title: Medication communication between nurses and doctors for paediatric acute care: An ethnographic study.
abstract: OBJECTIVE
  To examine how communication between nurses and doctors occurred for managing medications in inpatient paediatric settings.
  
  
  BACKGROUND
  Communication between health professionals influences medication incidents' occurrence and safe care.
  
  
  METHODS
  An ethnographic study was undertaken.
  
  
  METHODS
  Semi-structured interviews, observations and focus groups were conducted in three clinical areas of an Australian tertiary paediatric hospital. Data were transcribed verbatim and thematically analysed using the Medication Communication Model.
  
  
  RESULTS
  The actual communication act revealed health professionals' commitment to effective medication management and the influence of professional identities on medication communication. Nurses and doctors were dedicated to providing safe, effective medication therapy for children, within their scope of practice and perceived role responsibilities. Most nurses and junior doctors used tentative language in their communication while senior doctors tended to use direct language. Irrespective of language style, nurses actively engaged with doctors to promote patients' needs. Yet, the medical hierarchical structure, staffing and attendant expectations influenced communication for medication management, causing frustration among nurses and doctors. Doctors' lack of verbal communication of documented changes to medication orders particularly troubled nurses. Nurses persisted in their efforts to acquire appropriate orders for safe medication administration to paediatric patients.
  
  
  CONCLUSIONS
  Collaborative practice between nurses and doctors involved complex, symbiotic relationships. Their dedication to providing safe medication therapy to paediatric patients facilitated effective medication management. At times, shortcomings in interdisciplinary communication impacted on potential and actual medication incidents.
  
  
  CONCLUSIONS
  Understanding of the complexities affecting medication communication between nurses and doctors helps to ensure interprofessional respect for each other's roles and inherent demands. Interdisciplinary education delivered in healthcare organisations would facilitate greater clarity in communication related to medications. Encouraging the use of concise, clear words in communication would help to promote improved understanding between parties, and accuracy and efficacy of medication management.
authors.affiliation: Melbourne School of Health Sciences, The University of Melbourne, Parkville, VIC, Australia.
authors.forename: Narelle
authors.initials: N
authors.lastname: Borrott
authors.affiliation: Nursing Research, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia.|Departments of Nursing and Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Kinney
authors.affiliation: Nursing Research, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia.|Departments of Nursing and Paediatrics, The University of Melbourne, Parkville, VIC, Australia.|Murdoch Childrens Research Institute, Parkville, VIC, Australia.|Clinical Haematology, Royal Children's Hospital, Parkville, VIC, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Newall
authors.affiliation: School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Williams
authors.affiliation: Clinical Pharmacology Unit, Department of Medicine, Royal Children's Hospital, Parkville, VIC, Australia.|Australian Paediatric Pharmacology Research Unit (APPRU), Murdoch Childrens Research Institute & The Royal Children's Hospital, Parkville, VIC, Australia.|The University of Melbourne, Parkville, VIC, Australia.
authors.forename: Noel
authors.initials: N
authors.lastname: Cranswick
authors.affiliation: School of Pharmacy, University College London, London, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Wong
authors.affiliation: School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, VIC, Australia.|The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.|Melbourne School of Health Sciences, The University of Melbourne, Burwood, VIC, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Manias
mesh_terms: D003142:Communication; D003422:Critical Care / Q000523:psychology; D017144:Focus Groups; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology*; D008508:Medication Errors / Q000517:prevention & control; D054539:Medication Therapy Management; D009741:Nursing Staff, Hospital / Q000523:psychology*; D019555:Physician-Nurse Relations; D036301:Qualitative Research
keywords: collaborative practice; communication; ethnography; interprofessional interactions; language; medication communication; medication management; nursing; paediatrics; patient safety