Reflective Journal on Ineffective Communication in Nursing Practice

This reflective journal discusses the impact of ineffective communication in nursing practice. It analyzes a specific incident and identifies the causes of the communication barrier. The journal also links the incident to relevant theories and discusses strategies to prevent similar incidents in the future.

Running head: NURSING ASSIGNMENT
Nursing Assignment
Name of the Student
Name of the University
Author Note

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Introduction:
Reflective Journals utilizes self reflective practice which allows reflection and
retrospection on past experiences in order to record the experience and learn from the
experiences (Al-Rawahi et al., 2015). It can help students to reflect on and note their
experiences and observations as well as their response to specific situation that they can later
use to understand and assess their thinking and decision making process, identify scope of
improvement and develop strategies to address similar situations (Kurunsaari et al., 2016).
This strategy is therefore vital in nursing practice, as it allows the development of the
knowledge, skills and competencies of the nurses through their professional experiences
(Naber & Wyatt, 2014). Discussed below is an important incident that I experienced as a
nursing professional that made a significant impact on me personally.
On August 10th, 2018, my shift started with a handover of a patient from the
postoperative care department, who have recently undergone a bypass surgery. During the
handover, the nurse shared information regarding the patient’s present condition, the
presented situation, medication needs, progress notes and care plan for the patient. The nurse
doing the handover also informed that she was very stressed as she had a very hectic day after
attending several patients that day, and did not run me through the detailed handover sheet.
Due to this, I was not clear about the safety concerns for the patient such as changing of the
IV and risks of infection. However, later on in the shift I noted that the site of insertion of the
IV was blocked and there was a sign of infection, which the nurse did not notice or inform
me about. After informing the doctor it was found that the IV was blocked due to which the
patient didn’t get the necessary dosage of antibiotics and started developing signs of
infection.
Analysis of Journal:

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In the particular case, I was able to identify the cause of the improper handover as
ineffective communication between me and the previous nurse. The ineffective
communication caused the significant information not being conveyed to me and also
prevented me to completely clarify any confusions or queries beyond the scope of doubt.
During the handover, the previous nurse was in a lot of hurry to hand over the patient was
soon as possible in order to end her shift quickly. I realized that due to a lack of time the
relevant information and care plan for the patient was not completely documented or
conveyed to me, as a result of which I did not know when to change the IV drip for the
patient. Furthermore, as I was informed that the IV was working fine and did not need
changing, I did not check the IV myself during the handover to confirm the same. This
overlook resulted in the blockage of the IV not being noticed, which in turn increased the
risks of infection as the antibiotics did not get delivered to the patient properly through the
IV. This was a significant clinical error on the part of both the previous nurse and me, and
jeopardized the health and wellbeing of the patient (Drach‐Zahavy & Hadid, 2015).
After analysis of the cause of the communication barrier or ineffective
communication during the handover, I realized that the error was caused due to two reasons
(or minor themes) (Kowitlawakul et al., 2015). The first reason was a lack of experience and
conceptual clarity of both the previous nurse as well as myself and a sense of stress and
anxiety of the previous nurse due to the long shift she worked. Conceptual clarity is vital
since it helps to understand the clinical conditions and potential risks during clinical
handovers. Due to a lack of experience by both the previous nurse and me, we were unable to
follow the standard protocols of the handover process, and the proper handover strategy was
not followed to the letter (Brady et al., 2017; Sawatzky et al., 2016). Due to my lack of
experience, I also failed to clarify any concerns in a holistic manner thereby further limiting
the communication during the handover of the patient. For example, using the SHARED

