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Poor communication effects on patient care

Jasmine Barco

Youngstown State University

NURS 6900: Healthcare Issues and Trends

Dr. Susan Lisko

November 22, 2022

Abstract

Poor communication can ultimately lead to poor patient outcomes. To properly care for patients

the whole care team must openly communicate with each other and the patients / families.

Improper communication leads to unwanted treatments or inappropriate use of life support.

Nurses can effectively help lessen communication failures by openly having honest

communication with patients regarding their needs and wishes. This information can then be

relayed to providers to help create the best plan of care collaboratively with patients. By using

patient portals, patients have their active health information and can be an asset to the health care

team by being better educated to help make care decisions. With group meetings and daily

check-ins patients ultimately suffer less as they have an active educated voice in choosing what

is best for them.

Poor communication effects on patient care

Communication is a key tool in providing excellent patient care and creating a trusting

relationship with your patients or family members. Nurses are with patients and families more

than any other person on the health care team. As being the sole person to interact with patients it

is important to know the care team’s plan and goals for a patient. Knowing an accurate plan

provides the nurse with the opportunity to properly care for a patient and answer any questions

that might arise. Increased patient acuity often brings an increased number of specialists to treat a

multi-organ problem. Having increased providers comes with multiple opinions and treatments,

treatments to help their specific system might hurt another and provide conflicting treatment for

another provider. When families receive conflicting information from providers it causes

mistrust and confusion, leading to impaired decision making (Wood et al., n.d.). It is important

for a family to trust in their nurse as they are the patient advocate and provide the most direct

care. Lack of communication provides unsafe patient care as a nurse is unsure of what orders to

follow or what concerns to be looking for. Clear communication amongst providers, nurses and

patients provides easier clinical decision making and ultimately better outcomes for patients

(Communication Between Doctors and Nurses, 2020).

Historical aspects

Most of the care for sick people was provided at home by family for all of history up until

the 19th century. People were not cared for by others unless there was a vast illness amongst the

population and additional help was needed, and during this time our version of medicine was not

available (Whelan & Buhler-Wilkerson, 2011). Homemade tinctures, cool washcloths, and

isolation for the sick to prevent spread was the extent of care. It was during this period that

Florence Nightingale along with a group of nurses went and took care of the British soldiers
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(Whelan & Buhler-Wilkerson, 2011). When imagining nursing then the infamous scene of a

nurse tending to a soldier’s needs and wrapping bandages comes to mind. Nurses were given

orders from doctors at bedside and provided what interventions they had available. A doctor,

nurse, and sometimes an orderly was the extent of the care team, therefore communication was

not a huge downfall. There were not multiple specialists creating multiple opinions, and due to

lack of medical advancements not many options were available. Nurses were not relied on to

distinguish accurate communication and then provide it to patients and families. Until the last

few decades visitors were not even allowed in acute care areas for more than an hour or so a day.

The perception was the doctor was always right and would tell you the plan and decisions,

families and patients did not have much say as they were not the experts. Since the plan came

from one provider, and nurses were there to carry out orders and not have a voice,

communication was not a barrier in proper patient care.

More recent historical communication downfalls with nurse’s provider a larger

consequence with severe injury or even death. The most recent medication error that was very

well reported was a nurse who mistakenly administered vecuronium instead of versed.

Vecuronium is a paralytic drug that when given stops self-regulated movement of the diaphragm,

therefore if the patient is not intubated will cause respiratory arrest and ultimately death. This

nurse had received an order to give versed to her patient before a scan to help reduce her anxiety

from claustrophobia (Sofer, 2019). This is a fine example of good communication; the patient

expressed her fears to the nurse who then spoke with a physician to provide the best care for her

patient by easing her fears and completing the needed test. If this communication did not occur

the test more than likely would not have occurred and then there could have been a potential

delay in care. When this nurse went to remove the versed from their medication dispenser it was
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not listed, so she used the override function and searched “VE” which is ultimately how she

obtained the vecuronium instead of versed (Sofer, 2019). This represents how poor

communication ultimately costs the patient’s life. When the ordered medication did not show up

in the medication dispenser the nurse should have called pharmacy to check if there was a failure

in approval of the order or availability, if there were no solutions presented as to why it was not

showing as an active order then a call should have been made to the physician to see if the order

had yet to be entered or perhaps entered on the incorrect patient.

