Please read through and make sure the instruction is understood before you send proposal. Communication assignment.
Running head: COMMUNICATION FAILURE IN HEALTHCARE SETTING 0 Case Study: Communication Failure in Healthcare Setting Three Communication Failures in Communication Dr. Levitzky, a Family pediatrician had provided recommendation about Rory condition after critically examining the child information that was to be used by the NYU Langone doctors to make accurate diagnoses and treatment. The information was not used nor viewed as important when deciding on Rory’s care. The reason why the information was not viewed or relied on was because the hospital records did not reflect any communication with Dr. Levitzky, on her finding of Rory (Dwyer, 2013). The doctors made a clinical decision of discharging Rory believing that the fluid made him better even when vital signs had indicated that Rory was seriously ill. The hospital laboratory established that Rory was producing vast quantities of cells that combat bacterial infection. The lab result reported neutrophils and bands, white blood cells that suggest a bacterial infection. This information was not presented to Ms. Stauntons or action taken by the hospital to reach out to Ms. Staunton to know the child current situation and at most requests Ms. Stauntons to present the child back to the hospital for treatment. Dr. Levitzky said that she did not know about lab test done to the child meaning that she was not informed about lab tests or asked about the tests conducted on the child (Dwyer, 2013). This is a clear indication of a communication breakdown between physicians associated with NYU Langone’s. The consequence of lack of communication for the patient and Healthcare organization Lack of communication from NYU Langone to Rory’s family contributed to the loss of Rory’s life because Ms. Staunton did not know what to do after getting discharge notice for home supportive care. If there was effective communication about the lab finding, Ms. Stauntons could have pressured the doctor do further diagnoses or transferred the child to another healthcare setting where Rory could receive quality care. Poor communication resulted in misdiagnosis and mistakes that led the emergency doctor to discharge Rory without waiting for the lab results to make an accurate clinical decision on whether to discharge Rory or not. After the lab result was out the hospital did not get in touch with the patient even after noticing that Rory was in danger. The communication breakdown led to delays in providing essential treatment which negatively affected the patient outcome resulting in death. Experience with healthcare setting communication breakdown I experienced a communication breakdown in a local healthcare facility where we sought healthcare services. My cousin who was 40 years old was rushed to the emergency department at Patan Hospital with a complaint of weakness in the right of the body, and fever. The physician came and reexamine the patient and instructed a nurse to give a certain injection to stabilize the patient. A nurse was to give an injection as prescribed by a physician; the lab technician was to undertake a blood test afterward. In this case, a nurse delayed in giving an injection and after 30 minutes a lab technician entered the ward and conducts a blood test, a procedure that was to be undertaken after nurse had injected the patient with the drug prescribed by the doctors. After lab personnel had taken the test, a nurse entered the ward, injected the patient as prescribed. The doctors after receiving the lab result further recommended a similar injection to the patient, and another nurse was instructed to give the injection. I saw a nurse entering the ward I had to stop her and let her know the status of the patient; where he reported that after the patient was given the first injection the test indicated that he was still unstable. I intervene by informing the nurse that the patient was given the first injection after the lab test was conducted. Originally, the lab test was supposed to be undertaken after the first injection. This scenario shows a communication breakdown between physicians, lab personnel, and nurses and this could result in medical error through overdose. I felt that the nurses were not careful and the patient was not safe in that hospital, if the physician gave instruction without following up to know whether the patient was given the first medication as instructed. The nurse looked a bit tired and unmotivated. The reason I was able to coordinate the communication is because I was sitting outside the ward and I could see and seek information on what was happening and even bothered to know the status of the patient after each healthcare personnel enter or move out of the ward. References Dwyer, J. (2013, July 11). An Infection Unnoticed Turns Unstoppable. New York Time: Retrieved from https://www.nytimes.com/2012/07/12/nyregion/in-rory-stauntons-fight-for-his-life-signs-that-went-unheeded.html
Please read through and make sure the instruction is understood before you send proposal. Communication assignment.
