Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
change in communication patterns. There are many other instances
where role reversal between nurse and physician complicate
communication in today’s healthcare hierarchy and delivery of safe
patient care. Thus, the use of communication within the context of a
role reversal is worth studying to begin to examine the potential
need for change in the structure of healthcare and the roles that
hold the hierarchy together as we try to develop a culture of safety.
The Social Construction, Communication and Culture
Within the culture of healthcare and the operating room the
social construction of the nurse-physician relationship is a dominant
factor in healthcare delivery. Due to this dominant relationship I do
believe this relationship does influence team communications such
as in the use of Universal Protocol.
And, as related to this study I take a particular approach to
communication, one grounded in the social constructionism
perspective. From the perspective of social constructionism in
healthcare, professionals have socially constructed rules by which
they communicate known as the rules of engagement. In
healthcare, the rules of engagement follow the structure of the
medical hierarchy in that as individuals communicate some roles
function to be subordinate while others are dominant. The
individuals within these roles then follow in varying types of
subordinate and dominant communication patterns.
Within the context of the rules of engagement and how nurses
and physicians communicate, this communication and socially
constructed relationship stems from the many years that nurses and
physicians have developed as a care delivery pair. Thus, there is a
legacy of social construction between nurses and physicians.
The Nurse Physician Relationship, Healthcare Environment and
Communicative History
The nurse-physician relationship has primarily been one of
subordination and domination, not collaboration. This pattern has
traditionally followed gender and hierarchal relational issues
(Brimblecombe, 2005; Godden & Forsyth, 2000, Group & Roberts,
2004). In contrast, nursing today has become a blend of roles that
are contextually developed through the nursing education process
and actual professional working hours of preparation and continued
practice (McGarvey, Chambers, & Boore, 2004).
And even though nurses have the responsibility for taking
charge in the patients’ interests, contemporary nurses are still
positioned as subordinates in the healthcare profession. This leads
to communication patterns that reproduce the subordinate
responses ostensibly transformed by the culture of safety. Instead
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