Another past incidence of poor communication was the doctor who prescribed multiple

1000mcg doses of fentanyl to the terminally ill. All these larger, unusual doses of a very potent

opioid were administered by a nurse causing respiratory depression and death. Although these

patients were end of life it was a controversial topic because it promoted quicker death than what

was expected. Narciso reports that two nurses each administered 1000mcg to the same patient

twenty minutes apart. The nurse that gave the second dose was unaware a dose was given twenty

minutes prior (2022). There are multiple communication failures in this specific incidence,

between nurses, doctors, and pharmacy. Being such a highly unusual dose of a lethal medication,

the pharmacy should have never approved the order or both orders twenty minutes apart which

would have triggered a nurse to think about administration beforehand. Any nurse who has given

fentanyl before is aware 1000mcg is a very large dose, too large, the doses range from 25 -

100mcg at a time. Both nurses who administered such a high dose of fentanyl should have

questioned the dose with pharmacy and the physician also, even if ordered it is still the nurse’s

responsibility to make sure the order is safe and refuse administration if not. A nurse’s license is

at risk if they carry out a directly harmful order that should have been questioned just as the

doctor will be held liable for ordering it as well. What is even more of a failure is that the nurse
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who gave the 2nd dose did not know the first one was given, was it signed off in the electronic

medical record (EMR), was the 2nd dose signed off in the EMR? When giving pain medications it

is standard practice to preview the EMR and see when the last dose was given. Which of these

two nurses was the patients primary nurse, there should have been communication between them

when administering this dose. If the primary nurse gave the initial dose and another nurse was

asked by the doctor to give a dose, he should have first checked with primary nurse about past

administrations, and if the other nurse gave the first dose it should have immediately been

communicated to primary nurse as this is an important part of patient care. Lack of

communication about the initial order, administrations, and order verification cost this patient a

quickened death and the family a traumatic memory attached to their loved ones passing.

Implications

There are many implications that nurses are responsible for when it comes to effective

communication in health care. Nurses cannot control how well physicians communicate and

report to each other but can be a voice for the patient. If the nurses are adequately able to explain

and relay information or plan of care to patients it creates a better trust bond. When there is a

good therapeutic relationship between nursing and patients/ families it is easier to provide

excellent care. When a patient is very acute, and the family is the one left to make the decisions

for care, it is easier for them to come to a care conclusion that best follows the patient’s wishes if

they have trust in the healthcare staff (Wood et al., n.d.).

Nurses are responsible for carrying out the orders written by the medical staff to provide

proper care for patients. It is reported that 27% of malpractice suits were from communication

failure regarding medications (Tiwary et al., 2019). Whether the communication failure was not

actively nurse driven, the nurses are still apart of medications errors as they administer it. Often
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two physicians do not agree on treatment depending on what body system they are trying to heal

but fail to communicate this to each other. Although physicians write daily progress notes they

don’t often communicate with each other when treatments conflict, verbal communication

portraying the concerns pairs best with written communication to provide effective

communication (Umberfield et al., 2019). The nurse is often tasked with making sure one

provider knows what orders have already been carried out due to being prescribed by another

team member or also sometimes must explain why one feels their desired treatment is not always

the best choice. Since the nurse is always at bedside it often leaves them to be the middle person

and then despite communication must go along with orders that another physician would not

have wanted. Families find it harder to make adequate care goals and decisions for their loved

ones when they are getting conflicting information. This also puts a strain on the therapeutic

relationship they have established with their nurse as it makes it appear no one can agree on a

treatment plan, causing care decisions to be difficult (Wood et al., n.d.).

A nurse’s main priority is to be an advocate for their patients and to provide the best care

based on their needs and wants. When it comes to patient care what they want might not always

be what will heal them but what might provide them with the best quality of life. When a patient

is end of life, family often becomes the decision-making surrogate due to the patient’s inability

to do so. Open effective communication from the beginning of the hospital stay makes it easier

to decision make. Families report they are more likely to make a decision that improves quality

of life when there is frequent, honest communication. A study showed that patients who would

end up dying regardless of care provided spent less time on life support when the family was

appropriately communicated with. Having a well-trained nurse in communication that can speak

with the family daily to update them and make sure they are fully understanding what is
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happening with the body and what treatments are taking place is effective in making quality life

decisions (Wood et al., n.d.).

Communication is something the nurse is very involved in and a main player in keeping

the patient safe. Whether it is the nurse who reports and allergy to prescribed medication or

reports a patient’s fear about a chosen care plan, it provides for easier patient care. There is little

we can do about communication between providers except voice our concerns for the patient,

and make it known that the patient’s safety and health is our ultimate concern. When the nurse

can help ease a patient’s or family’s mind, what is ultimately best for a patient occurs.

