As a nurse, you understand the need for effective patient communication. To provide ethical, high-quality care, you must be aware of and respond appropriately to your patient’s cultural beliefs, values, language, and literacy level. Having a framework and establishing expectations can help you and your organization improve the quality of patient-centered communication.
A recent report from the American Medical Association (AMA) provides such a framework. “Improving Communication—Improving Care” was written by the AMA’s Ethical Force Program, which focuses on the shared ethical expectations of healthcare providers, healthcare insurers, and consumers. Through the American Nurses Association (ANA) Center for Ethics and Human Rights, nursing is represented among the program’s leaders.
How the report parallels nursing ethics
The Ethical Force Program Consensus Report offers guidelines and measurable expectations for nursing performance in six major content areas for evaluating communication with patients of diverse backgrounds. Strong parallels exist between this report and the ANA Code of Ethics for Nurses. Here’s a summary of the parallels for each major content area.
#1: Understand your organization’s commitment.
By serving in leadership roles, helping to develop programs to promote patient communication, and encouraging ongoing evaluation of communication programs, you strengthen your organization’s commitment to patient-centered communication (ANA Ethics Code #7.1). Your professional commitment to promoting, advocating for, and striving to protect patients’ health, safety, and rights—combined with your leadership attributes—improves patient communication in your workplace (ANA Ethics Code #3).
#2: Collect information.
Collect, organize, and code reliable data for a better understanding of your patients’ demographics and communication needs. If you have direct contact with patients, ask them about their common communication needs. Understanding each patient’s uniqueness unrestricted by social considerations, economic status, and personal attributes and with fair treatment of all is at the root of nursing practice (ANA Ethics Code #1, 2, 3).
#3: Engage communities.
As a nurse, your primary commitment is to the patient—whether that patient is an individual, a family, a group, or a community (ANA Ethics Code #2.1). Make a demonstrable effort to reach out to the communities you serve by establishing relationships with community groups and inviting community members to assist in shaping organizational policies (ANA Ethics Code #8.1). You have a responsibility to be knowledgeable about the health status, health threats, and safety issues that exist in your patients’ communities (ANA Ethics Code #8.2). By participating in community organizations, you increase awareness of barriers to health and successful efforts to promote health (ANA Ethics Code #8.2).
#4: Develop your workforce.
Nurses advance the profession by recruiting and mentoring the next generation of nurses (ANA Ethics Code #7.1). Nursing requires representation from every population. Assist your organization in employing and training a workforce that reflects and appreciates the diversity of your patient population. Involve relevant staff in decision making about patient-care issues to ensure that health services are available to all persons requiring care (ANA Ethics Code #2.3).
#5: Engage patients.
By delivering care with respect to your patients’ needs and values without prejudice (ANA Ethics Code #1.2), you assist your organization in engaging all individuals—especially those belonging to vulnerable populations.
#5a: Sociocultural context
Plan care with attention to the individual patient’s lifestyle, value system, and religious beliefs. Encourage patients to take an active role in planning, implementing, and evaluating their health care (ANA Ethics Code #1.2). Consider sociocultural factors that affect your patient’s health beliefs and ability to interact with the healthcare system.
All patients have the moral and legal right to receive accurate, complete, and understandable information, making it imperative that language assistance is available to them. Nurses must implement training of language assistance resources to meet patients’ needs (ANA Ethics Code #1.4).
#5c: Health literacy
Offer patients medical information appropriate to their health literacy level. Provide verbal, written, and other media communication as indicated. Assess patients’ comprehension of the information provided and the implications of decisions based on this information (ANA Ethics Code #1.4).
#6: Evaluate performance.
Regularly evaluate your organization’s communication structure, process, and outcome measures in an attempt to maintain patient safety. You are obligated to bring forward any difficult issues that compromise your patient’s safety or your organization’s integrity (ANA Ethics Code #3.4).
Benefits for all
By focusing on the individual patient’s culture, language, and health literacy skills, you can deliver ethical, high-quality nursing care. Taking a patient-centered approach can lead to high-quality patient care, improved community relations, enhanced morale, and cost savings for healthcare organizations.
Visit http://nursingworld.org/mods/mod580/cecde03.htm for the ANA Code of Ethics with interpretive statements.
American Medical Association. 2006. Ethical Force Program Consensus Report. Improving Communication—Improving Care. Chicago, Ill. Available at: www.amaassn.org/ama1/pub/upload/mm/369/ef_imp_comm.pdf. Accessed July 15, 2006. (For a list of the Ethical Force Program Oversight Body members, see page 142 of the report.)
American Nurses Association. 2001. Code of Ethics for Nurses WithInterpretive Statements. Silver Spring, Md. Available at: www.nursingworld.org/mods/mod580/cecdevers.htm. Accessed July 15, 2006.
Institute of Medicine. 2001. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC. Available at: http://newton.nap.edu/catalog/10027.html?onpi_newsdoc030101. Accessed July 21, 2006.
Laurie Badzek, RN, MS, JD, LLM, is Director of the ANA Center for Ethics and Human Rights and a professor at West Virginia University in Morgantown, where she serves as a member of the Ethical Oversight Body.