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Quality Communication: Effective Communication in Healthcare

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Quality communication in all aspects of healthcare is essential for providing quality and safe patient care and improving patient satisfaction. In healthcare, there can be a number of reasons for poor communication including the unpredictable, stressful and complicated nature of patient treatment – a patient’s condition could change very fast and unusually (Kraut, 2018). The impact of poor communication (whether intentional or unintentional) between nurses and other health care providers (as well as with the patients) can have a ‘significant negative effect on patient safety, quality of care, patient outcomes, and patient satisfaction’ (Kraut, 2018). Within the healthcare environment and during patient care, nurses and health care professionals need to communicate with the patient for a variety of reasons. Nurses and healthcare professionals provide a wide range of assistance to patients with everyday activities such as eating, toileting, washing, dressing and more in addition to their primary care or treatment (Kieft., et al 2014). Nurses and other health care professionals need to assess the patient and be prepared to assist in any function or with any activity where needed. The purpose of this discussion will be to look specifically at how assisting a patient with feeding requires effective communication to ensure quality care and patient satisfaction.

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In a study by the Controlled Risk Insurance Company in the United States (CRICO-US), it was observed that approximately thirty percent of 23,000 medical lawsuits where patients suffered harm were as a result of miscommunication of facts and findings among the health care professionals (White, 2016). In a review of 38 scientific studies concerning surgical patient care, it was found that communication failures are common in surgical care and ‘not only lead to errors in care provision but also lead to patient harm’ (Nagpal et al., 2010). In the UK, three critical care networks in the North West of England reported 7.1% of patient incident reports arising from communication problems between health care professionals and patients between 2009 and 2014 (Thomas and MacDonald, 2016). Since the research shows that ineffective communication among healthcare professionals and between healthcare professionals and patients lead to medical errors and patient harm, it then follows that effective communication in healthcare is essential for safe and quality patient care. However, health care professionals’ training may not be similar across the board, giving rise to diverse styles of communication with some health care professionals even reporting a lack of confidence in their ability to communicate with their patients (Orsini, 2018). In the UK, the Nursing and Midwifery Council (NMC) provides a standard that all nurses and other healthcare professionals must adhere to regarding effective communication amongst professionals and patients called ‘The Code’ (NMC, 2018). 

‘The Code’ of the Nursing and Midwifery Council is structured around four themes to ‘prioritise people, practise effectively, preserve safety and promote professionalism and trust’ for nurses and other health care professionals such as midwives and nursing associates (NMC, 2018). Effective interpersonal skills and techniques such as active listening, individualised solutions and communicating on time and clearly with colleagues (i.e., other nurses, midwives and nursing associates they may be working with), are highlighted in ‘The Code’ (NMC, 2018). Providing a standard to all nurses, midwives and nursing associates (midwives and nursing associates are here on referred to as health care professionals), the Nursing and Midwifery Council (NMC) ensures that even with different communication styles, healthcare professionals are able to work in diverse teams and have different levels of autonomy and responsibility (NMC, 2018) leading to better patient care and improved patient satisfaction. 

Numerous factors play a part regarding mealtimes in the healthcare environment. For one, environmental factors play an important role during mealtimes because the setting in which a patient is in while eating a meal can contribute to the amount they eat based on how comfortable they feel at the moment they are eating (Ottrey et al., 2017). One solution to this that has been tried in the UK is the implementation of a protected mealtime (PM) scheme which involves patients eating without disruptions in a relaxed atmosphere (Porter et al., 2017). The aim of this is to enhance the ‘quality of the mealtime experience’ and improve the patients experience of hospital food which in turn increases the patient’s nutritional intake (Hickson et al., 2011). Another factor that plays a role in patients’ mealtimes  could be the patients’ age; elderly patients may have limitations to accessing and eating their meals such as needing assistance to cut or soften their food if they do not have teeth and cannot chew,  or not being able to finish their meals in the given mealtimes if they eat too slowly whereas younger patients may be concerned about the dietary choices available to them if they are young picky eaters or care about the timing and delivery of their food (Marshall et al., 2019). One solution to this from clinical observations in practice could be the system at University Hospitals Leicester (UHL) where they use a red tray symbol system. A patient will receive their meals using a ‘red tray, jug lid or beaker’, and this allows hospital staff and volunteers to clearly identify patients that require additional support or assistance during mealtimes (Edwards, Carrier and Hopkinson, 2017). 

