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BACKGROUND/RATIONALE:
The potential for adverse events is high in the complex ICU environment. Nurses are key in preventing adverse patient outcomes and patients in intensive care units are perhaps the most vulnerable of all hospitalized patients. Ineffective communication between nurses and physicians regarding nursing activities could adversely affect a number of outcomes, including resulting in longer lengths of stay or hospital readmissions. Currently, however, we know little about communication between nurses and physicians in the ICU setting or how characteristics of the work culture might promote or inhibit effective communication.
OBJECTIVE(S):
The first objective of this project is to develop qualitative instruments and procedures for obtaining information about how and what information gets communicated between nurses and physicians.
The second objective of this project is to test and further validate a quantitative instrument designed to identify behaviors that support a culture of safety and may prevent adverse outcomes in the ICU.
METHODS:
Using a convenience sample of 3 ICUs in the same VA facility, we will develop and test qualitative and quantitative instruments and procedures. For objective 1, we will conduct a review of the literature to identify existing tools that might be used as a basis for observing communication patterns in the ICU. Next, the preliminary protocol and procedures for conducting the observations will be further developed and refined through actual observation in the ICUs. Observation periods will be proportionally weighted towards morning and afternoon hours, when most nurse/physician communication occurs. We will include patient care rounds, anticipating that no more than 5 nurses will be observed. Observations will be conducted either by two nurses with ICU experience or by a nurse and a physician. At the end of their assigned shifts, observed nurses and at least one of the physicians they communicated with will be asked to participate in retrospective, semi-structured interviews. All field notes and interviews will be transcribed. An iterative process will be used to test and refine observation and interview protocols. For objective 2, we will administer the Safety Organizing Scale (SOS) to measure nurses' self-reported behaviors that enable a safety culture. The SOS demonstrates good psychometric properties, but has not been used in either an ICU setting or VA medical centers. This instrument is designed to provide background for the context in which nurse/physician communication occurs. All nurses who work in 3 ICUs will be invited to complete surveys anonymously. We will use several strategies to improve response rates. Descriptive statistics and confirmatory factor analysis will be conducted to test the content validity of this instrument in ICUs caring for critically ill veterans. Results will also be used to obtain effect size data for a future power analysis in subsequent work.
FINDINGS/RESULTS:
Enter text here.
IMPACT:
Effective communication between nurses and physicians is important in promoting the best possible care for our veteran patients and particularly for those who are critically ill. This pilot study will develop and test procedures and instruments that will be used in a future investigation aimed at identifying mechanisms that contribute to ineffective nurse/physician communication, and ultimately could lead to poor patient outcomes. Better understanding the dynamics of communication and the context in which it occurs provides an opportunity for developing strategies to promote more effective communication between nurses and physicians in the ICU with the ultimate goal of improving care outcomes for hospitalized veteran patients.
PUBLICATIONS:
None at this time.
DRA:
Acute and Traumatic Injury
DRE:
none
Keywords:
none
MeSH Terms:
none
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