Having been immersed in my own family crisis for the last three or four weeks, I am focusing this chapter of my blog on the importance of purposeful communication. I apologize for my tardiness in posting my biweekly blog.
My elderly Mother has been grievously I'll, and thankfully, is making a determined recovery. She has been hospitalized in Derriford hospital, a relatively small facility in Plymouth that is serving a community too large to cope with efficiently, given the financial restrictions it is under.
Thanks to Jeremy Hunt, the minister of health for the UK, the health care cuts have carved care to a dangerous minimum, and stretched hospital staff and facilities to the bare bones.
Prenatal care has suffered, and even high risk mothers are being sent home within four hours of giving birth, with no postpartum midwife visits. My niece was one of those Mothers, so I speak from experience.
Staff are stressed and without good leadership, and the subsequent chaos is both inefficient and reflects badly on care and communication. Indeed often the left hand does not know what the right hand is doing.
Besides being very grateful for what care my Mother did receive, and being careful to acknowledge the physicians, and staff that did invest in her personalized care, overall there was a sad and obvious lack of purposeful communication, or a willingness to take responsibility for that imperative aspect of her care..
On one of those occasions, my Mother was whisked off for a risky and potentially fatal procedure a day early, without the family being notified. My father arrived to visit an empty space where her bed had been, only to think the absolute worst. We had been told they would " fit her in " either on a Thursday or a Friday, but she disappeared on a Wednesday, without any apparent warning to the ward staff either. Their excuse was that they "didn't know in advance, " but no one had thought to telephone the next of kin.
As a nurse myself, I am in a position to say that administration and nursing leadership seems to be at fault. Essentially it is they who are responsible for good care and communication, together with the multidisciplinary team. Doctors do not run hospitals, Administration and Nursing do. They need to work together to form a cohesive chain of communication and action.
The family is an extension of the patient, and caring for them, is part of carving a safe passage for the patient through the often precarious and stressful journey to their recovery. The "positive patient experience" depends on many facets of care, and communication ranks as one of the highest in that hierarchy. Taking responsibility to impart essential information in a timely fashion,is an important key to good leadership and happy customers.
People understand that they have to wait, if staff are busy, and a simple, "I will be with you in a minute" or " may I help you? " , goes a long way. Making sure that auxiliaries know that they must not yank a patient by their left arm, because they have a new pacemaker, is an example of vitally important communication. It doesn't take two minutes to let a family member know that their loved one is going a day early for a vital procedure.
I must interject that the doctors taking care of my Mother at Derriford got full marks for their unhurried and very gracious attitude to her and our family, and were a fine example of how communication should be. They took the time to call me in America when my Mother's condition became dire, and once pinned down, gave precise explanations and informed choices. But the process of finding out who those physicians were in the first place, when they would round, and persuading the charge nurses to arrange an audience between family and physician was arduous and unnecessarily stressful. The process of getting any information was a nightmare.. Given the laws of confidentiality, one has to respect patient privacy; but with elderly parents who need an advocate, the process is archaic.Even after involving the patient liaison representative to help facilitate a smoother communication process, they told us that ultimately they are powerless to influence immediate change.
In stark contrast, our experience in Liskeard community hospital, ( which admittedly is not as busy, and is not an acute hospital), has been quite different. The telephone is answered politely, visitors are greeted with a smile, and family are treated with respect and dignity without being made to feel they are a nuisance. Even when the staff is busy, they always look at you, smile, and make arrangements to " be with you in a minute", answer questions to the best of their ability, and answer patient call lights promptly.
Our outpatient visit to Derriford cardiac department for a pacemaker check was wonderful. From the secretary who greeted us, to the cardiac nurses , they treated the patient and the family with respect, consideration, and answered all questions with answers geared to our level of understanding.
So I am being careful to not tar all Derriford departments with the same brush.
In short, good communication costs nothing. With good communication, people know what to expect, and are willing to forgive the odd mishap, or tardiness.
Attitude and communication are closely linked. If family is considered a nuisance, then often good communication is avoided. A good attitude speaks wonders for a busy facility, and it costs nothing.
All health care workers should be put in the shoes of a patient. If they were able to experience what it is like having a family member in the hospital, or be a patient themselves, it would give them a completely different perspective.
This concept was explored in a very good film, released in 1991... Called The Doctor,.... Starring William Hurt
It explores the patient experience from the once arrogant and godlike doctor, turned vulnerable patient. It is worth watching.
