Study Shows Physicians, Nurses How They Talk to Each Other
Authors See Broad Utility in Model of Recording Medical Setting Interactions
August 20, 2018, 12:08 pm News Staff – GoPro footage is ubiquitous on the internet for good reason. The high-resolution video cameras are inexpensive and small, making them ideal for documenting brag-worthy, high-adrenaline moments: skydiving, ski jumping, snorkeling in exotic waters and the like.
Now, authors of a study published online July 14 in BMJ Quality & Safety have used the camera to record another daunting challenge: communication between physicians and nurses. Not exactly daredevil stuff -- unless increasing professional trust and patient safety is the rocky cliff you're trying to scale bare-handed.
The study, titled "Formative Evaluation of the Video Reflexive Ethnography Method, as Applied to the Physician-Nurse Dyad," centered on the video reflexive ethnography (VRE) method, which culminated in physicians and nurses sitting down together to watch videos of their exchanges and reflect on how their different communication habits interact.
"The 'ethnography' in VRE is attributed to the fieldwork that researchers undertake prior to and during the VRE process as a way of orienting themselves, building relationships of trust and contextualizing what emerges from the video reflexive process," the authors write. "'Reflexivity' is an interpersonal process that monitors and adjusts clinical practices to promote greater safety by drawing from the wisdom of the group."
Researchers used portable, high-definition, wide-angle GoPro cameras to record physicians and nurses during 12 medical team patient care rounds in which a total of 14 physicians participated. Physician and nurse participants then separately reviewed the footage, which ranged in length from 48 seconds to nearly five minutes, and then were interviewed about their reactions; they next looked together at the footage, which had been combined with the audio-recorded interviews.
The authors suggest that similar models could be undertaken at large medical facilities to improve outcomes.
The idea, they write, was to "illuminate the stream and structure of behaviors associated with complex practices and relationships." Showing the results to all parties "can stimulate learning and change, both of which are necessary to advance patient safety."
During one joint review of a video, the nurse told the physician, "I try to not be wordy with you or any doctor … because I know that you want to get on to see your next patient. But maybe if I was just a little bit more including of everything, maybe then you would get more of a full story. You wouldn't have to ask me, 'Oh, was a GI panel sent, too?'"
The physician responded, "It was helpful to know that it's important to share (my) reasons … But chest X-rays, these kinds of things, tests that we sometimes don't consider that big, it can be big because of the patient mobility or other issues."
The physician noted that nurses spend more time with patients and concluded that it would be good for nurses to know more about the reasons behind physicians' orders. "I think that would be the one take-home message for me," the physician said.
The study authors note that they recognized and worked around two key sensitive concerns: the privacy of patients whose cases were being discussed and the "authority gradient" between physicians and nurses.
Regarding the first concern, no patients were involved in the study, and sensitive information, including patients' faces and sensitive information, was blurred. Although this approach reduced the time and complexity involved, the authors said it sacrificed the opportunity to examine the patient perspective on physician-nurse communication.
To address the second concern, the researchers took steps that included having at least two members of the research team present for every joint video review, as well as interviewing participants when the physician was not on service and when the nurse was working but with duties being covered by others.
Still, that authority gradient shows up in the data.
"We noticed that many nurses used indirect communication when making requests of physicians, suggesting that an intervention aimed at nurses could consist of teaching them to be more assertive and use direct language, and at the same time teaching physicians to be more sensitive to the use of indirect language," the authors write.
Showing medical professionals their varied communication styles via VRE could have value in hospitals and practices, with specific implications for actions such as end-of-shift handovers and infection-control practices, they conclude.
"VRE brings into the foreground clinicians' expertise and abilities to assess their own (and their colleagues') behaviors, uncovering 'the actual and potential richness hidden in everyday activity and front-line staff relationships,'" the authors write. "As a result, when researchers use VRE, answers to questions of how and why specific events occur align more closely with the reality of everyday practice, promoting better understanding of the phenomenon under investigation so that interventions can be more effective."