Staff Confidence and Barriers to Complex Clinical Communication in Nursing Homes: A Convergent Mixed-Methods Study

To describe all nursing home staff members' confidence in engaging in complex clinical communication with residents and family carers, and to explore factors affecting their attitudes.

A convergent mixed-methods study used questionnaires (n = 288) and 15 group-based discussions involving 278 professionals across nine nursing homes between April and May 2025. Quantitative data were analysed descriptively, and qualitative data underwent inductive thematic analysis. Findings from the two strands were compared and integrated to develop mixed-methods inferences, with qualitative data given priority to confirm, expand or contrast the survey results.

Staff members reported limited confidence in sustaining complex clinical communication, mainly because of uncertainty in responding to family carers' questions, difficulty managing emotional reactions, lack of training and unclear role responsibility. Qualitative findings identified barriers at the facility (chronic understaffing, limited physician presence, structural limitations), team (hierarchical asymmetries, limited information sharing, intraprofessional conflicts) and resident/family levels (sensory/cognitive impairments, unrealistic expectations, distrust, role confusion, intra-family conflict). Integrated findings showed convergent and divergent patterns. Qualitative data added information on communicative and relational challenges with residents/families, understaffing-driven system barriers and structural limitations. Questionnaires suggested good leadership relationship and group cohesiveness, but group discussions revealed interprofessional and intraprofessional conflicts.

Limited confidence in complex clinical communication was linked to interacting barriers at the organizational, team and resident/family levels. Effective improvement requires combining education that builds communication skills and strategies for emotionally intense conversation, protected time and spaces, team and organizational initiatives that strengthen wellbeing and collaboration, and strategies that support residents' involvement, foster family trust, and reduce unrealistic expectations and role confusion.

Findings highlight the factors that undermine professionals' confidence in sustaining complex clinical communication in nursing homes, and offer targets that policymakers, nursing home managers and educators should consider to strengthen staff-resident/family interactions.

Mixed methods reporting checklist.

None.