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Nursing in the ICU and Communication, Capstone Project Example

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Capstone Project

Background of the Issue

            Nursing in the Intensive Care Unit (ICU) is quite different from that in other hospital units. This is because the ICU is a special unit for critically ill patients or those who are seriously injured or who are recovering from major surgical procedures. These patients need close and careful observation as well as constant monitoring, and they are cared for by specially-trained staff, particularly specially trained nurses. Nursing in the ICU is made easier by the use of special equipment such as heart rate, blood pressure, and respiratory rate monitors. Some patients in the ICU are also connected to ventilators to help them breathe or too breathe for them, until they are able to breathe independently (CPMC, 2005).

Patients and the families of patients in the ICU need proper feedback about the patients’ condition. This is why it is important that communication between ICU staff and patients is adequate, and this is especially true for nursing staff, as they are the frontline of interaction with patients. According to Gauntlett & Laws (2008), good communication skills are critical in crises situations, such as those in the ICU, and this is a key to quality medical practice. In addition, adequate communication skills are needed during meetings with families and when complex cases need coordination with hospital management and colleagues. Furthermore, adequate communication fosters better patient safety, quality of care, and patient outcomes. Inadequate communication can lead to medical error which can lead to liability disputes and lawsuits, as well as an unfavorable reputation for the healthcare facility (Gauntlett & Laws, 2008). Moreover, the main communication link that influences outcomes in the ICU is that between physicians and nurses.

Implications of Research

As it pertains to nursing in the ICU, communication with physicians is a major concern and affects patient outcomes in either positive or negative ways. Adverse outcomes of poor communication between nurses and physicians can take various forms such as major miscommunications regarding timeliness, understanding, or accuracy. This can result in different perceptions about communication elements between nurses and physicians (Manojlovich, Antonakos, & Ronis, 2009).

Nurses in the ICU are keys to preventing or minimizing adverse outcomes for patients, and they are better able to provide good care to achieve this when they are empowered by being involved in the decision-making process for patients’ care. Also, it is important that nurses have adequate information, openness, resources and support, as well as opportunities to learn and train so that they can be at their best. However, the main way to prevent or minimize adverse patient outcomes is through adequate communication channels for nurses (Manojlovich, Antonakos, & Ronis, 2009). Nurses are better able to promote and maintain safer environments for patients in the ICU with adequate and proper communication with the rest of the ICU staff, particularly with physicians.

Related Literature

Communication Skills in Critical Care

Good critical care in the ICU is largely dependent on good communication skills among the staff in the ICU, particularly nurses. This is explained by Gauntlett & Laws (2008) and they also point out that clinical experiences does not necessarily mean that someone has good communication skills in the ICU, although this can be taught. It is estimated that up to 50 percent of patients in the ICU experience inadequate communiation from ICU staff. This is were nurses can make a difference in ensuring more positive patient experiences and outcomes. Nurses relate to the patients and their families more closely and more often than other ICU staff, so they are better able to experience inter-personal relationships with them. However, nurses also have inter-professional relationships with other ICU staff, particularly with physicians and this means that adequate communication with these is imperative. Nurses are better equipped and able to do their jobs when they are adequately informed and trained.

Gauntlett & Laws (2008) also highlight the importance of communicating with patients and their families, even though it is difficult at times because of severity of a patient’s illness or condition and communcition may be limited in some way. This may be due to highly sensitive situations where patients are close to death, so bedside communication needs to be emphathic, caring and informative. This literature piece also focuses on communication competency as a core clinical skill, and states it should be taught and used in practice.

Communication Between Nurses and Physicians

According to Manojlovich, Antonakos, & Ronis (2009), there are many variables and factors in hospital ICUs that can negatively affect the outcome of patient care, and one of the main factors is lack of adequate communication between nurses and physicians. There is a definite relationship between patient care outcomes and the quality of the communication between nurses and physicians in the ICU. This is characteristic of the culture and methods used by the ICU practice environment.

Communication in the ICU, between nurses and physicians, has a direct bearing on factors such as unit response rates, levels of perceptions in understanding specific communication, and capacity utilization. It is noted that adequate and timely communication between nurses and physicians can eliminate or minimize adverse patient care outcomes. This literature piece examines how nurses perceive communication with physicians and how certain elements of communication provide more knowledge about how to modify communication so that it is adequately understood.

The main focus of achieving better knowledge from modified communication is the development of specific communication modification strategies through interventions. Also, adequate knowledge of the particular ICU environment at a particular facility is may be necessary. All hospitals are not 100% the same and all environments are products of the people that work there, the nursing care processes and procedures, and the level of inter-professional relationships between physicians and staff. Potential communication modification strategies include standardizing protocols, more timely consultations with patients, and empowering nurses to speak their minds when they feel it is necessary. It is noted that many times nurses work in silence because of intimidation from physicians. Specific protocols to allow nurses to add their input in clinical decisions can contribute to better communication and better patient care outcomes. These is because nurses are at the frontline with patients and are more intimately associated with them and many patients are more comfortable talking to nurses and telling them what they need and how they feel and revealing information that could help the ICU staff provides them better care.

