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Open in a separate window Data analysis For this research, data analysis involved the careful examination of all transcribed data from the interviews.
We identified recurring communication issues, explored the connections between issues, evaluated the seriousness of the problems and weighed the overall impact of these factors on clinician-patient and clinician-clinician communication. We engaged in several rounds of comparing, sorting, recoding and looking for issues and connections in the data.
From this process, we identified three main motifs, which were different types of communication problems in the ED. The first motif was experiential in nature i. The second was interpersonal i. The third was the contextual factors in ED communication i.
By delineating these three main types of communication issues, and by pinpointing two key problems within each type, the researchers revealed how communication in EDs is simultaneously affected by experiential, interpersonal and contextual factors.
Within each of the three types of communication issues, there are two specific concerns: The experiential parameter i. The interpersonal parameter i. Contextual factors patient and staffing numbers, patient expectations Time pressures i.
In short, communication in EDs is an intricate construction that contains a number of structural weaknesses; these areas of fallibility place patient safety and satisfaction at risk and they increase clinician burnout.
This process of translation occurs continually in a trilingual ED, as doctors and nurses move through patient triage, handover and treatment. Clinicians use Cantonese and English, and occasionally Mandarin, to shift between conversational vocabulary, technical terms, names of medications and treatment plans.
This process generates a high possibility of misinterpreting, omitting or altering crucial medical information, thereby placing patients at risk.
Factors affecting poor communication skill on to the magnitude and complexity of this translation issue, we have not focused on this problem within this paper; instead, the issue of translation will be addressed in another paper by the same research team.
The findings from this research project not only identified three main types of communication issues the experiential parameter, the interpersonal parameter and the contextual factors but also demonstrated the connections between these issues.
The following section provides precise data from the interviews to illustrate each of the above communication problems. This discussion also reveals links between these interwoven communication challenges.
Results In the high-stressed, time limited context of the ED, communication is complex, nuanced and interrupted, fragmented, rushed and consequently error prone.
As a result, patients often feel that the Doctor s had not adequately listened to them and consequently did not agree with or understand their diagnoses or their treatment plan. Yet clinicians argued that it was difficult to communicate with patients at length, to explain their diagnoses, treatments and prognoses frantic, fragmented and unpredictable nature of EDs.
Doctors and nurses feel enormous pressure to perform their clinical tasks efficiently and therefore they argue with very little, if any, time to attend to the interpersonal needs of the patients. The combination of these expectations and limitations creates a highly complex, challenging environment for communication.
The evidence we have from the many recorded interactions is that the development of rapport and empathy between clinicians and patients result in a higher degree of patient involvement, which in turn produce better clinical outcomes, such as mutually agreed treatment plans and better patient compliance.
The experiential parameter Inadequate transfer of medical information This type of communication problem involves processes and procedures in an ED. Because patients often present at an ED without any medical records, clinicians rely heavily on the medial records created within the ED.
The interview data for this project identified two key issues regarding the transfer of medical information: Each of these medical aspects of communication was seen as impacting patient safety and satisfaction in the ED.
In addition, clinicians may lack the information they need to adequately perform triage and handover. But their information is quite valuable to us. The data revealed that there are no standardised practices for conducting clinical handovers in this ED; handovers may be spoken or written, informal or formal, and they may be omitted altogether.
In addition, clinicians reported that they often handle patient care via pattern recognition, rather than by receiving clear, thorough information via handover or by asking questions of the patient or other clinicians.
This is not really about what you read [in the medical notes]; this is a pattern recognition. I mean, then we use the pattern to match things up.
I mean, this is the way things go. In this sense, detailed medical records were seen as complementary and optional, not essential and compulsory. However, neither the process of over-focusing on medical details nor the act of over-generalising about overarching symptoms generates sufficient understanding of a medical condition or treatment.
A few clinicians admitted that this inconsistent, casual approach to handovers sometimes resulted in mistakes. Our staff — the medical officer prescribed the pre-medication to the patient, but this pre-medication would be given to the patient inside the operation theatre.
Our staff forgot to handover the drugs to the operation theatre, the staff in the operation theatre. And the drugs came back to our department without handover to the other department.Poor workplace communication creates a negative feedback loop.
When your workers don't understand what's expected of them, their morale declines and this makes it even more difficult to communicate.
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