Mindful communication: A novel approach to improving delegation and increasing patient safety

Abstract

Abstract The realities of the healthcare environment pose numerous challenges for professional registered nurses in providing quality and safe care. In many models of care nurses increasingly rely on unlicensed assistive personnel as members of the healthcare team. In these models of care, nurses remain accountable for outcomes even though they need to delegate some direct care to the unlicensed personnel. Effective delegation that results in quality and safe outcomes depends on the right communication. Delegation, safetyf and quality of care are inextricably linked. Communication between the registered nurse (RN) and the unlicensed personnel can be threatened by poor quality information that is untimely or unclear. Under these conditions the care delivered may be inappropriate or missed resulting in adverse outcomes. Information quality, mindful communication f mindful ness), and mutual trust within the relational context of the delegation are explored as mechanisms to improve the quality of the information and communication between RNs and unlicensed personnel, thus improving the effectiveness of the delegation. Nursing implications are provided. Citation: Anthony, M., Vidal, K., (May 31, 2010) Mindful Communication: A Novel Approach to Improving Delegation and Increasing Patient Safety OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 2, Manuscript 2. DOI: 10.3912/OJIN.Voll5No2Man02 Key words: delegation, safety, information quality, mindfulness, trust, healthcare trends, unlicensed assistive personnel, RN accountability, communication quality The Institute of Medicine (IOM), in setting the agenda for quality healthcare in America, has identified fundamental healthcare delivery changes that are needed to improve the quality of care. Processes that improve coordination of care and team effectiveness are at the core of these changes to help achieve care that is safe, effective, patient-centered, timely, efficient, and equitable (IQM, 2001). However, changes in reimbursement models with declining reimbursement rates, a current and projected healthcare workforce shortage, and a rising case-mix acuity have combined to create the perfect storm, jeopardizing the delivery of safe and effective care. At the same time that this perfect storm is brewing, the public is calling for greater transparency of healthcare outcomes. Registered nurses (RNs) are the healthcare providers who give the care that positively influences healthcare outcomes fAiken. Clarke. Sloane. Sochalski. & Silber. 2002). The increasing need for professional registered nurses to achieve these outcomes represents a contradictory and competing demand to both increase quality and constrain healthcare costs. One institutional response to the constraints and challenges to provide safe and effective care has been to design alternative models of nursing care that utilize greater numbers of unlicensed personnel. Regardless of the method of assignment or care delivery system (such as primary or team nursing), most nursing care is delivered within a group practice model where coordination and continuity of care depend on sharing common practice values and establishing communication pathways fBrennan & Anthony. 2000). Within these models of care, the registered nurse is accountable for the delivery of nursing care and patient outcomes. However, care delivered exclusively by professional registered nurses is economically prohibitive. To achieve a cost effective model of care delivery, RNs must depend on, and delegate to the unlicensed assistive personnel (UAP) who assist them in providing direct care (Kleinman & Saccomano. 2006). The RN's ability to delegate effectively is essential for obtaining safe outcomes and quality care. Delegation consists of a series of competencies that require a complex skill set and are guided by professional principles. Delegation is the transfer of responsibility for the performance of a task from one individual to another while retaining accountability for the outcome (American Nurses Association [ANA], 2005, p. …