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Rule
1:
Dominant or submissive behavior usually stimulates the opposite behavior
in others. More explicitly, individuals who act dominantly usually stimulate
the person they are interacting with to act submissively, and individuals
who act submissively usually stimulate people to act dominantly.
Rule
2:
Hateful or loving behavior usually stimulates the same behavior from others.
 Restated,
individuals who act kindly toward others usually encourage kindness toward
others, while being hostile toward others usually stimulates aggressiveness
from others. Leary states that these responses toward others are involuntary
and immediate in interpersonal situations.
This
model can be directly applied to communication in the healthcare setting.
Physicians in healthcare settings often assume or are placed in the dominant
role, while nurses or other auxiliary professionals are placed in a submissive
role.
The
strength in the Leary model is the transactional way in which power and
affiliation issues are described in human interactions. If individuals
are to truly understand communication with others, the qualities that
both people bring to the interaction must be recognized. Two weaknesses
of the model are that it does not portray the ongoing, fluid process of
human communication; and it omits other important variables that arise
from the environment.
Gender
Differences in Communication
Researchers
have shown us that both conversational and professional interaction reflect
gender as well as professional styles of communication.
Conversational
Speech
In
conversational speech, differences exist between genders. It has been
reported that in comparison to women, men produce more units of speech,
speak faster, interrupt more (although women are more likely than men
to interrupt by asking questions), break silences more often, make more
speech errors, and fill pauses more (with "ah" or "uh"). Some people have
interpreted these gender differences as reflecting a tendency by men to
attempt to dominate conversations. Others have expressed that men are
less skilled verbally, and that some of these observed behaviors are compensatory.
In
healthcare settings, it is well documented that women usually verbally
disclose more information about themselves than men do. Likewise, healthcare
workers, particularly physicians, tend to verbally interact more with
women than with men. Women often receive more time, more explanations,
and less descriptive responses from physicians than do men. This may indicate
that the greater information received by women from physicians could be
the result of women's requests for information, not the amount of information
volunteered by physicians.
With
regard to nonverbal communication, women are better than men at decoding
(judging the accuracy of) nonverbal cues, recognizing faces and expressing
emotions through nonverbal means. They smile and gaze more than men and
may use smiling as a mechanism for coping with social tension.
Women
in general are better suited than men are to elicit information-giving
behaviors. Because of their superior skill at interpreting nonverbal cues,
their greater facial expressiveness, and their speech patterns, which
tend to enhance the speaker's position, women may obtain more information
from physicians both by interpreting physician's nonverbal cues more accurately
and by reinforcing physicians' speech.
In
reference to gender communication, differences exist between same-gender
and opposite-gender conversations. In same-gender conversations, men and
women display patterns of interrupting, whereas in opposite-gender conversations,
men interrupt women more frequently than the reverse. Smiling is more
likely in same-gender than opposite-gender interactions, but in opposite-gender
adult pairs, women smile more than men do.
With
regard to gazing, once again there is a greater tendency for same-gender
gazing than for opposite-sex gazing. However, these results seem to be
contingent upon on whether the pair are strangers or persons known to
each other.
Finally,
opposite-gender communications have been found to be louder and more unpleasant
than same-gender communications. Female-female loudness, dominance, unpleasantness,
business-like tone, and anxiety were lower than in male-male or opposite
gender communications.
Nonverbal
gender differences are most evident when one is within one's gender. With
the opposite gender, people control their behavior so it approaches the
other gender's norms. For example, men usually gaze more at women than
at other men, while women gaze less at men than at other women. Thus,
individuals from the same gender may be more likely to deviate from their
norms when they are communicating with individuals from the opposite gender;
individuals may behave more stereotypically when they are communicating
with members of their own gender.
Professional
Interaction
Gender
divisions are of primary importance in the assigning of roles and relationships
between doctors and nurses. Within the patriarchal doctor-nurse relationship,
parallels between husband and wife can be drawn. The nurse's role in this
dyad is looking after the emotional environment while the doctor decides
the patient's diagnosis and the method of treatment.
