Unit 4 Operating Department Care Skills 5N3767

Operating Department Care Skills - 5N3767

2013

Operating Department Care Skills 5N3767

UNIT FOUR: COMMUNICATION

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By The Open College Written by Siobhan Lynch Licensed holders of the copyright and publication rights for Ireland

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MODULE UNITS: 1. Safety and Health 2. Infection Control 3. Client Care and Clinical Activity 4. Communication

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UNIT 4 COMMUNICATION By the end of this unit you should be able to:  Demonstrate effective communication and interaction with staff and clients.  Use appropriate means of communication in the operating department.  Respect confidentiality in relation to client information.  Assist in the safe keeping of clients’ records while they are in the operating department.  Assist the registered nurse with the support of clients and family during locational changes.  Reflect on the effectiveness of personal communication in the operating department.

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EFFECTIVE COMMUNICATION Good communication skills are fundamental to the delivery of high quality care to patients and their carers. Effective communication provides the means to develop relationships with patients and their carers, providing a sense of belonging and security (Duke and Bailey, 2008).

Communication is the sending and receiving of a message and happens in many ways and at different levels. It is a means of exchanging information and feelings.

Aspects of Communication: Sender - the one who conveys the message to another person.

Message - the thought, idea, or emotion conveyed.

Channel - how the message is sent.

Methods of Communication: Communication skills are divided into two categories, verbal and non-verbal behaviour, with non-verbal communication considered particularly powerful in blocking or eliciting a response (Wilkinson and Mula, 2003; McCabe and Timmins, 2006).

The effective use of non-verbal behaviours can, however, signal to patients an interest in their wellbeing and can help to develop rapport, the foundation of a trusting relationship (McCabe and Timmins, 2006). Useful non-verbal behaviours include being aware of personal space, facial expression, eye contact, posture, gestures and using touch effectively (Wilkinson and Mula, 2003).

Listening and observing are two of the most valuable skills a carer can have. These two skills are used to gather the subjective and objective data for the nursing assessment.

Active Listening: is the process of hearing spoken words and noting nonverbal behaviour.

Active listening takes energy and concentration.

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Listening skills Observe and listen to everything the person is saying and expressing.

Use body language that conveys your attention.

Make eye contact.

Smile at the person you are communicating with.

Be relaxed and open.

Do not fidget or look around the room.

Stop and listen, do not do another task at the same time.

Don’t interrupt (encourage).

Empathise.

Be respectful and non-judgemental.

Give time to the person.

Remember what the person has said.

Allow silences to occur.

In health care it is vital that information is understood as misinterpretations can have serious consequences. Mehrabian (1960) listed this classis statistic for the effectiveness of spoken communication:

7% of meaning is in the words.

38% of meaning is paralinguistic (the way the words are said).

55% of meaning is in facial expression.

Therapeutic communication promotes understanding and establishes a constructive relationship between the carer and the client.

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Influences on Communication: Age. Education.

Emotions.

Culture.

Language.

Attention.

Surroundings.

Goals of therapeutic communication are: To obtain or provide information.

To develop trust.

To show caring.

To explore feelings.

Communication techniques: Clarifying/validating.

Asking open questions.

Using indirect statements.

Reflecting.

Paraphrasing.

Summarising.

Focusing.

Silence.

Within the Operating Department Excellent communication skills, both verbal and non-verbal, are needed throughout the perioperative experience to educate patients undergoing surgery and so ease their anxiety. In addition, good communication with theatre colleagues, the multidisciplinary team, and other departments, is vital to achieve technical excellence and individualised, holistic patient care.

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Bonnington (1994) asserts that good teamwork provides the solid foundation for achievement and when taking into account the variety of staff making up the multidisciplinary team in an operating theatre, it becomes apparent that effective communication is an essential skill.

Clear and effective communication with clients and among team members is crucial for patient, client and staff safety. Each member of the surgical team has a responsibility for patient safety and a role to play. Clarity of roles and relationships of team members is very important.

