Effective Communication in the Care of the Surgical Patient

This assignment discusses the importance of effective communication in promoting recovery in surgical patients. It covers the role and advantages of effective communication in the care of the surgical patient, issues and challenges in the care of the surgical patient, and identification of solutions to the issue. The reflective narrative includes personal experiences and critical evaluation of the WHO Surgical Safety Checklist.

University of Derby Online Learning
UDOL-OLUBB: Bachelor of Science (Honours) in
Perioperative Practice
6NU547: Care of the Surgical Patient
Module Lead: {Insert name}
{Student name}
{Submission date}
Student Identification Number: {Student number}
Word Count: 3500
Declaration:
I declare that this assignment is my own work and that I have correctly acknowledged the work of
others. This assignment is in accordance with University guidance on good academic conduct and in
line with the PLATO advice. https://plato.derby.ac.uk/start/index.html
Student ID {Student number} 1

Content
Title Page
Introduction 3
Reflective narrative 4
Role and advantage of
effective communication in
the care of the surgical
patient
4-5
Issues and challenges in
the care of the surgical
patient and identification of
solutions to the issue
5-10
Conclusion 10-11
Reference list 12-14
Introduction/Background
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This assignment will focus on the process used for effective communication to promote
recovery in surgical patient. As a surgical nurse in acute care clinics, I have encountered many types
of surgical patients with different types of health complexities. Along with the type of surgery, the
challenges in pre-surgery and post-surgery phase also increase because of the presence of many
other co-morbidities or other health condition in patient. Co-morbidities have a significant impact on
surgical outcomes of patients. Surgical outcomes are also influenced by many other factors such as
types of operation, quality of care, patient characteristics and presence of other concurrent disease
(Inokuchi et al. 2014). Identification of risk factors for complications in the pre and post-operative
complication is an important approach to reduce complications in patients (Hollis et al. 2016). We
follow series of pre-operative assessment and post-operative assessment activities to find out any
risk associated with patients past medical history and current health status. However, based on my
experience of caring for surgical patient in a busy hospital setting where wide range or surgeries are
performed, I can say that effective communication with surgical patient and the multi-professional
team is an important pathway for a safer surgical journey.
As a surgical nurse, I have worked in busy hospital settings where both general and
specialized surgeries are performed. I have met and interacted with surgical patients on a daily basis
to conduct routine assessment before and after surgery. Apart from the clinical aspects of care, I was
not aware that communication can promote safety practice and positive health outcome for patients
in such a significant way until I experienced an event of communication breakdown with surgical
patients. I started paying attention to the communication aspects of care after I experienced many
challenges in providing care because of communication related errors. There were many situations
where complications for patients could have been avoided had I taken the approach to effectively
communicate with patients regarding necessary preparations before surgeries and the things they
should avoid before surgery as per their clinical condition. After critically reflecting on discussion
post related to effective communication during the peri-operative phase, I learnt about the
communication methods while providing care to the surgical patient. Reflection on the learning
material and activities completed throughout the unit will help in providing a critically reflective
portfolio of evidence regarding synthesis of theory-practice interface in relation to effective
communication for the care of the surgical patient.
The main purpose of the reflective portfolio is to reflect on the importance of effective
communication to prevent complications and promote safety in surgical patient, to evaluate
contemporary issues and challenges related to engaging in effective communication with the
surgical staff and patient. The assignment has been approached by first discussing on the role of
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effective communication in surgical care along with support from research evidences. The next step
would focus on critical appraisal of own role in relation to the care of the surgical patient and critical
reflection of personal discussion postings related to the effective communication and use of WHO
surgical safety checklist in practice. It also demonstrated how the theory-practice gap is minimized
by learning from incidents and implementing lessons from the discussion posting to minimise the
likelihood of adverse events in the future.
Reflective narrative
Role and advantage of effective communication in the care of the surgical patient:
Majority of errors in the peri-operative setting occurs due to communication failures (Seifert,
Graling and Sanchez 2017). The likelihood of communication breakdown is high because of the fast
paced nature of the peri-operative environment. Nurses who enter newly into surgical practice lack
the skills to handle the fast paced nature of the surgical environment and they fail to share and
communicate vital patient information to other medical staffs. Lack of skills in effective
communication leads to patient safety issues and affects morale, self-esteem and engagement of
health care workers. Hence, it can be said that poor communication has impact both on patient and
staffs. Cvetic (2011) explains that improving communication between peri-operative team and
patients can improve the likelihood of providing competent, efficient and safe surgical care to
patient. It also minimizes burden during surgical practice by decreasing uncertainty regarding
surgical procedures, promoting harmony during team work and facilitating cost savings. Due to
these benefits, staffs entering into surgical setting are expected to have effective interpersonal
communication skills.
