INITIAL QUESTION: In Module 4, we discussed the nurse leader’s experience evaluating a poor patient outcome related to ED care and unmet discharge needs. Continuing that discussion, as the nurse leader in the ED, you must now gather additional information regarding the patient’s ED stay. To facilitate this, you will need to discuss the scenario with the individuals from the interdisciplinary team who played a role in this patient’s care. The team includes the bedside registered nurse (RN), the charge RN, the emergency medical technician, the nurse practitioner, and the physician. With this in mind, address the following discussion questions:
1. Examine communication techniques that may be appropriately utilized by nurse leaders in obtaining information in sensitive situations and/or providing constructive feedback when an error must be addressed. Apply your findings and suggest an approach for addressing the team in the scenario.
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2. Analyze the concepts of expecting perfection versus honoring excellence in addressing errors.
3. Describe 3 different preventable errors that occurred or may have occurred in this scenario. Examine the literature and explore possible methodologies for prevention of these errors. Synthesize your findings.
Peer interaction: 20 pts
One post written in response to fellow learners’ post between 100-150 words. Response is substantive insightful and contain at least one reference.
In the context of the healthcare field, communication can be defined as the verbal and non-verbal transactions that occur in the contexts of physical space, cultural, social values, and psychological conditions (Kourkouta & Papathanasiou,2014). In the COVID-19 pandemic, nurse leaders are facing increasing difficulties in the workplace with high rates of burnout amongst medical staff, low job satisfaction and higher workloads. First-line nurse leaders need to establish meaningful interdisciplinary collaborative relationships with subordinate nurses, ancillary staff, and providers. By doing so, it maintains trust and connectedness in the clinical microsystem (Jankelová & Joniaková, 2021).
In the module 4 discussion, a poor patient outcome was directly related to emergency department care and unmet discharge needs. The nurse leader must now address the scenario with the individuals from the interdisciplinary team who played a role in this patient’s care. The team includes the bedside nurse, charge nurse, emergency medical technician, nurse practitioner, and the physician. In order to obtain information in a sensitive scenario such as this, the nurse leader can use The Newcomb’s Model of communication. In Newcomb’s Model, communication works in a triangular format that concentrates on social purpose and sustaining the relationships between all participants to maintain equilibrium (Popescu et al., 2015). When applied to this scenario, the nurse leader is considered the message sender, with the topic being what happened in the emergency room that impacted the patient’s care and discharge. The message receiver would be one of the members of the care team. If the member of the care team is not ready to address the topic with the nurse leader, then it will directly affect the social system and equilibrium will not be achieved.
Constructive feedback and effective criticism by the nurse leader will empower the care team to be more mindful, have confidence in making the right decisions and provide reassurance that they are capable of correcting errors to prevent reoccurrence in the future (Panneerselvam, 2018). The nurse leader needs to stress the importance that no one on the care team is being judged, but rather giving importance to the learning process. The issues that need to be addressed include the shortage of staff, lack of collaboration, and not addressing the lactic acid level. Techniques to discuss constructive criticism should be included in regular conversations, diverse messaging, and conferencing huddles to improve information dissemination and workflow (Hartung & Miller, 2018). With use of open communication from health professionals, there is an expected improvement in the quality of care provided to patients (Kourkouta & Papathanasiou, 2014).
Perfectionism is often driven by internal factors to avoid failure and harsh judgement. Those with perfectionist tendencies are highly critical of themselves and are pulled towards goals based on the desire to achieve them, even if they’re unrealistic. This leads to a result focused perspective, rather than the process. As a healthcare professional, the concept of expecting perfection can lead to negative health outcomes. If goals are not achieved, this can result in a tendency to avoid further challenges, procrastination, and toxic thinking, leading to increased errors. On the contrary, honoring excellence is process-oriented and not solely focused on the goal or result. Although there may be internal factors that drive the personal desire to achieve success, an individual striving for excellence does not tend to be critical of themselves. Having this mindset will recognize that errors are inevitable and must be addressed. Errors are not seen as personal losses, but rather an opportunity for continual growth.
The three preventable errors that occurred in this scenario is in relation to the number of staff working, the lab results, and collaboration of care. There were two registered nurses and a nurse practitioner that called out sick during the shift where the patient had presented. The staffing shortage could have been prevented by having a solidified back up plan to ensure adequate staffing needs were met. If there were adequate staff, there may not have been the pressure to discharge the patient so hastily. As a result of the pressure to discharge the patient, a lactate level had not resulted until the patient was home and those results did not get communicated to the provider. To prevent this in the future, there needs to be closer monitoring of all diagnostic interventions and an adequate follow up if diagnostic results do come back after discharge. According to Schnapp et al. (2018), medical errors cause approximately 250,000 deaths per year in the US. Of these deaths, most errors are due to the way providers process data, or lack of. Lastly, there was no collaboration with a social worker to address the financial concerns expressed by the patient. The patient did not have insurance and likely could not afford the out-of-pocket expense for the antibiotic or outpatient visit. There were several errors that could have been prevented and with communication, training, and leadership, they can be avoided in the future.
Hartung, S. & Miller, M. (2018). Rural nurse managers’ perspectives into better communication practices. Journal of Community Health Nursing, 35(1). https://doi.org/10.1080/07370016.2018.1404829 (Links to an external site.)
Jankelová, N., & Joniaková, Z. (2021). Communication skills and transformational leadership style of first-line nurse managers in relation to job satisfaction of nurses and moderators of this relationship. Healthcare, 9(3), 346. https://doi.org/10.3390/healthcare9030346 (Links to an external site.)
Kourkouta, L., & Papathanasiou, I.V. (2014). Communication in nursing practice. Materia Socio-Medica, 26(1), 65–67. https://doi.org/10.5455/msm.2014.26.65-67 (Links to an external site.)
Panneerselvam, S., (2018). Feedback among nursing professionals: A narrative review. International Journal of Health Sciences and Research, 8(2).
Popescu, D., Pargaru, I., & Mihai, D. (2015). A multidisciplinary approach of communication. Theoretical and Applied Economics, 2(603), 65-76.
Schnapp, B., Sun, J., Kim, J., Strayer, R., & Shah, K. (2018). Cognitive error in an academic emergency department. Diagnosis, 5(3). https://doi.org/10.1515/dx-2018-0011 (Links to an external site.)