Interprofessional communication between surgery trainees and nurses in the inpatient wards: Why time and space matter.
Optimal interprofessional communication (IPC) is broadly viewed as a prerequisite to providing quality patient care. In this study, we explored the enablers and barriers to IPC between surgical trainees and ward nurses with a view towards improving IPC and the quality of surgical patient care. We conducted an ethnography in two academic centres in Canada totalling 126 hours of observations and 32 semi-structured interviews with trainees and nurses. Our findings revealed constraints on IPC between trainees and nurses derived from contested meanings of space and time. Trainees experienced the contested spatial boundaries of the surgical ward when they perceived nurses to project a sense of territoriality. Nurses expressed difficulty getting trainees to respond and attend to pages from the ward, and to have a poor understanding of the nurses' role. Contestations over time spent in training and patient care were found in trainee-nurse interactions, wherein trainees perceived seasoned nurses to devalue their clinical knowledge on the ward. Nurses viewed the limited time that trainees spent in clinical rotation in the ward as adversely affecting communication. This study underscores that challenges to enhancing IPC at academic health centres are rooted in team and professional cultures. Efforts to improve IPC should therefore: identify and target the social and cultural dimensions of healthcare team member relations; recognise how power is deployed and experienced in ways that negatively impact IPC; and enhance an understanding and appreciation in the temporal and spatial dimensions of IPC.
a Sunnybrook Research Institute , Toronto , Ontario , Canada.
Oshan
O
Fernando
a Sunnybrook Research Institute , Toronto , Ontario , Canada.|b Department of Surgery , University of Toronto , Toronto , Ontario , Canada.
Natalie G
NG
Coburn
a Sunnybrook Research Institute , Toronto , Ontario , Canada.|b Department of Surgery , University of Toronto , Toronto , Ontario , Canada.
Avery B
AB
Nathens
a Sunnybrook Research Institute , Toronto , Ontario , Canada.|b Department of Surgery , University of Toronto , Toronto , Ontario , Canada.
Julie
J
Hallet
b Department of Surgery , University of Toronto , Toronto , Ontario , Canada.|c St. Michael's Hospital , Toronto , Ontario , Canada.
Najma
N
Ahmed
a Sunnybrook Research Institute , Toronto , Ontario , Canada.
Lesley Gotlib
LG
Conn
D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D033183:Interdisciplinary Communication; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D009741:Nursing Staff, Hospital; D036301:Qualitative Research; D013337:Students, Medical
Communication; ethnography; health services research; interprofessional care; interprofessional relations; power; professional relations