College Essay Help Nurse-patient communication, Interdisciplinary communication, and patient safety

College Essay Help » Nurse-patient communication, Interdisciplinary communication, and patient safety

Overview This assessment requires you address the following topics: Define the seven principles of patient- clinician communication Explain how you apply each of these to your interactions with your own patients Describe the three methods being used to improve interdisciplinary communication Choose the one that you think applies best to your own area of practice, or the one that your area of practice currently uses, and clearly describe how you use it. Explain the ethical principles that can be applied to issues in patient-clinician communication Explain the importance of ethics in communication and how patient safety is influenced by good or bad team communication Make sure you also include a clear, separate introduction and conclusion as a part of this assignment, as these are worth separate points on the grading rubric. References Minimum of four (4) total references: two (2) references from required course materials and two (2) peer-reviewed references. All references must be no older than five years (unless making a specific point using a seminal piece of information)Peer-reviewed references include references from professional data bases such as PubMed or CINHAL applicable to population and practice area, along with evidence based clinical practice guidelines. Examples of unacceptable references are Wikipedia, UpToDate, Epocrates, Medscape, WebMD, hospital organizations, insurance recommendations, & secondary clinical databases.Style Unless otherwise specified, all the written assignment must follow APA 6th edition formatting, citations and references Number of Pages/Words Unless otherwise specified all papers should have a minimum of 600 words (approximately 2.5 pages) excluding the title and reference pages
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Patient-Clinician Communication:
Basic Principles and Expectations
Lyn Paget, Paul Han, Susan Nedza, Patricia Kurtz, Eric Racine, Sue Russell,
John Santa, Mary Jean Schumann, Joy Simha, and Isabelle Von Kohorn*
June 2011
*Working Group participants drawn from the Best Practices Innovation
Collaborative and the Evidence Communication Innovation Collaborative
of the IOM Roundtable on Value & Science-Driven Health Care
The views expressed in this discussion paper are those of the authors and not
necessarily of the authors’ organizations or of the Institute of Medicine. The paper
is intended to help inform and stimulate discussion. It has not been subjected to the
review procedures of the Institute of Medicine and is not a report of the Institute of
Medicine or of the National Research Council.
Advising the nation • Improving health
Patient-Clinician Communication:
Basic Principles and Expectations
Lyn Paget, Paul Han, Susan Nedza, Patricia Kurtz, Eric Racine, Sue Russell,
John Santa, Mary Jean Schuman, Joy Simha, and Isabelle Von Kohorn1
ACTIVITY
Marketing experts, decision scientists, patient advocates, and clinicians have developed a
set of guiding principles and basic expectations underpinning patient-clinician communication.
The work was stewarded under the auspices of the Best Practices and Evidence
Communication Innovation Collaboratives of the Institute of Medicine (IOM) Roundtable
on Value & Science-Driven Health Care. Collaborative participants intend these principles and
expectations to serve as common touchstone reference points for both patients and clinicians, as
they and their related organizations seek to foster the partnership and patient engagement
necessary to improve health outcomes and value from care delivered.
BACKGROUND
Health care aims to maintain and improve patients’ conditions with respect to disease,
injury, functional status, and sense of well-being. Accomplishment of these aims is predicated
upon a strong patient-clinician partnership, in which the insights of both parties are drawn upon
to guide delivery of the best care, tailored to individual circumstances. An important component
of this partnership is effective patient-clinician communication.
In the 2001 IOM report Crossing the Quality Chasm, patient-centeredness was defined
as one of the six key characteristics of quality care and has continued to be emphasized
throughout the IOM’s Learning Health System series of publications. Dimensions of patientcenteredness include respect for patient values, preferences, and expressed needs along with a
focus on information, communication, and education of patients in clear terms. Consistent and
effective communication between patient and clinician has been associated in studies not only
with improved patient satisfaction and safety, but also ultimately with better health outcomes,
and often with lower costs. Breakdowns of communication, or disregard for patient
understanding, context, and preferences, have been cited as contributors to health care disparities
and other counterproductive variations in health care utilization rates. Moreover, professional
ethics in health care stress the intrinsic importance of respectful and effective
communication as a core aspect of informed consent and a trusting relationship.
In an era of increasingly personalized medicine and escalating clinical complexity, the
importance of effective communication between the patient and the clinician is greater than ever.
As the ultimate stakeholders, patients should expect an active role in, and often shared
responsibility for, making care decisions that are best for them. Clinicians, in turn, should respect
and support patients in this role, valuing their input and prioritizing their preferences in shaping
care choices.