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guideline as a framework for nursing handover could have been used in order to prevent the
clinical error (Mannix et al., 2017). However, neither of use used this method completely,
and we only focused on the aspects of medication, patient’s condition and the care plan, and
the basic need for assessing the risk related information such as changing the IV and risks of
infections was not adequately shared causing the problem to be completely overlooked, until
it was already late (Cowan et al., 2018).
The second reason (minor theme) was stress and anxiety of the previous nurse which
led to the ineffective communication, since it caused the nurse to hurry through the handover
process and did not go through all the necessary details that were needed to take care of the
patient. Since the previous nurse had a very long and strenuous shift, it was possible that the
overlook was caused due to the stress and anxiety due to the work pressure (Khamisa et al.,
2015). Considering the high stress environment where healthcare professional often need to
work under, both stress and anxiety are common experiences of healthcare workers, and such
has been related with reduced productivity and increased risks of errors (Wallace et al.,
2015). Thus it can be assumed that the error of the previous nurse can also be attributed to the
work pressure causing anxiety and stress and limited her ability to perform her handover duty
in a proper manner, thereby causing an erroneous handover procedure and jeopardized the
health and wellbeing of the patient and put our competencies as nurses under question (Jones
et al., 2015).
Reflection:
The Rolfe Model of Reflection uses three questions or cues to analyze an experience
and identify learning outcomes and improvement plans. The three questions or cues are
What, So what and Now What. The first cue helps to outline the learning experience, while
the second cue is about the analysis of the incident to identify key information or learning

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outcomes and the third and final cue is about identifying strategies to implement the learning
outcomes in future practice or similar incidents (Nicol & Dosser, 2016). In management, the
Rolfe Model helps to deepen understanding of a situation and helps the management to
address the deeper issues related to the situation which might be affecting the progress of the
business. The three steps help to analyze the situation, identify learning opportunities or
important/relevant information and implement them in practice, thus guiding the management
practice in an organization. Furthermore, it also helps to understand the learning process of
individuals, which can help the management to implement effective learning strategies to
develop understanding of various situations that needs to be managed in an organization
(Spooner et al., 2018).
Discussed below is the analysis of the given incident using the Rolfe’s Model:
During the handover, the previous nurse failed to share all the relevant information
regarding the care of the patient, such as when the drip needs to be changed, the risks of
infection and the allergies of the patient. Additionally, I also failed to ask and clarify such
aspects from the previous nurse, as a result of which the need for replacing the IV drip was
not discussed. The previous nurse was in a hurry to complete her shift, I tried to be
accommodating to her, empathizing her situation, and also failed to ask these questions or
follow the SHARED guidelines to take over the patient from the previous nurse (Spooner et
al., 2018). Due to the improper handover, it was never clarified that the patient had a high
risk of infection as he was under immunosuppressant, and needed careful observation for any
signs of infection. I saw that the patient was administered with antibiotics to prevent infection
and thus was certain that everything was in place. However, since the IV was already
blocked, the patient did not receive the right dosage and signs of infection soon emerged.
Upon further checkup, it was soon analyzed that the patient had significant spread of

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infection which needed extended hospital stay and further medications (Alsolamy et al.,
2018).
The error was caused due to an improper handover, which resulted in improper
sharing of relevant clinical information and thus causing an overlook of the patient’s clinical
needs. This adversely affected the health and well being of the patient, increasing the length
of stay in the hospital and adversely affected the reputation of the hospital. It also put my
competency as a nurse under question, and I had to answer the nursing supervisor and doctors
as the cause of the error (Johnson et al., 2016). Analysis of the incident showed that the
erroneous handover was caused mainly because of improper or ineffective communication
between me and the previous nurse, which was the major theme of the situation. Further
analysis revealed that the problem was further caused due to two sub themes such as a lack of
conceptual clarity and anxiety/stress. Due to the lack of conceptual clarity neither me not the
previous nurse used the appropriate model or framework of clinical handover process thereby
increasing the risk of the error (Smeulers et al., 2014). The lack of clarity could be attributed
to the lack of experience in clinical handover, since both me and the previous nurse were
relatively new in the work. The risk of error was also increased due to the stress of the
previous nurse as she was in a hurry to finish her shift was soon as she could, thereby not
giving enough time to complete the handover process comprehensively (Forde et al., 2018).
Moving ahead, any such clinical error can be avoided through proper clinical
handover by using the SHARED guidelines and ensuring that all the necessary information is
shared in the handover process. I believe that it is also crucial for the nurse in charge of the
handover to analyze the competencies and conceptual clarity of the nurse taking over the
shift, to ensure that all the relevant information are well understood and all the necessary
actions can be performed properly. It is also vital that the nurses are assessed for work related

