What did you say?

Lisa Barry, Phd Student

College of Nursing, University of Utah 

Quickly after entering healthcare facilities, patrons experience a chorus of clarifications. “What did you say?”  “Would you mind repeating that?”  “I’m sorry I didn’t hear you.”  Healthcare facilities across the world experienced unique and unprecedented challenges in the last few months related to COVID-19.  Healthcare organizations quickly required varying levels of personal protective equipment (PPE) to help protect staff and patients.  With the enhanced protections, new challenges arose related to communication amongst the healthcare team and between patients.  Enhanced guidelines for safeguarding both healthcare providers and patients are necessary, but new methods for communicating are essential to encourage compliance.

Communication Before a Pandemic

Communication challenges have existed in healthcare throughout history.  The Institute of Medicine identified increasing communication in healthcare is key to decreasing patient harm events (Kohn et al., 2000).  Improving communication in healthcare teams has become a priority for many organizations to remain fiscally viable.  Harm-causing events affect the financial viability of hospitals by limiting or denying payment for conditions that are preventable with the application of appropriate care (cms.gov).  Communication challenges create increased fiscal demands for healthcare corporations.  The estimated cost of poor communication was $1.7 billion in 2015 (Kern, 2016).

https://healthcaregovernancereview.wordpress.com/cartoons/

New Challenges to Communication After COVID-19

In the face of uncertainty, regulating agencies, like the Center for Disease Control (CDC), have implemented increasing expectations for the use of PPE.   Current recommendations for patients and staff include the use of surgical or N-95 masks, goggles or face shields, or purified air purifier respirators (PAPR).  Nurses have expressed concern regarding the use of PPE during patient interactions.  Concerns expressed vary from decrease ability to connect with patients to a profound misunderstanding of verbal and non-verbal communication. Katherine Burnett has identified some of the challenges experienced by healthcare professionals.  

Pictures: Nurse wearing a face shield and surgical mask.  Nurse wearing goggles and a surgical mask.  

Since the change in PPE requirements, nurses have tried to find ways to overcome these challenges while complying with the safety interventions recommended.  Adaptations to masks to allow visualization of mouth movements create more natural communication for those with hearing loss.  To adapt to some of the challenges experienced, nurses have devised ways to provide personalization, adjust PPE for hard of hearing patients, and help increase comfort for pediatric patients.

While these innovations are timely and essential for patient satisfaction, barriers still exist regarding communication clarity and PPE use.  A nurse in a critical care unit described this problem clearly.  She was caring for an elderly patient in a busy emergency department.  After donning the appropriate PPE (isolation gown, PAPR, and gloves), she found a patient had fallen on the floor.  For several minutes, she attempted to get the attention of her coworkers to assist the patient back to their bed.  She was unable to get the attention of her peers.  She removed her PPE to call for help.  The removal of her PPE placed her at significant risk for contracting disease; however, the PPE impaired her ability to relay critical information to the team.

 A Call for Research

The adaptation and inclusion of new PPE for staff safety are essential to help protect personnel from deadly and unknown diseases.  While these changes are timely and appropriate, further research is needed to help understand the additional challenges regarding communication clarity with PPE use.  Nurses and other healthcare professionals need to provide timely and valid information continually.  If communication is unclear, providers could choose to break PPE guidelines to help provide clarity in critical patient communications.   Additionally, a preliminary research review did not offer any research on the impedance that PAPR or face shields cause with communication.

Enhanced PPE requirements are imperative to help sustain patient-care during uncertain pandemic conditions.  Understanding the barriers to compliance by healthcare providers will allow manufacturers to adapt PPE to protect staff and encourage use.  Research on communication barriers with PPE will provide vital guidance to help overcome these challenges. 

References

Burnett, K. (2020, April 8).  How nurses feel different from behind PPE.  Marie Curie. 

https://www.mariecurie.org.uk/blog/how-nursing-feels-different-from-behind-ppe/271552

Hackett, K. (2020, June 03).  Cartoon-style PPE:  How staff are reassuring young patients on a

paediatric unit.  NursingStandard.  https://rcni.com/nursing-standard/newsroom/news/cartoon-style-ppe-how-staff-are-reassuring-young-patients-a-paediatric-unit-161486

Kern, C. (2016, February 11).  Healthcare miscommunication costs 2,000 lives and $1.7 billion.

Health IT Outcomes.  https://www.healthitoutcomes.com/doc/healthcare-miscommunication-costs-lives-and-billion-0001#:~:text=Healthcare%20Miscommunication%20Costs%202%2C000%20Lives%20And%20%241.7%20Billion&text=Total%20numbers%20are%20probably%20higher,lives%20according%20toCRICO%20Strategies%20research

Kohn, L., Corrigan, J., & Donaldson, M. (Ed.). (2000).  To err is human: Building a safer health

system.  Institute of Medicine (US) Committee on Quality of Health Care in America; National Academies Press.  https://doi.org/10.17226/9728

Taggert, E.  (2020, April 6).  College student designs face mask for the deaf and hard of hearing. 

My Modern Met.  https://mymodernmet.com/face-mask-for-deaf-hard-of-hearing/

University of Minnesota Health.  (2020, May 14).  The person behind the PPE: Nurse uses smiling

photo to break down barriers. 

https://www.mhealth.org/blog/2020/may-2020/the-person-behind-the-ppe-nurse-using-smiling-photo-to-break-down-barriers