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Developing and Testing a Tool to Measure Nurse/Physician Communication in the Intensive Care Unit

Manojlovich, Milisa PhD, RN, CCRN*; Saint, Sanjay MD, MPH†‡; Forman, Jane ScD, MHS†; Fletcher, Carol E. PhD, RN†; Keith, Rosalind MHSA§; Krein, Sarah PhD, RN†∥

doi: 10.1097/PTS.0b013e3182192463
Original Articles

Objectives: The purpose of this study, conducted in 3 intensive care units (ICUs) at 1 Department of Veterans Affairs Medical Center, was to develop tools and procedures to measure nurse/physician communication in future studies.

Methods: We used mixed methods in a multistaged approach. Qualitative data came from 4 observations of patient care rounds and 8 interviews with nurses and physicians. Quantitative data came from anonymous surveys distributed to nurses in all 3 ICUs (n = 66). We administered the Safety Organizing Scale to measure nurses' self-reported behaviors that enable a safety culture. Analysis of variance was the main statistical test.

Results: Qualitative data were used to create an observation data collection tool and a working protocol, to measure nurse/physician communication in a future study. Analysis of variance revealed significant differences between the 3 units (f = 4.57, P = 0.02). There also were significant differences on 4 of 9 items of the Safety Organizing Scale. Using mixed methods, we gained multiple perspectives that helped us to clarify and validate the context and content of communication. Quantitative analysis showed significant differences between the 3 ICUs in nurses' perceptions of a safety culture. According to qualitative analyses, nurses from the unit which reported the weakest safety culture also were the least satisfied in their communication with physicians. Qualitative analyses corroborated quantitative findings and demonstrated the importance of contextual influences on nurse/physician communication.

Conclusions: Through the tools and protocol we created, more realistic strategies to promote effective communication between nurses and physicians may be developed and tested in future studies.

From the *University of Michigan School of Nursing; †VA Ann Arbor Health Services HSR&D Center of Excellence; ‡University of Michigan Medical School; §Doctoral Student in the School of Public Health, and ∥Department of Internal Medicine at the University of Michigan, Ann Arbor, Michigan.

Correspondence: Milisa Manojlovich, PhD, RN, CCRN, University of Michigan School of Nursing, 400 N. Ingalls, Room 4306, Ann Arbor, MI 48109 (e-mail: mmanojlo@umich.edu).

Funding: This project was supported by the Department of Veterans Affairs, Health Services Research and Development Services (SHP 08-138). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

© 2011 Lippincott Williams & Wilkins, Inc.