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TABLE OFC ONTENTS

SN TITLE PAGEI Introduction 3II Definition of Etiquette 4III Functions of Etiquette 5IV Etiquette in Islam 6V Etiquette in Medicine 7

VI Etiquette at KFMC 8

VII Etiquette- Based Medicine Project atKFMC 9 - 11

VIII Patient Satisfaction Survey Form 12 - 13IX Quote 14X Etiquette Based Medicine Article 15 - 17XI The Patient Comes First 19XII Organizing Committee 20

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Introduction:

The medical profession receives not a little ridicule for observingrules of etiquette, but their observance is a protection againstnot only embarrassment and confusion, but misapprehensionsand dissensions, injurious alike to physicians and patients.

Medical ethics and Etiquette, Austin Flint Sr., 1883

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Definition of Etiquette

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Functions ofE tiquette

When it provides for predictability in social relations,such as meeting strangers.

In its codification of behavior during events such asward rounds

When it determines the tacit rules governingprofessional interaction

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Etiquette in Islam

Prophet Mohammed (PBUH) was a living example of the finestand the most beautiful manners.

He stressed politeness and consideration as an expression of theMuslim faith, which means to treat other human beings as theylike to be treated and as one likes to be treated oneself.

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Etiquette in Medicine

There is a long tradition in medicine to discuss physicianconduct as a moral virtue necessary for the proper care ofpatients

Historic Greek literature stresses thatpoliteness, courtesy, manners, appearance, andrespectfulness are vital attributes of aphysician.

Hippocratic texts asserted theimportance of appearance andhumility for physicians.

Galen wrote about thecharacteristics of a good physicianand gave advice on how patientsshould select their physician.

The Chinese medical doctrine of Nei Jing wasformed from the cultural philosophies ofConfucius and Tao. These philosophers stressedgentleness, frugality, and humility.

The great Muslim physicians of the 10thcentury A.D. followed a similar tradition. AbadAl-Tib philosophized on the behavior ofphysicians, citing Hippocrates, Galen, andAristotle.

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Etiquette at KFMC

Recent patient surveys requires us to focus on measuresto improve the etiquette of our healthcare staff.

The article stresses that medical education and post graduate training should placemore emphasis on this aspect of doctor-patient relationship.

The Author suggests developing a checklist of physician etiquette for the clinicalencounter to improve patient satisfaction.

Such a checklist has the advantages of being clear, efficient to teach and evaluate,and easy for trainees to practice.

Our inspiration to implement an etiquette based approach to patient care comes froman article published in New England Journal of Medicine in May 2008

(Etiquette Based Medicine, Michael Kahn, M.D., Volume 358, Number 19)

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Etiquette Based MedicineProj ect at KFMC

We are initiating a quality improvement project about etiquette-based approach to patient care at KFMC.

Our Slogan Is“ I C A RE “

I - Introduce yourself to your patient

C - Communicate effectively and frequently so your patientknows you care

A - Address the needs of the patient in a prompt and caringmanner

R - Respect, show dignity and compassion to your patient.

E - Explain your role on the team

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Etiquette- BasedMedicine Project atKFMC

I

C

A

R

E

Do a polite introduction or If you know the patient , offer a sincere welcome and greeting Address the patient by their name and make eye contact

An important aspect of effectively communication is good manners andproper etiquette.

Talking is the easy part; listening and making sure that your patientsand colleagues are understanding is the difficult part.

Remember what is said is only a part of communication, the non-verbalexpressions are a critical part of communication.

Look at the person, show real interest and interact in an effective way.

Care for the patients most immediate needs like pain relief, bathroomuse, etc. in a prompt manner.

Apologize to the patient if there is a delay and explain why?

Obtaining patient’s respect and trust are pre- requisite to obtaining ameaningful history and convincing the patient to follow a therapeuticplan.

Building rapport is a complex process of sharing an understanding withthe patient, bonding and feeling empathy. It is difficult t accomplishand easy to lose. It can be achieved with charming manners or lost witha slovenly appearance or an unfeeling remark.

As we are a tertiary care facility, dealing with complex cases, requiringcare from a multi- disciplinary team. It is important for team membersto explain their involvement in the care of the patient.

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Physicians should be caring and emphatic,

Take the time to explain the findings of themedical evaluation.

