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
This communication variability translates into inconsistency
with team performance as related to the healthcare delivery
process. This variability is compounded in the communication
situation as each team member brings their own understanding to
the communication space in the premise of hierarchy, role function,
interaction and social construction (Shotter, 2005a; Shotter 2005b;
Pearce, 1989; Weick, 1987; Weick & Roberts, 1993).
An example is the nurse acting as a subordinate to a
physician; to appease the physician in some situations, a nurse may
alter what is said in a conversation. When someone alters their
speech there is then a potential alteration as related to intent,
which may unfold as increasing variability within a communication
and thus care delivery process. In healthcare, this type of
conversation may exist in multiple situations when we encounter a
subordinate and dominant relationship.
A specific example of the nurse-physician hierarchal
communication relationship and issue is reflected in a recent study
regarding “Communication in Emergency Medicine: Implications for
Patient Safety”; still evident today is that “Many nurses simply
remained silent when they disagreed, following physician orders and
only later expressing their objections to other nurses. This
hierarchical behavior is a serious weakness in the system, . . .” As
the nurses stated “ ‘You never tell a physician ‘No.’ Instead, you
say. ‘Are you sure this is what you want to do?’”, “an important
issue here is that the nurse must go out of their way to approach
the physician with questions or concerns” (Eisenberg, et al., 2005).
In reflecting upon the nurse and physician interaction and the
idea of hierarchal boundaries, it is these boundaries that create a
communication space which perpetuates a certain amount of
indifference about one another. In particularly, if one is not in a
position of authority and or what is believed to be an important
presence to pay attention to (i.e., the nurse is thought of as
subservient, and therefore of less importance) voices may remain
unheard (Shotter, 2002a). Thus, due to the hierarchal boundaries
and the subsequent inability to have an openly communicative
relationship between nurses and physicians patient care issues may
be missed.
To continue to pursue a culture of safety in an atmosphere of
hierarchy and boundaries I believe that we as healthcare
professionals have a responsibility to develop an understanding as
to how our social construction does alter the outcomes of
communication and ultimately patient care.
Research Question(s):
To develop a better understanding of operating room team
communication I posed the primary research questions:
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