1
Working Group participants drawn from the Best Practices Innovation Collaborative and the Evidence
Communication Innovation Collaborative of the IOM Roundtable on Value & Science-Driven Health Care.
Copyright 2012 by the National Academy of Sciences. All rights reserved.
Whether considering risks and benefits or personal values and preferences, patients and
clinicians each have unique and important information to contribute to understanding and
deciding on prevention, diagnosis, or treatment options. Obtaining the highest-value care for
each individual requires establishing common goals and expectations for care through shared
deliberation that marshals the best information. Effective communication therefore requires
clarity about patient and clinician roles, responsibilities, and expectations for health care;
principles to guide the spirit and nature of patient-clinician communication; and approaches to
tailor communication appropriately to circumstances (e.g., routine care, chronic disease
management, life-threatening disease) and individual patient needs (e.g., health literacy and
numeracy, living circumstances, language barriers, decision-making capacity).
Passage of the Patient Protection and Affordable Care Act of 2010 offers both
opportunity and mandate to reorient strategies, incentives, and practices in support of health care
that reliably delivers Americans the best care at the highest value—care that is effective, efficient,
and most appropriate for the circumstances. As an element of best practice, the effectiveness of
patient-clinician communication can be as important as that of a diagnostic or treatment tool and
should be the product of similarly systematic assessment and evaluation. The principles and
expectations identified in this document offer a framework to evaluate and improve patientclinician communication, and to sharpen and focus patient discussion tools, patient safety
assessment (e.g., the Agency for Healthcare Research and Quality [AHRQ], the National Quality
Forum [NQF], organizational and individual performance assessment and quality improvement
efforts (e.g., Consumer Assessment of Healthcare Providers and Systems [CAHPS], and
clinician certification processes (e.g., the American Board of Internal Medicine [ABIM]).
BASIC PRINCIPLES AND EXPECTATIONS FOR
PATIENT-CLINICIAN COMMUNICATION
Many factors affect the quality and clarity of communications between patients and
clinicians. However, at the core of the matter, certain basic principles pertain and serve as the
starting point for the expectations of patients and clinicians: mutual respect, harmonized goals,
a supportive environment, appropriate decision partners, the right information, full
disclosure, and continuous learning.
Patient-Clinician Communication
Basic Principles
1.
2.
3.
4.
5.
6.
7.
Mutual respect
Harmonized goals
A supportive environment
Appropriate decision partners
The right information
Transparency and full disclosure
Continuous learning
2
Drawing from these principles, the basic individual and mutual expectations of both
patients and their clinicians can be identified. These expectations are discussed below and
summarized in the accompanying box.

1. Mutual respect
   Each patient (or agent) and clinician engaged as full decision-making partners.
   Communication should seek to enhance health care decision making through the exchange
   of information and by supporting the development of a partnership relationship—
   whenever possible—based on trust and focused on the whole patient. This includes
   considering psychosocial needs, identifying and playing to the patient’s strengths, and
   building on past experience to meet immediate needs and anticipate future concerns.
   Respect for the special insights that each brings to solving the problem at hand.
   Information exchange should be characterized by listening, inquiry, and facilitation that is
   both active and respectful on the part of both the patient and the clinician. Information
   needs include patients’ ideas, preferences, and values; living and economic contexts that
   may affect patients’ health or decision making; the basis and evidence for alternative
   choices and recommendations; and uncertainties related to the proposed course of action.
2. Harmonized goals
   Common understanding of and agreement on the care plan. Full understanding—to the
   extent practicable—of care options and the associated risks, benefits, and costs, as well as
   patient preferences and expectations, should lead to an explicit determination of the shared
   agenda and goals. Factors should include health, lifestyle, and economic preferences and
   should accommodate language or cultural differences and low health literacy.
3. A supportive environment
   A nurturing and secure services environment. The success of the care plan depends on the
   attention paid in the service setting to patient culture, skills, convenience, information,
   costs, and implementation of the care decision.
   A nurturing and secure decision climate. The comfort and ability of the patient and
   clinician to speak openly is paramount to discussion of potentially sensitive issues inherent
   to many health decisions.
4. Appropriate decision partners
   Clinicians, or clinician teams, with skills appropriate to patient circumstances. With
   increasingly complex problems, and time often a factor for any individual clinician, it is
   important to ensure that the patient has access to clinicians with skills appropriate to a
   particular encounter; that, as indicated, alternative clinician opinions are embraced; and
   that provisions are made for the communication needed among all relevant clinicians.
