Nurse-physician Communication Research Articles

Improving Nurse-Physician Bedside Communication Using a Patient Experience Quality Improvement Pilot Project at an Academic Medical Center.

Introduction Patient experience is a crucial aspect of healthcare delivery, and it encompasses various elements that contribute to a patient's perception of the care they receive. Patient satisfaction and patient experience are related but distinct concepts. Patient experience focuses on whether specific aspects of care occurred, while patient satisfaction gauges whether patient expectations were met. It goes beyond mere satisfaction and delves into the broader aspects of how patients interact with the healthcare system and the quality of those interactions, with health plans, doctors, nurses, and staff in various healthcare facilities. Other aspects highly valued by patients include elements such as timely access to care and information, good communication with the healthcare team, and friendly staff. Patient experience can influence both the healthcare and financial outcomes of healthcare facilities. It is well understood that positive patient experiences may lead to better care adherence, improved clinical outcomes, enhanced patient safety, and better care coordination. Payers, both public and private, have recognized the importance of patient experience. Improving patient experience benefits healthcare facilities financially by strengthening customer loyalty, building a positive reputation, increasing referrals, and reducing medical malpractice risk and staff turnover. Methodology A multidisciplinary retrospective quality improvement initiative was initiated to effectively improve nurse-physician communication and organizational outcomes in several hospital units. Results Using an innovative staff-developed and driven acronym, IMOMW (I'm on my way), the study demonstrated significant positive outcomes such as increased Epic documentation (Epic Systems Corporation, Verona, Wisconsin, United States) of physician and nursing rounding by 13%, a 10.5% rise in recommend facility net promoter score (NPS) patient experience survey scores, 13.4% increase in physician and nurse team communication, 5.4% increase in nursing communication, and a 5.3% increase in physician communication. Moreover, pilot units outperformed the control group consisting of medical-surgical units located in newer portions of the hospital. Conclusion This quality improvement study demonstrates improved interdisciplinary nurse-physician communication, Epic documentation, and patient experience scores. Further investigation is necessary to better understand the specific factors and/or processes that influence the sustainability of interventions that improve nurse-physician communication and patient experience.

The Healing Power of Words: Examining the Effect of Communication Styles on Appreciation within the Hospital Setting

Nursing faces challenges such as high workload, low job satisfaction, and poor communication in high-stress environments with strict hierarchies. These factors contribute to increased errors and conflicts. Information technology solutions like clinical decision support systems and electronic health records can reduce workload, decrease errors, and improve patient care. However, effectively integrating these tools requires understanding communication dynamics within hospitals and between professions. Despite the known effects of poor communication on job satisfaction and care quality, there is a lack of research on nurse-physician communication from their respective perspectives. The paper aims to address this gap and focuses on research questions related to nurse-physician communication and appreciation.

Increasing Nurse-Physician Family-Centered Rounds Communication: A Quality Improvement Pilot Project.

High-quality nurse-physician communication during family-centered rounds (FCRs) can increase patient safety. In our hospital, interdisciplinary team members perceived that nurse-physician communication during FCRs declined during the COVID-19 pandemic. Using quality improvement methodology, we measured nurses' perceived awareness of components of the shared mental model, nurses' attendance during FCRs, compliance with completing FCR summaries, and average time spent per FCR encounter. A structured resident huddle took place prior to an FCR. Residents used a tool to send individualized alerts to bedside nurses to prepare them for an FCR. Residents developed comprehensive summaries after each FCR encounter and sent a summary text to nurses who were unable to attend the FCR. We assessed 40 FCRs over 16 weeks. Nurses' perceived awareness increased from 70% to 87%. Nurse attendance increased from 53% to 75%. We successfully piloted multiple interventions to improve nurse perceived awareness after an FCR.

Nurses' Perception Regarding the Quality of Communication between Nurses and Physicians in Emergency Departments in Saudi Arabia: A Cross Sectional Study.