It is noted that adverse outcomes in the ICU will not be eliminated completely, but they can be minimized with efforts toward better communication between nurses and physicians.

Is Communication in ICU Nursing Critical?

According to Loria (2013), it is critical for nurses in the ICU to be clear in their communication so that transitional care for patients is at its best. Communication is one of the best tools the ICU nurse uses to provide good bedside care to critically ill or critically injured patients who need constant assessment and monitoring.

It is noted that ICU nurses are typically only assigned one or two patients at a time, and this puts them in a better position to notice everything about the patients’ conditions so that they are better able to document any changes and communicate these changes to the rest of the ICU team members. In addition, ICU nurses need to be able to adequately communicate information to physicians as well to promote better continuity of care. This is important when the ICU team participates in daily meetings to assess patient care plans which often include the patient (if possible) and the patient’s family. Communicating to the patient and the family takes special care and ability, as they may not understand the information on the same level as the nurse would communite to the ICU staff.

It is also important that ICU nurses are familiar with and understand other forms of communication besides just speaking with patients. For example, sometimes patients may be permitted to communicate through electronic means, such as texting because they may be intubated and unable to speak. Also, patients on high doses of medication may not be fully coherent and may not be fully capable of following oral instructions or understand what the nurse is saying completely. However, they may feel comfort in non-verbal communication such as therapeutic touch or a simple smile to let them know they are being taken care of. Non-verbal communication is just as important as verbal communication in the ICU.

It is noted that adequate and consistent communication between nurses in the ICU is important as well. Each nurse should have a basic idea about what is going on in the unit so that they are aware enough to spot any problems. Poor communication in the ICU, particularly among the nurses, causes poor transitions of care, poor patient outcomes, and poor discharge instructions. This may hamper the patient’s ability to have their acute care needs attended to properly once they leave the hospital.

Loria (2013) further points out that nurse communication in the ICU has evolved more toward patient-centered communication over the years, and the nurses’ communciation with families has also transformed from simply telling the families about their loved ones’ delivery of care decisions to actually involving them in the decisions.

Nursing Communication Skills in Practice

It has already been established that good quality nursing care is directly related to good quality communication and interpersonal skills. This allows nurses to provide safe and effective care, maintain adequate therapeutic relationships, recognize specific patient needs (such as a patient needing an interpreter), promoting patient well-being, and maintain accurate and complete written and electronic records. In addition, nurses should be able to use a variety of communication technologies. Communication is an actual aspect of patient care that is necessary for the best outcomes for them (Webb, 2011).

Nursing communication is also important so that changes in patient morbidity are assessed properly. Also, in today’s era of patient-center care, patients should be made aware of their access to medical information and their empowerment to participate in their care plan decisions. Nurses should develop excellent interpersonal skills so that they are able to perceive patient reactions, pay attention to feedback, take adequate corrective actions, and present themselves well to the patients and their families so that they form a level of trust. The nurse-patient relationship is very important to the patient’s overall quality of care, because it is an integral part of the patient’s therapeutic care. So, the nurse’s communication with the patient is essential to the patient (Webb, 2011).

Furthermore, the nurse is a multidisciplinary team member and must communicate well with the other team members in the ICU to promote better care outcomes as well. Negative attitudes toward issues such as personal competition, personal differences, and cultural differences have no place in the care environment, and nurses should avoid becoming involved in these types of exchanges and should work to smooth any of these issues, if possible. Patient care comes first.

Conclusion

Critical care nurses are charged with focusing on providing the best quality care possible to critically ill patients or those who have been involved in traumas or who have had major surgical procedures, recovering in the ICU. This requires tenacity and a dedication to providing patients with a sense of calm and letting them and their families know they are in good hands. These patients are unstable and may be in life-threatening states; therefore, they require constant close monitoring and attention. The ICU nurse is on the frontline to make sure the patient is safe and well taken care of, being be alert, knowledgeable and able to assess rapidly changing patient conditions. This is best done through the ability of the nurse to adequately communicate to physicians and other ICU staff, particularly when a patient’s condition is on the verge of leading to the patient’s death. The ICU nurse’s role is critical in the critical care environment.

Reference

CPMC. (2005, June). What is the ICU (Intensive Care Unit)? Retrieved from Sutter Health: http://www.cpmc.org/learning/documents/icu-ws.html

Gauntlett, R., & Laws, D. (2008). Communication skills in critical care. Oxford Journals, 8(4), 121-124.

Loria, K. (2013, March 6). Communication is Critical in ICU Nursing. Retrieved from Advance for Nurses: http://nursing.advanceweb.com/Features/Articles/Communication-is-Critical-in-ICU-Nursing.aspx

Manojlovich, M., Antonakos, C. L., & Ronis, D. L. (2009, January). Intensive Care Units, Communication Between Nurses and Physicians, and Patients’ Outcomes. American Journal of Critical Care, 18(1), 21-30.

Webb, L. (2011). Nursing: Communication Skills in Practice (1st ed.). Oxford University Press.

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