According to ‘The Code’ from the Nursing and Midwifery Council (NMC, 2018) nurses and professionals in healthcare settings should recognise patients as individuals of different backgrounds with differing physical, social and psychological needs and avoid making assumptions. This is to ensure that patients receive assistance that is specific and caters to their own individual needs thus tailoring the patient’s care and leading to patient satisfaction. In addition, since Britain successfully introduced The Equality Act 2010 which protects people from ‘direct discrimination, indirect discrimination, victimisation and harassment’ (Butler, 2016) hospitals are required by law to provide fair and equal treatment among patients and this can include their dietary preferences. For example, religion. Religion can play a vital role regarding nutrition because some religions require food to be prepared in specific ways. Muslims will only eat permitted food (known as halal foods) that needs to be prepared and cooked in a way that respects their religious beliefs as well as avoiding the use of certain forbidden food like pork (known as haram foods) (Farouk et al., 2014). Not tailoring the dietary needs of a Muslim patient may not only lead to underfeeding the patient and thus affect the quality of care given to that patient but will also be a non-adherence to the law as it could be a form of indirect discrimination and victimisations. 

Patient needs, specifically dietary needs, should be assessed on an individual basis regarding their mobility to eat and their dietary requirements or preferences should not go unnoticed.  Having patients communicate their dietary requirements can help to create a menu adapted to the patient’s needs and can contribute to patients’ satisfaction levels and even care (Zhang et al., 2016). For example, having a diabetic inpatient. Diabetes is a lifelong chronic condition and the prevalence of diabetes amid adults in the UK is increasing while ‘one in six hospital inpatients (currently) has diabetes’ (Whicher et al., 2020). In 2013, 3.8 million people in the UK were diagnosed with diabetes. This figure was then predicted to rise to 5 million by 2025 (Young, 2013). The main cause of type 2 diabetes as well as a major reason of worsening type 1 diabetes is due to poor dietary and lifestyle choices that may easily lead to obesity (Asif, 2014). Nurses and healthcare professionals involved in the care of diabetic patients must understand the risk factors for type 2 diabetes since it is so prevalent in the UK and nurses and health care professionals can educate patients regarding managing their health, lifestyle and dietary choices to help reduce risk and manage the disease (Nazarko, 2019). West Suffolk hospitals in the UK have created a menu that effectively caters to those attempting to improve their dietary choices. Noticing the high level of type 2 diabetic patients, their menu has a ‘healthy options’ code of a heart against options that are low in fat, sugar, salt or high in fibre. As well as low glycaemic food as this effectively helps patients make choices to improve their lifestyle (West Suffolk Hospital 2018). 

Other hospitals use different methods of communication to clearly display a patient’s dietary requirements or preferences, for example the use of a triangle symbol beneath a patient’s name to show that they are diabetic (Edwards, Carrier and Hopkinson, 2017). Tailoring the menu to a diabetic inpatient would have benefitted overall patient care as the patient can contribute to their own care by making proper dietary choices if given the opportunity or outlet to communicate their dietary needs and preferences. A solution to communicating with the patient to get enough information to help tailor feeding to the patients’ needs could be to simply ask the patient what they would like to eat, which allows them to maintain even a small amount of independence and possibly overcome nutritional barriers the health care professionals may have been unaware of. Furthermore, giving patients the opportunity to communicate their dietary preferences also allows professionals to adhere to the law and the ‘The Code’ of the Nursing and Midwifery Council  by recognising and respecting the contribution that people can make to their own health and wellbeing, making sure that the patient’s physical, social and psychological needs are assessed and responded to (NMC, 2018), and avoiding indirect discrimination (Butler, 2016) leading to patient satisfaction and thus better quality of patient care. 