Background: One of the defining characteristics of safe and highly reliable patient care is effective team communication. It is becoming increasingly crucial to improve communication among healthcare team members since social and medical conditions change quickly. Main aim: The present study seeks to assess nurses' perception of the quality of communications between physicians and nurses and associated factors in the emergency departments of selected government hospitals in Saudi Arabia. Methods: A cross-sectional study was carried out in five hospitals in Jazan and three hospitals in Hail City, Saudi Arabia, on a convenience sample of 250 nurses total using self-administered questionnaires. Independent sample t-tests and one-way ANOVA were used for the data analysis. Ethical considerations were adhered to throughout the conduct of the study. Results: The mean score of all domains of nurses' perceptions of the quality of nurse-physician communication in emergency departments was 60.14 out of 90. The highest mean score was observed in the openness subdomain, followed closely by relevance and satisfaction, with mean percentages of 71.65% and 71.60%, respectively. Age, level of education, years of experience, and job position had significant positive correlations with nurses' perceptions of the quality of nurse-physician communication. (p = 0.002, 0.016, 0.022, and 0.020, respectively). Post hoc tests showed that nurses older than 30, those with diplomas, those with more than 10 years' experience, and those in supervisory positions had more positive perceptions of the quality of nurse-physician communication. On the other hand, there was no significant difference in the mean scores of quality of nurse-physician communication with regard to participants' sex, marital status, nationality, and working hours (p > 0.05). Multiple linear regression showed that none of the independent factors affected the nurses' perceptions of the quality of nurse-physician communication in emergency departments (p > 0.05). Conclusions: Overall, the quality of communication between nurses and physicians was not satisfactory. Future research should be meticulously planned, using validated outcome measures, that will capture and reflect the goals of communication among healthcare teams.

Artificial intelligence in virtual reality simulation for interprofessional communication training: Mixed method study

BackgroundVirtual reality simulations are shown to be an effective approach for interprofessional nurse-physician communication training. However, its scalability is constrained by unequal medical-nursing cohort size, rendering a great challenge for all nursing students to form an interprofessional team with medical students. With the evolution of artificial intelligence (AI), an AI medical team player can be integrated into virtual reality simulations for more nursing students to engage in interprofessional team training. ObjectivesTo describe the development of a novel AI-enabled virtual reality simulation (AI-enabled VRS) and to evaluate nursing students' competencies and experiences in communicating with an AI medical doctor. MethodsA mixed-methods design using a one-group pretest-posttest design and focus group discussions were employed in the evaluation phase. Nursing students from a university were recruited to undertake the 2-hour AI-enabled VRS. Pre-test and post-tests were administered to evaluate the participants' communication knowledge and self-efficacy. Survey questionnaires were administered to examine their experiences with the virtual reality environment and the AI doctor. Five focus group discussions were conducted to gain deeper insight into their learning experiences. ResultsThe participants demonstrated significant improvements in communication knowledge and interprofessional communication self-efficacy after the learning. They reported positively on the acceptability, feasibility and usability of the AI-enabled VRS. The subscale of “human-like” feature of the AI medical doctor was rated the lowest. Three themes surrounding participants' experiences of the virtual learning emerged: “relate to the real world”, “artificial intelligence versus human intelligence” and “complement with face-to-face learning”. ConclusionsThis study demonstrates initial evidence on the potential of AI-enabled VRS in fostering nursing students' learning on interprofessional communication skills. The findings have also provided insights on how to improve the AI-enabled VRS, in particular, the expressiveness of the AI pedagogical agent and facilitating more dialogue trainings with learner-agent conversations.

