Newsletter Column: Positive Intra- and Inter-Professional Communication Strategies in a Rehabilitation Center

Newsletter column: intra- and inter-professional communication strategies

You are the staff development director of an acute care rehabilitation center. The center has gone through some recent expansions resulting in “growing pains.” The staff has doubled in size in the last six months. The Director of Nursing approaches you with a problem. The client satisfaction scores have decreased significantly in the past six months, and she shows you quotes from clients that need to be addressed. She has given you the task of creating a column in the hospital newsletter focusing on positive intra- and inter-professional communication strategies.

From the Module 3 Client Satisfaction Survey quotes, create a column for the hospital newsletter:

• Choose two intra-professional communication examples from the survey quotes. For each, describe the consequences of the poor communication, propose a strategy to promote intra-professional communication and a therapeutic environment, and support your ideas with evidence.
• Choose two inter-professional communication examples. For each, describe the consequences, propose a strategy to promote inter-professional communication and a therapeutic environment, and support your ideas with evidence.
• Use professional language with correct APA citations, spelling and grammar.

Original example for study purposes (about 1,100 words).

Better Together: Communication That Heals

From the Staff Development Office

Our rehabilitation center has grown quickly. In just six months, our staff has doubled, and with many new colleagues comes the challenge of learning how to communicate as one team. Our patients have noticed. Client satisfaction scores have dropped, and patients’ own words show that how we talk with each other, and about our patients, shapes their experience and safety. The Joint Commission has identified inadequate hand-off communication as a major contributor to adverse events (The Joint Commission, 2017). This month’s column looks at four patient comments and offers practical, evidence-based strategies we can all start using today.

Intra-Professional Communication: Nurse to Nurse

Example 1: “My night nurse didn’t know I had been given pain medicine an hour before, so I almost got a second dose.”

Consequences. Incomplete shift handoff puts patients at risk of medication errors, missed assessments and delayed care. It also damages trust; patients who see staff “out of the loop” feel anxious and unsafe, and nurses may feel blamed or frustrated with colleagues.

Strategy: structured bedside shift report. Handoffs should take place at the bedside using a standardized format such as SBAR (Situation, Background, Assessment, Recommendation), with a review of the medication administration record and the most recent PRN doses. Involving patients lets them correct errors and ask questions. In a multicenter study, implementation of the I-PASS structured handoff program was associated with a 23% reduction in medical errors and a 30% reduction in preventable adverse events (Starmer et al., 2014). TeamSTEPPS recommends standardized handoff tools and a “check-back” to confirm understanding (Agency for Healthcare Research and Quality [AHRQ], 2023).

Creating a therapeutic environment. Introduce both nurses by name, invite the patient’s input (“Is there anything you want your next nurse to know?”) and close by confirming the plan for the shift.

Example 2: “Two nurses argued in the hallway about who was supposed to help me to the bathroom. I felt like a burden.”

Consequences. Visible conflict and unclear assignments make patients feel unwanted and unsafe, can delay toileting and increase fall risk, and erode morale among staff. Incivility among nurses is associated with stress, turnover and lower quality of care, which is why the American Nurses Association (2015) calls on nurses and employers to create cultures of respect free of incivility and bullying.

Strategy: clear role assignment and respectful conflict resolution. Start each shift with a brief unit huddle that clarifies assignments, patients needing two-person assists and “who covers whom” during breaks. When disagreements arise, move conversations away from patients and use a structured approach such as TeamSTEPPS’ DESC script (Describe the situation, Express concerns, Suggest alternatives, Consequences stated) to resolve them respectfully (AHRQ, 2023). Pairing new hires with experienced preceptors helps them learn unit norms quickly.

Creating a therapeutic environment. Respond to call lights with “I can help you now,” and if another colleague is assigned, tell the patient who will come and when. No patient should ever hear that they are a burden.

Inter-Professional Communication: Working Across Disciplines

Example 3: “My physical therapist said I could walk to the bathroom with my walker, but my nurse told me to stay in bed. I didn’t know who to believe.”

Consequences. Conflicting instructions confuse patients, slow their progress toward rehabilitation goals and increase the risk of falls if patients act on the wrong advice. Patients may lose confidence in the whole team.

Strategy: daily interdisciplinary rounds and shared mobility status. Nursing, physical and occupational therapy, physicians and case management should meet briefly each day to agree on each patient’s mobility level, precautions and goals, and post the current status on the patient’s whiteboard and in the electronic record. The Interprofessional Education Collaborative (IPEC, 2023) identifies roles and responsibilities, communication and teamwork as core competencies for collaborative practice. Using closed-loop communication, in which the receiver repeats back key information and the sender confirms it, reduces misunderstandings (AHRQ, 2023).

Creating a therapeutic environment. Explain the plan together when possible (“Your therapist and I agree you can walk to the bathroom with your walker and standby assistance”), and invite the patient to set goals with the team.

Example 4: “The doctor told me I’d go home Friday, but the case manager said it would be next week. Nobody explained what I needed to do.”

Consequences. Inconsistent discharge information causes anxiety, unprepared families, missed equipment or home health arrangements and potentially unsafe discharges or readmissions. It also wastes staff time correcting mixed messages.

Strategy: shared discharge planning and teach-back. Hold a weekly interdisciplinary team conference that includes the patient and family to agree on an estimated discharge date, criteria for discharge and remaining tasks. Document the plan in one shared location so every discipline gives the same message, and use teach-back to confirm that patients understand. When plans change, designate one team member, usually the case manager, to communicate the update to the patient and family and notify all disciplines.

Creating a therapeutic environment. Patients recover best when they feel informed and in control. A consistent message from a coordinated team builds that confidence.

What You Can Do Starting Today

• Use SBAR at every handoff and include the patient.
• Join the daily huddle and interdisciplinary rounds.
• Repeat back critical information (closed-loop communication).
• Resolve disagreements privately and respectfully.
• Give patients one consistent message about their plan.
• Sign up for TeamSTEPPS training through the Staff Development Office.

As we grow, our patients need to experience one team, not many separate departments. Clear, respectful communication is one of the most powerful therapeutic tools we have.

References

Agency for Healthcare Research and Quality. (2023). TeamSTEPPS 3.0. https://www.ahrq.gov/teamstepps-program/index.html

American Nurses Association. (2015). Incivility, bullying, and workplace violence [Position statement].

Interprofessional Education Collaborative. (2023). IPEC core competencies for interprofessional collaborative practice: Version 3. https://www.ipecollaborative.org/ipec-core-competencies

Starmer, A. J., Spector, N. D., Srivastava, R., West, D. C., Rosenbluth, G., Allen, A. D., Noble, E. L., Tse, L. L., Dalal, A. K., Keohane, C. A., Lipsitz, S. R., Rothschild, J. M., Wien, M. F., Yoon, C. S., Zigmont, K. R., Wilson, K. M., O’Toole, J. K., Solan, L. G., Aylor, M., … Landrigan, C. P. (2014). Changes in medical errors after implementation of a handoff program. New England Journal of Medicine, 371(19), 1803–1812. https://doi.org/10.1056/NEJMsa1405556

The Joint Commission. (2017). Inadequate hand-off communication (Sentinel Event Alert No. 58).