Moving beyond the measure: Understanding patients' experiences of communication with nurses

Abstract

Under Medicare's Value-Based Purchasing Program, scores derived from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey are used in the determination of incentive payments and financial penalties for healthcare organizations. Organizations, therefore, invest in approaches to improve the likelihood of positive patient responses. Evidence suggests that nurse communication as measured by HCAHPS influences overall patient satisfaction, yet little is known regarding what patients believe constitutes effective communication with nurses. In this qualitative descriptive study, we conducted phone interviews with 49 recently hospitalized patients to better understand patients' perceptions of their communication with nurses. Our findings indicate that patients perceived their communication with nurses to unfold via nurses' behaviors. Namely, nurses' engagement with patients, anticipation of patients' needs, responsiveness to patients' concerns, and teaching practices positively influence patient satisfaction with communication with nurses. These behaviors resonated most strongly with patients during particularly memorable moments of uncertainty and vulnerability over the course of a hospital stay. These findings suggest that focusing on the development of nurses' behaviors, ensuring processes are in place to support positive behaviors and creating organizational environments that position nurses to consistently apply these behaviors, can improve patients' perceptions of their communication with nurses. These findings also provide a foundation for further research focused on developing and testing specific behavioral interventions and their effect on communication perception.

Proposition of a Hospital Model for Patient Involvement in Self-Care

“…In addition to the abovementioned characteristics, the professional's ability to listen attentively, sensitively, with time and a welcoming and respectful behavior stands out in order to encourage the patient to participate in their care. This is imilar to the findings of another study in which these skills are identified as factors that favor establishing a trusting relationship between patient and professional 19 and empathetic communication, anticipating the patient's needs and positively influencing patient satisfaction 20 .…”

Dialogue is a prerequisite for the nurse–patient relationship in nutritional care: A secondary analysis using the fundamentals of care framework

“…The importance for patients to have a dialogue with the nurses must not be underestimated [ 37 ]. The patients in this study were not systematically involved in the decisions making regarding their nutritional care as the nursing staff perceived this as time‐consuming, which contrasts with the patients' call for nurses to respond to the patients' needs [ 38 ]. Communication that acknowledges the patient's role in care planning can make the difference in avoiding inadequate or missing care [ 39 ].…”

‘Commit to Sit’ to increase patient satisfaction

“…Sitting with patients allows nurses to explain the plan of care and address concerns while improving the patient's perception of the nurse's communication 6,8-11,15. Sitting versus standing when talking with patients is also perceived as spending more time with the patient; in fact, patients overestimated the time the clinician was in the room when sitting 8,14,16,17. Sitting not only affects the perception of time but also increases patient satisfaction scores and builds trust for an effective therapeutic relationship between the nurse and the patients 4,7,10-12,14,18…”