Advanced Effective Communication, Cultural Competence, and ...

A Roadmap for Hospitals
ChapterThree: Treatment
18
• Check the patient’s medical record for any identified
communication needs, including the patient’s preferred
language and any sensory or communication impairments.
• Arrange for language services to help with treatment of
patients whose preferred language is not English or
who are deaf.
• Make sure that appropriate auxiliary aids and services
are available during treatment of patients who have
sensory impairments.
• Provide augmentative and alternative communication
(AAC) resources to help with treatment of patients
with communication impairments.
• Note the use of communication assistance in the
medical record and communicate needed aids and
services to staff.
❑ Monitor changes in the patient’s
communication status.
A change in health status or the outcome of a medical
treatment or procedure can impair the patient’s ability to
communicate. Patients may develop new or more severe
communication impairments over the course of care, and
staff should periodically assess for changes in the patient’s
communication status (see Figure 5-1, Sample Tool for
Communication Assessment, page 19).
• Determine if the patient has developed new or more
severe communication impairments during the course
of care and contact the Speech Language Pathology
Department, if available. Provide AAC resources, as
needed, to help during treatment.
• Anticipate the communication needs of the patient
who is expected to develop communication
impairments from scheduled treatment or procedures
(for example, as a result of intubation, tracheostomy,
sedation, or other interventions that may compromise
the patient’s ability to communicate). In addition,
consider whether bed positioning or the placement of
medical equipment for treatments or procedures will
impede the patient’s use of required AAC resources.
• Note any changes in the patient’s communication status in
the medical record and communicate new needs to staff.
❑
Involve patients and families in the care
process.
Staff must involve both the patient and his or her family to
develop a treatment plan that is tailored to the patient’s
unique needs. Staff should encourage the patient and family
to ask questions throughout the course of care and provide
opportunities for them to participate in care discussions.
• Ask the patient which, if any, family members he or she
would like to involve in care discussions. Family
members may be broadly defined to include friends and
same-sex partners.* Staff should discuss a child’s care
with both parents, including same-sex parents.
• Adapt existing hospital procedures to better involve the
patient and family in care discussions. For example,
consider rescheduling patient rounds or making sure
the information provided to the patient during rounds
is available to the patient’s family members at a later
time.
• Urge patients to take a role in preventing health care
errors by becoming active, involved, and informed
participants on the health care team. The Joint
Commission, together with the Centers for Medicare
and Medicaid Services, has a national Speak Up
program which features brochures, posters, and buttons
on a variety of patient safety topics [1].
• Consider providing communication assistance to family
members whose preferred language is not English or
who have sensory or communication impairments to
facilitate family involvement in care discussions. †
• Make sure that appropriate communication supports
are in place during care discusssions; family and
friends should not be used to interpret.
• Notify the patient and family of ongoing opportunities
to ask questions. Encourage the patient and family to
write down questions for discussion with caregivers.
❑ Tailor the informed consent process to
meet patient needs.
The informed consent process allows patients and
providers to establish a mutual understanding about the
care, treatment, and services the patient will receive.
* Family involvement is a critical issue for lesbian, gay, bisexual, and transgender (LGBT) patients and families. In some cases, biological family
members may disapprove of the patient’s same-sex relationship and may try to exclude the patient’s partner from visitation or decision making.
Exclusion of a primary caregiver may compromise patient adherence with treatment recommendations. When treating children with same-sex
parents, staff should include both parents in discussions about the child’s health care, even if both do not have legal custody.
† See Chapter 6: Organization Readiness: Provision of Care, Treatment, and Services (page 40 and 41) for additional information on providing
language services, auxiliary aids, and augmentative and alternative communication resources.