While preparing for my surgical nursing course, my educator also gave brief idea regarding
communication process during peri-operative care. My professional nursing course built theoretical
knowledge on the topic. However, I experienced theory-practice gap when I started practicing in real
setting. Communicating with patients as well as other care providers became a challenging task for
me as I failed to keep up with the demands of other tasks. Communication aspect was ignored by me
at this time. However, after facing the aftermath of communication breakdown, I realized that
education related to safe communication measure was essential for me. After receiving proper
mentoring in communication aspect of surgical care, I realized that implementation of safe
communication protocols and checklist provide great support to nurses in reporting about patient’s
condition and minimizing errors. Further insight into specific scenarios, the challenges that I faced as
a surgical nurse in clinical setting and the lessons that I learnt from them has been provided below.
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Issues and challenges in the care of the surgical patient and identification of solutions to the issue
I started practicing in the area of surgical care after obtaining formal degree in the field. I
work in a critical setting where all types of surgical procedures are performed. My specialty is in peri-
operative nursing. A peri-operative registered nurse has wider scope of nursing responsibilities
compared to other registered nurse. Peri-operative registered nurses have to accurately implement
their duties in all three phase of surgery- before, during and after surgery. They need to provide care
to patients by proper assessment, planning and implementation of nursing care in all the three
phase of surgery. Other specific responsibilities include patient assessment, maintenance of sterile
and safe surgical environment, patient education, monitoring of patient safety and coordinating with
patient throughout the surgical care journey (AORN 2016). However, various environmental, team
and individual barriers created challenges for me in fulfilling all the responsibilities.
In the area of communication during surgical practice, Cvetic (2011) explained that having
good communication is crucial to aid practitioner in asking the right question from patient.
Interpersonal communication skills help health care staffs to build rapport with patient and promote
therapeutic relationship with patient. However, the communication should not be a one-way
process. Instead it should be a two way communication process where a practitioner should ensure
that the person receiving the information have correctly understood the message. Taking this
responsibility is vital to prevent communication breakdown. Kurtz, Draper and Silverman (2016)
states that active listening is also important to keep patients engaged in the decision making
process. However, theoretical knowledge is not always explicit and new and unique challenges
confront health care staffs when they start to internalize the process in their clinical practice ( Austin
2016).
Based on my experience as a surgical nurse in clinical setting, I realized that following the
above mentioned steps was not an easy task in practice setting. For example, during my initial days
of practice, I had to take care of an old lady who was to undergo a hip replacement surgery. During
the assessment, I got to know that the patient was allergic to a medicine. I asked the patient to
notify this to the incoming support staff. I also had the responsibility to note it down in the handover
chart before my shift time. However I missed updating the information on the chart as I got
distracted by an emergency call from another ward. On the next day, I had to bear the consequences
as the patient’s surgery was delayed because of the communication breakdown. She developed
acute allergy and was in great discomfort. Reflecting on this activity, I learnt that I could not
accurately fulfil my responsibility as a surgical nurse because of the presence of various distractions
in clinical practice. Persoon et al. (2011) supports the fact that distractions in the clinical
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environment are detrimental to clinical performance and quality of care. Distractions may come in
the form of telephone calls, irrelevant conversation between clinical task and overcrowding.
Although, the effect of distracting stimuli are difficult to measure, however dealing with them is one
of the contemporary issues for surgical nursing staffs.
While reflecting on the above incident, I could interpret that actual practice is challenged
both by environmental and individual barriers. For example, environment specific barriers like
distractions and emergency calls pose risk to patient safety. However, I realised that personal
accountability also plays a role in correcting errors or preventing errors. Hence, the error during the
assessment of the old lady with surgery could have been avoided, had I taken the step to engage in
one-to-one communication by asking whether the patient had understood my message or not.
O'hagan et al (2014) affirms that checking correct understanding of patient during information
delivery is critical for safe and high quality care. This action leads to the completion of an effective
communication activity during care of the surgical patient. Hence, the degree to which a surgical
nurse or surgical staff is accountable during the communication process also has an impact on risk
event. Peri-operative nurse are accountable not only till the time they deliver care, but also for
ensuring continuity of patient care (Renholm et al. 2017). For this reason, implementation of certain
communication resource like checklist and communication is considered useful as these tools
provide easy way to shared patient’s information in the right manner to maintain continuity of care.