Describe the disease process in layman terms

Do not rush when answering questions

Show sensitivity and compassion when relayingbad news

Display a realistic but positive attitude towardstreatment plans.

Explain the test procedures and medication beingrecommended

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To evaluate our quality improvement initiator there will be a patientsatisfaction survey from October 2009 to March 2010.

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Quote:

“Anyone to whom God has favored and givenknowledge of how to heal the sick, yet he is so hardhearted as to not advise them and commiserate withthem, than he is indeed far away from all good andfar away from medicine”

Hippocrates

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Review Article

Etiquette-Based MedicineMichael W. Kahn, M.D.

Patients ideally deserve to have a compassionate doctor, but might they be satisfied with one who issimply well-behaved? When I hear patients complain about doctors, their criticism often has nothingto do with not feeling understood or empathized with. Instead, they object that "he just stared at hiscomputer screen," "she never smiles," or "I had no idea who I was talking to." During my own recenthospitalization, I found the Old World manners of my European-born surgeon — and my reaction tothem — revealing in this regard. Whatever he might actually have been feeling, his behavior — dress,manners, body language, eye contact — was impeccable. I wasn't left thinking, "What compassion."Instead, I found myself thinking, "What a professional," and even (unexpectedly), "What agentleman." The impression he made was remarkably calming, and it helped to confirm my suspicionthat patients may care less about whether their doctors are reflective and empathic than whether theyare respectful and attentive.

I believe that medical education and postgraduate training should place more emphasis on this aspectof the doctor–patient relationship — what I would call "etiquette-based medicine." There have beenmany attempts to foster empathy, curiosity, and compassion in clinicians, but none that I know of tosystematically teach good manners. The very notion of good manners may seem quaint oranachronistic, but it is at the heart of the mission of other service-related professions. The goals of adoctor differ in obviously important ways from those of a Nordstrom's employee, but why shouldn'tthe clinical encounter similarly emphasize the provision of customer satisfaction through explicitactions? A doctor who has trouble feeling compassion for or even recognizing a patient's suffering cannevertheless behave in certain specified ways that will result in the patient's feeling well treated.How could we implement an etiquette-based approach to patient care?

The success achieved by Peter Pronovost and colleagues in solving a different kind of complex problem— reducing the likelihood of central-line infections in critical care patients1 — provides a thought-provoking suggestion. Instead of taking an elaborate, "sophisticated" approach — say, tacklinginfections by developing more advanced antibiotics or clarifying the genetic basis for drug resistance— Pronovost et al. introduced a checklist to enforce the use of hand washing, thorough draping ofthe patient, and other tasks that could be easily performed. The results of this simple interventionwere swift and dramatically effective. I would propose a similar approach to tackling the problem ofpatient satisfaction: that we develop checklists of physician etiquette for the clinical encounter. Here,for instance, is a possible checklist for the first meeting with a hospitalized patient:

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1. Ask permission to enter the room; wait for an answer.

2. Introduce yourself, showing ID badge.

3. Shake hands (wear glove if needed).

4. Sit down. Smile if appropriate.

5. Briefly explain your role on the team.

6. Ask the patient how he or she is feeling about being in thehospital.

Such a checklist has the advantages of being clear, efficient to teach and evaluate, and easy fortrainees to practice. It does not address the way the doctor feels, only how he or she behaves; itprovides guidance for trainees whose bedside skills need the most improvement. The list can bemodified to address a variety of clinical situations: explaining an ongoing workup, delivering badnews, preparing for discharge, and so forth.

Training for an etiquette-based approach to patient care would complement, rather than replace,efforts to train physicians to be more humane. Pedagogically, an argument could be made foretiquette-based medicine to take priority over compassion-based medicine. The finer points of patientcare should be built on a base of good manners. Beginning pianists don't take courses in musicianshipand artistic sensibility; they learn how to have proper posture at the piano and how to play scales andare expected to develop those higher-level skills through alifetime of study and practice. I may or maynot be able to teach students or residents to be curious about the world, to see things through thepatient's eyes, or to tolerate suffering. I think I can, however, train them to shake a patient's hand, sitdown during a conversation, and pay attention. Such behavior provides the necessary — if notalways sufficient — foundation for the patient to have a satisfying experience.