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stress from time to time, and it is ensured that they get some time between their shifts to relax
their mind (Bruton et al., 2016).
Linking to theory:
Studies have shown that ineffective communication can adversely affect the delivery
of proper care in a healthcare institution, and that effective communication strategies are
important to maintain clinical competency and quality of care. Discussed are some of the
important themes related to the significance of communication in healthcare organizations.
Clinical Errors:
Studies show that ineffective communication can increase the risks of clinical errors.
The errors are caused when the relevant information are not documented properly or shared
with other healthcare practitioners thereby leading to incorrect or inappropriate delivery of
care for the patient (Eggins et al., 2015). It has also been pointed out by authors that improper
communication is one of the leading causes of clinical errors in a healthcare system, as it
causes in improper documentation of patient symptoms, diagnosis of the condition, care plan,
treatment plan, medication needs, patient problems, health risks and patient safety related
information which are necessary aspects in the prevention of clinical errors (Khajouei et al.,
2018; Eggins et al., 2015)). Effective communication also helps the healthcare professionals
to learn from each other’s experiences and mistakes and share best practice guidelines thus
preventing the repetition of errors. In the context of the scenario discussed above it can be
implemented that the clinical error was caused due to the improper sharing of information
during the clinical handover, thereby leading to adverse health outcome for the patient
(Gardiner et al., 2015).
Workplace Conflicts:

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Ineffective communication can also increase the risks of conflicts within the team.
According to authors, difference in opinion is a significant cause of conflict in an
organization, and effective communication skills helps to develop approaches to understand
each other’s opinions and perspectives and thus resolve the conflicts in an effective manner
(Nicotera et al., 2015; Wood, 2015). On the other hand, conflicts can get aggravated due to
communication avoidance. Avoiding communication leads to the development of
misunderstanding as the differences opinions of the conflicting parties often stay unclarified
and unaddressed. It has also been pointed out that due to a lack of communication, a sense of
mistrust can also develop in the team, which further increases the risks of conflicts. In the
scenario discussed earlier, the ineffective handover the subsequent clinical error can be
related to the increased risk of conflict between me and the previous nurse (Burgess, 2017).
Increased Stress:
A breakdown in communication can also cause stress among the team members as it
can increase chaos and confusion. In healthcare teams, due to ineffective communication, the
roles of reach of the member of the healthcare team might become ambiguous or ambivalent,
and thereby causing confusion among the professionals (Hayes et al., 2015; Tuckey et al.,
2015). According to authors, it is necessary to clearly communicate the roles and
responsibilities of each member in a healthcare team to ensure that everyone knows what they
are responsible for (Hayes et al., 2015). Confusion that occurs when such aspects are not
clarified can lead to stress on the healthcare professionals as they are unsure of their specific
roles in the care of the patient. Thus it can be implied that in the discussed scenario, the
ineffective communication between me and the previous nurse can increase stress and
confusion (Afifi et al., 2015).
Ineffective Decision Making:

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Effective communication helps in the sharing of significant and important information
that is necessary for the clinical decision making process. Errors in clinical decision can
occur when there is a communication barrier that adversely affects the quality and integrity of
the information shared (Einstein et al., 2014). Thus ineffective communication can lead to
ineffective decision making process as they are not supported through proper flow of
information to the decision maker. According to studies, a significant amount of erroneous
clinical decision is caused due to ineffective communication due to which the relevant
information needed to support proper decision does not reach the decision maker (Eliacin et
al., 2015). In the given context, I overlooked the necessity of changing the IV drips for the
patient, since I was not provided adequate information regarding the infection risks and the
necessity of changing the drips more frequently.
Strategies to overcome communication barrier:
In order to avoid and overcome barriers in communication and to ensure effective
team performance, some of the strategies that can be used are discussed below:
Competency to work in multicultural and multidisciplinary healthcare teams:
Working in multicultural and multidisciplinary team, healthcare professional can
develop their communication skills as well as conceptual clarity. A culturally diverse team
helps the nurses to use effective communication practices in order to communicate with
everyone, overcoming the cultural barriers to communication and understand each other’s
perspectives in a better way (Shaw et al., 2014; Housley, 2017). According to authors,
multicultural healthcare teams can significantly improve the abilities of the nurses to
communicate better through the identification of the communication barriers and trying to
overcome them to achieve effective sharing of information (Oliver et al., 2016). Similarly,
working with a multidisciplinary healthcare team helps the nurses to develop better

