Milisa Manojlovich1, Molly Harrod2, Timothy P Hofer2,3, Megan Lafferty4, Michaella McBratnie4, Sarah L Krein2,3. 1. School of Nursing, University of Michigan, Ann Arbor, MI, USA. mmanojlo@umich.edu. 2. Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA. 3. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. 4. School of Nursing, University of Michigan, Ann Arbor, MI, USA.
Abstract
BACKGROUND: Poor communication between physicians and nurses is a significant contributor to adverse events for hospitalized patients. Overcoming communication difficulties requires examining communication practices to better understand some of the factors that affect the nurse-physician communication process. OBJECTIVE: To develop a more detailed understanding of communication practices between nurses and physicians on general care units. We focused on patient care rounds as an important activity in the care delivery process for communication. DESIGN: Qualitative study design PARTICIPANTS: A total of 163 physicians, registered nurses, and nurse practitioners who worked on pre-specified general care units in each of four hospitals in the Midwest. APPROACH: On each unit, data collection consisted of 2 weeks of observing and shadowing clinicians during rounds and at other times, as well as asking clinicians questions about rounds and communication during interviews and focus groups. A directed content analysis approach was used to code and analyze the data. KEY RESULTS: Workflow differences contributed to organizational complexity, affecting rounds and subsequently communication practices, both across and within provider types. Nurse and patient participation during rounds appeared to reduce interruptions and hence cognitive load for physicians and nurses. Physicians adopted certain behaviors within the social context to improve communication, such as socializing and building relationships with the nurses, which contributed to nurse participation in rounds. When rapport was lacking, some nurses felt uncomfortable joining physicians during rounds unless they were explicitly invited. CONCLUSIONS: Improving communication requires bringing attention to three contextual dimensions of communication: organizational complexity, cognitive load, and the social context. Initiatives that seek to improve communication may be more successful if they acknowledge the complexity of communication and the context in which it occurs.
BACKGROUND: Poor communication between physicians and nurses is a significant contributor to adverse events for hospitalized patients. Overcoming communication difficulties requires examining communication practices to better understand some of the factors that affect the nurse-physician communication process. OBJECTIVE: To develop a more detailed understanding of communication practices between nurses and physicians on general care units. We focused on patient care rounds as an important activity in the care delivery process for communication. DESIGN: Qualitative study design PARTICIPANTS: A total of 163 physicians, registered nurses, and nurse practitioners who worked on pre-specified general care units in each of four hospitals in the Midwest. APPROACH: On each unit, data collection consisted of 2 weeks of observing and shadowing clinicians during rounds and at other times, as well as asking clinicians questions about rounds and communication during interviews and focus groups. A directed content analysis approach was used to code and analyze the data. KEY RESULTS: Workflow differences contributed to organizational complexity, affecting rounds and subsequently communication practices, both across and within provider types. Nurse and patient participation during rounds appeared to reduce interruptions and hence cognitive load for physicians and nurses. Physicians adopted certain behaviors within the social context to improve communication, such as socializing and building relationships with the nurses, which contributed to nurse participation in rounds. When rapport was lacking, some nurses felt uncomfortable joining physicians during rounds unless they were explicitly invited. CONCLUSIONS: Improving communication requires bringing attention to three contextual dimensions of communication: organizational complexity, cognitive load, and the social context. Initiatives that seek to improve communication may be more successful if they acknowledge the complexity of communication and the context in which it occurs.
Authors: David A Gruenberg; Wayne Shelton; Susannah L Rose; Ann E Rutter; Sophia Socaris; Glenn McGee Journal: Am J Crit Care Date: 2006-09 Impact factor: 2.228
Authors: Lucian L Leape; Miles F Shore; Jules L Dienstag; Robert J Mayer; Susan Edgman-Levitan; Gregg S Meyer; Gerald B Healy Journal: Acad Med Date: 2012-07 Impact factor: 6.893
Authors: Kevin J O'Leary; Diane B Wayne; Matthew P Landler; Nita Kulkarni; Corinne Haviley; Katherine J Hahn; Jiyeon Jeon; Katherine M Englert; Mark V Williams Journal: J Gen Intern Med Date: 2009-09-19 Impact factor: 5.128
Authors: Nancy Dudley; Christine S Ritchie; Roberta S Rehm; Susan A Chapman; Margaret I Wallhagen Journal: J Palliat Med Date: 2018-11-01 Impact factor: 2.947
Authors: Lauren G Solan; Andrew F Beck; Stephanie A Shardo; Hadley S Sauers-Ford; Jeffrey M Simmons; Samir S Shah; Susan N Sherman Journal: J Hosp Med Date: 2018-01-18 Impact factor: 2.960
Authors: Emily C Cleveland Manchanda; Anita N Chary; Noor Zanial; Lauren Nadeau; Jennifer Verstreken; Eric Shappell; Wendy Macias-Konstantopoulos; Valerie Dobiesz Journal: West J Emerg Med Date: 2021-07-19
Authors: Gemma Traynor; Andrew Iu Shearn; Elena G Milano; Maria Victoria Ordonez; Mari Nieves Velasco Forte; Massimo Caputo; Silvia Schievano; Hannah Mustard; Jo Wray; Giovanni Biglino Journal: J 3D Print Med Date: 2022-01-19