Nurse Communication


[PODCAST] How Today’s Patients See Care Teams

Today’s patients see care teams differently than they once did. In the past, patients played more of a child-like role to their physicians and nurses. However, in today’s more patient-centered market, there has been a shift to patients wanting more information and control over their own care—they want to be a member of their own care team.

Listen to the podcast and see our related podcast to learn more: How Today’s Patients See Care Teams

5 Areas of Focus for HCAHPS eBook




How Today’s Patients See Care Teams

Today’s patients see care teams differently than they once did. In the past, patients played more of a child-like role to their physicians and nurses. However, in today’s more patient-centered market, there has been a shift to patients wanting more information and control over their own care—they want to be a member of their own care team.

patient centric care teams

Introducing the Healthcare Consumer

We all know the patients who would rather sit uncomfortably than call their nurses to help them or the patients who don’t want to ask the doctor too many questions because they are so busy.

Today’s modern healthcare consumer is empowered. They want to take an active role in their own healthcare because they not only want to know what they are paying for, but they want to be part of the decision-making process.

The modern patient does not sit by the sidelines as members of a care team makes choices for them. Instead, they are active participants – actual members of their care teams. They are involved in:

  • Decision-making
  • Care team conversations
  • Treatment planning

So, how can healthcare professionals help patients feel more a part of their own care teams? Nurses and other members of the healthcare community need to readily embrace this shift in attitude and find ways to bring the patient on board. A great way to start is with the bedside shift report.

Engaging Bedside Shift Reporting

In the old days, the bedside shift report was a discussion between the off-going nurse and the oncoming nurse that took place in front of the patient—not with them.

Bedside shift reporting today takes a complete approach. The goal of the report is the same, but the information comes directly from the patient—making them part of the team. A key tactic to use here is the teach-back method, where the outgoing nurse prompts the patient to explain their care to the oncoming nurse. This puts the patient, and their family members, in the driver’s seat on issues such as pain management, treatment planning, and scheduling.

When it comes down to it, the patient is ultimately in charge, so why not work with that to empower them?

Changing Roles in Discharge Planning

improved hcahps scores

The final step is to involve both the patient and family members in planning their discharge to the next level of care. Discharge planning goes into effect immediately when the patient is admitted to the hospital. Nurses should prompt the patients and family members to think ahead to when they will be going home, and to begin planning what they will need to continue their care.

This advanced planning gets them thinking ahead about the discharge process and how to prepare for it. They will begin constructing questions in their mind to ask prior to discharge, and it will give them plenty of time to gather the necessary information to take over their care.

The parent/child dynamic that once existed between a healthcare provider and patient failed in many ways. The healthcare landscape today supports more of a peer-to-peer scenario, giving each party the respect they deserve and the information they need for better outcomes. Patients are no longer sideline observers in their own health care strategies. Today, they are members of the care team and able to take an active role in their own care.5 Areas of Focus for HCAHPS eBook

[PODCAST] How Nursing Leadership Can Move Surveys from Usually to Always

Nurses and nurse managers, strive to provide safe care along with an excellent patient experience. If your organization has attained that goal, then you may have found your hospital in the upper 25th percentile of the national database. That’s an accomplishment, so congratulations – high fives all around. The problem is once you meet that milestone, how can nursing leadership continue to improve?

Listen to the podcast to learn more: How Nursing Leadership Can Move Surveys from Usually to Always

5 Areas of Focus for HCAHPS eBook




How Nursing Leadership Can Move Surveys from Usually to Always

As a nurse or nurse manager, you strive to provide safe care along with an excellent patient experience. If you have attained that goal, then you may have found your hospital in the upper 25th percentile of the national database. That’s an accomplishment, so congratulations – high fives all around. The problem is once you meet that milestone, how can nursing leadership continue to improve?

nursing leadership in busy hospital

Taking the next step means moving those patient survey responses from “Usually” to “Always”. The idea is to provide care that will encourage your patients to pick “Always” on the HCAHPS survey in every domain, presenting you with top marks for your care, but how?

FREE DOWNLOAD:  HCAHPS Tactical Guide

Adding Definition to Your Strategies

Consistency is the key to quality care and improved scores on the HCAHPS survey. It seems to make sense to dedicate your department to a “flavor of the month” enhancement like patient safety, communication, and responsiveness, but are you consistent in the way you deliver them?

To provide care that will make an impact on your patients, nursing leadership must be consistent in practicing core principles such as safety, communication, and responsiveness. This means focusing on a few basic tactics, that can make an impact on both your patient’s experience and how they score you on the HCAHPS survey.