Proposal to resolve issue

There are a few things that nurses can do to help improve communication amongst

themselves, providers, and patients. In high acute care areas, it is shown that having family

meetings often with daily check-ins promotes best care and decisions for patients (Wood et al.,

n.d.). A nurse cannot demand a provider hold a patient meeting every few days or insist he call

the family, but they can effectively communicate how active the family is. Often if providers are

aware of how interested a family is in care and decision it is more likely they will meet with

them. When meeting with families it is often important to stop and have them explain what they

understand so far to make sure they are comprehending accurately, if families are given a lot of

information but cannot comprehend what it means from the start there is more likely to be a

communication mistake. Speaking in clear lemans terms is most important for effective

communication, it provides for less confusion and better decision making (Wood et al., n.d.).

Between provider meetings it is important that daily clear communication happens with the nurse

to ensure the current care plan is understood and agreed upon, families that know accurate
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information and expected outcomes are more likely to choose the most ethical treatment choice

(Wood et al., n.d.).

If the patient is being seen but multiple specialists it is important to make sure they speak

to each other about treatment plans. Nurses cannot force the providers to agree or communicate

but hopefully facilitate suggest or facilitate it. When two providers are on the floor a nurse can

offer to get the provider so they can communicate in person on treatment plans or bring up a

concern and offer to call them and the two providers can discuss together. Families are more

receptive to information coming from the primary providers, so encouraging this much needed

communication is important to enhancing the trust and therapeutic relationship to promote

success for a patient (Wood et al., n.d.).

Another intervention nurses can do is to encourage the use of online patient portals. Most

hospitals provide these to patients, and they are updated in real time. Providers notes, nursing

notes, radiology results and lab work are all uploaded in a timely fashion to help promote

awareness. Nurses often can sign up the patient for an online account or send them a link where

they can register themselves to have immediate access to all information. Having immediate

access to this information helps patients and families be better prepared when they meet with

healthcare providers. Having the basic details of the overall progress, or already formulated

questions reduces time wasted on formulating them as they arise in conversation giving patients

more time to get efficient answers.

Achieving a trusting bond with your patient is ultimately what is best with your care.

There is only so much to help facilitate communication that a nurse can do but the best effort is

what is needed. So often doctors walk in and say we need to check for xyz by doing xyz, well is

this what the patient really wants or do they want a more comfort care approach. Acknowledging
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their wishes and knowing what the patients plan for themselves is, helps come up with the

treatment plan (Wood et al., n.d.). Whether it is voicing the patients concern for them or

encouraging them to make a list of questions and asking themselves, patient centered care is the

main goal of effective communication.

Conclusion

Communication is the key point to effective patient centered care. Providers, nurses and

patients should all effectively communicate together to provide the best plan of care for a patient.

As mentioned above in two scenarios poor communication amongst a variety of different team

members can ultimately lead to untimely patient death. Although in the worst-case scenario it

can happen, the goal is to do no harm in any measure. Nurses cannot complete change practice

and eliminate communication errors but can provide a huge role in eliminating some. By

encouraging providers to speak with each other to have a matching care plan greatly increases

trust in the healthcare team (Wood et al., n.d.). Being the most available healthcare team member

gives nurse the largest voice when it comes to portraying the patients fears and concerns,

encouraging use of web portal helps better prepare the patient to have effective communication

when providers come in the room. Using Effective communication amongst all parties involved

in care provides a more comfortable death for patents that will ultimately die (Wood et al., n.d.).
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References

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https://www.hipaajournal.com/communication-between-doctors-and-nurses/

Narciso, D. T. C. D. (2022, March 10). Nurses say they gave fentanyl doses to same patient 20

minutes apart at Husel’s direction. The Columbus Dispatch.

https://eu.dispatch.com/story/news/crime/2022/03/09/two-former-nurses-say-husel-

prescribed-high-fentanyl-doses-to-one-patient/9437539002/

Sofer, D. (2019). Is a medical mistake an error or a crime? AJN, American Journal of Nursing,

119(5), 12. https://doi.org/10.1097/01.naj.0000557895.82994.81

Tiwary, A., Rimal, A., Paudyal, B., Sigdel, K. R., & Basnyat, B. (2019). Poor communication by

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case reports. Wellcome Open Research, 4, 7.

https://doi.org/10.12688/wellcomeopenres.15042.1

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