Supporting Communication Between Nurses and Physicians

ii Acknowledgements . iv List of Tables . viii List of Figures . ix List of Appendices . x Chapter 1 Introduction . 1 1.1. Interprofessional Communication . 1 1.2. The Problem: Information Loss between Nurses and Physicians . 3 1.4. Objectives and Rationale . 6 1.5. Research Questions . 6 1.5.1. Importance . 6 1.6. Organization of the Thesis . 7 Chapter 2 Related Research . 10 2.1. Script Theory . 11 2.2. Strategies to Improve Interprofessional Communication . 13 2.3. Content Analysis . 19 2.4. Conclusion . 21 Chapter 3 Research Strategy . 23 Chapter 4 -Theoretical Framework . 24 4.1. Bullet Rounds Scripts . 24 4.2. Application of Script Theory to Communication in Bullet Rounds . 30 Chapter 5 Mapping The Bullet Rounds Environment . 32 5.1. Research Question and Objective . 32 5.2. Overview . 32 5.3. Methods . 33 5.3.1. Step 1Observation . 33 5.3.2. Step 2 Content Analysis . 34 5.4. Results . 36 5.4.1. Structure and Process Models . 36 5.4.2. Content and Process of Bullet Rounds . 39 5.4. 3. Discussion . 41 5.4. 4. Standardizing the Scrip . 43 5.4. 5. Conclusions . 47 Chapter 6 Evaluation of the Process Engineering Intervention: Background and Study Design . 48 6.1. Research Question . 48 6.2. Background . 49 6.2.1. The Process Engineering Intervention . 50 6.2.2. The Objectives of the Process Engineering Intervention . 51 6.2.3. Discussion . 53 6.3. Study Design . 54 6.3.1. Narrative Methods and Structures . 54 6.3.2. Rationale . 54 SUPPORTING COMMUNICATION BETWEEN NURSES AND PHYSICIANS vi 6.3.3. Case Study Structure . 55 6.3.4. Research Questions . 55 6.3.5. Propositions and Units of Analysis . 56 6.3.6. Linking Data to Propositions . 57 6.3.7. Interpreting Findings . 57 6.3. 8. Threats to Validity and Rival Explanations . 58 6.3. 9. Case Study Process and Format . 59 Chapter 7 Evaluation of the Process Engineering Intervention: Methods and Results . 60 7.1. Methods . 60 7.1.1. Observations of Bullet Rounds . 60 7.1.1.1. Data Collection . 60 7.1.1.2. Data Coding and Transcription . 61 7.1.1.3. Data Analysis . 63 7.1.2. The Physicians‟ Script . 65 7.1.2.1. Data Collection . 65 7.1.2.2. Data Analysis . 67 7.1.3. The Nurses‟ Script . 69 7.1.3.1. Data Collection . 69 7.1.3.2. Data Analysis . 70 7.2. Results . 71 7.2.1. Observations of Bullet Rounds . 71 7.2.1.1. Information Loss . 73 7.2.1.2. Frequencies of Information Categories . 75 7.2.1.3. Categories of Information Loss . 77 7.2.1.4. Source of Information Loss . 78 7.2.1.5. Discussion . 79 7.2.1.6. Conclusion . 82 7.2.2. The Physicians‟ Script . 82 7.2.2.1. The Process Engineering Intervention . 82 7.2.2.2. Information Exchange with Nurses: Overview . 83 7.2.2.3. Barriers to Information Exchange . 85 7.2.2.4. The Goal of Bullet Rounds . 85 7.2.2.5. Bullet Rounds Process: Help or Hindrance? 86 7.2.2.6. Resident Physician Orientation . 88 7.2.3. The Nurses‟ Script . 88 7.2.3.1. The Process Engineering Intervention . 88 7.2.3.2. Information Exchange with Physicians: Overview . 90 7.2.3.3. Barriers to Information Exchange . 91 7.2.3.4. The Goal of Bullet Rounds . 91 7.2.3.5. Bullet Rounds Process: Help or Hindrance? 92 7.2.3.6. Discussion . 93 7.2.3.7. Conclusion . 95 Chapte