Chapter 3 – Interprofessional Communication in Nursing
Factors Influencing Interprofessional Communication
There are several factors that can influence interprofessional communication in positive or negative ways – and can therefore have positive or negative effects on healthcare professionals and client outcomes.
The factors affecting interprofessional communication can be divided into three main categories: those related to the physical environment, those related to the context, and those related to communication styles of the people involved. See Figure 3.4.
Figure 3.4: Factors affecting interprofessional communication
You should consider these factors and how you can modify your communication patterns to engage in effective interprofessional communication.
- First, you will often be working in physical environments that are sometimes noisy and have many moving parts including clients, families, and multiple members of interprofessional teams. In addition to the many people, there may be beeping machines and overhead announcements. You should be aware that this can cause sensory overload: healthcare environments are often unfamiliar for clients and their families, so you should take this into consideration.
- Second, interprofessional communication in healthcare environments takes place in a complex context involving a lot of information and dynamic and complex clinical situations that require a high level of acuity. It can be very intense, with life-threatening conditions, death, uncertainty, fear, and anxiety – and can lead to work overload. This context can also influence the dynamic nature and intensity of interprofessional conversations. The hierarchical relationships that exist in interprofessional teams and imbalances of power or ideas about power can also affect how individuals communicate and interpret conversations. It is vital that you communicate clearly, compassionately, and systematically.
- Third, each group of healthcare professionals has their own culture and communication styles, which may not align with those of other healthcare professionals. For example, nurses are often taught to be descriptive and embed narrative elements in their communication. This descriptive style capitalizes on a comprehensive and storied approach. Other healthcare professionals, such as physicians and pharmacists, are taught to be more concise and efficient. As you can imagine, these two communication styles may not always align, so you should reflect on how to tailor your communication to the person or group that you are speaking with, while still communicating your point of view as a nurse.
Table 3.3 presents examples of ineffective interprofessional communication and strategies to manage each one.
Table 3.3: Ineffective communication
*HCP = healthcare professional
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Example |
Effects |
How to manage this type of communication |
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Disrespectful communication HCP #1 says HCP #1: “It’s 11 am already!” [shakes head in disapproval] “Goodness gracious, you haven’t got her out of bed yet?! What’s wrong with you?”
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Demoralizes and demeans another person. Although there may be a reason why the client was not helped out of bed, the healthcare professional may feel disempowered and not share the information.
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HCP #2 could respond by saying: “It is probably better for you to inquire about the reasons that I have not got the client out of bed. Your communication is disrespectful and disregards what is going on with Mrs. Hart. Would you like to know what is going on?” Alternatively, HCP #1, who was initially disrespectful, could have engaged in discussion that is guided by inquiry instead of blame, and said: “I noticed Mrs. Hart is not out of bed yet. How can I help?”
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Example |
Effects |
How to manage this type of communication |
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Failure to communicate concern. HCP #1: “The client’s BP is 140/88” HCP #2: “Okay.”
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The first healthcare professional stated a finding, but did not indicate or emphasize their concern. Thus, the second healthcare professional did not recognize the need to be concerned or engage in a dialogue. Failure to communicate one’s concern can have a negative effect on patient outcomes. |
When communicating, it is important to explicate and emphasize when you have concerns and make sure that the individual that you are discussing it with recognizes the importance of what you are saying. For example, the conversation could be modified such that the concern is acknowledged, and they engage in a discussion about the plan of care: HCP #1: “The client’s BP is 140/88. This is out of the ordinary for this client, their baseline BP is 100/60. I have a serious concern about the high BP and I think we should intervene.” HCP #2: “That is quite a jump. Is the client’s pain well-controlled?”
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Example |
Effects |
How to manage this type of communication |
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Failure to communicate rationale for an action or decision. HCP #1: “Let’s try putting the client in prone position.” HCP #2: “You want us to roll the client onto their abdomen.” HCP #1: “Yes.” HCP #2: “I think that will be difficult.”
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The communication is not dialogical because of the failure to communicate a rationale for an action or decision by either of these professionals. As a result, neither professional understands the perspective of the other. |
When communicating, it is important to provide rationale for your actions and decisions. For example, the conversation could be modified so that a person’s rationale is clearly identified, as such: HCP #1: “Let’s try putting the client in prone position. Some recent research has suggested that this can improve respiratory function when a client has severe respiratory distress that is not responding to other interventions.” HCP #2: “I am concerned about rolling the client onto their abdomen with all of the tubes and wires. Do you have a suggestion?” HCP #1: “If you are open to it, I can grab one more person and we can do it as a team. What do you think?”
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Example |
Effects |
How to manage this type of communication |
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Unclear/incomplete communication or miscommunication. HCP #1: “Can you help Ms. Di Lallo with her breakfast?” HCP#2: “Yes” HCP#1: “She’s at table 1.” HCP#2: [walks over to the client], “Hi Ms. Di Lallo, are you ready for your breakfast?” Client: “Yes, can you please pass me my coffee?” HCP#2: [passes Ms. Di Lallo her coffee]. HCP#3: “Oh, hold on! Ms. Di Lallo, we need to thicken your coffee first.”
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This unclear communication about the client’s diet led to a near miss. Unclear, incomplete, or miscommunication can result in errors related to client care and can have serious consequences for their health. |
When communicating, it is important to include all pertinent information to provide safe, effective care. All healthcare professionals need to clarify any communication shared. For example, the conversation could be modified by ensuring communicating all required information: HCP#1: “Can you help Ms. Di Lallo with her breakfast?” HCP#2: “Yes” HCP#1: “Great, she’s at table 1. Ms. Di Lallo has dysphagia, so you need to make sure all her fluids are thickened and follow the dysphagia diet protocol. The thickener should be on her tray. Do you have any questions?” HCP#1: “No, I’m aware of the dysphagia diet protocol and will monitor Ms. Di Lallo during her meal.” |
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Example |
Effects |
How to manage this type of communication |
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Ineffective conflict resolution on a plan of care. HCP#1: “Mr. Pink said he does not feel he is ready to be discharged and I agree.” HCP#2: “I think I’m able to determine when Mr. Pink can be discharged considering I’ve been working with him for 6 months and you just met him last week.” HCP#1: “I think we need to talk to the whole team.”
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The communication is ineffective because the HCPs disagree about the plan of care for the client. They are not focusing on the context of the interprofessional communication and/or explaining their reasoning based on the client’s needs. They are focusing on their own opinions instead of using a client-centred perspective and evidence-informed approach.
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In the case of a disagreement, HCPs need to effectively explain their reasons in the context of client-centred care and evidence-informed approaches. It’s always important to use effective conflict resolution strategies. For example, the conversation could be modified as: HCP#1: “Mr. Pink said he does not feel he is ready to be discharged. I agree with him because he has no support system in place to help him with his activities of daily living at home.” HCP#2: “I believe he is physically and mentally ready to go home, but you bring up a good point. Let’s put together a plan for home care.” HCP#1: “Great.”
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Now, you have learned about the factors that positively and negatively influence interprofessional communication. Inevitably, despite healthcare professionals’ best intentions, conflict is common in interprofessional contexts. Let’s examine this next!
