Excellent communication skills are a must for all medical professionals since they dictate the essence of their interaction with their patients. These abilities become particularly important for managing post-anesthesia care units, which are vital components of medical facilities. This is because they are mostly connected to operating room suites and are equipped to care for patients recovering from regional, general, or local anesthesia. As a result, patients in these environments are often insecure, and contact is critical to regaining stability. Regardless of how communication is done in this facility, eye-level coordination becomes essential for improved patient satisfaction ratings during discharge. According to the literature, patients are more secure when contact is conducted at the same eye level when released from post-anesthesia treatment units. This communication style fosters positivity, teamwork, encouragement, loyalty, and reciprocal trust.
Summary and Significance of Problem
The conditions for discharge from the post-anesthesia treatment unit vary according to whether the patient is being transferred to an intensive care unit, a recovery bed, the patient’s residence, or a short stay unit. Regardless of the location of which the patient is released, this change results in the patient’s treatment accountability and obligation being transferred. This is why it is a high-risk operation that requires effective coordination to ensure the provision of reliable care. This contact method can be done in various ways, but eye-level communication is the most efficient, resulting in increased patient satisfaction ratings. Apart from higher ratings, any mistakes made during this phase may significantly impact a patient’s condition and safety, as the majority of harmful events resulting in patient injury occur as a consequence of inadequate contact at this stage. Nonetheless, many obstacles to performance remain, including nurse behaviors, patient acuity, unit layout, and time. These obstacles are extensively discussed in the literature, as is their impact on the scores assigned by patients. Additionally, tools and strategies for improving eye contact coordination have been investigated to mitigate harmful consequences and related costs.
Database Search
A search with the keywords “eye-level communication,” “discharge,” “post-anesthesia care unit,” and “satisfaction scores” was conducted for two weeks on the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PubMed databases. This search was limited to studies done between 2012 and 2021, and both databases generated a total of 411 articles. However, after the removal of duplicates, 219 articles remained. These were then screened based on key themes of interest and an assessment of their abstracts which formed the basis for the inclusion of the nine selected studies. This process was conducted with a PRISMA flow diagram that was sketched during the inclusion and exclusion process. Consequently, each of the selected articles was thoroughly analyzed and assessed regarding the PICOT question.
Literature Review
Cari D. Lidgett (2016) utilized the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and the Press Ganey Satisfaction Survey questions in a 19-bed medical telemetry unit within a 369-bed acute care hospital in the Northeastern area of Texas City (Lidgett, 2016). The study intended to determine the Commit to Sit impact on the patient’s perception of nurse communication. Initially, the study results fluctuated as nurses reported frustration wherein they had it that they sat with the patients 100% of the time, yet only 40% of the patients said that the nurses had done so (Lidgett, 2016). However, improvements were made on the initiative, and the facility’s Nurse Composite score improved to the 43rd percentile from the 9th percentile (Lidgett, 2016). Based on these results, it is implicit that maintaining eye-level communication, which is the crucial concept in the Commit to sitting initiative. The method used in the study enabled nurses to interact and understand patient needs from a personal level which enhanced connection. However, the study was limited because nurses frequently floated the telemetry unit. Moreover, the patients had diverse views on nurses’ and doctors’ roles, which impacted their responses. The variability of outside staff control also limited the study. Moreover, the study sample size was too small. Nonetheless, it still portrayed the essence of sitting with patients to maintain the same eye level communication and identify areas of improvement and thoroughness, which would be essential in developing a proper eye-level communication technique.
