Our expert answers 3 Questions
I am thinking about how to improve communication between physicians and nurses. Effective communication occurs when there is shared understanding between communicators. Using this definition means that communication is more than a process of exchanging information. Shared understanding is important because knowledge about a patient’s illness and treatment is distributed among the physicians and nurses (and other disciplines) who are providing care. But nurses and physicians are trained in separate and distinct paradigms and they often differ in their perspectives about what information and knowledge is needed for patient care. This is why shared understanding - effective communication - can be very challenging to achieve.
Despite over 50 years of research on the topic, poor communication between physicians and nurses remains a pressing problem, contributing to ongoing and widespread barriers to patient safety. Poor or ineffective communication between physicians and nurses is one of the most common causes of adverse events for hospitalized patients, including death. Currently popular approaches to improving communication, such as the use of checklists and teamwork, have had uneven success and have not led to significant improvements in communication. My work takes an alternative approach, using the concept of “sensemaking” to overcome many of the barriers to effective communication faced by physicians and nurses. Sensemaking is a cognitive process that helps communicators purposefully negotiate their differences and jointly answer two important questions: “What is happening here?” and after that, “Now, what should we do about it?”
The greatest proportion of physicians’ time is spent in communication, which for registered nurses represents the second greatest proportion of time expenditure (patient care being first). Nurses, in their role as the 24-hour surveillance system for hospitalized patients, are often the first to detect early signs of patient deterioration. In raising the alarm, nurses must convey information in a way that physicians will understand and respond to. In a sensemaking approach, nurses use a “hook” to get physicians’ attention by focusing on cues extracted from the patient. Those cues form a starting point to purposefully negotiate differences, overcoming some of the difficulties encountered in a team-based approach, to arrive at shared understanding and effective communication.