Being on the other side of health care, as family of the patient, has given me a new respect for the American hospital system that I have worked in for the last 33 years. There are big differences between the American healthcare system and the National health, mainly that one is dependent on many different health insurance companies to finance care, and the other is dependent on a government imposed tax called national insurance.
I am not presuming to argue the prose and cons of a national health system here. I am simply observing that the British system has not really evolved from the perspective of customer satisfaction, rather than that of necessity and a basic right to health care. In the States, the culture of caregiving has evolved more around customer satisfaction and expectation. In America, people have learned to expect and demand more for their money. As a result, the American system is far more customer oriented, and a huge part of healthcare delivery is focused on communication.
All hospital employees are expected to introduce themselves to patients and families and explain what their role is in the patient's care. The delivery of "best care " practices require a high emphasis on communication. Part of the reimbursement from Medicare, and private insurance companies is dependent on patient satisfaction scores.
In England I know there is a move towards better care, communication, and customer service, and there are pamphlets and posters paying lip service to "how are we doing?" scattered around the hospitals . The patient advisory liaison service , (PALS) , is set up to act as an ambassador for patients and their families, and there are websites and surveys dedicated to improving the delivery of care. All in the face of devastating financial cuts.
Neither system is perfect, but in my personal experience, good communication has become an integral, compulsory and measured part of the standard of care in America, and the system has devoted large sums of money to make that aspect successful.
I will now get off my soap box, and give you some examples of poems with a message surrounding communication.
Alfred Lord Tennyson wrote one of the most famous poems describing the blundered Charge of the Light Brigade of 1854, led by Lord Cardigan against Russian forces during the Battle of Balaclava in the Crimean War.
Lord Raglan, had intended to send the Light Brigade to pursue a retreating Russian artillery battery, but due to miscommunication the Light Brigade was sent on a frontal assault against a different artillery battery, with well-prepared in defensive fire.
Although the Light Brigade reached the battery, it was under direct fire, and the badly injured brigade was forced to retreat immediately. The assault ended with very high British casualties and no decisive gains. (Wikipedia)
Half a league, half a league, Half a league onward,
All in the valley of Death
Rode the six hundred.
"Forward, the Light Brigade!
"Charge for the guns!" he said:
Into the valley of Death
Rode the six hundred.
"Forward, the Light Brigade!"
Was there a man dismay'd?
Not tho' the soldier knew
Someone had blunder'd:
Theirs not to make reply,
Theirs not to reason why,
Theirs but to do and die:
Into the valley of Death
Rode the six hundred.
Cannon to right of them,
Cannon to left of them,
Cannon in front of them
Volley'd and thunder'd;
Storm'd at with shot and shell,
Boldly they rode and well,
Into the jaws of Death,
Into the mouth of Hell
Rode the six hundred.
Flash'd all their sabres bare,
Flash'd as they turn'd in air,
Sabring the gunners there,
Charging an army, while
All the world wonder'd:
Plunged in the battery-smoke
Right thro' the line they broke;
Cossack and Russian
Reel'd from the sabre stroke
Shatter'd and sunder'd.
Then they rode back, but not
Not the six hundred.
Cannon to right of them,
Cannon to left of them,
Cannon behind them
Volley'd and thunder'd;
Storm'd at with shot and shell,
While horse and hero fell,
They that had fought so well
Came thro' the jaws of Death
Back from the mouth of Hell,
All that was left of them,
Left of six hundred.
When can their glory fade?
O the wild charge they made!
All the world wondered.
Honour the charge they made,
Honour the Light Brigade,
Noble six hundred.
There is an anonymous proverb, found in a number of forms, starting as early back as the 14th century: it reads;
For want of a shoe the horse was lost;
For want of a horse the battle was lost;
For the failure of battle the kingdom was lost--
All for the want of a horse-shoe nail.
The proverb, apart from the transparent meaning, illustrates the chain of causation and possible catastrophic consequences.
Lack of money and the cutting of essential medical services, flies in the face of evidence based practices, and will lead to catastrophic consequences.
Already the infant mortality rate is rising in Britain to statistics not seen since before the Second World War.
The Magnet Recognition Program is a recognition program operated by the American Nurses Credentialing Center that allows nurses to recognize nursing excellence in other nurses. It is considered the highest recognition for nursing excellence.
I wrote this poem to illustrate the importance of communication throughout the path of a patient's hospitalization, recognizing the role the interdisciplinary team plays in their synergistic efforts.