HSA 470/MIDTERM ASSIGNMENT SPRING 2021 Communication Processes and Challenges in Health Care Organizations A. B. C. D. Your Name, Internship Assignment, Employment/ Work Setting or Capstone Department or Work Unit if Applicable Main Internship Activities or Job Title and Responsibilities Identify Four Important Points covered in the Class Lecture discussion, Power-Point and/or Case Study on the Topic of Communication. Provide a detailed response with a description of: How these points are relevant to communication in health care settings. (Please see instructions on Page 2 of this document.) 1 KEY: CONTENT OF COLUMNS BY COLUMN LETTER IN SEQUENTIAL ORDER Your Name, Internship Assignment, Employment/Work Setting or Capstone: Your full name with Student #, Name of your internship assignment and /or Your Work setting. Provide, a brief description of the type of health care services organization where you work. Department or Work Unit if Applicable. Name of the department(s), where you employed or if applicable where you have been assigned to work during this semester. Main Internship Activities or Job Responsibilities Identify with bullet points, what are your Position Title and Main internship responsibilities/tasks that you are currently undertaking. Identify Four Points covered in the Class Lecture/ Discussion, the Power-Point and/or Case Study, “An Infection, Unnoticed, Turns, Unstoppable”, by Jim Dwyer. Provide in a bulletin point format, a detailed response with a description of: How these points are relevant to communication in health care settings. Updated: March 2021. 2
Please read through and make sure the instruction is understood before you send proposal. Communication assignment.
An Infection Unnoticed Turns Unstoppable An Infection Unnoticed Turns Unstoppable: Published:  July 11, 2013New York Times, By Jim Dwyer For a moment, an emergency room doctor stepped away from the scrum of people working on Rory Staunton, 12, and spoke to his parents. “Your son is seriously ill,” the doctor said. “How seriously?” Rory’s mother, Orlaith Staunton, asked. The doctor paused. “Gravely ill,” he said. How could that be? Two days earlier, diving for a basketball at his school gym, Rory had cut his arm. He arrived at his pediatrician’s office the next day, Thursday, March 29, vomiting, feverish and with pain in his leg. He was sent to the emergency room at NYU Langone Medical Center. The doctors agreed: He was suffering from an upset stomach and dehydration. He was given fluids, told to take Tylenol, and sent home. Partially camouflaged by ordinary childhood woes, Rory’s condition was, in fact, already dire. Bacteria had gotten into his blood, probably through the cut on his arm. He was sliding into a septic crisis, an avalanche of immune responses to infection from which he would not escape. On April 1, three nights after he was sent home from the emergency room, he died in the intensive care unit. The cause was severe septic shock brought on by the infection, hospital records say. Because sepsis, a leading cause of death in hospitals, can at first look like less serious ailments, a campaign to aggressively identify it for early treatment has been undertaken by a consortium of 55 hospitals in the New York region, including NYU Langone. Yet nowhere along Rory’s journey, from boy with a bellyache on Thursday to gravely ill boy on Friday night, did anyone act on strong indications that he might be fighting for his life. Critical information gathered by his family doctor and during his first visit to NYU Langone was not used, was not at hand or was not viewed as important when decisions were made about his care, records show. Moments after an emergency room doctor ordered Rory’s discharge believing fluids had made him better, his vital signs, recorded while still at the hospital, suggested that he could be seriously ill. Even more pointed signals emerged three hours later, when the Stauntons were at home: the hospital’s laboratory reported that Rory was producing vast quantities of cells that combat bacterial infection, a warning that sepsis could be on the horizon. The Stauntons knew nothing of his weak vital signs or abnormal lab results. “Nobody said anything that night,” Ms. Staunton said. “None of you followed up the next day on that kid, and he’s at home, dying on the couch?” NYU Langone declined to discuss any aspects of Rory’s care or hospital procedures. “Our deepest sympathies go out to the family at this difficult time,” said Lisa Greiner, a hospital spokeswoman. The Stauntons shared Rory’s medical records with a reporter for The New York Times who had met the boy last summer in a social setting. A full airing of the case, along with a commitment to reforms, his parents said, could save lives. They have hired a lawyer, Thomas A. Moore, but have not decided how they will proceed.   