Traditionally,
female nurses take on a subordinate, nonprofessional role in the male-dominated
medical division of labor, demonstrating the importance of gender ideologies
in the caring professions. The idea of care is seen as an extension role
and less privileged in status: working/middle-class nurses versus upper-class
doctors, hence the subordination of nursing to medicine. With the presence
of men in nursing, an interesting question arises. Is there a difference
in relationships between male nurses and doctors and female nurses and
doctors?
In
many instances historically, it was reported that doctors avoided working
with male nurses, implying that the aspect of doctor-nurse relationship
in which nurses service the needs of the doctor still remains heavily
dependent on the feminine identity of nursing. Rather than the submissive
role, male nurses were provided with confidence and assertiveness from
their gender socialization. This made them act as doctors' equals rather
than as subordinates. Consequently, male nurses were encouraged to assume
senior roles and function in administrative roles.
With
the deterioration of public esteem for doctors, recognition of their fallibility
and increasing numbers of female doctors and male nurses, the element
of gender role dominance/ passivity is negated. The value of nurses in
their own right, rather than as doctor's assistants or handmaidens is
acknowledged.
Recent
changes in the nurse-doctor relationship in patient care found the nurses'
work focused closely on diagnosis and treatment, and observed patterns
of nurse-doctor interaction were at odds with the traditional dominant-subservient
model. Nurses were found to be largely responsible for the categorization
of patients, history taking and observation, often indicating the likely
course of treatment before the patient was seen by the physician. However,
diagnosis was still formally recognized as the primary task of the doctor,
although younger, inexperienced doctors relied immensely on experienced
or senior nurses for advice and assistance.
Although
the subtle recommendation process of the nurse-doctor game may still be
observed, nurses more frequently offer advice in an open, straightforward
way, with senior staff intervening bluntly to point out shortcomings in
certain junior doctors' work.
Basic
Communication Techniques
Understanding
the basic components of communication assists us in developing more effective
communication skills. Seven key elements contribute to the success
or failure of individual communication. These components are the medium,
message, speaker, listener, feedback, interference, and context.
The
medium is associated with the carrier of the message, which may
be personal communication through face-to face interaction, telephone
call, or a note or letter.
The
message in personal communication is most critical because it is
influenced by culture and directness. Communication to be successful usually
must be direct.
The
speaker must be clear, effective, and culturally sensitive to the
individual's needs. An adequate vocabulary and clear expression are priorities
for success.
The
listener must devote full attention to the speaker. It is imperative
to provide the speaker with feedback; a reaction to the conversation
as an indication of attentiveness includes clarification of misunderstood
statements.
Interference
occurs when a listener fails to hear the message because of external (noise)
or internal (something else on mind) interference.
The
context is related to the time, place, and situation in which the
conversation occurs. The effectiveness of a communication may be related
to the receptiveness of and lack of interference for the participant.
Some
techniques one can use for communication include:
- effective speaking
- effective listening
- feedback
- alert to nonverbal signals
- emotional effect
- assertiveness, and
- handling conflict
Effective
Speaking
For
effective speaking the person should have something to offer to the conversation.
Individuals should have familiarity with a broad range of topics and possess
sensitivity to the interests of the listener. If you are highly knowledgeable
about your major field, but have little knowledge of other subjects, there
will be relatively few people who will find you a stimulating conversationalist.
If misunderstanding is occurring, improve the exactness of your communication
through vocabulary building. In communication between health professionals,
the use of precise terminology is most effective in promoting a collegial
environment. To ensure communicative clarity, formulate your thoughts
before speaking and be cognizant of the verbal and nonverbal feedback
from your listeners.
Effective
Listening
An
effective listener is as actively involved in the conversation as the
speaker is, but the role involves a greater effort and more concentration
than that of speaking. Since the speaker's nonverbal communication reveals
more than the actual words, the listener must be alert to posture, gestures,
facial expressions, eye movement, and the tone and inflection of the speaker's
voice. If listeners misinterpret what has been spoken, major misunderstandings
can be avoided if clarification is sought immediately.
Feedback
Initially,
a response to communication (feedback) is internal. The person's emotions,
knowledge, and past experiences initiate a particular response. Some common
styles of response by listeners are withdrawing, judging, analyzing, questioning,
reassuring, and paraphrasing.
Withdrawing
can occur when the topic of discussion creates uncomfortable feelings.
