Difficult communication in nursing

To describe difficult communication in nurse-patient interactions from nurses' perspectives.

Grounded theory methodology and follow-up questionnaire. Focus groups of nurses were conducted to explore nurses' perceptions of difficult communication in nurse-patient interactions.

Using a semistructured interview script, the moderator guided six unit-based focus groups at a 220-bed, Roman Catholic, community hospital, and a recorder took field notes of the interactions. The sessions were audiotaped for transcription and analysis. Level I coding was done by the moderator and recorder after each group. Level II coding was done with the transcripts and conferral of two of the researchers. A follow-up questionnaire with a 5-point Likert scale was used to validate the 13 categories of difficult communication derived from the focus groups.

Five themes were identified: specific diagnoses and clinical situations, patient and family emotions, nurses' emotions, triangle of nurse-physician-patient communication, and nurse coping behaviors with difficult communication. Emotion was the core variable that made communication more difficult.

The groups described five major themes in difficult communication. They also identified the heavy emotional component of nurse-patient communication and the difficulties arising in work relationships that complicated communication.