Bedside Nurses' Perceptions of Effective Nurse-Physician Communication in General Medical Units: A Qualitative Study

BackgroundThere is a dearth of research on successful interventions to improve nurse-physician communication (NPC). An important step is identifying what matters to bedside nurses and their perceptions of effective NPC communications and actions.MethodsWe conducted three focus groups with a total of 19 medical unit nurses across two hospitals in one academic medical center in the United States. Using a convenience sampling strategy, five to eight nurses voluntarily participated in each focus group. The recording was transcribed verbatim and two independent coders performed coding and resolved any discrepancies in codes. Qualitative content analysis was pursued to identify themes and associated quotes.ResultsThe presence of direct communication between physicians and nurses was identified as the first theme and perceived by nurses as very important. Additional themes related to physician communication and attributes emerged including collegiality and respect (e.g., engaging nurses as partners in patient care), attentiveness and responsiveness (e.g., listening carefully and addressing concerns), and directness and support (e.g., backing nurses up in difficult situations). Effective NPC is further facilitated by organizational structure, relationship development separate from patient care, and consistent/timely use of technology.ConclusionsHospital bedside nurses provided valuable insight into improved physician communication and what attributes contribute to more effective NPC. Most importantly, they emphasized the significance of physicians in supporting them with difficult patients.

Distinguishing High-Performing From Low-Performing Hospitals for Severe Maternal Morbidity: A Focus on Quality and Equity.

To investigate which organizational factors, policies, and practices distinguish hospitals with high compared with low risk-adjusted rates of severe maternal morbidity (SMM). Using a positive deviance approach, this qualitative study included 50 semistructured interviews with health care professionals (obstetrics and gynecology chairs, labor and delivery medical directors, nurse managers, frontline nurses, physicians or nurses responsible for quality and safety, and chief medical officers) in four low-performing and four high-performing hospitals in New York City. Hospital performance was based on risk-adjusted morbidity metrics from previous research. Major topics explored were structural characteristics (eg, staffing, credentialing), organizational characteristics (eg, culture, leadership, communication, use of data), labor and delivery practices (eg, use of standardized, evidence-based practices, teamwork), and racial and ethnic disparities in SMM. All interviews were audiotaped, professionally transcribed, and coded using NVivo software. Researchers blinded to group assignment conducted qualitative content analysis. Researchers wrote analytic memos to identify key themes and patterns emerging from the interviews, highlight illustrative quotes, and draw qualitative comparisons between the two hospital clusters with different (but unrevealed) performance levels. Six themes distinguished high-performing from low-performing hospitals. High-performing hospitals were more likely to have: 1) senior leadership involved in day-to-day quality activities and dedicated to quality improvement, 2) a strong focus on standards and standardized care, 3) strong nurse-physician communication and teamwork, 4) adequate physician and nurse staffing and supervision, 5) sharing of performance data with nurses and other frontline clinicians, and 6) explicit awareness that racial and ethnic disparities exist and that racism and bias in the hospital can lead to differential treatment. Organizational factors, policies, and practices at multiple levels distinguish high-performing from low-performing hospitals for SMM. Findings illustrate the potential for targeted quality initiatives to improve maternal health and reduce obstetric disparities arising from delivery in low-performing hospitals.

Intermediate care units in progressive patient care model: a systematic literature review


 Background: Progressive patient care (PPC) has been defined as a systematic classification and segregation of patients based on their medical and nursing needs. Aim of the present research was to perform a systematic literature review about existing medical intermediate care unit organizational models and their performance strengths and weaknesses with a specific focus on Italian implementation, respect to US model.
 Methods: Databases PubMed, Cinahl, Google and Google Scholar were searched until September 2017. The search was limited to Italian and English studies. All study design are included in the review.
 Results: Ten studies were included in the review. The American studies showed, after the PPC reorganization, an increase in level of satisfaction and nursing care, a reduction in average length of stay, costs and tensions between nurses and an improvement in nurse-physician communication. An Italian study reported the results of a project carried out in three case studies (Forlì, Foligno and Pontedera hospital), redesigning hospital patient flow logistics around the concept of intensity of care: in all three cases, after the reorganization, an increase in bed occupancy rate (before: 71%,81%,65%; after: 78%,84%,82%, respectively) and in hospital case-mix complexity (average DRG weight - before: 0.99,1.07,1.12; after: 1.19,1.09,1.61, respectively) and a reduction in turn-over ratio (before: 2.5,1.4,2.8; after: 1.5,1.2,1.7, respectively) was recorded. Considering Italian healthcare professionals’ point of view, majority of internists supported a hospital remodeling according to PPC model.
 Conclusions: The PPC model, theorized in US, has found several applications in Italian regional realities. Improvements in quality of care, appropriateness and productivity in healthcare facilities, that adopted the PPC program, were observed.