It usually is interpreted as lack of concern or callousness. Judging almost
immediately extinguishes open communication. Judgmental responses can
be damaging to relationships, especially when someone is judged negatively.
The judged person has to defend her/his opinion, belief, or behavior,
placing the person in a position of rejection of or resistance to the
judge.
Analyzing
is similar to judging. It explains to a person why they reacted as they
did. This leads to the person becoming defensive and less willing to reveal
their thoughts and feelings. Questioning can either enhance or inhibit
communication. Helpful questions are neither judgmental nor threatening,
but allow the individual to gain insights that they previously overlooked.
These questions usually encourage people to communicate rather than become
defensive.
Reassurance
indicates acceptance to the person. When appropriate, it includes addressing
positive ways of viewing the troubling situation, but also guarding against
making a judging response. Paraphrasing is the listener reiterating the
speaker's message and providing the speaker with the opportunity to correct
any misconceptions. It emphasizes the listener's attentiveness to the
speaker's words.
Alert
to Nonverbal Signals
Effective
communication requires that one is alert to the many nonverbal cues expressed
by listeners. These include posture, gestures, facial expression, tone
and inflection of words, personal dress, and personal space. It reflects
the individual's personality and culture. For example, how close to you
does a person stand as you talk? In general, moving close to you indicates
an interest in you or the discussion. Keeping a distance may indicate
uncertainty about you, or a dislike of or disinterest in your topic.
Watch
the person's hands as you interact. Even though the person appears calm,
nervousness is often revealed through hand activity. The classic sign
of folded arms over the chest may indicate that the individual may be
feeling defensive, and it is necessary for you to regress in your approach;
or it can indicate that the person is cold. This action demonstrates how
easily body language can be misinterpreted. The most important signs to
watch for are inappropriate facial expressions. Genuine emotions usually
cause a quick smile that encompasses the entire face. If someone is faking
an emotion, they often hold the expression too long. During interactions,
nonverbal and verbal messages often conflict. Usually, the nonverbal message
is the more accurate. It is easy to control our words, but more difficult
to control tone of voice, facial expression, posture, and other nonverbal
signals.
Emotional
Effect
Emotions
include feelings, physiological changes, and a pattern of overt expression.
Even people who have difficulty verbally expressing their emotions can
display them through their facial expressions and body language.
One
of the more difficult forms of communication for some people is sharing
emotions. Before individuals can express their emotions they have to understand
their feelings. In sharing emotions, it is more effective to use "I" statements
rather than "you" statements.
"I"
statements are expressions of personal feelings. "You" statements judge
another's behavior and place the responsibility for emotions on the other
person. "You" statements place blame and can force the listener into a
defensive position, while "I" statements encourage discussion.
Assertiveness
Communicating
assertively is the use of honest, direct communication that maintains
and defends one's rights in a positive way. People who are assertive express
their points while at the same time respecting the rights of others. Verbally,
assertive communicators speak clearly, calmly, and directly to those people
whom they are addressing. Nonverbally, they maintain direct eye contact,
and stand or sit with an erect posture that indicates control and confidence.
Handling
Conflict
Conflict
occurs in every relationship. It is generally any situation in which the
wants, intentions, and needs of one individual are incompatible with another
person's wants, intentions or needs. Usually, conflict is handled in one
of five ways - reflecting differing degrees of aggressive, assertive,
or passive, and cooperative or competitive behavior. Prolonged conflict
can destroy relationships unless a type of conflict resolution is instituted.
Conflict resolution is a concerted effort by all individuals to resolve
in a constructive manner the points of contention.
Five
steps that can be used to resolve conflict are:
- All
parties should agree to work on the problem and clarify the necessity
for participating in the process.
- Simultaneously,
the problem should be identified by all.
- Each
person should clearly describe and define his or her feelings about
the issue.
- Solutions
to the problem should be offered by all.
- From
all suggestions, a tentative solution should be proposed, with a second
meeting time scheduled to discuss the problem and evaluate progress
toward the solution.
Physician-Nurse
Communication
Sources
of Conflict
Historically,
sources of conflict have been reported between physicians and nurses.