Within the operating department, you will be communicating with various departments and staff, such as: Clients/patients.

Medical.

Nursing.

Administrative.

Support.

Cleaning.

Communication external to ODA. Wards, labs, X-Ray, suppliers, CSSD etc.

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INTERPERSONNAL SKILLS: Good interpersonal skills help create positive, healthy relationships at work, a positive communication climate helps to encourage effective interaction between staff. Thus, a positive communication climate promotes:

A work atmosphere which is supportive and productive.

Acceptance - 3 forms: o Recognition, acknowledgement, approval.

The avoidance of judgemental statements.

The treatment of colleagues with respect.

Empathy (understanding where others are coming from).

Dual perspective (awareness of others' and our own perspective).

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TEAMWORK Within each health care organisation the care of the patient or client is carried out by a health care team made up of many type of people with different knowledge and skill levels. The patient is always the focus of the team’s efforts. The goal of the team is to provide holistic care. Holistic care implies care of the whole person, physically, emotionally, socially and spiritually. As Carter and Goldschmidt (2010) state each member of the health care team’s job is as important as any other member’s job.

Think of the members of the health care team as links in a chain of care provided for the patient or resident and remember that the chain is only as strong as its weakest link.

Therefore, it stands to reason that each member of the team must provide care to the best of his or her ability in order to ensure that the health care team runs efficiently.

Sorrentino et al (2010) is of the opinion that teamwork means that staff members work together as a group. Each person does his or her part to provide safe and effective care.

Teamwork involves such things as: Working when scheduled.

Punctuality.

Being cheerful and friendly.

Performing delegated tasks.

Being available to help others.

Helping others willingly.

Being kind to others.

Good attendance.

Positive attitude.

Hygiene and appearance.

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Importance of good teamwork in healthcare:

Continuity of care.

Quality of care.

Problem solving.

Reducing friction and conflict.

Good working environment.

Respect.

Ensures flow of information.

According to a study by J. Williamson et al, published in 'Anesthesia Intensive Care', it is estimated that 70% to 80% of medical errors are due to breakdowns in communication and teamwork.

Handover and team meetings:

Allow for the passing on of essential information about patient care.

Are a good forum for discussion about care.

Encourage staff to voice opinions.

Allow for staff to ask questions.

Encourage the introduction of evidence based practice.

Are important for team building.

Ingredients for a successful team:

Supportive environment.

Good team leaders.

Respect.

Skills.

Role clarification.

Goals.

Opportunity to interact.

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In order for a team to work effectively, its members must be ‘competent to collaborate’ (Barr 1998). Barr (1998) has identified competencies which are thought to be necessary for effective inter-professional working. They include the ability to:

Contribute to the development and knowledge of others.

Enable practitioners and agencies to work collaboratively.

Develop, sustain and evaluate collaborative approaches.

Contribute to joint planning, implementation, monitoring and review.

Co-ordinate an interdisciplinary team.

Provide assessment of needs so that others can take action.

Evaluate the outcome of another practitioner’s assessment.

Nason 1984 suggests the skills necessary to achieve these competencies may include:

Networking.

Communicating.

Reframing.

Partnership.

Confronting.

Flexibility.

Monitoring and evaluation. (Nason, 1984.)

Historically, key members of the team were a doctor, nurse, physiotherapist, social worker, care manager or speech therapist. Although the health and social care environment has developed and recognises the value of the HCA’s role, some traditional boundaries are not parallel and have not widened appropriately.

Yet evidence suggests that despite having valuable information regarding a patient’s condition and progress, most HCAs are excluded from team meetings (Tatersall et al, 2006).

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The reason could be related to the perceived status of HCAs; there appears to be a reluctance to acknowledge and verify skills of these workers, and as such their role is often viewed as ancillary or less important.

HCAs should be actively encouraged to participate in team meetings, and supported to do so by their colleagues. This in turn, could allow accurate information to be shared with members of the team, which will subsequently enhance and improve decision-making and ultimately patient care suggests {Atwal, 2007}.

