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Nurses Need to be Direct When Communicating with Physicians

Analysis  |  By Jennifer Thew RN  
   July 31, 2018

By video recording nurse-physician interactions, researchers uncover common causes of poor communication.

It was a miscommunication. When something goes wrong, a communication breakdown is often cited as a contributing factor. In healthcare, poor communication threatens patient safety and can cause anything from medication errors to sub-optimal care transitions.

Now, a small pilot study by University of Michigan researchers, sheds some light on where nurse-physician interactions can go wrong, and provides insight about the potential causes of communication failures.

Nurses: Be Direct

After video-recording interactions among nurses and physicians, the researchers had the study participants watch and critique the footage together.

Several themes emerged to help explain the poor communication.

One barrier to good communication is that the hospital hierarchy puts nurses at a power disadvantage, and many are afraid to speak the truth to physicians, Milisa Manojlovich, PhD, RN, CCRN, U-M professor of nursing, says in a news release.

The recordings showed nurses didn't directly request what they wanted or express their needs. The indirect communication confused physicians, who often ignored the nurses' requests and moved on to the next agenda item rather than ask for clarification.

The study also found that because physicians and nurses approach patient care from vastly different angles, achieving understanding isn't easy.  Manojlovich defines communication as reaching a shared understanding.

One example of this was when a patient with mouth pain caused by the fungal infection thrush, couldn't swallow the pills needed to get better. The physician wanted to prescribe more medication to treat the thrush, but the nurse wanted to treat the patient with strong pain medication, as well.

"The physician realized that the pain was inhibiting the treatment, and treating the pain, as well as the condition, would solve the problem," Manojlovich says.

Additionally, the recordings showed that in good communication, the body language of both parties mimicked the other. In strained relationships, body language wasn't in sync.

Self-awareness Key to Improvement

For the study, Manojlovich and her team followed physicians and nurses at the U-M Health System. The nurses and physicians watched and commented on the video clips separately, and those comments were incorporated into the video. Finally, both groups watched the clip together.

"The only way you can become aware of your habits is by watching yourself," Manojlovich says. "One physician said, 'I didn't give the nurse a chance to answer,' and this physician had a habit of doing that and recognized it. She was one of the champions of the study."

In the future, Manojlovich hopes to record a larger group and use the videos as training tools to improve communication.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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