Literature Review

Building a Culture of Safety through the Concepts of Compassion, Empathy, and Caring: An Interpersonal Communication Perspective towards Quality of Care
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Building a Culture of Safety through the Concepts of Compassion, Empathy, and Caring: An Interpersonal Communication Perspective towards Quality of Care
Abstract
Patient safety is one of the most vital goals of the health care process. Various studies have investigated the impact of interpersonal communication as a strategy for building a safety culture based on the concepts of compassion, empathy, and caring. Studies, however, do not indicate how interpersonal communication can be used specifically in the context of nursing care and the role played by nurses in the creation of safety culture. The purpose of this paper was to review various literary sources on the attainment of a culture of safety in health sector while focusing on the elements of the interpersonal communication as the main routes for achieving the goal. Literary sources from Cochrane and ANA databases were reviewed to attain the required information. From the information analyzed, it can be concluded that most studies have shown a direct link between patient safety and outcomes. Some of the outcomes that are seen to be directly related to the safety culture include mortality, patient satisfaction and rates of readmission after being discharged. Interpersonal communication is also seen to play a major in establishing relationships between the patient and the care provider.

Such relationships are necessary for attaining empathetic and compassionate care.
Keywords: patient satisfaction, safety culture, interpersonal communication, quality care
Introduction
A culture of safety is an essential element for an organization to be regarded as a high-reliability environment. Health agencies can attain high reliability by consistently working to minimize adverse events that are associated with the complex and hazardous conditions. The culture of safety should entail the organizational commitment of resources to address the emerging safety concerns, a collaboration of various professionals at all levels to achieve the desired safety and an environment that is free from blame where individuals report errors that occur (Weaver et al. (2013). Interpersonal communication is necessary for a safe environment as lack of communication can lead to medical errors. The errors may result in severe patient injury and unexpected death. Communication is not only used for social interaction but also as a tool for building relationships that are necessary for achieving the level of safety that is needed. The concepts of compassion, empathy, and caring are embodied in effective communication that enables the understanding the requirements of other people in the care environment.
Various regulatory agencies provide rules and regulations as well as standards that should be used in the safety of patients and health workers. JCAHO provides standards that should be met by offering a particular policy that should adhere in the healthcare practice. The Joint Commission’s role in ensuring the quality of healthcare is to accredit health providers after meeting some of the required conditions of the health practices. Hospitals and healthcare providers who receive the JCAHO must have proven that they are capable of providing highest levels of performance and patient satisfaction. OSHA is charged with ensuring that a safe working environment is maintained for the better administration of health services and patient regulations (Douglas et al., 2014). ACA provides that for quality and affordable healthcare to be achieved patient safety should be enhanced and promoted. As an association that represents hospitals in South Florida, SFHA aims at working together with hospitals to attain the desired quality of healthcare. This paper reviews various literary sources on the attainment of a culture of safety in health sector while focusing on the elements of the interpersonal communication as the main routes for achieving the goal. A further discussion made regarding the roles of organizations such as JCAO, OSHA, and SFHA on the promotion of safety culture in nursing care.
Problem Statement
Extensive research has been done on the importance of communication in the nursing profession, however, the knowledge of how aspects of interpersonal communication such as compassion, empathy, and caring can be used to build a safety culture (Kourkouta & Papathanasiou, 2014). It has also been established that safety culture in hospitals is well improved as compared to the conditions in the nursing home. The nursing home, for instance, is said to have poorly developed quality standards and safety conditions. Interpersonal communication has been regarded as one of the most effective strategies for improving the quality of care that is provided to the patients. Studies, however, do not indicate how interpersonal communication can be used specifically in the context of nursing care and the role played by nurses in the creation of safety culture. Lack of safety in the care environment is a big problem given the fact that medical errors and mistakes account largely to the mortality rates in America and around the world.
The review entails analysis of information retrieved from various libraries to establish the impact of safety culture on the patient satisfaction and the role of nurses in the attainment of a high-quality health care being delivered to the patients. The sources used in the present study were retrieved primarily from the Cochrane database. Further information was obtained from the ANA database.
The Impact of Safety Culture on Nursing Care
The security of patients is seen as a high priority goal for most countries in the world. According to a 2013 study, most deaths in America are caused by lack of safety in the care environment that leads to medical errors. Various studies have hypothesized that the improving of the culture of safety in the nursing care improves the patients’ outcomes. Kirwan, Matthews & Scott (2013) for instance establish the critical role played by nurses in achieving the improved results in the healthcare sector. Nurses contribute significantly to the safety culture and patient satisfaction. Patient satisfaction is one of the most important measures of the quality of health services provided by an institution. Healthcare aspects such as clinical outcomes, medical malpractice claims, and patient retention are all affected to a great extent by the patient satisfaction. Other elements that are affected by patient satisfaction include the effectiveness, efficiency, and patient-centeredness of the care delivery process. Therefore, the relevance of the satisfaction of the patients cannot be overstated. Nurses just like any other health professionals are directly charged with the responsibility of ensuring that best clinical outcomes are achieved so as to achieve the highest quality of the health services being rendered. The success of the nurses is thus measured by the degree of the satisfaction of their clients.