Situation-Background-Assessment-Recommendation Technique Improves Nurse-Physician Communication and Patient Satisfaction in Cataract Surgeries.

Background:Implementation of the Situation–Background–Assessment–Recommendation (SBAR) communication technique has been shown to increase nurse–physician communication and collaboration. However, data regarding its implementation in ophthalmology settings are limited.Objective:The purpose of this study was to evaluate the impact of implementing SBAR on nurse–physician communication and on the safety and satisfaction of patients undergoing cataract surgery.Materials and Methods:This cross-sectional study was conducted in the Ophthalmology Department of Zhongshan Hospital, Xiamen University, Xiamen, China, from April 2016 to December 2018. SBAR was implemented through a 1-h course that was repeated every 2 months for 2 years. All nurses and physicians completed the Physician–Nurse Communication Satisfaction Questionnaire before SBAR implementation and 1- and 2-year post-implementation. In addition, all patients who underwent cataract surgery during the defined pre-implementation and 1- and 2-year post-implementation periods were invited to complete a patient satisfaction questionnaire.Results:In total, 10 nurses and 6 physicians completed all three pre- and post-implementation surveys. In addition, 1215 patients undergoing cataract surgery participated: 358 in the pre-implementation phase, 425 in the 1-year post-implementation, and 432 in the 2-year post-implementation. Physician–nurse communication significantly improved in both 1- and 2-year post-implementation periods compared with the pre-implementation phase (P < 0.01). In addition, there was a significant increase in patient satisfaction scores (P < 0.01) and a decrease in medical complaints and malpractices (P < 0.01) between the pre- and post-implementation phases.Conclusion:SBAR is a useful tool for enhancing nurse–physician communication and for improving the safety and satisfaction of patients undergoing cataract surgery.

120. Antimicrobial Prescribing Guidance and Communication Among Health Care Professionals in Five Guatemalan Hospitals

BackgroundCommunication among health care professionals during antimicrobial prescribing is critical to ensure appropriate use. This is of concern in Guatemala where physicians seldom consider guidance from other professionals during antimicrobial prescribing activities. MethodsWe carried out a cross sectional questionnaire and open ended interviews with physicians from five hospitals in Guatemala to describe perceptions of communication between health care providers, and acceptance of antimicrobial guidance during prescribing. ResultsFrom January to April 2021 an electronic questionnaire was sent to enrolled physicians of which 74% completed participation (n=107/145). Fifty-five percent participated in open ended interviews (n=79/145). Respondents perceived high levels of communication between physicians and ID specialists (94% of respondents); 52%, and 54% perceived high levels of physician-pharmacist, and physician-nurse communication respectively. Significant differences in the perception of physician-pharmacist communication were detected when comparing responses between hospitals, and between respondent sex (chi2, p< 0.05). Barriers to communication between professionals included lack of local guidelines or protocols, patient overload, COVID-19 pandemic, lack of mentorship, and little room to discuss antimicrobial therapy with higher-ranking physicians. Eighty percent and 45% of physicians were open to receiving antibiotic optimization recommendations from other physicians, and pharmacists respectively. Notable barriers to accepting recommendations from pharmacists included lack of regular communication, lack of clinical experience, and concern about evidence based recommendations. ConclusionEffective communication is perceived between physicians during antimicrobial prescribing activities. Marginal levels of communication and acceptance of prescribing recommendations have been detected between physicians and pharmacists.In this milieu, there is an opportunity to strengthen multidisciplinary teams to optimize antimicrobial use.Disclosures Mario Augusto Melgar Toledo, MD, Merck (Grant/Research Support)Pfizer (Grant/Research Support)

