Nurse-Physician Communication - Case Study Example

Nurturing a good communication culture between the nurse and the physician is a road to any health care organizational success. One of the beneficial consequences of the effective communication is displaying shared vision of positive patient outcome clearly in the mindset of primary healthcare providers. The examination and assessment of various elements of Nurse-to-Physician communication plays significant role for their ability to contribute to selected patient outcomes. Open communication and shared leadership is often difficult between the nurse and physician in healthcare organisation. Mistrust between nurse and physician can impede interdisciplinary communication. It is self evident that patient safety and care will suffer. When the objectives of care are not communicated or expressed effectively it leads to increasing costs and the likelihood of medical errors in healthcare delivery. To enhance communication between nurse and physician which maximizes safety of the patient, strategies of communication should be developed in the organizational policies itself. The communication between nurse and physician is seen as an open, rational, dynamic, goal-directed process focused on imparting realities from health care organization perspective. Sound nurse-physician communication is important for positive productive outcome for safe, efficient, and effective patient care. Introduction The physicians and nurses have primary responsibility for patient care in hospital care environment. The shared values and beliefs of primary care delivery providers are very important in the health care settings. The factors which contribute to improved patient outcomes are numerous. Cohesive efforts and collaborative knowledge of nurse and physician brings clinical success in terms of patient’s outcome. The key factor of any collaboration is ‘good communication’. Patient centered communication between nurse and physician should allow them to work selflessly towards the same objective/goal. Effective Nurse-to-Physician communication is one of the most important aspects to improve patient’s healthcare. If the communication between nurse and physician is poor, everyone in hospital is affected from patients, families to other staff members. This can affect readmission rates, results in healthcare errors, or even deaths. This can tarnish the image of a particular hospital. Therefore, from health care organisation point of view, it is imperative to develop better measures for assessing communication as well as designing effective interventions to enhance communication. Open communication and shared leadership is often difficult between the nurse and physician in healthcare organisation. Consequences of bad communication can be severe. Communication breakdown can give rise to whole set of problems. Hierarchical relationships, a lack of courtesy and disrespect for another’s discipline knowledge, expertise in the field are the problems identified for nurse-physician communication barriers (Joint Commission Resources, 2005). It has been studied that the majority of unanticipated adverse events within hospitals stem from communication failure (Leonard et al., 2004). The examination and assessment of various elements of Nurse-to-Physician communication plays significant role for their ability to contribute to selected patient outcomes. Handling of emergency situation The importance of effective communication between nurse and physician in an intensive care setting is a classical example to display direct effect on patient’s outcome. In an emergency unit, due to severity level of medical condition, the patients are at greater risk of dying. A high degree of involvement and interaction between nurses and doctors is essential to address the challenges and critical incidents in high stress work areas such as hospital emergency departments (Slade et al., 2008). In the operation theater, effective communication among all members of the operating team is important to make operation successful. The nurse and doctor communication and teamwork is pivotal to promote a safer care environment during labor and birth. The fetal assessment and oxytocin administration are two critical factors during labor. Nurses and physicians might not come to same conclusion at these issues. Such factors should be resolved without communication breakdowns to deliver healthy mother and baby (Rice et al., 2006). The emergency delivery care is characterized by the associated standards of care, understanding the importance of communication, and work to ensure the safety of the patient. 866 nurses in 25 intensive care units were surveyed to study the communication pattern and the inherent elements of communication between nurse and physician. It has been found that in the respectful, understanding, and trusting work environment, clear, open lines of communication exists which has positive outcome on patients (Manojlovich and DeCicco, 2007). Identification of conflict points between nurse and physician which impedes communication Physicians are highly individualistic, competitively aggressive under stress, and trained to be self reliant. This results in mistrust behavior while communicating with the nurse. If patient’s well-being is at risk, then nurse should be able to stop the physician from carrying out the medical orders. Physician nonresponsiveness to a question asked by the nurse related to patient, also results in bad communication and directly might affect patient outcome. Mistrust between nurse and physician can impede interdisciplinary communication. It is self evident that patient safety and care will suffer. Respectful interaction is necessary to avoid medical errors. In a hierarchical model, doctors give orders to nurses and nurses