Communication in the Healthcare Sector: The Implications from the Case “Findings of the Inquest into the Death of Roy Jacobs”

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Communication in the Healthcare Sector: The Implications from the Case “Findings of the Inquest into the Death of Roy Jacobs”

Communication is an integral component within the healthcare sector since it influences how care is planned, evaluated and implemented between care providers. Communication ensures that all members of a healthcare team are informed regarding a person’s health status as well the relevant therapeutic interventions that ought to be taken. This paper will, therefore, critically discuss the importance of communication within a healthcare sector in an attempt to prove the veracity of the finding of the report about the Inquest into the death Roy Jacob where the Coroner established that: “Failure to recognise and respond to clinical deterioration and non-compliance with early warning and response tools is a recognised issue across the health sector, public and private” (Coroners Court of Queensland (CCQ), 2018, p.35). The paper will argue for Coroner’s finding that supports this quote.

Critical Analysis: Failure to Recognise and Respond to Medical Deterioration and Non-Compliance

It has consistently been shown by several studies that there are visible often psychological anomalies that patients exhibit before their conditions worsen, leading to their admission into care facilities’ intensive care units (ICUs), unexpected deaths, and cardiac arrests, to mention but a few.  Some of the anomalies that often appear include high blood pressure, increased respiratory rate, unconsciousness, severe fever, low oxygen concentration in their systems, and high heartbeat rate, among other signs and symptoms that often appear in patients before they exhibit worse health status. Nonetheless, it has severally been established that notwithstanding these signs and symptoms, some patients end up losing their lives while in care facilities because their care providers fail to recognise their urgent need for treatment and medication, hence failing to respond in a timely and appropriate manner (Nurmi et al., 2015; Hore et al. 2003). According to a study by McFarlane et al. (2018), it was indicated that out of the patients who were in a care facility who never had a “Do Not Resuscitate” order who lost their lives within the care facility, approximately 50% of them had exhibited severe and serious signs and symptoms of anomalies such as high respiratory rate, high blood pressure, and faster heartbeat rate recoded within a period 8 hours before they could lose their lives and about half had registered anomalies within 8 and 48 hours before they lost their lives, and nearly 30% had signs of abnormalities  within their last 48 hours before they could die. Despite the significance of such abnormalities in patients as pointers of patients’ severe adverse events or clinical deterioration, studies have indicated that care providers normally fail to recognise and record them so that they can act upon them in time or provide timely responses (Fuhrmann et al., 2008; Gao et al., 2007; Goldhill et al., 2009). In a separate study, it was also noted that the frequency of documented observations that were made on patients in a care facility before they suffered cardiac arrest and die thereafter significantly varied from a patient to another (Peberdy et al., 2008). The stud as well established that only high blood pressure and pulse rate were recorded at least one time within a span of 24 hours (Bartholomew, 2014).

A sad finding is which was noted by Garvey (2015) indicated that vital signs and symptoms in patients were measured by researchers, and in case critical symptoms and signs were recognised in them, care providers in the care facility were informed. The care providers were then asked a number of questions by the researchers with the ultimate goal of getting to know whether the care providers were aware of their patients’ anomalous health status. Of the participants who took part in the study, it was revealed that 18% registered critical signs and in more than 41% of these cases, it was established that their care providers were unaware of their health abnormalities (Pagana & Sigma Theta Tau International, 2015). Evidently, despite the fact that patients sometimes exhibit critical signs, which are sometimes even documented in the patients’ records, care providers often fail to recognise the signs, thus unable to appropriately and timely respond to their patients’ clinical needs.

The above cases are not different for the case of Roy Rodney Jacobs, a 48-years-old Aboriginal male, who unexpectedly died at the Cherbourg Hospital on the 31^st August, 2017. In Roy’s case, as revealed in the Inquest into the death of Roy Rodney Jacobs, the review team to which the responsibility of diagnosing Roy was given identified several cases of missed diagnosis of Roy’s problems. Additionally, the review team also noted that there was failure to recognise Roy’s actual problems despite several crucial signs that could physically be noted in him. As such, an apt response was not given and this contributed to Roy’s clinical deterioration, which ultimately led to Roy’s death. The review team revealed a negligence on the care providers who attended to Roy. Additionally, to the review team of Roy’s case, it appeared that the clinical concentration that was given to Roy at the Cherbourg care facility regarded alcohol withdrawal or intoxication as opposed to giving attention to other possible causes of like cardiac concerns. Out of assumption, the care providers at the Cherbourg Hospital assumed that following past record, Roy was suffering from alcoholic intoxication. Similarly, whereas the nurses at Cherbourg considered to have the experience to give sufficient care services to patients, the clinical staffing was given to stand-ins when Roy presented himself besides the fact that the care facility’s permanent medical care officers were absent on their career development programs (CCQ, 2018). The treatments and management that was given to Roy during the first and second presentations were justified by Dr. Greg Treston. Nonetheless, he was convinced that better service should have been given to Roy during the third presentation owing to the fact that Roy was at that time exhibiting clear and conspicuous abnormal key signs (CCQ, 2018). Roy, during the third presentation had severe pain on his chest. However, this was ignored by the nurses at Cherbourg Hospital on grounds that like other drunkards, Roy needed some space to sleep to regain his mindfulness. As a result of the assumption, CN Gay never conducted a chest x-ray test on Roy as had been recommended by Dr. Nhapi: CN gay dismissed the chest x-ray on grounds that Roy lacked visible physical signs of a chest pain.

