Communication is a key component in nursing care. As nurses we must communicate with our patient’s, patients’ families, and a wide variety of healthcare team members. Communication can be vital to patient’s lives, informative to physicians, and calming or educational to families. The communication method, or theme, that a nurse uses as part of her care can positively, or negatively, affect every aspect of patient care. Communication plays a huge role in the way I care for patients and their families. Without positive, supportive communication I would have a very difficult time building a trusting relationship with my patients. My nursing career goal is to one day become a critical care nurse. I chose this article to further educate myself about affective communication and how I can apply this knowledge in a critical care setting. As a nurse working in the Intensive Care Unit, communication has a critical role in patient-centered care.
The objective of this study was to perform a qualitative analysis of nurses’ communication behaviors to develop interventions that will improve patient-centered communication in the critical care setting. The theoretical model of patient-centered care contains five domains. The five domains include: the biopsychosocial perspective; the patient-as-person; sharing power and responsibility; the therapeutic alliance; and the clinician-as-person domain. During the course of this study communication interactions between nurses’, patients, and patients families were analyzed and placed into one of the five domains.
Interviews with the nursing staff were also analyzed to identify specific themes in nurses’ roles and their preferences for communicating with patients and families. The data collected for this study contained a combination of interviews, direct observations within the ICU, family conferences, and informal conversations that took place between a patient’s family member and healthcare providers.
Analysis of the collected data found that the majority of nurses’ involved in the study communicated most often in the biopsychosocial, patient-as-person, and clinician-as-person domains. The biopsychosocial domain focuses mainly on information exchange. A majority of the nursing communication interactions observed were in this domain. Communication between the nurse, the patient, and the patients family were often related to life-sustaining interventions, however, the implications as to why these interventions were necessary was never directly addressed. Many communication behaviors also fell into the patient-as-person domain. Within this domain the nurse seeks to understand a patient’s personality outside of their illness. Non-verbal communication behaviors were frequently noted in this domain. The clinician-as-person domain involves interactions between the nurse and other clinicians, most often a physician, and recognizing one’s own emotional response to a particular patient and the situation. In the two remaining domains, it was noted that the participating nurses’ generally refrained from communication in these areas.
Sharing power and responsibility includes the active involvement of a patient, or family member in treatment decisions and forming an agreement about the plan of care. The therapeutic alliance domain includes a clinician that is involved with learning the patient’s desires and then working together alongside the patient to agree on a plan of care. A majority of the nurses’ interviewed agreed upon the importance of these two domains, they felt that it was not a part of their nursing role. Instead they regarded that the shared power and therapeutic alliance domains should be fulfilled by a physician. Once the communication behaviors were analyzed and placed into one of the patient-centered care domains, further evaluations were done to understand any reasoning as to why nurses chose to communicate more in certain domains and less in others. During the evaluation of nurses’ roles in communication two themes were discovered.
These themes tended to guide nursing communication behaviors based on their perspective of a nurse’s role within the patient-centered care domains. In the first theme nurses’ felt their role was to act as translator between the physicians, the patients, and the patients’ families. As a translator, nurses’ are able to clarify the overall plan of care for patients and the patient’s family members that may have been missed or misunderstood. It was also recognized that nurses’ sometimes acted as only one-way translators. This involved reporting patient information to the physician only. The nurses’ felt it was not their role to translate any critical health changes, or any misunderstandings that a patient, or a patient’s family member may have about critical life procedures. Nurses’ felt that it was the physicians’ role to fulfill those duties. The second theme involved topics that nurses were willing to discuss with patients and the patient’s family, as well as topics they refused to discuss with them.
The said verses not said theme tends to overlap with the translator theme. Once again, nurses’ did not feel that communicating bad news to a patient or the patient’s family was not their role but the physician’s role instead. Within this theme nurses’ often rarely shared their opinions to patients or the family when it differed from that of the physician. At other times nurses’ often conferred, or shared their opinions with other healthcare providers for any corroboration before they spoke with a patient or the patient’s family. During the nurses’ interviews, physicians were often referred to as the primary decision makers in patient care and that their role was to support and carry out the consequences of those decisions.
As healthcare providers try to accomplish more in less time these days, the relationship between patients and patient’s families suffer. Miscommunication, false understandings and failed patient relationships can all lead to poor outcomes. Patient-centered care involves treating patients as partners, involving them in decision making, and helping them feel a sense of responsibility in managing their care all while respecting their individual values and concerns. Nurses are usually the first healthcare providers to develop a trusting relationship with a patient and a patient’s family. Nurses’ are quick to discover a patient’s personality, beliefs and values, as well as their family dynamics. Interdisciplinary communication between physicians and nurses needs to be improved. By emphasizing shared decision making and interpersonal communication between nurses and physicians patient outcomes will improve. Two ways that nurses’ can enhance interdisciplinary communication is by maintaining the use of the SBAR communication tool.
This ensures that messages are organized and clear for the physician. Secondly, the nurse and physician should discuss the plan of care together before speaking with the patient or the patient’s family. The nurse may have more insight into the background, values, and wishes of the patient that may affect the plan of care. This intervention directly targets the said verses not said theme and involves the nurse in the shared decision domain. As a nurse on a critical care unit, it would be extremely beneficial to learn and explore what specifically the nurse role is in regards to communication and information that can be shared. Is the nurse able to participate in the shared power and responsibility or the therapeutic alliance domains, or is it truly defined as the role of a physician? As a nurse on the critical care unit, I would seek clarification as to what my role is in regards to communicating with the patient and the patient’s family.
I would also maintain the use of SBAR as part of my communication techniques and work on developing a trusting relationship with a wide variety of physicians. Effective communication is an important aspect of all nurse-patient interactions. It wasn’t until recent that nursing communication and its effect on patient-centered care began to be studied. Nursing communication interactions between the patient and the patient’s family highly contributes to patient-centered care and outcomes. By continuing to study nursing communication behaviors and interactions, interventions to improve patient-centered care can further be determined and implemented into practice.
BIBLIOGRAPHY Slatore, C., Hansen, L., Ganzini, L., Press, N., Osborne, M., Chesnutt, M., & Mularski, R. (2012). COMMUNICATION BY NURSES IN THE INTENSIVE CARE UNIT: QUALITATIVE ANALYSIS OF DOMAINS OF PATIENT-CENTERED CARE. American Journal Of Critical Care, 21(6), 410-418.
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