P15 - Nurses Explain

Background and purpose: Strong nurse communication is essential in involving patients in their care and engaging them in self-care and positive health outcomes. Active empathetic listening (AEL) is also required for truly understanding what the patient concerns and questions are. It was noticed that our HCHAPS scores were inconsistent in the "nurse explain" domain. Even though bedside nurses explain almost everything during their shift, if the patient is overwhelmed or not feeling understood then communication is not received.

Review of literature: Meyrs et al. (2020) determined a key indicator of patient experience is enhanced when the nurse listens using active empathic listening and explains things in a way the patient can understand. Negative outcomes can also occur when patients feel they are not understood or listened to. The nurse needs to make sure they do a good job of explaining so the patient understands. (Landis, 2021).

Goal statement: The goal of this project is to improve the quality of patient care as evidenced by an increase the percent box top Hospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS) scores in the nurses explain domain.

Methods: The process for this project was initiated by our clinical nurses participating in our unit shared governance council. To raise awareness, journal club focused on articles that addressed nurse communication from the perception of the patient. During bedside report, plan of care rounds, and general nursing care, nurses verbalized that they would explain. Instead of just asking if the patient had questions, they would use scripting to explain the procedure, medication, or any process that is impacting the patient. Colorful signs were hung in the patient room that read “Nurses love to explain.” When the nurse manager rounded, she would ask the patient to provide an example of
something that the nurse explained. Paper was also provided to the patient with pre-set questions about medications, discharge questions, and tests or procedures.

Outcome data: Data was obtained monthly from HCAHPS top box scores. The target was 79.1%. December pre-intervention actual was 75%, January was 78.3%, February was 83.3%, and March was 87.5%. Results show a steady increase in satisfaction with nurse explains from initiation of project in January. That is a 17% increase is patient satisfaction with how our nurses explain in a way that can be understood.

Implications for nursing: Patient experience is a key component of the performance metric in the hospital. Improving health literacy and understanding can also directly impact and improve patient outcomes and value-based care.