   3
   Assurance of competence and understanding by patient or agent of the patient.
   Understanding by both patient and clinician is crucial to arriving at the most appropriate
   decision. Understanding of patient options is important: how specific they are to
   circumstances; the associated risks, benefits, and costs; and the needed follow-up. If
   indicated, an appropriate family member or similar designee should be identified to act as
   the patient’s agent in the care process.
5. The right information
   Best available information at hand, choices and trade-offs thoroughly discussed. The
   starting point for shared decision making should be the sharing of all necessary
   information. When working collaboratively to craft an appropriate care plan, clinicians
   should provide evidence concerning risks, benefits, values, and costs of alternative
   options. All options should be discussed to bring out patient preferences, goals, and
   concerns and to explicitly consider the impact of various options on these issues.
   Presentation by patient of relevant perceptions, symptoms, personal practices. The
   clinician’s appreciation and understanding of patient circumstances depends on accurate
   sharing by the patient of perceptions, symptoms, life events, and personal practices that
   may have a bearing on the condition and its management.
6. Transparency and full disclosure
   Candid and explicit acknowledgment to patient of limits in science and system. A basic
   element of the care process is comprehensiveness and candor with respect to the limits of
   the evidence, delivery system constraints, and costs to the patient that may affect the range
   of options or the effectiveness of their delivery.
   Patient openness to clinician on all relevant circumstances, preferences, medical history.
   Only by understanding the patient’s situation can the most appropriate care be identified.
   Patient and family or agent openness in sharing all relevant health and economic
   circumstances, preferences, and medical history ensures that decisions are made with
   complete understanding of the situation at hand.
7. Continuous learning
   Effective approach established for regular feedback on progress. Identification and
   implementation of a system of feedback between patients and clinicians on status,
   progress, and challenges is integral to the development of a learning relationship that is
   flexible and can adapt to changing needs and situations.
   Established periodicity for course assessment and alteration as necessary. Early
   specification of treatment strategy, expectations, and course correction points is important
   for ongoing assessment of care efficacy and to alert both clinician and patient to possible
   need for care strategy changes.
   4
   Expectations
8. Mutual respect
   Each patient (or agent) and clinician engaged as full decision-making partners.
   Respect for the special insights that each brings to solving the problem at hand.
9. Harmonized goals
   Common understanding of and agreement on the care plan.
10. A supportive environment
    A nurturing and secure services environment.
    A nurturing and secure decision climate.
11. Appropriate decision partners
    Clinicians, or clinician teams, with skills appropriate to patient circumstances.
    Assurances of competence and understanding by patient or agent of the patient
12. The right information
    Best available evidence at hand, choices and trade-offs thoroughly discussed.
    Presentation by patient of relevant perceptions, symptoms, personal practices.
13. Transparency and full disclosure
    Candid and explicit acknowledgement to patient of limits in science and system.
    Patient openness to clinician on all relevant circumstances, preferences, medical history.
14. Continuous learning
    Effective approach established for regular feedback on progress.
    Established periodicity for course assessment and alteration as necessary.
    TAILORING IMPLEMENTATION TO NEED AND CIRCUMSTANCE
    These principles and expectations offer general guidance for successful patient-clinician
    communication. Moderating factors or constraints present in individual circumstances require
    certain tailored approaches and expectations for a particular visit—still with the aim of
    maximizing faithfulness to these principles to the fullest practical extent. Examples of such
    considerations include:
    5
    Visit reason
    Prevention
    Chronic condition management
    Acute or urgent episode
    Decision characteristics
    Number of decisions to be made during the visit
    Certainty, uncertainty, and relevance to the available evidence
    Decisions related to a preference-sensitive arena or choice
    Access to and use of the Internet
    Patient characteristics
    Functional capacity (level of physical or mental impairment)
    Communication capacity (language, literacy/numeracy, speech disorder)
    Receptivity (motivation, incentives, activation, learning style, trust level)
    Support (skilled family or other caregiver, financial capacity)
    Living situation (housing, community, grocery, pharmacy, recreation, safety)
    Clinician and practice characteristics
    Patient volume and complexity
    Patient support systems (language aids, interpreters, physical space, digital capacity)
    Decision support systems (digital platform, information access, decision guidance)
    Professional team profile and culture
    Condition-specific skill network and referral follow-up systems
    Reimbursement and other economic barriers
    DEVELOPING THE TOOLS AND PROCESSES
    FOR ADAPTIVE TARGETING
    As touchstone reference points for patients and clinicians, the principles and expectations
    presented here are vital to achieving the full measure of potential health outcomes and value
    from care delivered. But achieving that potential requires intent, commitment, and creativity in
    developing the tools and processes for adaptive targeting in the myriad conditions and
    circumstances found in different health care settings. Noted below are questions that may
    stimulate thought, conversation, and innovative approaches to their successful implementation in
    various settings and circumstances.