How can registered nurses prepare medical students to be better residents? A qualitative study on feedback in a simulated paging curriculum

Physician-nurse communication skills are critical for incoming residents; however, standardized training and feedback targeting these skills are not well-described. We used a qualitative approach to determine types of feedback standardized registered nurses (SRN) can provide to students pre-residency. Senior medical students enrolled in an elective one-month specialty-specific Residency Preparation Course in 2018 participated in a simulated paging curriculum where they responded to urgent pages from SRNs about mock patients. The SRNs followed a script and assessed students using a rubric, then provided immediate verbal feedback on the students’ clinical management and communication skills. We recorded, de-identified, transcribed, and coded feedback, then determined themes. Seventy-six students participated and 162 encounters were recorded. We developed nine codes and identified two themes: positive reinforcement and authentic clinical feedback. The SRNs connected the cases to real-life experiences, reflecting upon mistakes or interactions they have made, to emphasize learning points for the student. This non-scripted, authentic clinical feedback reinforced the feedback provided on specific domains including information gathering, communication, and clinical management. This study highlights the value of utilizing SRNs to provide interprofessional feedback to medical students just prior to residency.

Physician-Nurse Communication Surrounding Computerized Physician Order Entry Systems From Social and Technical Perspective: An Ethnographic Study.

Although computerized physician order entry systems improve order transmission and patient safety, overdependence on these systems can impede users' communication. This ethnographic study explored physician-nurse communication surrounding computerized physician order entry systems using a sociotechnical framework. Fieldwork conducted in a tertiary teaching hospital comprised 89 hours of participant observation, and individual semistructured interviews were held with seven nurses and five physicians. In addition, documents and artifacts were collected. Three core themes emerged. First, computerized physician order entry quality-related issues undermined the work efficiency of physicians and nurses. Specifically, usability was error prone because of cognitive overload, and the system was unable to perform relevant traces and raise alerts, demonstrating poor interoperability. Second, social factors, including insufficient training, unclear responsibilities, and a lack of awareness concerning interdisciplinary communication, compounded communication problems. Last, environmental factors, including noncoterminous spaces and times and insufficient technical support, impeded the resolution of communication problems. Technical and social contextual factors relating to computerized physician order entry systems jointly affected physician-nurse communication. Cognitive issues and insufficient alerts impacted work efficiency the most and were compounded by contextual individual- and team-related factors and environmental factors. Therefore, improved functions of computerized physician order entry systems and interprofessional communication training are required to optimize technical and social aspects of physician-nurse communication.

The essential role of nurses in supporting physical examination in telemedicine: Insights from an interaction analysis of postsurgical consultations in orthopedics.

Telemedicine changes clinical practice and introduces new ways of distributing tasks between physicians and nurses, and particularly the delegation of sensory assessments during remote physical examinations. As nurses become more involved in patient assessment and clinical decision-making, the quality of physician-nurse collaboration has been recognized as essential to ensure quality patient care. However, few studies have examined physician-nurse interactions during teleconsultations. This article presents the results of an empirical study of nurse-physician communication during remote physical examinations. In partnership with a university-affiliated hospital in Ontario, Canada, we observed and recorded 10 simulated postsurgical consultations in orthopedics (involving a physician, a patient, and an on-site nurse) and conducted auto-confrontation interviews with physicians. The results of the thematic analysis of the interviews informed the selection of consultation sequences for in-depth interaction analysis. The findings demonstrate the nurse's essential role during remote physical examinations and reveal specific practices accomplished by the nurse to ensure successful nurse-physician collaboration. The interview data shows how physicians view the nurse's role and contributions. The findings contribute to our understanding of the collaborative nature of sensory assessments during remote physical examinations in telemedicine and can inform the development of training programs for professionals focusing on communication skills. Implications for clinical practice are discussed.