Certain communication resource in the pre-operative setting standardizes the
communication process and plays a beneficial role in patient safety. For example, patient handover
charts, patient safety checklist and crew resource management are tools to address unintentional
events. They cannot address all types of barriers in communication process, however they aid
surgical staffs in maintaining continuity of care and ensuring that the care delivered is free from any
errors (Cvetic 2011). New research and new evidence constantly adds up new resources for surgical
staffs so that they can enhance the quality of care delivered to patients with complex surgery. After
reading the discussion posting, I came to know about the use of the WHO Surgical Safety Checklist in
minimizing risk and improving communication across the peri-operative staff. The utility of the tool is
that it ensures consistency across the team caring for a surgical patient by providing 19-point
checklist. It provides list of activities to be done before induction of anaesthesia, before skin incision
and before patient leaves the operating room (World Health Organization 2016). The briefings for
the WHO checklist mentioned that-
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‘The WHO safe surgery checklist contains the important steps to ensuring that each and
every operation is performed correctly, reducing morbidity and mortality risks’-(World Health
Organization 2016)
After reading the WHO briefing, I realized that simply following the checklist may not
improve patient’s outcome after surgery. While reflecting on of the utility of the WHO briefing
checklist on the discussion posting, I could interpret that the tool can be successful in offering
multiple safety checks only when it is executed as it is intended. Adherence to the checklist is
dependent on the safety culture and awareness of the staffs regarding the utility of the tool. Strong
leadership also plays a role in encouraging the whole medical team to use the checklist (Zingiryan et
al. 2017). Resistance and poor acceptance of service is common within health care environment. The
evidence regarding the utilization of WHO checklist in surgical setting of eight countries revealed
challenges in implementing the tool because of difference in guidelines for routine intra-operative
management in many countries (Treadwell, Lucas and Tsou 2014). However, after overcoming the
implementation related challenges, it was found that introduction of checklist significantly decrease
patient mortality rate and inpatient complications within 3-6 months. In my own practice setting,
many surgeons resisted to using the checklist. However, once the checklist was implemented after
proper training, it was found that the WHO safety checklist became an activity that could be initiated
by any discipline without any difficulty. I also acknowledge the usefulness of the tool as it gives both
nurse and other senior staffs the opportunity to accurately report about patient’s status in the right
manner.
On critical evaluation of the reasons for which the WHO checklist worked in my practice
setting, I could identify that local adaptation factors like safety culture and preoperative briefing
worked to our advantage. Synergy between safety culture and positive patient safety outcome has
been found based on research evidence synthesis. Fan et al. (2016) conducted a survey on patient
safety cultural factors such as communication openness, feedback and communication about errors,
handoffs and transition, staffing level and team work across surgical units. Presence of effective
safety culture was associated with better safety culture. Employee satisfaction, responsive
management and liberty to speak about patient safety issues favoured getting such outcomes. The
findings is consistent with the arguments by Hemingway, O’malley and Silvestri (2015) as the study
reported that changing the process for safety reporting, adding resources and communication
related to adverse events prevents surgical errors and ensures that appropriate safety measures are
in place to promote recovery of patient.
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Team briefings are also regarded as an important aspect of safety culture and incorporation
of this with the WHO checklist can enhance outcome of surgical patient. I would say that our surgical
team were able to successfully implement the WHO safety checklist because we had the team
briefing already in place before the introduction of the checklist. Evidence supports the positive
effects of peri-operative briefing and debriefing on patient safety outcomes in surgical setting. On
the contrary, Duclos et al. (2016) argues that even when safety checklists are implemented in
hospital setting, it cannot completely remove errors and patient complications. With my own
personal experience, I can also relate with the point because I had the handover checklist, however
my failure to appropriately document patient’s information contributed to communication and
patient safety issues. Hence, correct utilization of resource is also a challenge while providing care
for the surgical patient. I realized the importance of team briefings after going through the evidence
by Leong et al. (2017). The evidence revealed the potential of team breifing in readily sharing
information and lowering barriers to speaking up with individual health care staffs. Briefings and
debriefing before and after daily surgical routines has been found to positively influence team
climates and increase the efficiency of the surgical programme Therefore, team briefings can be a
solution for surgical team to address the challenge of poor utilization of safety resource.
During the discussion posting, one of the responses was that ‘WHO Safety checklist ....gives
that moment for the team to come together and stay focus on that particular patient’. On reflecting
on this posting, I had the question whether WHO safety checklist can improve team communication
process and prevent errors in surgical settings that occurs because of poor team communication.
Although communication is a crucial part of the surgical care pathway, however failure in
communication and information transfer has been widely witnessed. I was myself involved in one
such incident because of incomplete handover process. Mahaffey (2010) gave idea regarding other
instance of communication failure during the care of the surgical patient. The semi-structured
interview with multi-disciplinary surgical team such as surgeons, nurses and anaesthetist revealed
communication failure in each phase of surgery. During the preoperative assessment phase,
communication failure occurred because of poor communication between surgical and anaesthetic
teams. In both the pre and post operative phase, communication failures occurred because of poor
handover and incomplete or missing information. In response to these challenges in the surgical care
setting, I found that briefing and the WHO checklist together can address this challenge. Mahaffey
(2010) explained that WHO checklist can support multi-professional surgical team in improving
patient safety outcomes within operating theatres where as the briefing and debriefing process has
the potential to improve care planning and communication before and after the operations.
