Mr Keane aged 78
Case Description
Mr Keane, aged 78, was admitted to the hospital with an incident of APO (Acute Pulmonary Oedema), initially requiring BiPAP (Bi-level Positive Airway Pressure). With a history of CHF (Congestive Heart Failure). The caregivers resolved the initial health problem, but his lung’s left lower lobe developed an infection resulting in hospital-acquired pneumonia, which needed daily physiotherapy sessions.
On the fifth day of his stay in the hospital, after attending the physiotherapy session, he felt exhausted after his shower. Suddenly, his anxiety levels started to increase due to an episode of chest pain and breathlessness.
Mr Keane’s distress levels worsened; hence the caregivers activated the emergency button to summon the MET (Medical Emergency Team) members to the ward. The team’s primary purpose was to restore his homeostasis to prevent the rapid deterioration of his condition. The characters in the room were the patient, enrolled nurse, ICU nurse, ICU resident, medical registrar, anaesthetic registrar, and physiotherapist.
I will critically analyze this scene to identify human factors and their effects on the scenario. I will also evaluate various clinical leadership practices to improve situational awareness in advanced paramedic settings.
Scenario Evaluation
The MET members responded to the scene to aid in preventing the deterioration of Mr Keane’s condition. They were supposed to provide well-coordinated and collaborative emergency care to the patient. However, the following human factors depicted in the scenario played a significant role.
Table 1
Examples of human factors and their effects on the scene
| Human factors | Effects on the scene |
| Communication | Uncoordinated care processes |
| Information sharing | Delayed response |
| Active listening | Assumptions and misunderstandings |
| Trust | Lack of cohesiveness and teamwork |
| Leadership skills | Poor level of teamwork |
| Role clarification | Role misunderstandings |
| Client-centred care | Lack of goals and appropriate interventions |
Communication
The enrolled nurse failed to communicate and respond appropriately to the patient’s initial vital signs to prevent clinical deterioration. The nurse was overwhelmed because she was assigned to care for five other patients in the ward. Increased nursing workload affects nurses’ performance in delivering quality care. The sharing of the patient’s medical history was significant to enhance rapid and appropriate intervention to prevent worsening the situation. However, the team members did not demonstrate active listening between them and the client. MET did not establish a trusting relationship with Mr Keane and other members. Consequently, these actions resulted in uncoordinated care processes and a lack of understanding of care decisions.
Information Sharing
The multidisciplinary care team did not receive the patient’s information in time for timely and proper care planning. The enrolled nurse failed to communicate Mr Keane’s abnormal vital signs for appropriate interventions. The nurse was responsible for the other five patients, which could have resulted in her being overwhelmed. Nonetheless, the nurses shared the patient’s medical history with the healthcare team to intervene when the client’s condition had deteriorated. Therefore, lack of information sharing resulted in delayed response and rapid deterioration and worsening of the patient’s condition.
Active Listening
The physiotherapist did not ask the patient questions about how he was feeling before starting the session. The patient informed the physiotherapist to stop because he was experiencing shortness of breath, but she proceeded. MET members did not ask the client any questions. They seemed unbothered by the patient’s situation. Thus, a lack of active listening led to assumptions and misunderstandings.
Trust
The healthcare team did not establish trust between them and Mr Keane. The team demonstrated poor levels of teamwork and cohesiveness. Lack of trust among MET members and the client resulted in uncoordinated response and care in the scenario. Consequently, the patient’s condition worsened.
Leadership Skills
MET team lacked a clearly defined leader during the scenario. The leader should have acted fast and prudently to develop and implement interventions and communicate effectively with other team members. No one took charge of the situation to meet Mr Keane’s acute care needs. The team members did not demonstrate mutual respect and trust for each other. The team showed poor levels of teamwork and cohesiveness, which was a result of ineffective leadership and poor communication in the team. The group depicted uncoordinated activities, leading to jeopardized teamwork and the deterioration of the patient’s condition. The medical registrar could have taken the leadership role of instructing other members and using nursing assessment findings to decide on restoring Mr Keane’s homeostasis.
Role Clarification
The team members did not communicate their roles, knowledge and skills to each other and the patient. The team members did not understand what their roles were in the situation. Some of the members lacked respect for each other’s roles. For instance, differing priorities caused tension between the nurse whose role was the provision of immediate care and the medical registrar who provides clinical leadership and oversees patient care in emergencies. Furthermore, the medical registrar was unaware of the enrolled nurse’s scope of practice. This situation can result in the nurse’s incapability or unwillingness to perform a particular duty or act outside her scope of practice. The scenario’s lack of clarification resulted in role misunderstandings, leading to patient harm.
