The Elephant in the Room: Nurses’ Views of Communication Failure and Recommendations for Improvement in Perioperative Care

Abstract

Perioperative communication failures endanger patient safety and may reduce efficiency. The objective of our phenomenological research study was to determine the reasons for and consequences of perioperative communication failures and to seek recommendations for improvement. Fourteen perioperative nurses participated in this study. We conducted in-depth interviews with a semi-structured questionnaire following Colaizzi's seven-step methodology to extract themes. We organized the themes into categories: causes, consequences, and recommendations for preventing communication failure. Some themes for causes were inadequate time for preoperative preparation, lack of personnel, and disruptive behaviors of physicians. Consequences of communication failure were decreased staff retention, avoidance of colleagues, threats to patient safety, and intra-team violence. Two recommendations included enforcing institutional regulations and creating team spirit. The study revealed that nurses believe that institutional regulations should not only be present but enforced. Further, nurses believe that strengthening employees' interpersonal skills is essential to preventing communication issues.care, caused perioperative communication to fail. Apker et al 29 determined that inadequate staffing caused setbacks in verbal communication, which threatened patient safety. It is repeatedly pointed out in the literature that staffing deficits and excessive workload pose a risk to patient safety and are generally identified as systemic problems. [30][31][32] In this study, nurses indicated that some of the causes of communication problems are related to the perioperative environment, which is consistent with the related literature. 5,11,17,33,34 The stress caused by the physical environment of ORs, which can be caused by standing for long periods of time, working in an enclosed and noisy environment, exposure to radiation, shift work, after-hours work for emergencies, prolonged operations, and delayed breaks, can result in tension among staff members and hindered communication. McMullan et al 33 found that during hand overs, interruption by other team members, questions irrelevant to the subject, and noise were the external factors that disturb communication. Cvetic 11 stated that perioperative care is known for frequently encountered communication failure because of its rapid and dynamic structure. Nagpal et al 5 reported that a stressful work environment and inadequate support lead to frequent turnover of health care workers (ie, surgeons, anesthesia providers, and nurses), which causes environment-related communication problems. Clayton et al 17 underlined that effective communication is vital in perioperative environments because the perioperative environment is stressful, technically complex, and has an intense hierarchy. Davies 34 also pointed out the necessity of a culture of effective communication in perioperative care. Clayton et al 17 defined the constituents of effective communication as effective listening, clear and understandab...

Drivers of unprofessional behaviour between staff in acute care hospitals: A realist review

“…However, surgical contexts were consistently reported as 'hot-zones' for UB, which perhaps relates both to a greater and more rigid hierarchy, gender dynamics, and the high-pressure and high risk work environment (115). The presence of a steep hierarchy was often cited as inhibiting effective communication (reducing psychological safety), impacting patient safety and care quality (133). A study across seven Australian hospitals in 2022 highlighted that the environment in surgery is an ongoing problem, with one participant stating "'Some (surgical medical staff) in theatres are still very rude to nurses -every week I would witness a surgeon raising his voice, yelling, throwing things out of anger and impatience…'" (12).…”

Drivers of unprofessional behaviour between staff in acute care hospitals: A realist review

“…However, surgical contexts were consistently reported as 'hot-zones' for UB, which perhaps relates both to a greater and more rigid hierarchy, gender dynamics, and the high-pressure and high risk work environment [113]. The presence of a steep hierarchy was o�en cited as inhibi�ng effec�ve communica�on (reducing psychological safety), impac�ng pa�ent safety and care quality [131]. A study across seven Australian hospitals in 2022 highlighted that the environment in surgery is an ongoing problem, with one par�cipant sta�ng "'Some (surgical medical staff) in theatres are still very rude to nurses -every week I would witness a surgeon raising his voice, yelling, throwing things out of anger and impatience…'" [12].…”

A Saúde Mental dos Enfermeiros de Centro Cirúrgico: uma revisão integrativa

“…No estudo E-03 (Işık et al, 2020), estudo fenomenológico com 14 enfermeiros perioperatórios atuantes em dois hospitais em Istambul, Turquia, os autores buscaram compreender as razões e as consequências das falhas na comunicação. O estudo aponta que as falhas de comunicação estão relacionadas a conflitos na compreensão do papel dos enfermeiros, que sob o ponto de vista dos participantes, são tidos como secretários ou solucionadores de problemas.…”

“…Além disso, outro fator apontado como razão para a falha na comunicação foi o estresse advindo da pressão, uma vez que os participantes apontam que há pressão da equipe médica para terem pacientes preparados em tempos reduzidos, tornando o trabalho mais estressante, e com comportamentos dos colegas ora com tratamento não adequado entre a equipe interdisciplinar e a visão pelos enfermeiros de que são compreendidos como subordinados aos cirurgiões e não como cotrabalhadores. Adicionalmente, o estudo aponta as falas dos participantes que demonstraram já ter sofrido violência emocional, verbal e até mesmo física de integrantes da equipe cirúrgica o que corrobora para o estresse, e falhas na comunicação (Işık et al, 2020;Dos Santos et al, 2019).…”