The "doctor-nurse game," first described in the 1960's, is a stereotypical
pattern of interaction in which female nurses, while appearing to defer
to the doctor's authority, learn to show initiative and offer advice.
Today in clinical practice, this pattern appears less common but both
professions have ideal expectations of each other.
Generally
speaking, the problem appears resolved but scientific research has not
been conducted to document it. Consequently, the author brings these phrases
to the reader for review so one can speculate on the progress of nurses
over the last 30 years.
The
descriptive terminology used in the earlier years defines the following
phrases as sources of conflict:
Physician
Dominance and Nurse Deference:
In
the former years, physicians were described as freely conferring with
other colleagues, but consultation with a nurse seemed inappropriate.
Many doctors felt threatened when they exhibited signs that they were
not completely independent and totally in control of the healthcare situation.
Medical training gave doctors feelings of omnipotence in preparation for
a world of unwieldy responsibilities and a physician dominated doctor-patient
relationship.
The
nurse had accepted the position of deference to the physician and other
authority figures. She was described as docile, subordinated, and deferent,
with a traditional reputation of fulfilling a role of blind obedience
rather than one of autonomous professionalism. Some contributing factors
to this role were:
(1)
most physicians were male and nurses were female,
(2)
the higher level of education of the physicians, and
(3)
a striking salary difference.
The
educational gap along with salary differences could have contributed greatly
to the lack of mutual respect.
In
playing "the game," nurses were to be responsible for making significant
recommendations while at the same time appearing passive. These contributions
were to appear as being initiated by the physician rather than the nurse.
Physicians'
Devaluation of Nursing:
Related
to the dominance-deference pattern, another source of conflict in the
nurse-physician relationship was the growing dismay among nurses about
the value they perceived physicians placing on their patient care. Many
physicians still viewed the nurse's role as primarily carrying out their
orders and reporting the patient's progress to them. During this era,
when physicians were asked for suggestions for improving nursing care,
they typically equated good nursing care with fulfillment of their orders
and demands. In playing "the game," as long as nurses complied with the
physician's wishes, they were acceptable.
Knowledge
Deficit of Other Profession:
Other
factors that caused communication problems between nurses and physicians
were the physician's lack of understanding of the functions and goals
of the nurse, and the nurse's lack of insight into the scope of the physician's
responsibilities. Nurses and physicians placed different values on specific
parts of the healthcare process. These differing values led to differences
between professionals in determining the relative weight of patient problems.
Traditionally,
nursing and medical students do not have the same classes, nor are they
aware of the studies of the other group. A common ground of understanding
has not been established between the two professions, yet both are expected
to work together for the well being of the patient.
Psychosocial
Needs:
Nurses
placed a greater emphasis on the patient's psychosocial needs. Physicians
felt that nurses ignored the patient's physical needs in their effort
to serve the patient's psychosocial needs. Conversely, the nurses believed
the physician did not recognize the patient as a person. This area was
a major misunderstanding between nurses and physicians. Now that medical
schools are leaning toward a problem based model, possibly the two professions
will be more in agreement.
Nurses'
Retreat from Patients:
The
nurses' retreat from direct patient care to one of administrative duties
had greatly affected the physician-nurse relationship. Because nurses
encountered a reduction in patient care, less communication occurred between
the physician and nurse. Physicians sought other personnel or relied totally
on the patient for information. Lack of opportunity to communicate has
resulted in a loss of common ground and the opportunity to enhance the
communicative relationship.
Wide
Range of Education:
The
wide range of educational preparation among nursing personnel has been
confusing to physicians. With the addition of the nurse practitioner in
various specialties, the role may appear to be threatening to some physicians.
In a recent survey of physicians on the role of licensed nurse midwives,
the researchers found that licensed nurse midwives sought from their physician
colleagues increased communication, respect, and appreciation. This research
recognizes the lack of understanding and communication still evident among
physicians and nurses.
Two
Systems of Authority:
Generally
in hospitals, two systems of authority exist. The nurse, in her ambiguous
role, not only receives orders through the hospital administrator but
also from physicians. These lines come into conflict since they usually
overlap in certain areas. Where are nurse's loyalties to lie? Some difficulties
lie with the level of staff morale, their interpersonal stresses, and
the attitudes of physicians and nurses toward each other.
