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As a nursing major, I have been exploring different specialties that I could

potentially work in. After researching online and talking to current nurses and

physicians, I decided that a nurse anesthetist would be an interesting and rewarding profession. I began to explore peer-reviewed articles in the Academic Search

Premiere and EBSCOhost and online databases. I was unsure of an exact issue that

was taking place in the nurse anesthetists community, so I conducted a broad search of communication within the field. Through this search, I found the issue I was going to continue researching: nurse-patient communication in post-anesthesia care

settings. Communication is crucial is the medical field, and exploring this issue

allowed me to gain insight on the majority of sides of the issue. I have learned that each patient should be treated as an individual with his or her own specific

diagnosis, as no diagnosis is identical, and the only way to do that is through effective and personal communication.

Caring for patients in the intensive care unit (ICU) Patients in the intensive care unit require special and effective

communication from their nurses in order to fulfill their many needs. Some sources have argued that active, personal communication between nurses and patients is

critical in order to improve patient outcomes (Balas et al. 2012; Welch and Barksby

2011). More specifically, Balas et al., a group of medical professionals, suggest that a “bundle” of practices would be beneficial to both nurses and patients in the ICU

when performed collectively and reliably. A “bundle” is a set of evidence-based

practices, usually three to five. They explain,” The nurse is the communication link between each of the individual specialties and nurses are well suited to the

leadership roles required to individualize the ‘bundle’ to the institution (Balas et al., 2012, p. 45).” That being said, in order to properly care for patients in critical care, nurses must be well informed in all areas of practice and able to perform any task needed. While Balas et al. focus on an area of communication practice that will

benefit the ICU as a whole, Welch and Barksby, lecturers in health and social care at the Division of Nursing at the University of Nottingham, focus on a specific group

and assert the importance of the role of learning disability nurses in helping patients and their families cope with an unfamiliar and stressful environment.

Welch and Barksby discuss how nurses aim to provide patients and their

families the care to make them feel at home. Welch and Barksby state, “Staff need to maintain a person-focused approach, and it is essential that the specialist learning disabilities nurse stays actively involved in his or her care (Welch and Barksby,

2011, p. 17),” which places emphasis on the critical nurse-patient communication aspect of health care. There have been previous reports of instances when people with learning disabilities received care too late. Ineffective, impersonal

communication was to blame. Welch and Barksby seek to educate the nurses in the

ICU about the importance of their job in general and providing actively involved and personal care to their patients. While Balas et al. and Welch and Barksby discuss the

importance of caring for patients in the ICU, they focus on different aspects of nursepatient communication. Balas et al. focus on an impersonal aspect, while Welch and Barksby use a more personal approach. Use of Communication aids

Patients undergoing surgical procedures may have difficulty communicating

without the aid of someone or something. Some sources have stated that using

communication aids, such as argumentative and alternative communication aids (AAC) or electro larynxes, will allow patients to be able to communicate post-

operatively with their nurses (Mesko et al. 2011; Burnstein and Page 1995). More specifically, Burnstein, a staff anesthesiologist at the Veterants Administration

Medical Center in New York, and Page, the chief nurse anesthetist at the Veterans Administration Medical Center in New York, argue that it is important for the

anesthetist to become familiar with speech aids in order to establish effective

communication with old, postlaryngectomy patients. These patients have lost the use of their larynx, or voice box, due to cancer. They use an electro larynx, a

handheld medical device inserted into the trachea that produces vibration to allow speech in patients who have lost their original voice box, in order to communicate. Even though there are many risks of using the aid, such as electrical shock and

closure of the fistula, an abnormal connection between an organ, vessel, or intestine and another structure, most postlaryngectomy patients choose to use it while

learning other types of speech. Stating, “Effective communication between the

patient and anesthetist is an essential part of anesthetic care particularly in the

administration of regional anesthetics (Burnsetin and Page, 1995, p. 154),� meaning

that nurse anesthetists must communicate effectively, Burnstein and Page claim that speech aids are the most effective means of communication with patients who have

lost their voice box due to cancer or other illnesses. While Burnstein and Page focus on patients who have lost the ability to communicate without the aid of an electro

larynx, Mesko et al., medical professionals, focus on pediatric patients and their use of argumentative and alternative communication (AAC) picture communication aids.

Mesko et al. claim that children undergoing surgical procedures may have

difficulty communicating with their nurses. In order to have evidence to back up this claim, they conducted a study with the use of AAC picture communication aids.

