About Critical Reflection In Communication Information 2022

Running Head: CRITICAL REFLECTION 1
Diary entry and Critical Reflection
Name of Student
Name of Professor
Institution Affiliation
Date

CRITICAL REFLECTION 2
Diary entry
Communication is very critical in all professions but even more critical for
healthcare professionals. Poor communication or lack of communication in healthcare
can lead to errors or misdiagnosis, which can result in adverse health outcomes of the
patient. Poor communication can result in death or permanent health complications
for the patient. The following is a diary entry of an incident that involved one of my
close relative:
The incident involved a patient Mr. Y who was brought to the emergency
department (ED) of a hospital where Dr. X was the emergency physician on duty that
night. I was on placement at the hospital, and my role was assisting nurses with the
resuscitation of patients. The doctor was highly experienced because he had worked
in the hospital for more than six years. The ED was experiencing an influx of patients,
and there was an acute shortage of staffing in the facility. Mr. Y was brought to the
hospital suffering from severe abdominal pain, and he said that he had been drinking
alcohol the entire day. Nurses conducted a test, and the breathalyzer indicated that
blood alcohol level was at .204. The patient was alert and could communicate
property, but he was anxious since he said he was in a lot of pain. The doctor,
therefore, ordered the nurse to administer IV and hydromorphone 1-2mgIV after
every twenty minutes. The doctor there left a note to the nurses requiring the patient's
systolic blood pressure to be maintained at above 100. At the time the doctor was
giving these instructions, he had not examined the patient since the ED was so
crowded, and hence he had very many patients to attend. After getting about 6mg of
hydromorphone administered to the patient within an hour, he fell into cardiac arrest
and died despite resuscitation efforts. During the investigation, it was established that
the patient died due to a mix of alcohol and hydromorphone, which became toxic.

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When questioned, the doctor indicated that he was not aware of the blood alcohol
level of the patient. The doctor also said that he assumed that the nurse would put the
necessary monitors and use their judgment in deciding the amount of hydromorphone
to administer based on the response of the patients. Poor communication, therefore,
resulted in the death of patient Y, who could have been saved if there was proper
communication between the physician and the nurse.
Level 1: What
I was on clinical placement at the hospital, and my role in the department was to
assist the nurses in resuscitating patients. My other role includes carrying out different
simple tasks allocated by the nurses. After the nurse noticed that the condition of the
patient had deteriorated, he called me to assist him in resuscitating the patient.
Unfortunately, the efforts of reviving the patient failed, and he died just a few hours
after he had arrived in the hospital. The emergency department was chaotic since only
three nurses were working in the section, and more so only one doctor. The patients
were very many, and hence the doctor kept moving from one patient to the other.
The other people who witnessed the situation were shocked by the occurrences of
that night. The other two nurses in the emergency department were surprised at the
fast rate at which the condition of the patient deteriorated. When Mr. Y was brought
to the emergency department, his state did not look so exempt severe that he was
complaining of the intense pain. When the patient's condition became worse, he was
called in to assist the patient, but there was nothing he could do, and hence the patient
lost his life. The doctor was shocked by this occurrence, and he questioned the nurse
in charge and that when he realized that the patient had a very high blood alcohol
level, but he was not informed. The doctor and the nurse started quarreling, blaming
one another for the occurrence. The doctor blamed the nurse for not informing him of

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the high alcohol levels while the nurse blamed the doctor for administering
hydromorphone without examining the patient properly.
This incident resulted in the death of the patient. The relatives of the patient were
very saddened by the circumstances of the death of their son. They filed a lawsuit
against the doctor and the nurse. The hospital negotiated for an out of court
settlement, and the case was resolved.
I had a feeling of both sadness and anger. I was despondent because the patient
who was supposed to be saved had died at the hands of a qualified doctor and nurse
due to poor communication. If the doctor and the nurse in charge of the department
had appropriately communicated, the patient could have got proper treatment and
recovered without any complications. I was also angry because, despite the
catastrophic incident that had occurred, the doctor and the nurse resulted in a blame
game instead of assessing the situation to find out what had caused such as significant
communication breakdown that led to the death of the patient.
The good thing about the experience is that it taught me the importance of
effective communication when working as a team in a healthcare facility. In a
multidisciplinary team caring for patients, it is critical to ensure that there is effective
communication to avoid errors of a commission of omission, which could affect the
well-fare of the patient. Every important detail should be communicated to other
members of the team, and no assumptions should be made to avoid communication
breakdown. The other good thing about the occurrence is that I played my role in
assisting the patient, but I couldn't do much since my scope was limited. The bad
thing about this experience is that it resulted in the tragic death of a patient as a result
of a simple communication breakdown, which could have been avoided.