Maxson et al. (2012) assessed patient and personnel satisfaction with coordination and responsibility after introducing bedside communication. Since patient and personnel surveys were used to gather data, an institutional review board (IRB) was collected. There were 18 staff nurses and 30 patients who meet the inclusion criterion of being 18 years or older, having no learning impairments, and speaking and understanding English (Maxson et al., 2012). The investigator-designed survey was used to gather data before and one month after the bedside report was implemented. Patients were asked if they were aware of their treatment plan, their expectations of open contact with staff, their satisfaction with their feedback into their care plan, and their perceptions of staff integrity and trust during the report. Before and after introducing bedside communication, nurses were surveyed (Maxson et al., 2012). The questions assessed responsibility, coordination, workload prioritization, and drug reconciliation completion. Responses to the survey were rated on a Likert scale ranging from firmly accept (1) to disagree (2) strongly. (5). both patient and personnel surveys revealed a substantial gap. The mean of the patient surveys pre-and the post-practice transition was 1.5-2, and the mean changed to 1 (p=0.02). Staff polls revealed a mean of 2-4 before and after activity transition (p0.05) (Maxson et al., 2012). The study’s findings indicate that incorporating bedside reports had a beneficial effect on nurses and patients. According to research, bedside reporting allows patients and families to be involved in the treatment plan and handoff process. The report had several limitations: the study’s limited sample size of just one hospital unit. While not every patient is willing to partake in the handoff procedure, relatives can be present. The ability to envision the patient through handoff enables nurses to have a more extraordinary view of the patient and treatment plan, potentially removing communication breakdowns.
Another study conducted a cross-sectional descriptive-analytic study on 50 patients and 70 nurses in Alborz University of Medical Sciences affiliated hospitals. Two different questionnaires were used for patients and nurses, and the reliability and validity scores were assessed for both (Norouzinia et al., 2015). The study aimed to determine the barriers to communication perceived by nurses and patients. It was established that according to the patients, nurse-related factors had a mean of 2.15, while for nurses, it was 2.45 (Norouzinia et al., 2015). However, for common elements between both patients and nurses, the mean scores were 1.96 and 1.85, respectively. The other factors identified were environmental, with significant observed differences between the mean scores of patients and nurses for each of the elements (Norouzinia et al., 2015). Nonetheless, the study suggests that most of the factors that inhibit proper communication between patients and nurses are avoidable through such measures as raising awareness, creation of desirable environments, and effective training on appropriate communication skills in line with proper monitoring. It also established the essence of have having a technique that ensures patients are comfortable to ensure such barriers are bypassed with ease. However, the study was a general one and was not specific to post-anesthesia care units, limiting its validity and reliability in the context of these facilities.
The other study was an observational one done in a 30-bed unit in an intermediate care-level acuity facility with a diverse patient population having medical and surgical diagnoses. The hospital’s score in the nurse-to-patient was 67.6%, the fourth percentile, even though its target was 79.2% (George et al., 2018). patient satisfaction levels with nurses’ communication were identified to be unsatisfactory despite nurses spending adequate time with them during their shifts due to the lack of sufficient interpersonal connection that they noted that they needed(George et al., 2018). In line with the study’s objective, the leadership decided to implement the Commit to sit initiative to improve patients’ communication with nurses. In this regard, the task is essential in providing the value of patient-centered communication. Moreover, the researchers evaluate various other techniques that build on eye-level communication effectiveness. Nonetheless, the study’s principles are primarily based on previously determined facts that limit its uniqueness in the given setting.
Another selected article by Groves et al. (2021) looked at creating an open safety communication space to enhance positive patient response. The researcher’s primary objective was to describe the process followed by bedside nurses in recognition and response to patient safety concerns. The study sample included 25 bedside nurses from intensive, psychiatric, maternal-child, and medical-surgical inpatient units (Groves et al., 2021). Semi-structured interviews were utilized to gather the information that was analyzed through grounded theory. The study established that patients were more open when nurses created spaces for open safety communication as it provided them with a sense of security and patient safety. With nurses anticipating safety concerns, initiating discussions, and being more accessible, patients were more responsive (Groves et al., 2021). This study proved valuable in providing the means of applying effective eye-level communication. Its findings show the other essential factors that have to be considered in proper contact with patients. Even though it was drawn from various interacting components, the study retained its consistency despite the differences between cultures, nurses, and patient populations. Nonetheless, it did not also focus on patient discharge as required.
