Running head: THE EFFECT OF NURSE-PHYSICIAN COMMUNICATION
The Effect of Nurse-Physician Communication on the Quality of Patient Care
Amanda Cooley, Ora Despain, Tessa Elder, Adam Hyatt, Spencer May, Libbey Steed
Dixie State University
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THE EFFECT OF NURSE-PHYSICIAN COMMUNICATION
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Abstract
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THE EFFECT OF NURSE-PHYSICIAN COMMUNICATION
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The Effect of Nurse-Physician Communication on the Quality of Patient Care
The purpose of this paper is to conduct evidence based practice study as part of first
semester nursing school project.
Practice Question
While trying to find better ways to care for patients and provide better outcomes, the
topic of communication came up. Specifically, communication between nurses and doctors and
how it affects patient care. Six Dixie State University nursing students each performed an article
review in order to better understand this issue and make use of the findings in the clinical setting
and throughout our education.
P- Patient Population or Problem
The problem we’re concerned with is ineffective communication between the nurse and
admitting physician in acute care and how it relates to patient outcomes.
I- Intervention
We’re interested in what interventions can be done to improve nurse-doctor
communication (SBAR & other accepted communication methods).
C- Comparison
We’re comparing and contrasting standardized and non-standardized communication.
O- Outcomes
Our speculative outcome would be to identify common problems in communication, what
can be done to mitigate them, and what effect it has on patient outcomes.
The Following Question was Developed
In the acute care setting, does inconsistent communication between nurses and physicians
affect the quality of patient care throughout the duration of the stay?
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Evidence
This is a causation type of question and, as such, the online databases CINAHL,
Cochrane, Medline, and Pubmed were searched for articles related to cohort, case control,
descriptive, qualitative, and systematic review studies.
Search Items and Results of Search
The search terms garnered from the PICO question included: patient care, admitting
physician, nurses, acute care, and communication. The search was limited to articles in English
published from 2008 to the present. A search term excluded was long-term care. Based on the
search terms and type of question, our group found six articles related to our question. Of those
six, four were qualitative studies, one was a systematic review, and the other was a professional
opinion.
Study One
The purpose of this study was to evaluate the effectiveness of SBAR collaborative
communication for best practice. 215 staff and 30 physicians in a pediatric/perinatal unit on a
271 bed hospital in Arizona were involved in a convenience sample study. Data was collected
through pre-intervention and post-intervention questionnaires and evaluated using Mann-Wittney
U for statistical quantitative analysis. 212 staff participated in the intervention, 141 completed
pre-intervention surveys and 71 completed post-intervention surveys. The quantitative analysis
revealed that 18 out of 27 items from the questionnaires were significantly statistically different
in the post intervention compared to the pre intervention. Qualitative analysis suggested SBARCCE improved physician-nurse communication and relations which in turn improved patient
safety outcomes, although no specific safety outcomes were cited or measured. The
recommendations for larger populations including hospital wide populations, longer length of
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study, and increased physician involvement were made to improve the accuracy of the study. A
more organized approach to post-intervention would also have yielded more data collection. The
suggestion was to hold post-intervention in a meeting like the pre-intervention was set up instead
of handing out the questionnaire and hoping they would be returned. Lastly, the need for studies
focusing more directly on measurable patient outcomes is needed to quantify the impact of
SBAR communication styles beyond just a working relationship.
This study provided highly applicable information to our PICO question given the
involvement of acute care physician-nurse communication being the basis of the study and the
suggestion that further studies on measurable patient outcomes should be initiated.
Study Two
This study was done to analyze communication styles between nurses and doctors and
implement strategies for improving communication and collaboration. Two groups of nurses and
physicians were chosen at one facility in the Midwest. One group consisted of 34 nurses and 12
physicians and the other had 37 nurses and 22 physicians. The two groups systematically
implemented collaborative rounding or written communication about patients on central
clipboards, and representatives from each group then met with each other for eight hours over
four weeks to discuss progress. At the end of the study, it was found that, within these groups,
both nurses and physicians reported being able to communicate better and more accurately.
This study is relevant to our question in that it addresses the need to have more effective
and accurate communication in order to elevate patient outcomes, even though it did not directly
measure patient outcomes or satisfaction. Although this study did have some success in
improving communication, it was noted that there were limitations in sample size and duration of
study.
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Study Three
The purpose of this study was to identify ways to minimize adverse patient outcomes due
to poor communication or miscommunication between nurses and physicians in intensive care
units. To identify these problems the study selected 25 Intensive Care Units (ICU) from several
different institutions in Southeast Michigan. The units differed from large urban to single ICU
centers. The study was only done with Intensive Care Units and specifically with patients that
had ventilator associated pneumonia, bloodstream infections associated with central catheters
and pressure ulcers. The research concluded that not all elements of communication were
negatively related to a patient’s condition. The study also concluded that a larger sample area is
needed. In addition to that, with a larger area there may be significant communication influences
related to pressure ulcers. However, it was suggested that communication between nurses and
physicians is just one aspect of undesirable results in patient care and there are other processes
that are more closely linked to adverse outcomes, but this area is rarely researched.
This study was highly pertinent to our question in that it directly examined patient
outcomes regarding communication between nurses and doctors. Though the results of the study
were inconclusive, it was interesting to note the suggestion of communication being only one
piece of the patient care puzzle.