Client-centred Care
Mr Keane could have experienced complications due to his medical condition. The deterioration of his situation could have been due to delayed intervention of abnormal vital signs and lack of communication. The care team members did not act in the patient’s best interest because they lacked leadership and communication. It is so vivid that the client did not get an adequate response to his questions about treatment. He could not comprehend the information the team was telling him. MET members should have demonstrated clarity and objectiveness when communicating with the client. A therapeutic relationship with clients improves interaction. The patient did not feel part of the decisions regarding his treatment. Patient participation in developing and implementing care plans promotes client-centred care and enhances safety.
Analysis and Discussion
Medical errors are a significant public health concern globally (Shannon & Sebastian, 2018). Patient safety entails evidence-based care strategies for improving healthcare practice. It is a critical part of health practice whose primary purpose is to minimize serious clinical errors and prevent client harm (Grum et al., 2020). Australians trust caregivers to provide excellent and safe care (Australian Commission on Safety and Quality in Health Care, 2019). Nevertheless, not all patients receive top-quality care, and avoidable adverse events occur throughout the Australian healthcare system (Shannon & Sebastian, 2018). Lapses in patient safety and quality care result in adverse health outcomes (Calder et al., 2019). Therefore, the ACSQHC (2019) adopted a framework to improve Australia’s care quality and patient safety. The commission collaborates with clients, health professionals, all levels of government, health organizations, the private sector, and other stakeholders to achieve high quality, sustainable, and safe health systems (Bogossian & Craven, 2021).
According to Dunstan et al. (2022), intensive care units are high-risk departments for adverse events and medical errors due to the client’s fragile condition and the complexity of critical care settings. Human factors play an integral role in Australia’s patient safety culture. These factors impact a health professional’s performance. Therefore, an approach that includes these factors is crucial to high-quality healthcare services (ACSQHC, 2019). They influence care in various ways, such as client-centred care, leadership skills, role clarification, and communication skills (Calder et al., 2019).
Delaney (2018) states that person-centred care considers patients and their families equal partners in developing and implementing a care plan that meets clients’ needs. Members of the healthcare team should act in the patient’s best interest. Care in critical situations differs (Baier et al., 2019). Nonetheless, health professionals should respect client preferences, expressed needs, and values (Blight et al., 2021). They should provide emotional support, education and information. Also, caregivers should involve the client’s family to provide client-centred care (Delaney, 2018). The client should feel like part of the decision-making process. Consequently, person-centred care improves the quality of care services and minimizes the risk of adverse events and medical errors (Bogossian & Sebastian, 2021).
Moreover, MET members should address the clients’ concerns by answering their questions and offering emotional support to relieve anxiety and fear (Baier et al., 2019). Members of the care team should interact with the patient in a friendly manner and demonstrate practical communication skills to enhance patient understanding (Dunstan et al., 2019). Also, client-centred care improves better health outcomes in critically-ill patients (Blight et al., 2021).
Interprofessional communication entails exchanging information within a care team comprised of caregivers, clients, and societies (Liang et al., 2018). This type of communication enhances respectful relationships between team members and clients (Seaton et al., 2021). Mutual respect is essential in interprofessional contact because it fosters positive settings to set shared goals, develop collaborative plans, make shared decisions and share responsibilities (Gum et al., 2020).
Furthermore, Bogossian & Craven (2021) state that interprofessional communication involves honest and transparent interactions. Therefore, members of the care team can demonstrate practical communication skills by listening actively, being keen on body language, and agreeing on a shared apprehension of care plans (Blight et al., 2021). MET members in emergencies should share relevant patient information to facilitate appropriate and timely medical interventions (Gum et al., 2020).
Information sharing is essential in planning patient care quickly and effectively. Members of the care team should share relevant patient clinical details to develop a care plan that meets client goals and needs (Liang et al., 2018). Also, information sharing improves patient safety and minimizes incidents of medical errors and adverse outcomes (Bogossian & Craven, 2021).
Active listening is essential to communication because it encourages openness and honesty (Seaton et al., 2021). Caregivers should listen actively to what their patients say and pay attention to their expressions. They should answer patients’ questions and concerns about their healthcare (Shannon & Sebastian, 2018). Consequently, practical communication skills result in positive health outcomes and facilitate the creation of a safety culture in critical settings (Gum et al., 2020).
Moreover, practical communication skills enhance the establishment and maintenance of trust between MET members and clients (Delaney, 2018). Also, it promotes respect among members of the care team. Trusting relationships with MET members and the client enhances teamwork and cohesiveness (Calder et al., 2019). Trust positively affects clients because it relieves anxiety, fears and concerns. Excellent communication in critical settings lessens the risk of misunderstandings and conflicts and enhances collaborative care (Dunstan et al., 2019). Clients benefit from effective communication strategies through coordinated care processes resulting in positive health outcomes (Seaton et al., 2021).