Rory Staunton, 5 feet 9 inches tall and 169 pounds, was big for his age and a student of the world. “The most profound 12-year-old I had ever met,” his debate coach, Kevin Burgoyne, said. For his birthday, his parents gave him flying lessons after Rory, who spent hours on a flight simulator, tracked down an aviation school that accepted students at 12. He devoured the memoir of Chesley B. Sullenberger III, the pilot who safely brought down an airliner on the Hudson River. “I told him, ‘Sully did some fast math landing that plane,’ and for a short while, he was paying attention to math,” said Ciaran Staunton, Rory’s father. “Then he came back with, ‘Yeah, but by the time I’m a pilot they’ll have a faster way of doing it.’ ” Rory and his sister, Kathleen, 10, grew up in Sunnyside Gardens, Queens, which their parents, Irish immigrants, regarded as a global village of sublime pleasures: shared courtyards, a rich brew of cultures and merry mobs of children rolling from house to house. Ms. Staunton, the former director of an international student exchange, said neighborhood kids formed their own country, Kidadelphia, designed a flag, and adapted the United States motto for their slogan: “In God and Fun We Trust.” Rory was president. When he was 8, he raided his piggy bank to treat his parents to a Chinese dinner for their wedding anniversary. At the private Garden School in Jackson Heights, he was elected to the student council in seventh grade and led a campaign, Spread the Word to End the Word, to curtail the casual, derogatory use of the term “retarded.” Last summer, his uncle, a friend of mine, brought Rory, Kathleen and their mother to stay in my family’s vacation home for two nights. Rory would go from barreling down a water slide backward to sizing up President Obama’s prospects for re-election. Fascinated by North Korea, he tried to fathom how a country so afflicted by famine could afford a large army. (His parents recently found a note in his computer to the Swedish ambassador to North Korea.) At home, said Mr. Staunton, a civic activist and bar owner, they would have nightly shouting matches over homework Rory had not done or dirty clothes he had not picked up, in between scoping out corners of global history. During gym class on Wednesday, March 28, he dived for a ball and opened a cut on his arm. That night, Ms. Staunton said, Rory mentioned it: “How he presented it to me was, ‘I fell in the gym. Mr. D, the athletic director, put the Band-Aids on. And, I got the ball.’ ” Then he finished his homework and went to bed.   The bacteria Streptococcus pyogenes is part of the human ecosystem, normally dwelling in the throat or on the skin, areas where the body is well defended. Also known as Group A streptococcus, the strain typically causes strep throat or impetigo. But if it is able to penetrate soft tissue or blood, “it moves very quickly,” said Dr. Michael B. Edmond, the chairman of the division of infectious diseases at Virginia Commonwealth University. “The mortality rate is high. The clinical findings early in the infection can be relatively subtle.” The challenge for physicians is recognizing an invasive infection, whether from Group A strep or other pathogens, before the cascading damage of sepsis has picked up too much speed. The consortium of New York hospitals has a goal of starting antibiotics within an hour of spotting sepsis in the emergency room, according to officials with the Greater New York Hospital Association’s Stop Sepsis program. For every hour’s delay in giving antibiotics after very low blood pressure had set in, a study found, the survival rate decreased by 7.6 percent.   Shortly after midnight on March 29, Ms. Staunton heard Rory retching in the bathroom. “There wasn’t a huge amount of vomit, but he kept saying, ‘My leg, my leg, Mom,’ ” she recalled. Back in bed, he moaned. His mother rubbed his thigh. In the morning, he was weak, his leg still hurt, and his temperature was 104 degrees, his highest ever. The parents began calling Dr. Susan Levitzky, who had been the family pediatrician for about five years. She saw Rory that evening. “He was leaning on me as we were walking up to the office, because he could hardly stand from the weakness or pain in his leg,” Ms Staunton said. In the waiting room, Rory vomited. When the doctor swabbed his throat, he vomited on her. The swab test, a rapid but not definitive detector of strep, was negative. “We showed her the cut on his elbow, and I saw her follow up his arm from the cut,” Ms. Staunton said. “She said, ‘The cut’s not an issue.’ She focused on his stomach. We said, ‘Although you see him throwing up, that’s not what he’s really complaining about.’ Rory and I both said to her that it’s the pain in his leg that’s really bothering him.” The doctor told them that the leg pain might be from falling in the gym. “Rory said, ‘It wasn’t a fall, it was a skid,’ ” Ms. Staunton recalled. The parents also remarked that Rory’s skin became blotchy when they pressed a finger on it. Those concerns were well-founded, said Dr. Edmond, the infectious disease specialist, who was not involved in Rory’s care: The mottling, which Dr. Levitzky made note of, could mean that vessels in his skin were constricting from low blood pressure; the leg pain could mean an invasive infection. Rory’s temperature was 102 and his pulse was 140; he was taking 36 breaths a minute. These, too, were “worrisome” observations, Dr. Edmond said. Nevertheless, Ms. Staunton said, she did not recall being told that any of his vital signs were off: “She said, ‘Make your way over to NYU, and get him rehydrated. He’s vomiting now. He’s going to feel better, and tomorrow, he’ll have diarrhea.’ ” In a brief phone conversation, Dr. Levitzky said she could not discuss the case. “I sent him to a major medical center,” she said.   Rory arrived at NYU Langone, on First Avenue near 34th Street, at 7:14 that evening and was discharged about two hours later. Hospital records do not reflect any communication with Dr. Levitzky or her findings about the mottled skin. Like Dr. Levitzky, the NYU physicians believed that Rory’s discomfort was caused by a sick stomach and dehydration. His chart states that “labs, IVF, Zofran” were ordered.Zofran is an antinausea drug; two bags of intravenous fluids, or IVF, were administered; three vials of blood were drawn and sent to the hospital laboratory. “They did the various checks, up, down, back and forth,” Mr. Staunton said. A screening tool in the Stop Sepsis program, used when a patient first arrives in the emergency room, calls special attention to a person with three symptoms of a possible eight. At the hospital, Rory showed two: he was breathing 20 times per minute and his pulse was 143. Two hours later, though, he had three: his temperature had risen to 102, his pulse was 131 and his respiration rate was 22. But by the time those vital signs were recorded, at 9:26 p.m., they had no bearing on his treatment. In fact, the doctor had already decided that Rory was going home. Rory’s “ExitCare” instructions, signed by his father, were printed 12 minutes before those readings. To the pediatrician who examined and discharged Rory, it seemed that the fluids had done the trick. “Pt improved,” the doctor, Camille Scribner, wrote, prescribing “home supportive care.” There is no sign in the records that Dr. Scribner, described by a senior colleague as “hyper-conscientious,” considered alternative explanations. “They stated that it was a common flu that was going around,” Mr. Staunton said. “It would start off as high temperature and throwing up, and would end up as diarrhea.” Dr. Scribner could not be reached for comment through the hospital. As the Stauntons walked Rory onto First Avenue, the air temperature was in the mid-40s. “He was freezing,” Ms. Staunton said. “He took my coat leaving the hospital. It has a little frilly thing around the collar.” “Not a thing that a boy of 12 would put on,” Mr. Staunton said.   About three hours later, Rory’s lab results were printed. He was producing neutrophils and bands, white blood cells, at rates that were “very abnormal and would suggest a serious bacterial infection,” Dr. Edmond said. The Stauntons said they heard nothing about it. In bed, Rory “was groaning in his sleep,” Ms. Staunton said. “I felt the heat of the fever.” At 10 a.m. on Friday, the Stauntons began calling their pediatrician, Dr. Levitzky. “She told us to do a combination of Tylenol and Motrin,” Ms. Staunton said. Asked last month about the lab findings, Dr. Levitzky, who is associated with NYU Langone, said, “I never knew that testing was done.” Rory did have the predicted bout of diarrhea on Friday, which momentarily elated his family. Still, he could barely get to the bathroom. The doctor suggested fluids and crackers. “‘I told her, ‘I’m not sure you’re getting the picture, Dr. Levitzky,’ ” Mr. Staunton said. “‘I can’t even get him to sit up. I don’t know how you expect me to get food into him.’ ” Later, a slight touch would make him scream. “Around his nose was gone blue,” Mr. Staunton said. “Down his body side was gone blue.” At that point, Dr. Levitzky told them to return to the emergency room. They supported him as he walked to the car. “All he said was, ‘Can I please have a wheelchair when I get there?’ ” Ms. Staunton recalled. In the intensive care unit, his parents tried to mask their worry, Mr. Staunton chatting lightly. But Ms. Staunton noticed her son’s eyes following her. “He said, ‘Mom, my toes are really, really cold,’ ” she said. After extending an arm for blood to be drawn, “he thanked them when they were finished,” Ms. Staunton said. He had to be put on a ventilator. Just before he was sedated, Ms. Staunton said, “They told him, ‘We need to figure some stuff out. There are some marks on your body, and you need a little bit of help breathing, so we’re just going to intubate you and it’ll be fine.’ ” First, though, they checked his mental status. “Do you know what date it is?” “I know it’s March,” Rory answered. “Who’s the president of the United States?” He answered: “Barack Obama.” His mother smiled. “Ah,” she said, “but Rory, who is going to be the next one?” “Barack Obama,” he said. As the next two days passed, doctors tried anything that might halt the shutdown of Rory’s organs. “I can’t say enough about the I.C.U.,” Ms. Staunton said. Relatives and a priest gathered bedside, talking of Irish football and tomfoolery and politics. Perhaps, one doctor whispered in a fleeting, hopeful aside, Rory might get away with losing his toes and nose. His skin blackened. He passed no urine. His blood would not clot. His heart had to be restarted twice. Three specialists who chronicled Rory’s decline on his intensive care chart each noted that on Thursday night, when he was sent home from the emergency room, he had a fever and significant signs of infection in his blood. On Sunday night, Dr. Mayer Sagy, who had not seen Rory on his first visit to the hospital but spent the weekend struggling to keep him alive, told the Stauntons that the team had been unable to resuscitate him a third time. “I said to him, ‘I brought him here to you the other night and you sent him home,’ ” Ms. Staunton said. “He said, ‘You have every right to be angry.’ ” More than anything, the Stauntons said, NYU Langone owes an honest accounting of what happened. Racked with loss, they and others remembered Rory as an unflinching champion of schoolyard underdogs. “Above all,” Ms. Staunton said, “we know that Rory would want no other child to go through what he went through.” 8
Please read through and make sure the instruction is understood before you send proposal. Communication assignment.
Emotional Intelligence in Leadership Learning How to Be More Aware Does your emotional intelligence lift your team to new heights? When you think of a “perfect leader,” what comes to mind? You might picture someone who never lets his temper get out of control, no matter what problems he’s facing. Or you might think of someone who has the complete trust of her staff, listens to her team, is easy to talk to, and always makes careful, informed decisions. These are qualities of someone with a high degree of emotional intelligence . In this article, we’ll look at why emotional intelligence is so important for leaders – and how you, as a leader, can improve yours. What Is Emotional Intelligence? Emotional intelligence or EI is the ability to understand and manage your own emotions, and those of the people around you. People with a high degree of emotional intelligence know what they’re feeling, what their emotions mean, and how these emotions can affect other people. For leaders, having emotional intelligence is essential for success. After all, who is more likely to succeed – a leader who shouts at his team when he’s under stress, or a leader who stays in control, and calmly assesses the situation? According to Daniel Goleman , an American psychologist who helped to popularize emotional intelligence, there are five key elements to it: Self-awareness. Self-regulation. Motivation. Empathy. Social skills. The more that you, as a leader, manage each of these areas, the higher your emotional intelligence. So, let’s look at each element in more detail and examine how you can grow as a leader. Emotional Intelligence in Leadership 1. Self-awareness If you’re self-aware, you always know how you feel, and you know how your emotions and your actions can affect the people around you. Being self-aware when you’re in a leadership position also means having a clear picture of your strengths and weaknesses , and it means behaving with humility . So, what can you do to improve your self-awareness? Keep a journal – Journals help you improve your self-awareness. If you spend just a few minutes each day writing down your thoughts, this can move you to a higher degree of self-awareness. Slow down – When you experience anger or other strong emotions, slow down to examine why. Remember, no matter what the situation, you can always choose how you react to it. (Our article on Managing Your Emotions at Work  will help you understand what your emotions are telling you.) 2. Self-regulation Leaders who regulate themselves effectively rarely verbally attack others, make rushed or emotional decisions, stereotype people, or compromise their values. Self-regulation is all about staying in control. Bottom of Form This element of emotional intelligence, according to Goleman, also covers a leader’s flexibility and commitment to personal accountability . So, how can you improve your ability to self-regulate? Know your values – Do you have a clear idea of where you absolutely will not compromise? Do you know what values  are most important to you? Spend some time examining your “code of ethics.” If you know what’s most important to you, then you probably won’t have to think twice when you face a moral or ethical decision – you’ll make the right choice. Hold yourself accountable – If you tend to blame others when something goes wrong, stop. Make a commitment to admit to your mistakes and to face the consequences, whatever they are. You’ll probably sleep better at night, and you’ll quickly earn the respect of those around you. Practice being calm – The next time you’re in a challenging situation, be very aware of how you act. Do you relieve your stress by shouting at someone else? Practice deep-breathing exercises to calm yourself. Also, try to write down all of the