Further, despite the apparent deterioration that was evident in Roy, proper documentation was not done, no alternative conditions were assessed until Roy lost his life. Dr. Nhapi also never carried a review on Roy despite several reminders that was made by Nurse B (CCQ, 2018). A significant clinical gap was noted when Dr. Nhapi, who was serving as a senior and experienced care provider in the facility confessed that he had not seen the Q-ADDS (Queensland Adult Deterioration Detection System) chart, indicating that he never understood how it worked. For this reason, he could not decipher readings on the chart (Mathes et al., 2014). This contributed to his failure to recognise and respond to Roy’s clinical deterioration.

The Relationship between TC and Accountability

As aforementioned, communication is instrumental in the clinical arena. Medical experts agree that teamwork along with communication skills significantly role play within the healthcare sector by ensuring that quality healthcare is provided to patients (Abdolrahimi et al., 2017). This introduces us to the concept of therapeutic communication (TC). TC is defined as the process wherein communication techniques are used to encourage the wellbeing of a patient undergoing a healthcare practice (Barker, 2016; Leef & Hallas, 2013). Closely related to TC is accountability, which refers to agreeing to take responsibility for decisions and choices made during one’s professional practice (Bartholomew, 2014).

There is a strong relationship between accountability and TC, especially when nurses undertake their daily responsibilities and encounter their everyday challenges. Due to the demanding nature of their duties, nurses are often forced to strike an equilibrium point between their increased daily workloads and higher perspicacity patient appointments, organisational needs, and greater patient-to-nurse ratio (CCQ, 2018). To gamble between the two sides, nurses need to take responsibility for increasing or broadening their individual medical knowledge and skills and consistently employ robust standard evidence-based practice results for purposes of guiding their individual clinical interventions as they try to meet the increasing needs of their patients living with chronic illnesses (CCQ, 2018). According to CCQ (2018), ongoing clinical competency requires robust and active involvement in activities that function to enhance a nurse’s opportunity of achieving and maintaining skills and knowledge that are required to offer exceptional healthcare to patients. For this reason, nurses need to attend various training sessions with little or no interruptions; without the distractors, nurses will be able to remain focused to their capacity building programs and this will allow them get clarifications regarding every concern that they need to know. All in all, accountability should accompanied with TC and the opposite is true too.

Considering Roy’s case, it is evident that there was lack of effective TC among care providers who were attending to Roy. This resulted in gross absence of accountability among the care providers at the Cherbourg Hospital. Through the lens of CN Gay who left Roy behind as he went to go and call Dr. Nhapi, it is reported that Roy was found missing (Garvey, 2015).  This could be attributed to the fact that there was no sufficient TC between CN Gay and Roy, allowing room for misunderstanding between them (Mathes et al., 2014). After it is detected that Roy is missing, none of the hospital’s nurses is willing to take responsibility for the miss. What is more, it is revealed that during the presentation sessions, Roy tries to show that he is suffering from chest pain, a feeling that is ignored to the extent that no attempt is taken by the clinical officers to establish the problem with Roy’s chest (CCQ, 2018). Additionally, despite reminders to review Roy’s health condition by Nurse B, Dr. Nhapi neither does the review nor keep records regarding Roy’s health status. With no record and weak TC, no nurse is willing to be accountable for Roy’s death.

Conclusion

To sum it up, communication forms the backbone of clinical care provision. Care providers need, therefore, to ensure that they employ various communication techniques and skills when engaging with their patients as this serves to better their patients’ healthcare outcomes and wellbeing. Additionally, from the literature, it is evident that failure by care providers to recognise and respond to clinical crucial signs and symptoms is commonplace within the health care arena. As such, this paper finds sufficient justification to accept Coroner’s finding that: “Failure to recognise and respond to clinical deterioration and non-compliance with early warning and response tools is a recognised issue across the health sector, public and private.”