Lack
of Professional Commitment:
Since
a majority of nurses entering the profession are women, it may be perceived
that the primary emphasis of their employment is temporary because of
the stereotypical vision of women valuing marriage and motherhood over
a permanent committed position. Thus, turnover rates were high among women
who chose to parent their children at home following childbirth rather
than return to full time employment. Consequently, these nurses were not
perceived as career-oriented and most often their work was considered
as secondary and supplemental. This decision to place their family before
their career goals could have severely diminished respect for nurses by
physicians, and it could have greatly contributed to their lack of communication.
More
Education Frowned On:
Nurses
who strive for more education in the form of undergraduate and graduate
degrees in nursing, nursing specialties, or health education many times
are not perceived as offering a valuable service to the profession. Rather,
they are perceived as acquiring more education and administrative capabilities,
diminishing their roles as patient care specialists.
Policing
One Another:
Physicians
and nurses are in a position to observe one another's medical performance,
at least to the degree that their functions overlap. This role has caused
much stress on both professions in the healthcare arena. It has been suggested
that because the nurse is the only one to observe the physician's work,
she has been kept in the subservient role and thus unquestioning. Traditionally,
it has not been unusual for nurses to be subjected to the outrages of
physicians (often in front of patients) about the quality of their work.
The second role for the nurse can be an observer of the physician providing
a below standard quality performance. The nurse's ethics are called upon
to surface. Will the nurse challenge the medical decision of the physician?
What are the ramifications to the nurse's job? How will this action affect
the patient's care?
Fear
of Usurpation of Responsibility:
The
problem of overlapping functions and responsibilities between medicine
and nursing is enormous. The rise of the nurse practitioner in nursing
has been alarming to many older physicians. They fear that their responsibilities
may be usurped as the preference for the nurse practitioner in patient
care has soared.
Nurses'
Lack of Control Over Nursing:
Another
source of contention within the medical profession is physicians resenting
nurses' stepping into the realm of medicine, but physicians take it upon
themselves to set the dictates of nursing. This stems from the concept
that the medical society perceives itself as the authority in all medical
care.
Political
Conflicts:
Organized
nursing and organized medicine have been in opposition on numerous issues.
One of the ways in which nurses have asserted their independence has been
in their attempt to describe nursing as entirely separate from medicine.
They have instituted this role by claiming that the aspects of patient
care that nurses have been exclusively responsible for are central to
their role.
Four
Major Types of Interaction
Nurses
and physicians usually display different types of interaction when communicating.
Unproblematic subordination, informal covert decision making, informal
overt decision making and formal overt decision making are models used
to demonstrate the specific types of interactions observed between nurses
and physicians in making decisions about patient care.
Unproblematic
Subordination:
Traditionally,
unproblematic subordination is the interpretation of physician-nurse interaction
which involves nurses not questioning their obedience to medical orders,
and demonstrates complete absence of nursing input into decision-making.
For example, a medical order was given without prior consultation or explanation,
nurses carried out that order without further negotiation, and no alternative
explanation could be given for the subservience. Nurses thus display unquestioning
obedience.
Informal
Covert Decision-Making:
Informal
covert decision-making involves the guise of unproblematic subordination,
where nurses show respect for physicians by refraining from open disagreement
or making direct recommendations or diagnoses, while attempting to have
some input into decision making processes. The doctor-nurse game is implemented
here.
Informal
Overt Decision-Making:
Informal
overt decision-making involves deterioration of nursing consideration
and the overt involvement of nurses in decision-making. It describes open
involvement of nurses in decision-making, although on an informal basis.
Formal
Overt Decision-Making:
Formal
overt decision-making describes instances where the nursing process is
used by nurses to make decisions about care.
Balance
of Power
An
extensive investigation to determine opinions, perceptions, and attitudes
of physicians and nurses employed in teaching and non-teaching hospitals
was carried out in recent years. From this investigation specific issues
were found to generate conflict between nurses and physicians. In non-teaching
hospitals the atmosphere was recorded as easier, more relaxed, and characterized
by an informal working atmosphere; while in large teaching hospitals the
atmosphere was more formal and competitive, and often interfered with
working relations.
