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Therapeutic Communication 

Introduction to Ineffective Therapeutic Communication

Availability of commercial medical technologies and participatory medicine have contributed to the culmination of more methods to view and record the patient's health information and conduct communications. The recent shift in the clinical processes may because of the specific importance given to mental healthcare, where the creation of the initial rapport with the patient has a significant effect on the effectiveness of the therapeutic process (Parish et al., 2017). The patient-provider relationship is dynamic and complex such that it keeps changing concerning social, technical, and environmental factors (Croft et al., 2018). Failure to keep up with the transformational changes that take place leads to the Registered Nurse (RN) making errors. Nursing errors commonly result in infections, medication errors, and patient falls. The paper looks into the influence of ineffective therapeutic communication on patient care.

Identification of Therapeutic Communication Errors

The first error was a lack of effective communication with the patient to establish a rapport with the patient. Adopting approaches from the Clinical Reasoning Cycle (CRC), the initial step is to gather the information and cues from the patient (Yazdani, Hosseinzadeh, & Hosseini, 2017). In this case, the nurse made the initial mistake of not introducing herself to the patient. The lack of effective interpersonal relationships between the nurse and the patient is evident. The establishment of rapport with the patient makes her comfortable. The initial step is the establishment of a personal relationship. The breach of patient privacy by abusing the ethical standards of the RN. The nurse asked personal questions about the patient’s social context. Therefore, this made the patient act insecure being attended by the nurse.

The error of ineffective non-verbal and verbal communication is a critical part of providing care in a way that the patient feels conformable and secure. In the video, the nurse deviates from a collection of important cues to talk about other unrelated things. The nurse did not provide accurate information regarding blood pressure information. Given that the patient has a medical history of hypotension, the accuracy of the information obtained from the electronic device is important to the nurse and patient (Berghoff et al., 2018). The patient needs to have full information about the condition they are in at any time they are conscious. Moreover, the nurse had an unprofessional demeanour with frequent violations of patient physical safety by sitting on the bed and establishing substandard body language that has long-term undesirable clinical outcomes.

How They Influence Patient Outcome

The impacts of nursing errors on patient safety are myriad. It is worthwhile to mention that safety, in this case, is physical, medical, and psychological. The lack of collection of the cues and information during the initial stages of the CRC has an unprecedented impact on patient safety and output concerning recovery. Ineffective collection of information and cues renders the nurse inaccurately judge the scope of the problem and the establishment of diagnosis, assessments, and plans (Mattingly et al., 2017). For instance, the nurse in the video breached physical contact several times by conveying unprofessional non-verbal communication actions. Given that the medical history of hypotension is confirmed, the collection of the blood pressure records is important such that it affects the efficacy of the RN decision-making process. Medical errors are often caused by a lack of effective collection of cues and information.

Moreover, the patient has a medical history of eczema, which is a skin condition. Hence, the patient's Activities of Life (ALs) is the aversion of skin irritation. Research has shown that the condition is majorly generically determined, caused by an immune response to environmental stimuli (Wood et al., 2018). The consolidation is akin to asthma, which is also present on the patient. Therefore, the failure of the collection of accurate information accompanied by a breach of physical hygiene and space renders the entire process ineffective in situations like this; therefore, undesirable clinical outcomes are often common. The overall effects on the patient impact not only privacy breach but also the efficacy of the clinical problems and outcomes.

Therapeutic Communication Errors and their Impact Patient-Provider Relationships

The strategy used in rendering therapeutic or professional communications is important in the provision of essential healthcare that is focused on Patient-Centred Care (PCC) (Drossman, & Ruddy, 2019). In this case, the first error concerning therapeutic communication is the lack of laying the prerequisite for establishing effective communication. Effective communication is determined by maintaining eye contact, effective use of non-verbal cues, using introductory remarks, and active logging of cues and information by taking notes on the patient’s situation (Kerr et al., 2019; Omura et al., 2019). The lack of provision of effective PCC renders the patient insecure, uncomfortable and violated. The ineffective use of non-verbal communication, in this case, caused the culmination of environmental barriers. The obstacles made the collection and gathering of information difficult and hampered since the documentation was not done correctly.

Another error that the nurse in the case study did was the failure to avert infections by the nurse has a significant impact on the patient outcome. Given that the patient has a medical history of eczema, an akin condition that makes the skin sensitive to outside stimuli. The nurse used her phone and touched other unhygienic places while rendering medical services. The effect of this situation is that the patient will feel insecure, uncomfortable, and anxious. Nurses are required at all times, maintain clean hygiene standards. The standards, in this case, are utilising appropriate cleaning cathers and chlorhexidine for active hand washing (Drossman, & Ruddy, 2019). The errors done by the nurse herein could increase the chances of other undesired medication errors. The nurse not only failed to address all the pathophysiological determinants that have an impact on determining the establishment of solid assessments, diagnosis, and treatment. As such, the nurse failed to record and inform the patient on blood pressure parameters, breathing, and heart rate.

The Measures That the RN Should Take to Counter the Errors

Patient teach-back is the leading patient education approach in contemporary medical practice (Heath, 2020). During circumstances like these, the nurse asks a patient to imitate a set of instructions or concepts. The synthesis of the health information in their own words helps the patient to comprehend her condition and provide a platform to judge whether the patients understand the exchange. Medication errors besides having undesirable clinical outcomes like increasing chances of readmission and medical adherence have the potential of accruing devastating outcomes. Taking active action by consulting by an interdisciplinary team reduces errors. The elimination of medication errors can be done by proper use of Electronic Healthcare Records in the offering of serving in the initial Point-of-care (O’Donnell et al., 2018; Or et al., 2018). Patient history is critical in determining the assessment, diagnosis evaluation, treatment, and management approaches that the RN use in line with applications of CRC on offering effective PCC.