have to follow those instructions. One of the reasons for the obstruction for optimal professional interaction and clinical conversation between nurse and physician might be due to their difference in the educational background. This discrepancy might be due to the physican’s view about the nurses. The doctors assume that the nurses spent more hours in classroom, take less initiative to gain knowledge and have less exposure to patients (Youngberg & Hatlie, 2003). This type of understanding is potentially dangerous in healthcare delivery and can have serious implications on patient outcomes. In some circumstances where nurse has more knowledge about the patient, her moral responsibility is to communicate the information to physician. For example, when the patient’s condition is changing or patient is unstable, nurse is always there at the bedside. Therefore, she has more knowledge about the situation, than the physician who might be busy in the office or attending other patient. At some time, the nurse might have more education and training to handle certain conditions of patient. Sometimes, the nurse might establish good rapport with the patient and his/her family. Some patients might not be comfortable with the physician to communicate any problems. In such circumstances, the nurses have more accurate clinical suggestion based on wisdom and experience. But, many times, mutually respectable direct communication between nurse-physician is not agreeable to the doctor. Therefore, in patient’s best interest, she has to convey the message to the physician without hurting doctor’s ego. This technique is called as “doctor-nurse” game. To obtain required clinical action the nurse should tactfully handled the situation by making doctor feel his importance and let him ordered the required suggestion to the nurse. This game inhibits open dialogue communication between nurse and doctor. This is dangerous from patient’s point of view, since the nurse might not able to describe the clinical emergency required at that moment in proper words to the doctor. The nurse might judge the situation incorrectly which leads to improper assessment by the doctor. The limitation of this indirect type of communication might lead to inaccurate, insufficient, and inefficient judgement of the patient’s condition and can adversely affect patient’s outcome (Youngberg & Hatlie, 2003). Identification of strategies of communication to coordinate optimal patient care Disruptive behavior of primary health care providers in hospital settings, give rise to stress, anxiety, frustration, and anger. This acts as barrier for intercommunication. This affected communication result in avoidable medical errors, adverse events, and other compromises in quality care (Rosenstein and O’Daniel, 2008). Issues that have potential to cause conflict should be openly discussed and resolved. The opportunities should be purposely generated to discuss about methods of implementation and communication about clinical practices. In case of any communication conflict between nurse and physician, proper policies and procedures should be formulated so that patient will not suffer. The healthcare system should not dysfunction due to lack of communication. For example, when there is a need for immediate medical intervention in a patients condition, registered nurses should able to question physician orders in terms of patient advocacy. Direct request for alteration in the plan of care should not be taken as question of status and power by the physician (Patricia, 2005). An aggressive behavior should be properly channeled to get benefits from the situation. The intercommunication difficulties can be overcome by analysing the situation, fostering openness and incorporation of inclusive language. Healthy and productive conflict between nurse and physician helps to get divers ideas in care delivery. This fosters focusing on the facts versus opinions (Lindeke & Sieckert, 2008). When the objectives of care are not communicated or expressed effectively it leads to increasing costs and the likelihood of medical errors in healthcare delivery (Narasimhan et al., 2006). It has been found that the communication patterns between nurse and physician are developed over the time and is dependent on the clinical experience. It has by investigated that openness, understanding, and accuracy were important elements in intercommunication to achieve satisfaction in the work environment. Nurses reported satisfaction with their communications with attending physicians (Marshall, 2008). The educational and training programs to improve the overall effectiveness of communication among the health care team should be conducted and made compulsory for positive outcome. The intricacies of communication should be focused during training (Rosenstein and O’Daniel, 2008). Adoption of diverse styles of communication Communication is highly valued and rewarded part of any collaboration. The adoption of standardised tools of communication create an environment in which every member of health care team including nurses, physicians, and others can talk about the issues, and share common critical language to alert teammates to crucial circumstances. This helps in reducing adverse events and better clinical outcome (Leonard et al. 2004). Perfect conversation has three major parts: a desire to communicate, openness to suspend judgment, and sensitivity. Informal, comfortable, and relaxed atmosphere is necessary for open communication between nurse and physician (Youngberg & Hatlie, 2003). Good communication is a key to improve interpersonal skills between nurse and physician. Both should keep each other continually updated on the progress of the patient. Constructive suggestions in a positive atmosphere have capacity to solve most of the