Effective team working is a challenge to its members in any healthcare environment.

Developing and sustaining inter-professional relationships are further complicated by temporal-spatial challenges. Because of the nature of professional practice, health and social care practitioners often work in different clinics, wards or organisations at different times of the day.

This can prevent the development of professional and personal relationships and encourage individual rather than shared decision-making. As effective inter-professional collaboration is dependent on open channels of communication, the incompatible working hours of different professions often results in much of their work being hidden from the eyes of others. {Atwal, 2007.}

It is essential that as part of on-going professional development, HCAs spend time listening to and acquiring new skills from other team members. Effective team working depends on mutual recognition and appreciation of all the contributing members.

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CLIENT RECORDS A healthcare record is a full detailed history of a patient/client's care for the multidisciplinary team. It should follow the patient/client through every discipline in the hospital in which that patient/client receives care. Documents within the record should reflect the continuum of patient/client care. Each patient/client on admission is assigned a unit number, which is printed on the outside of the chart and used as a unique identifier for that patient/client.

Healthcare records can be:

Hard copy – paper, charts, forms, films etc.

Electronic – the above on computer.

Mixture – partly paper, part computer.

CONTENTS OF THE HEALTHCARE CHART

ADMINISTRATIVE SECTION: Patient labels.

Registration sheet.

Relevant billing/private insurance details.

Current, dated front sheet.

Contains personal details { name, DOB, next of kin, address, phone number, GP, religion, occupation}.

Must be checked for accuracy on every admission.

All details should be obtained at time of admission = if not, obtained at the earliest opportunity and passed onto appropriate personal.

There must be sufficient addressograph labels = checked for accuracy.

The patient labels must contain= medical record no., name, address, DOB, doctor, department.

Each section and sheet of the chart must have a patient label.

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CORRESPONDENCE SECTION: Referral letters.

Discharge communications.

Ambulance transfer sheets.

Other correspondence.

All filing must be in reverse chronological order.

CLINICAL NOTES: Inpatient and outpatient notes.

Patient emergency department notes.

All filing must be in chronological order.

NURSING NOTES: Temperature and observation charts.

Fluid balance sheets.

Intensive care nursing notes.

Theatre nursing care plans.

Nursing care plans.

Glasgow coma scale forms.

Pressure ulcer risk assessment forms.

Mobility assessment forms.

Evaluation forms.

Filing must be in chronological order.

PROCEDURE: Anaesthetic records.

Epidural infusion records.

Implants records.

Blood loss sheets.

Swab count sheets.

Instrument count sheet.

Theatre checklist.

Postoperative orders.

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Filing must be in REVERSE chronological order.

CONSENT: Consent forms for all procedures performed or pending.

Must be in REVERSE CHRONOLOGICAL ORDER.

CLINICAL MEASUREMENT: Cardiovascular / Haemodynamic.

Neurophysiology.

Vascular.

Pulmonary function.

GIT physiology.

Urologic physiology.

Audiology reports.

EEGs. Reverse chronological filing.

LABORATORY RESULTS: The lab results section is sub-divided and has corresponding mount sheets.

Each mount sheet has 11 self-adhesive strips which facilitate filing and they are numbered, with no. 1 being the first report to be filled.

It is important that dates of reports are checked and to ensure they are signed by clinician before filing.

Each mount sheet must correspond to the colour of the lab results forms.

LABORATORY RESULTS: Biochemistry results == GREEN. Haematology / blood group results ==PINK. Microbiology results== YELLOW. Immunology results == BLUE. Histopathology results and hospital post-mortem results == WHITE A4.

Molecular diagnostic results == GREY.

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RADIOLOGY & DIAGNOSTIC IMAGING RESULTS: Filed on mount sheets and must be signed before filing.

In this section all radiology, imaging, and video fluroscopy reports are filed.

PRESCRIBED MEDICATION: This section contains all prescribed medication and nutritional supplements.

