The Importance of Effective Communication and Reflection Practice in Healthcare - Essay Example

SCHOOL OF HEALTHCARE STUDIES ASSIGNMENT FORM Number: Programme: BSc (Hon In Intra & Perioperative Practice Module and (HC3075) Professional Practice Development Assignment title: Reflective Assignment Declared word count: (2006) _________________________________________________________________________ Introduction General consensus is that the importance of reflection in clinical practice is undeniable due to myriad riveting reasons. For starters, this is a magnificent way of allowing a person to smartly engineer an effective action plan and engage in a continuous learning process. Therefore, reflective practice in any context can be safely considered a principal and scintillating source of personal improvement and professional development. This explains how overtime this concept has gained popularity globally especially in clinical settings where high level of reflection is fundamental to nearly every practice (Price 2004). Facts and discussion presented in this assignment are basically structured in accordance with the Gibbs reflective model (1988). To validate the reflection practice, this paper includes a case scenario in which the practitioners involved in the care of the patient did not pay adequate attention to the importance of effective communication. Consequently, this lack of communication affected the patient for the worse. Therefore, this paper aims at scrutinizing the best research evidence to emphasize the need for proper communication in health care in order to refine clinical practice and respect patient values. The Description/Event Several years ago, I was in the cardiac theatre working as an anaesthesia technician and meanwhile, one 5 years old boy who was a cardiac patient was undergoing dental clearance by a trainee dentist. After the trainee was through, the inhalation agent got terminated so as to allow the patient recover prior to the removal of the endotracheal tube. Now in many situations, it is too risky for novices like dentists undergoing training to take full control of actual procedures to be performed on the patients and it also appeared later from a consent form that the patient’s parents had never agreed to the direct involvement of anyone but highly qualified professionals in their child’s treatment in the OT. Clearly, this critical incident originated due to lack of healthy communication between the surgeons and patients which is essential to avoiding risks in the OT. Though the patient did not experience a considerable harm but his parents had desired for any intervention to be carried out by trained professionals and not by trainees. Feelings Shock was one of the feelings that overcame me first when from another anaesthesia technician I learned that the patient’s parents had not wished for the involvement of a trainee to avoid any possible risks. This fellow technician despite knowing of the parents’ unwillingness refrained from bringing this thing to the doctor’s attention. It is claimed that patient safety is put at risk due to increased incidence of medical errors (O’Daniel & Rosenstein 2008) which occur when ethical and legal guidance in clinical practice is not carefully implemented. Also, the lack of trust within the suborganizations or different departments suppresses collaborative teamwork (Crabtree et al. 2008) which is essential for safe care delivery. All professionals including anaesthesia care providers ought to realize that there are countless areas where inability to adhere to ethical and legal perspectives of patient consent can produce critical or even chaotic results (Walker 1996). A lot of research has been done to find out if obtaining informed consent of the patients is an ethical obligation or a legal compulsion. Satyanarayana (2008) claims that the whole concept of patient consent basically arises from human rights as it is the foremost right of the patient to decide who should or should not approach his/her body during any procedure or surgery. Apart from this ethical approach, the legal perspective suggests that any act of touching a patient without his/her consent and clear permission is characterized as battery or physical assault which is punishable by law. Consent cannot avoid legal liability and obtaining one is a legal compulsion because patients have a right to autonomy (Satyanarayana 2008). The Ministry of Ethics UK also specifies that the act of touching a person without his/her permission falls under the category of “offences against the Person Act 1861 which is law relating to crime of assault (battery is a crime under common law)” (Ministry of Ethics 2010). Article 8 of the Human Rights Act 1998 is also worth mentioning here which is one of the statutory obligations for confidentiality and states that “everyone has the right to respect for his private and family life, his home and his correspondence” (Ministry of Ethics 2010). Research cites that “the Human Rights Act 1998 was introduced into UK law in 2000 and must be considered in all clinical cases” (Curtice 2008). Another source cites that all physicians in the UK are obligated by the Supreme Court to obtain a written consent to make sure that patients have agreed to a student or a trainee being involved in the care if they wish to include under training professionals in teaching (General Medical Council 2013). In essence, this means that the doctor, anaesthesia technician, and trainee dentist in this case are all found to be guilty as they did not respect the consent and can be charged in court with breaking the law on confidentiality. Ethical and legal principles in clinical practice together stress that all health care professionals should realize that it is not theirs but patient’s right to determine who handles them during the treatment process and therefore, everyone involved in the care delivery process should be extremely careful (Mann & Gordon 2009). Lack of communication between team mates is cited as one of the principal root causes of sentinel events (Victorian Government Department of Health 2010). But, good team communication can be ensured in the OT only if the hospital management and senior staff make efforts to create a culture in which mutual respect among team members is promoted (Davies 2005, p. 899). Also, legal guidance in clinical practice especially the Human Right Act 1998 which includes many concepts for clinical practice should be essentially taken into consideration as honest adherence to patient consent and safe care delivery is considered increasingly important by the UK courts. If the senior doctor and anaesthesia technician had focused on the message delivered by various legal principles and acts some of which are discussed above, this critical incident would