In their study, Kang et al. (2020) focus on nurse’s role in the delivery of discharge education to patients who have undergone surgery. The study is a qualitative one employing face-to-face individual interviews and focus groups. The sample size used was 21 nurses from a tertiary hospital in Queensland, Australia, with the data analyzed using inductive content analysis (Kang et al., 2020). The study established that assumptions were underlying patient education responsibilities without discharge communication; diversity in content, resources, and discharge delivery education; meeting operational demands; and patients’ support for self-management post-hospitalization (Kang et al., 2020). The study is essential in highlighting the vital role nurses have in discharge education and the challenges that constitute effective delivery of such education. Such findings are critical to identifying strategies enhancing discharge communication across health staff and the standardization of education delivery in line with improving postoperative patient outcomes. It reinforces the importance of ensuring that there is proper communication between patients and nurses during discharge. It consequently encourages nurses to undertake an active role in ensuring that there is communication between them and their patients to better their improvement and wellbeing and reduce the potential of any emergency or unplanned care. This is implicit in how patients score their nurses as they have a positive or negative perception of them. However, the study does not include patient perception, which gives a biased view on its findings as it is one-sided. Yet, patients are critical in determining how such communication is handled.
A study by Kee et al. (2017) sought to establish the most effective communication skills that must be inculcated in the communication curriculum for doctors based on exploring patient complaints in the establishment of a source of communication lapses(Kee et al., 2018). This is despite the training already in place in medical school. The study chose 38 cases of negative patient feedback made on junior doctors, and these were analyzed using qualitative content analysis. The findings showed that the patients were dissatisfied with the manner of verbal, non-verbal, content, and attitudes portrayed to them by the medical staff. The study is essential in describing the essence of the complex interpersonal relationship between patients and medical staff (Kee et al., 2018). This complexity arises primarily from lapses in non-verbal communication, which entails eye-level communication and eye contact. The study further suggests the best ways to overcome the issue through proper training and monitoring. However, the analysis is somewhat generalized and does not focus on discharge and post-anesthesia care units. This limits the scope of its reliability in this context. However, it still provides crucial pointers on improving eye-level communication and the areas that medical personnel needs to focus on to have better patient scores post-discharge.
In their article, Marca-Frances et al. (2020) identify the communication issues and what matters most to patients during communication. The study involved qualitative phenomenological research wherein the contents of subjective feelings, experiences, and behaviors were analyzed. The analysis resulted in 377 units synthesized into six themes and 22 categories (Marca-Frances et al., 2020). The thematic concerns revolved around health literacy, hospitalization procedure, patient proactivity, satisfaction, information content, and professional-patient relationship. Moreover, the study established that patients had more difficulty dealing with verbal information than written, and nurses were identified as the most available and friendly professionals. This study is crucial in underlying the need for improved delivery of communication to patients (Marca-Frances et al., 2020). It shows that patients prefer close open relationships, which boost their responses and score given by medical personnel. However, it points to the shortcomings that eye-level communication might have as patients prefer written information. Therefore, this means integrating written and eye-level communication to achieve better results for patients and the nurses.
Nkrumah & Abekah-Nkrumah (2019) conducted an exploratory study that utilized qualitative methods to collect data from three junior managers and seven senior managers in three district hospitals from Ghana’s central region. The study aimed to establish the organizational factors that support or impede patient-centered care wherein data was collected through interview guides and a checklist. The results identified leadership commitment, support, and education and training elements that enhanced proper patient-centered care (Nkrumah & Abekah-Nkrumah, 2019). However, ownership type, leadership conceptualization, lack of objectives, financial constraints, centralization degree, and communication-related challenges impeded the provision of this care. The study shows that the successful application of any communication strategy for better patient satisfaction scores relies heavily on the leadership of such medical facilities (Nkrumah & Abekah-Nkrumah, 2019). The success of eye-level communication depends on how leadership sets out guidelines and criteria for its implementation and enforcement. However, the study is limited by its relatively comprehensive coverage, which impedes its reliability and validity. Moreover, the results are not well tabulated to refer to figures to support a given concern.