Study Four
This study was done in order to identify and mitigate ineffective communication between
doctors and nurses in order to improve patient outcomes. It did this by performing a literature
review of fifty-three articles related to ineffective communication focusing on five aspects of
doctor-nurse relationships including traditional hierarchical roles, expanding workloads, mobility
of the workforce, differing perspectives and language barriers, and experience level of those
THE EFFECT OF NURSE-PHYSICIAN COMMUNICATION
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involved. To combat these barriers, they recommend a four part effective communication guide
for nurses to use when talking with doctors. Suggestions include recognizing your current
emotional state and the state of those with whom you are communicating, planning what you
want to achieve and anticipating the needs of the other person, using a structured approach to
make sure important details are covered, and utilizing graded assertiveness to amplify concern in
a systematic manner.
This study was pertinent to our question regarding communication affecting patient
outcomes, and very helpful in suggesting ways to communicate better and more effectively.
Study Five
This study was conducted to improve patients perception of quality and influence
improvement in health care provider efficiency. It was conducted on a 45 bed medical unit in a
350 bed trauma hospital in a large Midwestern city with the hospitalist group that rounded on
this medical unit and the nurses caring to that unit. Patients were randomly chosen from this unit
and no criteria were used. The results of this study showed that nurses and physicians agreed
that the project improved quality of care and communication, but did not eliminate the need to
further communicate after rounds. Although some physicians thought that this improved patients’
perception of quality of care there was no evidence stating so. A major factor in this study was to
see if nurse-physician rounding would reduce the amount of calls the hospitalists received after
implementing the collaborative rounds. The logs kept of calls were taken from the entire hospital
and not just the medical unit, so the logs were not reflective of the study. Overall, the study
showed that nurse-physician rounds had the potential for positive impact, but more studies need
to be done.
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For this study to be more valid to the research question, the surveys should have been
taken by the patients that received care and not by the physicians. A more structured study that
correlates nurse-physician communication with each individual patient’s quality of care would
be more relevant to the research question.
Study Six
This article wasn’t a study but a professional discussion about effective communication
between health care team members focusing on labor and delivery. It gave an example of a
typical scenario between a physician and a nurse in a labor and delivery unit. It indicated that
effective communication is essential to patient safety. The target population was physicians and
nurses. The recommendations given by the article for improvement of nurse-physician
communication are to set aside assumptions and address potential conflicts early. It also suggests
that effective communication is clear, direct, explicit and respectful. Since it was not a study,
there is no evidence, just professional opinion. It was a discussion of effective communication
styles.
Summary of Evidence and Practice Recommendation
While most of the studies suggested that poor communication between the nurse
and physician has an adverse impact on patient outcomes, they also indicated that more studies
were needed prove the efficacy of standardized communication interventions. Plus, participation
and completion rate of the participants was low in some of the studies, suggesting noncompliance or people reluctant to change current systems or behaviors. Also, most studies
stopped short of analyzing patient outcomes as they related to communication between the
nurses and physician. Perhaps a more extensive study that tracks nurse-physician
THE EFFECT OF NURSE-PHYSICIAN COMMUNICATION
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communication used with individual patients, then follows up with that patient to determine
quality of care would be an appropriate evaluation of our PICO question.
Conclusion
All of the studies that involved testing a hypothesis in a given sample of people
indicated the need for larger samples and a study of longer duration. Intuitively, any standardized
communication that can be consistently implemented should help with clearer, more precise
patient care, and, therefore better patient outcomes. Whether members of the health care team
use collaborative rounding, SBAR communication, graded assertiveness, or another form of
communication, if it is adopted by everyone on the team consistently, it will help ensure
important details get passed on to each member of the health care team, and thus the patient will
receive better quality of care.
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References
Aebersold, M., Averhart, V., Keenan, G., Kocan, M. J., Lundy, F., Tschannen, D. (2011).
Implications of Nurse-Physician Relations: Report of a Successful Intervention. Nursing
Economics. May/Jun 2011, Vol. 29 Issue 3, p127-135. 9p. 1 Diagram, 4 Charts
Antonakos, Cathy L., Manojlovich, Milisa, Ronis, David L. (2009). Intensive Care Units,
Communication Between Nurses and Physicians, and Patients’ Outcomes. American
Journal of Critical Care, 18(1), 21-30. doi: 10.4037/ajcc2009353
Beckett, C. D., & Kipnis, G. (2009). Collaborative Communication: Integrating SBAR to
Improve Quality/Patient Safety Outcomes. Journal for Healthcare Quality, 31(5). 19-28.
Doi: 10.1111/j.1945-1474.2009.00043.x
Burns, K. (2011). Professional Issues. Nurse-Physician Rounds: A Collaborative Approach To
Improving Communication, Efficiencies, and Perception of Care. MEDSURG Nursing,
20(4), 194-199.
Curtis, K., Tzannes, A., Rudge, T. (2011). How to talk to doctors – a guide for effective
communication. International Nursing Review 58, 13-20
Lyndon, A., Zlatnik, M., & Wachter, R. (2011). Effective physician-nurse communication: a
patient safety essential for labor and delivery. American Journal Of Obstetrics And
Gynecology, 205(2), 91-96. doi:10.1016/j.ajog.2011.04.021
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