According to Shannon & Sebastian (2018), a good team leader should be decisive, experienced, goal-oriented, and communicate effectively. They should demonstrate active listening skills, make decisions and handle stress. Delegation and supervision are essential skills in healthcare emergencies (Seaton et al., 2021). According to the case scenario, MET members lacked leadership characteristics (Shannon & Sebastian, 2018). Studies indicate that situations in critical care settings should have a clearly defined leader to guide other members in handling difficult situations (Baier et al., 2019). Effective leadership in emergencies aims to prevent health deterioration and disintegration of systems (Liang et al., 2018). Mr Keane’s scenario demonstrated a lack of leadership because no one took charge to establish a plan of care to meet his health needs and goals (Blight et al., 2021).
In emergencies, leaders should strengthen teamwork, communication, collaboration, and cohesiveness (ACSQHC, 2019). Members of the MET should demonstrate trust and mutual respect (Bogossian & Craven, 2021). Leaders should be trustworthy so that team members can trust them to make the right clinical decisions that promote patient safety and aid the client to achieve optimal health (Shannon & Sebastian, 2018). However, a lack of leaders or ineffective leadership contributes to the dysfunctional operations of the team, increasing the risk of medical errors, undesired health outcomes, and poor levels of teamwork (Baier et al., 2019).
According to Liang et al. (2018), inadequate leadership skill training decreases the efficiency and effectiveness of a medical team. Ultimately, poor leadership results in staff dissatisfaction and lower client satisfaction (Bogossian & Craven, 2021). Healthcare leaders should handle other issues in a facility, such as inadequate nursing staff and heavy workload (Liang et al., 2018). For example, the enrolled nurse in the case study cared for Mr Keane and the other five clients in the ward. Over-working in the healthcare workforce results in burnout and fatigue (Baier et al., 2019). Consequently, there is reduced employee productivity and a high risk for medical errors and patient harm. Other adverse outcomes of ineffective leadership in emergencies include delayed and low-quality care to clients (Shannon & Sebastian, 2018).
Performance, conception, and expectations define a role. Therefore, members of a care team should understand their roles and those of others. Calder et al. (2019) state that role clarification is essential for emergency care. A team leader should develop clarity about each member’s responsibility and role in the team (ACSQHC, 2019). Role clarification ensures that each team member has a shared understanding of each other’s role, shared responsibilities and expectations (Dunstan et al., 2019).
Moreover, a team leader should understand each member’s abilities and range of competencies in the team (Seaton et al., 2021). Members should know the assigned responsibilities and ensure they fall under their scope of practice (Calder et al., 2019). For instance, there were two misunderstandings of roles in the case scenario involving Mr Keane (Liang et al., 2018). The nurse’s role was to offer immediate care by assessing the patient (Bogossian & Craven., 2021). The registrar’s part was to use the nurse’s findings to make a clinical decision to restore the patient’s homeostasis (Blight et al., 2021). Hence, these differing priorities can result in role misunderstandings within the group. Furthermore, the medical registrar demonstrated unawareness of the enrolled nurse’s scope of practice (Baier et al., 2021). If the registrar assigns the nurse a duty outside the nurse’s course scope, she will show unwillingness and incapability to perform it (ACSQHC, 2019).
Role misunderstandings can result in low-quality healthcare services, unanticipated patient outcomes, client harm, and poor levels of teamwork (Blight et al., 2021). Health leaders should clearly understand and define each team member’s role to promote patient safety and minimize the risk of medical errors in emergency care (Baier et al., 2019). Thus, healthcare stakeholders should develop and implement role clarification strategies and policies to improve healthcare practice (Delaney, 2018). Role clarification enhances appropriate and effective response strategies in critical care situations, improving patient survival and recovery (Calder et al., 2019).
Conclusions and Recommendations
Human factors describe the association between individuals and the systems they interact with to improve efficiency, productivity, creativity, job satisfaction, and minimize errors. Healthcare practice continues to evolve rapidly. Intensive care is an essential field in the healthcare industry. Therefore, human factors such as leadership characteristics, communication skills, workload, trust, active listening, information sharing, role clarification, and person-centred care influence patient safety.
Also, the risk of preventable undesired events and serious clinical errors in critical settings has increased in recent years due to the rapid evolution of the healthcare industry. The Australian health system developed a patient safety framework comprising three fundamental principles; information-driven, consumer-centred, and organized for safety. The framework facilitates and mentors teamwork, respect, improvement, and psychological safety, keeping clients safe from harm.
Australia’s safety frameworks recommend interprofessional learning and simulation as strategies to promote patients’ safety in emergency settings. Interprofessional learning entails interactions between members of two or more professional fields. Interprofessional education and collaborative practice are essential in developing a workforce competent to meet complex health challenges and possess improved levels of collaboration, teamwork, problem-solving, and information-sharing. Also, interprofessional learning simulation techniques bridge the gap between classroom learning and real-life experiences and allow learners to put theory into practice.
References
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