Importance of Therapeutic Communication and Patient Safety in Nursing: A Critical Analysis

This critical analysis discusses the importance of therapeutic communication and patient safety in nursing through a case study. It highlights the accountability of nurses and the consequences of their negligence.

Running head: NURSING ASSIGNMENT
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Name of the Student
Name of the University
Author note

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Table of Contents
Introduction......................................................................................................................................2
Discussion........................................................................................................................................2
Conclusion.......................................................................................................................................7
References........................................................................................................................................8

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Introduction
Communication in the healthcare settings is an important tool for providing the patient
with efficient care and satisfying the patient with all the required needs. However, in some cases,
the miscommunications lead to lowering patient satisfaction. Every people come to the hospital
with the hope of receiving efficient care (Nayebi & Majd Teymouri, 2015). A team of people
are there in the hospital who are involved in providing care to the patients throughout their entire
healing process. The doctors, nurses, the other members of the culinary team and the family
members of the patient are involved in giving care to the patient. By maintaining effective
communication with the patient, the nurses and the other members of the hospital satisfy the
needs of the patients. They also ensure that their patients are receiving their best quality of care
(NMBA, 2019). If the nurses do not communicate properly, the patients will not be able to
describe the nurses about the different health issues that they are suffering from. This critical
analysis is going to discuss the communications that stuck between the interpersonal team and
the nurse while caring Mr Roy Jacob. In this report of the Inquest into the death Roy Jacob, the
Coroner identified that: “Failure to recognize and respond to clinical deterioration and non-
compliance with early warning and response tools is a recognized issue across the health sector,
public and private.”
Discussion
The therapeutic communication can be defined as the process of interaction occurring in
front, which focusses on the advancement of the emotional and physical well-being of the
patients (MacLean et al., 2017). The nurses use the technique of therapeutic communication for
giving support and information to the patients. The relation of the nurses and patients are mostly

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dependent on the conversation and actions of nurses. Apart from therapeutic communication, the
other important aspect of enlightening the health of the patient is maintaining the safety of the
patient (Choi, Song & Oh, 2015). The ultimate goal of the hospital executive is to keep the
patient safe since they are admitted in the hospital until their discharge (Bussard, 2015). If the
patients are ready to trust the nurses and the doctor, they should also respond back to the trust of
the patient (Deane & Fain, 2016). The nurses are also accountable for the decisions that they
have made and even the consequences of those decisions. Legal actions can be taken against the
nurses if they confidently pursue any wrong decisions (Griffith, 2015).
The nurses can incorporate a variety of techniques of therapeutic communication in
nursing practices. The most crucial method is maintaining silence as deliberate silences can give
both the nurses and the patients to think about the process about what they are going to
communicate next (Brown, 2015). The next important technique is to accept and affirm to what
the patients are saying and also the behavior of the patients must be highlighted (Lewis, Gaffney
& Wilson, 2017). The therapeutic communication serves as the broad opening where a direct
flow of conversation is maintained in between the nurses and the patients (Lai, 2016). By using
the verbal and non-verbal cues, the nurses encourage the patients to talk continuously. For this,
the nurses must become an active listener; active listening includes showing interest in what the
patients have to say (Gausvik, et al., 2015). The dimensions of the safety of the patients are the
commitment of the nurses to the overall continuous improvement of the patients. The priority of
the care should be given to the patients. The nurses must record and evaluate the incidences and
the best practices (Vaismoradi, Jordan & Kangasniemi, 2015The nurses must be concerned about
the personal management and the safety issues. The staffs of the hospital should get proper
training and education about their works (Hall, Frink & Buckley, 2017).

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The concept of therapeutic communication is very much related with the safety of
the patients as the nurses are accountable to the members of the family of the patient. At any
circumstances, the family members can raise questions regarding the safety issues of the patients
(Bahreman & Swoboda, 2016). If the nurses communicate with the patients rudely, then the
patients will be afraid of sharing their health issues with the nurses, and this will result in
ineffective treatments. Past researches have shown the importance of therapeutic communication
in maintaining the relation between the patients and the nurses (Williams, Ilten & Bower, 2016).
Several cases are there where the members of the family of the patients raised allegations against
the activities of nurses.
The case study is about Mr Jacob, who is an aboriginal man of 48 years of age who died
unexpectedly on 31 August 2016 at the Cherbourg hospital. According to the provided
information in the case study, he travelled from Brisbane to Cherbourg on 26 August 2016 for
attending a funeral. He drank a vast amount of alcohol and had a fall because of the intoxication.
He was admitted to the hospital for treating pneumonia, but he was found unresponsive and died
on the morning of 31 August. The case was described to police as the reason for his death was
mysterious. The doctor issued that the death occurred because of pneumonia. The purpose of
pneumonia was identified to be liver cirrhosis, but the proposed antecedent causes were unable
to explain logically that the cause of death was pneumonia. The review team involved senior
medical officers and nurses from several rural hospitals, an indigenous worker, and a health and
safety advisor of the workplace ("Home | Australia Commission on Safety and Quality in
Healthcare", 2019). The review team focused on intoxication or alcohol withdrawal in spite of
the other possible causes like cardiac issues. They also failed to recognize the actual problems of
Mr Jacob being unwell. The team who was reviewing this case identified that the interaction in