problems. Sense of belonging and good rapport among team members is required to achieve clinical success. Honest relationship among nurse and physician should be created. Direct open communication is the way to encompass this. Physician’s treatment strategy is based on the perception after diagnosis of patient, but from the nurse’s point of view any disease is a life experience. Trust, knowledge, mutual respect and patient centered approach is the basis of effective communication. The problems in conversation hinder the performance of any organisation. Formal and informal communication channels such as emails, viral communication, group meetings, one to one discussions etc should be used depending upon the requirement of the situation. Proper communication skills and methods should be acquired so that clear cut messages are delivered without any ambiguity. This helps teammates to work together. Patient centered communication is an open, sharing, collaborative process resulting in commitment to positive action. The words which are used in communicating important messages should be simple, clear and easily understandable. An introduction of feedbacks, open question systems etc. might able to explain and evaluate efficacy of communication. When knowledge and skills are shared, opportunities of success in patient outcome are increased (Leonard et al. 2004). Careful listening and clear presentation of ideas or perceptions are required for true communication to take place. Adopting various communication styles are important for collaboration to succeed. Nurse and physician both have different level of knowledge, experience, skills, or perspectives (Youngberg &Hatlie, 2003).Clear language should be established and used to express patient’s condition in all professional conversation as well as medical records or documentation. Use of universal language between nurse and physician delivers quality communication. This assists in correct interpretation about patient’s status, and avoids misconceptions about the patient’s condition. The health care providers should clearly understand the substance, implications, and urgency of what is being conveyed (Youngberg & Hatlie, 2003). The special attention is needed to be given to reduce barriers to communication between nurse and physician. The admitted patient should experience the environmental safety, which is directly dependent on nurse-physician positive communication. Positive medical communication results in prevention of medical errors. The decision regarding the patient’s heath care delivery should be coordinated effort. When there is a difference between physician’s idea and nurse outlook about the patient, proper communication would able to take correct decision in any situation. Conclusion The interdisciplinary between health care professionals can either negatively or positively affect patent outcome. The shared values and beliefs of primary care delivery providers are very important in the health care environment. The communication between nurse and physician is seen as an open, rational, dynamic, goal-directed process focused on imparting realities from health care organization perspective. Sound nurse-physician communication is important for positive productive outcome for safe, efficient, and effective patient care. The patient is the silent recipient of the benefits or hazards of interdisciplinary communication in healthcare delivery. The nurses contributions through suggestions and concerns should be considered as one of the solution providers in health care delivery. To enhance communication between nurse and physician which maximizes safety of the patient, strategies of communication should be developed in the organizational policies itself. Therefore, the organization should invest on developing conversational skills between nurse and physician. References Patricia, H. A. (2005). Nurse-physician communication: an organizational accountability. Nursing Economics, March-April, 2005. http://findarticles.com/p/articles/mi_m0FSW/is_2_23/ai_n17209038 Narasimhan, M., Eisen, L. A., Mahoney, C.D., Acerra, F. L., & Rosen, M. J. (2006). Improving nurse-physician communication and satisfaction in the intensive care unit with a daily goals worksheet. American Journal of Critical Care, March, 2006. Lindeke, L. L. & Sieckert A.M. Nurse-Physician Workplace Collaboration, Online journal of issues in Nursing, posted: 9/22/2008 10:05:52 AM [html] http://www.nursingworld.org/mods/mod775/nrsdrfull.htm. Youngberg, B. J. & Hatlie M. J. (2003). The Patient Safety Handbook. Published by Jones & Bartlett Publishers. Rice, S. K.,  Dotti, J.C., & Eric, K. G. (2006). Nurse-Physician Communication During Labor and Birth: Implications for Patient Safety. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 35 (4), 547-556. Marshall, D. R. (2008). Evidence-Based Management: The Path to Best Outcomes. Journal of Nursing Administration, 38 (5), 205 – 207. Issues and Strategies for Nurse Leaders: Meeting Hospital Challenges Today, Published by Joint Commission Resources, 2005 Leonard, M. Graham, S. & Bonacum, D. (2004) The human factor: the critical importance of effective teamwork and communication in providing safe care, Qual Saf Health Care,13, 2004, i85-i90. Slade, D., Scheeres, H., Manidis, M., Iedema, R. et al. (2008). Emergency communication: the discursive challenges facing emergency clinicians and patients in hospital emergency departments. Discourse & Communication, 2(3), 271 - 298. Manojlovich, M. & DeCicco, B. (2007). Healthy Work Environments, Nurse-Physician Communication, and Patients’ Outcomes. American Journal of Critical Care, 16, 536-543. Rosenstein, A. H. & O’Daniell, M. (2008). Managing disruptive physician behavior impact on staff relationships and patient care. Neurology, 70,1564-1570. Read More