My reference to HAPU's refers to Hospital Acquired Pressure Ulcers and our efforts to prevent them.
I've been a nurse for forty years
Seen many joys and many tears
We tend the sick and calm the fears
We dress the wounds and share in prayers
Compassion is a common goal
Respect for mind and body 'n soul
Basic nursing has not changed
Yet new poles have subtley rearranged
Magnetic forces are apparent
Professional Nursing grows transparent
Autonomy of nursing skills
Accountability now fills
the role of practice , PPM
Professional Practice Model
and then
Our synergistic path to guide
the patient, standing side by side
Promoting passage safely through
that sometimes hazardous avenue
that journey no one chooses to
Our practice, based on evidence
defines and measures precedence
of HAPUs, stages, why and where for
How to treat and how to care for
To everything there is a season
Turn turn turn , there is a reason
Hapu rates are monitored
Vital signs thermometered
Safe passage is our common pledge
Good nurses always have the edge
We listen, watch, observe, report
We administer support
Respect for cultural diversity
Facing ethical adversity
Good Communication sings
when all our inter-disciplines
work as one in synergy
Combining healing energy
Delivering the patient home
(and to check on them by phone)
With follow up appointments made
we can call the circle laid.
That circle of great care we take
That Magnet force our nurses make
for our patient's safety sake
We take pride in what we do
So Kudos now to You and You!
I rest my case
and salute me too !
Lastly, I would like to give you a little light relief, concerning communicating and asserting needs.
No matter how small those needs may seem to others, someone else's needs are very important to them. Listening carefully and fulfilling those needs doesn't always take a lot of effort, but can bring about great satisfaction. It's the little things in life that can make all the difference, especially when they are in a vulnerable position.
This poem is from a collection of poems by AA Milne, called "When we were very young "
The King's Breakfast
Alan Alexander Milne 1882-1956
The King's Breakfast
The King asked
The Queen, and
The Queen asked
The Dairymaid:
"Could we have some butter for
The Royal slice of bread?"
The Queen asked the Dairymaid,
The Dairymaid
Said, "Certainly,
I'll go and tell the cow
Now
Before she goes to bed."
The Dairymaid
She curtsied,
And went and told
The Alderney:
"Don't forget the butter for
The Royal slice of bread."
The Alderney
Said sleepily:
"You'd better tell
His Majesty
That many people nowadays
Like marmalade
Instead."
The Dairymaid
Said, "Fancy!"
And went to
Her Majesty.
She curtsied to the Queen, and
She turned a little red:
"Excuse me,
Your Majesty,
For taking of
The liberty,
But marmalade is tasty, if
It's very
Thickly
Spread."
The Queen said
"Oh!:
And went to
His Majesty:
"Talking of the butter for
The royal slice of bread,
Many people
Think that
Marmalade
Is nicer.
Would you like to try a little
Marmalade
Instead?"
The King said,
"Bother!"
And then he said,
"Oh, deary me!"
The King sobbed, "Oh, deary me!"
And went back to bed.
"Nobody,"
He whimpered,
"Could call me
A fussy man;
I only want
A little bit
Of butter for
My bread!"
The Queen said,
"There, there!"
And went to
The Dairymaid.
The Dairymaid
Said, "There, there!"
And went to the shed.
The cow said,
"There, there!
I didn't really
Mean it;
Here's milk for his porringer,
And butter for his bread."
The Queen took
The butter
And brought it to
His Majesty;
The King said,
"Butter, eh?"
And bounced out of bed.
"Nobody," he said,
As he kissed her
Tenderly,
"Nobody," he said,
As he slid down the banisters,
"Nobody,
My darling,
Could call me
A fussy man -
BUT
I do like a little bit of butter to my bread!"
I am happy to report that my Mother is slowly getting better, and is being well cared for in Liskeard community hospital. We hope that she will be discharged in the next week or two. She is looking forward to coming home to my father, and enjoying the little things in life, like home cooking and the view from the window over St John's lake.
Above all, she is looking forward to just sitting with my Father, and being in each other's company. They don't have to speak, their communication has matured and evolved over the 70 years they have been together.
“You can talk with someone for years, everyday, and still, it won't mean as much as what you can have when you sit in front of someone, not saying a word, yet you feel that person with your heart, you feel like you have known the person for forever.... connections are made with the heart, not the tongue.”
― C. JoyBell C.