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Level 2: So what
Communication is very vital in delivering safe and effective care. Most of the
major incidences of adverse health outcomes arise mostly due to communication
failure (Bagnasco et al., 2019, p.457). It leads to ineffective care and could also lead
to severe health conditions for the patients or death. Therefore, communication is very
vital during a patient’s stay in critical care as well as when a patient is being
transferred from one department to another. In the emergency department, various
health professionals work as a team to save lives and to offer patients optimum care.
According to Blackburn et al. (2019, p.31), there were more than 400 serious safety
incidences involving poor communication in Australia between the years 2017 and
2019. There are also hundreds of minor incidences that occur but are rarely reported
because they don’t result in severe consequences.
Additionally, poor communication has resulted in more than 1744 death of
patients in the last five years in Australia alone. The malpractice costs arising from
incidences of poor communication between healthcare workers are more than
1.8billion over five years (Källberg et al., 2017, p.18). This, therefore, shows the
importance of communication for both nurses and general practitioners.
One of the main benefits of effective communication in a healthcare setting is that
it leads to increased patient safety. Effective communication ensures that there is a
clear and uninterrupted flow of information between the healthcare professionals
involved in treating and caring for the patient (House & Havens, 2017, p.167). This,
therefore, reduces the probability of making an error due to gaps in information that
could have been avoided if the communication between the staff involved was better.
For example, in the case described above, the death of the patient could have been

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avoided if the nurse and the ED doctor would have given the attention to the need for
communication in the department. The nurse should have communicated his findings
of the high blood alcohol volume to the doctor. Failure to relay this information,
therefore, resulted in the doctor making the wrong decision, which cost the patient his
life. The doctor was also at fault for making assumptions instead of communicating
with the nurse effectively. Instead of assuming that the nurse could monitor the
patient and adjust the dose depending on the patient’s reaction to the drug, he should
have communicated the instructions expressly to eradicate any communication
loopholes, which could threaten the safety of the patient.
Communication is also very critical since it results in improved patient outcomes
(Sari et al., 2016, p.59). When there is effective communication between various
professionals in the healthcare sector, patients can receive a higher quality of care and
hence result in better outcomes. Effective communication within the hospital ensures
that everyone involved in the care of the patient has sufficient information required in
making decisions. This, therefore, makes it possible for nurses and doctors to make
informed decisions regarding the health of the patient. Having the right information
helps in making the correct diagnosis and hence enabling the doctor to prescribe the
right interventions to improve the health of the patient. According to Expósito et al.,
(2018, p.89), effective communication also guides nurses on the appropriate care that
should be offered to a particular patient. This, therefore, ensures that the patient is
given the best care and hence improving their health outcomes.
My experience in the ED also taught me the importance of having a good
relationship with co-workers (Liu et al., 2019, p.2944). The instance unearthed some
details about the relationship between doctor X the nurse. The two did not enjoy a
cordial working relationship even before the occurrence of the incidence involving