Bulking Up Your Score with Regular Rounding

There are two major tactics to factor in consistently to further enhance your nurse to patient communications skills. Start by initiating regular rounding or hourly rounding. This is good for many reasons, but, ultimately, it sets the patient’s expectations. They never feel deprived or alone when they know you, their nurse, are coming around in regular intervals.

From the nurse’s standpoint, if they know you are coming back on a schedule, it keeps your patient from getting up over and over without assistance. That’s a point for patient safety. For nurses, it adds certain efficiency to the work, as well.

Making Use of the Communication Boards

Another underused but highly effective communication tool is the communication boards. This is powerful and engaging information for the nurse, regular staff, and the patient. Communications boards clearly state:

  • Upcoming appointments
  • Medications
  • Nurse’s name

By keeping that information current, nurses reduce patient and family anxiety and foster effective communication all around.

Nursing Leadership Can Get Better Responses with Enhanced Responsiveness

Consider two tactics that work well in the domain of responsiveness:

  • The “Five Foot Rule” states that a nurse should never be more than five feet away from a call coming in at the nurses’ station. It’s a simple concept that ensures the patient never has to wait once that button is pushed.
  • Establish a department-wide policy that states no member of staff should walk by an engaged patient’s assistance light without checking to see what the patient needs.

Those two enhancements really focus the entire staff’s attention on responsiveness to the patient’s needs.

The trick is to learn to improve those scores by figuring out what works for you and your hospital. Ask the nursing managers to talk about enhancement tactics like the ones listed here during meetings. Bring them up any chance you get, really, maybe at larger group meetings, as well. Promote the idea of a skills lab that video tapes staff working with mock patients to see what works and what doesn’t and improve skill sets. Staff can provide feedback to promote consistent delivery.

Instead of just picking out new tactics with each patient or each shift, focus relentlessly on the basics listed here and soon you will find yourself moving up to the “Always” rank.5 Areas of Focus for HCAHPS eBook

An L&D Story: How a Good Patient Experience Could Have Been Great

Patient Experience and L&D

In March, my wife and I were thrilled to welcome our second child to the world. Our baby boy was born healthy and we could not be more thankful. I did catch myself taking notes, however, as I’ve been working closely with Always Culture and learning about best practices for providing an optimal patient experience. Our overall experience was good, but there were some areas of opportunities that, if addressed, could have made it great.

Our son was a big boy – over 9 pounds, and my wife is very petite, so a few days before the due date her doctor advised that we schedule a cesarean. We gratefully accepted. My wife’s water broke with our first child, and it was like one of those movie scenes where you rush to the hospital, so it was weird just showing up at a certain time to have the baby. Weird, but nice. We stayed for two nights.

COMMUNICATION

We didn’t have any really bad interactions with nurses, but we could tell a difference between the providers that were just going through the motions, trying to get through their shift, and the ones that were actually engaging with us. Right off the bat, they were asking some intake questions and mixed in with medical history, medications, and the like, was this one: “Have you ever thought of hurting yourself or anyone else?” The nurse asked it in the same casual tone that she asked about cigarette smoking. I couldn’t help but think that if the answer was “yes”, would anyone feel comfortable saying so? What would the follow-up be? It just seemed like a very personal and intimate detail that should have been approached with a bit more care.

After the baby came, we were like many parents with newborns; exhausted, delirious, and looking for the staff to assure us that our son was doing well. We may actually be a bit more sensitive than many parents. I know I tend to look for things to worry about when it comes to my kids. That’s why I replayed every word I heard from the care team over and over in my mind.

There is no “routine” for patients and their families

I remember at one point the pediatrician came in and asked us how the baby’s blood sugar was. I was thinking “I don’t know… let me ask the doctor!” The question was completely out of left field. I felt like there was something going on that we didn’t know about. I pestered the next few people who came in the room about “have you heard anything about his blood sugar?” They hadn’t. It was fine. I don’t know why the doctor asked the question, but I learned that routine communication is not routine for patients and caregivers.

Empathy goes a long way

We had a couple of nurses that I wish I could give a million dollars each. They were truly caring toward my wife. They listened, asked questions to discover what was important to her, and had empathetic responses that made us feel like we were in good hands. Breastfeeding was something that we were especially focused on because we had struggled with our first child. We knew we wanted to get as much advice as we could while we were in the hospital. Even though the nurses and lactation consultants didn’t have all the answers, the time spent with us “in the trenches” meant the world to us.

The last thing I would say about communication is that I wish that all of the staff had utilized the communication boards. Some did, but most didn’t. Time doesn’t seem to exist those first few days, so it’s helpful to know what meds you can have when, remember who your nurse is now, and how she can be reached if needed.

