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Contextual Barriers to Communication Between Physicians and Nurses About Appropriate Catheter Use
Milisa Manojlovich1, Jessica M Ameling2, Jane Forman2
1Milisa Manojlovich is a professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor. Jessica M. Ameling is a project manager, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Jane Forman is a senior qualitative methodologist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health-care System, Ann Arbor, Michigan. Samantha Judkins is a clinical nursing supervisor, Michigan Medicine, Ann Arbor. Martha Quinn is a senior qualitative research area specialist, Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor. Jennifer Meddings is an associate professor, Department of Internal Medicine and Department of Pediatrics and Communicable Diseases, University of Michigan Medical School and a researcher, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System. mmanojlo@umich.edu.
Physician-nurse communication barriers hinder appropriate use and removal of indwelling urinary and vascular catheters. Addressing organizational, cognitive, and social complexities is key to reducing health care-associated infections.
Area of Science:
- Healthcare quality improvement
- Clinical communication research
- Infection prevention
Background:
- Indwelling urinary and vascular catheters are frequent sources of health care-associated infections.
- Interventions to reduce catheter use may fail if not integrated into clinical workflows and communication.
Purpose of the Study:
- To identify communication barriers between physicians and nurses.
- To understand how these barriers impact the appropriate use and removal of indwelling catheters.
Main Methods:
- Conducted semistructured interviews with physicians and nurses in an academic hospital's progressive care unit.
- Analyzed themes using a framework of contextual communication barriers: organizational, cognitive, and social complexity.
Main Results:
- Communication barriers contribute to inappropriate catheter use and delayed removal.
- Workflow misalignment (organizational), electronic medical record/pager issues (cognitive), and strained relationships/hierarchies (social) were identified barriers.
Conclusions:
- Effective physician-nurse communication regarding catheter use is contextual.
- Innovations addressing organizational, cognitive, and social barriers are needed to improve catheter management and reduce infections.
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