Contextual Barriers to Communication Between Physicians and Nurses About Appropriate Catheter Use.
Academic Medical Centers
/ organization & administration
Attitude of Health Personnel
Catheterization
/ nursing
Catheters, Indwelling
Communication Barriers
Electronic Health Records
/ organization & administration
Humans
Interpersonal Relations
Interviews as Topic
Physician-Nurse Relations
Practice Guidelines as Topic
Workflow
Journal
American journal of critical care : an official publication, American Association of Critical-Care Nurses
ISSN: 1937-710X
Titre abrégé: Am J Crit Care
Pays: United States
ID NLM: 9211547
Informations de publication
Date de publication:
07 2019
07 2019
Historique:
entrez:
3
7
2019
pubmed:
3
7
2019
medline:
24
10
2020
Statut:
ppublish
Résumé
Indwelling urinary and vascular catheters are a common cause of health care-associated infections. Interventions designed to reduce catheter use can be ineffective if they are not integrated into the workflow and communication streams of busy clinicians. To characterize communication barriers between physicians and nurses and to understand how these barriers affect appropriate use and removal of indwelling urinary and vascular catheters. Individual and small-group semistructured interviews were conducted with physicians and nurses in a progressive care unit of an academic hospital. Common themes were identified, analyzed, and then organized using a conceptual framework of contextual barriers to communication: organizational, cognitive, and social complexity. Several barriers to communication between physicians and nurses contributed to inappropriate use and delayed removal of catheters. Workflow misalignment between clinicians was a barrier associated with organizational complexity, issues with electronic medical records and pagers were associated with cognitive complexity, and strained relationships between clinicians and rigid hierarchies were associated with social complexity. Communication is contextual, and improving physician-nurse communication about appropriate catheter use may require innovations that address the identified contextual barriers.
Sections du résumé
BACKGROUND
Indwelling urinary and vascular catheters are a common cause of health care-associated infections. Interventions designed to reduce catheter use can be ineffective if they are not integrated into the workflow and communication streams of busy clinicians.
OBJECTIVES
To characterize communication barriers between physicians and nurses and to understand how these barriers affect appropriate use and removal of indwelling urinary and vascular catheters.
METHODS
Individual and small-group semistructured interviews were conducted with physicians and nurses in a progressive care unit of an academic hospital. Common themes were identified, analyzed, and then organized using a conceptual framework of contextual barriers to communication: organizational, cognitive, and social complexity.
RESULTS
Several barriers to communication between physicians and nurses contributed to inappropriate use and delayed removal of catheters. Workflow misalignment between clinicians was a barrier associated with organizational complexity, issues with electronic medical records and pagers were associated with cognitive complexity, and strained relationships between clinicians and rigid hierarchies were associated with social complexity.
CONCLUSIONS
Communication is contextual, and improving physician-nurse communication about appropriate catheter use may require innovations that address the identified contextual barriers.
Identifiants
pubmed: 31263012
pii: 28/4/290
doi: 10.4037/ajcc2019372
pmc: PMC6760297
mid: NIHMS1028646
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
290-298Subventions
Organisme : AHRQ HHS
ID : P30 HS024385
Pays : United States
Organisme : AHRQ HHS
ID : R01 HS018334
Pays : United States
Organisme : AHRQ HHS
ID : R01 HS022305
Pays : United States
Organisme : AHRQ HHS
ID : R03 HS024760
Pays : United States
Informations de copyright
© 2019 American Association of Critical-Care Nurses.
Références
Am J Med. 2000 Oct 15;109(6):476-80
pubmed: 11042237
Lancet. 2001 Aug 11;358(9280):483-8
pubmed: 11513933
J Crit Care. 2003 Jun;18(2):71-5
pubmed: 12800116
Infect Control Hosp Epidemiol. 2003 Dec;24(12):942-5
pubmed: 14700410
Am J Infect Control. 2004 Jun;32(4):196-9
pubmed: 15175612
Int J Med Inform. 2007 Jun;76 Suppl 1:S89-97
pubmed: 16769245
Jt Comm J Qual Patient Saf. 2007 Jan;33(1):34-47
pubmed: 17283940
Ann Emerg Med. 2007 Oct;50(4):387-95
pubmed: 17498845
J Am Med Inform Assoc. 2007 Sep-Oct;14(5):542-9
pubmed: 17600093
Am J Infect Control. 2007 Nov;35(9):594-9
pubmed: 17980238
Qual Health Res. 2008 Mar;18(3):380-90
pubmed: 18235161
Infect Control Hosp Epidemiol. 2008 Apr;29(4):333-41
pubmed: 18462146
Methods Inf Med. 2008;47(4):336-45
pubmed: 18690367
J Hosp Med. 2011 Feb;6(2):88-93
pubmed: 20629015
Am J Nurs. 2010 Aug;110(8):40-5
pubmed: 20671495
J Patient Saf. 2011 Jun;7(2):80-4
pubmed: 21537199
Arch Intern Med. 2012 Feb 13;172(3):255-60
pubmed: 22231611
JAMA Intern Med. 2013 May 27;173(10):881-6
pubmed: 23529627
JAMA Intern Med. 2013 Jun 24;173(12):1084-9
pubmed: 23649040
BMJ Qual Saf. 2014 Apr;23(4):277-89
pubmed: 24077850
N Engl J Med. 2014 Mar 27;370(13):1198-208
pubmed: 24670166
Ann Intern Med. 2014 Oct 21;161(8):562-7
pubmed: 25329204
Int J Qual Health Care. 2015 Jun;27(3):183-8
pubmed: 25855753
Hosp Pediatr. 2016 May;6(5):275-81
pubmed: 27126798
Am J Infect Control. 2016 Dec 1;44(12):1744-1746
pubmed: 27397908
Res Nurs Health. 1995 Apr;18(2):179-83
pubmed: 7899572
Res Nurs Health. 1993 Jun;16(3):213-8
pubmed: 8497673