O. Fernando2, N. G. Coburn1,2,5, A. B. Nathens1,2,3,5, J. Hallet1,2,5, N. Ahmed1,6, L. Gotlib Conn2,4 1University of Toronto,Department Of Surgery,Toronto, ONTARIO, Canada 2Sunnybrook Research Institute,Toronto, ONTARIO, Canada 3University Of Toronto,Institute Of Health Policy, Management And Evaluation,Toronto, ONTARIO, Canada 4University of Toronto,Department Of Anthropology,Toronto, Ontario, Canada 5Sunnybrook Health Sciences Centre,Surgery,Toronto, ONTARIO, Canada 6St. Michael’s Hospital,Surgery,Toronto, ONTARIO, Canada
Introduction:
Optimal interprofessional communication is broadly viewed as a prerequisite to providing quality patient care and enhancing provider satisfaction. Poor interprofessional communication has been associated with medical error and patient harm. We explored the enablers and barriers to interprofessional communication between surgical residents and ward nurses with a view towards improving residents’ educational experiences and the quality of surgical patient care.
Methods:
We conducted a qualitative, ethnographic study of interprofessional communication between general surgery residents and nurses in surgical wards of two Toronto academic hospitals, Centres A and B, totaling 126 hours of observations. Additional data were derived from semi-structured interviews (n= 33) with residents and nurses. Data were collected and analyzed iteratively to the point of theoretical saturation. Data were compared between the two centres for analysis of context-specific variables influencing communication.
Results:
Constraints on communication between residents and nurses at the two centres derived from contested meanings of space and time. Residents experienced the contested spatial boundaries of the surgical ward when they perceived nurses to project a sense of territoriality. Residents were thus found to engage in ward avoidance behaviours and they perceived ward work to be devoid of collaborative interprofessional work or educational opportunity. Nurses expressed difficulty getting residents to respond and attend to pages from the ward, and to have a poor understanding of the nurses’ role. Contestations over time spent in training and patient care were found in resident-nurse interactions, wherein residents perceived seasoned nurses to devalue their clinical knowledge on the ward. Nurses viewed the limited time that residents’ spent in clinical rotation on the ward as adversely affecting communication. Residents felt nurses’ tacitly and explicitly diminished residents’ extensive education and clinical expertise resulting from a perceived unfamiliarity with the ward itself.
Conclusion:
There are numerous challenges to enhancing communication between nurses and residents at academic health centres that are rooted in culture. Interventions to improve the culture of interprofessional care have proven effective in some settings. Our study underscores that improvement efforts must (a) identify and target the many social and cultural dimensions of healthcare team member relations; (b) recognize how power is deployed and experienced in ways that negatively impact interprofessional communication; and (c) enhance an understanding and appreciation of each others’ professional attributes and be delivered within a framework that incorporates the temporal and spatial dimensions of interprofessional care.