Paper Example on Therapeutic Interview - Open Disclosure

Published: 2021-07-05
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Wesleyan University
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Open disclosure involves communication of events that resulted in harming of a patient. The primary objective includes ensuring proper and efficient communication of the injury caused to the patient. The paper will focus on promoting the right of patients of open disclosures. It is a benefit to both the clinicians and the patients involved in the circumstances leading to harm. Open disclosure ensures that the clinicians find an avenue to communicate with the carers, the family and then patient themselves as it is part of professional ethics (Iedema et. al., 2009). However, it is not an easy task or activity to communicate to patients when harm has occurred during their treatment or healthcare, and this necessitates the need for an appropriate framework to help clinicians in navigating through the complicated process. The systematic process of the open disclosure set within the health care sector assists medical organizations to control adverse medical events with compassion and professionalism.

Causes and Features of Open Disclosures

Open disclosures come in effect because of occurrence of adverse events during treatment. Adverse events are defined by the World Health Organization as the impairment of a function or structure of the body that leads to a deleterious outcome such as disability, injury, suffering, disease and in extreme cases, death. The harm caused to the patient may be either social, physical or psychological. The main features or components of the open disclosure involve making introductions during the meeting where all the parties concerned get to know each other. The next feature is a sincere apology provided on behalf of the clinicians and the health care service providers. Also, an explanation of the actual happenings that led to the adverse event in a clear manner to ensure understanding (Gallagher, Studdert & Levinson, 2007).

The explanation is made by the health care providers followed by an explanation from the patient, carer and family on the event and any questions they have for the clinicians. The patient, carer, and family are also encouraged to talk about how the event affected their personal life. A plan for the open disclosure gets agreed upon, and the health providers make a pledge for feedback on any information obtained from investigations or reviews (Mostaghimi & Crotty, 2011).

Interview Techniques

Introduction of Strategy

The introduction of open discussion involves the creation of a friendly environment where the patient, carer, and family are comfortable to engage in the debate of the events. The technique involves get acquainted and knowing the parties concerned if resulted in the adverse event on the patient. The family, the patient and the carer get to know each other, and this gets followed by an immediate apology from the medical providers. They have to explain all the facts surrounding the harm initiated to the patient ("The Australian Open Disclosure Framework | Safety and Quality," 2017). The aim of the introduction is to start exchange of information that will aid in the discussion of the unfortunate event or harm.

Pace of the Open Disclosure

The pace relies on the damage involved as well as the participation of the parties. The process should be systematic, and no individual should hasten the process. The explanation of the facts involved should be done well to ensure proper understanding. The family, the carer as well as the patient have rights to question all the facts that led to the occurrence of the adverse event (Mostaghimi & Crotty, 2011). The process involves questions as well as answers from the side of the patient to the clinicians and the health providers. Therefore, the pace of the open disclosure will depend on the discussion held, and it should not be hurried.

Self-disclosure between the open disclosures

The process of self-disclosure involves communication of personal information relating to the event. The individuals such as the patient are allowed to tell their own story on the harm done. They are encouraged to speak freely and communicate their feelings on the matter (Henretty & Levitt, 2010). Sharing of the personal effect caused by the occurrence of the medical harm enables the individuals to let out all the frustrations they have because of the harm was done. The clinicians and the health providers get the opportunity to sympathize and communicate their apologies when self-disclosure happens. It is an avenue for the carers as well as the family and the patient to communicate openly to the health providers concerning their demise.

Techniques of Therapeutic Use of Self in the Role Play

Understanding the Clients Feelings

The role-play provided an appropriate platform to show the frustration as well as the anxiety experienced by the customer or the patient. The harm caused by the client resulted in distress and pain. The discussion of the feelings made the client open up and narrate the story on the adverse event. The feelings of the customer are important to ensure that a solution is achieved harmoniously (Derlaga & Berg, 2013). The process involves free communication of the client's story relating to the medical harm. The client or patient should provide accurate detail of the facts on how it happened and ask all questions pertaining the injury caused.