never have occurred. Evaluation and Analysis Healthcare research indicates that as many as 80% of the errors responsible for critical incidents involve informational or personal miscommunication among different teams or between patient and physician (Woolf et al. cited in La Pietra et al. 2005). Research also claims that incomplete information transfer due to the irresponsibility of anaesthesia care providers form the principal root cause of anaesthesia-related sentinel events (Jayaswal et al. 2011). This shows that anaesthesia care providers or other health care professionals often lack adequate time to discuss the patients’ issues in details which can very effectively produce a negative impact on the patient (Brown et al. 2003). All kind of reasons should be assessed in order to construct safe working environment in the OT and reduce the rate of inadvertent medical errors (Awad et al. 2005, p. 770). Often, health care professionals perform many procedures in a hurried fashion irrespective of the patient’s or parents’ consent which can lead to drastic results costing billions of dollars annually (Stimmel 2009). Insufficient teamwork among health care teams contribute to more patient harm and medical errors than from road traffic accidents or even breast cancer (Challenges in Healthcare 2012). It is extremely vital that managements in hospitals raise awareness regarding more teamwork and legal guidance which is essential (Brown et al. 2003). The failure of the physicians to acquire important information from nurses or operating staff is cited as the principal cause of ineffective communication by Stanton (2012, p. 216) as was the issue in this case where the physician in the OT failed to obtain the required information from the technician. According to Frankel (2009, p. 49), failure to share known information like when a team member knows there is a problem but seems unable to speak about it to his/her superiors leads to flawed management of the complexity of patient care leaving the patients hurt. It is also implied by the British Medical Association (2012) that in accordance with ethical requirements in clinical practice, the patient or the parents/guardians should be asked for their consent in private and not in the presence of a student/trainee so that any concerns they may have could be expressed openly without any hesitancy. The teleological theory of ethics focuses only on the outcomes and argues that if the treatment process leads to the best outcomes for a large percentage of people, it should be perceived as just and healthy (Guido 2010, p. 172). In contrast, it is claimed that the practice of medicine should be fundamentally deontological in nature (White 2004, p. 288) because this approach pays non-negotiable respect to the patients preferences and not to the welfare of under training professionals. Under common law in the UK, touching a patient without consent constitutes criminal offense of battery (Department of Health 2006). This implies that despite seemingly successful dental clearance procedure performed by the trainee dentist, the registrar is still legally obligated to respect consent of the patient or guardians before initiating any procedure. Conclusion In my opinion, following the BMC guidelines and legal principles could have prevented the incident from occurring. In the mentioned case, an efficient leader who could adhere to the use of a checklist/consent and structured plan was absent. There was absence of a professional and responsible registrar who would have had the power to communicate with the anaesthesia technician and prevent the under training dentist from operating on the child. Small effective measures collectively made by all health care professionals in the taxing environment of the OT and responsible adherence to clinical principles as defined by statutory bodies can guarantee patient safety and also in this way, the patient’s or the parents’ will is not violated. Recommendation and Action Plan All health care professionals should be sufficiently trained to ensure effective communication and apply legal principles wherever necessary. I recommend that structured documentation checklist, good team work, and effective communication be made the key targets for quality improvement plan which ensures patient safety in all departments. Miscommunications occur when details are not precisely offered (Trafzer & Weiner 2001, p. 121) as was the case when the anaesthesia technician did not convey the information to the registrar even when he knew what the real state of the matter was. Actually, baseline factors that affect the quality of communication should be addressed and awareness programs should be conducted in the hospitals so that no patient will be hurt or harmed in any way due to a communication failure (Pillow 2007, p. 89). In context of legal implications, it should be understood by all health care professionals that other than routine physical examination, obtaining consent and respecting it is a legal requirement. As mandated by British healthcare and legislative policies, I strongly feel that healthcare professionals should adhere to the trust policy because research stresses that such a professional attitude helps to prevent adverse effects on patients (Pattinson 2011). The circumstances and content of communication, various discourse modes, presence of resources and opportunities for creating a common body of understanding, and reducing the linguistic and cultural distances should be considered valuable (Welsh Assembly Government 2008). Most of the miscommunication issues take place in the OT either between the doctor and anaesthesiologist/anaesthesia technician or between the doctor and the nursing staff (Davies 2005, p. 898). So, it is critically important for all health care professionals to have a solid sense of teamwork (Williams 2007, p. 958). But most importantly, it is imperative that adequate guidance be provided to all health care professionals regarding important legal requirements for gaining patient consent as penalties for non-compliance could be complicated and even gross. British Medical Association (BMA) and the UK courts insist that verbal consent prior to clinical encounter should be obtained from the patient or the parents by someone other than the student (Faculty of Medical Sciences 2010) so that the patients do not shy away from expressing their true concerns. References Awad, SS et al. 2005, Bridging the communication gap in the operating room with medical team training, The American Journal of Surgery, vol. 190, pp. 770–774. British Medical Association 2012, About the BMA, viewed, 02 April, 2013, Brown, G et al, eds., 2003, Becoming an Advanced Health Practitioner, Butterworth Heinemann, Edinburgh. 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