Nurse-Physician Communication in Patient Care and Associated Factors in Public Hospitals of Harari Regional State and Dire-Dawa City Administration, Eastern Ethiopia: A Multicenter-Mixed Methods Study.

BackgroundNurse–physician communication remains a public health challenge in the health care setting of developing countries. Clear and respectful nurse–physician communication is very crucial for the health of the patients. Numerous studies have shown that inter-professional communication gaps are the leading cause of adverse medical events that compromise the quality of patient care in the clinical setting. Although it has negative consequences and wider effects on patient care, nurse–physician communication in patient care is rarely studied in Africa. In eastern Ethiopia, predictors of nurse–physician communication in patient care have not been studied. Therefore, this study was aimed to assess nurse–physician communication in patient care in public hospitals of Harari Regional State and Dire-Dawa city administration, Eastern Ethiopia.MethodsThe multicenter-mixed methods (a quantitative cross-sectional and phenomenological qualitative) were conducted from March 07 to April 07, 2019 in public Hospitals of Eastern Ethiopia. A total of 440 nurses and physicians working in public hospitals in the Harari Regional State and Dire-Dawa administration were enrolled in the study. Participants were approached through a simple random sampling technique. Data were collected using a pretested, self-administered questionnaire and entered into Epi-Data version 3.1, and exported to STATA software (version SE 14) for further analysis. Descriptive statistics were carried out using frequency tables, proportions, and summary measures. Multivariable logistic regression analysis was carried out to identify the true effects of the selected predictor variables on the outcome variable after controlling for possible confounders. Statistical significance was declared at p-value <0.05. Qualitative data were collected from 10 key informants using a semi-structured questionnaire and analyzed using statistical software, Open Code (version 4.2) by thematic analysis method.ResultsOverall, the magnitude of the level of nurse–physician communication in patient care was found to be 53.2% [95% CI (48.9–58.0)]. In the final model of multivariable analysis, being in the age group of 31–40 [(AOR=0.42, 95% CI (0.25–0.72)], ever married nurse or physician [(AOR=2.28, 95% CI(1.41–3.69)], being a nurse professional [AOR=2.36, 95% CI (1.23–4.54)], a salary class of 2250–3562ETB [(AOR=0.25, 95% CI (0.08–0.84)], higher score for organizational related factors [(AOR=0.58, 95% CI (0.36–0.92)], and higher score for work-related attitude behaviors [(AOR=0.62, 95% CI(0.39–0.984)] were factors independently associated with the poor level of nurse–physician communication in patient care. In the qualitative findings, unattractive working environments and negative attitudes of professionals were found to be barriers to nurse–physician communication in patient care.ConclusionIn this study, the nurse–physician communication in patient care was relatively low because more than half of the level of nurse–physician communication was found to be poor. Increasing in age, getting a lower monthly salary, higher report for work-related attitude, and organizational related factors were the potential predictors that would decrease the good level of nurse–physician communication in patient care. This result provides cue due attention to improving nurse–physician communication in patient care through various techniques.

Remodeling Interprofessional Collaboration Through a Nurse-for-a-Day Shadowing Program for Medical Residents.