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between the nurses and the medical officer was a reason for the nurses to fail in checking the
regular nursing observations. The review of the independent emergency physician confirmed that
the standards of care which the patient received was not adequate. The improper and inadequate
treatment was the cause of his death. He did not receive appropriate treatment, as his diagnosis
was not conducted properly. After this, an exterior examination was completed, and the full
central autopsy was done. The results of the autopsy revealed that the fracture of the left ribs,
cirrhosis of the liver and the lipoid pneumonia were associated frequently with the ambition of
food, vomiting or foreign material. Several triple vessel coronary artery diseases resulted in more
significant than 90% of the lessening of the left anterior downward branch of the left coronary
artery. The toxicological study of the blood sample identified only paracetamol and a minor
quantity of codeine but not alcohol. After considering the results of the autopsy and the medical
history of the patient, the pathologist concluded that the cause of death of Jacob was acute
myocardial infarction, which resulted in cardiac arrhythmia and finally to death. The review
team, however, was not concerned about heart diseases, and they considered intoxication to be
the cause of Jacob’s death. The members of the review team were accountable for their wrong
decisions. Accountability means a person is going to give reasonable answers to their choices in
the course of one’s profession. In the given case, it is seen that neither the nurses nor the doctors
proficient regarding their works. The cause of death as identified by the doctors and the nurses
were completely wrong according to the autopsy report.
The patient also received wrong treatment from the nurses who were responsible for
caring the patient. GN Gray was the registered nurse appointed for the patient. She was not an
experienced nurse, and the treatment procedure that she followed went wrong for this patient.
After Jacob was admitted to the emergency department, the nurse told that the reason for his

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sudden fall was intoxication. However, he did not appear to be intoxicated and was not smelling
of alcohol. The nurse checked the vital signs, and the values of the vital signs were typical. She
completely ignored the other clinical symptoms and started his treatments based on his high pain
score. While the procedure was going on, the patient fled from the hospital to meet with his
family members. The hospital was responsible for maintaining the safety of the patient, but it
was not renewed. The nurse was accountable for her negligence towards her work. The first
presentation and the second administration was also managed properly. In the second
representation (28 August, 2016) the doctors and the nurses provided comprehensive care to the
patient. During the final description to the hospital, the patient had high blood pressure (130/80)
and elevated heart rate (120 beats per minute). The oxygen concentration was also low (90- 94%
on room air). The patient was very co-operative with all the treatments he received, but he died
only because of the negligence of the nurses.
Jacob was administered consecutively three times in the Cherbourg hospital after a fall
caused by intoxication. However, the nurse thought that she would have persistent the chest wall
injury, however, he could not. Even, when he was represented for the last time, he was
administered intravenous antibiotics for pneumonia and fluids for alcohol gastritis. The patient
had high Q-ADDS scores on the previous night before his death. This required frequent
observations and medical review, but neither the nurses monitored him regularly nor escalated
his conditions to the doctor. The causes of his death were finally found to be both coronary artery
disease, lipoid pneumonia and cirrhosis of the liver. During the initial stages of his treatment, he
was treated only for pneumonia. The nurses have not followed concepts of therapeutic
communication and safety of the patients. They should be accountable to the police and also to
the patient’s family members.

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The nurses should have adequately communicated with the patient for knowing precisely
about all the health issues that he was suffering. The nurses should have communicated with the
patients politely and should have considered the values and beliefs of the patient. The nurse
failed to maintain effective communication with the patient. A person who had fractured his ribs
have chances of acquiring coronary diseases. The nurses repeatedly administered paracetamol to
him to reduce pneumonia but did not deliver any medicines to reduce the pain. Since the first
admission only, the patient showed high blood pressure and increased heart rate, but the nurse
completely ignored this condition. The nurses were accountable for their negligence, but this
matter was ignored. The concentration of oxygen saturation was also slightly lower, so the nurse
should be considered vital signs. The patient might not suffer from the worsening of the heart
conditions if the adequate treatments were given at the right time. Along with violating the
nursing standards, the nurses violated the nursing codes of conducts by not conducting their
duties.
Conclusion
It is essential to identify and answer the clinical deterioration of any health conditions at
the right time to prevent the exacerbation of the diseases. The nurses are responsible for
providing the patients with all the adequate requirements. Before starting any treatment, the
nurses and doctors must diagnose the patients accurately and assess the patients according to the
diagnoses. The nurses should start treating patients after only they are confident about curing the
disease. In the given case study, the patient would not have died if the nurses were more
concerned about the concepts of therapeutic communications, the safety of patients and
accountability.

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References
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