The errors stemming from the lack of effective therapeutic communication skills leads to deterioration of the efforts of establishing rapport with the patient to collect the cues and information effectively. The problem can be solved by applying the principles of effective communication skills that focus on the introduction, creating a positive, compassionate, and warm environment that permits patient engagement (Amoah et al., 2019). The creation of meaningful patient engagement provides the chance of delivering essential care, such as offering education and awareness to the patient.

The errors stemming from lack of proper hygiene while handling the patient can be averted by the active prevention of infections and other clinically recommended methods of averting common allergen that could stimulate the acquisition or escalation of other illnesses. Using chlorhexidine and urinary cathers by avoiding prolonged use. Moreover, this error can be avoided by using documentation and properly assessing the biopsychosocial determinants of the patient’s ALs (Amoah et al., 2019). Importantly, this is done by active logging and monitoring the patient’s vital signs and symptoms. The caregiver must document the patient education rendered as well as the comprehension of the information to ensure that chances of errors happening are avoided.

Conclusion on Ineffective Therapeutic Communication

In summary, patient-provider communication is a critical factor for the provision of essential, safe, and quality care. Myriad patient-related, nurse-related, and environmental-related factors pose as barriers to rendering effective therapeutic communication. In this case, nurse-related issues posed larger risks. These issues affect not only the efficacy of the interventions used but also making the patient vulnerable to acquiring other illnesses like the escalation of hypotension and eczema. Environmental factors that arose in this case where the breach of the patient is physical and personal space. Generally, the quality of the patient-provider relationship has an impact on the patient outcome and quality of care. A RN needs to observe ethical standards at all times while serving the patient. By keeping upholding the standards mentioned above, the nurse creates an environment that puts the patient at ease and therefore can fulfil his/her duties appropriately. At all times, a RN should take responsibility by offering safe and high-quality care because, ultimately, they are held accountable for their actions.

References for Ineffective Therapeutic Communication

Amoah, V. M. K., Anokye, R., Boakye, D. S., Acheampong, E., Budu-Ainooson, A., Okyere, E., ... & Afriyie, J. O. (2019). A qualitative assessment of perceived barriers to effective therapeutic communication among nurses and patients. BMC Nursing, 18(1), 4.

Berghoff, C. R., Gratz, K. L., Portz, K. J., Pinkston, M., Naifeh, J. A., Evans, S. D., ... & Tull, M. T. (2018). The role of emotional avoidance, the patient–provider relationship, and other social support in ART adherence for HIV+ individuals. AIDS and Behavior, 22(3), 929-938.

Croft, H., Gilligan, C., Rasiah, R., Levett-Jones, T., & Schneider, J. (2018). Thinking in pharmacy practice: a study of community pharmacists’ clinical reasoning in medication supply using the think-aloud method. Pharmacy, 6(1), 1. Retrieved from https://www.tandfonline.com/doi/full/10.1080/10833196.2018.1450327

Drossman, D. A., & Ruddy, J. (2019). Improving patient–provider relationships to improve health care. Clinical Gastroenterology and Hepatology. Retrieved from https://drossmancare.com/download/Improving-Patient-Provider-Relationships-CGH-PreProof-2.pdf

Heath, S. (2020). Effective nurse communication skills and strategies. Retrieved from https://patientengagementhit.com/features/effective-nurse-communication-skills-and-strateg

Kerr, F., Wiechula, R., Feo, R., Schultz, T., & Kitson, A. (2019). Neurophysiology of human touch and eye gaze in therapeutic relationships and healing: a scoping review. JBI Database of Systematic Reviews and Implementation Reports, 17(2), 209. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382052/

Mattingly, T. J., Tom, S. E., Stuart, B., & Onukwugha, E. (2017). Examining patient–provider relationship (PPR) quality and patient activation in the Medicare population. Aging Clinical and Experimental Research, 29(3), 543-548.

O’Donnell, A., Kaner, E., Shaw, C., & Haighton, C. (2018). Primary care physicians’ attitudes to the adoption of electronic medical records: a systematic review and evidence synthesis using the clinical adoption framework. BMC Medical Informatics and Decision Making, 18(1), 101. Retrieved from https://link.springer.com/article/10.1186/s12911-018-0703-x

Omura, M., Levett‐Jones, T., & Stone, T. E. (2019). Evaluating the impact of an assertiveness communication training programme for Japanese nursing students: A quasi‐experimental study. Nursing Open, 6(2), 463-472.

Or, C., Tong, E., Tan, J., & Chan, S. (2018). Exploring factors affecting voluntary adoption of electronic medical records among physicians and clinical assistants of small or solo private general practice clinics. Journal of Medical Systems, 42(7), 121.

Parish, M. B., Fazio, S., Chan, S., & Yellowlees, P. M. (2017). Managing psychiatrist-patient relationships in the digital age: a summary review of the impact of technology-enabled care on clinical processes and rapport. Current Psychiatry Reports, 19(11), 90.

Wood, T. J., Koester, K. A., Christopoulos, K. A., Sauceda, J. A., Neilands, T. B., & Johnson, M. O. (2018). if someone cares about you, you are more apt to come around: improving hiV care engagement by strengthening the patient–provider relationship. Patient Preference and Adherence, 12, 919. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5973398/

Yazdani, S., Hosseinzadeh, M., & Hosseini, F. (2017). Models of clinical reasoning with a focus on general practice: a critical review. Journal of Advances in Medical Education & Professionalism, 5(4), 177. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611427/

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