negative things you want to say, and then rip it up and throw it away. Expressing these emotions on paper (and not showing them to anyone!) is better than speaking them aloud to your team. What’s more, this helps you challenge your reactions to ensure that they’re fair! 3. Motivation Self-motivated leaders work consistently toward their goals, and they have extremely high standards for the quality of their work. How can you improve your motivation? Re-examine why you’re doing your job – It’s easy to forget what you really love about your career. So, take some time to remember why you wanted this job. If you’re unhappy in your role and you’re struggling to remember why you wanted it, try the Five Whys  technique to find the root of the problem. Starting at the root often helps you look at your situation in a new way. And make sure that your goal statements are fresh and energizing. For more on this, see our article on Goal Setting . Know where you stand – Determine how motivated you are to lead. Our Leadership Motivation Assessment  can help you see clearly how motivated you are in your leadership role. If you need to increase your motivation to lead, it directs you to resources that can help. Be hopeful and find something good – Motivated leaders are usually optimistic , no matter what problems they face. Adopting this mindset might take practice, but it’s well worth the effort. Every time you face a challenge, or even a failure, try to find at least one good thing about the situation. It might be something small, like a new contact, or something with long-term effects, like an important lesson learned. But there’s almost always something positive, if you look for it. 4. Empathy For leaders, having empathy is critical to managing a successful team or organization. Leaders with empathy have the ability to put themselves in someone else’s situation. They help develop the people on their team, challenge others who are acting unfairly, give constructive feedback, and listen to those who need it. If you want to earn the respect and loyalty of your team, then show them you care by being empathic. How can you improve your empathy? Put yourself in someone else’s position – It’s easy to support your own point of view. After all, it’s yours! But take the time to look at situations from other people’s perspectives. See our article on Perceptual Positions  for a useful technique for doing this. Pay attention to body language – Perhaps when you listen to someone, you cross your arms, move your feet back and forth, or bite your lip. This body language  tells others how you really feel about a situation, and the message you’re giving isn’t positive! Learning to read body language can be a real asset in a leadership role, because you’ll be better able to determine how someone truly feels. This gives you the opportunity to respond appropriately. Respond to feelings – You ask your assistant to work late – again. And although he agrees, you can hear the disappointment in his voice. So, respond by addressing his feelings. Tell him you appreciate how willing he is to work extra hours, and that you’re just as frustrated about working late. If possible, figure out a way for future late nights to be less of an issue (for example, give him Monday mornings off). 5. Social Skills Leaders who do well in the social skills element of emotional intelligence are great communicators. They’re just as open to hearing bad news as good news, and they’re expert at getting their team to support them and be excited about a new mission or project. Leaders who have good social skills are also good at managing change and resolving conflicts diplomatically. They’re rarely satisfied with leaving things as they are, but they don’t sit back and make everyone else do the work: they set an example with their own behavior. So, how can you build social skills? Learn conflict resolution – Leaders must know how to resolve conflicts between their team members, customers, or vendors. Learning conflict resolution  skills is vital if you want to succeed. Improve your communication skills – How well do you communicate? Our communication quiz  will help you answer this question, and it will give useful feedback on what you can do to improve. Learn how to praise others – As a leader, you can inspire the loyalty of your team simply by giving praise  when it’s earned. Learning how to praise others is a fine art, but well worth the effort. Key Points To be effective, leaders must have a solid understanding of how their emotions and actions affect the people around them. The better a leader relates to and works with others, the more successful he or she will be. Take the time to work on self-awareness, self-regulation, motivation, empathy, and social skills. Working on these areas will help you excel in the future! This site teaches you the skills you need for a happy and successful career; and this is just one of many tools and resources that you’ll find here at Mind Tools. Subscribe to our free newsletter, or join the Mind Tools Club and really supercharge your career! 6