Filing is in reverse chronological order.

HEALTH ANDSOCIAL CARE PROFESSIONALS: Assessment forms for dietary needs.

Food diaries.

Specialised dietary regimes.

Physio instructions, care plans, mobility aids.

Occupational therapy specific instructions.

DOCUMENTS NOT HELD IN THE HEALTHCARE RECORD: Billing details.

Child protection reports.

Complaints.

Coroners' report [unless consent from coroner is obtained].

Correspondence from solicitors.

Data protection requests.

Financial information.

Freedom of information requests.

Garda reports.

Health and safety reports.

Medic-legal reports.

Incident reports and risk management forms.

ALL ARE STORED SAFELY IN ACCORDANCE WITH LOCAL POLICY.

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CONFIDENTIALITY AND SECURITY OF HEALTHCARE RECORDS Privacy and confidentiality is paramount. All records must be stored safely in a secured and supervised area with restricted access when not in use. When healthcare records are in a department, they must not be left in a public place. Within the theatre we have a duty to assist with the safekeeping of client records.

When patients arrive in the operating department, their medical file is handed over by the ward nurse to perioperative staff. During the perioperative stages, the medical records must remain with the patient throughout the journey, and be safe at all times, additional records are added to the appropriate sections before transfer back to the ward.

CONFIDENALITY Confidentiality is a fundamental part of professional practice that protects human rights. This is identified in Article 8 (Right to respect for private and family life) of the European Convention of Human Rights which states: 1. 'Everyone has the right to respect for his private and family life, his home and his correspondence.'

2. 'There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.’ The common law of confidentiality reflects that people have a right to expect that information given to a nurse or midwife is only used for the purpose for which it was given and will not be disclosed without permission.

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This covers situations where information is disclosed directly to the nurse or midwife and also to information that the nurse or midwife obtains from others. Nurses must never: discuss matters related to the people in their care outside the clinical setting. discuss a case with colleagues in public where they may be overheard. leave records unattended where they may be read by unauthorised persons.

The Code of Professional Conduct states: Information regarding a patient’s history, treatment and state of health is privileged and confidential. It is accepted nursing practice that nursing care is communicated and recorded as part of the patient’s care and treatment. Professional judgement and responsibility should be exercised in the sharing of such information with professional colleagues.

The confidentiality of patient’s records must be safeguarded. In certain circumstances, the nurse may be required by a court of law to divulge information held. A nurse called to give evidence in court should seek in advance legal and/or professional advice as to the response to be made if required by the court to divulge confidential information.

If a nurse or midwife is asked to deliver care they consider unsafe or harmful to a person in their care, they should carefully consider their actions and raise their concerns to the appropriate person. Nurses and midwives must act in the best interest of the person in their care at all times.

Nurses and midwives hold a position of responsibility and other people rely on them. They are professionally accountable to An Bord Altransis, the profession, as well as having a contractual accountability to their employer and are accountable to the law for their actions.

Information regarding a patient's history, treatment and state of health is privileged and confidential. Health care is communicated and recorded as part of a patient's care and treatment. (An Bord Altranais, 2000.)

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The HCA must ensure that they exercise good judgement in the sharing of information with professional colleagues. They must uphold the trust of those who allow them privileged access to their property, home or workplace.

Under the terms of the Freedom of Information Act, 1997, patients/clients are entitled to access a copy of any healthcare record that applies to them and which is maintained by a Health Board/Health Authority or a voluntary hospital. Freedom of Information Officers are employed by health service agencies and further information may be obtained by consulting them. While the above relates to nurses, the health care assistant will also have access to and be involved in patient documentation and for that reason the above guidelines should also apply to HCAs.

Remember: Medical records and charts must never be left where others can see them.

The screens of computers uses to store client information must be shielded from public view.

Documents should be closed when not in use.

Only staff directly involved with the client's care should have access to medical records.

All records should be stored in a safe and secure manner.

This is the End of Unit 3.

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NOTES:

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