De-escalation strategies within the open disclosures

The process involves a lot of tension between the health providers and client. The best strategy for reducing such stress and anxiety means making the customer feel in control of the situation. The clinician and the health service providers should ensure that the client talks more of the feelings rather than force them with facts in an attempt to justify the adverse event or harm (Kesten, 2011). The clinicians should adopt a front of taking the blame rather than pointing fingers at others such as the doctor involved or the nurse or the health service provider. However, they should ensure that the client becomes assured of support and help. They should pledge support and feedback on any information obtained because of their investigation of facts leading to the medical harm.

Client Need

The need of the customer is for their health status to get restored. The client needs the pain and injury to be alleviated, and it should be the responsibility of the health service provider to facilitate it. The need of the client should always be a priority to the medical care providers. The client requires health service in exchange for the fee paid. The provision of quality health care alongside proper treatment without negligence or any complication is the dream of the client ("The Australian Open Disclosure Framework | Safety and Quality," 2017).

Suggested Strategies

The suggested strategies surround the implementation of clear open disclosures policies within health care facilities. The occurrence of adverse events is unpredictable. However, they happen occasionally, and there is need to provide policies to govern when they occur. The application of organizational governance and risk management will help in managing adverse events. Accreditation and adoption of National Safety and Quality Health Service Standards (NSQHS) by health institutions will help health organizations in the integration of risk management, clinical governance, investigation systems and incident notification as required (Mostaghimi & Crotty, 2011). The clinicians, as well as the staff, should be made aware of their rights as well as responsibilities.

The evidence underpinning of the scenario

The occurrence of open disclosures is a matter of confidentiality and clinical professionalism. Most health care facilities have a difficulty communicating any form of medical harm caused to the patient or client (Audet, 2011). The need for open disclosure involves delivering the right of the patient in the event of the occurrence of an adverse event. There are legal considerations that occur because of an adverse event happening in a health care facility. The hospital may avoid helping such clients but it is a sign of professionalism, and now the NSQHS standards demand that all health institutions adopt such standards.

The hospital is required to take actions such as a disciplinary action against the clinicians involved in such events. The hospital is liable when the client suffers harm during medical treatment. Therefore, the client should be compensated for their out of pocket spending or any other form of payment because of the adverse event. The aim is to provide support to the client, and this includes a follow-up on the care of the customer efficiently and promptly (Audet & Everall, 2010). The support also involves providing information relating to those responsible for continued care while undergoing the recovery process from the adverse event. Therefore, the client gets provided with appropriate contact details of individuals that can provide them with proper service.

Improvement strengths and areas

The patient needs to focus on the important sector, which is creation awareness or client education on open disclosures. The occurrence of medical harm may occur at any time. Therefore, patients need to be made aware of their rights relating to open disclosures as their right as well as a responsibility on the side of the medical service providers such as clinicians and their responsible staff. The framework present in hospitals applying the open disclosures policies are weakly managed and adhered to; therefore, there is a need for strengthening through making severe disciplinary actions on this defaulting at both the hospital level and at the professional level (Iedema et. al., 2009).

The adoption and creation of awareness on the rights and responsibilities of the client will enable reduced cases of medical harm. The process of providing disciplinary guidelines will uplift the professional standards of the health facility and ensure clients get value for their money. Such policies should be in accordance with the guidelines and criteria of NSHQS to provide review and occasional monitoring of events related to patient harm during treatment ("The Australian Open Disclosure Framework | Safety and Quality," 2017). The clinicians should also be made aware of their responsibilities and be encouraged to work with diligence and report promptly any case of an adverse event. The management should become kept informed and enlightened of all cases of medical harm caused to clients. They should act immediately and provide a lasting solution.


Debriefing Process

The process of debriefing is critical as it unveils all the feelings of how an activity took place. The role-play involved examination of roles and communication of intended message by the team. The team identified their weakness and strengths individually before an assessment from the audience. There was a lot of learning as the actors identified their weakness and suggested measures and steps they could take to achieve the desired outcome (Arafeh, Hansen, & Nichols, 2010). The participants had their roles written down in a paper and given instructions on how open disclosures will get demonstrated to the audience. The feedback obtained from the process provided clarity on the intention of the role-play and it was well done. The process got short lived upon achievement of the intended purpose of communicating the strategies of delivering such messages to the client, the carer, and the family. The need for debriefing was to ensure that the message of the role-play got passed across and it reached effectively to the audience (Neill & Wotton, 2011).

Model of debrie...

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