Communication by Nurses in the Intensive Care Unit: Qualitative Analysis of Domains of Patient-Centered Care

Christopher G. Slatore, MD, MS⇓, Lissi Hansen, RN, PhD, Linda Ganzini, MD, MPH, Nancy Press, PhD, Molly L. Osborne, MD, PhD, Mark S. Chesnutt, MD and Richard A. Mularski, MD, MSHS, MCR

Christopher G. Slatore is an investigator, Health Services Research and Development, a staff physician, Section of Pulmonary and Critical Care Medicine, Portland Veterans Affairs Medical Center, Portland, Oregon, and an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland. Lissi Hansen is an associate professor, School of Nursing, Oregon Health and Science University. Linda Ganzini is a psychiatrist and director, Health Services Research and Development, Portland Veterans Affairs Medical Center. Nancy Press is a professor, School of Nursing and Department of Public Health and Preventive Medicine, School of Medicine, Oregon Health and Science University. Molly L. Osborne is a professor of medicine, integrated ethics program officer, Section of Pulmonary and Critical Care Medicine, Portland Veterans Affairs Medical Center, interim associate dean for education, associate dean for student affairs, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University. Mark S. Chesnutt is a staff physician, Section of Pulmonary and Critical Care Medicine, director, Critical Care, Patient Care Services Division, Portland Veterans Affairs Medical Center, and a clinical professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University. Richard A. Mularski is an investigator and senior staff physician, Center for Health Research, Kaiser Permanente Northwest, Pulmonary and Critical Care Medicine, Portland, Oregon, and an affiliate associate professor of medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University.

Corresponding author: Christopher G. Slatore, MD, 3710 SW US Veterans Hospital Rd, R&D 66, Portland, OR 97239 (e-mail: christopher.slatore@va.gov).

Abstract

Background High-quality communication is a key determinant and facilitator of patient-centered care. Nurses engage in most of the communication with patients and patients’ families in the intensive care unit.

Objective To perform a qualitative analysis of nurses’ communications.

Methods Ethnographic observations of 315 hours of interactions and 53 semistructured interviews with 33 nurses were conducted in a 26-bed cardiac-medical intensive care unit in an academic hospital and a 26-bed general intensive care unit in a Veterans Affairs hospital in Portland, Oregon. Communication interactions were categorized into 5 domains of patient-centered care. Interviews were analyzed to identify major themes in nurses’ roles and preferences for communicating with patients and patients’ families within the domains.

Results Most communication occurred in the domains of biopsychosocial information exchange, patient as person, and clinician as person. Nurses endorsed the importance of the domains of shared power and responsibility and therapeutic alliance but had relatively few communication interactions in these areas. Communication behaviors were strongly influenced by the nurses’ roles as translators of information between physicians and patients and the patients’ families and what the nurses were and were not willing to communicate to patients and patients’ families.

Conclusions Critical care, including communication, is a collaborative effort. Understanding how nurses engage in patient-centered communication in the intensive care unit can guide future interventions to improve patient-centered care.