Exploring Nurse to Physician Communication in Nursing Homes

Abstract

Background. The well-cited report from the Institute of Medicine stated that nearly 100,000 deaths in acute care are largely due to miscommunication. Residents in nursing homes are transported for acute care three times higher than those under the age of 65. Approximately 25 percent of these hospital transfers are avoidable. The influence of nurse-to-physician communication upon the decision to hospitalize nursing home residents is not well understood. Objective. The purpose of this study is to explore nurse-to-physician communication in the nursing home setting utilizing the Informatics Research Organizing Model (IROM) and Carrington’s Exploring Nurse-to-Nurse Communication Framework. Methods. The methodology use for this study was a qualitative descriptive (QD) design, with in-depth, one-on-one interviews of nurses and physicians with semi-structured open-ended interview questions. Communication between nurses and physicians regarding clinical events experienced by nursing home residents was digitally recorded and transcribed. Data was analyzed using natural language processing (NLP) methodology and conventional content analysis, as a means of intra-methods data triangulation. A purposive convenience sample of nurses and physicians who provide clinical care to nursing home residents at two sites was recruited. In addition to obtaining recorded communications between nurses and physicians pertaining to clinical events, these same study participants were interviewed to determine their perceptions regarding communication of the clinical events. Outcomes. Findings from this study will increase understanding of nurse-to-physician communication and its contribution to avoidable hospitalizations. Results will inform the development of an electronic interface that supports nurse-to-physician communication in the nursing home setting.