title: Nursing the patient with complex communication needs: time as a barrier and a facilitator to successful communication in hospital.
abstract: BACKGROUND
  Effective nurse-patient communication is an essential aspect of health care. Time to communicate, however, is limited and subject to workload demands. Little is known about how nurses manage this 'lack of time' when caring for patients with developmental disability and complex communication needs, who typically communicate at a slow rate.
  
  
  OBJECTIVE
  The aim of this study was to investigate nurses' expressed concepts of 'time' in stories about communicating with patients with developmental disability and complex communication needs in hospital.
  
  
  METHODS
  In 2009, 15 hospital nurses from a range of wards in two metropolitan hospitals participated in interviews about barriers to and strategies for successful communication with patients with developmental disability and complex communication needs in hospital. The data were analysed using narrative inquiry methodology and the stories verified with the participants.
  
  
  RESULTS
  Nurses identified 'time' as a barrier and a facilitator to successful communication. Time as a barrier was related thematically to avoiding direct communication and preferring that family or paid carers communicated on behalf of the patient. Time as a facilitator was related to valuing communication, investing extra time, and to applying a range of adaptive communication strategies to establish successful communication.
  
  
  CONCLUSIONS
  Time is perceived by nurses as both an enemy and friend for improving communication. Nurses who perceive that communication takes too long may avoid communication and miss opportunities to improve communication through increased familiarity with the person's communication methods. Those who take time to communicate narrate applying a range of strategies to achieve success in basic needs communication.
authors.affiliation: Communication Disability Centre, University of Queensland, Brisbane, Australia. b.hemsley@uq.edu.au
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Hemsley
authors.forename: Susan
authors.initials: S
authors.lastname: Balandin
authors.forename: Linda
authors.initials: L
authors.lastname: Worrall
mesh_terms: D000328:Adult; D003143:Communication Devices for People with Disabilities / Q000706:statistics & numerical data; D003144:Communication Barriers; D002658:Developmental Disabilities / Q000451:nursing* / Q000503:physiopathology; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006801:Humans; D009633:Nonverbal Communication; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital / Q000523:psychology*; D036301:Qualitative Research; D013064:Speech Disorders / Q000451:nursing*; D013997:Time Factors; D016526:Workload