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patient Y. They used to disagree on many issues, and sometimes they used to argue a
lot. Even after the death of the patient, both the ED doctor and the nurse could not
remain calm, and they debated on who was at fault for the mistake which had just
occurred. Teamwork is very vital in offering care to patients, especially in the
emergency department, where the difference between life and death is a matter of
seconds. Hence, there is no room for unnecessary disputes (Kumar et al., 2019, p.30).
In order to have effective communication between people working in the same
department, there must be a good working relationship between colleagues (Gharaveis
et al., 2018, p.49) Any differences that arise should be resolved amicably to avoid
communication breakdown that may compromise the safety of the patients or which
might result to poor quality services. Therefore, both the nurse and the doctor at the
center of the incidence should not have allowed personal differences come into the
way, and this could have avoided the death of the patient.
As I was helping with resuscitation, I was composed since I had experienced such
other incidence during my placement at the hospital. I was wondering why the
condition of the patient had deteriorated within a short duration despite the patient
appearing to be stable and not in grave danger just a few hours ago. I did not have a
significant role to play in this instance, but I offered the team of doctors and nurses all
the assistance they required to save the patient, but he passed away, unfortunately. All
the actions I performed during this occasion were informed by the instructions I was
given by the nurse, who was my instructor as well as the scope of training as a nurse.
The incident taught me some of the factors that contribute to communication
breakdown within the hospital setting. Apart from the poor working relationship
between the nurse and doctor X, the hospital had an acute shortage of staff. This,
therefore, meant that the doctor had many patients to look after and hence to make it

CRITICAL REFLECTION 8
difficult to concentrate and offer optimal care to one patient. This is very dangerous
because it means that the staff in the facility were overworking and hence increasing
the risk of making errors (O’Connor et al., 2020, p.201). The doctor could not get
time to assess the patient, and even the nurse was fully occupied, and this led to the
lack of effective communication between the two. The workload could, therefore,
have led to high-stress levels for the healthcare staff and hence leading to
communication failure, which led to the mistake that happened.
Level 3: Now what
To improve the effectiveness of clinical communication, it is critical to maintain
professionalism at work and avoid conflicts, which could lead to poor
communication. According to the Coiera and combs model of communication,
clinical communication becomes difficult when the people working together do not
have an excellent professional relationship (Abramson & Mancini, 2020, p.44). This
leads to the development of attitudes towards one another, which could lead to
communication becoming ineffective and hence compromising the quality of care
received by the patient.
To avoid a similar event occurring in the future, it is crucial to ensure that all
departments within a healthcare facility have adequate staff (Collette et al., 2017,
p.477). A lot of workload for healthcare workers leads to exhaustion, which makes it
difficult to concentrate. This, therefore, means that information can be communicated
but cannot stick to the mind of an individual because the nature of the working
environment makes it difficult to concentrate. As witnessed in the above discussion,
the doctor moved from one patient to the other. The workload affected his
performance at work and hence affecting his productivity. This leads to frustrations

CRITICAL REFLECTION 9
and thus making it difficult for proper communication to take place between the staff
(Naineni et al., 2019, p.12).
Additionally, constant interruptions interfere with the cognitive rehearsal of what
a person was doing (Redley et al., 2017, p.122). This might make them forget what
they were doing initially, and a mix up might occur and hence resulting in errors,
which could be very costly. Therefore, to correct this situation, it is critical for the
management of the facility to recruit additional nurses and doctors to the emergency
department to deal with the influx of patients.
The use of technologies can also enhance communication nurses as doctors, as
well as between nurses and patients (Aaronson et al., 2019, p.261). If the doctor is
occupied and is not physically present, they can give instructions to the nurse on what
they should do in each particular case instead of waiting for them. This is important
especially the case in a situation where there is under-staffing. It can help to ease
communication and hence save many lives. There is also a need for healthcare
professionals to embrace teamwork (Ghaferi & Dimick, 2016, p.51). This ensures that
all the staff members put away their differences and work together to ensure that the
patient gets quality care.
The consequence of implementing the above actions is that it will reduce the
number of deaths occurring in hospitals as a result of poor communication. The
actions will also mean that the risk of patients suffering complications due to poor
communication between clinical workers reduces significantly, and hence leading to
improved patient outcomes. Finally, the outlines of the action above will lead to a
reduction in the lawsuit of medical negligence and thus saving the hospitals and the
vast practitioners sums of money.

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References
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Abramson, P., & Mancini, A. (2020). The Importance of Effective Communication on
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Bagnasco, A., Costa, A., Catania, G., Zanini, M., Ghirotto, L., Timmins, F., & Sasso,
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e47-e51.

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Gharaveis, A., Hamilton, D. K., Pati, D., & Shepley, M. (2018). The impact of
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