BackgroundEvidence reflects that effective collaboration leads to improved care quality, patient satisfaction, nurse and physician retention, as well as decreased length of stay, readmissions, and costs. While interprofessional collaboration is widely accepted as the gold standard for health care, room for improvement exists within the nurse–physician relationship.PurposeTo evaluate the impact of a shadowing experience on nursing and resident perceptions of communication and collaboration through a shared clinical experience in providing direct patient care.MethodsFrom 2016 to 2020, the Internal Medicine Residency Training Program and Medical-Surgical Nursing Department collaborated to pair all internal medicine residents with a nurse preceptor for a 12-hour shift, where participants worked side-by-side in providing patient care. A total of 148 residents and 75 nurse preceptors participated in the study and were provided with a checklist of nursing activities as a guideline. Both residents and nurses completed a questionnaire regarding the shadowing experience utilizing a 5-point Likert scale, with questions focusing on collaboration and communication, program value, and impact on practice.ResultsThe study found increases in resident communication with nurses from pre-intervention to post-intervention, as well as enjoyment of collaboration with nurses and understanding of the nurse’s role. Residents believed that the program should be included for all residents at the beginning of their training; similarly, nurses advocated for the program, believing that the program would improve physician–nurse communication and collaboration.ConclusionInterprofessional training through a Nurse-for-a-Day Program may strengthen nurse–resident relations by cultivating understanding essential for effective collaboration through mutual role understanding.

Stakeholders’ perceptions of how nurse-physician communication may impact patient care: protocol for a concept mapping study

ABSTRACT Effective nurse-physician interprofessional communication is important to ensure that patients receive evidence-based care and treatment. There is a gap in knowledge about how nurse-physician communication impacts patient care. We propose using concept mapping to develop an in-depth understanding of patients, nurses, and physicians’ perspectives on how physician-nurse communication affects patient care. There are six phases to concept mapping: determining the focus, generating statements, structuring statements, producing the map, interpretating the map, and map utilization. We will use ‘Ariadne’, a concept mapping software package for data collection and analysis. The study outcome will be a two-dimensional concept map providing a visual representation of how nurse-physician communication influences patient care. We will report similarity and differences among three stakeholder groups. Our research will inform the development of testable hypotheses about nurse-physician communication and patient care.

Which Factors Promote Shared Understanding Between Physicians and Nurses in Inpatient Oncology Care Settings?: A Qualitative Exploration.

Effective communication between physicians and nurses is crucial to the safety of patients, especially for those with cancer, which is a complex disease requiring multidisciplinary treatment. However, little is known about the factors that contribute to effective communication, which is defined as the development of shared understanding between two or more people. This qualitative secondary analysis was conducted to identify factors that contribute to shared understanding between physicians and nurses from video-recorded conversations that occurred between them during inpatient rounds on oncology units. We used inductive grounded theory to identify videos depicting moments of shared understanding. We then searched for preceding events to develop a preliminary conceptual model that described the factors contributing to shared understanding. Four factors emerged as contributors to shared understanding: engagement, clarification, confirmation, and resolution. These factors occurred in sequence with engagement occurring first and resolution occurring last, as the closure of a communication exchange. Existing interventions to improve communication include some of the factors identified as contributing to shared understanding (eg, closed-loop communications require clarification and confirmation). However, nurses may need to pay attention to all four factors to develop shared understanding that will promote effective communication with physicians and thereby enhance cancer care. Nurses achieve effective communication when they are assertive and avoid indirect communication. A greater awareness of body language and positioning in relation to a physician at the start of a communication exchange may increase the effectiveness of nurse-physician communication.

Nurses' heart failure discharge planning part I: The impact of interdisciplinary relationships and patient behaviors

AimThe purpose of this interpretive descriptive study was to understand bedside nurses' motivation and decision-making during discharge planning for adult patients with HF on a 48-bed telemetry step-down unit. BackgroundHeart failure (HF) discharge planning interventions have largely excluded the contributions of bedside nurses. MethodsFifteen bedside nurses were interviewed. Coding was done using NVivo and thematic analysis was completed. ResultsThis paper is the first in a two-part series which presents separate results of the interpretive descriptive study delineating the factors that impact bedside nurses' motivation and decision-making during HF discharge planning. This paper presents the major finding of nurses' high levels of motivation to do effective discharge planning despite many barriers, such as poor physician-nurse communication and patient behaviors. These nurses described being motivated when they had good communication from the interdisciplinary team and time to establish a personal connection with patients. ConclusionsOverall, findings of this study emphasized a need for interdisciplinary relationship-building between bedside nurses, patients, and physicians to be factored into the organizational culture.