RESPONSIVENESS

There were only a couple of times during our stay when I got upset. They both had to do with responsiveness. After my wife’s catheter was removed, it took a while before she could go to the restroom on her own. While she waited, her pain (and anxiety) continued to build until it became unbearable. She had been told not to try and use the restroom on her own, but she really wanted to try so she could relieve the pain. We were unable to get help to the restroom. Multiple calls using the call light didn’t work. The staff that answered the call seemed indifferent and a little put off that they had been bothered.

Eventually, I helped her to the toilet and she was able to relieve her pain (and bladder). The nurse arrived while she was in the restroom, and I was a little surprised that she didn’t stay to help her back to bed. In general, the call lights seemed to be completely ineffective. There were several occasions when she needed pain meds that I eventually went out to the nurse’s station because it was the only way we could get help. I don’t know what she would have done had she been alone.

Shift Reports and Rounding set the tone for attentive care

We never experienced a bedside shift report or regular rounding. We often found ourselves just hoping someone would show up soon, and often expecting to have to track someone down. Several hours after one shift change I went to the nurse’s station asking if we could get some medication and they asked who my nurse was. I had to respond, “I don’t know, we never met her.” Despite having some sub-par experiences, it’s amazing how one person can turn it around. It was the nurse at the station who asked me who my nurse was. She understood that the ball had been dropped and she picked it up. She got my wife’s medication and set clear expectations for when we could expect to see her again. After finding the nurse assigned to us, she had taken over our care personally. Each shift change we had been hoping that we would get a nurse who was paying attention. She was a breath of fresh air.

Any inpatient stay is a vulnerable time for patients and their families, even on joyous occasions like childbirth. Having a caregiver who is truly paying attention makes all the difference in the world. Implementing best practices like bedside shift reports, regular rounding and communication boards can help make a patient feel like they are being cared for and make a good experience an exceptional one.

5 Areas of Focus for HCAHPS eBook

[PODCAST] The Metric that Most Correlates with Overall HCAHPS Ratings

When a patient sits down with their HCAHPS survey to answer questions on how they communicated with their nurses, they’re going to be answering questions based on just about every communication they had with all staff members at the hospital…

Listen to the podcast to learn tactics for improving patient communication with nurses or checkout the full video and article: The Metric that Most Correlates with Overall HCAHPS Ratings

5 Areas of Focus for HCAHPS eBook




The Metric that Most Correlates with Overall HCAHPS Ratings

When a patient sits down with their HCAHPS survey to answer questions on how they communicated with their nurses, they’re going to be answering questions based on just about every communication they had with all staff members at the hospital.

In terms of HCAHPS ratings, the questions they’re answering are:

Were you treated with courtesy and respect?

How often were you listened to, and how often did nurses explain things in a way you could understand?

Remember that as patients answer these questions, they are indicating if communication “never” happened or if it “always” happened, so consistency is the key.

COURTESY & RESPECT

A big part of conveying courtesy and respect is eye contact and open body posture. Even sitting down at the bedside is much more effective than standing up and looking down at a patient.
Research even shows that patients feel that they were listened to more, and that their questions and concerns were addressed more, when a caregiver simply sat down.

hcahps ratings

 

CLEAR EXPLANATIONS

In addition to courtesy and respect, provide your patients with clear explanations. Remember that the patient decides whether they understood an explanation clearly, not the provider. Minimize any confusing language, eliminate the jargon that would normally be used from caregiver to caregiver, and keep the conversation on their level. There are two main tactics that can be used to make sure that you’re explaining clearly:

  • Explain your care. Explain why you are performing any function, no matter how simple, whether it’s adjusting an IV or moving a call light closer: “It’s for safety…It’s for privacy…It’s for your comfort.” If the patient knows why you’re doing something, it makes a much bigger impact.
  • Listen to your patients’ responses. Listening to patients sounds like something that should be second nature, but it is imperative to make sure that patients feel listened to. This can be accomplished by employing a tactic known as active listening. Some examples of active listening include nodding your head when the patient is speaking, repeating small
    details, or asking for clarification on a certain point. These tactics communicate that you are interested and engaged in what the patient is saying.

If you employ one tactic to make sure your communication with patients is effective and showing up in HCAHPS ratings, it should be to remember courtesy and respect. Sit down when you’re in a room with a patient. Listen actively and use explanations that are free of medical jargon. These simple gestures make sure that patients know that they are important and that they are more than just a case number.




5 Areas of Focus for HCAHPS eBook