulation rounds for nurses to increase communication quality. First, the selected team for the EBP project will develop an educational program for nurses to explain the importance of role-playing for communication prior to starting simulation rounds (Reeves et al., 2017). The educational program will address the importance of rounds in improving nurse-patient communication. Then, the nurses will be informed about the project’s approach to learning – simulation and role modeling are forms of active learning that offer realistic experiences and facilitate real-world interactions and boost nurses’ confidence. Finally, the participants will receive information about their upcoming simulation rounds, including the schedule, simulated ward rounds’ content, and the feedback channels and a platform to share their reflection.
Then, the team will schedule simulation rounds for each nurse to occur once a week for three months. While the rest of the week will remain unchanged for participants, one day a week, they will meet with the designated team member (instructor) for a simulation round. Each simulation will last no more than 30 minutes, and the debriefing will take up about 15 to 30 minutes as well. The topics of conversation will include patients’ current state, progress, questions and problems, and pre-discharge review. The team will create a feedback channel for nurses and patients to collect information about outcomes and gather quality improvement data. For nurse participants, the instructor will guide the first reflection in a focus group to facilitate a discussion of training benefits and challenges. In the following reflections, the participants are encouraged to lead the discussion. The nurses will pick the main points at the end of each debriefing, which will be regarded as feedback for the project. For patients, patient satisfaction surveys will serve as the main channel of information.
Finally, the team will review the collected information and appraise it, setting new questions. The gathered data will include patient satisfaction survey results (with the focus on the quality of nurse-patient communication) as well as the length of stay for patients who were and were not included in the project. The PICOT question identifies the desired outcome as better communication and reduced length of stay; therefore, these two data sets are essential for the project. Aside from this knowledge, nurses’ feedback will be evaluated to present the set of positive and negative comments about the implementation and outcomes. Upon documenting and discussing the results of the study, the team will disseminate the knowledge to stakeholders. A formal presentation will be held for medical professionals, management, and advocates (with an electronic version for referencing), and a poster presentation with highlights will be available for the general audience.
As for the timetable of events, the preparation stage for the rounds to start should be completed in two months, during which team members make the schedule, gain approvals from the unit leaders and management, and inform nurses about the upcoming simulation rounds. After the three months of the intervention, one month is designated for feedback appraisal and final discussions; overall, the project should take up six months.
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The project is feasible because it does not take up much of the nurses’ time – they will contribute about one hour once a week for three months, allowing them to practice without sufficient additional stress. Moreover, it can be easily added to the existing schedule to help nurses interact with each other. The recommendation is supported by evidence that finds the benefits of such simulation training to be substantial to patient outcomes and nurse-patient interactions (Häggman-Laitila et al., 2016; Wershofen et al., 2016). Financial resources will be necessary for nurse training as well as paper-based and electronic materials to record data (such as feedback and patient surveys).
Blake, T., & Blake, T. (2019). Improving therapeutic communication in nursing through simulation exercise. Teaching and Learning in Nursing, 14(4), 260-264.
Bullington, J., Söderlund, M., Sparén, E. B., Kneck, Å., Omérov, P., & Cronqvist, A. (2019). Communication skills in nursing: A phenomenologically-based communication training approach. Nurse Education in Practice, 39, 136-141.
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.
Chan, E. A., Wong, F., Cheung, M. Y., & Lam, W. (2018). Patients’ perceptions of their experiences with nurse-patient communication in oncology settings: A focused ethnographic study. PLoS ONE, 13(6), 1-17.
Chan, Z. C. Y. (2017). A qualitative study on communication between nursing students and the family members of patients. Nurse Education Today, 59, 33-37.
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.
Dang, D., & Dearholt, S. L. (Eds.). (2017). Johns Hopkins nursing evidence-based practice: Model and guidelines (3rd ed.). Sigma Theta Tau International.
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.
Donovan, L. M., & Mullen, L. K. (2019). Expanding nursing simulation programs with a standardized patient protocol on therapeutic communication. Nursing Education in Practice, 38, 126-131.
Häggman-Laitila, A., Mattila, L. R., & Melender, H. L. (2016). Educational interventions on evidence-based nursing in clinical practice: A systematic review with qualitative analysis. Nurse Education Today, 43, 50-59.
Johns Hopkins Hospital. (2017). John Hopkins nursing evidence-based practice. Appendix I: Action planning tool [PDF document].
Johns Hopkins Hospital. (n.d.). John Hopkins nursing evidence-based practice. Appendix B: Question development tool [PDF document].
Johns Hopkins Hospital. (n.d.). John Hopkins nursing evidence-based practice. Appendix G: Individual evidence summary tool [PDF document].
Portney, L. (2020). Foundations of clinical research: Applications to evidence-based practice. F.A. Davis Company.
Reeves, S. A., Denault, D., Huntington, J. T., Ogrinc, G., Southard, D. R., & Vebell, R. (2017). Learning to overcome hierarchical pressures to achieve safer patient care: An interprofessional simulation for nursing, medical, and physician assistant students. Nurse Educator, 42(5S), S27-S31.
Tulsky, J. A., Beach, M. C., Burtow, R. N., Hickman, S. E., Mack, J. W., Morrison, R. S., Street, R. L., Sudore, R. L., White, D. B., & Pollak, K. I. (2017). A research agenda for communication between health care professionals and patients living with serious illness. JAMA Internal Medicine, 177(9), 1361-1366.
Wershofen, B., Heitzmann, N., Beltermann, E., & Fischer, M. R. (2016). Fostering interprofessional communication through case discussions and simulated ward rounds in nursing and medical education: A pilot project. GMS Journal for Medical Education, 33(2).
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.