Two
other obstacles that interfered with working relations were unequal balance
of power and practice constraints. The unequal balance of power between
physicians and nurses was perceived to arise principally from differing
education levels among the two disciplines. With increased nursing knowledge
and autonomy, the power between nurses and physicians may be altered.
The role of the nurse practitioner may also play an important part in
equalizing the imbalance.
Negative
attitudes and stereotypes from nurses and physicians were reported to
cause antagonism as well as differing opinions on healthcare and treatment
of patients. Those patients who were terminally ill were especially a
source of controversy.
Professional-professional
Relationships
The
spirit of collegiality among physicians and nurses is necessary for the
delivery of quality healthcare. Improvements have been occurring, but
areas of contention and misunderstanding still exist. Three problem areas
that have an impact on professional-professional relationships are:
(1)
role stress,
(2)
a lack of inter-professional understanding, and
(3)
autonomy struggles.
It
is important to address these conflicts as they affect the quality of
patient care.
Role
Stress
The
daily task of facing ill, suffering people is not easy. As part of this
role, physicians are often faced with explaining life-threatening diagnoses
to patients, and nurses must assist patients in maintaining their courage
to live through another day. The very nature of healthcare contributes
to the job stress experienced by individuals in the healthcare field.
Role
stress is due only in part to the nature of the work. Another major source
of work stress and strain is related to problems in carrying out professional
roles. Role conflict and role overload are two types of role stress that
can lead to problems in professional-professional relationships.
The
person experiencing role conflict is socialized to fit one role, and yet
is expected to fulfill a different role in the work setting. Kramer's
classic, "reality shock" describes the stress of new graduates upon discovering
the gap between their education and their job. Graduate nurses are not
prepared in school with the skills and abilities to face the many stresses
related to hospital employment. They learn that their ideals and aspirations
are seldom the same as the values that receive praise on the job. Role
conflict occurs as they experience the discrepancy between these two different
value systems.
Seasoned
nurses often experience frustration from the numerous non-nursing tasks
imposed upon them. These tasks many times impede the nurse from performing
routine nursing care.
Role
overload is a second factor that affects the stress of professionals.
A recent study which examined work stress and job morale found that workload
and scheduling stressors had a strong negative effect on staff morale
and the ability to carry out their jobs. Emergencies frequently occur
in which nurses are required to accept more responsibility than they can
reasonably manage within a given period of time. In addition, nurses are
often expected to wear many hats and to negotiate with numerous departments.
Hospital nurses sometimes experience the workload excess from different
shifts. Day shift nurses often leave unfulfilled tasks like rounds with
physicians or transcribing physician orders to the evening shift. Interpersonal
conflicts emerge between physicians and nurses as they struggle to cope
with role overload.
Lack
of Inter-Professional Understanding
Another
factor that influences professional-professional relationships is a lack
of inter-professional understanding. Professionals do not understand the
roles of other professionals. For example, the distinctly separate educational
experiences of physicians and nurses often lead to a lack of insight into
one another's roles and responsibilities.
A
study was conducted investigating the perceptions of nursing and medical
students in regard to each other's roles. The two groups differed significantly
in their understanding of one another's roles. In general, nursing students
were clearer about the roles of medical students. The researchers found
that the greater the gap in the students' understanding of one another's
roles, the more negative they were toward collaborative decision-making.
Another
factor that contributes to a lack of understanding is the lack of nurse-physician
communication on a regular basis. One observer noted over a three-month
period that physicians came to the unit and left without ever interacting
with the nursing staff. If professionals don't communicate, how can patients
receive quality care and services?
An
increase in territorial disputes is a second problem created by a lack
of interdisciplinary understanding. Nursing roles have expanded immensely
in recent years, leading to confusion as to which professional has expertise
in a particular area. For example, monitoring cardiac arrhythmias and
drawing blood gases were regarded as primarily the tasks of physicians,
but now are shared with nurses. This shift in roles can cause concern
in the professions in determining who has the expertise to accomplish
these tasks. When roles overlap, one professional might perceive that
the other person is trying to take over his or her power and responsibilities.
This action can result in unproductive competition.
