Assignment: Effective Communication Case

Assignment: Effective Communication Case

Assignment: Effective Communication Case

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Week 8 discussion Closing the Loop Complete the Week 8 AACN Essentials Self-Assessment (Links to an external site.)Links to an external site.. Compare your scores from Week 2 to Week 8. Describe how far have you come and how much further do you wish to go in improving your competencies during the next two years of practice. Next, review the Course Outcomes as listed in the Syllabus. Select one of the course outcomes and share with your classmates how you feel you have achieved the outcome and how you will utilize the essentials and course outcomes in your practice setting.

Effective Communication

Effective communication is essential in successfully assessing and resuscitating critically ill trauma patients, especially in times of high stress. It is important to maintain a common vocabulary, creating a shared mental model of the case to avoid assumptions.

What is a shared mental model?

Creating a shared model of the patient’s situation allows personnel from differing backgrounds to understand both the clinical and logistical implications of the case. It ensures that team members are familiar with one another’s roles and responsibilities; that they are able to anticipate the needs of other team members, and have a high level of adaptive capacity⁹. This collaborative approach helps break down boundaries between individuals with varying levels of experience. It also helps reduce the perception of a power differential between outside specialists coming into the emergency department. Stating common treatment goals prevents individual team members veering off on counterproductive tangents. An example of this is an orthopaedic surgeon fixating on a dislocated ankle while the patient has a life-threatening pneumothorax that needs dealing with first. A way of doing this is to brief the team prior to the patient’s arrival.

Briefing the team

Even before the trauma patient arrives in the department the team leader should gather the team and brief them. The aim of the briefing is to:

• allocate individual roles (for example, airway doctor/nurse)
• allocate tasks to be completed before the patient arrives (for example, draw up drugs, prepare for a chest drain insertion, pre-notification of radiology/blood bank/theatre)
• create a shared mental model of the patient’s current status as well as the anticipated plan and final destination
• create awareness of potential issues and how they might be dealt with (anticipate the ‘what if?’ scenario)
• allow the team to ask questions and clarify any issues before the patient arrives

Tacit vs explicit communication

Tacit knowledge can be described as that which is acquired through practice and experience and may be difficult to communicate¹⁰. The same idea can be applied when referring to communication skills in the ED. Tacit communication is communication that occurs, often without words, in which the intention is never actually stated. One example of this is an experienced anaesthetist putting their hand out and expecting to be handed the laryngoscope by their assistant without actually asking for it because that is the way they do things. It should be obvious that this method can lead to problems, especially in occasional teams in times of high stress.

By making communication explicit and specific such as ‘When I do … I would like you to do …’ and allowing questions to be asked, errors and critical incidences can be avoided. In times of high stress communication often shifts from an explicit to a tacit form without the team being aware of it. This leads to missed information and poor outcomes.

One technique that can help avoid this is using closed-loop communication.

Closed-loop communication

Once the team leader has either requested information or asked for a procedure to be performed by a named person, they should then acknowledge the request explicitly and then state when it is done. This allows for clarification of requests if needed and avoids errors of omission. Closed-loop communication allows the sender to know that their requests have been heard and understood.

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