A safe working culture leads to effectiveness nurse education and staffing levels as well as a positive environment that promotes the outcomes of the patient processes (Kirwan, Matthews & Scott, 2013). The safety culture also has a significant impact on the outcomes of the healthcare staff. Since the nursing staff is working in a hazardous and environment, they are constantly exposed to various health risks that may endanger them thus reducing their performance. It can thus be included that a culture of safety not only affects the outcomes of the patient process but also on the nursing staff wellbeing and performance. The nursing homes are also said to be at increased risks of adverse events and medical errors given the fact that residents do take multiple medications for several medical conditions. Studies have established that adverse events are likely to occur in such situations given the multiple combinations of the drugs being used to manage the health disorders.
Impact of Safety Culture
A safety climate has a direct impact on both the patients and staff outcomes. The impact on the patient outcomes is one of the main ways with which the safety culture can be measured and improve in the modern healthcare settings. The safety culture is used to refer to the manner in which the well-being of the patients is thought about, structured and implemented in a health organization. One of the primary subsets of safety culture is the staff’s attitude and knowledge regarding how safe their working environments (Haugen et al., 2013). The outcomes and satisfaction by the staff and the patient have been used as possible indicators of the culture of safety in healthcare settings. The following sections present the impact of the safety culture on both the patients and the staff.
Safety Culture and Patient Outcomes
One of the primary goals of health services is to improve the outcomes of the patients by ensuring that quality care is accorded to the patient to reduce the effects of the diseases on the patients while attaining the wellbeing of the patient. The main outcomes that have been focused by the various include readmission rates, medical errors, the length of stay, mortality and opportunistic complications. The researchers in the US have for instance investigated the connection between the safety climate and the rates of readmitting the patients in the hospital after 30 days of discharge. The other studies conducted have also indicated links between the complications and the safety climate in a hospital and nursing homes. It is for instance Haugen et al. (2013) report that the application of the surgical checklist as a safety precaution led to reduced cases of complications that are related to the various surgical procedures. Studies conducted in the US have also shown that decrease in the safety culture had a notable improvement in the number of days that the patients stayed in the hospital for the required care. The relationship between the medical errors and the various aspects of safety climate has been examined in various studies with the outcomes indicating that there is a connection between the two. For instance, a survey conducted in the US shows that the medical errors can be predicted using the safety climate of health organization. The potential association between the clinical outcomes and the mortality rates has also been a subject of research in some studies. In a review by Haugen et al. (2013), it is established that the safety climate was correlated with the surgical outcomes.
Safety Culture and Staff Outcomes
There is growing proof of an association between the safety culture and the staff outcomes. From the studies reviewed two primary staff outcomes are identified as being affected by the culture of safety. The staff injury rates and staff behaviors to improve the safety are the two indicators that are explicitly indicated by the relevant researches.
Safety Culture and Patient Satisfaction
DiCuccio (2015) identifies a relationship between the safety culture and patients just as established in similar studies. In her work, DiCuccio (2015) associate satisfaction of the healthcare’ clients as one of the main indicators of the outcomes of the service delivery with the safety culture being recognized as one of the primary technique for improving healthcare quality. It has been recognized that patient safety and patient satisfaction should be closely related. Nursing care in hospitals and homes should provide services that are safe and meets the expectations of the client. Organizational values such as family and patient-centered services contribute largely to a safe environment. Other aspects that contribute to patient satisfaction is when the nurses are motivated by their work. Safety thus arises as the nurses are well engaged and can spend maximum time tending to their clients. The caregivers will thus gain an understanding of their patient’s conditions and vulnerabilities and dictate their energy and time to solve the various complications. Such nurses are also in a better position to identify and address the psychosocial needs of the patients’ family and the people close to the client. Family and patient-centered care are thus seen as a basis for a safe nursing environment. Addressing the psychosocial needs of the clients and their families is further regarded as one of the most powerful and consistent drivers of patient satisfaction.
DiCuccio (2015) further cites studies that have established connections between safety and satisfaction. A review is presented in the previous studies in which the safety and well-being have been investigated regarding their response to the changing levels of nursing staffing and experience.
Various other studies and surveys have validated the hypothesis that improved client safety may lead to improved client care process. For instance, in a study to investigate the relationship between the relationship between the safety of culture and the evaluation of the hospital’s Sorra et al.(2012) established that patient safety was seen as a significant performance of the care process. The study was able to establish positive patients’ feedback in hospitals where staffs had positive perceptions regarding the patient safety. The study was thus able to support the previous that indicated that there is a relationship between the patient safety and patients’ outcomes. The authors were however limited their research to low levels hospitals they, therefore, recognize the necessity to expand the scope of the research in future studies to enable investigation in larger hospital settings.
