School of Nursing, University of Michigan, Ann Arbor, MI, USA.
Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
J Gen Intern Med. 2020 Mar;35(3):839-845. doi: 10.1007/s11606-019-05580-9. Epub 2019 Dec 12.
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.
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.
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.
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.
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.
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.
医生和护士之间沟通不畅是导致住院患者不良事件的一个重要原因。克服沟通障碍需要检查沟通实践，以更好地了解影响护士与医生沟通过程的一些因素。
更详细地了解普通护理病房护士与医生之间的沟通实践。我们专注于患者查房，因为这是护理提供过程中沟通的一项重要活动。
定性研究设计。
来自中西部四家医院指定的普通护理病房的总共 163 名医生、注册护士和执业护士。
在每个病房，数据收集包括在查房期间和其他时间观察和跟踪临床医生，并在访谈和焦点小组中询问医生有关查房和沟通的问题。采用有指导的内容分析方法对数据进行编码和分析。
工作流程差异导致组织复杂性，影响查房并随后影响沟通实践，无论是在不同的医疗提供者类型之间还是在同一类型的提供者内部。护士和患者在查房期间的参与似乎减少了医生和护士的认知负担，因为减少了中断。医生在社交背景下采用某些行为来改善沟通，例如与护士社交和建立关系，这有助于护士参与查房。当关系不好时，一些护士如果没有被明确邀请，会感到不舒服在查房期间与医生一起。
改善沟通需要关注沟通的三个背景维度：组织复杂性、认知负荷和社会背景。如果承认沟通的复杂性以及沟通发生的背景，旨在改善沟通的举措可能会更成功。