Autonomy
Struggles
The
freedom to be self-governing or self-directing (autonomy) is another problem
that threatens professional-professional relationships. Physicians have
considerable latitude in their actions in professional practice, while
nurses are limited in their autonomy. Discrepancies in degrees of autonomy
among professionals can lead to interpersonal tensions.
For
example, nurses often express frustration that they lack the authority
to make simple decisions for the safety or comfort of their patients,
such as changing inappropriate diets or deciding on the frequency of vital
sign monitoring. Nurses are expected to defer to medical authority, even
though the physicians are not on site.
Role
of Collaboration
Collaboration
is the most preferred of the conflict resolution styles. It requires both
cooperation and assertiveness, and involves fully recognizing others'
concerns while not sacrificing or suppressing one's own. Collaboration
requires energy and hard work. To resolve incompatible differences through
collaboration, individuals need to take enough time to explore their differences,
to identify areas of agreement, and to select solutions that are mutually
satisfying. Collaboration may be more difficult for nurses and physicians
until they spend more time together in face-to-face interaction; and until
they acquire a better understanding of the kinds of problems the other
group faces.
Collaboration
consists of sharing in planning, making decisions, solving problems, setting
goals, assuming responsibilities, working together cooperatively, and
communicating openly. Collaboration requires sharing control in an effort
to obtain innovative solutions that are mutually acceptable. Usually with
collaboration, the results are positive because both sides win: communication
is satisfying, relationships are strengthened, and negotiated solutions
are frequently more cost effective.
Collaborative
Strategies
Strategies
to promote collaboration include:
- awareness of gender roles,
- utilization
of basic communication techniques,
- recognition of professional-professional
components,
- changes of perspectives,
- attitude changes,
- open communication,
and
- team development in both groups.
Awareness
of Gender Roles
Individuals
participating in communicative roles must be aware of the role that gender
plays in communication. In the nurse-physician dyad, the male physician
may take the dominant role. Thus, the female nurse recognizes this action
and attempts to equalize the communication through assertiveness, accentuating
the patient's well-being as the center of the interaction.
Utilization
of Basic Communication Techniques
Both
parties should recognize the importance of the basic communication techniques
in conversations. Being an attentive listener and paraphrasing the speaker's
comments are among the techniques discussed earlier that the listener
can use to promote communication.
Recognition
of Professional-Professional Components
Physician-nurse
communication can exhibit conflicts related to personal or patient interaction.
The balance of power can interfere with the solution as a result of nursing
knowledge and autonomy. In this interaction, the role of the nurse practitioner
can be favorable to either physician or nurse. Both can perceive the expanded
role as beneficial to their professions. The physician views nurse practitioners
as assisting in primary care responsibilities, and the nurse views them
as advocates for more comprehensive care of patients. Consequently, the
expanded role of the nurse practitioner can assist physicians and nurses
in understanding each other's role.
Changes
of Perspectives
Generally
in a professional environment, physicians and nurses have reduced communication
skills in reference to patient care. Communication might not come naturally
for physicians; as a consequence, medical schools and continuing medical
education programs are finally beginning to teach the skill. The individuals
should make an effort to understand the other discipline's point of view.
Attitude
Changes
Both
professions must be aware of their individual roles and responsibilities.
For example, a nurse may feel offended when the ward clerk on the unit
is ill and the physician requests that the nurse write down some verbal
orders. Interrupting the nurse's professional responsibilities to be unit
clerk may not be pleasing to the nurse, and the nurse might perceive that
the physician feels his role is more important.
Open
Communication
Both
professions should respect each other's roles and responsibilities. They
should accept and share their differences to increase mutual understanding.
This openness can reduce role confusion and territorial disputes.
Team
Development
A
multidisciplinary team approach is an option for improved communication
and quality of care for patients. Physicians, nurses, and other team members
work together in the interest of the patient. The advantages of the multi-professional
team are better service, easier workload management, and collegial support.
There
are indications that the old hierarchical ways of communicating between
nurses and physicians are changing. Physicians are increasingly depending
on nurses' expertise and skill in critical care settings and emergency
departments, as well as in community settings, residential care settings,
and home care services. In this time of service restrictions, it is most
important for healthcare professionals to provide patients with the best
possible care. The quality of care can only be enhanced through communication
and good decision-making.
|
National Center
of Continuing Education