Stating,” AAC picture communication aids are a useful strategy for communication

to assess pain location in postoperative children who are temporarily unable or unwilling to speak (Mesko et al., 2011, p. 403)”, Mesko et al. pose a possible

solution their claim. There is a variety of AAC aids, such as aided or unaided and

low and high technology. Picture communication aids are considered unaided and low technology because they require gestures and no batteries. During the

observational portion of the study, the nurses questioned the children about the

location of their pain with the use of these picture aids. Their research suggested

that an inconsistency exists between the nurses documentation of the location of the pain. This inconsistency leads to surgical errors: the surgical site is not actually the site of the child’s pain. Once this questioning concluded, parent satisfaction of the

use of AAC picture communication aids was determined through a use of surveys.

Although the nurses did not accurately document the children’s pain location with

the use of the aids, parents were satisfied because they were easy for their child to

use. While Burnestin and Page and Mesko et al. discuss the importance of the usage of communication aids with speech-deprived patient, each focus on a different

group of patients. Burnstein and Page discussed the use of an electro larynx with

older individuals who had lost the use of their voice box due to cancer, while Mesko et al. conducted a study about children who used AAC picture communication aids to easily communicate with their nurses.

The Post Anesthesia Care Unit (PACU) : Communication with Time Being in Short Supply A variety of factors influence a patient’s stay in the post anesthesia care unit,

time being a major one. Some sources claim that patients in the PACU will have more understanding of their surroundings and a safer treatment environment

through timely and upfront communication from the nursing team. Some sources claim that a nurse’s role is complex and cannot be carried out to its full potential under time constraints (Keikkas et al. 2005; Torgersen 2005). More specifically,

Torgersen, Chief Nurse of the United States Air force Nurse Corps, emphasizes the importance of all forms of communication during the care of the obstetric

(pertaining to child birth) patient in the PACU. Stating, “Ineffective communication can interfere with optimal patient care and has the potential to increase the risk of preventable adverse outcomes in a variety of situations such as rapidly changing fetal status that needs prompt intervention, or a situation in which the nurse has learned additional information from the patient/family that has not been

communicated to the physicians (Torgersen, 2005, p. 179),” Torgersen asserts that the birth process can go wrong because of ineffective communication between

obstetric nursing staff members. He also argues that perinatal clientele have become

more complex in their presentation and care today than ever before, requiring care in units other than the traditional obstetric or perinatal unit. He supports this

argument by stating that, “It is extremely important that communication is upfront, direct, respectful, informative, and timely (Torgersen, 2005, p.177).” When

communication does not have those values, it is not effective and therefore is

meaningless. While Torgersen aimed to educate the PACU and obstetric nurses

about how critical effective communication is, Keikkas et al., medical professionals, focus on the time-conscious aspect of nurse-patient communication in the PACU. Keikkas et al. claim that specialty areas, such as the PACU, are currently

characterized by a shortage of qualified nursing personnel along with the pressure for a most cost-conscious function of services. They support this claim by

constructing a classification form that included all nursing activities and observing all PACU nurses. Their purpose was to categorize and quantify the activities of

nurses employed in the PACU of the General University Hospital of Patras, Greece, and to identify differences with regard to shifts, nurse-patient ratios, and nurses’

experiences. Keikkas et al. concluded that nurses spend fractions of their time doing irrelevant tasks. Stating, ” Nurses in the PACU should focus on decreasing the time during which the nurse-patient ratio is inappropriate and increasing the time

allocated to direct clinical care, patient assessment, and psychological support

(Keikkas et al., 2005, p. 320),” meaning that time is valued and constricted, Keikkas et al. emphasize the importance of time management. In combination with

Torgersen’s educational aim, Keikkas et al. complete the package. Together, the two articles discuss the issue of time in the post anesthesia care unit, using nurses as

their main focus, not the patients.

Patient Safety: When Things Go Wrong Preventing medical malpractice through effective communication is crucial

to patient safety. Some sources claim that patient safety is at risk every day

(Proczkowska-Bjorklund et al. 2008; Gondringer 1986; Ross and Ranum 2009).