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Therefore, combination of both strategies can be crucial to prevent communication breakdown
between inter-professional surgical staffs.
Effective communication is also important in a culturally diverse environment as
intercultural doctor-patient contacts is also a potential source of misunderstanding and poor quality
communication (Paternotte et al. 2015). Effective communication between patient-staffs is regarded
as a necessary part of the surgical care process. Research literature also provides evidence regarding
challenges in peri-operative communication process due to intercultural gap between staff-patient.
During my practice as a peri-operative nurse, I experienced challenges in communication with a
patient from other cultural background as I could not interpret the patient’s communication related
to pain. The patient did not favoured taking analgesics for pain because of side effects and she
wanted to take herbal drugs to cure herself. Instead of rationally explaining the patient the necessity
of taking analgesics, I allowed her to use her herbal drugs. This resulted in longer hours of suffering
for patient due to pain. Barrington et al. (2016) also identified the above mentioned types of
problem while providing care to surgical patients.
A qualitative study by Clayton, Isaacs and Ellender (2016) explored lived experiences of
challenges faced by peri-operative nurses in a multicultural surgical setting. The interview response
revealed how multiculturalism affected patient-staff communication process. During pre-operative
care, anaesthetics section is an opportunity to enter into good communication process with patients.
However, many patients fail to convey their needs to the nurse and they may not express what they
want contributing to quality and patient satisfaction issues. Patient who do not know English
language fail to get desired care. The discrimination faced is understood from the following quote in
the study: ‘.......because they couldn’t speak English properly, turned up, she wasn’t happy’ (Clayton,
Isaacs and Ellender 2016). This quote reflects that pre-operative nurse need additional skills set to
effectively communicate with patients from diverse cultural background. I think to address this
problem, the role and responsibility of a nurse manager is critical. The above evidence also gives
implications for change in peri-operative nursing education in countries where multiculturalism is a
norm. As a peri-operative nurse, looking for factors that can for effective communication with
patient is important. As stated by O'hagan et al. (2014), certain techniques in interactions such as
open or close ended questions, paraphrasing, clarifying information and giving patient the
opportunity to talk lead to effective communication process. Manners like tone of voice, smiling
gestures and sense of friendliness towards patients can facilitate rapport building and information
gathering phase.
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Conclusion
The critical reflection of my own role in the care of the surgical patient summarized various
situations where complying with peri-operative nursing responsibilities became a challenge for me. I
entered into practice accompanied with much theoretical knowledge regarding the skills set needed
to correctly assess patient in the surgical setting and the responsibilities related to communication
with patient and the multi-professional team. However, exposure to real setting confronted me with
many types of challenges in surgical practice. Internalizing theory into practice became difficult when
I realized that practice in real setting is associated with many barriers such as distraction, work
overload, language and culture gap and communication gap. Inability to overcome some of these
barriers created practice issues for me.
Peri-operative care setting is a fast paced environment and the reflective portfolio described
distraction as the first challenges for me which lead to communication breakdown between staffs
and affected patient outcomes. Distraction is one of the examples of environmental barriers while
entering into effective communication process during patient assessment before or after surgery.
The portfolio identified that by displaying accountability in care, peri-operative nurse have the
potential to overcome environmental barriers too. For example, in the scenario of incomplete
handover process for the old lady, taking the step to ensure that patient has correctly interpreted
the message could have prevented communication and medical errors during care of the surgical
patient.
Earlier I had the assumption that several resources in surgical setting such as handover
report, patient chart and other tools are for the ease of surgical staffs so that they can easily pass on
information to each members. However, I realised that these resource can become redundant if
accurate safety culture and team work does not exist. In response to the discussion posting on the
utility of the WHO safety checklist for surgical practice, the paper summarized that the WHO
checklist can provide all staffs irrespective of experience the opportunity to accurately report abort
patient’s status in crucial stages of the surgical journey. Despite this advantage, review of research
evidence revealed that success of WHO safety checklist was dependent on the presence of safety
culture and effective team work in clinical setting. Team briefing and debriefing before and after
surgery together with the WHO safety checklist can promote efficiency in surgical care. The paper
also summarized challenges for peri-operative nurse because of the multicultural environment in
surgical setting. In response to the issue of communication gap because of cultural and language
difference between patient-nurse, training of newly placed surgical in the area of cultural
competence and communication techniques has been identified to enhance the quality of care.
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Changes in nursing education program is also necessary for countries where multiculturalism has
become a norm so that newly placed surgical nurse do not experience theory-practice gap during
care of the surgical patient.
Reference list
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Barrington, J.W., Lovald, S.T., Ong, K.L., Watson, H.N. and Emerson Jr, R.H., 2016. How do
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001797
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