Synthesis Across Studies
This review of the literature concerning eye-level communication in post-anesthesia care unit during discharge to improve patient satisfaction has posed valid arguments in implementing this technique and including barriers and facilitators of the same. However, various gaps in research remain since most of the articles give a generalized perspective on this issue, and inference has to be made to come to a conclusion that is significant to the issue of concern. The articles reviewed have similar themes though they differ massively in other areas. Moreover, the problem set is the post-anesthesia care unit which is not explored directly and comprehensively. Furthermore, discharge and patient satisfaction are not analyzed as required as most of the articles are focused mainly on the issue of communication. Therefore, there is a need to explore these areas directly, primarily due to the complexity of factors that affect patient-nurse communication.
Despite the methodological limitations and gaps presented, most of them have sampled multiple populations, primarily patients and nurses. However, the samples used are too small with no evidence of power analysis. This is a shortcoming on the part of the validity and reliability of the presented results. Nonetheless, each study has its unique study design though the designs are all level. This is because the studies are original, and the results are based on data collection and not secondary research. However, there are no randomized control trials used.
Additionally, most of the research presented is at the descriptive level. The studies focus on describing the given populations and the situation between patients and nurses. They focus on answering the what, when, how, and where rather than the why. Despite this, there is enough evidence to conclude that eye-level communication improves patient satisfaction scores during discharge from post-anesthesia care units primarily because of the interpersonal relationship it creates.
However, most of the studies are limited because they have insufficient samples. Moreover, there is also the issue of generalization, which does not provide a specific context to concern. Nonetheless, comparing the results of the studies is somewhat tricky since they each different measure aspects of the PICOT question, each with its population. However, studies focusing on similar elements have the same findings and conclusion.
In conclusion, the review provides a proper framework for implementing eye-level communication in the situation and setting of interest. Though most of the studies had impressive results, they all significantly impact the handling of eye-level communication and how to improve it in various contexts. The information synthesized will be used to create a framework to facilitate eye-level communication in post-anesthesia care units to improve patient scores during discharge. Moreover, this communication will be the core issue in this project, with patient satisfaction scores even though they were highlighted briefly in the literature. As such, this form of communication could potentially be the way to improve patient satisfaction scores not only during discharge from post-anesthesia care units but in all medical contexts.
References
George, S., Rahmatinick, S., & Ramos, J. (2018). Commit to Sit to improve nurse communication. Critical Care Nurse, 38(2), 83-85. Web.
Groves, P., Bunch, J., Sabadosa, K., Cannava, K., & Williams, J. (2021). A grounded theory of creating space for open safety communication between hospitalized patients and nurses. Nursing Outlook. Web.
Kang, E., Tobiano, G., Chaboyer, W., & Gillespie, B. (2020). Nurses’ role in delivering discharge education to general surgical patients: A qualitative study. Journal of Advanced Nursing, 76(7), 1698-1707. Web.
Kee, J., Khoo, H., Lim, I., & Koh, M. (2018). Communication skills in patient-doctor interactions: Learning from patient complaints. Health Professions Education, 4(2), 97-106. Web.
Lidgett, C. D. (2016). Improving the patient experience through a Commit to Sit service excellence initiative. Patient Experience Journal, 3(2), 67-72. Web.
Marca-Frances, G., Frigola-Reig, J., Menéndez-Signorini, J., Compte-Pujol, M., & Massana-Morera, E. (2020). Defining patient communication needs during hospitalization to improve patient experience and health literacy. BMC Health Services Research, 20(1). Web.
Maxson, P. M., Derby, K., M., Wrobleski, D., M., & Foss, D., M. (2012). Bedside nurse-to-nurse handoff promotes patient safety. MEDSURG Nursing, 21(3), 140-145
Nkrumah, J., & Abekah-Nkrumah, G. (2019). Facilitators and barriers of patient-centered care at the organizational level: A study of three district hospitals in the central region of Ghana. BMC Health Services Research, 19(1). Web.
Norouzinia, R., Aghabarari, M., Shiri, M., Karimi, M., & Samami, E. (2015). Communication barriers perceived by nurses and patients. Global Journal of Health Science, 8(6), 65. Web.