More specifically, Ross, a perianesthesia nurse consultant and patient safety analyst with The Doctors Company, and Ranum, regional vice president of The Doctors

Company, argue that patient safety is a priority, yet little is understood regarding

the nature of errors in perianesthesia settings. To support their argument, Ross and Ranum identified 93 patient cases and gathered information about the differences

between the post anesthesia care unit and day surgery in regards to allegations and risk management issues. After examining the patient safety issues, they found that

nurses are the responsible party. Stating, “Thirty-nine percent of PACU and 25% of day surgery cases involved nurses as the primary responsible party (Ross and

Ranum, 2009, p. 144),� meaning that nurses need to be more aware of what they are doing on the job, Ross and Ranum state statistics to support their findings. While Ross and Ranum discuss the issue of medical malpractice and patient safety in

regards to specific patient cases, Proczkowska-Bjorklund et al. , Swedish medical professionals, discuss the same issue while focusing on children.

Proczkowska-Bjorklund et al. discovered that decision-making

communication could not predict the child’s compliance during pre-medication and that more knowledge is needed about communication to children in medical

settings and how it influences the child’s behaviors. After video-filming 102 children and studying the associations between child factors and different nurse decision-

making communication regarding pre-medication before ear, nose and throat (ENT) surgery, they concluded that children are hesitant while being asked to make decisions about themselves medically and that nurses need to adjust their

communication characteristics based on the response of the child. Stating, “To the

children showing signs of shyness, the nurse used more negotiation, questions and self-determination communication and less information. The nurse used more

compromise, negotiation and gave less information to children with less compliance (Proczkowska-Bjorklund et al., 2008, p. 713), “ Proczkowska-Bjorklund et al.

support their conclusion. While Ross and Ranum and Proczkowska-Bjorklund et al. focus on the patient safety aspect of medical malpractice, Gondringer, a licensed nurse in Lincoln, Nebraska, focuses on medical malpractice in view of the professional.

Gondringer argues that the area of medical malpractice/professional liability

has a significant impact on the anesthesia care provider. She reviewed a

practitioner’s aspects during the pre-, intra- and post-anesthesia periods in order to make the professional informed about medical malpractice and prevent such

litigation. Stating, “The practitioner is acquainted with the surgical patient and health care peers, as well as to adequately document on the patient’s record

(Gondringer, 1986, p. 490),” Gondringer explains how a practitioner can avoid

malpractice. She also claims that,” Negligent acts by health care providers that cause injury or bodily harm to a patient are the underlying reasons for litigation (p. 490),”

meaning that personnel who fail to meet the standards set by society cause issues of malpractice. Gondringer concluded that Medical liability can be slowed if the health

care provider will take the time and effort to communicate with patients, peers, and

other health care professionals and document the communication and actions taken. Another Perspective

My sources have covered the issue of nurse-patient communication and

anesthesia. However, they have not covered the curriculum guide or the training for incoming/practicing nurses. These missing components of nursing education are crucial, in that they give nurses knowledge on the lexis used within their field. If I

were to continue exploring this topic as a nurse anesthetist, I would look at current nursing college curriculums and basic communication training (if offered).

After looking over the College of Nursing BSN curriculum at the University of

Central Florida, I have found that the classes mainly focus on the clinical training.

There are classes offered, however, that focus on leadership, crisis intervention, and the role of the professional nurse, which may give nursing students hands-on experience with nurse-patient communication. A nursing elective, medical

terminology, is offered to all healthcare majors. After taking medical terminology,

students will have more of a knowledge base of the medical jargon used within the genre of the medical community.

The majority of the articles that I used to conduct my research focused on a

specialized area of nursing, nurse anesthesiology. Since the University of Central

Florida does not currently offer the nurse anesthetist graduate program, I looked

into the University of Florida’s program. I was unable to find curriculum specifics, but I did fiund an overview of the program. The Doctor of Nursing Practice (DNP) degree is becoming more and more popular, as the expansion of scientific

knowledge is required for safe nursing practice in an increasingly complex health care system.

Nursing students at all universities and practicing nurses in all hospitals

must have a strong knowledge base of the medical jargon used within their fields of study and professions. Becoming a nurse anesthetist requires even more jargon

training, as two to four years of schooling is required to gain this degree. To have a

clear understanding of the exact skill and communication training offered to nursing students, I would conduct a case study, like a few of my articles did, using practicing nurses as my subjects. I would observe about one hundred nurses in their primary working place and look at how they communicate with their coworkers and patients. From there, I would separate the 100 subjects based on if they had

previous training through classes or hands on experience. I would combine my results and see if there was any link, which I am sure there would be, between communication training and effective communication within the workplace.

Line of Inquiry Sample paper  

Sample Line of Inquiry paper