Hospital-based multi-disciplinary teams are composed of different types of healthcare professionals that include nurses, doctors, physical therapists, dieticians, social workers and more (Epstein, 2014). These professionals all work cohesively and with patients to achieve and also enhance patient satisfaction and patient care. The multi-disciplinary teams are very important within the hospital as they could contribute to more effective screening and treatment of patients at risk of malnutrition. Malnutrition of inpatients is a condition reported worldwide with a prevalence of approximately 40% (Barker., et al 2011). It has been demonstrated that malnutrition is a concealed cause of poor health outcomes and quality care will need to entail an intentionally more holistic and interdisciplinary process to address the crucial issue (Lovesley et al., 2019). As age is a factor that can contribute to a patient’s quality of feeding (Marshall et al., 2019). it is to note that malnutrition is prevalent among the elderly and unfortunately there are contributing factors within the hospital. Time, being one major barrier as nurses and healthcare professionals lacked sufficient time to feed older patients if they needed assistance (Marshall et al., 2019). Another barrier could be competing responsibilities for the nurses and healthcare professionals in patient care including ‘assessing and managing seriously ill patients; administration of medications and therapeutic treatments; and, providing hands-on assistance for patient activities of daily living’ could take priority over supervising mealtimes or providing assistance with elderly patients that may need mealtime assistance (Marshall et al., 2019). In the hospital, dieticians are greatly involved in ensuring patients’ nutritional requirements are met. They play a vital role in identifying patients who are at risk of malnutrition, preventing malnutrition and improving nutrition status (Holmes, 2019). Dieticians have the ability to introduce improved nutrition and hydration practices as it is mandatory to know if the patient is at risk in order to be able to effectively minimise the risk of malnutrition, this would be communicated to the nurses and health care professionals in the multi-disciplinary team to ensure the patient is satisfied (Holmes, 2019).  Malnutrition results in consequences such as prolonged hospital admission contributing to higher health care costs and increased economic burden (Marshall et al., 2019), increased utilisation of resources, an increase in readmission rates as well as an increase in rates of mortality (Barker., et al 2011). These unfortunate consequences thus further highlight the importance of effective communication between healthcare professionals, especially in multi-disciplinary teams, and with the patient about their feeding to deliver better quality care for the patient. It has also been suggested that patients may sometimes be hesitant to form interpersonal connections with healthcare staff (such as the dietician on the multidisciplinary team) when they appear to be very busy (Kornhaber et al., 2016) and ‘The Code’ requires nurses and health care professionals to recognise when patients are anxious and in distress and respond appropriately (NMC, 2018). Therefore, another crucial factor for effective communication in healthcare in regard to feeding is for nurses and health care professionals to develop an awareness of how their verbal and non-verbal communication may be interpreted by patients. A nurses’ or health care professional’s ‘body posture, gestures and eye contact can all combine with verbal communication to facilitate a meaningful positive communication with the patient’ (Hardavella et al., 2017), improving the patient’s comfort around the nurse and healthcare practitioner and in turn facilitating better patient care and increased satisfaction. 

Reforms in western healthcare have placed an emphasis on the importance of communication in the healthcare setting with bodies such as the Nursing and Midwifery Council (NMC) in the UK outlining the importance of communication in its code of conduct, affirming that nurses and health care professionals should meet people’s language and communication needs and ‘share with people, in a way they can understand the information they want or need to know about their health’ (NMC, 2018). The evidence given above and discussed in this paper, shows that effective communication between nurses and health care professionals and with the patient enhances patient care regarding assisting a patient with feeding because within the hospitals there are a diverse set of patients with specific needs and often a multitude of professionals who need to communicate well with each other to achieve their shared goal – to achieve appropriate feeding and through that maximum patient satisfaction and improved quality of patient care.

References 

  1. Thomas, A. and MacDonald, J., 2016. Patient safety incidents associated with failures in communication reported from critical care units in the North West of England between 2009 and 2014. Journal of the Intensive Care Society, 17(2), pp.129-135.
  2. White, J., 2016. How Communication Problems Put Patients, Hospitals In Jeopardy. [online] Healthcarebusinesstech.com. Available at: [Accessed 22 July 2020].
  3. Asif, M., 2014. The prevention and control the type-2 diabetes by changing lifestyle and dietary pattern. Journal of Education and Health Promotion, 3(1), p.1.
  4. Barker, L., Gout, B. and Crowe, T., 2011. Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System. International Journal of Environmental Research and Public Health, 8(2), pp.514-527.
  5. Kraut, N., 2018. Effects Of Poor Communication Patterns Between Nurses & Providers. [online] Healthstream.com. Available at: [Accessed 22 July 2020].
  6. Nagpal, K., Vats, A., Lamb, B., Ashrafian, H., Sevdalis, N., Vincent, C. and Moorthy, K., 2010. Information Transfer and Communication in Surgery. Annals of Surgery, 252(2), pp.225-239.
  7. Orsini, A., 2018. Get With the PROGRAM: A Guide to Compassionate Communication. The Journal of the American Osteopathic Association, 118(10), p.679.
  8. Kieft, R., de Brouwer, B., Francke, A. and Delnoij, D., 2014. How nurses and their work environment affect patient experiences of the quality of care: a qualitative study. BMC Health Services Research, 14(1).
  9. Porter, J., Haines, T. and Truby, H., 2017. The efficacy of Protected Mealtimes in hospitalised patients: a stepped wedge cluster randomised controlled trial. BMC Medicine, 15(1).
  10. Marshall, A., Takefala, T., Williams, L., Spencer, A., Grealish, L. and Roberts, S., 2019. Health practitioner practices and their influence on nutritional intake of hospitalised patients. International Journal of Nursing Sciences, 6(2), pp.162-168.
  11. Zhang, L., Chen, H., Li, M., Wang, J., Xue, C., Ding, T., Liu, Y. and Nong, X., 2016. Factors influencing patients’ satisfaction with hospitalization service in public hospitals in Shanghai, People’s Republic of China. Patient Preference and Adherence, 10, pp.469-472.

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