Improving Physician-patient and Physician-nurse Communication and Overall Satisfaction Rates: A Quality Improvement Project

IntroductionCommunication between healthcare providers and patients is a key component associated with the quality of healthcare and patient satisfaction. Often, simple communication skills may be insufficient to sustain a successful provider-patient relationship. The aim of this project was to assess and improve patient and nurse satisfaction with physicians via improvement in physician-patient and physician-nurse communication to a level greater than 90%.MethodsInitial surveys were given to the patients and nurses on admission to the regular nursing floor to assess current satisfaction rates. Afterward, visual handouts were given that provided details about the current medical team members and the role of each team member. which were updated daily along with the medical plan. Surveys were then handed out to the patients and their nurses at the time of discharge. All surveys were conducted anonymously.ResultsA total of 26 surveys (n = 13 patients, n = 13 nurses) were collected and analyzed for a preliminary assessment. Surveys concluded that 68.8% of patients were satisfied with the patient-provider communication; similarly, 74.4% of the nurses were satisfied with the nurse-provider communication. In the next six weeks, visual handouts were implemented. During this period, surveys involving a total of 40 patients and 40 nurses were collected. The results after the intervention revealed that 93.3% of patients were satisfied with the patient-provider communication, and 94.7% of nurses were satisfied with the nurse-provider communication. Post-intervention, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) displayed an improvement in physician communication, reaching the expected goal of 84.4%.ConclusionIneffective communication often goes undetected in many healthcare settings, causing serious effects on the health and safety of patients, and may ultimately jeopardize overall satisfaction. Literature has shown a positive correlation between patient satisfaction and improved clinical outcomes. Using visual aids and updating medical care plans on a daily basis are simple yet effective tools to improve communication. Written materials should be created in a patient-friendly manner to enhance communication, clarity, and understanding.

Nurse-Physician Communication Team Training in Virtual Reality Versus Live Simulations: Randomized Controlled Trial on Team Communication and Teamwork Attitudes.

BackgroundInterprofessional team training is needed to improve nurse-physician communication skills that are lacking in clinical practice. Using simulations has proven to be an effective learning approach for team training. Yet, it has logistical constraints that call for the exploration of virtual environments in delivering team training.ObjectiveThis study aimed to evaluate a team training program using virtual reality vs conventional live simulations on medical and nursing students’ communication skill performances and teamwork attitudes.MethodsIn June 2018, the authors implemented nurse-physician communication team training using communication tools. A randomized controlled trial study was conducted with 120 undergraduate medical and nursing students who were randomly assigned to undertake team training using virtual reality or live simulations. The participants from both groups were tested on their communication performances through team-based simulation assessments. Their teamwork attitudes were evaluated using interprofessional attitude surveys that were administered before, immediately after, and 2 months after the study interventions.ResultsThe team-based simulation assessment revealed no significant differences in the communication performance posttest scores (P=.29) between the virtual and simulation groups. Both groups reported significant increases in the interprofessional attitudes posttest scores from the baseline scores, with no significant differences found between the groups over the 3 time points.ConclusionsOur study outcomes did not show an inferiority of team training using virtual reality when compared with live simulations, which supports the potential use of virtual reality to substitute conventional simulations for communication team training. Future studies can leverage the use of artificial intelligence technology in virtual reality to replace costly human-controlled facilitators to achieve better scalability and sustainability of team-based training in interprofessional education.Trial RegistrationClinicalTrials.gov NCT04330924; https://clinicaltrials.gov/ct2/show/NCT04330924