title: Perceptions of nurses and physicians of their communication at night about intensive care patients' pain, agitation, and delirium.
abstract: BACKGROUND
  Ineffective daytime nurse-physician communication in intensive care adversely affects patients' outcomes. Nurses' and physicians' communications and perceptions of this communication at night are unknown.
  
  
  OBJECTIVE
  To determine perceptions of nurses and physicians of their communication with each other at night in the intensive care unit about patients' pain, agitation, and delirium and to develop a qualitative survey instrument to investigate this topic. Methods A validated survey was distributed to nighttime nurses and physicians in 2 medical intensive care units.
  
  
  RESULTS
  Most nurses (30/45; 67%) and physicians (56/75; 75%) responded. Nurses (35%) and physicians (31%) thought that a similar proportion of communications was related to pain, agitation, and delirium. Most nurses (70%) and physicians (80%) agreed that nurses used good judgment when paging physicians at night because of patients' pain, agitation, and delirium, but physicians (72%) were more likely than nurses (48%) to think that these pages did not portray the situation accurately (P = .004). For many text pages, physicians attributed a heightened level of urgency more often than did the nurses who sent the texts. Nurses often thought that physicians did not appreciate the urgency (33%) or complexity (33%) of the situations the nurses communicated via pages. More physicians (41%) than nurses (14%) agreed that nurses exceeded medication orders for pain, agitation, and delirium before contacting a physician (P = .008).
  
  
  CONCLUSIONS
  Perceptual differences between physicians and nurses about nurse-physician communications at night regarding pain, agitation, and delirium were numerous and should be studied further.
authors.affiliation: Northeastern University, Boston, MA 02115, USA.
authors.forename: Nada S
authors.initials: NS
authors.lastname: Al-Qadheeb
authors.forename: Jana
authors.initials: J
authors.lastname: Hoffmeister
authors.forename: Russel
authors.initials: R
authors.lastname: Roberts
authors.forename: Kenneth
authors.initials: K
authors.lastname: Shanahan
authors.forename: Erik
authors.initials: E
authors.lastname: Garpestad
authors.forename: John W
authors.initials: JW
authors.lastname: Devlin
mesh_terms: D000046:Academic Medical Centers; D000704:Analysis of Variance; D003142:Communication; D003625:Data Collection; D003693:Delirium; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D009551:Night Care / Q000458:organization & administration*; D010146:Pain; D019555:Physician-Nurse Relations; D011595:Psychomotor Agitation
chemical_list: D006993:Hypnotics and Sedatives