Furthermore, it's simpler to change behavior than attitudes. Although reading medically relevantliterary classics and writing reflection pieces (as is now done in many medical schools) may make somestudents more mature and humane, I wonder whether these exercises are most helpful for thosestudents who arrive at medical school already in possession of those qualities to some degree. Formany students, I suspect that these exercises may have a more limited effect, if only because they aretoo brief to allow the student to comprehend, practice, and master the intended values. It isn't easy tomodify a person's character or outlook in a classroom; besides, clinical training is more effective whenit resembles apprenticeship rather than graduate school. Trainees are likely to learn more fromwatching colleagues act with compassion than from hearing them discuss it.

Etiquette-based medicine would prioritize behavior over feeling. It would stress practice and masteryover character development. It would put professionalism and patient satisfaction at the center of theclinical encounter and bring back some of the elements of ritual that have always been an important

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part of the healing professions. We should continue our efforts to develop compassionate physicians,but let's not overlook the possibly more immediate benefits of emphasizing good behavior.

No potential conflict of interest relevant to this article was reported.

Source Information

Dr. Kahn is a psychiatrist and an assistant professor of psychiatry at Harvard Medical School inBoston.

References

Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections inthe ICU. N Engl J Med 2006;355:2725-2732. [Erratum, N Engl J Med 2007;356:2660.]

Internal MedicineNursing Department

“The Patient Comes First”

Nursing, as part of the multidisciplinary health care provider team, will utilize clinical skills, criticalthinking and the implementation of the nursing process to provide professional holistic quality andsafe patient care to patients admitted to the Internal Medicine Wards.

Our three C’s of Medical Nursing are Courtesy, Consideration and Concern.

Nurses commence utilization of the three C’s as soon as patients are admitted to the wards. Thenurse assigned will welcome the patient & family to the ward, escort the patient to her/ his room andensure that the patient is comfortable. Once the patient has settled into the bed, the room orientationwill begin. This will include orientation to the bathroom facilities, the nurse call bell system, bedcontrols, telephone, television, pantry use, visiting hours, meal times, and watcher permission &guideline policy.

When the patient is settled in his/ her ward environment, the assigned nurse will begin the patientadmission assessment and development of the nursing care plan.

The patient’s health status and risk indicators are assessed toidentify patient problems, both current & potential. When allinformation has been collected, the nurse will document the findingswhich will form the basis for the nursing care plan.

Planning of care includes:

1. Problem identification2. Goal identification3. Formulation of nursing care interventions4. Review & updating of the plan in relation to the patient’s

response.5. Preventative actions as per risk factors identified6. Patient/ family discharge education7. Discharge process/ outcomes

Prcon

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8. Home care equipment/ supplies.

ovision & implementation of care incorporates evidence based nursing practice taking intosideration the patient’s rights, cultural values, needs and responses.

Florence Nightingale

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Monitoring & evaluation of care is performed to assess the patient’s current health status. The nursewill monitor the patient on a daily basis to ensure that data are collected, documented and reviewedto identify current status, trends and changes. Findings are evaluated to determine the effectivenessof care provided. The plan is modified based on the evaluation and patient care needs.

Prior to discharge, the patient and family will receive information for their transition towards selfcare or home care. Patient and family education are a part of the ongoing care process. Themultidisciplinary health care provider team will be available for information about resourceavailability, equipment, supplies, transportation, and rehabilitation.

In short nursing encompasses autonomous and collaborative care of all ages, families, groups andcommunities, sick or well and in all settings. Nursing includes the promotion of health, prevention ofillness, and the care of ill, disabled and dying patients.

Nurses should focus on courtesy, consideration and concern at each patient encounter .There will bea patient satisfaction survey to evaluate this quality improvement initiative from October 2009 toMarch 2010.

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Organizing Committee

1. Dr. Khalid A. Qushmaq - Chairman, Internal Medicine2. Dr. Shazia Mukaddam - Consultant Internist3. Dr. Tariq Sulaiman - Resident, Internal Medicine4. Ms. Linda Kennedy - Director of Nursing, Main Hospital5. Ms. Helen Kirwan - Head Nurse, Female Medical Ward6. Ms. Lungelwa Magqashela - Head Nurse, Male Medical Ward7. Ms. Huda A. Al Husaini - Ward Clerk, Male Medical Ward8. Ms. Maisaa A. Al Ghareeb - Ward Clerk, Female Medical Ward