A., Sharafi, S., Bazzi, A. and Hasanzadeh, F. (2017) Therapeutic relationship: is it still heart of nursing? Nursing Reports, 7(1). doi: 10.4081/nursep.2017.6129.26 Morley, D. (2016) Applying Wenger's communities of practice theory to placement learning, Nurse Education Today, 39: 161–162.
27 Nursing & Midwifery Council. (2018a) Standards of proficiency for nursing associates. [online] Available: https://www.nmc.org.uk. Accessed October 2019.
28 Nursing & Midwifery Council. (2018b) Code professional standards of practice and behaviour for nurses, midwives and nursing associates. [online] Available: https://www.nmc.org.uk/globalassets/sitedocuments/nmc‐publications/nmc‐code.pdf. Accessed December 2019.
29 Olsen, R.M., Østnor, B.H., Enmarker, I. and Hellzén, O. (2013) Barriers to information exchange during older patients’ transfer: nurses’ experiences, Journal of Clinical Nursing, 22(19–20): 2964–2973.
30 Östman, L., Näsman, Y., Eriksson, K. and Nyström, L. (2019) Ethos: the heart of ethics and health, Nursing Ethics, 26(1): 26–36.
31 Pearson, H. (2013) Science and intuition: do both have a place in clinical decision making? British Journal of Nursing, 22(4): 212–215.
32 Rolston, E.J., Karsten, K., Auditore, A., Gimber, P. and McMillan‐Coddington, D. (2016) Transforming the clinical experience for associate degree nursing students, Teaching and Learning in Nursing, 12(1): 35–38. doi: 10/1016/j.teln.2016.08.007.
33 Schön, D. (1983) The reflective practitioner: how professionals think in action, Aldershot: Arena.
34 Stevens, S. (2018) Ways of knowing and unknowing in psychotherapy and clinical practice, Journal of Trauma and Treatment, 7(1): 418. doi: 10.4172/2167‐1222.1000418.
35 Swanson, K.M. (1991) Empirical development of a middle range theory of caring, Nursing Research, 40(3): 161–166.
36 Watson, J. (1985) The philosophy and science of caring: an essential resource, Colorado, USA: Colorado Association.
37 Wiechula, R., Conroy, T., Kitson, A.L., Marshall, R.J., Whitaker, N. and Rasmussen, P. (2016) Umbrella review of the evidence: what factors influence the caring relationship between a nurse and patient? Journal of Advanced Nursing, 72(4): 723–734. doi: 10.1111/jan.12862.
38 Williams, B. (2015) Enhancing teaching relationships through therapeutic use of self, The Journal of Mental Health Training, Education and Practice, 10(1): 61–70. doi: 10.1108/jmhtep‐04‐2014‐008.
7 Escalating Concerns
Tom Walvin
University of Plymouth, UK
Chapter Aim
The aim of this chapter is to introduce the reader to the methods that may be used when escalating concerns about a patient.
Learning Outcomes
By the end of this chapter, the reader will be able to:
Describe the role of the nursing associate in escalating concerns about a patient
Use a structured method to escalate concerns
Discuss the challenges of communication when escalating concerns about a patient
Test Yourself Multiple Choice Questions
1 What does ‘SBAR’ stand for?Situation, Background, Assessment, ReactionSafety, Background, Assessment, Ring for HelpScene, Background, Assessment, RespondSituation, Background, Assessment, Recommendation
2 In an acute hospital in the United Kingdom, which number can be called to summon emergency medical help for a patient?999922229993333
3 If concerned about a patient after completing an assessment, which healthcare professional could the nursing associate first escalate concerns to for clinical decision‐making and advice?Junior doctorSpeciality registrarRegistered nurseContinue to manage the patient yourself
4 What does ABCDE stand for in the context of deteriorating patient care?Airway, Breathing, Circulation, Deformity, EscalateAirway, Breathing, Circulation, Disability, EscalateAirway, Breathing, Circulation, Deformity, ExamineAirway, Breathing, Circulation, Disability, Exposure
5 Where can detailed information about the patient’s admission assessment, tests and initial diagnosis be found?Medical notesNursing handover sheetNursing care record summaryAmbulance clinical record
Introduction
The Nursing and Midwifery Council (NMC) educational standards require nursing associates to both understand how to escalate concerns to other appropriate healthcare professionals for expert help and how to recognise when a person’s health has deteriorated and escalate as needed (Nursing & Midwifery Council 2018a).
This chapter will develop understanding of both of these by introducing different methods for escalating concerns about patients, discussing how to escalate effectively and describing the pitfalls in communication so that these can be avoided. The NMC Code (Nursing & Midwifery Council 2018b) also contains requirements with regards to deteriorating patients and escalation. The nursing associate is required to maintain effective communication with colleagues, to make a timely referral to another practitioner when any action, care or treatment is required and to arrange, wherever possible, for emergency care to be accessed and provided promptly.
Green Flag
1 8.1 Respect the skills, expertise and contributions of your colleagues, referring matters to them where appropriate
2 13.2 Make a timely referral to another practitioner when any action, care or treatment is required
3 13.3 Ask for help from an appropriately qualified and experienced professional to carry out any action or procedure which is beyond the limits of your competence
4 15.2 Arrange, wherever possible, for emergency care to be accessed and provided promptly
The most common root cause of serious errors clinically and organisationally is related to inadequate verbal and written communication. The Institute for Innovation and Improvement (2010) notes that there are some important barriers to communication that occur across different disciplines and levels of staff. These barriers include:
Hierarchy
Gender
Ethnic background
Differences in communication styles
