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As we described in Part 1 of this series, there are important ways for nurses to speak with other providers in order to keep their patients safe. Likewise, there are crucial strategies for them to use when speaking with the patients themselves.

Again, Arnold Mackles, MD, MBA, Patient Safety Consultant for Innovative Healthcare Compliance Group and member of The Sullivan Group’s RSQ® (Risk, Safety, Quality) Collaborative took time to answer questions about exactly how nurses can safely communicate with patients.

What strategies can nurses use when communicating directly with their patients in order to keep them as safe as possible?

Effective communication with patients is just as important to ensuring positive outcomes in high-risk situations. Patients seek out health care for personal and often complicated medical conditions. They can be fearful, concerned, uncomfortable, worried, or even terrified when they visit a health care facility. Be mindful of your patients’ emotions and how these emotional states will affect the way they describe their symptoms and problems, how they interact with you, and how information and instructions are received.

The following list of patient communication strategies is straightforward and can be incorporated into any conversation with a patient:

  • Start with a warm introduction. Some providers walk into a waiting room and introduce themselves to their patients. This makes patients feel important. It indicates that the provider is not in a rush and is taking the time to greet them rather having them ushered into an empty exam room by office staff.
  • Greet the patient by name. Greet patients by their formal name. “Hello Mrs. Jones, I am Cathy and I’ll be your nurse today.” If you prefer to be less formal or you know the patient well enough, use first names. By nature, people like to hear their own names. When you know and use patients’ names throughout the medical process, stronger bonds and relationships are created.
  • Make eye contact. This feature of a personal interaction cannot be underestimated! If you don’t make eye contact with patients, they may assume that your thoughts are elsewhere or you are not interested in their medical issue. Eye contact is a sign of confidence, and patients want to feel confident that they are in good hands.
  • Be engaged. Patients know when you care, patients know when you are prepared; and patients know when you are authentically engaged. Consistency of communication is an art. Whether you are stressed, fatigued, or otherwise preoccupied due to any number of reasons, you must learn the art of being consistently engaged with all patients.
  • Listen to and acknowledge patient concerns. It is important that you listen, understand, and acknowledge what patients are saying. Take time to ask appropriate questions to ensure that important pieces of information were not overlooked by the patient. When you take the time to listen, miscommunication is–for the most part–averted and medical errors are significantly reduced.
  • Avoid interrupting the patient if possible. Allow the patient to finish explaining. Physicians and nurses often interrupt patients with questions in the middle of a conversation. Let patients complete their thoughts before questioning further. If patients go off on a tangent, politely interrupt and refocus them on what needs to be communicated.
  • Confirm understanding via “teach-back.” Rather than asking patients if they understand their health issues, intervention plans, or any aspect of their care, it is often more efficient to use an easy technique such as “teach-back” to confirm full comprehension–have them repeat what they understood. Simply ask the patient something like: “Mrs. Jones, since you will be taking home three different medications, just to be sure you fully understand the instructions, please explain to me how and when you will take each one.”
  • Provide patients with written instructions. Patients are often overwhelmed with news of a diagnosis or the seemingly complex plans for home- or self-care, which includes taking medications. Preparing and distributing written instructions will help avoid misunderstanding of the treatment and follow-up plans.

What else do nurses need to know about communicating effectively to improve patient safety in high-risk situations?

Data from The Joint Commission consistently reveals that poor communication is a leading cause of medical mistakes that result in patient harm. In fact, during the years 2014 and 2015, communication was the third most frequent “root cause” of all sentinel events reviewed.

Medical errors continue to plague our health care system. Many of these mistakes cause significant patient harm and often result in malpractice litigation. Communication breakdowns, rather than a lack of provider skill and/or medical training, are responsible for far too many adverse events. The good news is that we now have simple techniques that can be easily utilized to improve nursing communication and decrease medical errors.

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Join the editors of Evidence-Based Physical Examination: Best Practices for Health and Well-Being Assessment—Kate Sustersic Gawlik, Bernadette Mazurek Melnyk, and Alice M. Teall—to learn how an evidence-based approach lays the groundwork for the integration of wellness, health promotion, and disease prevention, ensuring patient safety and high-quality cost-effective care.


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