Effective Communication and Patient Safety
To become a skilled nurse, one is required to master effective communication skills so as to prevent mistakes and errors that may arise from the health care process while providing the high-quality care. The ability to communicate effectively with the patients and other health professionals helps to build relationships that are required for high levels of performance that is required of the healthcare delivery. The necessity of interpersonal communication can also be seen in the fact that critical information can only be relayed through active means of passing of messages that enables understanding between the various stakeholders.
Communication and values in an organization have also been seen to be the primary objects used for creating an effective work environment. The purpose of communication to promote the safety of the patients can majorly be considered in the fact that effective passing of information can be used to sensitize the staff and the clients on the safety procedures. It can also be seen that interpersonal communication can be used to change the attitude and perceptions of the staff regarding the climate of safety. Vertino (2014) recognizes the importance of the effective interpersonal by citing improvement of personal and professional lives of the nurses. It can thus be noted that a nurse with high-quality life is likely to have more positive attitudes towards the safety requirements and structure in the organization.
Importance of Interpersonal Communication for Patient Safety
Riley (2015) notes that the necessity of achieving a nurse-client relationship that can be used to enhance the safety of both the patients and the nurses. A nurse-client relationship, when founded on proper values, can lead to a safe climate by the attainment of caring, compassion, and empathy. The link can also help in the understanding of the needs and pains of the clients. The interpersonal relationship communication (IPC) is also important as it is used to improve patient satisfaction and compliance with the various regulations and standards of the practice. The patients who understand the nature of their illness and believe that the care provider is concerned about their wellbeing are more likely to cooperate in the care process and as such follow the treatment plan that can substantially increase the chances of recovering and achieving the quality life that is the key goal of the care process. The fact that patients are willing to comply with the treatment due to effective communication can be seen as another role played by the nursing staff.
Through interpersonal communication, a compassionate and empathetic care is achieved due to the nurse-patient relationship that is developed (Riley, 2015). The approach of care thus entails mutual understanding between the care providers and the patients. The nurse who understands the nature of the illness and the associated pain the patients are undergoing will feel for them and as such do everything under their care to alleviate the suffering or to avoid instances that may be harmful.
Scholars have established the effectiveness of empathy in the care process. Derksen, Bensing & Lagro-Janssen (2013) assert that empathy is a characteristic of the patient-nurse communication that is necessary for achieving the desired clinical outcomes. Empathy is seen as the backbone of the relationship between the patient and the care provider (Derksen, Bensing & Lagro-Janssen, 2013). The importance of empathy can be seen in the fact that patients considered it as one of the essential elements of the therapeutic relationships and used the element as one of the main factors to measure the quality of care that is provided to them. The link between empathy and communication is seen in the fact that empathy is defined in three levels of attitudes, competency, and behavior that must be communicated clearly to the relevant parties. The attitude is based on the moral standards of the care like interest in the other person and respectfulness of the authenticity of the patients. Compassionate care arises given the fact the care provider can understand the situation of the patient and be empathetic to him or her.
It has also been proven that there is a link between effective communication and the quality of health care that is provided to the clients. Many health organizations can thus be seen to rely on communication as a strategy for improving the quality of care in hospitals and nursing homes environments. Research indicates that engaging the patients in the care process is likely to result in high quality and safety (Derksen, Bensing & Lagro-Janssen, 2013). Promotion of engagement with the clients can be used as an evidence-based resource to improve quality as the hospital’s partner with the patients and their families to create a suitable atmosphere for the promotion of health values.
Team communication strategies help in achieving safe care as members of the staff collaborate to work towards patient-centered objectives. Better interpersonal communication leads to understanding and cooperation among the professionals of diverse knowledge, experience, beliefs, and values. The care providers can thus agree on the course of action to take in a particular scenario. Coordination of care is necessary for achieving the quality of the health service provided. Effective communication acts as the basis of coordination as the team members can be easily and efficiently be informed of their roles and what is expected of them (Derksen, Bensing & Lagro-Janssen, 2013). Goals and objectives can also be communicated clearly with the care providers knowing exactly what is expected of particular procedure or process. Effective communication can also be used for training of the staff to observe the safety regulations. A well-delivered nursing curriculum entails the production of care providers who understand their roles in the context of the hazardous and complex environment as well as high risk of adverse events. Well, trained nurses know the action to take for preventing adverse events while managing the risks to which the patients and staff are exposed.
Conclusion
First and foremost it is imperative to recognize the necessity of safety culture in a health care environment. However, some questions need to be answered to attain the perfect and safety health contexts that are necessary to achieve the desired outcomes. What is the role played by the nurses in promoting a safety culture and patient satisfaction? How effective is the interpersonal communication in building an empathetic and compassionate care? The author of the present paper is of the opinion that effective communication is an essential component of quality care and that a safety culture can be created through the collaboration between the patients and the care providers. The level of evidence used in this review is high this is because of the use of scholarly sources from reputable nursing databases and given the fact the articles are peer-reviewed and published in respected journals.
References
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