    For clinicians and health care organizations
    How are we doing now with respect to the principles and expectations?
    For which of them is our current culture and practice pattern most challenging?
    What initial steps might be good starting points for systems changes necessary?
    6
    How can we enlist patients and staff working together to help develop and lead?
    How can we take advantage of initiative and help from professional societies?
    What community tools or resources might be adaptable for us?
    How can we measure the impact for feedback to patients and staff on the results?
    For patients, consumers, and advocates
    What makes a clinician a good listener?
    What should we expect in conversations about health care with clinicians?
    How can available care and condition-specific materials be more easily understandable?
    Are there helpful ways to judge a care setting’s support of effective communication?
    What should we expect from clinicians to help interpret medical evidence?
    How can we best help clinicians in their efforts to improve information sharing?
    How will “continuous learning” from my care lead to better health care?
    For professional societies, policy makers, health plans, insurers, and employers
    How do current practices compare with the principles and expectations?
    What ought to be our expectations for clinicians we support?
    What metrics will be most useful for quality improvement and feedback?
    What tools are most needed to assist in application and site-specific tailoring?
    Can we develop case material to illustrate approaches and feasibility?
    What information can help demonstrate material returns in outcomes and value?
    Which reimbursement incentive structures are most important to consider?
    SELECTED REFERENCES
    Godolphin, W. 2009. Shared decision-making. Healthcare Quarterly. 12:e186-190.
    IOM (Institute of Medicine). 2001. Crossing the Quality Chasm: A New Health System for the
    21st Century. Washington, DC: The National Academies Press.
    __ . 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.
    Washington, DC: The National Academies Press.
    Stewart, M., J. B. Brown, H. Boon, J. Galajda, L. Meredith, and M. Sangster. 1999. Evidence on
    patient-doctor communication. Cancer Prevention and Control. 3(1):25-30.
    Stewart, M. A. 1995. Effective physician-patient communication and health outcomes: A review.
    CMAJ 152(9)1423-1433.
    Wennberg, J. E., A. M. O’Connor, E. D. Collins, and J. N. Weinstein. 2007. Extending the P4P
    agenda, part 1: How Medicare can improve patient decision making and reduce
    unnecessary care. Health Affairs 26(6):1564-1574.
    7
    NRSE 4510: MODULE 4: ASSESSMENT 8: WRITTEN ASSIGNMENT – NURSE-PATIENT COMMUNICATION,
    INTERDISCIPLINARY COMMUNICATION, AND PATIENT SAFETY – DETAILED INSTRUCTIONS
    Please continue to use the principles of setting up an APA 6th edition paper from week 1
    and 2 including introduction and conclusion.
    For this assignment, address the following topics:
15. Define the seven principles of patient- clinician communication
16. Explain how you apply three of the seven of these to your interactions with your own
    patients
17. Describe the three methods being used to improve interdisciplinary communication
18. Choose the one that you think applies best to your own area of practice, or the one
    that your area of practice currently uses, and clearly describe how you use it.
19. Explain the ethical principles that can be applied to issues in patient-clinician
    communication
20. Explain the importance of ethics in communication and how patient safety is
    influenced by good or bad team communication
    The headings for this paper are as follows
    Principles of Communication
    ? Define the seven principles of patient- clinician communication
    ? Explain how you apply three of the seven of these to your interactions with your own
    patients with at least one example for each of the principles.
    Methods of Communication
    ? Defines and describes the three methods being used to improve interdisciplinary
    communication
    ? Choose the one that you think applies best to your own area of practice, or the one
    that your area of practice currently uses, and clearly describe how you use it.
    Ethical Principles and Communication
    ? Defines the four ethical principles that can be applied to issues in patient-clinician
    communication and gives one example of each.
    ? Explain the importance of ethics in communication and how patient safety is
    impacted by team communication
    Assignment s …
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