Video technology and feedback can help overcome communication breakdowns between nurses and doctors, according to US researchers who note it is one of the main reasons for care mistakes.
In a small pilot study, University of Michigan researchers recorded interactions among nurses and doctors, and then had the clinicians watch and critique the footage with them.
“The only way you can become aware of your habits is by watching yourself”
They followed physicians and nurses at the University of Michigan Health System. Nurses and physicians then watched and commented on the clips separately. Those comments were incorporated into the video and, finally, both parties watched the clip together.
Several themes emerged to help explain the poor communication, and both nurses and physicians improved their communication styles as a result of the study, said the researchers.
One barrier to good communication was that the “hospital hierarchy” put nurses at a power disadvantage, with many afraid to speak the truth to doctors, said the study authors.
The researchers said the recordings revealed that nurses did not directly request what they wanted or express their needs. They communicated indirectly, which confused physicians, who often ignored the nurses’ requests and moved on to the next agenda item rather than ask for clarification.
“Poor communication between physicians and nurses continues to be a primary contributor to adverse events”
The study also found that because doctors and nurses approached patient care from vastly different angles, achieving understanding “was not easy”, claimed the researchers.
“Despite decades of research and interventions, poor communication between physicians and nurses continues to be a primary contributor to adverse events in the hospital setting and a major challenge to improving patient safety,” they stated in the journal BMJ Quality & Safety.
Study author Milisa Manojlovich, a professor of nursing at the university, said: “The only way you can become aware of your habits is by watching yourself.
Overall, she said the interactions between the two professions were positive – in the sense that there was not any contention, but there was room for improvement.
“One physician said, ‘I didn’t give the nurse a chance to answer,’ and this doctor had a habit of doing that and recognised it,” Professor Manojlovich said. “She was one of the champions of the study.”
Professor Milisa Manojlovich
Professor Manojlovich highlighted that one interaction in particular “really showcased” the different approaches to patient care between the two professions.
This involved a patient with mouth pain, caused by a fungal infection called thrush, who could not swallow the pills she needed to get better.
The physician wanted to prescribe more medication to treat the thrush, but the nurse – who knew the patient well – wanted to treat the patient with strong painkillers as well, she noted.
As a result of the interaction with the nurse, the doctor changed their view, Professor Manojlovich suggested.
“The physician realised that the pain was inhibiting the treatment, and treating the pain, as well as the condition, would solve the problem,” she said.
For the next part of her research, Professor Manojlovich said she hoped to record a larger group and use the videos as training tools to improve communication.