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chapter 6 | Getting People to Work Together 77 CikguOnline
without intending this to happen.Consider the fol- for sharing information. These mechanisms allow
lowing example: the nurses from the previous shift to complete their
tasks and those coming on duty to make inquiries
A respiratory therapist and a department adminis-
for clarification as necessary.
trator at a large health-care institution were
The report should be organized, concise, and
engaged in a relationship.They started sending each
complete, with relevant details. Not every unit uses
other personal notes over the company e-mail sys-
the same system for giving a change-of-shift
tem. One day, one of them accidentally sent one of
report. The system is easily modified according to
these notes to all the employees at the health-care
the pattern of nursing care delivery and the types of
institution. Both were fired. The moral of this story
patients serviced. For example, many intensive care
is simple: Do not send anything by e-mail that you
units,because of their small size and the more acute
would not want published on the front page of a
needs of their patients, use walking rounds as a
national newspaper or hear on your favorite radio
means for giving the report. This system allows
station tomorrow morning.
nurses to discuss the current patient status and to
Although voice tone cannot be “heard” in e-mail, set goals for care for the next several hours.
the use of certain words and writing styles indicates Together, the nurses gather objective data as one
emotion. A rude tone in an e-mail message may nurse ends a shift and another begins. This way,
provoke extreme reactions.Follow the “rules of neti- there is no confusion as to the patient’s status at
quette” (Shea, 2000) when communicating through shift change. This same system is often used in
e-mail. Some of these rules are listed in Box 6-3. emergency departments and labor and delivery
units. Larger patient care units may find the “walk-
Reporting Patient Information ing report” time-consuming and an inefficient use
of resources.
Change-of-Shift Report It is helpful to take notes or create a worksheet
It is important to understand exactly how your day while listening to the report. A worksheet helps
at work will begin.Regardless of which shift an indi-
vidual works, some things never change. Nurses
traditionally give one another a “report.” The box 6-4
change-of-shift report has become the accepted Information for Change-of-Shift Report
method of communicating patient care needs from • Identify the patient, including the room and bed numbers.
one nurse to another. In the report, pertinent infor- • Include the patient diagnosis.
mation related to events that occurred is given to the • Account for the presence of the patient on the unit. If the
individuals responsible for providing continuity of patient has left the unit for a diagnostic test, surgery, or
just to wander, it is important for the oncoming staff
care (Box 6-4). Although historically the report has
members to know the patient is off the unit.
been given face to face,there are newer ways to share • Provide the treatment plan that specifies the goals of
information. Many health-care institutions use treatment. Note the goals and the critical pathway steps
audiotape and computer printouts as mechanisms either achieved or in progress. Personalized approaches
can be developed during this time and patient readiness
for those approaches evaluated. It is helpful to mention
the patient’s primary care physician. Include new orders
box 6-3
and medications and treatments currently prescribed.
Rules of Netiquette • Document patient responses to current treatments. Is the
treatment plan working? Present evidence for or against
1. If you were face-to-face, would you say this?
2. Follow the same rules of behavior online that you follow this. Include pertinent laboratory values as well as any
when dealing with individuals personally. negative reactions to medications or treatments. Note
3. Send information only to those individuals who need it. any comments the patient has made regarding the
4. Avoid flaming; that is, sending remarks intended to hospitalization or treatment plan that the oncoming staff
cause a negative reaction. members need to address.
5. Do not write in all capital letters; this suggests anger. • Omit personal opinions and value judgments about
6. Respect other people’s privacy. patients as well as personal/confidential information not
7. Do not abuse the power of your position. pertinent to providing patient care. If you are using
8. Proofread your e-mail before sending it. computerized information systems, make sure you know
how to present the material accurately and concisely.
Adapted from Shea, V. (2000). Netiquette. San Rafael, Calif.: Albion.