9NURSING ASSIGNMENT
conceptual clarity, since they are often involved in the sharing or relaying of information to
the healthcare professionals from specialized domains (Hartgerink et al., 2014).
Establishing effective channels of communication with senior healthcare personnel:
Developing effecting channels of communication with the senior healthcare
professionals helps the nurses to develop their understanding and knowledge about their
work, improve the transmission of relevant information and can help the nurses in the
decision making process. Through the proper use of the channels, the communication
between the healthcare providers can also develop. (Housley, 2017) Studies suggest that
involvement of senior healthcare personnel also helps to use the best practices and support
better health outcomes for the patients (Shaw et al., 2014). Thus this strategy also helps to
overcome barriers in communication and establish standardized protocols for sharing
information. Moreover, involvement of senior and experienced healthcare professionals also
can minimize the risks of clinical errors due to better supervision of the nursing activities
(Oliver et al., 2016).
Leadership strategies:
Leadership is an important quality in nursing as it allows senior and experienced
nurses to guide the junior and inexperienced nurses in their work, help them identify and
implement best practice in work and also maintain quality and safety of care. Effective
leaders can help the nurses to identify barriers in communication and help them to overcome
them and improve team coordination as well as team performance (Démeh & Rosengren,
2015). Good nursing leaders can also provide examples from their own professional practice,
that can be followed by the other nurses and thus inspiring them towards professional
development. They can also help in effective resolution of conflicts in the team through
improved communication and understanding of each other (Kim et al., 2015).

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Effective Use of Time:
Time management is also vital to overcome communication barriers as it can help the
nurses to use their time in a better manner and prevent rushing in to the decision making
process. Through effective utilization of time, nurses can ensure that they provide adequate
time towards each activity such as during nursing handovers and thus avoid ineffective or
incomplete sharing of information (Nyssen et al., 2018). Thus time management can support
better communication by supporting better utilization of time in the process of clinical
communication. It can also be implied that through better time management, the nurses can
also reduce the risks of clinical errors, which could be identified in the given scenario (Khan
et al., 2015).
Conclusion:
Reflective journals are useful in nursing profession and for nursing students as it
allows them to reflect upon their own learning experiences and identify key learning
outcomes that can support their professional development. Effective reflective writing skills
allow individuals to analyze their experiences in a structured way to identify the learning
outcomes and can help them to implement those learning outcomes in their professional
practice. My reflective journal entry was based on an incident that took place during a
nursing handover on August 2018, during which adequate information was not shared with
me regarding the patient and the safety requirements in patient care. This ineffective sharing
of information caused a communication barrier between me and the previous nurse in the
handover process which further led to a clinical error. Due to the clinical error, I overlook the
need to replace the IV drips and failed to check the signs of infection. The patient’s condition
was adversely affected due to this overlook as he was in a high risk for infection. Using the
Rolfe’s model for reflective writing, I was able to identify the main cause 0of the clinical

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error to be the ineffective communication, as well as relate two sub themes that also
contributed to the communication failure, such as lack of conceptual clarity and anxiety/stress
due to long shift hours. I was also able to identify from key journal articles, that poor
communication increases the risks of clinical errors, conflicts in workplace, work related
stress, and ineffective clinical decisions. Also to improve communication capacity, nurses can
work in multicultural and multidisciplinary healthcare teams, develop effective
communication channels with senior healthcare workers, use leadership strategies and utilize
effective time management skills.
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